Appendix 1 - APC Biennial Report 2022-24
Perth and Kinross Council · 4 December 2024
Back to Perth and Kinross Council — 4 December 2024 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
Page 1
1 1 APC Biennial Report 2022 - 2024
Page 2
2 2 Contents Page No. 1. Introduction 4 1.1 Foreword from the Chair of Adult Protection Committee 4 1.2 Introduction to the report 6 1.3 ASP Summary 7 2. Local and National Context to Adult Support and Protection 8 2.1 Perth and Kinross population context 8 2.2 ASP Vision and Purpose 9 2.3 ASP National Context 9 3. Statutory Requirements 10 3.1 Summary of how we safeguard adults at risk of harm 10 3.2 ASP Governance and Leadership 11 4. Analysis of Harm – what our data tells us 13 4.1 Vulnerable Persons Reports and Adult Protection Concern 13 Referrals 4.2 The importance of responding early to any adult protection 15 concerns 4.3 Inter-agency referral discussions 16 4.4 ASP Inquiry and ASP Investigations 17 4.5 ASP investigation – who has been supported? 18 4.6 The use of multi-agency ASP case conferences to manage 19 complexity 4.7 Protection Orders 19 4.8 Large Scale Investigations (LSI) 20 4.9 Perth and Kinross is a national pathfinder for post LSI work 22 4.10 Wider Large Scale Investigation strategic governance 22 arrangements 4.11 In Summary 23 4.12 How the revised ASP Codes of practice will change our 23 ASP investigation language going forward. 5. ASP Activity and service Improvements between 2022 and 2024 24 5.1 ASP joint inspection 24 5.2 APC involved in national improvement work 26 5.3 Investment in the NHS Tayside Public Protection Team 26 5.4 Update form Police Scotland 27 5.5 Strengthening the multi-agency support to the care home sector 28 5.6 Using data to redesign of the Access Team 29 5.7 APC supporting those who experience gender-based violence 29 5.8 Re-establishing an increased focus on financial harm. 30 5.9 Improving our use of service user feedback 31 5.10 Improving the transition from Child Care Services into Adult 32 Care Services
Page 3
3 3 5.11 Reviewing and refreshing the ASP Learning and Development 33 Plan 5.12 How we support those who experience those who experience 33 self-neglect and hoarding 5.13 Our commitment to qualitative and quantitative audits to 34 inform our improvement work 5.14 APC as part a wider Public Protection approach to protecting 35 people 6. Training, Learning and Development 36 6.1 Overview 36 6.2 Council officer training programme 37 6.3 APC learning exchanges 37 6.4 APCs commitment to Trauma Informed Practice and a Trauma 38 Informed workforce 6.5 APC supporting ASP Matters 39 6.6 APC learning reviews throughout 2022/23 40 7. Engagement, Involvement and Communication 42 7.1 Communication and Public Awareness 43 7.2 National ASP day 44 7.3 The importance of sustaining close safeguarding relationships 45 with wider organisations 8. Looking forward 46 9. Summary 47 APPENDIX A – Commonly used Acronyms 48 APPENDIX B – Infographic summary (text) 48
Page 4
4 4 1. Introduction 1.1 Foreword by the Chair of the Adult Protection Committee I am pleased to present the Biennial Report of the Adult Support and Protection Committee (APC) in Perth and Kinross for the financial years 2022/24. The APC has a statutory responsibility to provide a biennial report for Scottish Ministers but, in addition, for many years the APC in Perth and Kinross has produced an annual report for the years which are not covered by a biennial Report. On 6 March 2024, Council approved the Annual APC Report covering the year 2022/23. The trend in the last few years has continued to be one of rising cause for concern reports for vulnerable adults and an increase in the number of referrals for consideration by statutory agencies Whilst the majority of concerns involve those over 65 years there has been a continued rise also in those facing mental health issues. Despite the rise in concerns being submitted, over 90% of these have been appropriately considered by Social Work Teams within the agreed timescales. The APC considers the rise in referrals a reflection of the work done to heighten awareness of vulnerable adults amongst professionals and the public and this is evident in health services where an investment by NHS Tayside in specialist adult protection staff and training for all staff has seen an increase in referrals coming from that agency. In the last year, the rate of increase has slowed down and as the APC further develops its data collection we are more able to interpret more quickly changes in patterns of referral and the reasons for that. Th APC has built up over the last few years a variety of self-evaluation and improvement activity including audit, data analysis and learning from cases, using Learning Reviews. However of particular importance over the reporting period has been the external inspection of Adult Support and Protection arrangements in Perth and Kinross by the Care Inspectorate (CI); His Majesty’s Inspectorate of Constabulary (HMIC) and Health Improvement Scotland (HIS) which was published in August 2022. This Inspection evaluated key processes to support and protect adults as effective and strategic leadership for adult support and protection as very effective and a very recent care inspectorate summary report of all 25 inspections placed Perth and Kinross within the top group nationally for strategic leadership and close to the top for key processes. This provides external assurance not only that arrangements in Perth and Kinross are of a high quality but also that there is a commitment to continue to develop this further through the APC Improvement Plan. In contrast, too, during the last two years the APC has increasingly benefited from more, concise, focused audit work by the
Page 5
5 5 lead officer which allows improvement actions to be reported and commenced quickly and effectively. Supporting vulnerable adults in Perth and Kinross is not the sole responsibility of the APC and over the last two years there has been a strong focus on strengthening public protection arrangements across Perth and Kinross under the leadership of the Chief Officer Group via the Public Protection Coordinating Group. There is clearly significant advantages in improving cooperation and collaboration across issues of common interest including transitions; training and development; violence against women and girls and substance misuse. Partnership working by the APC is not only evident in public protection but also in the work undertaken to strengthen pan Tayside work in adult support and protection and in the active participation and leadership in the national Adult Protection Improvement Programme. Adopting in Perth and Kinross the revised national Code of Practice in 2022/23 has given impetus locally not only to developing common definitions and procedures (for example AP Investigations) but also encourages a wider interpretation of vulnerable adults with complex needs using trauma informed practice in a public protection collaborative approach Whilst the improvement work of the APC has been effective in driving up standards over the years the APC recognises in this complex area of work ultimately it is the quality of the practitioners that ensure vulnerable adult, and their families get the help they need when they need it and for that reason, training and development and support and engagement of practitioners particularly by the lead officer has been a major priority and will continue to be so over the next two years For a number of years now, the APC has highlighted the importance of involving vulnerable adults and their families in the services and progress has been made in the advocacy support available to vulnerable adults in adult support and protection processes but these improvements work needs to continue to ensure meaningful engagement and genuine involvement of families in service development as well as service delivery In conclusion, it is my view there has been progress in a number of areas of adult support and protection work over the last 2 years in Perth and Kinross, but significant work remains to be done as workloads continue to rise and the complexity of cases that staff are involved become more challenging. Bill Atkinson, Independent Chair of the Perth and Kinross Adult Protection Committee
Page 6
6 6 1.2 Introduction to the APC Biennial Report for the reporting period 1 April 2022 to 31 March 2024. The Adult Support and Protection Act (Scotland) 2007 (hereby referred to as the ASP Act) aims to protect adults who are unable to safeguard their own interests and are at risk of harm because they are affected by disability, mental disorder, illness or physical or mental infirmity. The ASP Act places certain duties on councils and other organisations to investigate and, where necessary, act to reduce the harm or risk of harm. One of these duties is the provision of a biennial report. Section 46 of the ASP Act requires the Convenors of Adult Protection Committees (APC) to produce a biennial report analysing, reviewing, and commenting on APC functions and activities in the reporting two year period. This biennial report summarises the work of the APC from 1 April 2022 through to 31 March 2024. It reflects upon a continued cycle of self-evaluation and audit, highlighting strengths and identifies areas for improvement. This report also reflects the findings from our ASP joint inspection in June and July 2022. The APC has a strong commitment to self-evaluation, quality assurance and improvement work across the partnership in Perth and Kinross at all levels. The APC, Elected Members and members of the Integrated Joint Board (IJB) all receive regular reports on performance and the impact of multi-agency partnership working with vulnerable adults who need support and protection. As part of this assurance, the APC produces an annual performance report rather than relying on biennial reporting. Therefore, this Perth and Kinross APC biennial report for the period 2022 to 2024 reflects some of the content of the APC annual report for 2022/23. Our past APC annual and biennial reports are shared publicly at: Adult Support and Protection Committee - Perth and Kinross Council (pkc.gov.uk) The format of this report uses the Scottish Government’s template for APC biennial reporting covering 6 key areas: 1. Statutory Requirements 2. Analysis of Harm 3. Activity and Service Improvements 4. Training, Learning and Development 5. Engagement, Involvement and Communication 6. Looking Forward
Page 7
7 7 1.3 ASP Summary 2022-24 . 1 1 A textual version of this summary is provided in Appendix A for those who require assistive technology
Page 8
8 8 2. Local and national context to Adult Support and Protection 2.1 Perth and Kinross Population Context Perth and Kinross covers an area of 5,286 square kilometres and is the fifth largest area by land mass in Scotland. As of 2022, it had a population of 153,810[1]; which has grown 14.3% since 1998, compared to 7.9% for the whole of Scotland. The number of people resident in Perth and Kinross who are over 65 years old accounts for 24.1% of the population, compared to 19.6% for the whole of Scotland. The age group 75 and over has increased by 55.8% since 1998, whilst its younger age cohort (25-44 years) decreased by 6.3%.These population changes present considerable challenges in the delivery of sustainable and effective Health and Social Care Services. In Perth and Kinross, there are seven Local Action Partnerships: • Eastern Perthshire Action Partnership (Council Wards 1, 2 and 3) • Highland Action Partnership (Council Ward 4) • Strathtay Action Partnership (Council Ward 5) • Strathearn and Strathallan Action Partnership (Council Wards 6 and 7) • Kinross-shire Action Partnership (Council Ward 8) • Almond and Earn Action Partnership (Council Ward 9) • Perth City Action Partnership (Council Wards 10, 11 and 12) These localities each have a local action partnership made up of Elected Members, communities, and public services. Through the local action partnerships, the community planning partnership identifies their particular needs and challenges. As we move forward, our Public Protection arrangements (including adult support and protection) will align with the different locality action plans as well as the Perth and Kinross Community Plan 2022-2032. [1] Mid-2021 population estimates: https://www.nrscotland.gov.uk/files/statistics/council-area-data- sheets/perth-and-kinross-council-profile.html#population_estimates
Page 9
9 9 2.2 ASP Vision and Purpose It is our vision that people have the right to live as independently as possible in a safe environment, free from harm, to have their wishes and feelings considered and to have the minimal amount of intervention into their personal lives. Within this two year period, we have been actively promoting and testing the awareness of our ASP vision through public raising awareness campaigning, and through a cycle of self- evaluation and audit, the extent to which we can evidence that the ASP vision is now more evident in practice. 2.3 ASP National Context Adult Support and Protection in Perth and Kinross is connected to the National ASP Strategic Forum: https://www.gov.scot/groups/adult-support-and-protection-national-strategic-forum The National Forum provides a strategic and cross sectoral view of what is needed to improve the delivery of Adult Support and Protection across Scotland. The forum assists Scottish Government and delivery partners in identifying the workstreams required to improve the assurance and operation of Adult Support and Protection and its interface with existing and developing legislative and policy areas. The Scottish Government also supports the role of the National Adult Protection Coordinator. This role involves making connections to build stronger local networks and to improve the co-ordination, development, and dissemination of best practice, as well as promoting joint working between Adult Protection Committees. The National Improvement Plan has identified 6 main ASP areas: • Assurance and Inspection • Governance and Leadership • Data and outcomes • Policy • Practice Improvement • Prevention
Page 10
10 10 The Perth and Kinross Adult Protection Committee Improvement Plan for 2024/26 is aligned and driven by with these 6 key strategic areas. The Perth and Kinross APC also contributes to the national ASP agenda. The Perth and Kinross APC Independent Chair, the Associate Nurse Director for the NHS Tayside Public Protection team, the Detective Inspector, Tayside Division Risk and Concern Hub and the Perth and Kinross ASP coordinator are all engaged in several Tayside and National ASP strategic longstanding and short life working groups. The work stemming from these groups influences and informs the Perth and Kinross APC Improvement Plan. 3. Statutory Requirements 3.1 Summary of how we safeguard adults at risk of harm. The following is an overview of the pressures, developments, complexities, and challenges in delivering the range of statutory Adult Support and Protection (ASP) activity within this reporting two year period and the adult protection governance arrangements that oversees this work. Safeguarding adults at risk of harm is an organisational priority in Perth and Kinross. Only a qualified council officer is authorised to undertake certain functions of the Adult Support and Protection (Scot) Act 2007. A council officer is a qualified social worker who has completed both post graduate social work experience and undertaken the council officer training programme. Perth and Kinross has increased the number of available council officers from 40 full and part-time council officers in Jan 2021 to 61 full and part time council officers in Jan 2024. This demonstrates a commitment to fulfilling statutory responsibilities, our ability to recruit, retain, support and encourage social workers develop. It also demonstrates our commitment to understanding current and future workforce planning. The number of available council officers in Perth and Kinross is able to meet the current ASP demand to inquire and investigate where harm may exist, and that is evidenced later in our data and in our audit work.
Page 11
11 11 Our data also shows a consistently high number of adult protection concerns received throughout this two year period, and an increase in comparison to the reporting period 2020- 2022. Our data also demonstrates how our use of the ASP Act has changed in recent years and how this trend reflects an increase in complexity, a more multi-agency and coordinated approach to safeguarding as well as a better understanding how the ASP Act can and should be used to keep adults safe from harm. More about this will be discussed later in this report. Adult Support and Protection is a multi-agency approach to safeguarding harm, and throughout this report, reference will be made to how we have strengthened these partnerships. This includes our multi-agency response to supporting the care home sector and those vulnerable adults who are resident within them. 3.2 Adult Support and Protection leadership and governance A continued focus has also been given to the wider public protection agenda throughout 2022/24. There is collective leadership of public protection in Perth and Kinross, and this ensures that there is a focus on public protection, and it is prioritised. The Perth and Kinross Chief Officers’ Group (COG) meets quarterly and offers support, scrutiny and challenge to the APC alongside other public protection partnerships. The infographic highlights that the COG does not work in isolation but is directly connected to the work of the Public Protection Coordinators Group. The independent APC chair reports to the COG detailing the work of the APC and key issues and risks by exception. The dynamic public protection risk register is maintained and considered by the COG at each meeting. This allows the opportunity to understand changes in strategic and operational risk and a swift ability to commit resources where required.
Page 12
12 12 The APC continues to have wide representation from a diverse range of agencies which reflects the broader public protection agenda and the views of the public. In this last year, particular attention has been given to: - Ongoing commitment to a cycle of self-evaluation and audit and overseeing any improvement work - Better understanding of our response to Large-Scale Investigations - Supporting improvement work in relation to financial harm, hoarding and engaging adults and their unpaid carer throughout the ASP episode. To ensure governance and strategic scrutiny, the APC continues to report each year to the Integrated Joint Board (IJB). The APCs annual performance reports and the Scottish Government APC biennial reports, the adult protection contribution to the Perth and Kinross Council Annual Performance Report and Chief Social Work Officer report have all been presented to the IJB and the equivalent Boards in Police and NHS Tayside. Within these contributions, focus remained on progress relating to the various ASP activity and any subsequent ASP related improvement plans. The APC Annual report is shared with Elected Members and the IJB each year. A dedicated ASP/Public Protection Development session was delivered to IJB members in April 2022. Tayside ASP Lead Officers, Police Scotland, and NHS Tayside have continued to meet to coordinate work that provides consistency for regional partners and identifies common areas of ASP work. Work ongoing includes: • A short life multi-agency working group to scope out the delivery of a Tayside wide ‘Inter-agency Referral Discussion’ (IRD) process. • Initial development work to create Tayside guidance on medical examinations • A review and refresh of the Tayside Multi-Agency ASP guidance • Review of Tayside guidance relating to: o Chronologies o Professional Curiosity o Information sharing o Escalation
Page 13
13 13 o Our trauma informed approach to safeguarding including supporting those who experience hoarding In summary, despite the challenges faced by services and practitioners in this reporting two year period, we can evidence that: - Partnership working is stronger at both front-line practitioner and at governance levels. Consequently, we can evidence that our ASP work is more multi-agency in nature. - Services have managed an increase in complex ASP work. Our self-evaluation and audit work highlights that despite this, a high standard of work across all ASP has been sustained. This is supported by the findings from inspection in 2022. - We have continued to develop our multi-agency early intervention and prevention approach to safeguarding and extended this to the multi-agency support provided to the care home sector. - There has been an ongoing cycle of evaluation, quality assurance and improvement throughout this two-year reporting period. 4. Analysis of harm – what the data tells us The following gives an overview and some analysis of the ASP activity throughout 2022-24. 4.1 Vulnerable Person Reports and Adult Protection concern referrals A Vulnerable Person Report (VPR) is a report submitted to social work by Police Scotland where Police have come into contact with an adult and have concerns about the adult’s ability to safeguard himself/herself. An adult protection concern is the term given to any other adult protection (AP) concern submitted by anyone else, including health, family,
Page 14
14 14 unpaid carer, self, Scottish Fire and Rescue, Scottish Ambulance Service or another support agency etc. VPRs and AP concerns are screened in the same way. The information contained in the referral received is used alongside other information held to determine if the adult requires support, and if so, from whom and whether the ASP Act or any other adult legislation is required to safeguard. The data shows a 38% increase in the total number of adult protection referrals received in 2022/24 in comparison to the reporting period 2020/22. The Adult Protection Committee takes the view that where concerns exist, it is better to share these so that services can intervene and safeguard where required. VPRs continue to dominate the total numbers of all adult protection concerns received, and this is consistent with the data from previous years in Perth and Kinross. This is also consistent with national data. This is the first year that our data indicates that there is no year on year increase in the numbers of VPRs received. Many factors contribute to this and although a short life working group has been established to explore this in more depth, it is considered that from the reporting years 2020 through to 2024, society experienced covid, lockdown, isolation and a cost of living crisis. Although the cost of living crisis and long covid still has some relevance, this may not be at the level where it might require a crisis response. Therefore, one would expect to see a levelling of VPRs and AP concern as we move out of these challenging periods. Mental health also features in many of our VPRs received, on its own, or linked to other areas of concern including those who experience drug and/or alcohol addiction. Mental health services have (and continue) to be redesigned to reflect emerging themes and trends. The Access Team are the first point of contact for the majority of all VPRs and AP concerns. In 2023/24, the Access Team developed a specialised fast track triage system. Where an VPR/AP concern is received and it features mental ill-health and/or addiction, where appropriate and after screening for whether the ASP Act needs to be used, this can be directly and immediately shared with specialist mental health/drug and alcohol services who are better placed to respond to any concern and/or informal supporting need. The strength of this approach was highlighted in the APC VPR audit 2023/24: “In recent years, commitment has been given to service redesign, particularly the Access Team who provide that first point of contact for many adult concern referrals. This
Page 15
15 15 supports a wider HSCP commitment to the principles of supporting an early intervention and preventative approach to responding to harm and to the principles of the Getting It Right for Everyone (GIRFE) and getting the right support, from the right people at the right time. Whilst there is room for improvement, this audit demonstrates that the principles of GIRFE and early intervention and prevention are embedded into adult protection decision making and practice.” The numbers of AP concerns (752 in 2023/24) relate to adult protection concerns submitted by other non-Police services. This increase in AP concerns throughout 2022/24 can be attributed to a number of factors. It demonstrates the value of the NHS Tayside adult protection team where health services are supported and encouraged to recognise when an adult might be at risk of harm and to report it. This also reflects an increase in our public awareness raising campaigns throughout 2022/24. Raising public awareness of the ASP agenda remains a key APC priority. 4.2 The importance of responding early to any adult protection concern. Responding early to any VPR/AP concern received is crucial. The earlier that services can respond to harm, the earlier services are able to intervene. This table demonstrates that despite another year where high numbers of AP concerns and VPRs were received, an average of 98.3% of all of these concerns were screened by a social work team leader or assistant team leader within 24-hours of these being received.
Page 16
16 16 The ASP coordinator also audits the AP concerns and VPRs that are not screened within 24- hours (52 out of 3070). Whilst the majority of these that were not screened within 24-hours were screened within 48-hours, the audit found that no adult was left at any undue harm as a consequence of this delay. Some of the findings from this audit work has led to improvement work. 4.3 Inter-agency referral discussions Interagency Referral Discussions (IRD) were introduced into Perth and Kinross ASP practice in 2021/22. They provide an opportunity for a multi-agency approach to deciding how to safeguard an adult who is (or might be) at risk of harm. In August 2023, the Care Inspectorate published a summary of their key findings, key themes, and key messages from phase 1 of all inspections of 25 adult protection partnerships, and 25 published reports. As part of this summary report, it points to our use of IRDs as an example of best practice in responding to adults considered at risk of harm. The report states: “SOUND PRACTICE:… PERTH AND KINROSS PARTNERSHIP: IRD discussions held productively at the initial inquiry stage. Good participation by core partners social work health and police. They supported the right outcome for the adult at risk of harm.” The following table gives some overview into how IRDs have been used since their introduction into adult protection work in Perth and Kinross. One of the strengths to our use of IRDs is that these are routinely audited. The IRD audit in 2022/23 highlighted their importance in relation to multi-agency safeguarding. It also highlighted some learning, including, at times, their overuse. A cornerstone of the ASP Act is that an adult and their unpaid carer is given the opportunity to remain central to any ASP
Page 17
17 17 journey. IRDs are intended to simply facilitate the multi-agency sharing of information to determine how to safeguard an adult at risk of harm. The audit found that on occasion, IRDs unintentionally descended into a professionals only, wider multi-agency, multi-disciplinary team case conference to consider many aspects of the adult’s health and social work/social care. Consequently, the adult and his/her unpaid carer were excluded from being a part of this ASP episode. Therefore, a slowing of IRDs in 2023/24 was expected and in line with the findings from our audit. The multi-agency IRD audit group continues in 2024/25, this time with social work team leaders rather than lead officers. This itself also demonstrates an improvement. Our ASP joint inspection staff survey highlighted that practitioners did not always feel included in ASP audit work. Therefore, the opportunity to be a part of this ongoing audit work was shared with practitioners. 4.4 ASP inquiries and investigations We carry out an ASP inquiry where we need to inquire if harm exists. Where we know harm exists, we investigate what this is, who the harm is from and what needs to be done to mitigate the risk. Data shows that we see a 30% reduction in our use of an ASP inquiry in 2022/24 in comparison to the reporting period 2020/22. However, this change must be seen in the context in our use of IRDs in ASP work. Where we have used an ASP inquiry to inquire if risk exists, we now see that the information shared at an IRD is now obviating the need to inquire and go straight to ASP investigation. The data on our use of investigations supports this analysis, where ASP investigations in this last two year period has increased by 46%. ASP investigations are more detailed and tend to be used where risk and harm are more complex. An ASP investigation brings certain powers not afforded to those who undertake an ASP inquiry. Therefore, our shift to using an ASP investigation also suggests that we are getting better at understanding the extent to which the ASP Act can be used to safeguard. An example of 2019/2 0 2020/2 1 2021/2 2 2022/2 3 2023/2 4 Inquiry 142 180 212 166 114 Investigation 63 69 106 140 148 Total 205 249 318 306 262 0 50 100 150 200 250 300 350 Total Number of Inquiries and Investigations (YoY) Inquiry Investigation Total
Page 18
18 18 this is the growth in our use of medical examinations (section 9 of the ASP Act) to inform any assessment of risk. Furthermore, ASP investigations can be co-worked between council officer and another ASP trained practitioner (referred to as a second worker). In this two year reporting period, we also see an increase in health colleagues who are trained to be a second worker in ASP investigation work. Therefore, we can now demonstrate that our ASP investigations are now more likely to be a multi-agency, joined up and coordinated response to safeguarding. Although our use of ASP inquiries and investigations has changed in recent years, and this reflects how our practice is becoming more multiagency to manage increased complexity, our data shows that we have used the same amount of ASP inquires and investigations in 2022-24 (567) in comparison to 2022-24 (568). 4.5 ASP investigation – who has been supported? In this reporting two year period, an ASP investigation was more likely to be used to safeguard an adult from physical harm (35%) and for neglect (31%). Financial harm attributed to 15% of all ASP investigations in 2022-24, emotional harm (10%), sexual harm (5%) and domestic abuse (4%). Where an ASP investigation was used, it tended to be someone described as being frail (29%). 23% of ASP investigations were used with those who were described as having a diagnosis of dementia. 17% of all ASP investigations in 2022-24 were used with someone with a learning disability, old age (14%), mental health (13%) and 4 % of all investigations were used with someone described as experiencing addiction. This data is relatively comparable to how an ASP investigation was used in the reporting years 2020-22, albeit there is a noticeable growth in ASP investigations being used for those experiencing financial harm and those where mental ill health exists in the periods 2022-23 and again in 2023-24. This data has led to some improvements in these particular areas that will be discussed elsewhere in this report. Females accounted for 63% of all of the ASP investigations in 2020-2022. In this reporting two year period this changed to a 58% of all investigations were carried out on females and 42% for men. It is difficult to draw any conclusions from this data set only, although it does suggest that males are now more likely to be seen as an adult at risk of harm than they were in previous reporting periods. Our ASP work would broadly reflect the demographics of Perth and Kinross. As mentioned earlier in this biennial report, the population of Perth and Kinross is older when compared
Page 19
19 19 to Scotland overall. Therefore, one might expect to see the ASP Act being used more for the older adult. Although our current data reporting does not allow us to report on ASP data from each of the three Perth and Kinross localities, anecdotal ASP data does highlight the challenges faced by the HSCP in delivering quality and consistent health and social care services in some of the more rural localities. 4.6 The use of multi-agency ASP case conferences to manage complexity Where we see an increase in ASP investigations to manage complexity, we also see this complexity extending into how we use an ASP case conference to safeguard an adult who is at risk of harm. ASP case conferences are multi-agency in nature and co-ordinate complex protection plans. Year Type April May June July Aug Sept Oct Nov Dec Jan Feb Mar Total 2022 - 23 Initial 1 2 2 1 1 1 1 2 3 1 4 4 23 Review 3 4 5 2 4 2 2 2 1 2 1 3 31 2023 - 24 Initial 2 1 3 2 2 1 1 3 3 2 2 2 24 Review 3 4 6 7 7 6 6 12 7 11 7 8 84 An ASP initial case conference creates a multi-agency protection plan. ASP review case conferences monitor, review and update the protection plan over time. In this reporting year, whilst we see a similar rate of initial case conferences for 2023-24 in comparison to 2022-23, we see a 92% increase in our use of ASP review conferences. ASP review case conferences are often used for those adults who have more than one diagnosis and are at risk from different and often multiple categories of harm. This ASP review case conference data demonstrates how the ASP Act is being used to coordinate a prolonged multi-agency response to managing increased complexity. 4.7 Protection Orders In 2022/24, 5 protection orders were either granted or had been granted but remained active in this two year reporting period. - A banning order was granted to protect a father from a son where it was considered the son was exploiting his father emotionally and financially
Page 20
20 20 - A banning order was granted to protect a mother from emotional and physical harm from her son - A banning order was granted against a man who was a sexual risk to a vulnerable female member of his extended family. - A banning order was granted against a man considered to be a financial, physical and emotional risk to a vulnerable female (and to a number of vulnerable females) - A banning order was granted for a female who was seen as a risk of domestic abuse from her partner. Data shows our use of a banning order is more likely for safeguarding those adults with a dual diagnosis of learning disability and poor mental health, with some alcohol and/or drug use and who are in relationships with a partner who are considered to be a risk to her emotionally, financially, physically and/or sexually. This analysis also suggests that practitioners are growing more confident and competent about using a formal protection order to safeguard. Using the ASP Act to safeguard those at risk from domestic abuse has been a key priority area for the APC and the Violence against Women (and girls) agenda. The banning order granted in 2023/24 to safeguard an adult from an abusive partner is evidence of how this joint improvement work has brought about a clear impact and positive outcome for the adult. More about this joint ASP/VAW cross cutting work will be discussed later in this report. 4.8 Large Scale Investigations The ASP Act makes no reference to Large Scale Investigations (LSIs), but these have become increasingly prevalent across Scotland since the implementation of the Act. An LSI may be required where there is reason to believe that adults who are service users of a care home, supported accommodation, an NHS hospital or other facility, or who receive services in their own home, may be at risk of harm due to another service user, a member of staff, some failing or deficit in the management regime, or in the environment of the establishment or service. Adopting the principles of contextual safeguarding, an LSI may also be indicated by the need to address structures or systems that lead to possible harm for all those under such structures. In such circumstances, this means that there is a belief that a particular service may be placing some or all of its residents or service users at risk of harm.
Page 21
21 21 Although caution needs to be taken when comparing ASP data with other APC areas, data did point to Perth and Kinross being more likely to use an LSI to safeguard. In 2022/23, a thematic review of our use of LSIs was completed. This review highlighted a number of emerging and often recurring themes that led to an LSI being instigated, including staff shortages, medication being wrongly administered, lack of leadership and poor moving and handling practices. It also found that missed opportunities existed to deliver a truly multi-agency approach to LSIs. The findings from this review led to several improvements. The most crucial being that colleagues from the Care Home Operational Group and the Enhanced Care Home team remain central to determining whether an LSI is required to safeguard adults at risk of harm and to use their expertise to consider what support and from whom is required to mitigate any risk and improve standards of care. Understanding these themes has allowed the provision of a more targeted, early intervention and preventative support to the care home sector. Following our audit and implementing the improvements, our LSIs have reduced in numbers and in length of time between start and it being concluded: - From April 21 – March 22, we opened 11 LSIs with an average length of each LSI being 7.5 months. - From April 22 – March 23, we held 7 LSIs with an average length of 5 months - From April 23 – March 24, we held 6 LSIs with an average length of 3.5 months This demonstrates: 1. The benefits of the multi-agency Care Home Operational Group (CHOG) and Enhanced Care Home Team being central to the discussion whether an LSI is required in a care home. 2. Understanding emerging trends, pressures and sharing concerns early enough is providing a better, targeted opportunity to provide the right support from the right people to prevent the need for an LSI, again supporting an early intervention and prevention approach. 3. Delivering a more multi-agency approach to LSIs is contributing to the need for an LSI to be used less. The ASP coordinator and the NHST AP advisor are both members of the CHOG to ensure that this work remains joined up and coordinated.
Page 22
22 22 4.9 Perth and Kinross is a national pathfinder for post LSI work. The ASP Coordinator and the Independent Sector Lead for the Scottish Care Group are both members of the Scottish Government’s short life working group (SLWG) to develop national LSI guidance. As part of this work, Perth and Kinross developed a post LSI debrief report where the Independent Sector Lead for the Scottish Care Group meets the provider where the LSI was conducted. The report provides the opportunity for the provider to feedback how they found the LSI using 7 key principles: - Was the LSI person-centred? - Was it supportive? - How planned was the LSI? - Was the LSI multi-agency? - Is there any evidence to demonstrate the LSI was professionally curious? - Was the LSI lawful? - Was the LSI clearly communicated? The ASP Coordinator and the Independent Sector Lead for the Scottish Care then meet with the LSI core group to share the feedback. A redacted copy is shared with the CHOG and a multi-agency LSI improvement working group identifies any improvements stemming from the feedback and monitors the progress. The Scottish Government is using the post LSI debrief work in Perth and Kinross as a national ‘test of change.’ 4.10 Wider Large Scale Investigation strategic governance arrangements Data on LSIs and its analysis is collected monthly and presented to the HSCP Care and Professional Governance Forum and the NHS Tayside Public Protection Executive Group. These governance groups have oversight of the adult protection work in the care home sector and give scrutiny to emerging patterns of risk. For example, analysis of the data in relation to LSIs found that one ‘national’ care home group featured in several of the LSIs conducted within Perth and Kinross, and that the areas of concern raised as part of the LSI from within this group were similar in nature. This allowed the opportunity for senior managers across the HSCP and other scrutiny groups to seek robust and sustained improvements at a strategic level from that particular care home group. This also
Page 23
23 23 demonstrates a clear connection between practice and strategic leadership and illustrates close working relationships with the Care Inspectorate. 4.11 In summary, this data tells us that: - There is a continued high number of adult protection concerns received throughout this two-year reporting period across all client categories. - 98.3% of all adult protection concerns received within this reporting period have been screened within 24-hours. High priority is given to all adult concern referrals in line with local guidance. Our audit work into the screening and triaging of adult concern referrals continues to give some scrutiny and assurance to the APC that front line services respond to harm and to risk appropriately and proportionately. This key performance indicator is scrutinised by the HSCP Integrated Management Team. - There is an increase in adult protection concerns being submitted by colleagues from health, giving some suggestion that the work of the NHS Tayside adult and public protection team is successfully supporting colleagues in all health sectors to recognise and report harm. - Our audits tell us that adults at risk received appropriate and proportionate multiagency support, both statutory and informal. - We are able to demonstrate that our ASP work is more joined up, multidisciplinary and coordinated as a consequence of our improvement work. This extends to how we approach our Large Scale Investigations. - Our increased use of an ASP investigation and our ASP case conferencing is evidence of our multi-agency approach to safeguarding, particularly where complexity exists. 4.12 How the revised ASP Codes of practice will change our ASP investigation language going forward. In 2022/23, the Scottish Government revised the ASP Codes of Practice. One of the changes that it made was to review the ASP inquiry and the ASP investigation. To better support a clear delineation between the two, the Scottish Government redefined the ASP investigation as an ASP inquiry (using investigatory powers). Whilst this does not have any significant impact on how we deliver ASP here in Perth and Kinross, as we transition across to a new social work and social care recording system in the summer of 2024 (MOSAIC), we have used this opportunity to update our ASP language to align our ASP practice with the changes to the ASP codes of practice. Therefore, for the purpose of clarity and comparison, this biennial
Page 24
24 24 report continues to use the existing ASP language, and in particular, ASP investigations. However, future reports will refer to ASP inquiries using investigatory powers. 5. ASP activity and Service Improvements within this reporting two year period 5.1 Adult Support and Protection inspection The Care Inspectorate, His Majesty’s Inspectorate of Constabulary, and Healthcare Improvement Scotland carried out a formal inspection of our multi-agency adult support and protection services during June and July 2022. This was part of the Scottish Government’s improvement programme for adult support and protection. The final report of the joint inspection for Perth and Kinross was published on Tuesday 23 August 2022. https://www.careinspectorate.com/images/documents/6794/Perth%20and%20Kinross%20a dult%20support%20and%20protection%20report.pdf The inspection findings are positive and shows strong multi-agency arrangements in Perth and Kinross, keeping adults who are at risk of harm safe and protected. Alongside this, our key strengths are leading to positive outcomes for vulnerable adults in Perth and Kinross. The joint inspection report includes a statement about the partnership’s progress in relation to two key questions: 1. How good were our key processes for adult support and protection? The inspectors concluded that our key processes for adult support and protection were effective. There were clear strengths supporting positive experiences and outcomes for adults at risk of harm, which as a whole outweighed the areas for improvement. 2. How good was our strategic leadership for adult support and protection? The inspectors considered that our strategic leadership for adult support and protection was very effective and demonstrated major strengths, supporting positive experiences and outcomes for adults at risk of harm. The inspection was based on scrutiny of five key areas: - Analysis of supporting documentary evidence and a position statement that we submitted. - Staff survey of 346 staff from across the partnership responded to our adult support and protection staff survey. - Review of social work records of 40 adults at risk of harm who did not progress beyond adult support and protection inquiry stage.
Page 25
25 25 - Scrutiny of health, police, and social work records of 50 adults at risk of harm, where their adult protection journey progressed to at least the investigation stage. - Staff focus groups: two focus groups were held with frontline practitioners and strategic leadership where the inspectors met with 24 members of staff from across services. Summary of findings from the ASP Inspection Strengths • We have strong self-evaluation and quality assurance processes. • We are providing opportunities for collaboration and information sharing between partners (screening and triage arrangements and IRDs were particularly highlighted). • IRDs had improved the quality of inquiries and outcomes for people • Perth and Kinross Council had put in place an electronic case management system to enhance current methods of recording social work and social care information. • We have very effective leadership and oversight of adult support and protection arrangements. We are promoting community engagement to take forward our vision and improvement plan. • The Care Home Operational Group has supported large scale investigations and provided guidance and support to staff in care homes. Key areas for improvement. • We need to improve independent support through advocacy and the direct involvement of adults in need of protection in key processes including case conferences • We need to be more consistent in considering the need for medical examinations • We need to improve our recording of assessments of risk, and actions to support people at risk of financial harm. Since inspection, improvements have been made in each of these areas. As will be discussed later in this report: - Our use of advocacy has improved significantly. - The ASP coordinator has developed draft Tayside medical examination guidance with colleagues from NHS Tayside. Training on medical examinations is delivered as part of the APC learning and development plan.
Page 26
26 26 - The new ASP MOSAIC2 assessment and protection plan also gives more focus to the need to consider medical examinations and the importance in the role of advocacy for the adult and his/her unpaid carer. - ASP defendable and defensible recording training has been developed and delivered twice each year. This highlights the importance of recording a clear rationale for decisions made and the discussions that led to the decisions. - The ASP coordinator has re-established a dedicated multi-agency financial harm and SCAMs prevention sub group 5.2 The APC involved in national ASP improvement work Throughout 2022-24, various members of the APC have been actively involved in different national ASP and ASP related workstreams including: - National ASP learning and development workstream - Better use of chronologies in ASP work to inform risk assessments - Self-evaluation - Service user engagement and involvement - Developing national guidance to support transition between children’s services and adult services. - Developing a national ASP data set The Perth and Kinross ASP independent chair and lead officers also remain actively involved in the national ASP independent chair and lead officer group. The NHST Public Protection Associate Nurse Director is also chair of the National Scottish Health Leadership Group for Adult Protection and is a member of the National ASP Strategic Forum. 5.3 Investment in the NHS Tayside Public Protection Team Throughout this reporting two year period, NHS Tayside has continued to strengthen its commitment to safeguarding people with a move to a Public Protection approach, bringing together the child and adult protection advisory teams under shared management and developing a shared vision. For example, the appointment of a Public Protection Learning and Development Co-ordinator evidences the commitment NHS Tayside has made to ensure 2 The Council has invested £2.7M in procuring a bespoke replacement for the current SWIFT system. The CSWO has chaired the SWIFT Replacement Programme BOARD and successfully procured a new case management system called MOSAIC. ASP requirements have been built into the specification of this new system and work is underway to implement the new system in the Autum of 2024.
Page 27
27 27 all staff are appropriately trained and supported to understand their role in recognising harm and responding appropriately in context of legislative requirements. The impact of this work can be seen in the increase in numbers of ASP referrals received from the health sector as well as health being an active and proactive partner in ASP work in Perth and Kinross from IRDs through to supporting complex protection planning. The leadership of the NHS Tayside Associate Nurse Director in Public Protection provides clear and explicit recognition of the importance of this agenda, which must be at the roots of all of health clinical pathways. Further growth in the team enables improved engagement in key processes in protecting adults and/or facilitates clinical colleagues to be supported to engage in these. The increase in number of calls to the NHS Tayside Adult Protection Advice Line evidences the growing knowledge and awareness of adult protection amongst clinical teams. The NHS Tayside Adult Protection Team now take pre-registration nurses on placement, further evidencing the commitment of NHS Tayside to embed safeguarding knowledge and skills from the earliest point. 5.4 Update from Police Scotland Lee Stewart, Detective Inspector, Tayside Division Risk and Concern Hub, Police Scotland writes: “Police Scotland is committed to working in partnership with statutory agencies and other organisations to prevent and tackle harm and abuse. We have dedicated Adult Support and Protection Officers who work together locally with partners in Perth and Kinross to identify concerns and coordinate activity to ensure those at risk can receive the help and support they need to live safely. This can come in a variety of way from sharing information, participating in statutory multi-agency meetings and Large-Scale Investigations to attending bespoke professionals’ meetings. To support our own response to adults at risk of harm, bespoke Tier 2 Adult Support and Protection training course was launched in November 2023. This course is intended to provide specialist training to officers within division dealing with complex Adult Support and Protection investigations. Furthermore, we have introduced mandatory training for all officers up to the rank of Inspector on Protecting Adults at Risk of Harm.
Page 28
28 28 During the reporting period there has also been a significant amount of partnership working to help mitigate the risk posed to and safeguard adults living with EUPD (Emotionally Unstable Personality Disorder) and other complex issues. Police in Perth and Kinross continue to support the Non-Fatal Overdose group which has the overarching principle of providing a compassionate effective response to vulnerable people in distress, improving the likelihood of continued engagement with services and reducing the risk levels attached to taking illicit drugs and repeat overdose incidents. During the reporting period a multi-agency audit of Adult IRDs was undertaken. The audit identified good practice and areas for improvement with the aim of delivering better outcomes for those in our communities subject to ASP processes.” 5.5 Strengthening the multi-agency support to the care home sector Care Home Operational Group (CHOG) The Care Home Operational Group meets weekly and brings a collaborative approach to supporting care homes and the adult’s resident within them. The multi-agency team is comprised of different health disciplines and specialisms, social work, HSCP policy and commissioning, third sector representation and input from the care inspectorate. All have a joined-up focus on supporting the care home sector and report on any protection issues that arise. This team brings a particular adult protection focus ensuring that adult protection remains central and pivotal to the support to care homes. The council officer and NHS Tayside adult protection advisor aligned to Care Home Operational Group lead on adult protection work ensuring continuity and expertise within the care home sector. In this reporting year, we can begin to see evidence in how this partnership working is more able to provide the care home sector with better informed and targeted support. It is this
Page 29
29 29 approach to providing the care homes with a consistent multi-agency support that is obviating the need to use a formal LSI to safeguard and mitigate harm. 5.6 Using data to redesign of the Access Team The Access Team is the first point of contact for most adult protection concerns. It is based upon a multi-agency early intervention and prevention model of support and service delivery. The VPR audit titled “No Protection Without Support” in 2022/23 and a follow up VPR audit in 2023/24 sets out areas of strength and areas for improvement in triaging adult protection concerns. Both audits measured our screening of adult protection concerns against the ‘Care Inspectorate Quality Indicator Framework’ and found that overall, we have a valid and well-understood system for prompt, accurate screening of all adult protection concerns intimated to our partnership. The three-point criteria is almost always applied, but the audit found that there is room for making this more consistent. The audit also refers to how the analysis of our adult protection data helps inform a redesign of the Access Team with greater focus on early intervention and prevention, a better response to crisis and using the ASP Act to safeguard. As stated elsewhere in this report, understanding the changing trends has led to the implementation of a fast track triage system for those adult concern reports and referrals received where there are mental health and/or drug and alcohol concerns. This approach embraces the benefits and principles of early intervention and prevention and is based on a ‘no referral, no waiting list’ premise and to determine the right supports, at the right time and from the right people. 5.7 The ASP Act safeguarding those who experience gender-based violence In 2021, APC data flagged that the ASP Act was rarely used to safeguard an adult at risk from domestic abuse, yet the data held by Police Scotland showed high numbers of weekly reports where adults were at risk of domestic abuse. The ASP coordinator, the Violence Against Woman and Girls (VAW) coordinator and a social worker (who is also a qualified council officer) with a key interest in supporting those where gender-based violence exists met with Police Scotland colleagues to review the existing MARAC pathway. MARAC is an acronym used for a multi-agency risk assessment conference to support those where gender-based violence exists. As part of this improvement work, this short life working group also explored practice in another APC area where the ASP Act was
Page 30
30 30 being widely used to safeguard victims of domestic abuse. A joint VAW/ASP multi-agency session investigated the ‘blockages’ in our shared process. In 2022/23, further joint work was undertaken and the MARAC referral form was changed to include the option to refer the adult to ASP. That way, we can demonstrate that the ASP Act is now being considered for each and every adult who is referred to MARAC. The ASP coordinator also led a number of development sessions with third sector colleagues who support this work within Perth and Kinross. This session also raised awareness in the use of a banning order where the ASP Act can be used to apply to Court to ban an adult from another where evidence supports that the adult is at risk. Iin 2023/24, a further joint in-person ASP/VAW development session was held with a focus on how past and current trauma can lead to an inability to safeguard and the impact of coercive control. At the request of those who attended, a further joint ASP/VAW development session is planned for 2024/25 where colleagues from Woman’s Aid in Perth and Kinross will lead a session on how to respond to non-engagement and the subtle differences between someone being considered unwilling to engage and those who might be unable to engage. This work reflects the revised ASP codes of practice. The ASP coordinator is an active member of the Perth and Kinross VAW partnership to ensure that this cross-cutting work remains coordinated. This continues to be a key area for improvement for the APC. 5.8 Re-establishing an increased focus on financial harm. Analysis of our 2022 data revealed that financial harm re-emerged as a prevalent area of risk for vulnerable adults in Perth and Kinross. Therefore, in 2023/24, the Perth and Kinross multi-agency Financial Harm APC subgroup was re-established. Membership of this group includes Police, Trading Standards, Community Safety, Social Work, Health, and invites extended to Welfare Rights, to Citizens Advice and the banking/financial sector in Perth and Kinross. In December 2022, this subgroup merged with the wider APC subgroup so that both groups could benefit from the learning.
Page 31
31 31 In March 2023, the APC held an ‘in-person’ conference on financial harm. Dr Melanie Durowse, lecturer at Dundee University and author of a thesis on financial harm was a keynote speaker. This was arranged as part of the APCs commitment to addressing financial harm in Perth and Kinross. 45 delegates from different agencies and disciplines attended. Dr Melanie Durowse returned to deliver another financial harm session in October 2023 where she presented initial findings from her research around this area. Dr Durowse is working in partnership with Perth and Kinross adult social work to develop a financial harm ‘checklist’ to help practitioners better determine what might be financial harm. She is due to present the findings from her research to the APC in 2024. The prevalence of online banking and artificial intelligence has led to a significant increase in a range of what is considered financial harm. This would appear to be a global issue and not one intrinsic to Perth and Kinross. The APC hosted another webinar in 2023/24 where researchers from Abertay University presented their findings from their own research around romance fraud and how they are developing software to help safeguard those who might be vulnerable to online financial harm/scams. Led by the ASP coordinator, a Perth and Kinross SCAMS short life working group was created in 2024 to coordinate the public messaging about known scams. Membership of this incudes social work, health, Police, community safety, trading standards and colleagues from the Perth and Kinross communications team. 5.9 Improving our use of service user feedback We recognised the importance of hearing the voices of people with lived experience of ASP and their families and carers to inform changes and improvement. The APC improvement plan 2022/23 highlighted the importance of gathering meaningful, consistent feedback from those who have lived experience of being supported through an ASP episode. The ASP joint
Page 32
32 32 inspection supported this position and considered this to be an area for improvement for the APC. In 2022/23, the APC was presented with a number of options in how this could be improved. Using the Care Opinion digital framework was considered the best option to take forward. Care Opinion (https://www.careopinion.org.uk/info/care-opinion-scotland) is a digital feedback platform which has been commissioned by the HSCP and develops stories to illustrate experiences and to inform practice learning and development. Unfortunately, using Care Opinion for ASP work has been challenging and it did not bring the depth of feedback that it intended to do. The new ASP MOSAIC risk assessment forms have been reviewed and redesign and give more attention to the outcomes, experience and impact of ASP as described by the adult and their unpaid carer. MOSAIC is due to ‘go live’ in the summer of 2024. Therefore, each ASP episode will be better placed to share user feedback in a way that the current recording system is currently unable to do so. Furthermore, the ASP coordinator is leading on a proposal to work with colleagues from the 3rd sector to support the adult and his/her unpaid carer to complete a post ASP episode feedback report, based on their experience of the ASP episode and the impact that it has had on whether they feel safer as a consequence of it. Furthermore, we are also looking to establish a citizen-led Public Protection Safeguarding Board, where those with living and lived experience of any of the Public Protection agendas can be supported by our advocacy partners to give a view on our Public Protection arrangements. This remains a key improvement area for the APC. 5.10 Improving the transition from Child Care Services into Adult Care Services Within this reporting period, the APC and the Child Protection Committee (CPC) continues to be committed to establishing a coordinated transition pathway for young people as they move into adulthood. Although there is a well-established transitions pathway in Perth and Kinross for young people who experience complex and enduring disabilities, there is a need to extend this pathway further to ensure a coordinated pathway for all young people transitioning between child care and adult care services.
Page 33
33 33 In 2023, an invite was sent to each APC and CPC to join a Scottish Government led transitions short life working group to develop national transition guidance. The APC coordinator and the CPC coordinator for Perth and Kinross participated in this national work. Perth and Kinross was the only local authority area to have both the CPC and the APC represented in this national working group. This reflects and highlights the importance Perth and Kinross is giving to this work. A joint Perth and Kinross CPC/APC transition guidance has been drafted. This Perth and Kinross guidance has been adopted nationally. A shared APC/CPC transition development session is planned for 2024 to continue to move this work forward. This work makes Perth and Kinross compliant with the revised national guidance for child protection (2023). 5.11 Reviewing and refreshing the ASP Learning and Development Plan An ASP Learning plan was established in 2022 to support learners and managers across services who have a direct and indirect role in supporting adults at risk. Across three levels of training, this pathway delivers learning opportunities to support those practitioners to be more competent and confident in how to recognise and respond to adults at risk of harm. We believe that the plan has been developed in a way that supports a multi-agency approach to safeguarding in Perth and Kinross. The Perth and Kinross ASP Coordinator is part of the national ASP Learning and Development network 5.12 The APC taking a lead in reviewing how services support those who experience self-neglect and hoarding. The APC led a multi-agency short life working group into how support is delivered to those who experience self-neglect and hoarding. This short life working group was established in 2022 following the publication of the Angus APC P19 significant case review. This review found that services failed P19 in a number of key areas, particularly around their approach to his self-neglect.
Page 34
34 34 This short life working group met on four occasions to review the learning from P19 and to challenge the existing Perth and Kinross and Tayside practice guidance in their effectiveness to support this complex work. The workshops were co-chaired by the ASP coordinator and Turning Point Scotland (one of Perth and Kinross’ 3rd sector support providers). The sessions were attended by colleagues from housing, housing support providers from the 3rd sector, social work, mental health social work, Scottish Fire and Rescue, health, psychology and environmental health services. The extent to which these workshops were attended, and the range of practitioners involved reflects the ethical and practical challenges, complexities and the difficulties that practitioners from all sectors face when seeking to support someone who experiences self- neglect and/or hoarding. The discussion within these four workshops led to a draft proposal to change the existing self-neglect and hoarding pathway into one that is considered more trauma informed, person centred and better fits with contemporary research about what is considered best practice. Throughout 2022-24, the ASP coordinator has led several conferences, training and development sessions challenging our approach and our support to those who experience hoarding, challenging what is considered to be lifestyle choice, the subtle differences between decisional and executional capacity and our shared ability to deliver a trauma informed response. This work remains a key priority and is ongoing where the ASP coordinator continues to work alongside different sector agencies including health and colleagues from housing in revising their approach to this work. 5.13 Our commitment to qualitative and quantitative audits to inform our improvement work The APC and HSCP is fully committed to self-evaluation, audit, quality assurance and review as a means to delivering confident and competent support to those adults considered to be at risk. This was seen as a key strength in the joint inspection of our ASP arrangements in 2022. Following inspection, the APC has been approached by other APC areas for advice about how they can strengthen their own self-evaluation arrangements. This commitment to improvement includes the APC producing an annual report rather than the required biennial reporting. In this reporting two year period, the APC has conducted the following audits:
Page 35
35 35 I. NHS Tayside AP Annual Report 2022/23 II. NHS Tayside Quality Assurance Framework III. Multi-agency Audit 2022/23 and 2023/24 IV. LSI thematic review 2023 V. IRD audit 2022/23 VI. VPR audit 2022/23 and 2023/24 VII. IRD audit 2023/24 Throughout this report, we refer to the specific improvements to our ASP practice as a direct result of this self-evaluation and audit work. We believe that our ASP work is more multi- agency in our approach (greater use of health colleagues as 2nd worker) and in our processes (multi-agency rather than single agency chronologies to assess risk and greater use of medical examinations). We can demonstrate that our use of advocacy in ASP work has improved. Our IRDs are more targeted, coordinated and the information shared in these has allowed us to move quicker to investigating harm rather that inquiring if harm exists. We are also able to evidence wider service redesign from our audit work to better support an early intervention and preventative approach to safeguarding harm. 5.14 APC as part of a wider Public Protection approach to protecting people. Within this reporting two year period, the multi-agency Public Protecting Coordinators Group (PPGC) continued with membership from all agencies with a responsibility for protection of those considered to be at risk or those who are considered to be a risk. This group extends to membership from Child Protection, Adult Protection, Violence Against Women Partnership, Alcohol and Drug Partnership, Multi Agency Public Protection Arrangements (MAPPA), Suicide Prevention and Safer Communities. The APC is an active participant in a much greater enhancement of our public protection approach here in Perth and Kinross. There arrangements and partnerships have strengthened considerably in this reporting two year period. The Perth and Kinross Chief Officers Group (COG) meets quarterly and offers support and challenge to the APC alongside other public protection partnerships. The independent APC chair reports to the COG detailing the work of the APC and key issues and risks by exception. The dynamic Public Protection Risk Register is maintained and considered by the COG at each meeting. This allows the opportunity to understand changes in strategic and operational risk and a swift ability to commit resources where required. A good example of this is using the
Page 36
36 36 public protection risk register to monitor any risk related to continued year on year increase in ASP work and the numbers of available council officers to meet this demand. In 2022, 7 additional social worker posts were funded, partly in response to a proactive workforce analysis based on a continued year on year increase in ASP work. Examples of ASP/Public Protection cross cutting themes: - The ASP Act being used to support those where domestic abuse exists - Using the ASP Act to safeguard those considered at risk of suicide. - Using the ASP Act to support those who experience addiction. - The APC and CPC has always retained strong partnership working with many cross- cutting themes including delivering a trauma informed approach, transition work and shared learning reviews. - A coordinated public protection approach to financial harm and SCAMs - A public protection approach to learning and development - Establishing a public protection citizen-led safeguarding board 6 Training, Learning and Development 6.1 Overview We are committed to developing a competent, confident, and skilful workforce. Our staff are highly motivated and committed to their own continuous professional development. We are empowering and supporting our staff with a wide range of evidenced-based multi-agency learning and development opportunities, which are evaluated and having a positive impact on practice. The content of these learning and development opportunities takes account of changing legislative, policy and practice developments. The ASP learning and development plan was developed in 2022 and remains under regular review by the Adult Social Work and Social Care Forum and the APC to ensure its relevance to current practice. This offers a range of learning opportunities from basic ASP awareness raising through to specific, targeted and specialised training. The APC learning plan also reflects findings from recent audits and learning reviews. In 2023/24, council officers were asked to complete a learning and development survey. The findings from this has informed our ASP learning and development plan. Our learning exchange programme is a good example of this targeted learning from our self-evaluation work.
Page 37
37 37 6.2 Council officer training programme A social worker is not able to carry out formal ASP work until such times as they have completed the council officer training programme. We remain fully committed to supporting social workers to participate in this. This extends to: - In 2023, and after review, our council officer training increased from being delivered twice a year to three times a year. As discussed on page 11 of this report, our numbers of qualified council officers has grown significantly throughout this reporting two year period. - Council officer refresher training (for those who may need to revisit the training) is offered twice a year. - ASP 2nd worker training is aimed at a range of professionals who will carry out the second worker role in investigations and/or LSIs. Increasing our numbers of trained ASP 2nd workers from a wide range of disciplines allows us to deliver a more multi- agency and at times a specialist approach to investigating harm. - ASP defensible decision making is seen as an improvement area. This learning is offered to practitioners as a Perth and Kinross/Dundee collaboration twice per year. 6.3 APC Learning Exchanges Following inspection, multi-agency practitioner learning exchanges were facilitated as part of a rolling programme of learning, development and improvement. Rather than implementing formal trainer led learning, learning exchanges offer an opportunity for group involvement and discussion. The theme for each session is based directly on findings from local and national learning reviews, self-evaluation, audit and inspection work as well as the APC Improvement Plan for 2024-26. These include: 1. Meet the Perth and Kinross APC 2. A summary of the revised ASP Codes of Practice 3. The role of advocacy in ASP work 4. How can we better involve practitioners in APC improvement work 5. How Adult Support and Protection learning reviews conducted in Perth and Kinross should lead to improvement work 6. Hear about how the Tayside Capacity Assessment Pathway applies in Perth and Kinross
Page 38
38 38 7. How can we better gather user feedback in adult protection work 8. How should we be using medical examinations in Adult Support and Protection work 9. How the principles of the Adult Support and Protection Act apply in Perth and Kinross 10. How should chronologies support our adult protection work 11. The importance of understanding escalation in adult protection work 12. Why is it crucial that harm is reported early 6.4 APCs commitment to trauma informed practice and a trauma informed workforce In 2022, Perth and Kinross Council appointed a full time Trauma Approach coordinator. The ASP coordinator is part of the trauma informed steering group to ensure that ASP work remains trauma informed, particularly with the publication of the revised codes of practices paying particular attention to the need for the ASP Act to extend to those who might be unable to safeguard as a consequence of trauma. In 2023, a dedicated ASP trauma informed e-module was developed and shared with practitioners. It gives a focus on how trauma can lead to an inability to safeguard. https://rise.articulate.com/share/xUk4y6ufpHnsS3QRANuryLP3QTRjlTjM The ASP coordinator continues to lead on other trauma informed related multi-agency learning including: - Challenging our views of what is considered lifestyle choice, particularly for those who experience addiction and/or homelessness - Our approach to those who experience hoarding - The importance of understanding the nuance and often subtle differences between decisional and executional capacity/incapacity - Using the ASP Act to safeguard those who are at risk from domestic abuse - Our response to non-engagement and the difference between seeing the adult as unwilling to engage or is unable to engage.
Page 39
39 39 6.5 APC supporting ASP Matters (peer led support) ASP matters is a practitioner led peer support network for those who practice in and/or are involved in adult protection work. Supported by our colleagues from HSCP learning and development, it is an open forum for practitioners to discuss practice and use the experience from within the peer group to share and learn from each other. The practitioner lead for ASP Matters sits on the APC sub-group and provides a link from ASP matters into ASP practice. The number of practitioners who take part in the ASP matters peer group has grown throughout 2022/24 to 91 practitioners. The meetings take place monthly and are not exclusive to council officers but has a common theme around how we best support and protect adults. The forum offers a safe, learning space for those who have a vested interest in adult protection work and has led to larger learning events. The Community of Practice learning events have been designed in collaboration with Dundee University and third sector partners based on knowledge requests from frontline practitioners such as those that attend the ASP matters. The Community of Practice aims to help improve practice and inform service delivery through: • Developing links • Enhancing the evidence base to how we protect adults at risk from harm • Undertaking collective research • Promoting coproduction leadership • Enhancing knowledge, skills and values base • Sharing and making best use of joint resources • Peer Support and enhancing wellbeing
Page 40
40 40 6.6 Learning reviews conducted throughout 2022/24 Within this reporting two year period, the APC approved two learning reviews. Both learning reviews were shared with the Chief Officers Group and the HSCP Clinical Care and Professional Governance Forum. L22: A review of our support to those who experience personality disorder This informal learning review came from the 2022 ASP joint inspection. A formal escalation was raised on the basis of a number of concerns found following the joint review of L22’s case file. The joint inspection team noted that although they did not find L22 to be an adult left at risk as a consequence of the multi-agency intervention, they did find a number of areas of practice that they considered required escalating. The L22 learning review panel acknowledged the concerns raised as part of the inspection escalation. The panel universally agreed that at the time L22s case file was inspected, she was experiencing regular period of extreme distress, resulting in risky behaviours. The multi- agencies supporting L22 used the learning review to share the challenges and complexities in trying to support L22 throughout periods of crisis, in a way that was person centred, trauma informed but also kept her safe. The review panel heard that being able to keep her safe whilst promoting choice and autonomy, rights and responsibilities, all in a climate of fluctuating capacity and consent was not easy. This review found a number of improvement areas, some of which formed part of an improvement plan prior to inspection, and others that were identified as part of this learning review following escalation. G20: A critical review of our shared approach to those who hoard This informal learning review was based on a request made by the Mental Welfare Commission (MWC) following the submission of an application in 2022 to subject G20 to a Compulsory Treatment Order (CTO). Within the CTO application, reference was made to missed opportunities to consider G20 as an adult at risk of harm as a consequence of deteriorating self-neglect and hoarding behaviour.
Page 41
41 41 A multi-agency learning review group was established and it reviewed a combined chronology for the two year period preceding her detention. The learning review found evidence of good practice: - The AP concern that was submitted in December 2022 led to a multi-agency IRD held within two working days. The following day, G20 was detained into a hospital setting and therefore safeguarded. This highlights the value of IRDs and the quick multi- agency, coordinated response to keeping G20 safe. It also demonstrates where we were able to use different legal frameworks to keep G20 safe: - ASP Act to bring people together and: - The Mental Health (Scot) Act to authorise and facilitate her immediate move into hospital - The review acknowledged the ethical tensions that brought about an added complexity to this case. It found that the practitioners who were involved with G20 were genuinely concerned for her, and decisions were taken on the basis of what they thought was right for her whilst balancing her right to choice and self- determination The learning review also highlighted missed opportunities and areas for multiagency improvement, including: - Our response to those who do not engage and whether we consider the adult as unwilling to engage or unable to engage. - Training to help practitioners understand the complexities that exist when seeking to safeguard those who might experience self-neglect and hoarding, moving away from this being considered as a lifestyle choice to someone who may be seen as lacking the skills means and opportunities to safeguard. - Practitioners also need to value the role and benefit of being professionally curious. The learning from both reviews informed the ASP learning and development plan and the APC Improvement plan 2022/24 and again in 2024/26. The focus of the different ASP related learning exchanges highlighted on page 38 of this report reflects the findings from the G20 and L22 learning reviews.
Page 42
42 42 7 Engagement, Involvement and Communication The APC understands the benefits of independent support for adults at risk of harm and are deeply committed to the use of advocacy throughout ASP processes in a person-centred approach and to elevate the voice of the adult and to keep their wishes central to decisions and actions. The role of advocacy is underpinned by section 6 of the ASP Act and is clearly embedded within our Perth and Kinross ASP multi agency guidelines. Advocacy (instructed and non- instructed) within Perth and Kinross is commissioned and provided by Independent Advocacy Perth and Kinross (IAPK)[1]. It is our view that non-instructed advocacy is crucial for those who may lack capacity or have communication difficulties. The APC Advocacy Plan 2022/24 sets out the relationship that IAPK shares with the APC, the extent to which advocacy is provided and how IAPK is enabling improvements. The 2022 ASP inspection found that: “Overall, the involvement of independent advocacy was mixed. Some files lacked information about independent advocacy involvement when we would have expected to see this. When advocacy workers were involved in key stages of the adult protection process, such as case conference, their contribution benefitted the adult at risk of harm. In a few cases, the adult at risk of harm was not offered advocacy when they should have been. Even when advocacy was offered, it was not accepted by most adults. The partnership needed to ensure support and input from independent advocacy was arranged and clearly documented when requested.” The annual APC multi-agency audit 2023 focused on this improvement work. The findings noted that in 76% of the case files audited, it was clear that advocacy was either involved in supporting the adult or it had been offered, but the adult didn’t want it. In the cases audited where there was no mention of advocacy, this was due to the council officer failing to record this properly and/or some confusion about when and how to refer to advocacy where the adult lacked capacity to consent to a referral. Although the audit found that some improvements in our use of advocacy had been made, there was still room for further improvement.
Page 43
43 43 The APC continues to see how we engage adults and their unpaid carers as a key priority area for 2024/25: I. The Chief Executive and Operations Manager for IAPK attended a ‘meet the APC’ Development session in 2023. This encouraged discussion about the role of advocacy in ASP and a further advocacy development session for front line practitioners is offered to promote the benefits and take-up of advocacy support. Another session is planned for 2024 and beyond. II. A series of practitioner ‘learning exchanges’ have been established to highlight the importance of advocacy in ASP work.’ This includes the importance of considering non instructed advocacy where the adult may not have the capacity to make an informed decision about advocacy support. The ASP coordinator and colleagues from IAPK take a joint lead in this. III. The third area for improvement following this audit work relates to our use of well-articulated, defendable, and defensible recording. Where advocacy has been considered but not required, and legitimate reasons exist for advocacy not being used, this needs to be recorded. Furthermore, where advocacy has been offered but declined, this needs revisiting later in the ASP episode in the event that the adult and his/her unpaid carer changes their mind. IV. The new MOSAIC ASP assessment and protection planning forms give more attention to the need to consider advocacy for the adult and his or her unpaid carer. MOSAIC will be able to provide a more robust and reliable data set in terms of how and where advocacy has been used in our ASP work. V. Keeping adults and their unpaid carers fully engaged in ASP work here in Perth and Kinross is crucial and it represents another improvement area. The use of advocacy is one way to support this. As stated earlier in this report, it is hoped that colleagues in IAPK can support this work further by gathering feedback from adults and their unpaid carers about their ASP journey as well as supporting a wider Public Protection citizen-led safeguarding board. 7.1 Communication and Public Awareness We continue to review and develop the Perth and Kinross APC webpage which provides public information about adult protection in Perth and Kinross, including our use of ASP as a means to safeguard harm, how to recognise harm and where to report it. Annual reports, learning reviews and APC minutes are shared publicly on this site.
Page 44
44 44 (Perth and Kinross Council - Adult support and protection (pkc.gov.uk). Mary Willis is a Perth and Kinross Council Communications Officer who is aligned to the work of the APC. She states: “We continue to support both national and local social media campaigns either directly relating to adult support & protection, or allied to this area of care and support, including the campaign supporting national ASP day, advice on financial harm, scammers, cold callers, and sextortion.” 7.2 National ASP Day on 20 February 2023 and 2024 February 20 each year marks the start of an annual Scottish Government campaign to raise awareness about adult support and adult protection. Local landmarks and Perth and Kinross Council social media sites are used to promote the themes of national adult protection day. On 20 February 2023, the lights on Smeaton’s Bridge were blue and white to reflect the APC logo colours. On 20 Feb 2024, social media was once again used to raise awareness in recognising an adult at risk of harm and how to report this. It was also used to highlight the risks associated with sextortion.
Page 45
45 45 The APC uses the week leading up to Feb 20 as an opportunity to deliver ASP and ASP related conferences and training opportunities. In this reporting two year period, ASP leads from Dundee and Angus, as well as lead officers from Health, Police and Scottish Fire and Rescue contributed to several Tayside wide training and learning events. These had a focus on supporting adults at risk of neglect and self-neglect and how to recognise and intervene when someone is at risk from sextortion3. 7.3 The importance of sustaining close safeguarding relationships with wider organisations Protecting adults is everyone’s business. Therefore, the APC acknowledges the value of a wide APC membership including a representative from University of the Highlands and Islands (Perth College campus). The campus has students with a range of physical and 3 'Sextortion' is a form of blackmail. It involves threatening to publish sexual information, photos or videos about someone. This may be to extort money or to force the victim to do something against their will. Photos or recordings are often made without the victim realising or consenting.
Page 46
46 46 learning disabilities and those with whom have disclosed a mental health support need. Retaining this close working relationship, particularly during the challenges posed by Covid has been key to ensuring that those who are considered vulnerable, at risk or in need of support from wider agencies are able to access this. This has included taking a joined-up approach with UHI more recently where evidence suggested that some students from Perth College were vulnerable to cuckooing4. The 3rd sector also play a growing and integral part of the APC and APC subgroups. Scottish Care is represented in the APC and colleagues from Hourglass, PKAVS and Turning Point Scotland sit as part of the APC subgroup membership. Colleagues from Turning Point Scotland co-lead the self-neglect and hoarding improvement work and in 2023/24, the ASP coordinator held a safeguarding development session with PKAVS. 8 Looking Forward This report has identified key areas for our programme of work over this next year. The findings from inspection identify areas which, if consistently embedded into ASP work, will elevate us from having effective policies and processes into what should be considered very effective. The older adult continues to dominate our ASP activity, and the APC and APC subgroups continue to be connected with the different older adult strategies that exist in Perth and Kinross. Hourglass5 is a national charity dedicated to supporting the order adult at risk of harm, and they sit within the Perth and Kinross APC subgroup to support and help improve our practice in terms of how we seek to safeguard the older adult. We will give a continued focus on key issues such as violence against women, financial harm, understanding the adult protection impact on those where drug and alcohol features, mental health, and suicide prevention. Priority will also be given to supporting the emerging prevalence in ASP activity around the young adults and those young people in transition between services. This ties in with the joint improvement work between the CPC and APC about establishing a supported transition 4 Taking the name from cuckoos who take over the nests of other birds, cuckooing is a practice where people take over a person’s home and use the property to facilitate exploitation, including dealing, storing or using drugs and using the property for sex work. 5 https://wearehourglass.scot/scotland
Page 47
47 47 pathway between services for young people. This has also been highlighted within this report as an area of priority across the wider public protection agenda and an area that requires a multi-agency, coordinated response. Supporting adults and their unpaid carers to better engage in the ASP episode in a more meaningful way is also seen as a key area for improvement. This report has highlighted the need for a robust, reliable quantitative and qualitative data set from across all partner agencies to inform planning, manage workload efficiently, target resources on key issues, inform improvements to practice, and to demonstrate outcomes. As we continue to move towards implementing a new social work recording system, it is intended that this new system and the data produced from it will help better understand impact, outcomes and experiences of those here ASP has been used to safeguard. We acknowledge the importance of chronologies to help identify patterns of behaviour. Our audit into some of our own ASP work identified that work needs to be done in this reporting year to ensure that our multi-agency chronologies are available, up to date, focus on key life events and the implications on risk. Furthermore, our risk assessments, risk management plans, and chronologies are consistently shared among all our adult protection partners to ensure a coordinated and joined up approach to safeguarding. 9. Summary This biennial report seeks to give analysis to the adult protection activity and its impact between 1 April 2022 and 31 March 2024. It summarises the positive ASP joint inspection in the summer of 2022, and it highlights where we are able to demonstrate several key areas where multi-agency adult protection activity within Perth and Kinross is strong. This report also identifies areas in which we seek to improve. The improvements identified within this report are framed within the APC Improvement Plan for 2024/26. Iain Wilkie Adult Protection Coordinator
Page 48
48 48 Appendix A Most commonly used acronyms AP (concern) Adult Protection Concern APC Adult Protection Committee ASP Adult Support and Protection CHOG Care Home Operational Group COG Chief Officers Group CSWO Chief Social Work Officer HSCP Health and Social Care Partnership IAPK Independent Advocacy Perth and Kinross IJB Integrated Joint Board IRD Inter-agency Referral Discussion LSI Large Scare Investigation NHST AP NHS Tayside Adult Protection VPR (Police) Vulnerable Persons Report VAW Violence against Women (and girls) Appendix B A textual summary of the ASP Summary Infographic Page 8 of this report is an infographic summary of the ASP activity in Perth and Kinross from 1 April 2022 through to 31 March 20234 In order to make this APC annual Report more accessible to more people online, this appendix is a written summary of this infographic page. The first infographic tells us that in this reporting year, Perth and Kinross has received a total of 6151 Adult Protection referrals, which is an increase of 23% in comparison to the reporting period 2022-2024. The second infographic tells us that out of all the ASP investigations conducted in this reporting period. 35% were conducted for physical harm, 31% were used for neglect and 15% of investigations were used for financial harm. Emotional harm accounted for 10% of investigations, 5% were used for sexual harm and domestic abuse accounted for 4% of all ASP investigations. The third infographic relates to who is receiving support. The data tells us that 29% of all ASP investigations conducted were used with someone who was frail, 23% were used with
Page 49
49 49 someone with dementia and 17% were used with someone with a diagnosis of learning disability. Mental ill-health accounted for 13% of all ASP investigations and 4% were used with someone who experienced addiction. The fourth infographic tells us about the impact of the adult at risk. It tells us that between 1 April 2022 and 31 March 2024, 98.3% of all adult protection concerns received were screened within 24-hour hours of being received. Our data tells us the within this reporting period, we saw a 92% increase in our use of review ASP case conferences and 58% of all ASP activity was used for females. The full APC Biennial report gives more analysis to this. The fifth infographic relates to where harm happens. The data tells us that 48% of harm occurs in the adult’s own home, 39% occurs in a care home setting and 13% happens elsewhere The next infographic tells us what age group is most at risk. 35% of all ASP activity relates to those aged 81 and over. 23% relates to those who are aged between 65 and 80. The seventh infographic gives us a very short summary of what the APC did between 2022 and 2043. It tells us that we made progress with the APC improvement plan, we had our joint ASP inspection, we strengthened relationships across all public protection partners, and we implemented better arrangements for protecting residents in care home settings. The next infographic tells us that in this reporting two-year period, we secured four formal protection orders. More is discussed about this in the main report. The last infographic tells us what our priorities are going forward. We see the need to improve our engagement in the ASP episode with adults, families and carers. We want to develop our multi-agency approach to using the ASP Act and give a greater focus on safeguarding those at risk from financial harm and understanding how trauma can lead to an inability to safeguard.