Transcript PRESENTATION FOR PATIENT SERVICES MANAGER POST

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.
Ms A; Justice Denied.
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
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
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
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 …. ‘the martini approach’ ??
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
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.
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.
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.
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?
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
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
Ms A – Justice Denied
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Mental Welfare Commission Report – April 2008
67 year old woman with a learning disability and
in care of local authority since age 8
Repeated sexual assaults by more than one
man over a prolonged period of time
The protective supports now in place amount to
a severe restriction of liberty
Ms A
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No prosecution
People with a learning disability should have
equal access to justice (UN Convention on
Rights of People with a Disability)
“... the responses of health, social care and
criminal justice services combined to deny
Ms A access to justice” (MWC report)
Attitudes of professionals towards people
with a learning disability affected their
responses – different standards applied
Ms A - findings
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Staff in agencies were confused about their
professional responsibilities in reporting a crime
Knowledge of relevant legislation and procedures
lacking
No consensus on whether Ms A had the capacity to
consent to sexual activity
Assessment of her competence as a witness did not
include people who knew her well
No consideration on support and means of preparing
Ms A to act as witness
PF left with little option than to abandon any action
Ms A; small group discussion
• Consider the facts and findings in the case of
Ms A
• What changes would you bring into place
• What recommendations would you make
• Could this happen here
Ms A; selected recommendations
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APC to coordinate multi-agency training on capacity
and consent to sexual activity and vulnerable
witnesses
APC to ensure procedures include reference to
vulnerable adult witness support
APC to ensure procedures allow for appropriate
sharing of information
Clarify role of MHO in adult protection case
conferences
Ms A
AYRSHIRE ADULT
SUPPORT & PROTECTION
PROCEDURES
North Ayrshire Council, East Ayrshire Council,
South Ayrshire Council, NHS Ayrshire & Arran
Strathclyde Police
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
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.
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
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).
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
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
Initial Actions
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SSW/DepMan decide on level of investigation and plan
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Consider; consent, capacity, risk, services
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Safeguard the adult
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Professional judgement of recorded facts
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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 – council officer along
with other appropriate person
Case conference within 10 working days.
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 (JIT docs)
– Inclusion of the adult
– Legal options
Final pub quiz
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Describe definitions;
– Of an adult at risk of harm
– The 3 point test
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Define the principles
What do we mean by ‘consent’, ‘capacity’ and ‘risk’
Answer the ‘martini’ question
Describe some of the ways an adult might be harmed
What protection orders are available
What other laws are relevant
Who are the partner agencies
Who can carry out inquiries
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
AYRSHIRE ADULT
SUPPORT & PROTECTION
PROCEDURES
NHS Ayrshire & Arran
North Ayrshire Council, East Ayrshire Council,
South Ayrshire Council, Strathclyde Police