Strategic Inspection of Adult Support and Protection
North Ayrshire Council · 9 May 2024
Back to Integration Joint Board — 9 May 2024 and its agenda
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1 Integration Joint Board 9th May 2024 Subject: Strategic Inspection of Adult Support and Protection in North Ayrshire. Purpose: To advise board on the outcomes of the strategic inspection of adult support and protection completed by the Care Inspectorate, Health Improvement Scotland and His Majesties Inspectorate of Constabularies. Recommendation: Board members are asked to: • Note the outcomes of the inspection. • Note the submission of the improvement plan and the governance of this through the Adult Protection Committee and Chief Officers Group. Direction Required to Council, Health Board or Both Direction to: - 1. No Direction Required X 2. North Ayrshire Council 3. NHS Ayrshire & Arran 4. North Ayrshire Council and NHS Ayrshire & Arran 1. EXECUTIVE SUMMARY 1.1 This paper updates board on the process, outcomes and submission of the action plan as it relates to the strategic inspection of Adult Support and Protection (ASP) in North Ayrshire which was undertaken between September and December 2023. The inspection team scrutinised the records of 89 adults at risk of harm for the preceding two-year period, from September 2021 to September 2023. This paper will reference those parts of the inspection report that apply to delegated services only with observations offered if this impacts the interface between the HSCP and NHS Ayrshire and Arran and/or Police Scotland. The full Inspection report can be found here. 1.2 The inspection found clear strengths in ensuring adults at risk of harm are safe, protected and supported. The inspection highlighted key strengths and also identified areas for development including: • Overall, adult support and protection inquiries were undertaken in line with the code of practice. They were of a high quality, prompt and competently determined whether to proceed to full investigation. • The quality and competence of adult support and protection investigations was a clear strength. They reflected multi-agency contributions and supported effective risk assessment.
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2 • The creation of an NHS Ayrshire and Arran associate nurse director for public protection and other initiatives impacted positively on health operational practice and strategic partnerships. • The partnership’s strategic leadership was committed to continuous learning and improvement. This was channelled through well-established, and regularly undertaken, audit and self-evaluation activities. The inspections also reported key areas for improvement. These included: • Access to independent advocacy was limited. The partnership aimed to address this through their refreshed advocacy strategy. This should be a priority area for improvement. • Police Scotland inconsistently applied policy and practice across several areas, which when combined weakened the operational effectiveness of the partnership’s adult support and protection activity. These require to be promptly addressed to ensure parity of service levels across the partnership 2. BACKGROUND 2.1 Inspection activity in relation to ASP nationally concluded its first phase and in the first phase North Ayrshire was inspected in 2017. Learning from this national activity prompted Scottish Ministers to request that the Care Inspectorate lead a second phase of joint inspection and development of adult support and protection in collaboration with Healthcare Improvement Scotland and His Majesty’s Inspectorate of Constabulary in Scotland. Phase two is closely linked to the Scottish Government’s improvement plan for adult support and protection, and the national implementation groups which support it. The joint inspection focus: Phase two joint inspections aim to provide national assurance about local partnership areas’ effective operations of adult support and protection key processes, and leadership for adult support and protection. Updated codes of practice were published in July 2022. In recognition that adult protection partnerships were at different stages of embedding these, the Care Inspectorate issued a single question survey to all partnerships in Scotland. This asked respondents to describe their approach to inquiry and investigation work and outline the role of council officers. Twenty-two partnerships responded, and findings showed that practice and adoption across Scotland is variable, with most areas having work to do in this respect. North Ayrshire partnership fully adopted the codes of practice from March 2023. The focus of the inspection was on whether adults at risk of harm in the North Ayrshire partnership area were safe, protected and supported.
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3 The joint inspection took place between September and December 2023. The inspection team scrutinised the records of adults at risk of harm for the preceding two- year period, from September 2021 to September 2023. Progress statements To provide Scottish Ministers with timely high-level information, the joint inspection report includes a statement about the partnership’s progress in relation to our two key questions. • How good were the partnership’s key processes for adult support and protection? • How good was the partnership’s strategic leadership for adult support and protection? Joint inspection methodology: In line with the targeted nature of the joint inspection programme, the methodology for this inspection included five proportionate scrutiny activities. • The analysis of supporting documentary evidence and a position statement submitted by the partnership. • Staff survey. 319 staff from across the partnership responded to our adult support and protection staff survey. This was issued to a range of health, police, social work and third sector provider organisations. It sought staff views on adult support and protection outcomes for adults at risk of harm, key processes, staff support and training and strategic leadership. The survey was structured to take account of the fact that some staff have more regular and intensive involvement in adult support and protection work than others. • The scrutiny of social work records of adults at risk of harm. This involved the records of 39 adults at risk of harm who did not require any further adult support and protection intervention beyond the initial inquiry stage. • The scrutiny of the health, police, and social work records of adults of risk of harm. This involved the records of 50 adults at risk of harm for whom inquiries used investigative powers under sections 7-10 of the 2007 Act. This included cases where adult support and protection activity proceeded beyond the inquiry with investigative powers stage. • Staff focus groups. We carried out three focus groups and met with 38 members of staff from across the partnership to discuss adult support and protection practice and adults at risk of harm.
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4 3. PROPOSALS 3.1 Key Themes There are three key themes within the report that board should be reflective of, these are: 1. Key Processes: The inspectorate concluded, “Overall, the quality of North Ayrshire’s adult support and protection work across social work and health is commendable. While there is always room for improvement performance was strong and collaborative in every area of core adult support and protection business including inquiries, investigations, risk assessments and protection planning. This reflected our findings in the 2017 inspection and was evidence of the partnership’s sustainability and push for excellence.” While there is much detail in the report it is worthy activity to acknowledge the quality and consistency of key processes. The scrutiny activity reflected on timely inquiries, good quality risk assessments and protection plans and noted the high quality of case conferences. These key processes and the consistent level of quality is directly linked to a confident, competent and skilled workforce. The link between confident and well-trained practitioners and outcomes for people is well established. The approach to learning and development by both the Adult Protection Committee and the recent Partnership Strategy, Be The Best You Can Be, signals our commitment to continue to support and develop the workforce into the future. 2. Collaborative Working: The report is consistent in its reflection upon the scale and efficacy of collaborative working across the partnership area. Specific reference is made in relation to: • Almost all staff believed they were supported to work collaboratively. • Police sharing information to keep people safe. • The investment by NHS Ayrshire and Arran in its Public Protection Team. • The third and independent sector are providing a strong supporting role within the ASP Partnership. Collaborative working in this area of practice is critical. Practitioners very rarely have all the information and exert professional judgement on a daily basis. Effective collaborative working reduces risk through sharing of information and more effective risk management practices. 3. Governance: The report highlights the governance of ASP activity at all levels as a strength. The report highlights key aspects in relation to staff development and the presence of governance in almost all Social Work records.
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5 At a strategic level the work of the Chief Officers Group is highlighted with reference to effective strategic leadership, governance of ASP and oversight of performance and strategy. Areas for Improvement: Adults at risk of harm will have access to independent advocacy The partnership were aware of the need to improve access to quality independent advocacy services for adults. A new Independent Advocacy service, provided by Voiceability, is in place and links have been made with Adult Protection Services. The ASP Lead Officer will carry out quarterly monitoring of Adult Support and Protection statistics to ensure improvement on the number of adults receiving advocacy following referral. The Advocacy Strategy and monitoring framework will be reviewed annually to evaluate the ongoing effectiveness of advocacy and highlight any gaps/identify future needs. Improvement in consistency of police resilience matrix research and assessments Policy and practice reviews by NRAC, will review professional curiosity, rational/decision making and legal pathways used for sharing all types of vulnerability as part of the risk matrix protocol. New iVPD general user “why” training will highlight the need to widen focus to ensure this is not solely on criminality where a vulnerable individual is involved. Domestic Abuse Safety plans are under development and a planned future iVPD will include a safety plan template to facilitate and encourage local policing input on ASP, especially for adults already subject to partner support but still requiring a policing response. Training to be offered for local policing CWU to attend tier two ASP training where benefit will be gained from input from outside agencies. Improve compliance of PAARoH training. 3.2 Anticipated Outcomes The recent joint inspection feedback and report provides reassurance of the North Ayrshire approach to Adult Support and Protection across a range of agencies. Whilst there is always scope for improvement and learning, the most recent inspection reflects the non-negotiable priority of striving to safeguard and protect adults from harm in North Ayrshire. 3.3 Measuring Impact A multi-agency improvement plan in response to the findings of the inspection has been submitted to the Care Inspectorate by the ASP Lead Officer. Monitoring of the
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6 local delivery will be via the Adult Protection Committee and on to Chief Officers Group for strategic oversight. The individual improvement agencies will liaise with partners in relation to single agency issues. The Partnership will continue its referenced multi agency audit activity to ensure performance and outcomes are subject to strong ongoing governance. 4. IMPLICATIONS 4.1 Financial There are no financial implications. 4.2 Human Resources There are no human resource implications. 4.3 Legal There are no legal implications. 4.4 Equality/Socio-Economic There are no equality or socio-economic implications. 4.5 Risk Public Protection activity remains an area of high risk. While there is assurance from this report that key processes and governance structures are working well, our practitioners in this area often work with out the full picture. This results in the exercising of professional judgement at all stages. 4.6 Community Wealth Building There is no implication for community wealth building. 4.7 Key Priorities The key priorities will naturally focus around the areas for improvement and for the HSCP this relates primarily to the issue of access to advocacy. This work has been subject to a recent paper to IJB on our refreshed advocacy strategy and retendering process. Work will progress to ensure ASP referrals and supports become a regular part of business with our new advocacy service. The other priority area related to Police Scotland who will be supported by HMICS to support improvement. The other priority will be to ensure we continue to support and look after our practitioners to maintain this high level of professional practice. Ultimately this is to ensure we continue to collectively respond in a compassionate way to those in our community subject to circumstances where protection is needed.
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7 5. CONSULTATION 5.1 The inspection preparation, facilitation and improvement activity has been overseen by a multi-agency group. Regular updates on the process and outcomes have been provided across services through management structures. Public Protection Lead: Scott Hunter, Chief Social Work Officer scotthunter@north-ayrxhire.gov.uk Adult Support and Protection Lead Officer: Julie Mitchell juliemitchell@north-ayrshire.gov.uk