Adult Support and Protection National Strategic Forum minutes: September 2020

Attendees and apologies

Attendees

• Clare Haughey (chair), Minister for Mental Health
• Kate Hall (co-chair), Scottish Government
• Jane Johnstone, Scottish Government
• Vikki Milne, Scottish Government
• Murray Meikle, Scottish Government
• Paul Comley, Stirling University/ASP National Practice Co-ordinator
• Suzi Moran, Police Scotland
• Fidelma Eggo, Care Inspectorate
• Kirsteen MacLennan, Care Inspectorate
• Julie Lusk, Chief Social Work Officers Group
• Cathie Cowan, NHS Chief Executives
• Austen Smyth, Coalition of Care and Support Providers in Scotland
• Grace Gilling, NHS ASP Network
• John Paterson, SASPICA National Convenors Group
• Maureen Berry, Health Improvement Scotland
• Karen Hedge, Scottish Care
• John Urquhart, COSLA
• Mike Diamond, Mental Welfare Commission for Scotland
• David Thomson, National Mental Health Nurse Leads Group
• Kirsty McGrath, Secretary, Scottish Mental Health Law Review
• Derek Barron, Chair, Forensic Mental Health Review
• Isla Jack, Forensic Mental Health Review

Apologies

• Stephen Brown, IJB Chief Officers Group
• Shaben Begum, Scottish Independent Advocacy Alliance
• Donald Macaskill, Scottish Care
• Brenda Walker, Social Work Scotland ASP Leads Network
• Fiona Brown, Office of the Public Guardian

Items and actions

Chair’s welcome to the Forum (Clare Haughey)

Clare Haughey welcomed everyone to the Forum.

Apologies

Apologies noted.

Previous minutes and matters arising

The minutes of the previous meeting held on 3 March 2020 were agreed as an accurate record.

Vikki Milne summarised the actions from the previous meeting:

• John Scott expressed interest in attending the 5 Nations Conference. The work group to include the secretariat in the invitation list. Alex Davidson has invited John Scott
• Mental Health review webpage to be disseminated through ASP networks. Sent by the MH Secretariat along with next action
• Mental Health review secretariat to include ASP Convenor and Practitioner Network Groups as part of their engagement activity. ASP Team to provide dates for these meetings
• ASP Convenors and ASP Leads invited to proactively get in touch with the Mental Health review should they have evidence they wish to contribute to enable a broad range of views to feed into the review. ASP Convenors coordinating feedback with ASP leads to take this forward
• ASP Team to invite the Forensic Team Review to the next Forum. Derek Barron who Chairs of the Forensic Mental Health Review presenting today
• Alex Taylor invited John to deliver session to the Chief Social Officers. Alex to email the secretariat with an invite

Written updates – comments and questions

The Minister asked for comments on the written updates from the Improvement Plan, Convenors, Police Scotland and National Coordinator. No comments were offered although Paul Comely pointed out that, since his paper had been circulated, Alex Davidson had chaired a ASP Conveners Group meeting leading to co-ordination of a response to the Mental Health Act Review.

Reviews and context: Scottish Mental Health Law Review

Kirsty McGrath spoke to the paper she had provided to the Forum ahead of the meeting. Key points:

• call for evidence extended due to COVID-19. The call for evidence focussed on Mental Health (Care and Treatment) (Scotland) Act 2003 as there was a gap in understanding as to how well people thought this Act was working 
• Chair’s interim report published end of May 2020, summary of responses published end June 2020
• further interim report to be published by December 2020, setting out timetable for conclusion of Review
• themes emerging from call for evidence; communication and language; resources; the way the law is working at present; capacity and supported decision making; appropriate treatment; convergence of legislation
• five working groups in progress – communication and engagement; compulsion; children and young people; capacity and supported decision making; economic, social and cultural rights
• from the responses to the call for evidence, there are mixed views as to whether adult protection should remain as a separate piece of legislation or if it should form part of a fused piece of law
• Paul Comley is preparing case studies to aid understanding of the way the mental health, incapacity and adult support and protection legislation currently work alongside each other. The Executive team of the Review will use these to work with ASP stakeholders to bring ASP fully into the considerations of the Review
• in addition, the Chair, John Scott, will meet with ASP convenors in the autumn, and will be involved in the five nations Adult Protection conference planned for December

Discussion – points raised as follows:

• Paul Comely said the general view from Adult Protection Committees was that ASP should not be merged with Adults With Incapacity (AWI) or mental health legislation
• John Paterson commented that he was very pleased to hear how ASP issues fit in to the review

Reviews and context: Forensic Mental Health Review

Derek Barron spoke to a PowerPoint presentation on the Forensic Mental Health Review. Key points:

The review is guided by PANEL principles, namely: Participation; Accountability; Non-discrimination; Empowerment; Law.

For this review, ‘forensic mental health services’ mean services that provide assessment, care, treatment and support to:

• people in high, medium and low secure hospitals or hospital units
• people accused of offending or who have offended and are in intensive psychiatric care, hospital units or open rehabilitation inpatient facilities
• people not in hospital who are at risk of offending, accused of offending or who have offended and have a mental illness, personality disorder or mental illness

The timeline from start of the review to publication of the interim report last week.

The questions being considered by the review and the working group approach, underpinning approach and consultation approach.

Emerging themes are:

• frustration
• capacity
• strategic thinking
• women’s issues
• people with an intellectual disability
• people with a neurodevelopmental disorder
• prison
• community
• rehabilitation
• housing
• employment

Discussion – points raised as follows:

• John Paterson said that his work on the refresh of the ASP Code of Practice and Guidance would aim to generate a tone that allows for a broader definition of a person at risk of harm which chimes well with the aims of the review
• on the subject of women’s issues, the Minister suggested that the review have a conversation with Christina McKelvie, the Minister with responsibility for women’s issues
• Cathie Cowan invited Derek to address the NHS Boards Chief Executive Group on the work of the review
• Jane Johnstone requested that Derek’s presentation be shared with the Forum
• Jane Johnstone pointed out Social Work Scotland (SWS) has commissioned a piece of work in respect of older adults in prison

Action points

• Christina McKelvie to be provided with information and invitation to meet with the Review – ASP policy to follow up with Review Secretariat
• Cathie Cowan to follow up invitation to Derek Barron to address NHS Chief Execs. ASP Team to send contact details to Cathie Cowan
• presentation to be shared – slides (PDF) to be issued along with minute of meeting
• SWS work on older adults to be shared with the Review team

Experiences and lessons emerging from COVID-19 and priorities for action

Paul Comely spoke to a presentation on the lessons emerging from the pandemic. Key points:

• overall themes: role of Adult Protection Committees in response to the pandemic; additional guidance in the Adult Support and Protection Code of Practice (CoP) and APC Guidance in response; communicating with public and awareness raising on hidden harm; information/data
• APC functions during national crises
• statutory functions
• service user and patient contact
• effective communication
• data
• cross over issues
• harm and hidden harm
• care settings
• questions to consider including around systems and practices; training; dissemination of lessons from pandemic; close monitoring of the Lord Advocate’s review and the newly announced SG review of care

Discussion – points raised as follows (including in ‘chat’):

• Cathie Cowan stressed the importance of taking positives from the experience citing examples of high-risk families building resilience. She said she would be keen to share information from an NHS perspective
• Karen Hedge agreed with Cathie on the need to draw positives. However she said that the pandemic had impacted on the level of training – in ASP and more generally – available. She also commented that much of the current training and educational materials look ‘dated’. On the issue of DNARs, she said that it had been an issue in Scotland in the early days of the pandemic but had been quickly closed down. She also raised a concern that some people had been admitted into a care home environment with a proper assessment of any additional needs
• Fidelma Eggo said that she would reflect on Karen’s point on assessments on care home admissions. She explained that the inspection programme methodology had been changed in the light of the pandemic experience Fidelma also raised concerns about hidden harm and the need to consider how harm is identified as part of remobilisation plans. She suggested it may be helpful to link with other regulators across UK to identify any learning
• Jane Johnstone suggested that we ask ASP Committees to add their pandemic reflections to their biennial reports and made the more general point that we should look to use what is already in place rather than create something new. John Paterson said that the biennial reports were probably too close to sign-off for them to be added to in that way but others ways to come at it could be considered
• Julie Lusk offered to take emerging ASP lessons to the Chief Social Workers Group
• David Thomson highlighted the importance of Hidden Harm when developing remobilisation plans and the need to be flexible to adapt
• Cathie Cowan suggested it would be useful to seek response from Chief Officers Groups and to take ASP lessons from COVID19 through Health

Action points 

• further thought to be given and work to be done on how best to ‘capture’ pandemic experiences including good practice
• further work undertaken to engage with key groups; APCs, CSWOs and Health
• findings from this presentation and any further work will inform actions being taken forward as part of the ASP priorities

Reviews and context: Adult Support and Protection Priorities update

Vikki Milne explained that the following priorities had been agreed at the Forum meeting in March and will focus the actions of the Forum over the next two years:

Partnership working - Good connection into Health and Social Care integration, how can this be maximised.

• NHS Board Policy and Accountability Framework - strategic public protection approach combined child and adult protection and MAPPA. Cathie Cowan NHS CE Forth Valley supported the proposal at the NHS Board CE meeting in March
• NES Education resource – developing NHS training which includes both child and adult protection

Getting Basics right - Inspection will focus on remaining 26 partnership across Scotland to assess whether adults are support and protected and to identify areas for improvement.

• the Multi-Agency inspection programme commenced in January. Due to the impact COVID19 on resources the inspection partners suspended the joint Adult Support and Protection inspection programme in March
• with restriction being eased the Inspection Partners are now actively looking to resume ASP inspection activity. The programme will require to be delivered in the context of physical distancing. As such, partners require to look to alternative means of undertaking some of our inspection activity, include use of IT support this
• inspection programme – ‘digital by default’ opens up new possibilities and ways of working. Need to be more flexible and agile in how we work
• inspection programme partners expect to resume the programme as soon as possible once the methodology has been robustly tested and in place. 

Enable consistency in how ASP is applied in practice: enabling consistency across Scotland in a way in which links to local processes.

• ASP data returns 2019/20 due end Sept - data gathering and information sharing across APCs. Developing a revised ASP data set
• biennial reports due end October – evidence and learning on key issues across APCs to inform action and priorities at local and national level.

Refresh of the Code of Practice and APC Guidance

• the ASP National Strategic Forum agreed that, as the review of the Mental Health legislation would take some time to complete and implications for the ASP Act to become clear, it would be useful to explore a refresh of the ASP code of practice
• in April 2020, additional guidance to the Adult Support and Protection Code of Practice in relation to the current COVID-19 outbreak and its aim is to support local decisions and the development of local guidance
• however further work is required to bring the Code of Practice and APC Guidance up to date with changes in policy and legislation, as well as changes to practice and process. The Minister agreed to undertake a refresh of the Code of Practice and guidance for APCs
• John Paterson is the lead reviewer for the refresh. Vikki invited John to provide a short update on work to date and engaging the Forum (see note on discussion)

Discussion – points raised as follows (including in ‘chat’):

• John Paterson spoke about his approach to the refresh of the Code of Practice and APC guidance and the importance of involving service users and carers. He also pointed out that a lot of the existing language needed update to reflect current terminology. John stressed that any suggest changes should be in line with requirements under the current ASP Act. While the terms of reference do not explicitly reference COVID-19, the refresh will seek to reflect the experience and lessons learned
• Cathie Cowan offered to seek comments on the refresh from NHS Chief Executives. Vikki Milne said a letter from John would be provided to all Forum members about the refresh work. Julie Lusk offered the involvement of COG members in this work
• Austen Smyth said he would like the refresh to draw on ‘institutional harm’ issues and how to best engage with those. Cathie Cowan agreed that a lot of harmful and inaccurate things had been said about the level of ‘institutional harm’ and that this had generated anxiety
• Fidelma Eggo said it would be helpful to map the COVID issues identified in Paul Comely's presentation to the national strategic priorities, to see if key issues are covered and/or consider any gaps

Action points

• letter on refresh to be sent to all Forum members
• comments on refresh to be sought from NHS Chief Executives
• comments on refresh to be sought from the COG

A national Adult Protection/Prevention Public Information strategy - raising awareness through the creation of a professional and public awareness group which could inform and coordinate local activity and inform national activity.

• ASP Convenors, National Practice Co-ordinator and SG have begun work on developing a Communications Strategy for Adult Support and Protection with the aim of assisting in the development of any national messages.

Summary and close

The Minister thanked all contributors and highlighted the very useful discussion on COVID-19 lessons for adult support and protection issues.

She thanked everyone for the work they have done to support and protect adults at risk of harm, in particular the hard work and commitment demonstrated in response to the onset of the pandemic.

She said that issues or actions arising from the discussion will be captured in the note of the meeting. She said that the next meeting of the Forum will take place in March 2021, with a calendar request to be issued in due course.

The Minister then brought the meeting to a close.