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AYRSHIRE ADULT
SUPPORT & PROTECTION
PROCEDURES
North Ayrshire Council, East Ayrshire Council,
South Ayrshire Council, NHS Ayrshire & Arran
Strathclyde Police
Objectives
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To explore the support and protection of adults at risk.
To clarify operational duties and processes.
To identify best practice and areas of development.
Introduce Interim pan-Ayrshire & Arran ASP Procedures.
To consider the range of legal options.
Familiarise staff with procedure to be followed when it is
suspected that harm has occurred.
Identify the roles and responsibilities of the agencies
involved.
Learning Outcomes:
You Will Know ….
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Harm happens.
What it is, where it happens and how it happens.
What to do and how to progress concerns.
The systems in place.
Health Board, Local Authority and Strathclyde Police
responsibilities, duties and powers.
The legislative basis; ‘the toolbox’
Borders enquiry; learnings to apply here.
Borders Report; facts
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A woman with learning disability taken to hospital with
multiple injuries from physical assault and sexual assault.
Police investigation revealed a catalogue of abuse and
assaults over previous weeks and longer. Three men
were convicted of the assaults in 2002.
Over many years events and statements were taken by
social work, health services and Police that raised serious
concerns.
Others were receiving care under the same
circumstances, with varying degree of learning disability,
physical disabilities and mental health needs, which were
largely neglected.
They were neglected, lived in unsuitable and unsanitary
conditions and were financially and sexually exploited.
Borders Report; Some Findings
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Failure to investigate appropriately serious allegations of abuse.
Acceptance of poor conditions in which the people lived.
Lack of comprehensive needs assessments.
Lack of risk assessments.
Lack of information sharing and co-ordination.
Disagreements between agencies at the front line.
Un-sustained contact with the individuals concerned.
Poor case recordings.
Lack of care planning.
Failure to consider statutory intervention.
Lack of compliance with VA procedures.
Poor supervision.
Lack of senior management and leadership.
Lack of clarity of role.
Borders Report; Recommendations
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Review all cases of adults with learning disability to
assess level of risk and quality of service.
Review of LD services.
Guidance of staff on complex cases.
Vulnerable adult procedures.
Comply with SSSC codes of practice.
Improve training for MHOs.
Acute discharge protocols.
Develop better risk assessment methods.
Improve case recording and review mechanisms.
Introduce random case monitoring processes.
Monitor the effectiveness of case transfer
arrangements.
Share information more effectively.
Borders; learnings
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Is about people
Key messages:
 Attitudes (they live this way!)
 Fragmentation of service response (who had
the whole picture?)
 Identifying risk at key times.
 Communication and transfer of information.
 Audit/recording/monitoring.
 Resolving differing views (two tribes).
 Poor consideration of statutory powers.
Borders Report; A Check List
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Allocated worker with necessary skills and experience.
All relevant information been gathered?
Chronology of events and implications of these events
understood?
Comprehensive assessment, including risk?
Care and protection plan?
Statutory intervention considered?
Individual seen on regular basis?
Good communication and collaboration?
Case been reviewed in accordance with procedure?
Case been subject to oversight by line manager?
Framework; procedures
Part 1
Introduction;
• Historical context
Part 2
Definitions
• The law
• Harm & context
Part 3
Principles and framework for
legal intervention
• Principles in law
• Legal toolbox
Part 4
Inter-agency responsibilities:
• Common responsibilities
• Council; SW, legal, others
• NHS, Police
• MWC, OPG, Care Commission,
• Independent sector, advocacy.
Part 5
Framework for Assessment and
Intervention:
• Practice procedures
Part 6
Documentation Framework
• Risk assessment and protection
plan
Part 1; Introduction –
historical context
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Growing public awareness of abuse/media coverage of
incidents and public enquiries.
Increasing older population of potential adults at risk.
Procedures introduced from 2000, updated 2008.
National policy; Law Commission 1997, Borders Inquiry,
SG consultation 2005, ASP Bill.
AWI & MHA left gaps re ‘vulnerable adult’ and ‘adult at
risk’.
Adult Support and Protection (Scotland) Act 2007
Part 1; introduction - purpose
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Prevention – always the first priority
Procedures – the structure
Action where harm has occurred
Partnership across all sectors
Abuse; an action
Harm; the outcome
Part 2; Definitions
Adult Support and Protection (Scotland) Act 2007,
Adults at risk
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Adults over 16
Unable to safeguard their own well-being, property, rights or
other interests
Are at risk of harm, and
Because they are affected by disability, mental disorder,
illness or physical or mental infirmity, are more vulnerable to
being harmed than adults not so affected.
Adults at risk of harm
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Another persons conduct is causing the adult to be harmed
The adult is engaging in conduct which causes self harm
Part 2; Definitions
Adults with Incapacity (Scotland) Act 2000
• Law presumes adults are ‘capable’
• Can be overturned if evidenced that the
adult’s capacity is impaired in relation to
decisions
• Making decisions
• Acting on decisions
• Retaining memory of decisions
• By reason of mental disorder (or inability to
communicate because of physical disability)
Part 2; Definitions
Mental Health (Care and Treatment)(Scotland) Act
2003, rights or other interests
• Mental disorder
• Mental illness, personality disorder,
learning disability
• Excludes sexual deviancies, dependence
on alcohol or drugs, behaviour that
causes alarm, etc and acting as no
prudent person would act.
Abuse; group exercise
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Definitions; what is abuse
Examples; from professional experience
Signs; what to look for
Who abuses; ??
Context; where, when, how
Discuss in groups and feedback
Part 2; What is Abuse?
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An action.
A violation of an individual’s human and civil
rights by any other person.
The wrongful application of power by
someone in a dominant position.
Includes aggressive, subtle and nonintentional acts, deficiency of care and
treatment, exploitation, harm.
Others ….
Part 2; Abuse: examples
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Physical
Emotional/Psychological
Deprivation of ….
Isolation
Financial/Material
Sexual
Human Rights
Institutional
Malpractice
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Verbal
Neglect
Self Neglect
Racial
Abuse/Discrimination
Random Violence
Domestic Abuse
Ageism
Information Abuse
Medication
Part 2; Some Signs
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Unusual or suspicious injuries.
Unusual or unexplained behaviour.
Allegations of abuse.
Adult found alone in a situation of risk.
Frequent/inappropriate contact with agencies.
Interval between injury/illness and contact.
Living with known perpetrator.
Misuse of medication.
Physical deterioration.
Increases in confusion.
Demonstration of fearof another person.
Others.
Part 2; Abuser?
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ANYONE
Staff member.
Professional.
Volunteer.
Another person receiving the service.
Spouse, relative, member of social network.
Neighbour, member of public, stranger.
A person who targets vulnerable people.
Part 2; Abuse: Context
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Own home.
A carer’s home.
Residential/nursing care.
Work setting.
Educational setting.
Hospital.
Social situations/public place.
Hostel/temporary accommodation.
Accommodation with support.
Part 3; Underpinning Principles
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Every adult has a right to be protected from all forms
of abuse, neglect and exploitation that result in harm
The adult’s welfare takes primacy
Self-determination
If self-determination over-ridden, must be
proportionate and be least disruptive response
ASP, AWI & MHA all take into account;
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Privacy, dignity, safety, choice, respect,
empowerment, equal consideration, preferences,
participation, benefit, minimum intervention
Part 3; Adults Have Rights
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Adults have the right to make their own decisions in
relation to their safety, security and behaviours:
And can only be overturned by law
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Can the person understand the nature and
consequences of the risks they may be subject to
Can the person consent to any intervention that may
be proposed
Does the person have the capacity to make informed
decisions to accept or refuse assistance
Consider….
• CONSENT
• CAPACITY
• RISK
• Consider; context, degree, frequency,
outcome, effect
Dilemmas
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Intruding on someone’s liberty vs protecting
this person.
Acting vs not acting.
Respecting the victim’s pride and fear of
recrimination vs taking action.
Dealing with tyranny vs respecting individual
choice and control.
Respecting vs intruding on confidentiality.
Criminality vs confidentiality and fear
Part 3; Legislative Framework
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Social Work (Scotland) Act 1968 as amended
by NHS & Community Care Act 1990
• General duty to assess unmet needs in
provision of community care services
• Provision in ASP/MHA/AWI of least
restrictive actions, indicates action under
68 Act is preferred
Part 3; Legislative Framework
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Adults with Incapacity (Scotland) Act 2000
• Provides for decisions for adults who lack
the capacity to manage their affairs in
relation to welfare, property and finances
• Includes duties on local authorities to
investigate welfare concerns
• Interventions can include applications to
the sheriff for Intervention or Guardianship
Orders
Part 3; Legislative Framework
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Mental Health (Care and Treatment)(Scotland) Act
2003
• Includes duties on local authorities to inquire into
deficiencies in care, treatment or support for people
living in the community
• Assessment of needs for community care services
• Provision of care and support services to promote
well-being, social development and social inclusion
• Compulsory measures available
Part 3; Legislative Framework
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Adult Support and Protection (Scotland) Act 2007
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Duties on councils to inquire about an adults well-being,
property or financial affairs, when thought to be an ‘adult at
risk’
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Requires cooperation from other statutory agencies; NHS,
police, Care Commission.
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Protection Orders; entry, assessment, removal, banning.
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Role of ‘council officer’
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Council must consider provision of services, including
advocacy
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Adult Protection Committees
Part 3; Legislative Framework, other
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Human Rights Act 1998
The Protection of Vulnerable Groups (Scotland)
Act 2007
Vulnerable Witnesses (Scotland) Act 2004
Appropriate Adults Schemes
Various other Acts;
• matrimonial homes, disability and other
equality Acts, housing, regulation of care, etc
AYRSHIRE ADULT
SUPPORT & PROTECTION
PROCEDURES
North Ayrshire Council, East Ayrshire Council,
South Ayrshire Council, NHS Ayrshire & Arran
Strathclyde Police
Part 4; Inter-agency responsibilities
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Common responsibilities
• All staff must be capable of recognising and acting
on concerns for the safety of adults (and children)
• Are familiar with the inter-agency procedures to
support and protect adults at risk
• Can take immediate action in an emergency
• Cooperation across partner agencies
• Sharing of information for the purposes of inquiries
and protection planning
• Be alert to child protection concerns where a child
is present where an adult is at risk of harm
Part 4; Council Services,
social work, legal.
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Lead responsibility to inquire into harm perpetrated
on adults at risk
Responsibility to put in place support and protective
measures
Will require liaison and assistance from
– NHS
– Police
– Mental Welfare Commission
– Office of the Public Guardian
– Care Commission
Legal officers will make applications to sheriff along
with the council officer
Part 4; other agencies
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NHS
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Police
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Contribute to inquiries and conduct medical examinations
Lead on criminal investigations
A referral must be made to the police if it is believed an offence has
been committed
OPG - Investigate complaints where financial or property matters in
jeopardy
MWC - Investigate deficiency in care
Independent sector
– Cooperate with council and other agencies
– For APL must have internal ASP procedures
– Contractual responsibility to report incidents of harm
Whistleblowing
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Guidelines, protection and reassurances to
encourage disclosures of suspected or actual
malpractice.
Staff have the right to raise concerns and
have them heard in an open and sensitive
manner.
Staff should be aware of procedures for
whistleblowing, harassment policies,
disciplinary procedures, complaints.
Part 5; Framework for Assessment
and Intervention
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All partner agencies must ensure staff have an
awareness of adult protection issues and a
working knowledge of systems and practice
Social work is lead agency
Referrals require full referral information
Principles applied
Referral to police if it is believed a criminal
offence may have been committed
Refer to full procedures
Part 5; good practice in ASP
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Don’t promise to keep secrets.
Don’t place yourself at risk
Explain what you are going to do
Protect people
Accept responsibility
Work in partnership
Share and record information
Be tenacious
Part 5; Your Initial Practical
Responsibilities
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You witness, suspect or receive information about abuse:
 Talk to victim seek consent to take action.
 Where person does not give consent for action, discuss
with line manager.
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Emergency - contact appropriate emergency service.
Consult with line manager/supervisor (if unavailable an
alternative manager):
 To refer to local authority social work department.
 To refer to police where indications of a criminal
offence (referral discussion to decide on appropriate
action if victim does not wish to make complaint).
Part 5; referral process
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Refer to the community care team for the area in which the
adult lives
Enquiry and Information Team
 Prestwick, Kyle St, Riverside/Holmston, Maybole
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Or, if known to a specialist team
Adult mental health, elderly mental health, learning
disability, physical disability, sensory impairment
Young adults; disability, throughcare
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Initial inquiries; check with appropriate others, eg, NHS
SSW/DepMan consider information and determine ASP or
other action, eg, care management
Part 5; referral process – young adults
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In addition to the referral routes listed previously, if a
young adult of 16/17 is at risk of harm
 Establish if an order under children’s legislation is
in place
If so, refer to the relevant C&F team
If not or not known, refer to relevant community
care team
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Initial inquiries; check with appropriate others, eg, NHS
SSW/DepMan consider information and determine ASP or
other action, eg, care management
Part 5; Initial Actions
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SSW/DepMan decide on level of investigation
Consider; consent, capacity, risk
Safeguard the adult
Professional judgement
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Context, degree, frequency, effect, outcomes
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Extent of harm, impact, a pattern, intent, legality, urgency
Council Officer investigative role
Investigation visit within 24 hours.
Case conference within 5 working days.
Part 5; Investigations
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Joint Improvement Team documentation;
 Risk Assessment and Protection Planning tools
Council Officer leads inquiry unless police lead
due to criminality
Two staff always
Most appropriate person to conduct interview may
be from partner agency
Investigation must be planned
 Compile information, where, who, when, timing
 Record information
 Consider advocacy and other services
Part 5; case conference
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Purpose
– to make decisions about support and
protection
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Multi-agency; shared responsibilities
Convened by SSW/DepMan
Considers;
– risk management and protection plan
– Inclusion of the adult
– Legal options
Part 6; Documentation
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Joint Improvement Team document set
Risk Assessment and Protection Plan; four elements
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Core information and data
• Basic factual information and lead officer
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Communication requirements
• Who requires to be involved
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Risk assessment
• Comprehensive information
• Balance risk and protection
– Protection Plan
• Framework for decisions and action
Tom & Lesley
Consider:
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What you do.
Individual and joint agency responsibilities.
Joint working
Consent and sharing of information.
A plan of care/action.
Tom & Lesley
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Tom Walker is a 60 year old man who lives with his girlfriend Lesley.
Services were withdrawn from Tom after he sexually assaulted a care worker. Lesley was
resettled after spending much of her life in a long stay learning disability hospital.
Neither Tom nor Lesley wish to receive any support or services. Tom is aggressively dominant
of Lesley.
A fire (cause unknown) has caused damage to the kitchen of the flat and the fire prevention
officer is concerned that the couple neither understands nor is coping with the seriousness of
the situation.
Lesley suffered burns.
The fire officer reports that the flat is no longer weather tight (it being winter), the wiring is
unsafe for use and the house is in a deplorable and filthy condition: there being little furniture,
extremely cold; piles of papers lying around (which may constitute a fire risk); no evidence of
food or provisions.
On speaking to Lesley he found her extremely flat and depressed. Tom resented certain
questions in respect of his concerns and told the fire officer to “get out and leave them alone,
he is the master of this house and Lesley”. The fire officer made an emergency referral to S.W
Lesley was taken to A&E, her burns were treated and although she is well enough to go home
hospital staff are seriously concerned about her safety and welfare.
Repeated calls from a social worker have been met with hostility from Tom.
A GP has seen Tom and Lesley recently. He refused to divulge information on them and felt
they were just naturally responding to a crisis which they would “get over” and should be
allowed to get on with their lives and their right of confidentiality protected.
AYRSHIRE ADULT
SUPPORT & PROTECTION
PROCEDURES
NHS Ayrshire & Arran
North Ayrshire Council, East Ayrshire Council,
South Ayrshire Council, Strathclyde Police