Information Booklet

March 2013

Course Objectives 3

Course Programme 3

The Facts of the Borders Investigation& Lessons to be Learned 4

Adult Support & Protection (S) Act 2007 7

When is an ‘adult at risk’ of harm 7

What do we mean by ‘harm’ 7-11

Principles of Act – Ethical and good practice guide 11-12

Capacity & Consent 13

Duty to Report & Cooperate -What to do when concerns arise 14

Dilemmas in adult protection 15-16

Inquires and investigation 16

Protection Orders 16

Adult Protection Committee 17-18

Useful Information 19

Course Objectives

•Introduce the Adult Support and Protection (S) Act 2007 (ASP Act)

•Introduce the overarching principles of the ASP Act

•Develop and understanding of what we mean by an “adult at risk”

•Explore signs and symptoms of an adult at risk of harm & context of harm

•Know your role if you observe or suspect that an adult is at risk of harm

•Explore the key processes and concepts in Adult Protection

•Introduce the three Protection Orders of the ASP Act

Course Programme

Session 1 - AM / Session 2 - PM
9.30 / Registration &Introductions / 13.30 / Registration &Introductions
Adult Protection Committee / Adult Protection Committee
Background to the Act / Background to the Act
The 2007 Act / The 2007 Act
Exercise - Threshold / Exercise – Threshold
Harm / Harm
10.45 / Break / 14.45 / Break
11.00 / Duties and Cooperation / 15.00 / Duties and Cooperation
Principles / Principles
Exercise – AP1 / Exercise – AP1
Processes in Adult Protection / Processes in Adult Protection
Protection Orders / Protection Orders
12.30 / Questions and close / 16.30 / Questions and close

The Facts of the Borders Investigation

& Lessons to be learned

On 1 March 2002, a woman was admitted to BordersGeneralHospital after she went to the house of a neighbour who found her to be badly injured and called the police and an ambulance. She was taken to hospital and was formerly medically assessed and was found to have multiple injuries of a physical and sexual nature. A police investigation revealed a catalogue of abuse and assaults over the previous weeks and much longer. Three men were convicted of the assaults later in 2002.

The woman was considered to have a learning difficulty. A series of events had led to her being cared for by one of the convicted offenders. Over many years dating back to early 70s, there were events and statements in records held by social work, health services and the police that raised serious concerns about this person's behaviour toward this woman.

The police investigation identified that other individuals within the Borders area were receiving care under similar circumstances. The adults in these sitautions had varying degrees of learning disabilities, physical disabilities and mental health needs, which were largely neglected, to the point of becoming potentially life-threatening for some.

Health and social work records contained numerous statements of concern about their care, including allegations of serious abuse and exploitation that were not taken seriously and acted upon.

From late 2000, the lives these individuals became increasingly chaotic. They were neglected, lived in unsuitable and unsanitary conditions and were financially and sexually exploited.

The people involved had numerous contacts with:

  • Social Workers
  • General Practitioners
  • District Nurses
  • The local Learning Disability Specialist Team
  • General Hospital Services
  • Dieticians
  • Police

In June 2003, the Minister for Education and Young People asked the Social Work Services Inspectorate (the Inspectorate) to carry out an inspection into the social work services provided to people with learning disabilities by Scottish Borders Council's Department of Lifelong Care.

Within a similar timescale, the Mental Welfare Commission (the Commission) carried out an investigation into the involvement of health services in this case, paying particular attention to joint working between health and social work services.

In order to protect the identities of the individuals involved, the Mental Welfare Commission does not usually publish full reports of its investigations. Reports are provided to the key agencies, in this case NHS Borders and Scottish Borders Council and in anonymous form to Scottish Ministers.

Despite the different scope and remit of the Inspectorate's investigation and the Commission's inquiry, the two organisations liaised closely throughout their respective investigations to ensure appropriate information-sharing and avoidance of duplication wherever possible. Set out below is a summary of the main findings of both investigations, followed by their recommendations in full. Border Inquiry Findings

THE FINDINGS OF THE INVESTIGATIONS

Listed below are the main findings from both investigations. Although some of the findings are common to both investigations and some are directed at the relevant service, they are listed together to emphasise the importance of joint working in cases such as this one.

  • failure to investigate appropriately very serious allegations of abuse
  • an acceptance of the poor conditions in which the people involved lived and the chaos of their lives
  • lack of comprehensive needs assessments, including carers' assessments, or assessments of very poor quality, despite clear and repeated indications of need from the earliest point of agency contact
  • lack of information-sharing and co-ordination within and between key agencies (social work, health, education, housing, police)
  • disagreements between agencies at frontline and middle management level, with no mechanism for resolving these
  • unsustained contact with the individuals by the specialist Learning Disability service
  • failure by some members of the Primary Care Team (GPs and District Nurses) to act on information about poor home conditions and to make these concerns known to the social work service
  • lack of risk assessment and failure to consider allegations of sexual abuse
  • very poor standards of case recording, falling well below acceptable practice
  • lack of care plans identifying the purpose of contact with individuals
  • lack of understanding of the legislative framework for intervention and its capacity to provide protection
  • failure to consider statutory intervention at appropriate stages
  • failure to understand and balance the issues of self-determination and protection
  • failure to protect the finances of vulnerable individuals
  • inability and/or unwillingness to confront aggression and staff's consequent collusion with aggressors to the detriment of victims
  • lack of understanding of the complexities of child/adult protection and of the need to explore all allegations of abuse and the possible reasons for retraction of these
  • failure to communicate with service users or to engage them effectively in assessing their needs
  • lack of compliance with procedures
  • infrequent, unstructured and poorly recorded supervision of frontline staff by managers
  • serious deficiencies in training and development
  • lack of clarity of roles and reporting responsibilities
  • uninformed and inaccurate assumptions of individual staff expertise in particular areas and consequent dangerous reliance on this
  • lack of senior management and leadership
  • ineffective management of poor practice
  • breaches of the Scottish Social Services Council Code of Practice for employers

A total of 42 recommendations were made

  • 12 refer to the need for better information sharing
  • 13 refer to better interagency working
  • 7 refer to agency or interagency training
  • 10 refer to improvement in investigation recording and case conferences
  • 5 refer to risk assessment
  • 8 refer to issues of quality assurance and monitoring

The Borders Inquiry findings and recommendations highlighted our responsibility as public organisations and professional people to support and protect those adults in our communities who are at risk of harm. In order to achieve this, we require to work closely with each other, across all the agencies communicating effectively and sharing appropriate information and concerns to raise awareness of adult harm and the forms this can take and provide support through the available legislation and the provision of appropriate responses and services.

This is why we welcome the new Adult Support & Protection Act 2007 to sit alongside other adult legislation currently in place

The Adults with Incapacity (Scotland) Act 2000

The Mental Health (Care & Treatment) (Scotland) Act 2003

The AdultSupport & ProtectionActMultiagency Level 2 training will advise of what the new Act does to further support and protect adults at risk of harm in our communities.

Adult Support & Protection (Scotland) Act 2007

Definition of an ‘adult at risk’ of harm

The Adult Support and Protection (Scotland) Act 2007 (Section 53) defines an ‘adult at risk’ as:

Any adult aged 16 years or over that can meet the three conditions set out in the 2007 Act Section 53 which defines an ‘adult at risk’.

An adult at risk is an adult who:

  • is unable to safeguard their own wellbeing, property, rights and other interests
  • is at risk of harm; and
  • because they are affected by disability, mental disorder, illness or physical or mental infirmity, is more vulnerable to being harmed than an adult who is not so affected

All 3 points of the criteria above must be met for action to be taken under the Act

It is important to note that the existence of a particular condition does not mean that adult is at risk. A person may have a disability and be able to safeguard themselves.

For those aged 16-18 years this will also apply unless the person is the responsibility of the local authority under child care legislation

What do we mean by ‘harm?’

The definition of harm/abuse can be wide and varied and has been defined as:

"The physical, emotional or psychological abuse of an older person by formal or informal carers. The abuse is repeated and is the violation of a person's human & civil rights by a person or persons who have power over the life of a dependent."

(Eastman 1984)

"Abuse may be described as physical, sexual, psychological or financial. It causes harm to the older person either temporarily or over period of time. "

(SSI Report 1997)

"A single or repeated act or lack of appropriate action, occurring within a relationship of trust, which causes harm to an older person."

(ACTION ON ELDER ABUSE Oct. 1997)

Harm or abuse, in terms of the Adult Support and Protection (Scotland) Act 2007 includes all harmful conduct whether it is intentional and/or non-intentional. The following list of types of harm is not exhaustive:

Physical

This involves actual or attempted injury. Examples include:

Physical assault e.g. punching, pushing slapping, tying down, giving food or medication forcibly or covertly.

Use of medication other than as prescribed.

Inappropriate restraint. E.g. using bedsides to prevent someone getting out of bed or locking doors to keep people in.

Emotional/Psychological

This results in mental distress for the adult. Examples include:

Swearing, shouting, bullying, humiliation.

Manipulation or the prevention of the use of services or facilities, which would aid or enhance life experience.

Isolation or sensory deprivation.

Financial or Material

This involves the exploitation of the resources and belongings of an adult by paid or unpaid carers. Examples include:

Theft or fraud.

Misuse of money, property or resources e.g. spending a vulnerable adult’s benefit without their agreement or buying inappropriate goods that the adult will not benefit from.

Removal of personal items and belongings

Sexual

This involves sexual activity where an adult cannot or does not give their consent. Examples include:

Incest.

Rape, indecent assault e.g. inappropriate touching.

Acts of gross indecency.

Neglect (including self neglect)

This involves severe exposure of a person to danger, or failure to fulfil basic needs whether on a single occasion or on a persistent basis. Examples include:

Denial or lack of food, sleep, clothing.

Failure to provide for warmth, shelter, medical treatment.

Failure to provide for psychological wellbeing.

Denial of medication.

Failure to respect differences and resulting needs.

Random Violence

Random violence i.e. an attack by a stranger or strangers on an adult is an assault and should be reported to the Police. These assaults will not usually require the implementation of the procedures. However, there is a possibility that the violence may be part of a pattern of victimisation in a community or neighbourhood, and in this case, the Adult Protection procedures should then apply.

Domestic Violence

Police Scotlanddefines domestic violence as “any form of physical, non physical or sexual abuse, which takes place within the context of a close relationship, committed either in the home or elsewhere”. In most cases, this relationship will be between partners (married, cohabiting or otherwise) or ex partners.

Clearly, there are strong similarities within this definition and the definitions of an adult at risk. However, not everyone who experiences domestic abuse will satisfy the 3 point criteria of the Act. The key factor in activating Adult Protection Procedures in situations of domestic abuse should be an adult at risk as defined within this guidance.

Forced Marriage

A forced marriage is not the same as an arranged marriage. A forced marriage is when one or both spouses do not freely give their consent, or in the case of some adults at risk, cannot consent to the marriage and duress is involved.

Duress can include physical, psychological, financial, sexual and emotional pressure, threatening conduct, harassment, threat of blackmail, use of deception and other means. The duress may be from the parents, other family members and/or the wider community.

Forced marriage is not a cultural issue, no culture condones the marriage of someone against their will without full consent.

Some of the signs that someone might be being forced to marry could be:

  • a change in behaviour from outgoing to withdrawn
  • a change in dress from western to more traditional
  • signs of anxiety and/or stress
  • self harming, eating disorders
  • change of habits e.g. no longer attending extra curricular activities at school, not joining in other social groups etc.

Some forced marriages take place in Scotland with no overseas element while others involve a partner coming from overseas, or a British national being sent abroad.

The local authority can apply to court for a Forced Marriage Protection Order if they know or believe that a person who is now married was forced to do so. It can also be used for those currently being forced to marry against their will. Forced Marriage Protection Order make forced marriage a criminal offence carrying a 2 year prison sentence.

Clearly, there could be some occasions whereby an adult, due to a certain condition, could have limited understanding of the nature of marriage, what is involved, the commitments and how their life may change thereafter. There may also be issues in terms of the adult having limited understanding in terms of sexual relationships, making an informed decision and being able to legally consent to a marriage.

If you have any concerns, you must report these immediately to your line manager and Social Work Resources. Forced marriage procedures are now in place within South Lanarkshire Council.

Self Directed Support (SDS)

Self-directed support is the principle that people have informed choice about the way that their social care and support is provided to them. People canchoose to take a lot of control over their support – for instance through a direct payment or individual personal budget – or they can decide to take less control and ask the local authority to arrange their support on their behalf or a combination of both.

This legislation will change practice for professionals and will transform the way service users receive their care services. Some service users may decide to broker their own care services while others may choose to become employers and hire their own carers.

Whilstthis may improve service user choice and experiences it may also bring with it increased risks, for example:

  • unregulated services
  • no compulsory criminal records checks
  • support staff working in isolation: limited supervision and monitoring

If you have concerns about any adult who is in receipt of Self Directed Support you have a duty to report this to your line manager and Social Work Resources.

Context of Harm

For adults at risk, where harmful conduct and the potential for harmful conduct are from others, an unequal power relationship will exist.

An unequal power relationship can potentially be found in:

  • Someone’s own home
  • A carer’s home
  • Care Home
  • Work setting
  • Educational setting
  • Hospital /treatment setting
  • Social situations
  • A hostel or temporary accommodation
  • Accommodation with support.

Harm can occur in any setting where someone:

  • Can tell another what to do.
  • Provides intimate personal care.
  • Has status or credibility.
  • Meets essential needs material, social, or emotional.

Institutional harm is a familiar concept and involves conformity to routine, imposition of values and standards on users of the service to meet the needs of the institution and to the detriment of the individual. It should, however, be noted that it is possible for an adult at risk to personally experience harmful conduct in an institution without the institution as a whole being abusive.

For adults at risk of harm from their own conduct this may potentially occur in any setting.

Principles of Act

There are certain rights enshrined within theAdult Support and Protection (Scotland) Act 2007that must be respected when intervening in ‘adult at risk’ circumstances. The Act alsohas overarching principles which must be considered in relation to any intervention in the life of an adult at risk.

A public body or office holder must be satisfied that any intervention will provide

  • Benefit to the adult which could not reasonably be provided without intervening in the adults affairs and
  • Is, of the range of options likely to fulfil the object of the intervention, the least restrictive to the adult’s freedom

In addition the public bodies or office holders must also have regard to the following principles:-

  • Honouring the adult’s ascertainable wishes and feelings ( past & present)
  • Listening and acknowledging the views of adults nearest relative, primary carer, guardian or attorney and any other person who has an interest in the adults well being or property.
  • The importance of the adult’s participating as fully as possible in the performance of the function and providing the adult with such information and support as is necessary to enable the adult to participate.

Public Bodies or office holders must also have regard to: