Adult Support and Protection: Large Scale Investigation guidance

9. Conducting the Large Scale Investigation

9.1 Establishing milestones locally

Every LSI is unique. Therefore, the overall timescale for an LSI is not outlined in this guidance (although the overall timescale for each LSI should be discussed and planned locally). It is recommended that the LSI team establish milestones within this overall timescale that can be considered during the progress of an LSI. Milestones are unique to each LSI and are particular points where a decision needs to be taken, or when LSI moves on in a significant way. Milestones should always evidence progress in an LSI in some way – for instance, when all planned interviews have been completed.

Milestones are important for several reasons. They prevent drift and delay; they help all those affected by a LSI, especially adults and their families, to feel confident in the process; and they help with resource management. This guidance supports local conversations about the most appropriate milestones in the circumstances, from which timescales can be derived. Each local area should be able to evidence that they have set their own reasonable and proportionate timescales.

Agreeing milestones locally, coupled with effective local governance from the LSI Oversight Group (see Section 8.9), help ensure action points are progressed.

9.2 Initial planning and activity

The Lead Investigation Officer (see Section 8.8) and the team conducting the LSI should meet as a team as soon as practicable after the LSI Planning Meeting (see Section 8.7). This will enable the team to:

• review the agreed objectives of the LSI
• agree milestones related to these objectives, which are to be time-bound and clearly recorded
• analyse gaps in current evidence and make plans to address this
• discuss the current and future risk to adults who use the service, including the progress of individual ASP referrals.
• establish a strategy for communicating with other partners who may be carrying out parallel investigations
• discuss whether specialists are needed and how they will be involved. This may include (but is not limited to) LSIs that involve health issues or financial harm.
• agree to a schedule of meetings to discuss progress within the team conducting the LSI

After the initial planning activity, the LIO and the team conducting the LSI should continue to meet regularly. In these regular meetings, updates should be given on all the agreed milestones. The LIO and the team conducting the LSI should also practice professional curiosity (see Section 7.9), helping each other to analyse the evidence collected so far.

9.3 Individual ASP Inquiries/Investigations and possible learning reviews

The LIO should identify which individuals should be the subject of an ASP inquiry/investigative activity. These should follow local operating procedures, and the principles underpinning the Adult Support and Protection (Scotland) Act 2007 (see Section 5.1).

The LIO should advise the LSI Oversight group of the outcome of any individual ASP Inquiries/Investigations, including any protection actions that may be required and the need to convene an Adult Support and Protection multi-agency case conference.

The LIO should also have regard to the applicability of other statutory interventions, including consideration of any ASP Protection Orders, and any applications which may be required under the Adults with Incapacity Act or the Mental Health (Care and Treatment) Act.

The LIO will also have regard to extent to which any individuals’ circumstances may meet the criteria for an ASP Learning Review. Where this may be considered to be possible, individual cases should be brought to the attention of the LSI Oversight Group. Where the LSI Oversight Group considers that formal consideration of an ASP Learning Review would be warranted, local ASP Learning Review procedures should be followed.

9.4 Duty of Candour

The organisational duty of candour may apply in some LSI circumstances. This is a general duty to be open and transparent with people who receive care from services. Its aim is to make sure that those providing care are open and transparent with the people using their services, whether or not something has gone wrong. The legal duties, and issues that organisations will want to consider, are outlined in the Organisational duty of candour: guidance.

A crucial part of the duty of candour is the apology. Apologising is not an admission of liability. This is the case, regardless of whether the organisation is in health or social care, or public or private sectors. This statutory duty of candour was brought into law in 2014 for NHS Trusts and 2015 for all other providers and is now seen as a crucial, underpinning aspect of a safe, open and transparent culture. It is so fundamentally linked to concepts of openness and transparency that often the policies and procedures related to it have come to be known by staff by other names, for example, “Being Open”, “Saying Sorry”, and “Just Culture”.

A notifiable safety incident (notifiable to the Care Inspectorate) is a specific term defined as the duty of candour regulation. It must meet all three of the following criteria:

1. It must have been unintended or unexpected
2. It must have occurred during the provision of an activity regulated by the Care Inspectorate
3. In the reasonable opinion of a healthcare professional, already has, or might, result in death, or severe or moderate harm to the person receiving care. This element varies slightly depending on the type of provider.

If any of these three criteria are not met, it is not a notifiable safety incident (but the overarching duty of candour, to be open and transparent, always applies).

9.5 Meeting with the agency, service or organisation subject to an LSI

Communication and the relationship with the agency, service or organisation subject to an LSI are central to an effective LSI. Therefore, it is recommended that th e agency subject to an LSI also designates a main point of contact for the Liaison Lead. This representative could also take responsibility for cascading information about the LSI within their own agency.

The nominated Liaison Lead within the LSI team (see Section 8.8) should regularly meet with the representative within the service (how regularly should be decided locally, according to the circumstances of the LSI). The Liaison Lead should collaborate with the organisation subject to an LSI over meeting times, in order to promote positive relationships and minimise service disruption. If this is a service commissioned by the Council, the Liaison Lead may be accompanied by representatives from the council’s Contracts and Commissioning service and/or representative from the Care Inspectorate.

In this meeting, and in subsequent meetings, it is important to establish with the organisation that an LSI is an Adult Support and Protection intervention, is time-limited, and not a tool for ongoing service improvement. The organisation subject to an LSI may have questions about the process; many of these will be answered in Appendix 2, and it may be useful to share this document or a locally adapted equivalent with them. If the service is ‘unregistered’ – for instance, a charity, faith group, or other organisation that does not directly provide health or social care services, clearly explaining an LSI is likely to take on greater significance.

It is also important to acknowledge that the LSIs often feel destabilising to the organisation, to those who work in it, and to those who rely on its services. All LSI meetings should discuss how adults and their families will be kept informed, and how independent advocacy can represent the views and wishes of adults and their families.

Each organisation subject to an LSI will have different support mechanisms in place for its staff and it is that organisation’s responsibility to support their own staff. However, in practice, the Liaison Lead can ask what supports they have in place. The Liaison Lead can be clear on the benefits to all when staff are supported. These benefits include not only those related to an individual’s wellbeing, but also their ability to participate fully in the LSI, with the psychological safety to recall and reflect.

Depending on circumstance, the Liaison Lead may wish to signpost to support for staff working in the organisation subject to an LSI, or offer some joint support, such as shared debrief sessions. This approach can also be beneficial in fostering partnership working throughout the LSI. But there is no requirement on the LSI Team to offer this, and it depends on local capacity and circumstance.

The Liaison Lead should proactively communicate regularly with the representative of the service, to ensure they feel informed, and are able to pass information on the LSI to their own staff. It also means that the LSI team can understand any changes made, offer support or answer questions, and continually assess the ongoing risk of harm.

9.6 Interviews, focus groups, and liaising with adults at risk and their families

When interviews or focus groups with adults who use the service, or their families, take place, Part 1 (Sections 1 & 2) of the Adult Support and Protection (Scotland) Act 2007 must be observed. These establish that the intervention will provide benefit to the adult, be least restrictive to the adult’s freedom, and have regard to their (and their families’) ascertainable wishes and feelings. Section 2(d) also states that the adult should be provided with such information and support as is necessary to be able to participate. Therefore, every consideration should be given to issues of accessibility, ease, equality and diversity. All necessary supports, including interpreters and communication aids, and/or a professional who knows the adult well, can be considered in order to support this. Consideration should be given to the setting and time of day of the interview or focus group, and this should be the choice of the adult(s), wherever possible.

In some cases, the interview and/or focus group should also give regard to the principles of ‘supported decision-making’. As defined by the Mental Welfare Commission, supported decision-making is any process in which an individual is provided with as much support as they need in order for them to be able to:

1. Make a decision for themselves; and/or

2. Express their will and preferences within the context of substitute decision-making.

The purpose of supported decision-making is to ensure that the individual’s will and preferences are central to and fully respected in decisions that concern them. There are briefings available on supported decision-making from Iriss and from the Mental Welfare Commission.

Independent advocacy, as a means for the individual or group to have their voice heard during the process, can also be a means to promote participation in the interview and/or focus group. Adults should be offered independent advocacy prior to the interview or focus groups.

If running a focus group rather than conducting an interview, the LSI team should ensure that this is the most effective and trauma-informed approach to take. Focus groups can be positive: they promote interaction, enabling participants to ask questions of each other, as well as helping participants to re-evaluate and reconsider their own understandings of their specific experiences. However, they can also have limitations. They can discourage people who are not confident or who do not wish to share their experiences with many other people; they can also distress participants as sensitive topics are discussed in a group setting (Sim & Wakefield, 2019; Gibbs, 1997).

Where there is an ongoing parallel police investigation (or this is yet to be established), the police should be consulted as they will be able to advise on any legal aspects of the interview or focus group.

The professional(s) conducting an interview with an adult at risk of harm should always follow local ASP procedures for investigative interviews. The following principles may also be helpful:

• Provide information as to the purpose of the interview in advance. This should indicate what questions may be asked and information on what to expect. This will give the person an opportunity to think about what they would like to say in advance.
• Conduct interviews in a trauma-informed way. Adults and their family members who are involved in LSIs may have been (or are) experiencing the effects of trauma. Those carrying out interviews are encouraged to ensure they are familiar with the impact of trauma and seek appropriate support if needed.
• Use professional curiosity (see Section 9.9)
• Be clear that adults need to give their consent to being interviewed.
• Be patient with, and sensitive to, complex issues. Consider the impact on the adult throughout – not just of harm or potential harm, but of the LSI process itself. For instance, adults who rely on the service subject to an LSI may feel that they are ‘getting people into trouble’ if they talk about harm, abuse or neglect. They may feel like their home, or the way they live their life, is threatened.
• Wherever possible, reduce or eliminate the need for adults to answer the same questions to different professionals. This will require close collaboration with multi-agency partners and information sharing (see Section 9.7).
• Check understanding throughout the interview and leave contact details at the end.

It is essential that those conducting interviews involved have all undergone specific training in investigating allegations of harm. As per section 8 of the Act, all interviews with adults at risk should be conducted by a Council Officer , and one other appropriate professional. Those conducting the interview should meet before the interview to ensure that they are each aware of all the circumstances related to the adult. There is further information about conducting interviews as part of the Adult Support and Protection process in Chapter 7 of the Adult Support and Protection (Scotland) Act 2007: Code of Practice.

There should be consideration given to all adults using the service, whether they are being interviewed or not, and they should be kept informed as to the progress of an LSI. These updates should be provided as part of the LSI plan and be included as a specific and time-bound action. What these updates will be depends on the nature of the organisation subject to LSI and the circumstances of the LSI itself, but at a minimum, adults should be kept informed as to when an LSI is expected to conclude.

9.7 Information sharing

The Adult Support and Protection (Scotland) Act 2007: Code of Practice states that “good practice is that all relevant stakeholders will co-operate with making referrals and assisting with inquiries, not only those who have a duty to do so under the Act.” While there are named public bodies in the Act (see section 6.2) who have a duty to share information in order to keep adults safe and protected, a wide range of other services also contribute to the protection of adults at risk. These include independent contractors such as General Practice, Dental Practices, Community Pharmacy, Out of Hours services and Optometry Practice; Scottish Fire and Rescue Service; and agencies of the Scottish Government. These services are also expected to co-operate with assisting inquiries. This is the case for LSIs as well as individual ASP inquiries/investigations. All partners in an LSI are expected to share necessary information to progress the LSI, since it is an ASP process to keep adults at risk safe. There is a template for information sharing at Appendix 3.

Data protection law enables organisations and businesses to share personal data securely, fairly and proportionately. The Information Commissioner's Office (the "ICO") has a Data Sharing Code of Practice and the resources available at their Data Sharing Information Hub provide detailed guidance and tools to aid data sharing in compliance with data protection law. A step-by-step guide to data sharing is available online. There are many misconceptions and fears around data sharing, and the ICO have a helpful page exploring these at Data sharing myths busted.

As information is collated throughout the LSI, it can be added to an organisational chronology (see section 9.8), and this can be shared will all partners.

Records of any individual ASP inquiries, investigatory activity and interventions undertaken as part of the LSI will be created, stored and retained by the Council. Partnerships will want to make sure that clear arrangements are also in place to manage the wider records produced by the multi-agency Investigation and Oversight groups, and it is suggested that these records are retained in accordance with any relevant Scottish Council Archive and Record Retention Schedules (SCARRS) in force at the time.

9.8 Creating and maintaining organisational chronologies

Chronologies provide a key link in the chain of understanding needs and risks, including the need for protection from harm. When used with an individual in Adult Support and Protection, they set out key events in sequential date order and give a summary timeline of that person’s circumstances, patterns of behaviour and trends in lifestyle that may greatly assist any assessment and analysis. They are a logical, methodical and systematic means of organising, merging and helping make sense of information. They also help to highlight gaps and omitted details that require further exploration, investigation and assessment.

An organisational chronology can be used in work to prevent LSIs as well as when an LSI is underway. It works to the same principles as individual ASP chronologies, but in this case the focus is on the agency, service or organisation subject to an LSI. All agencies involved in an LSI should be invited to contribute their knowledge in order to create a comprehensive timeline, which can be added to as more background information becomes known and/or the LSI progresses.

Good organisational chronologies contain comprehensive yet succinct entries, with enough detail to make them easily understood. There is no definitive list of what to include in an organisational chronology, but the following should be considered for inclusion:

• Previous LSI activity (including when a potential LSI was under discussion, but the decision was taken not to proceed)
• Current and previous individual ASP referrals
• identification and analysis of patterns of ASP activity in the organisation (for instance, repeated instances of financial harm) and action taken to address these
• significant changes in the management or organisation of the service
• outcomes of inspection activities
• analysis of the risk in the organisation, including strengths and protective factors in the organisation
• views of multi-agency partners, including information on criminal investigations
• a person-centred approach that reflects the views of adults that use the service.
• intelligence from any prevention activity (including Early Indicators of Concern indicators)

There is a template for creating an organisational chronology at Appendix 5.

9.9 Using professional curiosity

Professional curiosity is about how we change information into intelligence. It means questioning and challenging the information received, thinking through different possibilities, being able to identify concerns, and to make connections between different types of information. It’s also about being open-minded and being prepared to have difficult conversations. LSIs use professional curiosity throughout, in order to get to the heart of the issue – both about individuals and the big picture over time. 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.

All those working on an LSI should practice professional curiosity. Members of the LSI team should be encouraged to professionally challenge one another, be open to challenge themselves, identify gaps and inconsistencies, and to offer different perspectives on the evidence gathered. This will support the robust triangulation of evidence, the consideration of multiple hypotheses, and really use the valuable skillsets of those who work in Adult Support and Protection.

9.10 Communications with the media regarding the Large Scale Investigation

There is always a possibility of local or national media attention in the event of an LSI. A media statement acknowledges the media interest but doesn’t go into detail. Where there is likely to be media interest at any stage in the LSI Process and there is an ongoing parallel police investigation (or this is yet to be established), a media statement and media strategy should be prepared with the police and must include consultation with the police Senior Investigating Officer.

In most circumstances, when preparing the media statement, it would also be agreed with the agency, service or organisation subject to the LSI, who may have a dedicated communications officer.

All in the LSI Team, their multi-agency partners, and relevant people in the council can be provided with the media statement, which they will be able to quote in the event of media interest. The media statement should be regularly reviewed and updated, as necessary. The service subject to the LSI can also be provided with the media statement, which they can also use in the event of direct media enquiries.

Elected members, including MSPs and local councilors, may receive enquiries from their constituents or the local community on the LSI. The council may consider providing elected members the media statement and a confidential briefing, so the elected members can feel confident when talking to members of the public or press. In the event of a parallel police investigation, this briefing must also be prepared jointly with the police.

9.11 Consideration of LSI Team welfare during the LSI

Conducting an LSI can be an intense and demanding part of Adult Support and Protection work. HSCPs have a responsibility to take a trauma-informed approach in supporting their staff. Supported staff will have more capacity for analysis and reflection, skills that are paramount to the LSI’s effectiveness.

Support measures for those conducting an LSI might include (but are not restricted to):

• relieving them of other work
• promoting a sense of collective learning and togetherness in conducting the LSI
• robust and reflective supervision
• ensuring that those feeling overwhelmed are identified, and supported to access higher intensity care if needed
• opportunities for debrief and peer support, ensuring that these are also a safe space for sharing worries and emotions triggered by the LSI process.

Staff working on an LSI also have a responsibility for their own self-care, and to proactively bring wellbeing issues to their manager or supervisor.

9.12 Oversight of the LSI process

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

The LIO will provide updates to the Chair of the LSI Oversight Group (or, depending on the agreed frequency of Oversight Group meeting, to the Oversight Group itself). How and when this is done will be determined by the nature of each Investigation, reflecting the risks, dynamics and workload involved. However, updates are likely to include:

• Overall current status of the LSI
• Any new or emerging risks identified
• Completion of milestones
• Any challenges or difficulties
• Positive progress and good practice by the LSI Team
• The impact on the adults using the service subject to an LSI
• Any proposed changes to the original plan or timescales, and why

The LSI Oversight Group holds responsibility for updating other key stakeholders who are not part of the group. This may include (but is not limited to) other Heads of Service, the Chief Social Work Officer, the Adult Protection Committee (APC), the Chief Officers Group (COG) and other senior managers.

9.13 Concluding the Large Scale Investigation

An LSI is an Adult Support and Protection intervention. This means that the duty of those conducting an LSI is to ensure adults who are at risk of harm are safe. This may mean that there are still issues of poor care to be addressed. However, ongoing monitoring of the quality of care is not necessarily the responsibility of those conducting the LSI.