Adult support and protection: learning review guidance

3. Initiation of a Learning Review: The Decision-Making Process

A learning review process map is attached at Annex 1.

Adult Protection Committees should have in place mechanisms for deciding whether or not to initiate a Learning Review. The decision-making process should embody the key features of proportionality and timeliness. The responsibility for initiating a learning review and overviewing the process, and implementing any agreed recommendations, including the development and monitoring of an action plan, rests with the Adult Protection Committee, and should be reported to and ratified by, the Chief Officer Group.

Any agency with an interest in an adult's wellbeing or safety can raise a concern about a case which it is believed may meet the criteria for a Learning review and submit a notification to the APC using the Learning Review notification form (Annex 2). Families are not able to request learning reviews but have access to complaints procedures within agencies where they feel dissatisfied with aspects of how cases have been dealt with.

On receipt of this notification the nominated person or sub-group within the APC should request further information from agencies involved with the adult and family. This is done using the information for Consideration of a Learning Review form (Annex 3).

The purpose of information gathering at this stage is to inform a decision about whether or not to process with a Learning review with reference to the criteria as specified in the previous section. The information gathered should be only enough to assist in making that decision. It will include a brief account of agency involvement prior to the event which triggered the notification and some very initial reflection regarding practice and decision-making within that agency.

After consideration of the gathered date the nominated person or sub-group will then make a recommendation to the APC on whether or not to proceed with a Learning Review. The recommendation will contain the following information;

• A brief outline of the case and the basis for referral
• The current circumstances of the adult and what actions have been taken
• Any other formal proceedings underway including criminal investigation

The Chief Officers Group, which should include the Chief Social Work Officer, should be informed of the decision about whether to proceed with a Learning Review or the reasons for not doing so, and will determine whether they ratify this decision or seek further actions through the APC.

The Care Inspectorate must be informed of this decision using its online notification form.

If the final decision ratified by the Chief Officers Group is to go ahead with a Learning Review, then a review team will be established and a chair of this team identified. Lead reviewer(s) will be appointed.

Consideration should be given by the COG and APC as to the engagement required with the adult and their family. Consideration should also be given as to whether there is likely to be media interest at any stage in the review process and, if so, strategies for dealing with this should be prepared. A Communications and Media Guide is provided in Annex 8.

Time frame for the initial decision-making process

The timeframe for this initial decision-making stage will vary depending on the situation being considered. However, timeliness is important, so that any learning arising is relevant to the current practice context. It is suggested that 28 to 42 days from the receipt of a referral would be an appropriate and realistic timeframe for the completion of this initial process.

Cross-authority cases

A Learning Review in one APC area may involve agencies from a different local authority, health board or police division.

In the case of a potential cross-authority Learning Review, the relevant Adult Protection Committees should agree a mechanism for joint working, including which Adult Protection Committee should take the lead, and if required there should be joint commissioning of a lead reviewer. It will also be important that clear channels are identified for how information is shared across authorities. This should be authorized by the Adult Protection Committee Conveners and coordinated through the Adult Protection Committees, with authority delegated to Coordinators or Lead Officers. Any disputes (between local authorities) should be escalated to the Chief Officers' Group or equivalent for consideration, and Chief Social Work Officers should be kept informed.

In the case of a potential cross-border Learning Review, the APC Convener should meet with the relevant Chair of the Safeguarding Adults and/or Children's Board, or equivalent, in order to agree a mechanism for joint working.

Links between services for children and adults

Situations may arise for learning reviews, particularly for 16 and 17 year old people, where there are legitimate interests and engagement from services for both children and adults. In such circumstances there should be discussions between the Child and Adult Protection Committees to determine which is the most appropriate to lead on a Learning Review, with agreement reached as to how each of the committees will be involved and updated on progress of the Review. This will require consideration on a case by case basis, and the involvement of the Chief Social Work Officer may be helpful in these deliberations.

The Learning Review and other formal staff processes

If any issues of staff malpractice or competency emerge during the course of a Review these should be referred to and managed by the relevant agency's own staff procedures. Learning Reviews are about multi-agency learning in order to improve future practice. They are not investigations or a means of dealing with complaints.

If a situation does not meet the criteria for a Learning Review

There will be some situations where, after careful consideration, it is decided that the criteria for undertaking a Learning Review have not been met. However, the situation may contain some valuable reflective learning for practitioners and services and therefore it is important that APCs give consideration to what might be learned and how that learning can be disseminated to the multi-agency workforce. Such cases should be brought to the attention of the APC.