Adult Support and Protection: Large Scale Investigation guidance

8. Commencing a Large Scale Investigation

Once the decision has been taken to proceed to an LSI, a clear start to an LSI can yield benefits throughout the whole process. This section covers the notification process, the first meeting to begin the LSI, the roles and responsibilities of those involved, and establishing oversight.

8.1 Notifications process

Notifications of LSI are not only a formal process. They are the basis for good communication through the LSI, ensuring everyone who needs to know about the LSI is kept informed. They can also provide extra information that helps address anxieties about the LSI, signposting to further details and support. The person or persons responsible for the notifications below should be decided locally, and a clear record made of this.

8.2 Notifying the organisation, agency or service subject to an LSI

Working with the agency or service concerned will be key to the successful completion of the investigation. Proprietors, Boards of Trustees, managers and staff will potentially be involved in the LSI and their co-operation will be essential. Although it is a formal necessity to notify the agency or service via letter, consideration should be given to the feelings, concerns and anxieties of all concerned. It is important to start with the view that – unless it is proven otherwise – everyone wishes to provide good care and not cause harm. A sensitive notification can have positive effects right through the course of an LSI. It is particularly helpful, if possible, that a worker who knows the organisation subject to an LSI is involved in notifying them.

This means that the notification should contain information about what the service can expect from an LSI. This may be general information about LSIs (see Appendix 2) alongside more specific information about the nature of this particular LSI. A named contact, to act as the Liaison Lead to the service, should also be provided in this notification if possible (or as soon as possible following the notification). A sample letter is included in Appendix 7.

8.3 Notifying adults (and their families and supporters) who use the service

Adults who use the service (and those who support them) may be understandably anxious at the news of an LSI in a service that they use. If the LSI takes place in a care home, or in supported housing, this is where the person may live on a permanent basis, and call home.

It is essential that, when notifying those who use the service that clear information is provided on what an LSI is (and what it isn’t) and what it seeks to achieve. This should be provided in a format that adults who use the service are most likely to understand. Reassurance should be provided that the adult and their supporters will be kept informed as to the progress of the LSI. The notification should include a named contact, to act as the Liaison Lead to adults (and those who support them) who can be contacted in the event of any queries. This Liaison Lead also has responsibility for proactively keeping those who use the service informed.

The service subject to the LSI may also request to have their own representative ’s contact information included in the notification, in order that they may also be contacted to answer questions. This can be decided after discussion with the service in question, taking into account any factors relevant to the circumstances of the LSI.

The notification should inform the adults that their rights will be upheld and that their participation is valued. It should also include details of independent advocacy, explanation of what advocacy is, and how to access this. Information of advocacy should also include, where appropriate, details of ‘non-instructed advocacy’. This form of advocacy can be offered to people who have some level of incapacity, or who (for any reason) are unable to clearly express whether they would like an independent advocacy worker. A sample letter is included in Appendix 9.

8.4 Notifying other council areas (including those outside of Scotland)

Action should be taken, by a named worker, as soon as possible to identify any adults using the service who are outside of the council area conducting the LSI. Information should be provided from the host council (e.g., where that service is based) to any other council with adults who are using that particular service (the placing council). This can include people who self-fund their care, as the placing council may still hold relevant information about their care that could inform the LSI. The placing council may also have some important information about the service, and they should share this with the LSI Team.

A communication plan associated with the LSI should include clarity about whether enquiries regarding the LSI should go to the host or placing council in the first instance. A single point of contact and substitute contact from each council should be established to ensure consistent, accurate and timely communications between councils. This may be the social worker or team leader for the team in the placing council holding the case for the adult (if known). If not, enquiries can be directed to a senior social work manager, operations manager, or ASP Lead Officer of the placing council.

The placing council will be invited to send representation to LSI meetings and may have a role to play in reviewing the needs and care of the individual (in close collaboration with the host council conducting the LSI).

If the placing council is outside of Scotland, it is recommended to make it clear that an LSI falls under Scottish Adult Support and Protection legislation. If the line of communication with a council outside of Scotland is unclear, advice should be sought from the Chief Social Work Officer and/or a council’s legal services.

Should the service or organisation subject to the LSI also operate outside Scotland, and there are potentially 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. There is a template for notifying other councils at Appendix 8.

8.5 Notifying GPs

It is good practice to notify, by letter or email, all the GPs involved in the care of any adult affected by the LSI. GPs can also be a valuable source of information during the course of an LSI. 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.

As set out in the Adult Support and Protection (Scotland) Act 2007: guidance for General Practice, all GPs are expected to share information in the context of an ASP referral or inquiry relevant and proportionate to the specific concerns raised. UK law (including UK GDPR), GMC guidelines, ICO guidelines and the Caldicott principles do not prevent sharing of personal information for the purposes of safeguarding.

Any information received in the course of an inquiry is treated with the utmost confidence and will not be disclosed to any third parties other than in accordance with the provisions of the Act.

8.6 Other notifications

The below is a summary table of who else to notify when an LSI begins.

8.7 LSI planning meeting

The LSI Planning Meeting should be held soon after the multi-agency initial LSI discussion (see Section 7.2) and once the decision has been taken to proceed to an LSI. It is recommended that this meeting take place within five working days of the decision to proceed to an LSI. Even if some planning has already taken place, a detailed and robust planning meeting is essential to an effective LSI. It is a critical part of the LSI process, is multi-agency, and sets in place the structure, processes and action to be taken during the LSI.

This meeting may be called by different names in different local areas, but the purpose of the meeting will remain the same.

Exact invitees are decided in collaboration between the Chair (likely a senior officer of the council at Head of Service level, or above, with previous experience of chairing Adult Support and Protection case conferences) and the team conducting the LSI . Invitees may include (this list is not exhaustive and attendees will be determined on relevance ):

• Council ASP staff
• Council contract monitoring staff
• Council quality assurance and commissioning staff
• (If applicable) representatives from any other councils who have placed adults in the service subject to the LSI
• The Care Inspectorate
• Police Scotland
• The Mental Welfare Commission
• Healthcare Improvement Scotland
• Relevant health staff
• Scottish Fire and Rescue.

Many, if not all, of those invited will be the same as those invited to the multi-agency initial LSI discussion as set out in Section 7. The manager and/or owner of the service may be invited to the meeting (or part of the meeting) unless their presence would compromise the LSI.

As a minimum, the meeting aims to achieve, and assign named people for actions arising from, the following:

• Official confirmation that an LSI will be initiated
• Identify the objectives of the LSI, with these being as SMART (specific, measurable, achievable, relevant and time-bound) as possible
• Confirm the Lead Investigation Officer (see Section 8.8) and the team conducting the LSI
• Identify a Senior Manager from the HSCP to chair and convene the LSI Oversight Group (see below)
• Identify or confirm lead officers from each agency involved, and points of contact for each agency
• Identify any relevant agencies who have not yet been notified, and make a plan to inform these agencies
• Discuss the existing evidence, for instance all previous concerns, complaints and reports. This is likely to build on the discussions in the multi-agency initial LSI discussion as set out in Section 7.
• Agree an initial risk management plan, including any immediate actions to protect adults at risk. The meeting may also need to address whether a moratorium on referrals to the service needs to be introduced (this can also be a voluntary moratorium, agreed with a service provider). This will very much depend on the nature of the issues under discussion.

A discussion on the needs of the adults who use the service. This is likely to include:

• Identifying any users of the service deemed at risk of harm that may need a separate ASP risk assessment, separate ASP case conference, and (potentially) a separate ASP protection plan.
• Identifying any users of the service who may need their care and support packages reviewed, in order to ensure their care and support needs are being met now, and in the immediate future, while the LSI is being conducted. If it appears that these needs are not being met, then alternative arrangements should be identified.
• Identifying which users of the service may have been assessed as lacking capacity and whether there are appropriate proxy powers in place. Where there are no powers in place, the early provision of non-instructed advocacy should be considered.
• Identifying which users of the service should initially be the subject of the LSI
• Plans for a clear notification and engagement strategy with users of the service, their families and supporters, including direction to independent advocacy services as soon as possible.
• Clarify any parallel investigations (such as by the police, Care Inspectorate, Scottish Social Services Council, the Mental Welfare Commission, or Healthcare Improvement Scotland; individual Adult Support and Protection investigations; adverse events review process; single agency health reviews; internal investigation activity or disciplinary procedures and agree mechanisms for communication and feedback
• Address any cross-boundary issues – for instance, where adults who use the service have been placed by a different council (including councils outside of Scotland) or where the provider runs services in other council areas
• Allocate the resources needed, including a physical space, if required, for the investigation team. Release of practitioners and clinicians to undertake the LSI should be prioritised and senior managers should address existing staff workloads to ensure capacity to undertake the LSI.
• Consider possible interest from the media and elected members, and agree a formal media strategy (See Section 9.10)
• Agree how information will be securely shared and stored, allowing key information to be quickly accessed. This should be supported by business processes and systems.
• Consider the possible impact of the LSI, including in the cases of a suspension of new referrals to the service and service closure
• Consider the support needs of the service provider and the staff working at the service. Although the Council is not responsible for the support needs of other employers, it is good practice to (at a minimum) discuss with the owner or proprietor of a service about the anxieties that may be triggered in their staff around an LSI and enquire about the support available to them.
• Agree an action plan and timescale.
• Agree a next meeting date.

There is a sample Agenda in Appendix 6.

The meeting should be minuted, with the agreed action plan attached to the minutes.

It should be acknowledged that although the LSI planning meeting’s purpose is to agree plans, structures and actions, an LSI will always require a degree of flexibility in its approach. Changing needs and circumstances are likely as the LSI proceeds, and it is therefore essential that the LSI Oversight group (see Section 6.4) is regularly updated, in order to give a clear steer to the LSI.

8.8 Lead Investigation Officer (LIO) and the LSI Team

Having one key person leading the LSI is important. For the purpose of this guidance, that role is called the Lead Investigation Officer, but the local terminology and exact functions may differ.

A Lead Investigation Officer (LIO) for the LSI will be designated (likely by a Head of Service or other senior officer of the council) once the decision to proceed to LSI has been taken. The LIO will lead the investigation and is responsible for the day-to-day progress of the LSI, including designating roles within the team conducting the LSI.

Adult Support and Protection experience is very important in the LIO role, due to the sensitive, complex, and highly collaborative nature of LSIs. This means the LIO is likely to be a senior manager with substantial experience of Adult Support and Protection work. It may be beneficial for the LIO to be a qualified social worker registered with the SSSC, and it is recommended that this individual be an authorised Council Officer (as defined by Section 53(1) of the Adult Support and Protection (Scotland) Act 2007).

Once appointed, the LIO takes responsibility for coordinating any immediate actions to keep an adult or adults at risk safe. These actions can also be discussed with the Chief Social Work Officer and any manager who has been involved in relevant individual ASP cases at that stage.

The LIO will oversee the day-to-day progress of the LSI and support the LSI team. The LIO takes responsibility for providing updates that have been agreed locally, such as to the Chair of the LSI Oversight group and the Adult Protection Committee. The manner and frequency of these updates is also to be agreed locally, reflecting the risks, dynamics, and workload involved.

8.9 The LSI Oversight Group

A formal multi-agency group should be established to oversee the LSI and ensure the actions of the team conducting the LSI are accountable. Such a group is called the LSI Oversight Group for the purposes of this guidance, but local terminology may vary. This group will also be responsible for briefing other senior stakeholders who are not actively involved in the LSI. The Chair of the LSI Oversight Group should be independent of the team conducting the LSI.

The LSI Oversight Group has overall responsibility for the planning, monitoring and review of the LSI. This includes ensuring agreed timescales are adhered to and ensuring the resources allocated are both proportionate and adequate.

The LSI Planning Meeting (See Section 8.7) will identify a Senior Manager from the HSCP to chair the LSI Oversight Group who will convene the membership of the Oversight Group. Exact membership will be dependent on the nature and circumstances of the LSI. Usually, however, it will include

• Senior representatives from the HSCP, including Contracts and Commissioning staff
• Chief Social Work Officer
• Adult Support and Protection Lead Officer

According to circumstances the following, amongst others, may also be part of the LSI Oversight Group:

• Police Scotland
• Local Health Board
• the Care Inspectorate
• the Office of the Public Guardian
• the Mental Welfare Commission
• Health Care Improvement Scotland
• other council services
• other services within the council area, including independent advocacy
• other councils and partnerships, who may become involved if they have adults placed in the service subject to the LSI.

Specific consideration will need to be given to whether a representative of the agency subject to the LSI should be part of the LSI Oversight Group. In some cases, it may be considered appropriate for them to be part of some, or all, of LSI Oversight Group discussions; in other cases, this may be considered to be detrimental to the LSI and could potentially hinder any associated potential criminal investigations by Police Scotland. Specific advice should be sought from Police Scotland on this point. Where they are not included as part of the LSI Oversight Group, it will be important to agree how and when updates are provided to the agency subject to an LSI, and who will provide them. Key messages to the service should be done in coordination with the LSI team to ensure consistency of message and to avoid any duplication.

The LSI Oversight Group should meet regularly, with frequency and duration of meetings decided locally. The frequency and duration of LSI Oversight Group meetings will be determined by the assessment of risk, the pace of the LSI and the need for a sufficiently flexible response to what may be a rapidly changing situation.

The LSI Oversight Group should ensure that Adult Support and Protection principles, and the Large Scale Investigation principles (as set out in Section 5 of this Guidance) are adhered to throughout the LSI. When the organisation subject to an LSI is an in-house provider rather than an external agency, it will be particularly important for the LSI Oversight Group to ensure an equitable and unbiased process.

The LSI Oversight Group should also ensure that appropriate administrative support is provided for the conducting of the Investigation, including the scheduling and minuting of LSI meetings.