Adult Support and Protection: Large Scale Investigation guidance

7. Instigating a Large Scale Investigation

Just as with any individual concerns as laid out within the Adult Support and Protection (Scotland) Act 2007, proportionate discussion should take place regarding the need for an LSI. The least restrictive principle should be considered when it comes to the decision whether, or not, to instigate an LSI.

The criteria that determine whether an LSI is to take place is dependent on whether there is more than one adult at risk of harm, as defined in the Adult Support and Protection Code of Practice. Sometimes this will be clear, but – due to the nature of possible institutional harm, or harm at scale in the community, often it will not. This section of the guidance is designed to support the best possible local decision-making when commencing an LSI.

7.1 Responding to the initial referral

In the first instance, on receipt of an ASP referral, ASP Section 4 inquiries and local ASP procedures should be followed. The speed and accuracy of an initial response to a referral can prevent further harm from occurring, embed oversight and support from the earliest stage, and ensure a prompt evaluation of the circumstances. If it appears that immediate action is needed to protect any adults at risk of harm, this should be taken without waiting for further stages in the LSI procedure.

When a referral is received indicating that more than one adult may be at risk, this referral should be screened by a Team Leader or Manager within 24 hours, with a view to considering if LSI criteria may be met. Any local guidance, which may provide a detailed local process to follow, should also be consulted at this stage. This should occur in parallel with continuation of local ASP procedures in response to the referral, including the undertaking of any S4 enquiries.

From this initial screening, and if it looks like an LSI might be a possible outcome, the Team Leader or Manager who screened the initial referral should contact the relevant senior manager (designated locally) within 24 hours of the initial referral screening. This senior manager is then able to oversee initial inquiries to establish whether the referral is likely to require an LSI. The Chief Social Work Officer, relevant Head of Service, and Adult Support and Protection Lead Officer should also be notified at this stage.

7.2 Convening a multi-agency initial LSI discussion

Although the decision to begin an LSI is with the council, they should work in partnership and take account of the opinions of their multi-agency partners. This can be most effectively done at a multi-agency initial LSI discussion to reach a consensus whether to instigate an LSI or not. This meeting may be called by different names in different areas – the exact terminology is not important.

Since every potential LSI is unique, there is not a definitive list of who should be invited to this discussion, although it is likely that Police Scotland and relevant local health managers should be invited. Contracts and commissioning services may also hold useful information. The case holding inspector from the Care Inspectorate can also be invited should the concerns relate to a service registered with them. In essence, all professionals with key information and/or evidence, whose professional insight will help with the decision whether or not to proceed to an LSI, should be invited.

Consideration should be given to how the service subject to the potential LSI is involved at this stage. It may be appropriate to invit e a representative of the service to all or part of this discussion (providing their involvement would not negatively affect any police, ASP or Care Inspectorate activity) ; or to notify them that the initial discussion is occurring .

The purpose and possible outcomes of the discussion, essentially whether to proceed or not to an LSI relating to the named agency, service or organisation, should be clearly stated in the invite. It should also be stated that each invited person should collate, and be prepared to present, their evidence at this meeting (see 7.3, Collating and presenting evidence, below).

This multi-agency initial LSI discussion should be chaired by a senior officer of the council with sufficient authority to effect strategic and operational changes, including the authority to proceed with an LSI.

A sample agenda for the multi-agency initial LSI discussion can be found at Appendix 4.

7.3 Collating and discussing initial evidence at the multi-agency initial LSI discussion

Dependent on the nature of the specific agency, service or organisation under discussion, and the circumstances of possible harm, the evidence presented at the meeting can vary. Possible evidence that an attendee may present includes (but is not limited to):

• Previous Adult Support and Protection referrals related to the specific agency, service or organisation under discussion – including previous LSI discussions
• Details of any prevention work undertaken, including evidence related to Early Indicators of Concern
• Details of any improvement work undertaken to date, even if the improvements have not been sustained
• Organisational chronologies, which show patterns of previous concern and/or improvement work
• Information on previous criminality in the specific agency, service or organisation under discussion
• Intelligence from complaints, feedback and contract monitoring
• Previous inspection reports related to the specific agency, service or organisation under discussion
• Any locally produced organisational guidelines
• Any referrals made to regulatory bodies, such as the SSSC or NMC.

There is a Summary of Information template included at Appendix 3 that invitees may find it useful to complete in advance of the meeting.

In presenting and discussing the evidence, the task of the multi-agency initial LSI discussion group is to ascertain whether the central criteria for an LSI are met: whether there is more than one adult at risk of harm. The discussion should also aim to consider whether there is a risk to other adults not mentioned in the initial referral. In doing this, the attendees may be attempting to differentiate between ‘poor care’ and ‘harm’. This can be a difficult distinction to draw, especially since poor care can foreshadow harm. Skills of professional analysis and always returning to the central point whether there is more than one adult at risk of harm, can help focus this discussion and aid decision-making.

This discussion should also consider the potential impact of an LSI on adults at risk and their families, taking a trauma-informed approach at all times. Being trauma-informed means that all workers, in the context of their own role and work remit, have a unique and essential trauma informed role to play in responding to people who are affected by trauma. There is more information about trauma and trauma-informed practice in the National Trauma Transformation Programme.

The multi-agency initial LSI discussion should always be minuted, with actions clearly documented. This should include the specific agencies and/or individuals responsible for these actions, and timescales for their completion. These minutes should also be shared with anyone who was invited but could not attend.

7.4 Making a decision

The decision to proceed, or not to proceed, with an LSI rests with the council. But the council should always work in partnership and take account of the professional judgement and evidence of their multi-agency partners. If the attendees at the multi-agency initial agency discussion ascertain, through the evidence and their professional judgement, that more than one adult is at risk of harm, this would indicate an LSI should proceed.

The decision to proceed should take into account the ASP Principles. For example, c onsideration should be given to whether conducting the LSI may provide benefit to the adult(s) at risk and – of the range of options available – will be the least restrictive to the adults’ freedom. However, it should also be noted that assessing the benefit, or degree of restriction, before an LSI begins may be unrealistic. It may sometimes be necessary to instigate the LSI in order to properly assess the provision of benefit and least restrictive option.

If the attendees at the multi-agency initial LSI discussion decide that more than one adult is experiencing care that falls short of expected standards, and that adults are not at risk of harm, then this would indicate other mechanisms outside of an LSI (at least as a first response). This would also be consistent with the ‘least restrictive’ principle. In this event, robust mechanisms for addressing poor care outside of an LSI (such as through contract monitoring and quality assurance). In this case, the attendees can suggest alternative actions to an LSI (dependent on the particulars of the agency, service or organisation under discussion). It may also be discussed how and when to keep this decision under review, and in what circumstances this decision might be reconsidered.

There may be instances where the decision is not clear-cut. The council may decide , for example, to implement improvements within a specific timescale , before or in tandem with commencing an LSI . A review meeting should be arranged to monitor these improvements after a specified time, which may also inform subsequent LSI-related decisions.

Details of the decision whether or not to proceed to an LSI, the rationale for this, and any actions arising, should be clearly included in the minutes.

If a Head of Service is not present at the multi-agency initial LSI discussion, it is good practice to inform them of the decision within 24 hours. It is also good practice to update the Chief Social Work Officer, the Chief Officers Group (COG), the Adult Protection Committee (APC) and other senior managers of the decision whether or not to proceed to an LSI.

7.5 Disagreements with the decision, or if a decision cannot be reached

In some cases, a decision cannot be reached whether to proceed to an LSI or not. In other cases, one or more attendees may disagree with the decision to proceed, or not to proceed, to an LSI. If this occurs, the decision should be escalated to a senior management group of decision-makers.

This group will differ according to local circumstances. It may, for example, include the Chief Social Work Officer, Director of Nursing, and Clinical Medical Director. They will work to the same principle s as the multi-agency initial LSI discussion group and decide, through the evidence and their professional judgement, whether or not more than one adult is at risk of harm and whether an LSI should commence.

If this group is also unable to decide whether or not to proceed to an LSI, or there is a potential conflict of interest, the decision -making may be further escalated; for example, to the local Chief Officers Group (COG).