1. AYRSHIRE ADULT SUPPORT & PROTECTION PROCEDURES
North Ayrshire Council, East Ayrshire Council,
South Ayrshire Council, NHS Ayrshire & Arran
Strathclyde Police

2. Objectives To explore the support and protection of adults at risk.
To clarify operational duties and processes.
To identify best practice and areas of development.
Introduce Interim pan-Ayrshire & Arran ASP Procedures.
To consider the range of legal options.
Familiarise staff with procedure to be followed when it is suspected that harm has occurred.
Identify the roles and responsibilities of the agencies involved.
Explain and set out objectives for the session
Introduce and show group the Policy & Guidelines. That they should made available on request from managers and that they are on NHS Intranet

3. Learning Outcomes: You Will Know ….
Harm happens.
What it is, where it happens and how it happens.
What to do and how to progress concerns.
The systems in place.
Health Board, Local Authority and Strathclyde Police responsibilities, duties and powers.
The legislative basis; ‘the toolbox’
Borders enquiry; learnings to apply here.
Ms A; Justice Denied.
Refer to title and explain that by the end of the 1/2-day they will know the following outcomes.
Briefly talk around each one

4. Introduction – historical context
Growing public awareness of abuse/media coverage of incidents and public enquiries.
Increasing older population of potential adults at risk.
Procedures introduced from 2000, updated 2008.
National policy; Law Commission 1997, Borders Inquiry, SG consultation 2005, ASP Bill.
AWI & MHA left gaps re ‘vulnerable adult’ and ‘adult at risk’.
Adult Support and Protection (Scotland) Act 2007
Refer to title, then explain that the following are fundamentally why we need a formal approach to awareness.
Then reveal each point in turn and briefly talk around them
Highlight that although abuse has always taken place :
The first book published in UK “Old Age Abuse”, By Mervyn Eastman, 1984.
No Secrets DOH 2000, England & Wales
In Safe Hands, Northern Ireland, 2000
Scotland,Bill still progressing through Parliament

5. Introduction - purpose
Prevention – always the first priority
Procedures – the structure
Action where harm has occurred
Partnership across all sectors
Abuse; an action
Harm; the outcome
Self explanatory

6. Abuse; group exercise Definitions; what is abuse
Examples; from professional experience
Signs; what to look for
Who abuses; ??
Context; where, when, how
Discuss in groups and feedback

7. What is Abuse?
An action.
A violation of an individual’s human and civil rights by any other person.
The wrongful application of power by someone in a dominant position.
Includes aggressive, subtle and non-intentional acts, deficiency of care and treatment, exploitation, harm.
Others …. ‘the martini approach’ ??
Explain that it is difficult to get agreement on a definition due to differences such as culture, attitudes & individual standards
However, there are agreed principles of what constitutes abuse.

8. Abuse: examples Physical Emotional/Psychological Deprivation of ….
Isolation
Financial/Material
Sexual
Human Rights
Institutional
Malpractice
Verbal
Neglect
Self Neglect
Racial Abuse/Discrimination
Random Violence
Domestic Abuse
Ageism
Information Abuse
Medication
This slide can be used to get the group involved.
Refer to title
Ask group to to name the different types of abuse
The flip chart can be used to record their responses
Reveal the bullet points in turn & discuss comparisons

9. Some Signs Unusual or suspicious injuries.
Unusual or unexplained behaviour.
Allegations of abuse.
Adult found alone in a situation of risk.
Frequent/inappropriate contact with agencies.
Interval between injury/illness and contact.
Living with known perpetrator.
Misuse of medication.
Physical deterioration.
Increases in confusion.
Demonstration of fearof another person.
Others.
Refer to title
Ask group to to name some signs
The flip chart can be used to record their responses
Reveal & discuss comparisons

10. Abuser? ANYONE Staff member. Professional. Volunteer.
Another person receiving the service.
Spouse, relative, member of social network.
Neighbour, member of public, stranger.
A person who targets vulnerable people.
Refer to title. Inform group that potentially any one can be an abuser
Ask group for examples.
The flip chart can be used to record their responses
Reveal and compare

11. Abuse: Context Own home. A carer’s home. Residential/nursing care.
Work setting.
Educational setting.
Hospital.
Social situations/public place.
Hostel/temporary accommodation.
Accommodation with support.
Refer to title. Inform group that abuse can occur anytime,any place, any where.
Ask group for examples.
The flip chart can be used to record their responses
Reveal and compare

12. Borders Report; facts
A woman with learning disability taken to hospital with multiple injuries from physical assault and sexual assault. Police investigation revealed a catalogue of abuse and assaults over previous weeks and longer. Three men were convicted of the assaults in 2002.
Over many years events and statements were taken by social work, health services and Police that raised serious concerns.
Others were receiving care under the same circumstances, with varying degree of learning disability, physical disabilities and mental health needs, which were largely neglected.
They were neglected, lived in unsuitable and unsanitary conditions and were financially and sexually exploited.
The next 3 slides are closely linked.
They are about informing the group about the Border Report.
Give out handouts to support the slides and the Borders Analysis.
Reveal each slide in turn and talk around the point

13. Borders Report; Some Findings
Failure to investigate appropriately serious allegations of abuse.
Acceptance of poor conditions in which the people lived.
Lack of comprehensive needs assessments.
Lack of risk assessments.
Lack of information sharing and co-ordination.
Disagreements between agencies at the front line.
Un-sustained contact with the individuals concerned.
Poor case recordings.
Lack of care planning.
Failure to consider statutory intervention.
Lack of compliance with VA procedures.
Poor supervision.
Lack of senior management and leadership.
Lack of clarity of role.

14. Borders Report; Recommendations
Review all cases of adults with learning disability to assess level of risk and quality of service.
Review of LD services.
Guidance of staff on complex cases.
Vulnerable adult procedures.
Comply with SSSC codes of practice.
Improve training for MHOs.
Acute discharge protocols.
Develop better risk assessment methods.
Improve case recording and review mechanisms.
Introduce random case monitoring processes.
Monitor the effectiveness of case transfer arrangements.
Share information more effectively.

15. Borders; learnings Is about people Key messages:
Attitudes (they live this way!)
Fragmentation of service response (who had the whole picture?)
Identifying risk at key times.
Communication and transfer of information.
Audit/recording/monitoring.
Resolving differing views (two tribes).
Poor consideration of statutory powers.
Reveal and compare with the feedback on flip chart

16. Borders Report; A Check List
Allocated worker with necessary skills and experience.
All relevant information been gathered?
Chronology of events and implications of these events understood?
Comprehensive assessment, including risk?
Care and protection plan?
Statutory intervention considered?
Individual seen on regular basis?
Good communication and collaboration?
Case been reviewed in accordance with procedure?
Case been subject to oversight by line manager?
NB this slide brings together the salient points regarding the Borders Report:
Reveal & discuss in turn.
Give hand out at the end

17. Underpinning Principles
Every adult has a right to be protected from all forms of abuse, neglect and exploitation that result in harm
The adult’s welfare takes primacy
Self-determination
If self-determination over-ridden, must be proportionate and be least disruptive response
ASP, AWI & MHA all take into account;
Privacy, dignity, safety, choice, respect, empowerment, equal consideration, preferences, participation, benefit, minimum intervention
Refer to title
Ask which groups of people are most vulnerable
The flip chart can be used to record their responses
Reveal & discuss comparisons

18. Adults Have Rights
Adults have the right to make their own decisions in relation to their safety, security and behaviours:
And can only be overturned by law
Can the person understand the nature and consequences of the risks they may be subject to
Can the person consent to any intervention that may be proposed
Does the person have the capacity to make informed decisions to accept or refuse assistance
Refer to title and inform group that as practioners/carers/professionals there are 2 basic rights to be considered in respect vulnerable adults.
Reveal 1st point ask group for their opinion.
Reveal rider to the above and discuss.
Reveal 2nd point ask group their opinion.
Reveal rider to the above and discuss

19. Consider…. CONSENT CAPACITY RISK
Consider; context, degree, frequency, outcome, effect
Refer to title. Inform the group that with regard to the previous slide, the following are points to consider when dealing with someone who is suspected of being abused.
Reveal and ask regarding personal experiences

20. Dilemmas Intruding on someone’s liberty vs protecting this person.
Acting vs not acting.
Respecting the victim’s pride and fear of recrimination vs taking action.
Dealing with tyranny vs respecting individual choice and control.
Respecting vs intruding on confidentiality.
Criminality vs confidentiality and fear
Refer to title. Inform the group that “ it may not be abuse “ and with regards to the previous slides, the following are dilemmas that may not be uncommon
Reveal and ask regarding personal experiences

21. Ms A – Justice Denied Mental Welfare Commission Report – April 2008
67 year old woman with a learning disability and in care of local authority since age 8
Repeated sexual assaults by more than one man over a prolonged period of time
The protective supports now in place amount to a severe restriction of liberty
Emphasis on all that has gone before.. The responsibility to act, but in such a way that protects people, respects their rights, taking the initiative but consulting and involving others, engaging people and maintaining the working relationship…
This reflects the previous slides and discussions… it’s important to re-emphasise the responsibility we ALL have…
Final slide of session 1…..

22. Ms A
No prosecution
People with a learning disability should have equal access to justice (UN Convention on Rights of People with a Disability)
“... the responses of health, social care and criminal justice services combined to deny Ms A access to justice” (MWC report)
Attitudes of professionals towards people with a learning disability affected their responses – different standards applied
Again, round the table for a brief discussion.. .get some feedback, there will be debate.. Some might say, eg, that children always come first in preference to a vulnerable adult.. .reality is, any abusive situation must be dealt with.. .
Adults have rights too,, to be protected, no less, no more, than any other person in society….
Point 3; duty of care, inventive ways of working based around relationship skills….

23. Ms A - findings
Staff in agencies were confused about their professional responsibilities in reporting a crime
Knowledge of relevant legislation and procedures lacking
No consensus on whether Ms A had the capacity to consent to sexual activity
Assessment of her competence as a witness did not include people who knew her well
No consideration on support and means of preparing Ms A to act as witness
PF left with little option than to abandon any action
Self explanatory
Give out handout of slides

24. Ms A; small group discussion
Consider the facts and findings in the case of Ms A
What changes would you bring into place
What recommendations would you make
Could this happen here
Refer to title and inform that frameworks are required because of certain fundamental principles ……
Reveal each slide in turn.

25. Ms A; selected recommendations
APC to coordinate multi-agency training on capacity and consent to sexual activity and vulnerable witnesses
APC to ensure procedures include reference to vulnerable adult witness support
APC to ensure procedures allow for appropriate sharing of information
Clarify role of MHO in adult protection case conferences
Refer to title and inform that this legislation exists because of the previous agreed principles
Reveal while explaining that these are possible measures which can be brought into force to protect the person. Ask group about their experiences.
NB the first 2 examples are taken a bit further on the next 2 slides

26. Ms A
Refer to title and inform that this Act came into force October 2005
Reveal and explain. Ask about personal experiences
NB inform the group that this is to increase awareness and the their manger can arrange specific training

27. AYRSHIRE ADULT SUPPORT & PROTECTION PROCEDURES
North Ayrshire Council, East Ayrshire Council,
South Ayrshire Council, NHS Ayrshire & Arran
Strathclyde Police

28. Inter-agency responsibilities
Common responsibilities
All staff must be capable of recognising and acting on concerns for the safety of adults (and children)
Are familiar with the inter-agency procedures to support and protect adults at risk
Can take immediate action in an emergency
Cooperation across partner agencies
Sharing of information for the purposes of inquiries and protection planning
Be alert to child protection concerns where a child is present where an adult is at risk of harm
Explain that the following 2 slides are the 2 most commonly used Acts.
Reveal and explain
NB inform the group that this is to increase awareness and the their manger can arrange specific training

29. Whistleblowing
Guidelines, protection and reassurances to encourage disclosures of suspected or actual malpractice.
Staff have the right to raise concerns and have them heard in an open and sensitive manner.
Staff should be aware of procedures for whistleblowing, harassment policies, disciplinary procedures, complaints.
Refer to title:- ask group their thoughts on whistleblowing
Reveal & talk around each point
NB everyone has a duty of care to report their concerns
Our policy is a Zero Tolerance Policy

30. Framework for Assessment and Intervention
All partner agencies must ensure staff have an awareness of adult protection issues and a working knowledge of systems and practice
Social work is lead agency
Referrals require full referral information
Principles applied
Referral to police if it is believed a criminal offence may have been committed
Refer to full procedures
Reveal title: explain that one law does not fit all cases.
Reveal and ask which legislation could apply.
Then as an example discuss the following:
Different types of abuse require different powers of legislation: For example Domestic Abuse;
Criminal Law
Civil Law
Common Law
Mental Health Act
National Assistance Act
Does not matter which, if any , law is relevant, WE HAVE A DUTY TO REPORT AND RECORD

31. Your Initial Practical Responsibilities
You witness, suspect or receive information about abuse:
Talk to victim seek consent to take action.
Where person does not give consent for action, discuss with line manager.
Emergency - contact appropriate emergency service.
Consult with line manager/supervisor (if unavailable an alternative manager):
To refer to local authority social work department.
To refer to police where indications of a criminal offence (referral discussion to decide on appropriate action if victim does not wish to make complaint).
Refer to to the title and point out that our response depends upon where we are in the organization
This slide is about ensuring that the attendees are fully aware of their responsibilities
Reveal each point and inform them of their responsibilities
NB. It is important to remind everyone of the importance of Confidentiality with the media

32. Referral process
Refer to the community care team for the area in which the adult lives
Enquiry and Information Team
Prestwick, Kyle St, Riverside/Holmston, Maybole
Or, if known to a specialist team
Adult mental health, elderly mental health, learning disability, physical disability, sensory impairment
Young adults; disability, throughcare
Initial inquiries; check with appropriate others, eg, NHS
SSW/DepMan consider information and determine ASP or other action, eg, care management
Self explanatory. 32

33. Referral process – young adults
In addition to the referral routes listed previously, if a young adult of 16/17 is at risk of harm
Establish if an order under children’s legislation is in place
If so, refer to the relevant C&F team
If not or not known, refer to relevant community care team
Initial inquiries; check with appropriate others, eg, NHS
SSW/DepMan consider information and determine ASP or other action, eg, care management
Self explanatory. 33

34. Initial Actions SSW/DepMan decide on level of investigation and plan
Consider; consent, capacity, risk, services
Safeguard the adult
Professional judgement of recorded facts
Context, degree, frequency, effect, outcomes
Extent of harm, impact, a pattern, intent, legality, urgency
Council Officer investigative role
Investigation visit within 24 hours – council officer along with other appropriate person
Case conference within 10 working days.
For information, as many people attending the briefings will be font-line staff who need to know what they must do immediately and what they must do next…. Ie report it up the line….
But it’s always useful to know where the info goes, who will deal with it and the possible outcomes…
Yes, it’s the good old local authority that has responsibility… again.

35. Case conference Purpose to make decisions about support and protection
Multi-agency; shared responsibilities
Convened by SSW/DepMan
Considers;
risk management and protection plan (JIT docs)
Inclusion of the adult
Legal options
Self explanatory.

36. Final pub quiz Describe definitions; Of an adult at risk of harm
The 3 point test
Define the principles
What do we mean by ‘consent’, ‘capacity’ and ‘risk’
Answer the ‘martini’ question
Describe some of the ways an adult might be harmed
What protection orders are available
What other laws are relevant
Who are the partner agencies
Who can carry out inquiries
Refer to title. Inform that Bill is currently progressing through the Scottish Parliament, ….
Reveal & talk around then points

37. Good practice in ASP Don’t promise to keep secrets.
Don’t place yourself at risk
Explain what you are going to do
Protect people
Accept responsibility
Work in partnership
Share and record information
Be tenacious
Refer to title and explain that there are certain things we should not do…
Reveal, talk around the slides & ask for comments from group.

38. AYRSHIRE ADULT SUPPORT & PROTECTION PROCEDURES
NHS Ayrshire & Arran
North Ayrshire Council, East Ayrshire Council,
South Ayrshire Council, Strathclyde Police