South Ayrshire

Adult Support and Protection Committee

Biennial Report

2014-2016

Vision Statement

The South Ayrshire Adult Protection Committee is committed to promoting public awareness of any harms affecting vulnerable adults and to working on an inter-agency basis with the wider community to support and protect all vulnerable individuals in South Ayrshire.

South Ayrshire Adult Support and Protection Committee

Biennial Report

2014-16

CONTENTS Executive Summary

Section 1 Background 1.1 Population Profile

1.2 Partnership Working

Section 2 Management of Services 2.1 Health and Social Care Partnership-Governance 2.2 ASP Reporting

Section 3 Management Information 3.1 Summary of Performance and Trends 3.2 Audit

Section 4 National Priority Workstreams 4.1 Residential Care and Self-Directed Support 4.2 Financial Harm 4.3 ASP in Accident &Emergency 4.4 Data 4.5 Service User and Carer Engagement

Section 5 Initial and Significant Case Reviews

Section 6 Training

Section 7 Conclusion

Appendices

Appendix 1 South Ayrshire Adult Protection Committee Members

2 Executive Summary This is the fourth Biennial Report by the Convener of the South Ayrshire Adult Protection Committee. The role of the Committee remains one of promoting the protection of adults at risk through sensitive and effective interagency working. All partner agencies share a responsibility and are accountable for current service standards, underpinned by clear policies and processes. This is not a remote process however and the involvement of a wider public in recognising potential harm or exploitation to some individuals within communities is imperative. Since the commencement of the Adult Support & Protection Act in 2009 there has been a marked increase in Adult Support & Protection referrals. During this reporting period 2014-16, the referral rate has increased by 190%.This presents both an important challenge for all contributory organisations, but also reflects a positive raising in awareness of some of the issues being presented about vulnerable adults and what responsibilities are vested in both public and private sectors to ensure their safety and wellbeing. The Committee has carried out a number of initial case reviews which have followed on from events affecting a vulnerable individual. Some of these led also to a more detailed significant case review. The learning points from such reviews have helped the Committee consider what changes to multi-agency reporting is required in these types of situations, and also refresh and update on development and training for a range of frontline staff. Their judgement and actions have to be supported by clear leadership about the supports required for effective adult support and protection. The governance arrangements have continued to be overseen by a Chief Officers’ Group for Public Protection, reporting in turn to the Community Planning Partnership, whose functions ensure strategic linkages across all areas of public protection, including offender management, violence against women and children and alcohol and drug services. The formation of an Integrated Joint Board by the Health & Care Partnership now also has a pivotal responsibility across the spectrum of primary health and social care. In addition to the partnership commitments and responsibilities of the Adult Protection Committee, much of this work relies on maintaining safe communities where family, friends and neighbours can continue to “look out” for some of our most vulnerable citizens and feel they are being supported appropriately.

David Cumming Independent Chair October 2016

3 Background

1.1 Population Profile Area South Ayrshire is set in the south west of Scotland, a large rural area of 422 square miles (1,093 square km) extends from Troon and Symington in the north to Ballantrae and Loch Ryan in the south.

Population Estimates The estimated population of South Ayrshire on 30 June 2015 was 112,400. The population is made up of 52% female and 48% male. The percentages of the population under the age of 16 years and of working age are both below the national average. The percentage aged 65+ is above the average in Scotland. Approximately 70% of the population live in the towns of Troon, Prestwick and Ayr. The rest of the population live in Maybole and Girvan and rural Kyle and Carrick. South Ayrshire has a relatively small ethnic minority community (1.4% of the population compared with 4.1% for Scotland). Population Density With a population of 112, 400, South Ayrshire is in the mid-range of Scottish local authorities in terms of population and area size. South Ayrshire’s population density of 92 persons per square kilometre is lower than in neighbouring North and East Ayrshire Council areas, reflecting the predominant rurality of the area. Population Projections The population of South Ayrshire is projected to decrease by 2% over the next 25 years, from 112,910 in 2012 to 110,158 by 2037, in contrast to a 9% increase for Scotland. The main changes predicted in the age structure of South Ayrshire’s population are:

 The number of children aged 0-15 is projected to decrease by 7%, in contrast to a 5% increase in Scotland.

 The working age population is projected to decrease by 10%, in contrast to a 4% increase in Scotland.

 The pensionable age population is projected to increase by 17%, compared with a 27% increase in Scotland.

 There is a projected increase in population of those aged 75+ by +79%, compared with a +86% increase in Scotland.

 There is a projected increase in the proportion of the, population of pensionable age from 25% in 2012 to 30% in 2037 which contrasts with the projected proportion of the population of Scotland of pensionable age from 20% in 2012 to 23% in 2037.

4  South Ayrshire had the 4th highest proportion of people of pensionable age in 2012 (25%).

Household Projections

Despite, the anticipated fall in population, the number of households is expected to increase from 51,515 in 2012 to 54,104 by 2037, an increase of +2,589 (+5.0%). In Scotland as a whole, the projected number of households is set to increase by +16.6% over the same 25 year period.

In Scotland, the number of lone adult households is projected to increase by +35.3% over the 25 year period. In South Ayrshire, the number of lone adult households is projected to increase by +23.7%, and the number of larger households in South Ayrshire is projected to fall, with the number of households of 2 or more adults with children decreasing by -24.3% over the 25 year period.

These projected changes to the structure and composition of the South Ayrshire population over the next 25 years will require services to combine to ensure that good outcomes result from all service interventions and that any risks to wellbeing are mitigated by clear strategic approaches which recognise the importance of public awareness and supports from extended family, friends and neighbours to ensure potentially vulnerable individuals can continue to lead full and independent lives in their own homes.

1.2 Partnership Working In the reporting period 2014-16 the implementation of a number of significant strategic and operational developments have impacted upon and facilitated the partnership work of the Adult Protection Committee (APC). Most notably, the establishment of Police Scotland, the Scottish Fire and Rescue Service and South Ayrshire Health and Social Care Partnership have provided an opportunity to clarify and strengthen the roles of APC members and to more effectively progress the work of the Committee across South Ayrshire. Following on from the previous Biennial Report, APC members from Scottish Fire and Rescue (SFRS), Third Sector, NHS, and Trading Standards have advanced locally the national priority workstreams.

These links with statutory partners have been instrumental in the development of a new “Police Concerns Hub” which will focus specifically on the increasing number of adult protection/vulnerable adult referrals which Police Scotland pass on to South Ayrshire Adult Protection. The model for this has been piloted by partners in East Ayrshire and has proven to be particularly effective in terms of responding to keeping people safe and in resource utilisation. It is expected that implementation in South Ayrshire will have an equally significant impact. The Adult Protection Co-ordinator has also ensured more effective pan-Ayrshire partnership working through progressing further the development of links and approaches with Adult Protection colleagues in both North and East Ayrshire.

5 Regular meetings of the Co-ordinators and the combined training and development of staff are held throughout the year, with pan-Ayrshire plans agreed and worked on to mutual benefit. An example of the outcome from these links is the joint planning and delivery of Adult Support and Protection Level 3 (Council Officer) training on a pan-Ayrshire basis, resulting in a training programme that is more cost effective, flexible to meet workforce demands, and more accessible for participants. The Adult Support and Protection team also works with colleagues through the West of Scotland and National Adult Support and Protection Learning and Development Networks. Each of these fora enables the sharing of ideas and the identification and dissemination of best practice. This ensures that staff locally can be supported through the provision of up-to-date and meaningful information, advice and guidance. During 2014-16 the production of the revised West of Scotland Code of Practice was completed and this is currently being incorporated into a revised set of pan-Ayrshire guidance.

Over this reporting period, stronger links have been developed with providers of care services across the non-statutory sector. This includes regular attendance at both the “Care at Home Providers Forum” and the “Care Home Providers Forum”, where issues relating to adult protection can be discussed and solutions to particular difficulties identified. This has also led to a more flexible approach to meeting organisational training and development needs, including, where appropriate, delivering training programmes for specific providers within their own establishment. This is supplementary to the inter-agency training programme which is developed with providers each year and which has proven to be both well received and effective.

Within the Adult Protection Committee membership and across the range of stakeholders, an example of the effectiveness of the partnership was the planning and undertaking of a multi-agency case-file audit. This had active participation from Police Scotland, Scottish Fire and Rescue, NHS Ayrshire and Arran, housing, service-users and their families. The nature and scope of the audit required each of the partners to make a clear commitment to the audit process and also to commit the time and resources required for its implementation. That the audit was planned carried out and reported on effectively is clear evidence of the good work developing across the partners involved.

During such extensive organisational change and within a period of national economic austerity impacting on public services, it is necessary to emphasise the importance of partnership engagement with individuals and groups within communities to best support individuals who might otherwise become vulnerable.

6 Section 2 - Management of Services

2.1 Health & Social Care Partnership – Governance.

In June 2013, South Ayrshire Council and NHS Ayrshire and Arran approved the establishment of a Health and Social Care Partnership (HSCP). Integration plans were agreed which included the establishment of a Transitional Integration Board (TIB) which would make arrangements for the establishment of a Shadow Integration Board (SIB). The SIB was established in April 2014, and continued until April 2015 when full integration was implemented and the Integration Joint Board (IJB) commenced. As specified in the Public Bodies (Joint Working) (Scotland) Act, the Health Board and Council delegated community health and social care functions for adults and older people to the IJB. In South Ayrshire, it was also agreed that Children’s Community Health Services and Children and Families Social Work Services were also delegated, along with Criminal Justice Social Work Services.

The IJB approved a Strategic Plan for 2015-18 in April 2015 which aims to provide a 10 year vision for integrated health and social work services and contains a three- year strategic planning framework which sets out priorities for the new Partnership and how it will use its resources to integrate services in pursuit of National and Local Outcomes.

The South Ayrshire Health and Social Care Partnership now brings together a wide range of health and social work services into a single operational delivery unit. The Partnership’s Integration Joint Board is responsible for planning and overseeing the delivery of a full range of community health and social work/ social care services, including those for older people, adults, children and families and people in the Criminal Justice system. Integration Joint Boards with similar functions have been established in North and East Ayrshire Council areas. Legislation requires, that the Health Board is common to all three, and the Partnerships take cognisance of each other’s priorities, particularly the implications that these may have for the Health Board. Where specialist services are managed by a ‘Lead Partnership’, the Strategic Plan includes reference to the vision and priorities for those services.

The Partnership’s Head of Community Health and Care is the Chief Social Work Officer (CSWO), reporting directly to the Partnership’s Director and also to the Chief Executive of South Ayrshire Council. The CSWO is a member of the Partnership’s Integration Joint Board, comprising of members nominated and appointed by NHS Ayrshire and Arran and South Ayrshire Council; the Partnership’s Directorate Management Team comprising the Director and senior managers responsible for health and care services; and is a member of, and adviser to South Ayrshire’s Chief Officers’ Group for Public Protection(COG), which has responsibility for the strategic leadership and oversight of delivery of services and for improved outcomes for Child

7 Protection, Adult Protection and Offender Management (MAPPA) issues affecting South Ayrshire. During the organisational changes of the last 2 years, the APC has continued to report to the South Ayrshire Chief Officers’ Group for Public Protection

2.2 ASP Reporting The Council’s Adult Protection responsibilities are contained within the Adult Support and Protection (Scotland) Act 2007. Specific responsibilities under the Act apply to adults (16 years and over) who are known or believed to be at risk of harm and meet the 3 point test of the Act:

 They are unable to safeguard their own well-being, property, rights or other interests;  Are at risk of harm; and  Are vulnerable to being harmed because they are affected by disability, mental disorder, illness or physical or mental infirmity.

The multi-agency South Ayrshire Adult Protection Committee (APC) undertakes a strategic and monitoring function in relation to the implementation of the Act and its associated responsibilities and is convened by an Independent Chair. A range of public bodies and their office holders have a duty to report Adult Protection concerns and to co-operate with adult protection enquiries made by the Council.

The Adult and Support Protection process involves an initial inquiry into any concerns reported. This may be followed by an investigation where harm is identified and the Adult meets the three point test contained in the Act. In some instances this will lead to a multi-agency case conference (which the adult is invited to attend) in order to further assess risk and agree a Protection Plan for the adult. When it is felt necessary, the Act allows the Council (or the adult) to apply for Protection Orders to assist with supporting and protecting the adult. These Orders (for assessment, removal or banning) must be applied for to the Sheriff Court.

3. Management Information-Summary of Performance and Trends

3.1.1 The graph below clearly outlines that from 2013–2014, there has been a year on year increase in the numbers of ASP referrals. During 2014/15 this increased yet further. There has been a total of 1581 from April 2014-March 2016, in contrast with 824 during the previous Biennial reporting period of 2012-2014. This is an increase of 190%. Analysis of referrals indicates that this sharp increase can be attributed to the introduction of new adult support and protection procedures and awareness raising training with external agencies.

3.1.2 The proportion of referrals which progressed to a formal Adult Support and Protection investigation increased from just over 1 in 7 (2012/13 – 2013/14) to just under 1 in 10 (2014/14 – 2015/16). This is attributed to more effective

8 application of the guidelines and ASP criteria and assessment of risk at the initial inquiry stage.

Adults Support and Protection (Scotland) Act 2007

2012/13 2013/14 2014/1 2015/1 5 6 Adult Support and Protection Referrals 275 549 736 845 Adult Support and Protection Case 109 125 125 194 Conferences Adult Support and Protection 68 49 64 101 Investigations

3.1.3. South Ayrshire Council also monitors ASP referrals with its benchmarking partners which confirm a consistent upward trend and also that South Ayrshire continues to receive an above average rate of referrals in comparison to the other Ayrshire Councils.

Total number of ASP referrals per local authority, by head of population:

Per Per 2014/2015 100,000 of 2015/2016 Total 100,000 of Population Population East Ayrshire Health and 552 451 511 1063 419 Social Care Partnership South Ayrshire Health and 736 651 845 1581 751 Social Care Partnership North Ayrshire Health and 812 595 697 1509 512 Social Care Partnership

3.1.4 The APC links with the Care Inspectorate (CI) enables a good exchange of information about the performance and quality of regulated care services in South Ayrshire. This has allowed the scrutiny and improvement work of the CI

9 to inform services and to take any actions which might reflect a poor performing service.

3.1.5 As in previous years the greatest number of referrals continued to come from Police (1103), representing 61% compared with 56% the previous year. The number of referrals from Social Work has increased slightly over the past year from 40 in 2014/15 to 56 in 2015/16. Around 12% (101) of all referrals resulted in an investigation during 2015/16, which is slightly higher than the previous year at 9% (64). There has been an increase in the number of case conferences in 2015/16 (194) which is 51% higher than the previous year (125).

3.1.6 The increase in adult support and protection referrals and the requirement to respond to all referrals is having a significant impact on workloads for all Community Care Teams. In particular an area where real pressure is being experienced is in relation to the statutory duties associated with Mental Health Officers (MHO’s). The workload in this area is significantly greater with a noticeable increase in private guardianships and is placing significant pressure on our ability to meet our statutory duties. It is recognised however, that this is not just an issue for South Ayrshire but is also being experienced nationally.

10 3.2 AUDIT

Audit Activity South Ayrshire Adult Protection Committee is committed to the process of self- evaluation. Two multi-agency audits were undertaken in September 2015 and February 2016.

3.2.1 The first audit focused on one distinct area of adult protection intervention and this included a sample of 10 cases. All referrals to the Health and Social Care Partnership for ASP result in an Inquiry with some proceeding to Investigation and further action. The cases included an adult protection intervention and follow up case conference.

A multi-agency case-file Audit Planning Group was formed to plan and prepare for carrying-out the audit. This included representatives from South Ayrshire Council Adult Protection team, NHS Ayrshire & Arran, South Ayrshire Health and Social Care Partnership, Police Scotland and Scottish Fire and Rescue Service. The Planning team agreed on the scope of the audit and the specific Quality Indicators to be used.

Areas of good practice from the audit were:  Most individuals and their families felt that they were treated with respect and as individuals felt well supported and kept informed about the ASP process.50% of individuals felt that they had good support from all the professionals involved.  All practitioners involved felt that they had been well supported and had the appropriate range and level of knowledge and skills required; managers felt that they had a sufficiency of appropriate resources available to deal with the relevant cases and that they were well supported to do so.  In the majority of cases, ASP concerns were responded to timeously and proportionately.  There was also clear evidence of the assessment and management of risk being used to keep people safe. In almost all cases, there was clear evidence of the assessment of the individual’s wider needs, and clear evidence of appropriate additional resources being used to meet the individual’s needs.  In all cases, the individuals concerned felt that they were listened to and their views respected.

11  Almost all cases evidenced that the individuals had been offered an advocacy service and the majority of the individuals had taken up the offer. In all cases there was evidence of a human rights approach to ASP.

 Where families were involved, the individual and their family were always enabled to take part in key decision-making processes. In the majority of cases there was clear evidence of effective inter-agency working, with a clear understanding of the different roles and responsibilities and effective information sharing. The establishment of the Council Officer Forum was reported by practitioners to be a useful and effective support in the development of their own knowledge, skills and practice.

The results from two case files read pointed to a number of areas for improvement, and these are summarised below:

 There is a need to ensure that ASP policy on the response to repeated referrals is adhered to. File-readers were concerned that, in terms of the assessment of risk and the overall risk to the individual and focus on a specific incident, recorded actions did not take account of the “bigger picture”. Case- notes within these files contained little clear evidence of effective planning and little clarification of the outcome or impact of support put in place. In the absence of such evidence it was difficult to gauge the extent to which the individuals were in fact being kept safe or having an improved quality of life.  In these two cases, there was little evidence of comprehensive assessment of the individual’s needs and a lack of evidence of the impact of supports/interventions as there was no systematic review of the case following a specific/critical incident. There appeared to be little leadership/management to support the worker and formally review the case.  There was also an issue of whether or not an individual had capacity to consent to, or meaningfully engage in the ASP process; and in some cases the case-notes did not appear to reflect the amount or detail of good, effective work that had taken place.

3.2.2 The second audit took place in February 2016 which focused on ASP referrals to social work services. This included decisions and subsequent actions taken as a more robust system was developed with paperwork now available on the South Ayrshire electronic system. This has ensured that risk assessments became a proactive part of adult protection investigations.

This audit was based on all ASP referrals received between September 2015 and December 2015. A 25% sample of referrals from each month was selected

12 at random and resulted in a total of 54 referrals being reviewed. Following an initial planning meeting, it was agreed that the audit would look at all the different stages of the ASP referral/action. Information was gleaned with respect to the extent to which the “3 Point Test” for an “Adult at Risk” had been applied and appropriate actions had been taken. Actions taken were within timescales identified in South Ayrshire ASP procedures, decisions made were clear and justifiable and associated paper work had been completed appropriately.

In summary, the materials sampled provided some evidence of good practice in the process of supporting and protecting adults at risk of harm. However, the audit also pointed to a number of areas where improvements with respect to practice, process and adherence to required timescales could be improved.

Recommendations from this audit were:

 South Ayrshire Council Adult Support and Protection Operational Procedures/Local Operating Procedures should be reviewed and updated (in line with West of Scotland Inter Agency Adult Support and Protection Practice Guidance (2015)).  The review should consider how best to record, and provide operational support where an individual is the subject of multiple referrals.  Council Officer Refresher Training should be developed and delivered to all current Council Officers. The training, which should be practice-based, should include coverage of the range of issues identified from the audit:  A system of ongoing and systematic review of Adult Support and Protection referrals by Operational managers should be introduced.

Recommendations

There were a number of recommendations and suggestions for action which the Adult Protection Committee requested be developed into an Action Plan. Some of these related specifically to the operational arrangements in place to support and protect adults at risk of harm and others related to the development of the self-evaluation and auditing of these activities. This action plan is actively being worked on and is evidencing a more joined up approach to working together to keep individuals safe.

Section 4 - National Priority Workstreams

The APC has continued to adhere to the Scottish Government’s national priority workstreams, first approved in 2012.This has assisted in maintaining a long term view of key factors affecting adults in need of support and protection and has allowed the

13 APC to take into account any changing circumstances evident from the experience of frontline staff.

4.1 Residential Care and Self-Directed Support

The Adult Protection Committee reviewed performance of this priority workstream in 2014 and decided that in addition to our monitoring of regulated residential and home care services we would also focus on Self- Directed Support (SDS). This reflects the higher number of vulnerable adults living in their own homes and who may opt to manage their own care. This is a positive alternative for some individuals and still requires public authorities to exercise their duty of care and so minimise risk.

The APC acknowledges the many personal benefits that self-directed support can offer people who need support in their lives. Over the last two years self-directed support has been fully incorporated into local statutory assessment and procurement processes across South Ayrshire. Uptake is still low but not significantly less than the national average. The APC has made active links with the Lead Council Officer for SDS and the Ayrshire Independent Living Network (AILN), a local agency commissioned to guide and support people who choose the individual personal budget option. The Committee is interested in monitoring local trends, particularly in the emergence of an unregulated workforce. Through these links the APC receives regular updates, and actively promotes local adult protection awareness through information sharing and training offers for recipients of SDS budgets and for personal assistants employed by recipients.

4.2 Financial Harm

This workstream has been led locally by Trading Standards who have developed a strategy to assist vulnerable and older adults to live safely within the community. This has initially included a focus on how to prevent incidents of individuals becoming victims of scams and bogus traders approaching local consumers on a cold calling basis deceiving them into paying large sums of money for poor services and parting with some large sums made as cash payments. The importance of devising a local strategy has been based more on local reporting of incidents than on objective data. This reflects the high rate of under-reporting of such scams nationally.

14 The reporting by Police Scotland in 2014 of South Ayrshire incidents of mail and phone scams by rogue traders was 32 individual incidents targeted at 80% over 60 years of age. There is a comparable figure of 34 alleged doorstep crimes recorded by Trading Standards in 2014-15.

As part of this strategy, the increasing reporting of financial harms has caused the APC to engage on a local level with banks and other commercial lenders where there is a suspicion that customers are being subject to financial harm. This has been nationally evidenced in a variety of ways, from individuals purporting to be from the individual’s own bank, or from police advising the customer that there is a criminal investigation into the customer’s bank .This has resulted in the individual being advised to withdraw and transfer funds into a” safer “system.

Towards the end of this reporting period a short life working group was set up with a Pan Ayrshire approach led by South Ayrshire .The pan Ayrshire group included trading standards, operational social work staff as well as managers of services. The group’s purpose has been to develop information leaflets and advice for the general public. There will also be clear guidance for staff across the Health and Social Partnership as well as all staff groups who work with individuals in relation to financial harm. The work is almost complete and will be reported on more explicitly in the next reporting period.

South Ayrshire has also contributed to the work of the National Financial Harm Prevention Group which has been an all Scotland initiative to develop joint protocols and commitments to eradicating financial harm, and which has been aimed at devising a more structured approach to raising awareness at corporate and operational levels within the public and private sectors of financial harm as a major and growing issue within all communities. This will develop further the local initiative taken in South Ayrshire and ensure that frontline staff are able to spot the signs of financial harm and that through policy and training; appropriate preventative actions are taken where harm is suspected

4.3 ASP in Accident & Emergency

During this reporting period there has been ongoing work in relation to how acute emergency services are engaged in adult support and protection. The new Emergency Department(ED) within University Hospital Ayr and the Combined Assessment Unit (CAU) will ensure a more person centred approach to enable individuals to return home or to a homely environment more quickly.

There has been ongoing work with the Clinical Nurse Manager for ED and CAU who has responsibility in both areas and the ASP training and development team within

15 the South Ayrshire Health and Social Care Partnership. This has been successful in developing a new bespoke training package for all nursing and medical staff. This innovative training package is supportive of the current” Learn pro” which is a basic online ASP package. This training will be rolled out in the next Biennial period within the South Ayrshire Partnership initially, and then more widely pan Ayrshire.

The object of this bespoke training is to use different case studies to highlight risk and vulnerability through:

 Improved identification of adults at risk within a short assessment period.  Improved understanding of the reporting responsibilities of NHS staff.  Raising awareness of who has prime responsibility for raising ASP referrals for distressed adults and sharing this within the ED and CDU and also with partner agencies.

4.4 Data The national work stream for collecting consistent data across Scotland has been piloted and incorporated into the performance information routinely considered by the APC. Collation of this information has proved to be subjective as the national data collation analysis has illustrated wide variations in the reported position across local authorities.

In 2016 it is hoped that the reporting position of local authorities can be examined closely to establish whether there are real differences in ASP activity across Scotland or whether the differences are attributable to recording and reporting practices. If the latter, it will be necessary to further refine the guidance that is required for further data collection.

The South Ayrshire Social Work Information System (SWIS) has been further developed during 2015 to incorporate both the AP1 which is the Inquiry and AP2 which is the Investigation and Risk Assessment. This has vastly improved reporting as well as practice which can be seen by the increase in investigations and case conferences within South Ayrshire.

There have been 2 audits undertaken by the Adult Protection Co-ordinator and training and development officer within this Biennial period which has been supportive to both operations and the APC. From this audit data reporting to both the APC and

16 the COG will be more outcome focussed, measuring how our intervention in relation to ASP supports an individual to remain safe or safer as a result of our intervention.

From the multi-agency audit in September 2015 and the audit of AP1 and AP2 in February 2016(referred to at 3.2) an audit action plan has been developed. The action plan is updated and presented quarterly to the APC with a short report detailing improvements also taken to the COG quarterly.

4.5 Service User and Carer Engagement

The APC’s focus on supporting service users and carers was led by Voice Advocacy for the period 2014-16.Following a change to the commissioned service, Circles Network is the new advocacy provider from April 2014.

During this time, agreed best practice with the South Ayrshire social work department and then from April 2015, the Health and Care Partnership was to support anyone under adult support and protection (ASP) measures to be offered an independent advocate to assist the individual to express views at meetings or other areas requiring representation through advocacy.

When attending ASP case conferences the advocate's role is to support the advocacy partner to express their views or take instruction and advocate on the advocacy partner's behalf. Advocacy would arrange an initial interview before the ASP Case Conference to obtain the partner's views and to ascertain if the advocacy partner wished to attend the meeting. If the individual did not wish to attend the meeting they would have the option to instruct the advocate to attend the meeting on their behalf. In such circumstances the advocate would meet up with the partner shortly afterwards to feedback what actions had been agreed or go over the minutes once received and then obtain the partner's views on the outcome.

The third Biennial Report included results of a questionnaire seeking the advocacy partner's views on the adult support and protection procedure used by South Ayrshire Council. All advocacy partners who had been under ASP were contacted and asked if they would like to participate in completing a questionnaire surrounding the process. An appointment was arranged to go through the questionnaire with those Advocacy Partners who agreed to participate. The outcome entailed very few completed questionnaires.

17 Over the last 2 years the then Manager of Voice Advocacy service contributed to the work of the APC and provided detailed reports on the impact of advocacy involvement.

The main issue brought to the APC between 2014 -16 was that not all people referred under ASP were being given the option to have advocacy support. This can arise where the individual is asked if she/he wishes to accept an offer of advocacy support and where there had been a refusal or reluctance, that advocacy was not being proactively encouraged. The APC has aimed to ensure a greater percentage uptake under these circumstances and will continue to monitor rates of advocacy involvement, which has to date been at a rate of 10% of all referrals for ASP.

From April 2016 Circles Network was commissioned to provide a professional issue- based Advocacy service to vulnerable people, aged 16 and over, whose circumstances include, but are not restricted to, mental health issues, mental/personality disorders, learning disabilities, personality disorder, physical disabilities, acquired brain injury, dementia and autistic spectrum disorders, as well as chronic illness and who are unable to safeguard their own well-being, rights, care or other interests.

In terms of continuity of advocacy services from the previous to the new provider, 39 people were introduced to Circles Network Advocacy including 13 existing Adult Support and Protection referrals from Voice Advocacy.

Section 5 Initial and Significant Case Reviews

Reports of an Initial Case Reviews (ICR) have been an important part of the APC’s responsibilities for reviewing the background factors which have been present at the time of a significant incident. This has usually followed a report of a completed suicide, some other accidental death or concerns about self-neglect for which a review of service supports and systems is indicated.

There were 8 ICRs reported between 2014-16 and of these 3 also led to a more detailed consideration by a Significant Case Review (SCR).These focused on two adults who had completed suicide and who were jointly reviewed following separate processes of individual Initial Case Reviews in 2015.A third adult who tragically died as a result of a fire in her sheltered home was also considered under the SCR process.

In the case of the 2 individuals who completed suicide, the information gleaned during separate ICRs indicated a number of common factors. An SCR Panel, comprising representatives from Housing, Health (both Acute A&E and mental health), Social Work, Police and the Health and Social Care Partnership was convened to consider

18 all available information, including whether anything could have been done to anticipate the events leading to these suicides.

The Learning Points from the first two SCRs included the following recommendations:

 Escalation of action under adult support and protection is required by the Health and Social Care partnership when 3 separate referrals of concern have been received’  Individuals with a history of borderline mental health may be unable to be fully supported by clinical services. It is important to consider all options available, including community supports as part of a management plan.  Assessment of need as a possible vulnerable adult remains the key starting point for any consideration, and this requires time for direct contact with a vulnerable individual.  Individuals, who make multiple referrals to a range of agencies, require some coherent approaches based on up to date care plans.  Review current systems of prioritisation for certain individuals who are not considered to be in a “critical” or “substantial “need for care including hospital discharge to ensure that any service variation can be offered.This may require to be developed through a more specialised ASP Team approach.  The parallel consideration by the multi -agency ICR/SCR process can also overlap with an NHS Adverse Event Review (AER) for mental health, and can lead to both delays in reaching conclusions and also in coordinating any direct approaches to nearest relatives. This is currently the subject of a review of AER processes on a pan Ayrshire basis.  Each agency with responsibility for adult support and protection should apply a standard question of ”Is this a concern to be considered under ASP?”

The third individual about whom a Significant Case Review had been convened had been in sheltered housing when a fire had accidentally been started in the individual’s own home.

The key learning points included:

 Staff providing domiciliary support to promote independent living in the community should be continually vigilant about any new factors which might constitute a risk to the individual or others.  Risks to immediate safety may require key staff to convene to consider if these materially alter a care plan about an individual’s ability to remain in independent living.

19  Commissioned services for independent living should maintain regular reviews of any material changes in lifestyle and advise the Health and Social Care Partnership which has overall responsibility.  Systems of Telecare require proper evaluation of functions to ensure that where a fire alarm is activated, this does not render the existing communication system of the alert equipment to be disengaged, resulting in alert operational staff not being in communication with an individual using this service.  The Policy issues of independent living must ensure there is a clear understanding in practice that “shifting the balance of care” must always be based on the best interests of both the individual and others living nearby.  The learning points from the remaining 5 ICRs have also been instructive in terms of how services may require to alter approaches to certain individuals. In the case of 2 individuals who had been well known to a number of agencies and where there had been well coordinated arrangements in place. The APC saw evidence of committed staff jointly acting to mitigate the risks.  One other ICR was undertaken jointly by the Child and Adult Protection Committees in regard to an adult and a child whose living conditions were poor, including hoarding of refuse within the home which also had no means of heating. As the adult and child continued in work and school respectively, there had been no previous causes of concern until a neighbour had alerted environmental health services about home conditions. As this was an example of a household about which there had been no previous concerns, it was only when a direct contact was made and the living circumstances observed that the scale of self-neglect was fully witnessed. This has provided excellent formal learning for a range of personnel across all disciplines.  These events have highlighted the continuing importance of recognising how certain “distressed adults” require coordinated responses with appropriate interventions during and after the particular crisis event. This is part of a national concern but which continues to require local application on a pan Ayrshire basis.  The APC has also tried to engage directly with frontline staff to hear their views about where any gaps in service had been evident. Each professional inevitably feels a strong sense of commitment to the individual and a great sense of loss and professional guilt where a suicide is completed. It is important to maintain such engagement both to learn from direct frontline experience and also to convey a strong support from the APC to frontline staff.

20 . 6. Training

Training and Development

Introduction

In South Ayrshire there continues to be a rolling programme of multi-agency training and also pan-Ayrshire training in Adult Support and Protection. South Ayrshire has one dedicated Training and Development Officer for adult protection, and also makes use of a small number of external trainers to deliver the training programme.

Levels 1, 2 and 3 Cross Sector Training There are three levels of dedicated ASP training aimed at staff in all sectors depending on their particular role in Adult Protection. These are as follows:

Level 1 training is aimed at all staff who come into contact with adults in carrying out their respective role within the local authority, health, third and independent sectors. The aim of this training is to provide a basic introduction to the Adult Support and Protection (Scotland) Act 2007.

Level 2 training is also across all sectors, aimed at staff whose responsibility is to make Adult Protection referrals. The aim of this training is to provide a more in depth knowledge of the Adult Support and Protection legislation and the local operating procedures.

21 Level 3 (Council Officer) training is aimed at local authority Social Workers with one year’s post qualifying experience who will be required to undertake the role of Council Officer as part of their duties. The aim of this course is to provide a detailed knowledge of the Adult Support and Protection legislation and the specific duties, powers and responsibilities of the local authority.

The content and delivery of each of these is currently being reviewed on a pan- Ayrshire basis, with a target of piloting delivery in early 2017.

The ASP training delivered in South Ayrshire includes investigative interviewing, 2nd person interview skills, risk assessment and risk management. Additional training inputs are developed when a particular need is identified. In this reporting period these have included:

 Defensible Decision Making and training for Council Officers on the introduction of new on-line processes for the completion of AP1 and AP2 forms.  A series of Fire-safety/Telecare briefings developed and delivered to all Community Care social work teams, with further deliveries planned beyond the end of this reporting period for home-carers. This followed the Significant Case Review in 2015,referred to previously in this Report.  Briefings for Police Scotland across Ayrshire were targeted at community- based Sergeants, who would further cascade the information to their own officers. Ten of these briefings were delivered in Ayr, Kilmarnock and Irvine police stations.  “On site” for specific services including local care homes, a GP practice, an advocacy service and a specialist day-care service for people with dementia.  Council Officers - 2015-16 saw the introduction of a pan-Ayrshire agreement to plan and share the co-ordination and delivery of Council Officer training. Previously, each authority would arrange its own training, with a one-off delivery in each year. The agreement has enabled each authority to schedule a delivery of the training over the course of the year, with a four month gap between each course. Each authority now has access to at least five places on each course, which has proven to be most effective.  For 2016, Council Officer training has been delivered to South Ayrshire Council’s Young People’s Support and Transitions Team. This was largely precipitated by a need for greater clarity around the issues of at-risk young people aged over sixteen years who were in danger of falling between the services and a” changing focus between adult support and protection and child protection. This has ensured better service continuity at transitions.  Briefings to Elected Members – following the commencement of the Health & Social Care Partnership resulting in changing governance, a seminar for members on Public Protection has enabled current issues experienced by

22 front line practitioners and monitored by the APC to be shared with elected members.

Overview of training delivered, 2014-16

South Ayrshire Council ASP 2014-15 2015-16 Total Training ASP Level 1 132 286 418 ASP Level 2 77 121 198 ASP Level 3 (Council Officer) 6 44 50 Interviewing Skills 22 6 28 Adults with Incapacity 33 33 Older People/Domestic Abuse 12 12 Risk Assessment/Management 13 13 Adult Protection Awareness 38 38 Chronologies 23 23 Crossing the Acts 15 15 Second-person Interview Skills 7 7 Fire-safety/Telecare Briefing 72 72 Defensible Decision Making 72 72 SWIS AP1/AP2 72 72 1051

In addition to specific training deliveries, a number of training and development events have been held over the period:

23  In September 2014 a pan Ayrshire learning event focussed on” People in Distress” with learning focussed on the experience across the 3 Ayrshire council areas for local case reviews.  In September 2015 a pan-Ayrshire learning event on “Self Neglect” was planned and hosted by South Ayrshire. This was a follow up to the 2014 event and attended by around 90 people from a range of disciplines, predominantly frontline practitioners. This featured a key-note speaker (Professor Michael Preston-Shoot, University of Bedfordshire), real-life practice case-study presentations and a series of workshops. The event allowed for consideration of how frontline staff can build up evidence to understand the factors which might typically feature as a series of individual concerns but which over time indicate serious concerns about an individual and the need to take confident supportive and protective actions.

The day was evaluated very highly by participants and provided valuable information for improving practice with individuals who, by the nature of their circumstances and behaviour are particularly challenging and difficult to support in the community. The whole day was also filmed, resulting in the production of a range of film material which has subsequently been used at other training and development events across Ayrshire. (A follow-up event, “Trauma through the Lifespan” was held in May 2016 was equally successful but will be reported on the next Biennial reporting period). Further learning and development opportunities have been provided through the regular Council Officers’ Forum and Mental Health Officers’ Forum (both locally and pan-Ayrshire). Practice issues and information and guidance on new legislation feature regularly, as do guest speakers. This was an opportunity for the Independent Chair of the APC to make an informal presentation of the APC’s priorities and to hear views and discussions with this key group of frontline staff about their challenges in ASP issues. These fora also provide an opportunity to facilitate practice discussions and identify training needs/interests which can be addressed. An example of this is the recent development and delivery of training on Personality Disorders which has been a feature of the APC’s work in Initial and Significant Case Reviews. This was very well received and provided a valuable link with practitioners, in terms of learning points from such reviews. Information from all these sessions is now available on web-based forua, dedicated to Council Officers and Mental Health Officers, which as well as providing opportunities for discussion, have been developed as repositories for ongoing useful information exchange and guidance. In order to maintain a high level of training and development, the Adult Protection Co- ordinator and the Learning and Development Officer each engages in a wide range of learning/development activities, including involvement and partnership working with colleagues on national, West of Scotland and pan-Ayrshire bases. Each is also

24 involved with a wide range of local services, projects and fora where they can provide information and advice, gather information and engage with contacts, helping to promote and develop the practice of keeping adults at risk safe.

Planning for 2016-18

The training plan for 2017 is flexible and able to be adapted in the light of changing needs for training of key staff groups. This currently includes:

 Piloting revised content and delivery of ASP Levels 1-3  Continued delivery of ASP Levels 1-2 training on a multi-agency basis  Development of Councillor Officer (Refresher) training and for this to be offered to all current Council Officers  Development of Council Officer handbook  Delivery of Level 3 (Council Officer), Investigative Interviewing and Risk Assessment/ Management to be agreed, planned and shared on a pan- Ayrshire basis.

7. Conclusion

During this period of continuing organisational change the Adult Protection Committee has sought to maintain business continuity by monitoring the effectiveness of Adult Support and Protection services. The opportunities for joint working presented by the Health & Social Care Partnership and its partners will ensure that we keep a firm focus on the needs of the most vulnerable individuals in our communities.

25 We remain vigilant on behalf of an ageing adult population whose supports from family, friends and neighbours we value in this joint work. More progress is still necessary as emerging challenges and any threats to wellbeing, direct or indirect, continue to be responded to with high levels of commitment and integrity across all partners.

Appendix 1

Committee Members

David Cumming Pauline Draper Independent APC Chair Divisional Housing Co-ordinator (January 2014) South Ayrshire Council

Jim Deas Frank McMenemy Voice Advocacy Services Senior Manager for Learning Resigned March 2016 Learning Disability & Sensory Health & Social Care Partnership

Joanne Doolan Liz Roy Circles Network Senior Manager (April 2016) Service Hubs H & SCP

Roddy Wright Carol Fisher Operations Director Senior Manager Hansel Alliance Mental Health H &SCP

Karen Briggs Albert Bruce Legal & Licensing Station Manager Manager Scottish Fire & Rescue

26 South Ayrshire Council

Sandra Rae Angela O’Neill ASP Co-ordinator Associate Nurse Director South Ayrshire Acute Services Council (January 2014)

James Hendrie Inspector Police Scotland

Hamid Gazem Team Leader Environmental Health & Trading Standards

Kenny Leinster Head of Service for H& SCP, and Chief Social Work Officer

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