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

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

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

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

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

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

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.

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

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

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

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

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

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.

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.

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

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

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

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

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

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

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…..

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….

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

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.

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

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

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

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

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

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

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

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

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

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.

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.

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

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.

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