Adult Support and Protection- Social Work Annual Report 2021-2022 and Adult Protection Committee Biennial Report 2020-2022
North Lanarkshire Council · 21 February 2023
Back to Adult Care and Social Work Committee — 21 February 2023 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
Page 1
North Lanarkshire Council Report Does this report require to be approved? ☐ Yes ☒ No Ref DF/HI Date 21/02/2023 From Diane Fraser, Chief Officer of Adult Social Work Services E-mail FraserDi@northlan.gov.uk Telephone Executive Summary This Paper provides an overview of two key Adult Support and Protection Reports which were recently published: Social Work Annual Report 2021-2022, and Adult Protection Committee Biennial Report 2020-2022. The paper initially provides information on the profile of adult protection in North Lanarkshire, referencing increased referrals to social work and identifying increased numbers of referrals from care homes and health providers. The background and summary points of two core Adult Support and Protection (ASP) Reports, are provided, reflecting recent activity and developments for ASP in North Lanarkshire. The Social Work Annual Report 2021-2022 provides a summary of all adult support and protection activity responding to adult at risk (AAR) referrals in that period. It provides assurance that this statutory function continues to be met on a timely and proportionate basis and provides example of improved scrutiny and monitoring practice. It also reflects some of the complex and skilled work required through both individual statutory and large- scale investigation activities to mitigate risk for adults living in North Lanarkshire. The Adult Protection Committee Biennial Report 2020-2022 provides a summary of the multi-agency partnership activity and reflects how the Committee has continued to discharge its key responsibilities, as outlined in legislation and guidance. Recommendations It is recommended that Adult Care and Social Work Committee; 1) note the content of this report and those attached. The Plan for North Lanarkshire Priority Improve the health and wellbeing of our communities Ambition statement (14) Ensure the highest standards of public protection Adult Care and Social Work Committee Adult Support and Protection: Social Work Annual Report 2021-2022, and Adult Protection Committee Biennial Report 2020-2022
Page 2
1. Background 1.1 This paper provides the Committee with an overview regarding two key reports reflecting adult support and protection activity and governance in North Lanarkshire. 1.2 Adult Support and Protection is a statutory role of Adult Social work services, as defined in the Adult Support and Protection (Scotland) Act (2007). This Act identifies the requirement of local authorities (now delegated to Health and Social Care Partnerships) to make enquiries and mitigate risk where adults are deemed to be ‘at risk’. 1.3 In November 2022, North Lanarkshire Adult Protection Committee (NLAPC) published its latest Biennial Report to the Scottish Government. This is the seventh Biennial Report of NLAPC and covers the period April 2020 to March 2022. The Report explored strategic, operational and governance details of adult support and protection on a multi- agency basis, as reflected through the work of the multi-agency Adult Protection Committee. 1.4 North Lanarkshire Social Work’s Adult Protection Report 2012-22 was published in December 2022 and provides information on adult support and protection (ASP) activity undertaken by Social Work Services in North Lanarkshire during period 2021 - 2022. Social Work remain the statutory lead agency for ASP and as such this report details all referrals received during the year in comparison to previous years, and what stage they reached in the adult protection process. The report also provides some analysis of the information collated regarding performance and wider developments in adult protection across North Lanarkshire. 2. Report Profile of Adult Protection activity in North Lanarkshire 2.1 The Adult Support and Protection (Scotland) Act 2007 stipulates that adult at risk referrals be submitted to local authority adult social work, who must make enquiries into the referral. As such, social work data provides a full profile of adult at risk (AAR) concerns annually. This report provides a summary of two data sets; the social work overview of 2021/22, and the Biennial Report data from 2020/22, which provides a multi-agency overview of ASP to the Scottish Government. 2.2 During 2021/22 North Lanarkshire Social Work Services, as part of Health and Social Care North Lanarkshire, received 2434 ASP referrals. This is the third consecutive annual increase. Indeed, 4,860 referrals were received in 2020/22, this being a 9% increase from the previous Biennial Reporting period of 2018/20. 2.3 The data also reflects some changes in the profile of AAR referrals, both in sources of referral, and the types of harm being identified. 2.4 There has been an increase in referrals received from both Care Home and Health settings. In 2021/22 AAR referrals from Care Homes demonstrated a 9% increase (from 416 to 455); with 19% of total ASP referrals coming from this source. Information suggests that this links to both increased complexity and advanced needs of residents, and to increased monitoring, support and scrutiny of care home services, and reflects the additional challenges and profile that Care Homes have faced during the pandemic. 2.5 2012/22 has seen health referrals become the most prevalent (19% of referrals received); overtaking police (16%) as the primary referrer. There has been significant
Page 3
decline in police referrals, of 36% from 2020/22 (from 598 to 381). However, there is an increase in police referrals to social work where a person is not viewed as being an adult at risk. These ‘adult concern’ reports received by Social Work, rising 13% in 2021- 22 (from 3552 to 4004). The Report reflects continued active referral activity from many partners, reinforcing a wide-ranging understanding of adult support and protection across partners. North Lanarkshire Social Work Adult Protection Report 2021-22 2.6 This report provides an overview of Social Work ASP activity for 2021/22, including: 2.7 With regard to AAR, referral activity the report reflects that in North Lanarkshire we continue to see a consistent profile of activity. Eighteen percent of the total number of ASP referrals received progressed onto a full investigation. This percentage conversion rate has increased by 3% since the same time last year (from 15% to 18%), however it remains in our long-term trend, which traditionally reflects national average data in this area. Data shows that in 2021/22, 25% (108) of investigations progressed onto an initial case conference, which again is similar to last year. There was however a 32% increase in the number of initial case conferences, to 108 in 2021/22. Additional profile information is provided in the report. 2.8 Throughout the year, regular performance management reports have highlighted increased demand on social work human and service resources and the impacts on resources across partner agencies. The service has continued to be effective in providing a consistent statutory response to referrals, and mitigation of risk. 2.9 Public protection is identified as an area of high risk on the Councils’ risk register. It thus continues to be subject to scrutiny and monitoring activity as a matter of course. A local audit report submitted to the Council’s Audit and Scrutiny Panel in September 2021 concluded that arrangements were satisfactory and offered an opinion of reasonable assurance; it also recognised the prioritisation of public protection during the pandemic. Routine self-evaluation activity of the Chief Officers Group Public Protection has also informed a refresh of multi- agency action plans across all public protection areas to promote consistency of structure. 2.10 The report provides information on developments to monitoring and supporting ASP activity and reviewing AAR referrals from care homes. This has promoted an ‘early intervention’ approach to identify emerging concern/s, specific patterns and/or trends and provides additional scrutiny and assurance for senior managers and the CSWO. 2.11 There were 13 ASP Statutory Orders implemented in 2021/22: • 6 X Removal Orders, • 3 X Banning Orders with Power of Arrest and: • 4 X Temporary Banning Orders with Power of Arrest. 2.12 North Lanarkshire Council commissioned and carried out two ASP Large Scale Investigations (LSI) in 2021/22, including one with national involvement due to the nature of the care home and its subsequent closure. The work associated in carrying out both LSI’s was significant and complex for all professionals involved. 2.13 Statutory duties for Appropriate Adult services are set out via the Criminal Justice (Scotland) Act 2016 and, Appropriate Adults: Guidance for Local Authorities (2020). Appropriate Adult Services in North Lanarkshire are currently fully operated, funded and delivered through Social Work Services with sixteen employees trained to perform
Page 4
AA roles during business hours and SWES (Social Work Emergency Services) staff providing support out of hours. In 2021/22 Appropriate Adult referrals decreased by 23% (from 92 to 71) in North Lanarkshire. 2.14 The areas of work within the Social Work annual report which sits within the governance of the Adult Protection Committee (APC) is referred to from section 2.12 of this Report. 2.15 The North Lanarkshire Social Work Adult Protection Report 2021-22, summarises the continued increase in ASP activity in North Lanarkshire, provides oversight of improvement and monitoring activity and shares information on services development over the time period. North Lanarkshire Adult Protection Committee (NLAPC) Biennial Report 2020-2022 2.16 The seventh Biennial Report of the North Lanarkshire Adult Protection Committee (APC) was submitted to the Scottish Government in November 2022 and covers the period April 2020 to March 2022. This report focusses on the multi-agency partnership approach to Adult support and protection in North Lanarkshire, which is led by our Adult Protection Committee (APC). A selection of key points are summarised below: 2.17 The report reflects the significant national and local developments in adult support and protection in this period, with a strengthening of national profile and governance processes, which have helped to guide the work of the APC. 2.18 North Lanarkshire’s APC partners continue to support our vision that adults who experience or are at risk of harm are safer as a result of the support, protection and services they receive. This is reinforced by our aim to drive forward professional and public awareness of harm affecting adults at risk; working in partnership with our members and the wider community to ensure that vulnerable and at risk people in and from North Lanarkshire are safe and protected from harm. 2.19 The report reflects the significant partnership response to addressing ASP concerns during the pandemic, including the increased monitoring, support and scrutiny activity given the demographic links between ASP risks and vulnerable members of our communities. This includes a shift to some virtual activity, revised training provision and operational flexibility to respond to changing risk and need. 2.20 The report reflects the work of the APC and includes positive self-evaluation findings, with well-established arrangements in place across all aspects of partnership working. This activity lead to reinforced APC representation across key agendas, such as care home assurance, acute and the Alcohol and Drug Partnership. This is helping to raise the profile of ASP across relevant agendas. 2.21 The report highlights areas of positive and innovative practice from APC partners. This includes work with the National Missing Persons Project to understand and respond to missing people concerns across all ages and services in North Lanarkshire. This culminated in the development of the North Lanarkshire Multi-agency Missing Persons protocol. 2.22 The APC has committed to a trauma informed approach to adult protection. All training and policy development has awareness of the impact of trauma embedded in its content and language. This includes a commitment to transitional safeguarding based on a contextual safeguarding approach we share with our Child protection Committee. 2.23 The report reflects the progress of the APC’s Improvement Plan, including ongoing work to improve the quality of chronologies and risk assessments in adult protection cases, and to strengthen information sharing. This also includes development activity such as the development of guidance such as working with Neglect and with financial
Page 5
harm. The APC is also working to strengthen representation from people with lived experience within the Committee framework. 2.24 The report also provides an update on the APC’s training learning and development activity of the APC, including the development to online training, with over 1,100 people accessing various training opportunities over the two-year period. This has also included new training provision to address emerging need, such as self-neglect and hoarding, a GP training programme and relaunching our multi-agency forums to share learning and good practice. 2.25 North Lanarkshire Adult Protection Committee’s Biennial Report 2020-2022 provides a comprehensive overview of the priorities, and activity undertaken, over this timescale. Identified improvements have formed the basis of the 2022/23 APC Improvement Plan. 3. Measures of success 3.1 These two reports are indicative of the significant level of ASP activity across partners. A robust programme of social work and multi- agency monitoring, and scrutiny of this activity continues on a quarterly basis and indicates that risk is assessed and addressed on a timely and appropriate basis. 3.2 A suite of self-evaluation activity has given assurance that our strategic and operational frameworks are effective and proportionate. 3.3 Adult Protection partners are aware of the ongoing improvement activity identified as part of the APC Improvement Plan and identified areas for improvement are monitored through the APC and its subcommittee structure. 3.4 We follow a timetable of policy and procedural development and refresh which has led to the establishment of key guidance and policies to support thematic and emerging risk. 4. Supporting documentation 4.1 Appendix 1 - North Lanarkshire Social Work Adult Protection Report 2021/22 4.2 Appendix 2 - North Lanarkshire Adult Protection Committee Biennial Report2020- 2022 Diane Fraser Chief Officer of Adult Social Work Service
Page 6
5. Impacts ( http://connect/report-template-guidance ) 5.1 Public Sector Equality Duty and Fairer Scotland Duty Does the report contain information that has an impact as a result of the Public Sector Equality Duty and/or Fairer Scotland Duty? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact? If Yes, has an assessment been carried out and published on the council’s website? https://www.northlanarkshire.gov.uk/your- community/equalities/equality-and-fairer-scotland-duty-impact-assessments Yes ☐ No ☐ 5.2 Financial impact Does the report contain any financial impacts? Yes ☐ No ☐ If Yes, have all relevant financial impacts have been discussed and agreed with Finance? Yes ☐ No ☐ If Yes, please provide a brief summary of the impact? 5.3 HR policy impact Does the report contain any HR policy or procedure impacts? Yes ☐ No ☒ If Yes, have all relevant HR impacts have been discussed and agreed with People Resources? Yes ☐ No ☐ If Yes, please provide a brief summary of the impact? 5.4 Legal impact Does the report contain any legal impacts (such as general legal matters, statutory considerations (including employment law considerations), or new legislation)? Yes ☐ No ☒ If Yes, have all relevant legal impacts have been discussed and agreed with Legal and Democratic? Yes ☐ No ☐ If Yes, please provide a brief summary of the impact? 5.5 Data protection impact Does the report / project / practice contain or involve the processing of personal data? Yes ☐ No ☒ If Yes, is the processing of this personal data likely to result in a high risk to the data subject? Yes ☐ No ☐ If Yes, has a Data Protection Impact Assessment (DPIA) been carried out and e-mailed to dataprotection@northlan.gov.uk Yes ☐ No ☐ 5.6 Technology / Digital impact
Page 7
Does the report contain information that has an impact on either technology, digital transformation, service redesign / business change processes, data management, or connectivity / broadband / Wi-Fi? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact? Where the impact identifies a requirement for significant technology change, has an assessment been carried out (or is scheduled to be carried out) by the Enterprise Architecture Governance Group (EAGG)? Yes ☐ No ☐ 5.7 Environmental / Carbon impact Does the report / project / practice contain information that has an impact on any environmental or carbon matters? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact? 5.8 Communications impact Does the report contain any information that has an impact on the council’s communications activities? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact? 5.9 Risk impact Is there a risk impact? Yes ☐ No ☒ If Yes, please provide a brief summary of the key risks and potential impacts, highlighting where the risk(s) are assessed and recorded (e.g. Corporate or Service or Project Risk Registers), and how they are managed? 5.10 Armed Forces Covenant Duty Does the report require to take due regard of the Armed Forces Covenant Duty (i.e. does it relate to healthcare, housing, or education services for in- Service or ex-Service personnel, or their families, or widow(er)s)? Yes ☐ No ☒ If Yes, please provide a brief summary of the provision which has been made to ensure there has been appropriate consideration of the particular needs of the Armed Forces community to make sure that they do not face disadvantage compared to other citizens in the provision of public services.
Page 8
0 Appendix 1 North Lanarkshire Social Work Adult Protection Report 2021/2022 1st April 2021 – 31st March 2022
Page 9
1 North Lanarkshire Adult Protection Committee Report 1st April 2021 – 31st March 2022 Contents Contents ....................................................................................................................... 1 Introduction .................................................................................................................. 2 Definition of an Adult at Risk… ...................................................................................... 2 Last Year’s update ........................................................................................................ 2 National position… ........................................................................................................ 4 Case file audit / review .................................................................................................. 6 Local Profile… .............................................................................................................. 6 ASP Large Scale Investigations… ............................................................................... 14 Additional Elements Supporting Adult Protection ......................................................... 14 North Lanarkshire Adult Protection Committee ............................................................ 16 Case Reviews .............................................................................................................. 16 Local Developments and Events… .............................................................................. 19 ASP Learning and Development .................................................................................. 22 Key Areas of Reflection ................................................................................................ 22 Summary of Adult Protection Activity for 2021/22 ........................................................ 24 Individual Agency Referral Summary… ........................................................................ 26
Page 10
2 Introduction The Adult Support and Protection (Scotland) Act 2007 came into force on the 29th October 2008. Under ‘the Act’, North Lanarkshire Council as lead agency, has a statutory duty to make inquiries about the well-being, property or financial affairs of an individual if they know or believe that the person is an adult at risk and that they might need to intervene. ‘The Act’ provides powers available to Council Officers to carry out investigations as deemed appropriate for the purposes of inquiry into the circumstances of an adult in order to protect them from harm. This report provides information on adult protection activity undertaken by Social Work Services in North Lanarkshire during period 2021 - 2022. It details all recorded referrals received during the year in comparison to previous years, and what stage they reached in the adult protection process. The report also provides some analysis of the information collated regarding performance and wider developments in adult protection across North Lanarkshire. Definition of an Adult at Risk Section 53 of the Act defines an adult at risk as a person aged 16 years or over and who: • is unable to safeguard their own wellbeing, property, rights and other interests; • is at risk of harm; and; • because they are affected by disability, mental disorder, illness or physical or mental infirmity, are more vulnerable to being harmed than an adult, who is not so affected. It is important to note that simply the existence of a particular condition does not mean that an adult is at risk. A person may have a disability and be able to safeguard their own wellbeing. For the Act to apply all three criteria must apply. Last Year’s Update Public protection is identified as an area of high risk on the Councils’ risk register. The corresponding local audit report submitted to the Council’s Audit and Scrutiny Panel in September 2021 concluded that arrangements were satisfactory and offered an opinion of reasonable assurance; it also recognised the prioritisation of public protection during the pandemic. Recommendations for improvement were promptly acted upon and supported routine self-evaluation activity of the Chief Officers Group Public Protection. Improvement actions have informed a refresh of multi-agency action plans across all public protection areas to promote consistency of structure. Throughout the year, regular performance management reports have been produced on a weekly, four weekly and quarterly basis which review and analyse ASP activity and identify how these impact on sources and funding implications. Quarterly reports continue to highlight increased demand on social work human and service resources and the impacts on resources across partner agencies. The Performance Management Reports are shared across local Partnership Boards, Chief Officer Groups, Social Work Management Teams and the Adult Protection Committee. The service has continued to be effective in providing a consistent statutory response to referrals from all sources e.g. services users, families, members of the public and professionals, throughout the past 12 months. Within each locality, robust arrangements were in place to streamline staffing via rotas to ensure safe coverage of the ASP duty rota.
Page 11
3 While home visits to ‘adults at risk’ continued to take place in line with national and local guidance, a number of developments were required to manage the AP meetings process that promoted good communication between Social Work Services and partner agencies to come together, and to share timely information for risk assessment and risk management purposes. Work was undertaken, in collaboration with social work managers and colleagues from Advocacy services, to design and develop a range of templates and supporting guidance to conduct virtual AP meetings. As the pandemic restrictions ease, the ASP response will retain some elements of virtual meetings for professionals however more face to face work with adults at risk is preferred. A forthcoming review of ASP procedures for Social Work Services (required during 2022 -2023 period) will provide opportunity to explore best practice regards technology use in ASP case management. ASP Council Officers (Social Workers) continue to undertake risk assessments on an individual basis for the protection of Adults with lived experience of harm. Since April 2020, the Senior Officer with responsibility for ASP has been working closely with colleagues across localities and NLC Quality Assurance Team to produce weekly (and fortnightly/four weekly) AP data reports. Such reports are required for both internal and external reporting requirements e.g. Senior Social Work Managers, NL CSWO, CHAT and Scottish Government. Initially, it was recognised that while the weekly data reports will provide a basic weekly trend (e.g. whether the data set has increased or reduced), there were broader limitations within the data sets, in terms of identifying more specific trends and patterns. To address this issue, in addition to the weekly data set information, a ten-week analysis of referrals, investigations and case conferences, with a comparison, to the same period last year, is provided. Feedback from Locality Social Work Managers is positive, in that, the information is useful as it is current and provides a detailed account of AP activity for their own locality area, in comparison to other localities. Throughput the period, every ASP referral that has been submitted regarding adults that reside in care homes in NL, has been reviewed. This work has promoted an ‘early intervention’ approach to identify emerging concern/s, specific patterns and/or trends and provides additional scrutiny and assurance for senior managers and the CSWO. Moreover, good practice guidance in ASP risk assessment and risk management is explored in partnership with Senior Social Workers and Council Officers, where required, which contributes to continues improvement activity in ASP. During the year, a number of development activities have taken place to strengthen AP governance and quality assurance systems within Social Work Adult Services. For example, work is ongoing with the development of an AP governance data base that supports the logging and tracking of cases of concern and/or significant events and CSWO case escalation process. The system promotes a ‘reflective learning from practice’ approach and provides additional assurance that each event is analysed carefully to ensure that learning is taken forward with social work and multi-agency practitioners across localities. Another example is the development of the ASP Service Provider Group. This forum provides a platform for communication between senior social managers (e.g. within Headquarters and Localities) to discuss new and emerging risks within services, as they arise. This group also has a key focus upon Large Scale Investigations (LSI) within North Lanarkshire and other
Page 12
4 local authority areas, where North Lanarkshire residents may be within the service. Members from this group are involved with the development of updated AP Large Scale Investigation (LSI) policy and procedures; work is ongoing and will capture learning from practice as the Council carried out two AP LSI’s during this period (see LSI below). Finally, to improve information sharing where ASP Protection Orders are being implemented, the Senior Officer Adult Protection, NLC Legal Services and Police Scotland have a local information sharing process regarding ASP Protection Orders in North Lanarkshire. Colleagues from NLC Legal Services inform Police Scotland at the earliest opportunity where they obtain and implement an ASP Banning Order (with power of arrest). This provides timely and accurate information for Police Scotland to ensure those adults who are deemed at serious risk of harm are safeguarded and protected. The Post Graduate Certificate (University of Stirling) in ASP is presented each academic year at University of Stirling. For academic period 2020 – 2021, three experienced social workers were supported to complete the course; this was however delayed due to the pandemic with the social workers graduating in March 2021. For academic year 2021 – 2022, two experienced social workers have been supported to attend the course; both social workers will graduate in December 2022. This is very positive as it provides further evidence of the councils’ commitment to invest in employee development and to build upon staff resources that supports the continuous improvement of ASP practice. While ongoing development work in ASP performance and scrutiny; AP governance structures and employee learning and development will provide evidence of continuous improvement activity here in North Lanarkshire, the Council continues to undertake a range of AP quality assurance and self-evaluation activities in preparation of the forthcoming joint inspection (see Case file audit / review section below). National Position The Scottish Government, via the National Strategic Forum for Adult Support and Protection, published a detailed three year plan covering Assurance, Governance, Data and Information, Policy and Guidance, Practice Improvement and Prevention. This plan confirmed that all adult protection partnerships in Scotland would be jointly inspected over the next two/three-year period. The Care Inspectorate has updated its activity for the Adult Protection Joint Inspection Process, reflecting the ongoing impact of Covid 19 and the pandemic on both services and the community. The Inspection Partnership Briefing Document, which provides partners with the practicalities of inspection requirements, is being updated accordingly. The Scottish Government ASP Improvement Plan can be accessed by clicking here North Lanarkshire’s Inspection Readiness Multi agency group continues to prepare for inspection through a continuous improvement model. Improvements in a number of areas have been highlighted through self-evaluation. Members are encouraged to ensure that their service’s case files continued to be monitored and internally audited, and that their policies and procedures reflect the Adult Support and Protection agenda. There is currently a significant level of activity with regard to legislative and national policy proposals which directly affect Adult Support and Protection. There is a stated commitment
Page 13
5 from the Scottish Government Adult Protection Team to ensure connectivity across this activity. This specifically relates to ‘connectivity’ of the consultation responses/findings regarding the Scott Report , Feeley Report and three revised ASP Guidance documents to inform the progress in all of these areas. Summary of recent national activity is provided below: The responses and analysis for the National Adult Protection Code of Practice and for Guidance for Adult Protection Committees consultation were published in March 2022: o Brief summary report of the consultation analysis o The responses A report on the responses to the GP and Primary Care Guidance is already published and should be considered as part of this package of consultations. Adult support and protection - GP and primary care guidance: consultation analysis - gov.scot (www.gov.scot) The National Care Service ( NCS) Bill is due to be presented to Scottish Parliament in coming months. Within this Bill it is intended that amendments be made to the Adult Support and Protection Legislation. With the creation of an NCS, it is likely that, as part of the transfer of adult social services to the NCS, adult support and protection functions and duties in the Adult Support and Protection (Scotland) Act 2007 (the 2007 Act), which Councils and Council Officers hold, will transfer to the NCS and its officers. As part of the NCS Bill, a number of amendments are being considered to the Adult Support and Protection (Scotland) Act 2007. A limited consultation has taken place with regard to changes, with concerns expressed to ensure connectivity to the ongoing work discussed above and the need for robust consideration of the proposed changes. These amendments include: • Council Officers to be known as “Adult Support and Protection Officers” (ASP Officers), with a potential for some amendments to their role. • the duty in section 4 (Council’s duty to make inquiries) to be undertaken by ASP Officers. Currently the duty is on the Council, with Council Officers being required to undertake ASP Investigation. • The proposed changes also included a fundamental change to the legislation through a change of language and thus definition to the three-point criteria of who is an ‘adult at risk’. Given the high level of feedback to the Scottish Government on the challenge to adapt this criteria without wide and robust consultation, verbal updates from Scottish Government advisors indicate this proposal will not be progressed at this point. The latest Scottish Mental Health Legislative Review Consultation was published on 17th March, with the response due on 27th May 2022 https://consult.gov.scot/mental-health-law- secretariat/scottish-mental-health-law-review/ This is a complex Review across different legislation, with the focus for the Council being the references to Adults and Risk and the 2007 ASP (Scotland) Act. There is a continued
Page 14
6 concern that the Adult Protection Legislation does not fit well within this Review process and as yet Adult Protection has appeared largely absent in reports and consultations. The Senior Officer Adult Protection and ASP Co-ordinator have worked in partnership to consider and contribute to, wider national developments and how such developments are taken forward locally, in partnership with local partners. Local consultation, involving senior managers and Council Officers was undertaken to provide views upon the updated ASP Code of Practice and National Care Service; feedback from colleagues and partners contributed to a formal response by the council, to both national consultations. Detailed consultation work has also taken place to identify adult protection updates required for the Councils’ new IT case recording system for social work services; this work is ongoing at present. Case file audit / review The ongoing monitoring and review of adult protection operational activity remains a key feature for Social Work Services. A multi-agency inspection readiness group was formed with senior representatives across the public bodies and led by a Senior Social Work Manager. This group has met regularly to support the pre inspection agenda, as well as planning multi-agency case file reading and tidy up work across localities during April and May/June 2021; this activity will identify areas for policy and practice improvement and, will explore remote and virtual file reading methods to help prepare the partnership for future inspection activity. The Council continues to undertake a range of ASP quality assurance activities to support continuous improvement, including: • The production of AP weekly reports which provide ongoing monitoring and assurance via the review of general ASP referrals and for those specifically related to care home services in North Lanarkshire. • The production of quarterly performance management reports which review and analyse ASP activity. These reports are reviewed via the APC, and in partnership with other agencies and services. • Case review process: ASP governance data base that supports the logging and tracking of cases of concern and/or significant events. The system promotes a ‘learning from practice’ approach and provides additional assurance that each event is analysed carefully to ensure that learning is taken forward and disseminated to social work and multi-agency Local Profile During 2021/22 North Lanarkshire Social Work Services, as part of Health and Social Care North Lanarkshire, received 2434 ASP referrals, an increase of less than 1% compared to 2020/21 (from 2,426 to 2,434). This is the third consecutive year that an annual increase has been measured.
Page 15
7 Number of Referrals 800 700 600 500 400 300 200 100 0 Quarter 1 Quarter 2 Quarter 3 Quarter 4 General referrals Police Scotland continue to be one of the main referrers with 16% (381) of all ASP referrals received. Seven years ago Police Scotland replaced their local reporting system with a central “Concern HUB” which covers both North and South Lanarkshire areas. We initially saw a significant increase in the number of adult protection referrals; however, following a review of their screening processes there was a steady decrease however, now a significant decline, with Police referrals down 36% from the same time last year (from 598 to 381). Other 6% Referrals In Period by Referral Source - 2021/22 Social Work Self 0% Police 16% 15% Carer 15% Health 19% Fire Service 4% NLC-Housing 5% Care Home 19% Family/ Public 1% 574 576 649 575 611 600 592 683 2020/21 2021/22
Page 16
8 While there was a reduction in Police Scotland ASP referrals, the data reveals a significant increase in Police ‘Adult Concern’ Reports rising 13% in comparison to the same time last year (from 3552 to 4004). The data below provides a wider context on police ‘adult concern’ report data, over the last few years, as follows: 2017/18 – 3023 2018/19 – 3148 2019/20 – 3027 2020/21 – 3552 2021/22 – 4004 As above, police concern reports have increased by 981 reports (32%) since 2017/18 (from 3023 to 4004). This is the third year running when significant increases have occurred; this work continues to generate significant resource pressures. There were increases in the number of ASP referrals received from both Health (from 426 to 473; up 11%) and Social Work (from 324 to 371; up 15%). Such increases have resulted in Health and Social Work increasing their percentage share of referrals to 19% and 15% respectively. Housing Services measured a 10% decrease (from 139 to 125) while Fire & Rescue Services demonstrated a 9% decrease (from 93 to 85) in ASP referrals submitted compared to the same time last year. In general, despite the reduction in ASP referrals from Police Scotland, it’s very positive that referral rates are increasing - across the public bodies (and partner agencies) - as much work has been undertaken via training, learning and development and pre-inspection work to promote the importance of employee duties and responsibilities to raise concerns for adults at risk of harm. For this period, ASP referrals from Care Homes demonstrated a 9% increase (from 416 to 455); this means that 19% of total ASP referrals come from this source. Information from inquires and investigations processes suggest: • Those Adults that require Care Home provision are now more advanced with complex health conditions when moving into the service e.g. dementia; • Updated Care Inspectorate ASP procedure that ensures Inspectors seek (and log) information from service providers regarding progress and outcomes of ASP referrals; • Internal NLC Quality Assurance systems such as quarterly reporting via the HYVE system and Senior Officer / Collaborate monitoring/scrutiny visits to Care Homes providers; • Ongoing work from NL APC via events to raise awareness and priority of ASP within Care home settings, and; • Increased scrutiny of care home services during the pandemic. Monitoring and support in this area is provided by colleagues in Quality Assurance in
Page 17
9 addition to thorough ASP Multi agency training and, in line with the increased focus on Care Homes during the pandemic this area of activity has more recently also been monitored through weekly review of ASP referrals for care homes and multi-professional Care Home Oversight arrangements e.g. Care Home Assurance and Tactical group (CHAT). Lanarkshire’s Care Home Assurance Operational and Oversight Group promotes multi- agency working and provides oversight of activity in care homes. A strengthened structure provides better connection between operational services and strategic leadership, and has enabled closer working between partners, to identify concerns within care homes at an early stage. This development of enhanced scrutiny and assurance processes has supported informed decision making. A collaborative ‘supportive visit’ structure was introduced to support care home providers during the pandemic and reflects the established links between care homes, NLC Quality Assurance, social work localities and senior managers, the Care Inspectorate, and the District Nursing Care Home Liaison Team. For some care homes, the approach has involved monitoring and support from a locality social work department and the NHSL Care Home Assurance Team, to implement an improvement plan without implementing an ASP Large Scale Investigation. Localities In comparison to the same time last year, statistics show that two (2) localities measured increases in referral rates, as follows: • Airdrie up 26% (from 316 to 398), and • Bellshill up 10% (from 311 to 343). In comparison to the same time last year, statistics show that four localities measured decreases in referral rates, as follows: • Coatbridge down 10% (from 403 to 364), • Cumbernauld down 5% (from 298 to 329), • Motherwell down 8% (from 322 to 295), and; • Wishaw down 14% (from 464 to 397); Data reveals that Airdrie (398) and Wishaw (395) localities received the highest amount of ASP referrals for North Lanarkshire for 2021 - 22. ASP referrals progressed by SWES colleagues increased by 1% (from 256 to 258) between yearly periods.
Page 18
10 Referrals In Period by Agegroup and Sex 400 350 300 250 200 150 100 50 0 16-24 25-39 40-64 65-69 70-74 75-79 80-84 85+ Gender Consistent with last year, Social Work Services received more referrals for women than men for 2021/22 (e.g. women: 1299 – men: 1136). The data is consistent to last year and represents a 53% (women) - 47% (men) percentage split. Statistics show that both men and women are more likely to be referred for ASP, when above the 65-year age range. This finding remains congruent with last year’s data for both women and men. Referral by category Adults with mental health issues were represented in 35% (858) of the total ASP referrals received, being the main primary user group referred. Referrals for this group have decreased since the same time last year but remain high in overall percentage terms (from 939 to 858). This only reinforces the importance of key service developments such as Distress Brief Intervention (DBI) and social work investment in delivering ASP training for those organisations who deliver services at home to our most vulnerable service users. For the first time, physical harm and psychological / emotional harm are joint highest reason for referral with 35% each of total referrals received. This marks a significant shift from previous years when psychological / emotional harm was the highest; this could be attributed to the high numbers of ASP referrals received for Care homes that involve physical type incidents between residents. The 2018/19 ASP procedural review introduced the new harm term of self-neglect in an attempt to identify and separate those adults that may be at risk of harm due to not caring for themselves, from those at-risk adults who rely upon care from others. It has been recognised in research that self-neglect cases can be some of the most complex to manage for practitioners, as they are fraught with issues that cut across ethical, legal and practical considerations. Raising awareness of such issues, for multi-agency practitioners, has been a key focus within the Multi agency forums and within ASP multi agency training; a locality working group on self-neglect for practitioners, is currently being considered. For this period, there were 241 self-neglect cases which measures 10% of total ASP referrals 374334 231 127 77 75 99 99 69 102 117 151 103 133179 124 Males Females
Page 19
11 received. Referrals for self-neglect situations are third highest reason for all referrals and have increased by 4% since last year (from 232 to 241). Referrals for Financial harm (7%), Institutional harm (5%), Sexual harm (3%) and Material harm (1%) continue to have a focus in adult protection and have similar levels to the same time last year. Referral Outcomes There continues to be a high number of referrals that progress to no further action under adult protection legislation (1,644 or 68%). This may be for a number of reasons e.g. the adult may not meet the three point criteria under the 2007 Act and/or the adult may be better supported by another care agency. Despite many ASP referrals progressing to no further action under the legislation, there is still a legal requirement on the council to carry out initial inquiries. This places responsibility on the locality social work teams to respond to every referral received and undertake detailed work to ensure that the right decisions are made. This can often result in lengthy involvement from social work staff as the adults circumstances evolve and risks change. Some of those referrals may require ongoing work to take place over a longer period of time to ensure that the adult’s welfare, finances, rights and/or property is safeguarded, and they are supported to manage the risks they face. Referrals in Period by Primary Reason SEXUAL SELF NEGLECT 10% 3% SELF HARM 4% EMOTIONAL OR PSYCHOLOGICAL 35% PHYSICAL 35% FINANCIAL 7% MATERIA INSTITUTIONAL HARM L 1% 5%
Page 20
12 Referrals in Period Leading to Investigations by Primary Reason 127 75 69 76117 135 64 64 8 12 0 1 4 6 25 3 0 7 ASP Investigations There were 434 investigations carried out in 2021 -22 which marks a 17% increase from last year (from 370 to 434). Data reveals that 18% of the total number of ASP referrals received progressed onto a full investigation. This percentage conversion rate has increased by 3% since the same time last year (from 15% to 18%). 160 140 120 100 80 60 40 20 0 0 Similar to last year, 25% (108) of investigations progressed onto an initial case conference with Emotional / Psychological harm (135) being the highest reason for investigation, followed by Physical harm (117), Financial (69), Self-neglect (64), Institutional (25), Sexual (12), Self-harm (8) and Material harm (4) coming next. As the above table illustrates, in comparison to last year, investigations increased for Physical harm, Emotional / Psychological harm, Self-neglect and Institutional harm. The largest increase between yearly periods has been physical harm type investigations. Quarterly reports continue to highlight the increase for referrals in care homes which often include physical type incidents between residents. Increased awareness of self-neglect and the associated impacts for adults continues to take place in localities via practitioner learning and training; this supports an increase in our ability to identify self-neglect type situations and, collaborate with multi agency professionals to consider proportionate and safe interventions, in partnership with the adult. Case Conferences Case conferences often result following an investigation and are always chaired by Locality Social Work Managers (LSWM). Partner agencies are invited under their duty to co-operate and their contribution is vitally important in sharing accurate information in order to produce and implement effective multi agency risk assessments, protection plans and informed outcomes for those at risk of harm. There were 108 ASP initial case conferences and 52 ASP Review case conferences held for 2021 - 22. This measures a 32% increase in comparison to the same period last year (from 82 to 108). 11 2020-21 2021-22
Page 21
13 Referrals in Period Leading to Case Conference by Conference Decision (if known) 70 60 50 57 40 31 30 66 20 10 0 0 9 0 9 9 0 7 1 0 0 1 Ongoing CC Cont NFA Concerns NFA for ASP - Further Proceed under N/A Concerns further Not Passed for Investigation AWI investigation Substantiated Allocation As noted from the above table, the overwhelming majority (66) of case conferences reached a decision that concerns were ongoing; this means that a full or interim protection plan would be implemented in each case situation. Previously, end of year reports have highlighted that there continued to be a number of ASP cases upon the electronic recording system, at different stages in the ASP process, where no decision had been recorded. This year, the data shows that only three cases, one at each stage i.e. Inquiry, Investigation and Case Conferences processes, had no recorded decision. This is impressive and huge progress made; this positive development is testament to the ongoing pre-inspection preparations that include ASP case file auditing and tidy up work being undertaken by many colleagues within and across Social Work Adult Services (SWS Headquarters and Locality staff). Statutory Orders/Functions For the period 2021/22, North Lanarkshire Council, as part of Health and Social Care North Lanarkshire implemented thirteen (13) ASP Protection Orders, as follows: • 6 X Removal Orders, • 3 X Banning Orders with Power of Arrest and: • 4 X Temporary Banning Orders with Power of Arrest. In addition to ASP work, qualified social workers within community care teams continued to also hold statutory responsibilities under Adults with Incapacity legislation as follows: • Delegated Officer responsibility for 226 Guardianship Orders where the Council acts as Guardian Supervising Officer Responsibility for 760 private Guardianship Orders. 2020-21 2021-22
Page 22
14 Large Scale Investigations North Lanarkshire Council commissioned and carried out two ASP Large Scale Investigations (LSI) during this period. An ASP LSI undertaken in 2021 related to a community-based care at home service. It required a flexible and responsive approach from the Council and a particular focus on domestic environmental and safety risks, as the service being investigated provided care and support for individuals within their own homes. The most significant ASP LSI undertaken relates to a local care home; carried out from November 2021 to February 2022, at which point the care home closed. It required senior leaders from the Council, Health and Social Care Partnership (HSCP), NHSL, and Police Scotland Lanarkshire Division to establish significant resources to ensure the protection of the facility’s 70 residents from across Scotland. North Lanarkshire had one resident within this service. This was a complex LSI, given the number of HSCPs involved as each undertook reviews for those individuals they were responsible for placing. This work was intensive and complex and required strong leadership at all levels. It involved close co-operation with the Scottish Government, the Care Inspectorate, and COSLA. Plans are currently being put in place to ensure learning from this LSI is shared both locally and nationally; the first step in this has been ensuring the report has been considered by the Adult Protection Committee and the Learning Review Executive Group (formerly called the SCR Executive Group). As aforementioned, it has been recognised that the work associated in carrying out both LSI’s was significant and challenging for all professionals involved. Partners remained professional, focused and resilient throughout the investigation process to safeguard and protect adults, at all times. From both experiences, Social Work Services has recognised that carrying out ASP Large Scale Investigations will require flexibility in approach and investigative methodology and good partnership working to ensure a proportionate, targeted and joined up response. The learning from undertaking both investigations is currently being drafted into an updated AP Large Scale Investigation policy and procedure. Local Care homes and other contracted provider’s continue to have access to adult protection training and awareness sessions, which keeps them informed and supports good practice. NLC Quality Assurance Officers provide further support and scrutiny of adult protection issues. North Lanarkshire Guidance for the Protection of Adults within Registered and Contracted Services policy and procedures is currently under review. Additional Elements Supporting Adult Protection: Appropriate Adults Services Appropriate Adults (AA) facilitate communication between vulnerable individuals and the police (and other governmental organisations such as DWP) during investigation processes. People who are eligible for support will be over the age of 16 years who, as a result of a mental disorder, appear to the Police to be unable to understand sufficiently what is
Page 23
15 happening or communicate effectively. AA support can be provided for suspects, victims and witnesses. Statutory duties for Appropriate Adult services are set out via Sec 42 and, Sec 98 to 106 of the Criminal Justice (Scotland) Act 2016 and, Appropriate Adults: Guidance for Local Authorities (2020). These confirm that: • The Council has duties to provide AA services in their area and, to provide training for Appropriate Adults; • Police Scotland has a duty to identify whether an adult requires AA support and, to make a request to the Council, and; • The Care Inspectorate has the duty to assess the quality of AA Services. Appropriate Adult Services in North Lanarkshire are currently fully operated, funded and delivered through Social Work Services with 16 employees trained to perform AA roles during business hours and SWES (Social Work Emergency Services) staff providing support out of hours. In line with statutory guidance produced by Scottish Government, work is underway to develop a local Appropriate Adult Oversight Group. This multi-agency group will have responsibilities for policy and practice development in this area e.g. recruitment, training, confidentiality, health and safety and service complaints. As below, Appropriate Adult referrals decreased by 23% (from 92 to 71) from the same time last year. North Lanarkshire is similar to other local authority areas who have also experienced reductions in referral rates; this is being monitored by the national Oversight group, Scottish Appropriate Adult Network (SAAN) and Police Scotland. While there was a decrease, there were increases in the number of times AA’s are being asked to attend police stations (for the same offence) and are spending an increased amount of time supporting vulnerable adults whilst there. As Council employees perform the AA role in addition to professional social work roles, this continues to contribute to resource pressures. North Lanarkshire Appropriate Adult Service requests by Year and number 2017/18 2018/19 2019/20 2020/21 2021/22 158 108 114 92 71 During 2021-22, local and national developments have continued to take place to assist with the ongoing implementation of the national statutory framework e.g. review of local AA service duty system, development of Scottish Government AA Oversight Group, AA national training group, and the requirement to complete a service based questionnaire on North Lanarkshire AA Services, for the Care Inspectorate. The Council is currently working in partnership with the Care Inspectorate and other partners to design a self-evaluation model for ongoing quality assurance purposes for AA Services. Distress Brief Intervention (DBI) The Scottish Government announced that Health and Social Care North Lanarkshire were successful in their bid to host the Central Team for the Distress Brief Intervention (DBI) test programme as well as run one of the pilot sites. The test sites became live in the spring of 2017.
Page 24
16 Over the last four years, with Scottish Governments support, the vision, collaborative culture and programme infrastructure has enabled the programme to expand and include young people aged between 16 and 17 years. A Distress Brief Intervention is a time limited and supportive problem solving contact with an individual in distress. It is a two-level approach. DBI level 1 is provided by front line staff and involves a compassionate response, signposting and offer of referral to a DBI level 2 service. DBI level 2 is provided by commissioned and trained third sector service Life Link (North Lanarkshire) who will contact the person within 24-hours of referral and provide compassionate community-based problem solving support, wellness and distress management planning, supported connections and signposting for a period of up to 14 days. On the 14th April 2020, the First Minister announced the expansion and development of the Distress Brief Intervention (DBI) programme into a nationwide response for people presenting in distress to the Mental Health HUB at NHS24, during the Covid-19 pandemic period. The council remain one of the key pilot areas delivering the DBI service, with the second highest referral rates across the 5 pilot areas. Referrals are higher for females and age range is predominately 18-59, and, mostly come from hospital emergency departments. Data reveals that 78% of those referred, engaged in support with reported improvements in median distress levels and outcomes. Until this year DBI referrals were for 16 years and over however the service is now being piloted in some North Lanarkshire Council schools. North Lanarkshire Adult Protection Committee North Lanarkshire’s Adult Protection Committee (APC) partners continue to support our vision that adults who experience or are at risk of harm are safer as a result of the support, protection and services they receive. The APC has statutory duties to promote communication and co-operation within and between the public bodies, to be involved in the development of local adult protection policies, procedures and practice, and to provide adult protection learning and development opportunities for multi-agency employees. Independent APC Chairs have a statutory duty to submit a Biennial Report to the Scottish Government every two years, outlining activity and progress of implementing the 2007 Act in their area. This has been helpful in measuring local performance and how far adult protection has progressed over such a short period. The Biennial Report for 2018 -20 is available by clicking upon the icon below: North Lanarkshire Adult Protection Com
Page 25
17 The APC undertook a self-evaluation exercise in 2021-22, based on recommendations from the National Guidance for APCs. This included consideration of key Adult Protection Committee documentation, including terms of reference and induction materials; governance arrangements following changes in the corresponding arrangements of key partner agencies; and the capacity and resources of the Adult Protection Committee. Results from the self-evaluation exercise were positive and identified well-established arrangements in place across all aspects of partnership working by Committee and Sub- committee members but reflected that additional links to newly established governance routes would be beneficial. As the recently formed Care Home Assurance Team (CHAT), is a new body, it does not feature in national ASP codes of practice or guidance and therefore there is no guidance in terms of governance across these bodies. However the Adult Protection Committee self-evaluation recommended increased links in this area and the Lead Nurse for Care Home Liaison is now a member of the APC. Similarly, the Health and Care Partnership Support Care and Clinical Governance Committee, October 2021, agreed on the increased benefits from more explicitly ensuring links across all relevant groups. With the Adult Protection Co-ordinator, now a member of this Committee, this has strengthened governance links with NHS Lanarkshire. The self-evaluation identified the need for representation by acute services on the Adult Protection Committee. This has helped to raise awareness of adult support and protection within acute service of NHSL. Membership of the NHSL Strategic Public Protection Group have been extended to include Pan Lanarkshire Adult and Child Protection Leads, improving the cohesion, clarity of governance and communication routes between the Adult Protection Committee and its strategic partners. There are a number of thematic developments being progressed on a Pan Lanarkshire Basis via North Lanarkshire Adult Protection Committee. Given an increased national focus on Interagency referral Discussion (IRD) for adult protection nationally, a Pan Lanarkshire working group have agreed to a small IRD pilot to inform our position on the implementation of IRDs for ASP in both North and South Lanarkshire. This will take place in May/June 2022 The Pan Lanarkshire Financial Harm Group is now established with a Terms of Reference agreed. An initial focus for the group will be Section 10 information sharing for financial institutions. A Pan Lanarkshire Self Neglect Group has also been established, aiming to develop a multi- agency framework guidance; work is ongoing in this area. A programme of learning and development for the GP Locality Forums has been facilitated by the Adult Protection Committee. An overall session was delivered in December 2021, this
Page 26
18 was followed by a Pan Lanarkshire evening event as part of the GPs learning and development programme. This is being followed up by the Adult Protection Coordinator attending all of the Locality Clinical Forums and providing training to Trainee GPs. This work focuses on awareness raising of adult support and protection, understanding of ability to protect, reducing the stigma of adult support and protection, Section 10 of the Act (information sharing), and the national GP and Primary Care guidance. Advocacy providers are active members of the Adult Protection Committee Network, a sub- committee comprising community and third sector organisations, and are active partners in Adult Protection Committee work. Providers report they have positive relationships with social workers and discussions at the Network reflect a well-established referral process involving staff trained in adult support and protection and promote positive partnership working across all agencies. North Lanarkshire Public Protection Partners and the National Missing Persons Project have worked closely together to understand and respond to missing people concerns across all ages and services in North Lanarkshire. This culminated in the development of the North Lanarkshire Multi-agency Missing Persons protocol. This aims to mitigate the risk to the people who go missing, provide a consistent approach for the relevant agencies when a person is missing, and ensure that the collective response delivers on the achievement of the objectives contained within the National Framework. Police Scotland information on episodes of missing adults is now part of the APC quarterly data reporting. In addition to missing persons, the APC currently also has monitoring and oversight for Appropriate Adult Services, to ensure that these emerging agendas have clear governance within North Lanarkshire. APC Partners have worked to ensure that the workforce responds to adult protection in a way that is trauma informed. The APC signed up to the National ‘Trauma Informed Practice’ Pledge in 2021 and the Adult Protection Coordinator is a member of North Lanarkshire’s Trauma Steering Group. The Committee continues to work with partners across the public protection agenda to embed trauma informed approaches within our training, audit and policy development. Within this approach we are embedding approaches informed by Contextual Safeguarding to inform procedures and practices. We are committed to promoting a shared approach to language, working alongside our Child Protection Committee, the Senior Officer for Contextual safeguarding, and with the national Contextual Safeguarding Network to promote and enable transitional safeguarding approaches in North Lanarkshire. North Lanarkshire is the Scottish representative in a UK wide research programme led by the Contextual Safeguarding to consider systems and practice for older young people and adults.
Page 27
19 Improvements implemented over the last two years have focused on addressing known and emerging risks by developing policies to support practice, improving training and guidance for practitioners, creating effective and flexible digital systems in response to the pandemic which have enhanced the ability of partner agencies to safeguard adults in local communities. Case Reviews (now known as Learning Reviews) There was one notification from Social Work Services in regard to case reviews or significant incidents made to the APC, for the year 2021 - 2022. NLC-APC-ICR022, was a case of sexual violence carried out on one resident to another in an independent care home in North Lanarkshire. The initial case review found that the incident could not have been predicted, however, there was clear learning, largely based on how partners responded. An action plan for partners, from the review, was amalgamated into local public protection and single agency workforce development planning. The Adult Protection Committee completed one Significant Case Review over the year 2019 - 20. The Review for ‘Susan’ was endorsed by the Adult Protection Committee on 4th February 2020. The subsequent action plan following from the findings was progressed throughout period 2021/22. Key actions included refreshing our social work adult support and protection procedures and an increased focus on domestic abuse in adult support and protection training. For example, the role of senior social workers (SSW) has been strengthened throughout the ASP process. Assurance regarding the Duty ASP SSW remit has been strengthened to ensure that the SSW screen and allocate all ASP referrals and continues to sign off and provide oversight at each stage. Learning from both reviews has been embedded into training and action planning via the APC subgroup structures and process. This includes work regarding changing sexualised behaviour, chronologies, trauma informed practice and increasing links between domestic abuse and adult protection processes. Local Developments and Events: Public Protection Newsletter – PPN North Lanarkshire Public Protection Newsletter was updated last year and is now produced in an electronic format and is circulated monthly to 4,000 subscribers. As a well-established way of sharing information, it became a weekly briefing during lockdown measures. The Newsletter shares updates on national and local adult support and protection issues, including publications, guidance, consultations, and resources. It is also a way of reiterating links across public protection agendas. Regular positive feedback is received by practitioners, across agencies, as to the type and nature of information being shared. ASP Multi agency Forums The APC delivered the thirteenth series of the multi-agency fora in November/ December 2021. The programme was interrupted by the Pandemic in 2020 to 2021, and these sessions ran as online events given the restriction remaining on face-to-face sessions.
Page 28
20 The fora included a recognition of the significant impact of the Covid Pandemic on all services in the last two years and the specific challenges to protecting adults, The aims of the sessions are: 1. To bring together operational staff with a responsibility for adult protection across North Lanarkshire within their locality; 2. To share relevant information, learning and practice developments; 3. To provide opportunities for best practice to be disseminated across localities; 4. To provide opportunities for communication both within and across agencies; 5. To support links with staff across the Partnership and the Adult Protection Committee This year, the multi-agency fora had three main themes, as follows: Updates on National and North Lanarkshire This reflected the significant progress made in developing a national strategic approach to Adult Support and Protection and included an update on the progress of the National ASP Improvement Plan including the developing role of the National Strategic Forum: • IRISS have been commissioned to support the development of a National Data set and consistent framework to the Biennial Report • National Consultations with regard to the statutory Code of Practice, APC Guidance and GP and Primary Care Guidance • National work impacting on protecting adults such as the National Review of Mental Health Legislation, National Care Service Consultation • The National programme of Joint Inspection of Adult Protection Adult support and protection in a changed climate These activities reported in section one illustrate an increased profile for Adult Protection nationally. The session then went onto update on Local developments, with a specific focus on the impact of Covid. This included discussion on the additional focus on ASP during the pandemic, including increased governance, and national guidance Discussion included staff roles, how we support and assessing risk changed, risks from hidden Harm and Reduced support v Increased scrutiny Changes to the profile of risk was also discussed, specifically regarding self-neglect/ neglect Learning from Reviews The largest part of the session focused on sharing learning from reviews. this includes:
Page 29
21 • Local & National SCRs • ICRs & Reflective Learning Review • National review of SARs ( England and Wales) 2017 – 19 • Audit • National Inspection Reports Six key themes were explored, with opportunity for discussion and reflection . Each reflects specific learning for Review and a recognised focus for work in North Lanarkshire. All have/ are being taken forward through different public protection activity. Resources and learning were shared, with links made to changes in policy, procedure and training locally: • Role of decision maker and oversight • Chronology • Domestic Abuse • Ability to protect • Responding to changing and sexualised behaviour • Self-Neglect Practitioner discussion promoted a practice-based element to each subject. Evaluation Evaluation forms and feedback received indicate a positive transition from face to face to online facilitation, although face to face remains the chosen format. The forums took place during a time of an increase in Covid infection and restrictions, in addition some localities had specific capacity challenges. Although reduced attendance from some partners and varied attendance from some localities was anticipated, the decision to go ahead with the sessions reflects the need to work as closely to ‘business as usual’ as possible. Again, there is a commitment that face-to-face sessions are resumed as soon as feasible. Two of the six Forums did not take place due to specific capacity issues in those areas, but as the sessions were online some participants were able to attend other locality forums. 70 multi agency professionals participated across the four sessions. Public Awareness Raising Campaign Social Work Services have actively contributed to national awareness raising by liaising with colleagues via Social Work Scotland and committing to raise national and local awareness by holding an annual Adult Protection Day, held on 20th February 2018, 2019, 2020 and 2021. Key partners have a co-ordinated to post and share each other’s information to generate interest. Within North Lanarkshire the APC and their partners contributed to the local campaign by the following:
Page 30
22 • Press releases across North Lanarkshire; • Regular posts on Face book and Twitter across the partners; • Newsletters were shared across the voluntary and public agencies. ASP Learning and Development In line with continued national restrictions and the inability to deliver classroom-based learning, the AP Co-ordinator and members of the APC Learning and Development subgroup reviewed and updated all ASP Multi agency training materials to support remote learning/delivery approaches; training materials now also include trauma informed awareness and approaches for staff to reflect upon and consider. During the period, nine Level 1 courses (3 hours) and seventeen level 2 courses (4 hours) were delivered for multi-agency partners to maintain learning and development momentum in adult support and protection. This year, twenty-four (24) social work staff attended Level 2 training with most social workers progressing onto the full ASP Council Officer Training programme. ASP Council Officer Training (Day 2) and Investigative Interviewing Training (Day 3) materials were reviewed and updated by the Senior Officer, Adult Protection, to deliver via remote based learning due to the inability to provide face to face learning. Two separate deliveries of the training programmes were required during period March 2021 to May/June 2021 where 30 social workers completed the training in order to perform ASP Council Officer roles; please note, this training is a legal requirement for social workers who undertake investigative functions under the 2007 Act. The updated training materials now include Trauma Informed Practice as part of the wider training delivery. One ASP Council Officer Development session was delivered in February 2022 to four Social Workers. This session was held to capture those social workers recently appointed by the Council, and have previous experience of assessing and manging risk in other disciplines e.g. Child Protection and/or MAPPA. As aforementioned, for academic year 2021 – 2022, two experienced social workers have been supported to attend the Postgraduate Certificate in ASP course; both social workers will graduate in December 2022. Key Areas for Reflection • During the period 2021 - 22, Social Work Services received 2434 ASP referrals, an increase of less than 1% compared to 2020/21 (from 2,426 to 2,434). This is the third consecutive year that an annual increase has been measured. The Council additionally received 4,004 Police ‘Adult Concern’ Reports, an increase of 15% from last year (from 3,552 to 4004); therefore the total number of adult protection activities undertaken to keep adults safe across North Lanarkshire for 2021 - 22 was 6,437. • Police Scotland ASP referrals reduced by 36% however they still remain one of the main referring groups. While Police referrals reduced, there were significant increases in referrals being submitted by Health (from 426 to 473; up 11%)) and Social Work
Page 31
23 Services (from 324 to 371; up 15%). It’s very positive that referral rates are increasing - across the public bodies (and partner agencies) - as much work has been undertaken via training, learning and development to promote the importance of employee duties and responsibilities to identify and report concerns for adults at risk of harm. • For this reporting period, Social Work Services received more referrals for women than men for 2021/22 (e.g. women: 1299 – men: 1136); the data is consistent to last year and represents a 53% (women) - 47% (men) percentage split. Statistics show that both men and women are more likely to be referred for ASP, when above the 65-year age range. This finding remains congruent with last year’s data for both women and men. • For the first time, physical harm and psychological / emotional harm are joint highest reason for referral with 35% each of total referrals received. This marks a significant shift from previous years when psychological / emotional harm was the highest; this could be attributed to the high numbers of ASP referrals received for Care homes that involve physical type incidents between residents. • The 2018/19 ASP procedural review introduced the new harm term of self-neglect in an attempt to identify and separate those adults that may be at risk of harm due to not caring for themselves, from those at-risk adults who rely upon care from others. For this period, there were 241 self-neglect cases which measures 10% of total ASP referrals received. Referrals for self-neglect situations are third highest reason for all referrals and have increased by 4% since last year (from 232 to 241). • There were 434 investigations carried out in 2021 -22 which marks a 17% increase from last year (from 370 to 434). Data reveals that 18% of the total number of ASP referrals received progressed onto a full investigation. This percentage conversion rate has increased by 3% since the same time last year (from 15% to 18%). In comparison to last year, investigations increased for Physical harm, Emotional / Psychological harm, Self- neglect and Institutional harm. The largest increase between yearly periods has been physical harm type investigations. • For the period 2021/22, North Lanarkshire Council, as part of Health and Social Care North Lanarkshire implemented thirteen (13) ASP Protection Orders, broken down as follows: 6 X Removal Orders; 3 X Banning Orders with Power of Arrest and, 4 X Temporary Banning Orders with Power of Arrest. • North Lanarkshire Council commissioned and carried out two (2) ASP Large Scale Investigations (LSI) during this period. Social Work Services has recognised that carrying out ASP Large Scale Investigations will require flexibility in approach and investigative methodology and good partnership working to ensure a proportionate, targeted and joined up response. The learning from undertaking both investigations is currently being drafted into an updated AP Large Scale Investigation policy and procedure. • The Scottish Government, via the National Strategic Forum for Adult Support and Protection, published a detailed three year plan covering Assurance, Governance, Data and Information, Policy and Guidance, Practice Improvement and Prevention. This plan confirmed that all adult protection partnerships in Scotland would be jointly inspected
Page 32
24 over the next two/three-year period. The Care Inspectorate has updated its activity for the Adult Protection Joint Inspection Process, reflecting the ongoing impact of Covid 19 and the pandemic on both services and the community. The Council and partners, continue to meet and to undertake a range of AP quality assurance activities, including file audits and case file reading, in preparation of the forthcoming joint inspection. • North Lanarkshire Social Work Services continues to work in partnership with other agencies and the APC to ensure adults who may be at risk of harm are supported to keep themselves safe. Regular audits and reviews are undertaken with the results of this activity used to shape and influence policy, practice and employee learning to help retain a focused approach to adult protection and ensure staff and services are suitably trained to deliver positive outcomes for those who may be subject to harm. • Appropriate Adult referrals decreased by 23% (from 92 to 71) from the same time last year. North Lanarkshire is similar to other local authority areas who have also experienced reductions in referral rates; this is being monitored by the national Oversight group, Scottish Appropriate Adult Network (SAAN) and Police Scotland. Local and national developments continue to take place to implement the national statutory framework. Summary of Adult Protection Activity for 2021/22 Total Referrals 2435 Investigation 434 18% Ongoing Work 8 0.3% NFA - Other Service 342 14% NFA 1644 68% Not Recorded 7 0.3% Investigations 434 Initial Case Conference 108 25% Application to Court 0 0% Ongoing Work 4 1% NFA - Other Service 64 15% NFA 257 59% Not Recorded 1 0% Initial Case Conferences 108 Application to Court 0 0% Ongoing Concerns 66 61% Ongoing Work 0 0% NFA - Other Service/Legis. 10 9% NFA 31 29% Not Recorded 1 1% Cases Reviewed (at least once) 52 Ongoing AP Concerns 11 21% No Further AP Concerns 40 77% Review Conference Continued 1 2% Active At End Of Period 203
Page 33
25 Individual Agency Referral Summary (Main Referring Agencies) The following table shows referral data from the four main referring agencies, as recorded on the social work management information system (MIS), hence the total referrals shown is less than the actual total received in the year. This shows the number and proportion of referrals reaching different stages within the ASP process, and the numbers went on to receive service from other areas of social work. The differences between agencies cannot easily be explained, as they are due to a combination of factors, such as individual’s refusal to engage in the process, individual’s backgrounds and previous involvement with services, reasons for and circumstances of referral, the capacity of individuals at the time of referral, and other individual factors. A graphical summary of each agency’s referral data is shown in appendices 3 to 6, along with a table showing the number of referrals each agency recorded as making on their own MIS, if available. Differences between the two systems are due to the possibility that referrals can go through more than one source before reaching social work, so may be recorded against another source.
Page 34
Social Work Police Health Housing Fire Service Care Home No. % No. % No. % No. % No. % No. % Total Referrals 1890 Investigation 159 43% 33 9% 85 18% 21 17% 7 8% 21 5% Ongoing Work 1 0% 1 0% 0 0% 1 1% 0 0% 2 0% NFA - Other Service 36 10% 101 27% 83 18% 16 13% 17 20% 37 8% NFA 175 47% 245 64% 304 64% 85 68% 61 72% 394 87% N/A 0 0% 1 0% 1 0% 2 2% 0 0% 1 0% Total 371 100% 381 100% 437 100% 125 100% 85 100% 455 100% Investigations 326 Initial Case Conference 51 32% 7 21% 22 26% 3 14% 0 0% 4 19% Planning Meeting 1 1% 0 0% 0 0% 0 0% 0 0% 2 10% NFA – Ap proc in place 1 1% 0 0% 0 0% 0 0% 0 0% 1 5% NFA – Other services 25 16% 10 30% 17 20% 6 29% 2 29% 0 0% NFA 80 50% 16 48% 46 54% 12 57% 5 71% 14 67% App. Temp banning order 0% 0 0% 0 0% 0 0% 0 0% 0 0% N/A 1 1% 0 0% 0 0% 0 0% 0 0% 0 0% Total 159 100% 33 100% 85 100% 21 100% 7 100% 21 100% Initial Case Conferences 87 Ongoing Concerns 32 64% 5 71% 15 68% 3 100% 0 0% 2 50% CC cont further investigation 0 0% 0 0% 0% 0 0% 0 0% 0 0% NFA concerns not substantiated 14 28% 2 29% 5 23% 0 0% 0 0% 1 25% NFA for ASP – passed for allocation 3 6% 0 0% 2 9% 0 0% 0 0% 1 25% N/A 1 2% 0 0% 0% 0 0% 0 0% 0 0% Total 50 100% 7 100% 22 100% 3 100% 0 0% 4 100% 27
Page 35
1 Appendix 2 North Lanarkshire Adult Protection Committee Biennial Report 2020- 2022 Marian Martin Interim Independent Chair October 2022
Page 36
2 Contents Preface Introduction .…………………………………………………………………….. page 2 1. Covid 19 …………………………………………………………………………. page 5 2. Data Analysis of Harm ...............................................page 7 3. Outcomes, achievements and service improvements.......page 11 4. Training, Learning and Development ………………………………page 17 5. Engagement, involvement and communication .............page 22 6. Challenges and areas for improvement ........................page 24 7. Looking Forward …………………………………………………………………page 26 8. Appendix One : ASP Data 2020 / 2022………………………………page 27
Page 37
3 PREFACE This is the seventh Biennial Report of the North Lanarkshire Adult Protection Committee (APC) and covers the period April 2020 to March 2022.These have been exceptional years - covering the onset of the Covid- 19 (Covid) pandemic in the UK, several periods of lockdown and work towards service recovery and stabilisation. The word ‘unprecedented’ has become very familiar as we began to realise the far-reaching effects of the impact on communities, individuals and services during this period. We experienced and appreciated a continued commitment from partners during this time to meet both new and additional demand and emerging issues for public protection. The focus of this report reflects how the Committee has continued to discharge its key responsibilities, as outlined in legislation and guidance. We welcome the development of new Guidance by IRISS to support our preparation of this report and acknowledge the enhanced national strategic oversight and support for adult support and protection over the period of this report. There has been considerable national change in the period of this report, with the strengthening of the role of the national Adult Protection Oversight Group, the commissioning of IRISS to provide Adult Support and Protection support on a national basis, including the ongoing development of the national dataset for adult protection. These developments have helped guide the work of the Committee and our partners, with a focus on national and local priorities, as outlined in this Biennial Report. Our committee staff have remained in place during this period, providing consistency during a time of dynamic and changing risk and need. In common with other areas of Scotland we have a joint chair of our Adult and Child Protection Committees, with Marian Martin, being the Convenor for the APC since January 2019. Heather Irving has been the APC Coordinator since January 2020. Marian Martin, Heather Irving Independent Convenor Adult Protection Coordinator
Page 38
4 We have seen a number of changes to the Committee membership over the period of this report, however enthusiasm and commitment from new members and partner organisations remains high and a culture of collaboration and shared governance has been maintained. We have strengthened our induction processes for new members and consolidated governance arrangements with the APC, reflecting both developments linked to Covid and integrated services. North Lanarkshire’s APC partners continue to support our vision that adults who experience or are at risk of harm are safer as a result of the support, protection and services they receive. This is reinforced by our aim: ‘to drive forward professional and public awareness of harm affecting adults at risk; working in partnership with our members and the wider community to ensure that vulnerable and at risk people in and from North Lanarkshire are safe and protected from harm.’ This report reflects how Adult Support and Protection (ASP) activity has sustained, and adapted in this difficult period, with a commitment and dedication from partners to addressing change. This includes consideration of how risk and harm are identified, how services mitigate and address risk. The innovation and commitment of staff in such difficult circumstances has been outstanding and we are grateful to all individual staff for their work in continuing to safeguard and protect our most vulnerable members of the community. This report includes information of the impact of Covid restrictions in some areas of the Committee work and also how we have planned our recovery moving forward. Supporting information for this biennial report can be accessed on the North Lanarkshire Adult Protection Committee website at www.northlanarkshire.gov.uk/adultprotection/ Marian Martin Interim Independent Convenor North Lanarkshire Adult Protection Committee 2022
Page 39
5 Adult Protection Committee North Lanarkshire Covid-19 In North Lanarkshire, the impact of Covid has impacted Adult Support and Protection services and activity, in respect of both our strategic response and the increase of risk in the community. Close collaboration between key partners to identify changing trends and patterns of harm has been used to proactively disrupt this. With exception of the first few weeks of lockdown, throughout the pandemic North Lanarkshire consistently experienced high prevalence rates for Covid infection. The period under review covers a time when the impact of Covid created sustained challenges for all public services, including acute and community-based health and social work services. In response, the Council worked with partners to promote guidance to assist staff working on the front line to identify adult risk or harm and to report this in a timely manner. This work required collaboration with Police Scotland to identify changing trends and patterns of harm and the use of such information to proactively disrupt emerging issues. The response to adult support and protection referrals was maintained throughout the pandemic, with staff being supported to continue to meet their safeguarding and investigative responsibilities. The local authority area continues to have significant periods of high demand, as evident on continued pressures on NHSL services. Despite this, public protection has remained a priority, with services operating flexibly and remaining adaptable to ensure adults who may be at risk receive the best care and support. In the first phase of the 2020 Lockdown, our Chief Officers’ Group for Public Protection (COGPP) met on an weekly basis, combining with the South Lanarkshire Chief Officers Group on a rotational basis to reflect our shared NHS Board and Police Division. The focus of the meetings was to interrogate both local and SOLACE data and put in place effective responses to any emerging risks. The Adult Protection Committee (APC) also convened a weekly Adult Protection Operational Group drawn from the APC membership to receive assurance that services continued to prioritise Adults at Risk while considering the fast moving national and regional situation. These meetings addressed practical challenges, emerging risk and shared strategic decision making and the development of local guidance. The return to substantive COGPP and APC arrangements was gradual, with the ability to ‘stand up’ additional provision as required. The response to adult support and protection referrals was maintained throughout the
Page 40
6 pandemic, with staff being supported to continue to meet their safeguarding and investigative responsibilities while following guidance on social distancing and infection control. Statutory services continued to operate around the clock to meet public protection duties. Third sector partners were quick to respond to providing support during lockdown to the most vulnerable individuals in local communities. Some examples include welfare calls which reduced isolation for those living alone or shielding, as well as delivering medication, providing transport to medical appointments, and collecting shopping. We have also seen opportunities for improvement changes created by our experience of the pandemic. Significant developments within Monitoring and Assurance, Learning and Development and responding to emerging thematic risks are explored in different sections of this report. A shift to some services being delivered virtually, led quickly to additional guidance on identifying potential risk, given the different skills and knowledge this may require. North Lanarkshire circulated new guidance to staff with regard to Covid and Protection, with our Talent and Organisational Development section providing training and support for staff to develop new skills and confidence. Local Guidance was reinforced and revised to reflect national guidance once this was issued. Public protection has remained a priority, with services operating flexibly and remaining adaptable to ensure adults who may be at risk receive the best care and support. Gold, silver, and bronze command structures have provided strategic oversight, direction and response to rapid changes throughout the pandemic. North Lanarkshire Health and Social Care Partnership (NHSCP) Chief Officer held SLT meetings weekly to provide oversight of service delivery, challenges, and risks. All localities established daily huddles with all agencies participating including GPs, Social work and Health, to ensure robust communication was in place, including reporting and analysis of ongoing and emerging risks. Staff health & wellbeing strategies were recognised as critical and various strategies, for example wellbeing rooms in health centres were implemented to support staff. Communication to all staff was prioritised in our response. Additional National Adult Support and Protection Guidance for Chief Officers and Adult Protection Committees was communicated widely to staff through enhanced routes such as the Public Protection newsletter; as was the Public Protection Governance and Escalation Process Covid-19 Communication update. Written support tools, such as the ABC of Adult Support & Protection and Covid, and aids to be trauma informed and ASP aware when communicating on the phone, reiterated the commitment to prioritise public protection during the pandemic.
Page 41
7 Our Adult Protection Covid Recovery Matrix was developed in June 2020 and reviewed in 2021. However it became clear that the sustained pressures of the pandemic continued to impact the delivery of public services not least in the areas of staff capacity during the timeframe of the report What your data tells you Summary of Adult Support and Protection activity 2020-2022 In 2021/22 Social Work received 2,441 adult at risk (AAR) referrals, relatively unchanged from 2020/21 (2,442), meaning 4,883 AAR referrals were received over this reporting period of 2020/22. This is a 9% increase of 450 from the previous Biennial Reporting period. Figures for the last two years are the highest recorded in North Lanarkshire. Trends are being monitored and analysed to understand this increase There are positive signs that referrals across some partners have risen due to increased awareness of ASP, such as increased awareness across NHS Lanarkshire (NHSL) ; however, there are also concerns that the prolonged pandemic and cost of living concerns are impacting on risk. Types of Harm and Presentation The primary harm recorded in AAR referrals in 2020/22 identified a prevalence of emotional and psychological harm (252). Physical harm is then identified as the second highest category with 188 cases, financial harm with 141, and neglect with 120. Work is ongoing to ensure consistency across health and social care localities in this area. Our number of sexual harm referrals remains low; with sexual harm also sometimes identified through secondary or physical harm. Our work to promote practice in this area is discussed later in this report. Our Learning Review (022) identified learning needs regarding identifying and addressing increased risk of sexualised harm perpetrated by some adults as an impact of dementia or delirium. Additions to Multi agency ASP training now explicitly cover this area. Source of Adult at Risk Referrals We continue to see a wide range of ASP referral sources, reflecting awareness of adult protection across all partners. This information is monitored through our Monitoring, Reporting and Improvement APC Sub Committee, and reflects the ongoing investment of partners in both training and procedures. 956 referrals from Health and GP practices were submitted over this period, which narrowly exceeds Police Scotland AAR referrals (955) for the first time. Both agencies account for
Page 42
8 20% of all AAR referrals. This reflects an increased awareness and activity from NHSL partners with regard to clinical concerns. We have seen an increased focus on risk in care home settings. While we have seen a continued reduction in Police Scotland AAR referrals, we have seen increased activity in Adult Concern reports. Police ‘Adult Concern’ reports are deemed not to meet the adult protection threshold and are not subject to the same legislative requirements. Social workers have received a rising number of these concerns, with up to 1,000 now received quarterly. All concerns are considered by the social work team, with some ‘upgraded’ to adult at risk status when assessed . Partners are working closely to monitor and understand this increased activity, including a focus on thresholds and consistency. ASP referrals from care homes rose by 13% over the reporting period to 864, 18% of overall referrals. The scrutiny role of the social work quality assurance team has supported development across care homes. As indicated in Appendix One, we continue to see appropriate referral rates from partners such as Housing Services and Scottish Fire & Rescue (SF&R). We have seen a rise in referrals arising from these areas in relation to self-neglect, squalor and hoarding issues. SF&R have also are specifically active with regard to risks identified through their timely responses to home fire safety activity. A recent amalgamation of North and South Lanarkshire SF&R has led to current work to create a joint approach to ASP Pan Lanarkshire. Adult Protection activity 2020-22 As per the legislation and our procedures, all AAR referrals received by Adult Social Work services see an inquiry, as per our Social Work Procedures. 787 adult protection investigations were carried out in 2020-22, with 17% of the total number of ASP referrals received progressing to investigation. This is broadly consistent with the national average and North Lanarkshire’s historical practice. This provides us with some level of assurance that during the pandemic thresholds and assessment remained consistent. The profile of adults involved in adult protection investigations saw 204 (26%) identified as having a physical disability. This was followed by mental health (172 - 22%) and infirmity linked to old age (92 - 12%). Case Conference and Reviews There were 455 adult protection case conferences during 2020-22, which includes 269 initial case conferences and 186 review conferences. This is a 14% increase from the previous reporting period, with 37% of investigations leading to initial case conferences. We have
Page 43
9 also seen an increase in recorded review case conferences, specifically in 2021-22, which saw consistently high numbers and 136 Review conferences took place. Statutory Orders In 2020/22, the Council sought and implemented 20 protection orders: • 7 Removal Orders, • 9 Banning Orders, and • 4 temporary Banning Orders (all of which progressed to full Orders and all with a power of arrest). The 6 Removal orders in 2022 were linked to supporting the move of residents from one Care Home to interim or permanent placements at the point of the homes closure. Significant and Initial Case Reviews Two initial case reviews have taken place in this period. Both were deemed not to meet the criteria for a Significant case review (SCR) but led to recommendations for reflective learning reviews. Learning from these reviews has been embedded into training and process. This includes work regarding changing sexualised behaviour, trauma informed practice and increasing links between domestic abuse and adult protection processes. Improvement work following a previous SCR, led to updated North Lanarkshire ASP Operational Procedures strengthening the role of senior social workers (SSW) throughout the ASP process. Assurance regarding the Duty SSW remit has been strengthened to ensure that the SSW screen and allocate all ASP referrals and continues to sign off and provide oversight at each stage. Our SWES (Social Work Emergency Service) also receive and process referrals out of hours. An APC learning review in 2021 identified improvement work was required in terms of refreshing the service model. This is being progressed by adult social work services. An action plan following from the findings from an SCR completed in January 2020 has been progressed. Key actions included refreshing our social work adult support and protection procedures and an increased focus on domestic abuse in adult support and protection training. Large Scale Investigations Notification and updates of LSIs are standing items on both the Adult Protection Committee and Chief Officer Group Public Protection agendas. We have had three LSIs in North Lanarkshire in this period. An LSI undertaken in 2021 related to a community-based care at home service. It required a flexible and responsive approach from the Council and a particular focus on domestic environmental and safety risks, as the service being investigated provided care and support
Page 44
10 for individuals within their own homes. A robust improvement plan identified improvements moving forward. The most significant LSI in this time related to a Care Home and was carried out from November 2021 to February 2022,at which point the care home closed. This activity required Public Protection partners to establish significant resources to ensure the protection of the facility’s residents, who were placed in the facility from across Scotland. This work culminated in all residents moving to alternative placements, often closer to their original home, which better met their individual needs. This work was intensive and complex and required strong leadership at all levels. It involved close co-operation with the Scottish Government, the Care Inspectorate, COSLA and other national partners. The practical tools and documentation developed during this LSI, have helped to inform the approach established and processes undertaken to manage a third LSI, again for a specialist Care Home provider which has recently concluded. A new LSI procedure and tool kit has been drafted which uses the learning from these varied LSIs to produce a robust and flexible procedure moving forward.
Page 45
11 Outcomes, achievements, and service improvements The Adult Protection Committee undertook a self-evaluation exercise in 2021-22, based on recommendations from the National Guidance for APCs. This included consideration of key Adult Protection Committee documentation, including terms of reference and induction materials; governance arrangements following changes in the corresponding arrangements of key partner agencies; and the capacity and resources of the Adult Protection Committee. Results from the self-evaluation exercise were positive and identified well-established arrangements in place across all aspects of partnership working by Committee and Sub- committee members but reflected that additional links to newly established governance routes would be beneficial. As the recently formed Care Home Assurance Team (CHAT), is a new body, it does not feature in national ASP codes of practice or guidance and therefore there is no guidance in terms of governance across these bodies. However the Adult Protection Committee self-evaluation recommended increased links in this area and the Lead Nurse for Care Home Liaison is now a member of the APC. Similarly, the Health and Care Partnership Support Care and Clinical Governance Committee, October 2021, agreed on the increased benefits from more explicitly ensuring links across all relevant groups. With the Adult Protection Co-ordinator, now a member of this Committee, this has strengthened governance links with NHS Lanarkshire. The self-evaluation identified the need for representation by acute services on the Adult Protection Committee. This has helped to raise awareness of adult support and protection within acute service of NHSL. Membership of the NHSL Strategic Public Protection Group have been extended to include Pan Lanarkshire Adult and Child Protection Leads, improving the cohesion, clarity of governance and communication routes between the Adult Protection Committee and its strategic partners. The APC currently also has monitoring and oversight for adult missing persons and appropriate adults, to ensure that these emerging agendas have clear governance within North Lanarkshire. Improvements implemented over the last two years have focused on addressing known and emerging risks by developing policies to support practice, improving training and guidance for practitioners, creating effective and flexible digital systems in response to the pandemic which have enhanced the ability of partner agencies to safeguard adults in local communities.
Page 46
12 Covid Pandemic Given the challenge faced through the pandemic and lockdown, maintaining our adult protection processes to a high level has been a identified as a positive outcome. We have maintained timely responses to adult protection referrals and responded in person wherever possible. In addition, a suite of improvements and achievements have responded to known and emerging risks. The implementation of national public protection reporting during the pandemic helped to strengthen our internal monitoring systems. It led to the development of a weekly Chief Social Work Officer (CSWO) report to focus specifically on ASP activity in care homes. All AAR referrals received from care homes are now individually reviewed and reported in this way. This is further supported by a detailed monthly CSWO report on all adult protection activity in that period. Highlight reports are shared with CHAT, partnership governance groups, and the APC to support consistency. Trauma informed practice APC Partners have worked to ensure that the workforce responds to adult protection in a way that is trauma informed. The APC signed up to the National ‘Trauma Informed Practice’ Pledge in 2021 and the Adult Protection Coordinator is a member of North Lanarkshire’s Trauma Steering Group. The Committee continues to work with partners across the public protection agenda to embed trauma informed approaches within our training, audit and policy development. Within this approach we are embedding approaches informed by Contextual Safeguarding to inform procedures and practices. We are committed to promoting a shared approach to language, working alongside our Child Protection Committee, the Senior Officer for Contextual safeguarding, and with the national Contextual Safeguarding Network to promote and enable transitional safeguarding approaches in North Lanarkshire. North Lanarkshire is the Scottish representative in a UK wide research programme led by the Contextual Safeguarding to consider systems and practice for older young people and adults. Neglect Emerging concerns about self neglect and neglect in the community have been identified through various routes. Members of the APC Network, our community and voluntary sector APC subcommittee reported increased concerns about known and newly referred adults which indicated a rise in self neglect, potentially linked to increased isolation due to the pandemic. APC monitoring and reporting also identified that the risk of self-neglect escalated during the pandemic.
Page 47
13 As a result, a multi-agency Pan Lanarkshire Neglect group has been established. Guidance on Working with Neglect and Resistance was agreed by the APCs in August 2022 with a launch event planned for later in the year. This guidance aims to support practitioners and managers working across all agencies within Lanarkshire whose work includes concerns of neglect and/or managing resistance with adults and/or their carers This includes those adults and/or their carers who present as hostile when an adult is subject to adult protection concerns. A programme of training on working with self neglect, resistance and hoarding has also been well received, with around 400 multiagency staff trained to date. Financial harm The refreshed Pan Lanarkshire Multi-agency Financial Harm Group was reconvened in 2021. The group has refreshed our Pan Lanarkshire Financial Harm Guidance booklet and enhanced the reach of adult support and protection to partners working with at risk adults. Monitoring and Reporting improvements 2020-22 has seen various mechanisms enhanced and developed to ensure effective use of data in adult protection processes. These includes data submitted quarterly to the Adult Protection Committee by its partners. This submission to the APC Monitoring, Reporting, and Improvement Sub-committee provides an insight into current performance and supports our understanding? of the profile of ASP in our area. This approach also promotes consistency across partners in, for example, identifying thresholds for referral. Weekly statistical reports to the Chief Social Work Officer with regard to both the SOLACE dataset and local data on all care home and ASP activity include a review of each ASP received from care homes. This has significantly enhanced our understanding of emerging issues and work with care homes. Care Homes All Care Homes in North Lanarkshire are managed by independent providers. North Lanarkshire was an early adopter of a multi-disciplinary team approach to supporting Care Home and Care at Home providers at the outset of the pandemic. This has served to strengthen collaboration between agencies. It also ensured that guidance on adult support and protection was followed consistently across a broad range of services. We have a robust framework of scrutiny and support across the operational and strategic agenda of care home provision. Recently established scrutiny and support systems have enabled enhanced monitoring of duty to inquire processes. In 2021, the Health and Social Care Partnership developed systems to monitor real time trends and themes in adult protection activity. This weekly report to the Chief Social Work Officer includes trend data
Page 48
14 and a focus on key areas of adult support and protection, for example AAR referrals received from care homes. Adult support and protection referrals received from care homes are reviewed in addition to the section 4 inquiry process. Themes and outcomes are reported weekly, and a four weekly report is produced for the CSWO and the strategic meeting of the Pan Lanarkshire Care Home Assurance Team (CHAT). The CHAT is a group led by senior managers including the NHS, Social Work, and the Care Inspectorate, which provides high level scrutiny, monitoring and leadership to support a collaborative approach to support and scrutiny for all care home providers across North Lanarkshire and has oversight of the activity described below. Partnership working also promotes a preventative and early intervention approach to safeguarding, identifying emerging risks for services and adults, providing scope for focused improvement work, and increasing assurance across localities, which resulted in five focused quality improvement groups. The Council’s Quality Assurance team has implemented a quarterly reporting system for contractors that includes adult protection data. Quality Assurance officers are linked specifically to individual services and provide timely relationship-based support and advice, guiding services around risk and adult protection activity. Our Care Home Service Provider Group provides a platform for communication between senior social managers (e.g. within social work headquarters and localities) to discuss new and emerging risks within services, as they arise. This support intensified through the Covid period, with daily phone contact/ huddles, weekly meetings and ongoing support from quality assurance, and learning from this is being embedded in locality based. Lanarkshire’s Care Home Assurance Operational and Oversight Group promotes multi- agency working and provides oversight of activity in care homes. A strengthened structure provides better connection between operational services and strategic leadership, and has enabled closer working between partners, to identify concerns within care homes at an early stage. This development of enhanced scrutiny and assurance processes has supported informed decision making. A collaborative ‘supportive visit’ structure was introduced to support care home providers during the pandemic and reflects the established links between care homes, social work localities and senior managers, the Care Inspectorate, and the District Nursing Care Home Liaison Team. For some care homes, the approach has involved monitoring and support from a locality social work department and the NHSL Care Home Assurance Team, to implement an improvement plan without implementing an LSI.
Page 49
15 The social work recording tool was enhanced after a significant case review noted the need for professionals to carry out summative risk assessments to a higher standard. Developing a digital approach to adult protection In 2021, the implementation of an online referral in NHSL systems led to the introduction of electronic AP1 submissions from NHSL to the relevant locality duty social work team, with a copy automatically emailed to the NHSL Public Protection Team’s ASP email box. The NHSL ASP Advisor quality assures these referrals, considering the application of the three-point criteria and thematic analysis and may contact staff to offer advice and support if required. Risk, including ASP, is considered as part of Health based assessments, for example, all new patients admitted to District Nursing caseloads will have a comprehensive nursing assessment completed which includes assessment of all risks including any adult protection issues. MAPPA Multi Agency Public Protection Arrangements (MAPPA) and Adult Support and Protection (ASP) have existing operating protocols and information sharing protocols which will be enhanced by the development of this joint protocol. The aim of this protocol is to establish a framework for MAPPA and ASP to work together to enhance public protection and the reduction of reoffending and the risk of harm to adults, whilst recognising the principal differences between MAPPA and ASP. Missing persons North Lanarkshire Public Protection Partners and the National Missing Persons Project have worked closely together to understand and respond to missing people concerns across all ages and services in North Lanarkshire. This culminated in the development of the North Lanarkshire Multi-agency Missing Persons protocol. This aims to mitigate the risk to the people who go missing, provide a consistent approach for the relevant agencies when a person is missing, and ensure that the collective response delivers on the achievement of the objectives contained within the National Framework. Police Scotland information on episodes of missing adults is now part of the APC quarterly data reporting. Case auditing We have established virtual case auditing methodology, supported by a digital collation and analysis. There have been two substantive audits in this period. A multi-agency case file audit in 2021 identified that risk assessment and management should be more explicitly recorded through investigatory activity. Work is ongoing to ensure consistent recording across the six localities and ensure visibility of risk assessments.
Page 50
16 Internal audit indicates that while there are examples of comprehensive chronologies, there is a need to ensure that these are consistently in place and of good quality. As such, the development of risk management plans for vulnerable adults begins at the first point of contact-irrespective of whether this is with police officers, health and care staff, or other referrers. This approach is reinforced through our multi and single agency training which reinforces the importance of recording, defensible decision making, and professional curiosity. Advocacy The programme of procurement activity has continued over the period to ensure ongoing access to quality service provision is available across North Lanarkshire; this included renewed Advocacy contracts and the establishment of advocacy for carers. North Lanarkshire has strong and effective advocacy provision for adults involved in adult support and protection. Close and robust partnership work between social work and advocacy providers sees high levels of uptake and involvement with advocacy services. Audit identifies that advocates regularly attend case conferences with adults and work flexibly with adults to reflect their needs and choices. This has included support to adults whose services were subject to Large Scale Investigations. Thresholds In 2020, both Social Workers and police noted that reporting of police concerns was an area where improvements required to be made. A Police Scotland / APC audit identified that some police concern forms required to be upgraded to AAR by Social Work. Various learning needs were identified relating to police triage processes. These have been addressed through peer learning and further attendance at multi-agency training. Additional training for Community Police has been agreed and plans are being progressed to facilitate this across Lanarkshire in Q3 of 2022. Information systems A range of improvements have been progressed in terms of information systems and processes, for example: An update to the Adult Support and Protection Operational Procedures in 2019 strengthened the process to record information, analyse risk, and improve the use of the 3-point criteria in terms of social work case recording. This change has explicitly added the inclusion of relevant questions in the client information record. A new approach to recording options within SWIS (the Social Work Information System)was implemented, after it was identified by Social Work and NHSL staff that care records and patient records did not always accurately reflect both interventions and the outcomes achieved.
Page 51
17 Records management will be further enhanced through the introduction of a new information management system for social work. The tendering process for this has been completed and the contract will be implemented in 2023. Comprehensive scoping work ensured requirements for recording statutory adult support and protection processes and practice are reflected appropriately in the tender. Within NHSL, the Morse information management system has been rolled out. This allows information sharing across all health services more timeously and helps manage risk across multiple services. IRD In 2022 North Lanarkshire undertook the initial phase of a Pan Lanarkshire Adult Protection Interagency Referral Discussion pilot, supported by COGPP and relevant services. This ‘proof of concept activity saw IRDs facilitated as part of the inquiry stage across one locality. Early outcomes have been positive in terms of more timely and proportionate information sharing. A further pilot is being developed to provide wider evidence to fully progress this work which in the longer term aims to result in even more collaborative risk assessments. Chronologies A practitioner's survey (January 2022) on the use of chronologies was targeted at health and social work staff who work with adults at risk. This found a good understanding of the need for chronologies when risk is identified, although this was reduced for adults at a lower threshold. Adult Protection Committee audits indicate that some chronologies are of a good quality, but work is ongoing to ensure high quality chronologies are consistently in place across the Social Work Information System and other agency information systems. NHSL has made progress on this through the roll out of Morse and this has been actioned as part of the tender for the Council’s new information management system. A specific action on improving chronologies is identified in the Learning and Development Sub-committee improvement plan. This is an area that has been impacted by the pandemic and is a priority for the APC Learning and Development Officer when recruited. Training has been strengthened regarding consideration of ability to protect and there is now an increased focus on trauma informed approaches, analysis of unwillingness and working with resistance, and the adult’s ability to execute choice. This has supported the development of our new practitioner guidance on Working with Neglect and Resistance. Following a reflective learning review (022) in 2021, work has been undertaken to increase professional understanding of the relationship between adult support and protection and capacity. Lanarkshire Police Division issued fresh internal guidance on Section 47 certificates which includes progressing to criminal investigation and the need to ascertain the views of adults.
Page 52
18 The Adult Support and Protection Operational Policy includes specific guidance for staff who work in mental health and addiction recovery teams (ART). Risk assessments, which are completed and reviewed in partnership with adults who use mental health services, inform the adult’s care and risk management plans. Recent audit work has reinforced the need to ensure that information is shared and made available across agencies and systems. The addition of e-Care information in SWiS provides shared health and social work information within the one system. To improve information sharing where Protection Orders are being instigated, the Senior Officer Adult Protection, NLC Legal Services and Police Scotland have a local information sharing process regarding ASP Protection Orders in North Lanarkshire. Colleagues from NLC Legal Services inform Police Scotland at the earliest opportunity where they obtain and implement an ASP Banning Order (with power of arrest). This provides timely and accurate information for Police Scotland to ensure those adults who are deemed at serious risk of harm are safeguarded and protected. Training, learning and development The Learning and Development Sub-committee workplan details the breadth of single and multi-agency training provision and learning opportunities for the Adult Protection Committee partners in order to maintain and support skills and knowledge. In 2020, the APC Pandemic Recovery Plan recognised the impact of, and challenges arising from the pandemic. A priority was to ensure staff remained skilled and confident in an evolving environment. Multi and single agency adult protection training provision has been redesigned and developed as a virtual model. Despite the challenges, significant adult protection training activity was facilitated during 2020/21 with a total of 476 workers receiving core adult protection training. This increased to over 700 in 2021/22. ASP training and resources have been developed to reflect the different way in which people were accessing services and to ensure the issues which the lockdown exacerbated (such as hidden harm and carer needs) were able to be addressed. New workforce development models were also created, which included rewriting and designing training programmes. Initially this focused on developing training based on the telephone based and virtual activity necessitated by lockdown. Our Social Work and Council Officer training was redesigned into a blended model and within the Health and Social Care Partnership an online and facilitated training provision is available as part of the induction training process.
Page 53
19 Training provision has now moved to a mixture of online and blended learning with bespoke face to face sessions provided as required to specific organisations, for example the North Lanarkshire Deaf Club. The APC’s multi-agency training was adapted to reflect national and local learning, strengthening input on sexualised behaviour, domestic abuse, defensible decision making, and ability to protect. We evaluate all courses and consistently receive excellent evaluation from attendees of 88 to 100% rating. We adapt the course in direct response to comments, for example, in response to comments that the course was not long enough we increased the allocated time. We ask participants to identify how they will change their practice following training. The responses below reflect common comments: “I Encourage my team and I to explore case reviews more regular than just at annual development sessions” “Be more assertive in my judgement and more confident in highlighting my concerns and fo procedure” “I would not think twice about raising any fears with my Line Manager” “I won’t be judging people by their appearance and looking at the bigger picture”. The Adult Protection Committee Newsletter is circulated monthly to around 4,000 subscribers. As a well-established way of sharing information, it became a weekly briefing during lockdown in 20020 gradually returning to a monthly edition in 2022. The Newsletter shares updates on national and local adult support and protection issues, including publications, guidance, consultations, and resources. It is also a way of reiterating links across public protection agendas. Pan Lanarkshire Neglect and Hoarding training has proved to be of particular value. This reflects the significant profile of harm currently identified across Lanarkshire. Over 400 people have now attended this virtual training, with ongoing sessions remaining fully subscribed. The training is provided to reflect identified need in this area and is identified as helpful through evaluation. This also supports awareness of the Pan Lanarkshire ‘Working with neglect and managing resistance’ multi-agency guidance 2022. Our FGM and Forced Marriage training has been refreshed and is facilitated by the Violence Against Women and APC Co-ordinators. This popular course is facilitated four monthly to a capacity attendance. Forced marriage is also included in the multi-agency ASP training. Following learning from an ICR, we have embedded learning with regards to developing sexually inappropriate behaviour or challenging behaviour by adults. Multi-agency training
Page 54
20 has updated learning content in this area, and it now underlines the requirement for close working relationships between legal, mental health, and other key services. The APC’s well-subscribed multi-agency locality forums were re -established as virtual events during 2022. These share national and local learning at a locality level and give practitioners the opportunity to discuss adult support and protection practice. North and South APCs co-hosted our recent Care Home World Café, at which care home managers, deputy managers, clinical service managers and supporting agencies heard presentations from key agencies which explored their roles within Care Homes and adult protection. Presentations from The Care Inspectorate, Police Scotland, Care Home Liaison Nursing, MAPPA leads, and North Lanarkshire Social workers considered issues arising in care homes and explored statutory roles and responsibilities. The event saw Police Scotland referencing learning regarding capacity and ASP, where they shared their position regarding capacity, criminality, and the rights of individuals. This multi-agency discussion and learning model is crucial to our approach. Some service and agency specific training and awareness raising highlights have included: Each year, NLC supports qualified social workers to attend the Post Graduate Certificate at University of Stirling. In 2022, the council has supported two, and NHSL one, place. This annual commitment means that a significant number of social workers and senior practitioners can cascade expertise within their locality teams and are also part of a tutor pool to support multi-agency training. The newly qualified social worker training programme in NLC includes all areas of public protection, including level 2 Multi-agency ASP training and trauma informed practice. Compulsory adult support and protection training is also in place for all NHS Lanarkshire (NHSL) staff , for example, the adult support and protection Learn Pro module is available to all NHS staff, with 5,310 staff completing modules during 2021/22. Dissemination of the NHSL Public Protection Learning and Development Programme has been rolled out to community mental health team leaders to promote public protection awareness and training for all community mental health staff. The NHSL Care Home Liaison team carry out collaborative visits to care homes with social work colleagues and deliver specific training to staff as and when required. Adult support and protection training within the Scottish Fire and Rescue Service has been redeveloped in the last two years and community officers continue to participate in Adult
Page 55
21 Protection Committee multi-agency training. Community and voluntary sector involvement in multi-agency training continues to be widespread, with ongoing commitment from partners to ensure a wide range of practitioners are trained. Appropriate Adults North Lanarkshire’s Appropriate Adults service is well developed during both daytime and out of hours. A training programme is under development to recruit and support the training of additional staff to this role. Appropriate Adult services are fully operated, funded and delivered through Social Work with 30 employees trained to perform roles during business hours and Social Work Emergency Services staff providing support out of hours. Governance and reporting for Appropriate Adults are incorporated in the remit of the Adult Protection Committee and are a standing item on the Monitoring, Reporting, and Improvement Sub-committee. General Practitioners Training Programme: The APC has facilitated specific training across a number of partners in this period. A programme of learning and development for our GP Locality Forums was facilitated by the Adult Protection Coordinator. A session, delivered in December 2021 to the NHSL Lead Clinical Locality forum, identified the benefit to GPs of increased awareness of ASP. This was followed by a Pan Lanarkshire session as part of GPs’ learning and development programme. North Lanarkshire Adult Protection Co-Ordinator then attended the GP Locality Clinical Forums to provide bespoke sessions and also provided training to Trainee GPs. This comprehensive programme of work focused on awareness raising of adult support and protection legislation and practice, an understanding of the three point criteria, Section 10 of the Act, and the national GP and Primary Care guidance. Data relating to GP referrals is considered within our data collation. Adult Protection: Senior Officer, Learning and Development COGPP have jointly funded a temporary Learning and Development post for the Adult Protection Committee. Recruitment for this is underway, with the focus of this post being to support continuous improvement activity outlined in the APC Improvement Plan.
Page 56
22 Engagement, involvement, and communication Processes to ensure meaningful engagement with adults and their carers and family are embedded in the Adult Support and Protection Operational Procedures. We are committed to consistent access to and effective use of independent advocacy throughout adult support and protection activity. Strong links between advocacy and adult support and protection services have been demonstrated in a number of areas over this reporting period. In 2021, Independent advocacy services in North Lanarkshire went through a retendering process, and two providers successfully maintained their contracts. Current contracts for both advocacy and carers services focus on the protection of children and adults at risk. This stipulates those services must adhere to local procedures and work in accordance with inter-agency guidelines. Adult protection concerns are included in their quarterly contract management framework return, and all activity is discussed at quarterly meetings between the Advocacy provider and the Council’s Quality Assurance team. Advocacy providers are active members of the Adult Protection Committee Network, a sub- committee comprising of third sector organisations. Providers report they have positive relationships with social workers and discussions at the Network reflect a well-established referral process involving staff trained in adult support and protection, supporting positive partnership working across all agencies. In April 2022, the Network held the first face to face event in two years which focused on debunking myths and stereotypes in adult support and protection and making more effective use of legislative powers. This highly successful event saw people with lived experience, carers and practitioners come together to explore difficult but vital subjects. The event aimed to demystify and destigmatise adult support and protection. The event was evaluated as excellent, with specific praise for the positive tone and language used. As reflected in the Lanarkshire’s Carer Plan 2020-25,carers with responsibility for adults (where adult support and protection is a concern) are provided with a Carers’ Assessment and additional support. The Adult Protection Committee Network has active membership from all the main local carer organisations, as reflected in the statement prepared by these members in evidence for inspection. Large numbers of carer support staff attend our multi- agency training and work closely with other agencies to support adults and their carers.
Page 57
23 Lived Experience The APC is actively considering how we sustain and develop representation of the voice of those with lived experience within the APC itself. The Network partners already actively influence the direction of the committee. However, given the current national progress been made with regard, for example, to the Promise, the APC plans to review our current arrangements. Public Protection Communication and Information Sharing Subcommittee In 2020 the four pillars of public protection in North Lanarkshire agreed to merge their Communication and Information Governance Subcommittees, reflecting the joint agendas and shared membership. This meeting has an annually rotated Chair, shared across the Public Protection; the Adult Protection Coordinator performed this role in 2021-22, with the Domestic Abuse Coordinator now in post.
Page 58
24 Challenges and areas for improvement Involvement and representation of people with lived experience on the Adult Protection Committee is referenced above in this report. Work is ongoing with the Network to take this forward on a planned basis. Information Management Systems The Council’s information management system has been through a retender process, with the Senior Officer for Adult Protection an active member of the retender group. The successful provide, MOSAIC, will be working closely with the organisation to ensure that the new information management system will support required improvements in recording and information sharing across services and agencies. This will be used to support progress in other identified areas of improvement, including chronologies and risk assessment. Chronologies Work to improve our Chronologies is a priority for the APC, as reflected in our Improvement Plan. It is an identified priority for the Learning and Development Officer currently being recruited. Our audits demonstrate good progress in that most files now contain a chronology, and we see some chronologies being developed before a trigger thresholds of risk are met. The quality of chronologies is still variable. This work will be supported through the new information management system. Risk Assessment As part of the planned review and refresh of NLC Adult Protection Procedures, consideration will be given to improving our risk assessment tools. This will be supported through the implementation of the newly commissioned MOSAIC systems and reinforced through the implementation of the new national Code of Practice from Adult Support and Protection. The APC has a number of actions linked to strengthening our established learning and development programme. This will be supported by the appointment of an APC Learning and Development officer, and will include: Chronologies training Chronologies training, linked to wider development in this area, will be a priority in the next two years. We have made some progress in the use of chronologies, and this will focus on the consistency, language and content of these. Second Worker Training
Page 59
25 The APC Learning and Development Group has committed to developing and facilitating a programme of work for ASP second worker training and development. Police training Police and a wide range of partners continue to participate in APC multi-agency training. Pan Lanarkshire training for locality based operational police is planned for winter 2022, to be facilitated by the two APC Leads in conjunction with Police Scotland Risk and Concern Hub staff.
Page 60
26 Looking forward Looking forward, North Lanarkshire recognises the national and local challenges and opportunities over the next two years. We anticipate considerable activity linked to implementing and embedding national developments linked to recently refreshed Guidance. Adult protection procedures and policies will be adapted and refreshed to comply with the new Code of Practice, Learning Review Guidance and GP and Primary Care Guidance. The APC will also ensure compliance with the 2022 Guidance for Adult Protection Committees. We have an opportunity with the development of the National Data Set to develop data analysis systems within the new social work information management systems, to enhance our data set to meet both national and partnership best practice. Work on this is being progressed through the APC Monitoring and Reporting Group. We are aware of the continued impact of national challenges on our services, specifically the current cost of living challenges and the ongoing impact of the pandemic on our community and services. The NHS continue to address the impact on long waiting lists for medical treatment on a frail elderly population, thus presenting challenges of managing increased risk. The local authority capacity to offer support is being affected by inflation and budget provision. Planning to address this, in addition to responding to individuals being affected now, are already key priorities for the council. We are already seeing the individual impact of fuel and food poverty in the community and an increased prevalence of impact on people living with neglect and self-neglect has been referenced, along with our response to address this. North Lanarkshire was subject to a Joint Inspection of Adult Support and Protection in July - November 2022, which is shortly to be concluded. The improvement plan from this will be amalgamated to our APC’s current workplan, which is based on the activity and improvements noted in this report. These will then form the basis of the APC’s Improvement Plan moving into 2022-24. We began the report by reflecting on one over-used word and we conclude by using another ‘Permacrisis’. At the time of writing the Scottish and UK governments have both announced sobering statements in respect of public finances which will result in severe financial cuts to public services. Structural change is in prospect with the introduction of the National Care Service Bill. In continuing to protect the most vulnerable sections of society public services will require further resilience and resourcefulness in the future.
Page 61
27
Page 62
28 Appendix One Summary of Adult Support and Protection Activity 2020-2022 1. Summary Of North Lanarkshire Adult Protection activity 2020/22 2. Summary of North Lanarkshire Adult Protection referral activity 2020/22 955 referrals from Police Scotland 635 referrals for unpaid carers 174 Referrals from Scottish Fire and Rescue 320 referrals from other council dept.s 2022-22 4862 Adult Protection Referrals 956 referrals from Health professionals and GPs 41 Referrals from family and public 712 referrals from Social work self referrals 4863 Adult Protection referrals Police Adult Concerns 807 Adult protection Investigations North 75% Inquiry decisions within 5 working days Lanarkshire Adult Support and Protection 2020- 22 455 Care Conferences 0 SCRs 20 Protection Orders 3 Large Scale investigations
Page 63
29 4863 Inquiries 2. Summary breakdown of North Lanarkshire Adult Protection decisions 2020/22 455 Conference 787 Investigation