Adult Support and Protection National Strategic Forum minutes: September 2021

Attendees and apologies

Attendees

• Kevin Stewart (chair), Minister for Mental Wellbeing and Social Care
• Iain MacAllister, Scottish Government
• Vikki Milne, Scottish Government
• Jamie Aarons, Scottish Government
• Heather Gibson, Scottish Government
• Julie Paterson, Mental Welfare Commission
• Suzi Moran, Police Scotland
• Kirsteen MacLennan, Care Inspectorate
• Paula Ross, Care Inspectorate
• Maureen Scott, Healthcare Improvement Scotland     
• Claire Duncan, Chief Officer Group Aberdeen City HSCP
• Julie Lusk, Chief Social Work Officers Group
• Brenda Walker, Social Work Scotland ASP Leads Network
• John Paterson, ASP Conveners Scotland
• Rhona Willder, Development Manager, Scottish Independent Advocacy Alliance
• Karen Hedge , Scottish Care
• Jane Byrne, Healthcare Improvement Scotland
• Hazel Borland, Chief Exec NHS Ayrshire and Arran (In place of Cathie Cowan)
• Austen Smyth, Coalition of Care and Support Providers in Scotland
• Hannah Ross, COSLA
• Elaine Torrance, Vice Chair of ASP Conveners, Scotland
• Mary Notman, (recently retired) ASP Lead for Perth and Kinross
• Anna Kynaston, Scottish Government
• Kiran Haksar, Scottish Government

Apologies

• Paul Comley, Stirling University
• Fiona Brown, Office of the Public Guardian
• Eleanor McCallum, Health and Social Care Scotland
• David Thomson, National Mental Health Nurse Leads Group
• Cathie Cowan, NHS Chief Executives
• Jeff Ace, NHS Chief Executives
• Laura Caven, Coalition of Care and Support Providers in Scotland
• John Urquhart, COSLA
• Grace Gilling, NHS ASP Network Group

Items and actions

Chair’s welcome to the forum (Kevin Stewart)

Kevin Stewart welcomed everyone to the forum. Mr Stewart noted a copy of the previous meeting’s minutes, written updates and a copy of the biennial report were issued in advance of the meeting. Mr Stewart noted actions from the previous meeting had been completed and invited the forum to respond on whether the minutes were an accurate record of the last meeting, and whether there were any matters raising from the minutes (none were raised) and minutes were agreed by members.

Biennial report - current challenges to improving ASP in Scotland

Mr Stewart invited Elaine Torrance to present her reflections on key challenges identified by the biennial report, following which Brenda presented lessons from a case conference perspective. Key points were then raised by forum members following the presentations:

• the biennial report was welcomed, along with commitment to working across organisations to take forward areas for improvement
• noting the timing of the report with outcomes from the current inspection being disseminated. ASP processes - in particular importance of chronologies across health and social care to understand any background issues, attention to hidden harm, and continuing to undertake visits during the pandemic were noted as areas to have particular focus going forward
• noting that, like Child Protection, Adult Protection is everyone’s business
• request was made for greater continuity in multi-agency approaches and working across service areas (Mr Stewart noted person centred approach is central to the National Care Service consultation)
• the importance of engaging community support was noted, especially where there may be hidden harm
• reflection that, as we learn to live with COVID, staff and service users have become more comfortable with face to face contact, but we need to consider what agencies can do to maintain contact
• it was noted that contributions of case studies to Adult Protection Committees and other strategic planning groups can assist in senior management understanding of ASP in practice and the impact of policy and strategy on same
• note that many day centres stepped down again as a result of staffing challenges

Refresh of the Code of Practice and guidance from Adult Protection Committees

Mr Stewart invited John Paterson to set out key changes following the refresh and Mary Notman to present on the challenge of balance between duty of care vs autonomy and the right to refuse support (one of the key considerations as part of the refresh). Key points were then raised by forum members following the presentations:

• information sharing continues to be a key concern noting many organisations still are unclear about their requirement for information sharing. Note that updated section on information sharing is much clearer
• note that Alan Small, Fife APC chair, circulated a letter via all chairs nationally. The letter was from Chief Officers in health, police and local authority in Fife advising all staff in Fife of the importance of sharing information to protect adults at risk of harm. It reassured staff that if they did so in the best interests of the adults, they would be fully supported
• knowledge of Adults with Incapacity (AwI) is an area for improvement as highlighted in the Mental Welfare Commission's authority to discharge report. HSCPs are taking action to address. NES are also keen to support. PoA campaign is about to be launched by OPG too
• noted need for training of new staff and refresh for existing staff on legislative requirements and attention to complex issues with relevant support
• SG responded noting that there is a big training need for staff but understand that limited access to private sector legal reps for people is biggest current challenge in this space.  Training on legislation is not difficult in principle, including refresher training, but time and capacity to do it, especially with staff turnover at present in the sector, is a challenge
• related to AwI training, note that independent advocacy organisations have had training from ex-PG, Sandra McDonald, on AwI and she made a huge effort to tailor the training to independent organisations
• defensible decision-making process – ensuring all angles covered and explored. Network groups for professionals are an excellent resource to discuss complex cases and seek ideas/support from colleagues
• need for the unpicking of reasons behind the increase of cases getting to a critical stage and the subsequent support measure required
• noted increase in Large Scale Investigations since the onset of the pandemic. SG note the Care Inspectorate is collating statistics on the number of LSIs. And that the social care GOLD group is actively considering. Also noting SG recently issued a survey to ASP leads to gather more info on LSIs undertaken over the past 18 months. An evidence paper is being drafted and will be shared with ASP Conveners and ASP Leads with a view to developing a national framework for undertaking LSIs (addressing variation across areas, and improving data and evidence available). There needs to be some unpicking of the reasons behind the increase, fundamentally - the reason why things are not being dealt with before getting to a critical stage and subsequent support measures. Also need to consider issues re the processing of LSIs - stress and distress for individuals and staff, moratorium affects delayed discharge and financial support to provider, staff more inclined to leave to avoid vilification thus further impacting on ability to provide safe quality care
• need for a balance between human rights and interventions in care homes and learning lessons from COVID-19. Further comment on independent advocacy support for adults’ voices to be heard

National Care Service consultation

Mr Stewart invited Elaine Torrance and Brenda Walker to highlight key ASP issues to consider in response to the consultation. The following points raised during the discussion:

• Mr Stewart noted COVID-19 has shone a light on social care challenges and the need to reduce postcode lottery of care
• Mr Stewart noted the need for quality national standards and for human rights to be at the heart of the National Care Service (NCS) with an emphasis on taking a person centred approach. He noted the importance of the ethos of Getting it Right for Everyone
• Mr Stewart also noted the need for continuous improvement to continue (noting that the NCS will take time to be developed and this should not impact on continuing to improve services right now). He believes that the best possible work should be embedded in NCS, consistent with national standards
• Mr Stewart noted it would not be possible to cover every social care role within the consultation document, however recognised the importance of social care professions, including social work, and that their roles are given within the NCS consultation. He is keen to see social work seen as a recognised profession
• agreement on the need for a whole family approach
• Mr Stewart responded to a concern about out of area placements noting the NCS is an opportunity to address an individual with more complex needs without the need for accessing care outside Scotland
• more detail was requested about the links between justice and community safety and the role of social work across these areas. The Minister encouraged forum members to respond to the consultation with their views and these will be considered
• governance was also raised and the links between the NCS and NHS
• Mr Stewart emphasised that people with lived experience are central to the creation of the NCS, including involvement in governance processes and that governance arrangements should be meaningful
• Mr Stewart thinks there is a need to acknowledge and address a current public perception of lack of ministerial accountability in social care, and perhaps a lack of public understanding of HSCPs and IJBs
• Mr Stewart encouraged all forum members to be advocates for engaging with the NCS consultation, encouraging a wide range of people to contribute their views

Summary and close

Mr Stewart closed the meeting thanking forum members, for the work they have done continuing to support and protect adults at risk of harm, in particular for the hard work and commitment from you and your colleagues in response to the pandemic.

The next meeting of the forum is likely to take place in march of next year with invitations issued in due course.