Adult Support and Protection: Large Scale Investigation guidance

6. Public and other key bodies involved in a Large Scale Investigation

6.1 Introduction

In an LSI, collaborative working is an expectation at all levels, whether in frontline work or at leadership level.

This section provides an overview of the remit of those commonly involved in an LSI. However, because every LSI is unique, there is potentially a very wide pool of other professionals who may be involved. During an LSI, there may be organisations, agencies and individual professionals who are not used to working together. They may not know of each other’s remit, and this section will help provide clarity.

Roles and responsibilities may adapt to the particular circumstances of individual LSIs. This section aims to enable local conversations about the most appropriate roles and responsibilities for each partner to undertake during an LSI. Each local area should be able to evidence that they have had a discussion that agreed local roles and responsibilities for the duration of an LSI.

6.2 Public bodies involved in a Large Scale Investigation

The Adult Support and Protection (Scotland) Act 2007 requires councils and a range of public bodies to work together to support and protect adults who are unable to safeguard themselves, their property and their rights. Section 5 of the Act provides that certain bodies and office holders must, so far as it is consistent with the proper exercise of their functions, co-operate with a council making inquiries under Section 4 of the Act and with each other where this is likely to enable or assist the council making the inquiries.

The Adult Support and Protection (Scotland) Act 2007 Code of Practice states LSIs "must" involve Care Inspectorate, the relevant local council, and the service provider responsible for the care of the adults. This, however, does not imply that other public bodies’ involvement is not valuable and, in some circumstances, vital to an LSI’s effectiveness.

The following public bodies are the most likely to be part of an LSI.

6.3 Health and Social Care Partnerships, Councils and Health Boards

From the specific context of adults, each health and social care partnership (HSCP) is responsible for adult social work, adult social care, adult primary health care and unscheduled adult hospital care. HSCPs are comprised of councils and local Health Boards. Third and independent sectors may also be connected to the HSCP. Integration arrangements may vary in different areas, and therefore the composition of the HSCP itself may vary.

Every HSCP works towards a set of national health and wellbeing outcomes. HSCPs are required to work with their local communities, and providers of care, to ensure care is responsive to people’s needs.

Under Adult Support and Protection legislation, councils have a statutory duty to investigate harm. In an LSI, the council (or social work service, where relevant to delegation arrangement) is the lead agency. This means the council is responsible for decisions related to the start and the end of an LSI, and leading on the LSI throughout. The council is also responsible for keeping the LSI on track and for coordinating other agencies’ involvement.

In some cases, a council may manage or fund a service subject to an LSI. Impartiality is crucial throughout an LSI so, in these cases, a council may consider if the LSI would benefit from involving a different council in aspects of the LSI – for instance to oversee the LSI process, or to chair certain key meetings.

Local NHS Health Boards are responsible for the protection and the improvement of their population’s health and for the delivery of frontline healthcare services and also provide clinical leadership, advice, and strategic planning. Clinical Directors, Chief/Lead Nurse(s) or Nurse Consultant(s) require to be assured that clinical and care governance has a high profile, ensuring that the quality of care – including attention to adult protection - is given the highest priority at every level within integrated services. They take the professional lead on all aspects of the health contribution to safeguarding and are central to the Health Board’s clinical and care governance processes for public protection.

A Council may also be responsible for commissioning a service that becomes subject to an LSI, such as a care home or a care-at-home service. This means that council contracting and commissioning teams will also be involved in an LSI, as these teams are able to provide information on contractual terms.

Both Councils and Health Boards may have substantial background information both on a service that is subject to an LSI and on the adults who use that service. This can be vital at the start of, and during, an LSI.

6.4 Police Scotland

The main purpose of policing is to improve the safety and wellbeing of persons, localities, and communities in Scotland. In addition, where a crime has been committed it is the duty of the police to trace the offender and bring them to justice. The police do this in partnership to protect the safety of vulnerable adults and any other identified person within their family or the wider community.

The paramount consideration in any decision or arrangement in respect of LSIs taking place alongside other investigations is the need to protect adults from harm. In many instances this will be achieved by securing improvements in systems which exist to prevent adults being exposed to harm alongside, where relevant, the successful prosecution of those who pose a threat to adults.

Whilst criminality will not always be a factor in an LSI it is imperative that the police are notified about the LSI from the outset. This allows for both early identification of, or early elimination of, criminality.

The investigation of crime requires a high degree of cooperation between all departments, stakeholders and partner agencies. Police are responsible for making quick-time decisions to protect the safety of vulnerable adults and also any other identified person within their family or the wider community. The need to gather information and evidence must always be balanced against the need to take any immediate protective action.

A criminal investigation is led by the police. The council will consult with police in LSIs where there is a criminal investigation, and the police will advise how these parallel investigations can progress.

Even if criminality is not suspected, Police Scotland can provide background checks, relevant local or national information, and advice on safety planning and/or risks to the community. Where the risk of harm is significant and immediate, the focus of the initial risk assessment is to ensure direct action is taken to mitigate risk and to provide appropriate safety measures to the adult(s).

Through early engagement with the police, and their inclusion throughout an LSI, vital evidence can be obtained, and plans put in place to ensure an efficient and effective parallel investigation is carried out alongside any intervention to safeguard any individual adults at risk. This joint working ensures that safety and welfare considerations are captured within the investigation strategy.

6.5 The Care Inspectorate

The Care Inspectorate is a scrutiny body which supports improvement. They look at the quality of care in Scotland to ensure it meets high standards. Where improvement is needed, the Care Inspectorate supports services to make positive changes. If the Care Inspectorate finds underperforming care, they take action: outlining areas for improvement and issuing requirements for action. This can include using enforcement powers and, as a last resort, cancelling the registration of a service subject to the decision of a sheriff.

The Care Inspectorate require Councils and HSCPs to notify them at the commencement, and the completion, of an LSI where the subject of the LSI is a service or provider registered with them. This must be done via the Care Inspectorate notifications web page.

Because the Care Inspectorate is the national regulator for care services in Scotland, when an LSI concerns a service registered with them the Care Inspectorate must be invited to be involved throughout an LSI. This includes being invited to key meetings or as part of the LSI Oversight Group. The exact type of collaboration with the Care Inspectorate can vary according to the nature of each LSI (and, in some circumstances, they may not be involved at all). However, during an LSI, the Care Inspectorate can be a valuable source of current and historical evidence in relation to services that are registered with them. This might include information from previous inspections, and can often include information on leadership, management, and workforce skills in a service registered with them. Information arising from the LSI may also inform Care Inspectorate activities in other services (if any) provided by the same organisation.

Alongside an LSI, the Care Inspectorate may carry out their own scrutiny activity related to the standard of care in a service registered with them. If this is the case, it is important that there is coordination between the Care Inspectorate and the team conducting the LSI. In some cases, it may be appropriate for the LSI team and Care Inspectorate staff to undertake joint visits and jointly examine records.

6.6 Healthcare Improvement Scotland

Healthcare Improvement Scotland (HIS) has a statutory duty to further improvement in the quality of health care. They support, ensure and monitor the quality of healthcare provided or secured by the health service.

HIS is not routinely involved in LSIs in NHS settings. When an LSI occurs within an NHS setting, representation in LSI meetings would be provided by someone appropriately senior and informed from the health board. Where appropriate, however, HIS may become involved under its statutory duty to support, ensure and monitor the quality of healthcare provided or secured by the health service.

6.7 Mental Welfare Commission

The Mental Welfare Commission is an independent body, set up by statute with a safeguarding role. It protects and promotes the rights and welfare of people in Scotland with a learning disability, mental illness, personality disorder, dementia, and related conditions. It has statutory duties to safeguard the interests of people under mental health or incapacity law, notably the Mental Health (Care and Treatment) (Scotland) Act 2003 and the Adults with Incapacity (Scotland) Act 2000. The Commission carries out these statutory duties by focusing on five main areas of work: visiting people, monitoring the Acts, investigations, information, and advice, and influencing and challenging.

The Mental Welfare Commission is not routinely involved in LSIs. However, it does have duties under the 2007 Act to raise ASP referrals and cooperate in any investigation. If the LSI concerns one or more adults at risk with a learning disability, mental illness, or other mental disorder, or who is subject to compulsory measures under the 2003 Act or the 2000 Act, it is good practice to notify the Mental Welfare Commission at the commencement of an LSI. In this circumstance, the Mental Welfare Commission may become involved in an LSI as part of their statutory duty. Notifications to the Commission are available on their website.

6.8 Office of the Public Guardian (Scotland)

The Office of the Public Guardian (OPG) in Scotland has a general function to maintain a public register of powers of attorney registered, guardianship and intervention orders granted and authorisations granted under the access to funds scheme. OPG also supervise those individuals who have been appointed to manage the financial and property affairs of adults who lack the capacity to do so for themselves, and investigate circumstances made known to them where the property or finances belonging to an incapable adult appear to be at risk.

The OPG is not routinely involved in LSIs. However, if there is a belief that the LSI may overlap with OPG responsibilities (for example, if there are concerns about the actions of a proxy decision maker, appointed under Adults with Incapacity legislation), they should be contacted for discussion and to assess a possible role in the LSI.

6.9 Other bodies key to an LSI

While the Adult Support and Protection (Scotland) Act 2007 places statutory duties on public bodies, it is everyone’s business to help identify and safeguard adults at risk of harm. Since every LSI is unique, this means there are potentially a very wide range of organisations and individuals who may be involved in an LSI. The following list is not exhaustive; however, it does include bodies whose involvement, where appropriate, is likely to be central to the successful outcome of an LSI.

6.10 The agency, organisation or service subject to an LSI

When an LSI relates to an agency, organisation or service, working in partnership with them (wherever possible, and where it does not conflict with a police investigation) is often the key to an LSI’s successful outcome. Proprietors, Boards of Trustees, managers and staff will all potentially be involved in the investigation, and their co-operation will be essential.

It is the responsibility of the team leading the LSI to clearly explain what an LSI is and why the service is subject to it. Clear and patient explanations are important at all times but take on particular significance when the service subject to an LSI does not provide health or social care services and is not registered with a public body such as the Care Inspectorate. Providing, or adapting, the material in Appendix 2 may be helpful.

All those involved in conducting the LSI should also take care to avoid apportioning blame. Blaming language is likely to hamper co-operation from staff, managers and/or owners of a service subject to an LSI. The team conducting the LSI should also be sensitive to the disruption an LSI is likely to have on a service, especially to the adults who rely on it; clearly communicating key milestones and actions to the service subject to an LSI (unless there is a good reason not to). There should be defined lines of communication, with named contacts, between the service subject to an LSI and the team conducting the LSI.

The service subject to an LSI should co-operate fully with the LSI team in order to keep adults at risk safe and ensure the LSI proceeds as smoothly and fairly as possible. This includes, but is not limited to, sharing information when asked; facilitating interviews with staff and users of the service; responding promptly to requests; and attending LSI meetings when invited.

Managers and proprietors of a service should be encouraged to develop their own communication strategy, whose aim is to help adults who use their service, families, and their own staff to understand the LSI process. Appendix 2 can help with this.

6.11 Independent advocacy

Independent advocacy is about speaking up for, and standing alongside individuals or groups, and not being influenced by the views of others. Essentially it is about everyone having the right to a voice, addressing barriers and imbalances of power, ensuring that an individual’s rights are recognised, respected, and secured.

There is a statutory duty in the Mental Health (Care and Treatment) (Scotland) Act 2003 for each council and each local health board (in collaboration with each other), to secure the availability, to persons in its area who have a mental disorder, of independent advocacy services – and to take appropriate steps to ensure that those persons have the opportunity of making use of those services. In the Adult Support and Protection (Scotland) Act 2007, the responsibility to ensure that those with a mental disorder have access to independent advocacy is reiterated and has the same meaning as in the Mental Health (Care and Treatment) (Scotland) Act 2003. It is also made clear that services should have regard to the importance of independent advocacy services for all adults at risk under the Act.

Independent advocacy services should be proactively offered to adults at risk, and their families or supporters, in any service subject to an LSI. Clear explanations as to the purpose of advocacy should be provided, ensuring people understand its importance in upholding their rights. Independent advocacy should be offered at the start of, and throughout, an LSI. Information on independent advocacy should be included in information sent to adults at risk.

It is good practice to involve independent advocacy services as early as possible, including in any preventative work. The same principles of information sharing and multi-agency collaboration apply to independent advocacy as they do to all other agencies involved in an LSI. Local advocacy strategic plans should ensure that there are sufficient resources for independent advocacy organisations taking part in an LSI. Often, multiple people will be supported in one setting, and this may require more intensive input from the independent advocacy organisation.

Some of the independent advocacy may fall under the category of ‘non-instructed advocacy’ within the context of Adult Support and Protection. This form of independent advocacy can be provided to individuals who are unable to give a clear articulation of their views or wishes in a specific situation and are unable to clearly express whether they would like an independent advocate.

If the adult at risk does not want independent advocacy, it is important to clearly record this. Adults who initially refuse independent advocacy should still be offered it periodically. Their decision should be revisited and noted during each formal review, such as at multi-agency meetings, assessments, or professional meetings.

6.12 Adults at risk support groups and family support groups

The central concern of an LSI is to keep adults who may be at risk safe. The Adult Support and Protection (Scotland) Act 2007 makes it a statutory duty to take account of the wishes and feelings of the adult (as set out in Section 5 of this guidance). Moreover, engaging directly with adults at risk and their families to ascertain their experiences in and perspectives of the service subject to an LSI is vital evidence.

If there is a support group for adults who use the service that is subject to an LSI, or for their families, this group should be contacted as soon as possible after a decision has been taken to progress to an LSI. They should be kept informed as to the progress of the LSI and, if appropriate, the team conducting an LSI should seek to meet with these user/family support groups.

For this engagement to be meaningful, the views of adults at risk have to be considered in both an open-minded and non-judgmental way. Sometimes, this is straightforward, requiring no specialist input or expertise beyond the sensitive and empathetic communication skills which would be expected of all professionals liaising with individuals in what can be challenging circumstances. In other cases, there will be special requirements around communication or accessibility. The team conducting the LSI should put in place all arrangements needed for the active and meaningful participation of adults at risk and their families.

6.13 Scottish Care

Scottish Care is a membership organisation and the representative body for independent social care services in Scotland. It represents services delivering residential care, nursing care, day care, care at home and housing support services.

If a service subject to an LSI is an independent social care service, they may be a member of Scottish Care. Scottish Care can offer support to their members around LSI activity, including advising them on their rights and responsibilities.

Independent Sector Leads (ISLs) can provide support and guidance to independent social care services during an LSI (regardless of Scottish Care membership). Independent social care services should check with their local HSCP to see if there is an ISL in their area for support.

6.14 GPs and general practice staff

The involvement of GPs and general practice staff in LSIs can be significant. For instance, in LSIs involving care homes, specific GPs may hold considerable information on several adults. General practice hold responsibilities to share information – either verbally or written – relating to adults at risk; participate in discussions and decision-making; understand the wide range of risks involved for their patient, and partake in any risk assessments; offer their patients help if they think their rights are being abused or denied; and act promptly on any concerns they have about a patient.

Further information about Adult Support and Protection responsibilities for general practice can be found in the RCGP safeguarding standards for general practice and the seven-minute briefing Adult Support and Protection for GPs, primary care and other health staff.

6.15 Scottish Fire and Rescue Service

The Scottish Fire and Rescue Service (SFRS) works in partnership with communities and with others in the public, private and third sectors, on prevention, protection and response to improve the safety and wellbeing of people throughout Scotland.

SFRS is not routinely involved in LSIs. However, there may be occasions when SFRS involvement is valuable for their area of expertise, including fire prevention, fire safety legislative compliance and operational response. If this is the case, they should be contacted for discussion and to assess a possible role in the LSI.