Report on a day long event for Lead Officers
Introduction
Jean Maclellan, Head of Adult Care and Support in the Scottish Government, welcomed
everyone to the conference which was designed to share experiences of the implementation of
the Adult Support and Protection (Scotland) Act 2007 and consider how practice can be
improved further. She said she was keen to hear if lead officers found this type of networking
event useful and wanted to see it continue.
Jean then provided an update on the work of the division since the last event in March.

Self Directed Support
A strategy for a 10 year programme to develop Self Directed Support (SDS) in Scotland has
been approved following a consultation and will be published in the autumn. Proposals for
an SDS Support Bill have also being consulted on which would provide a legislative
framework for more people to direct their own support. A draft Bill is likely to be published for
a second phase of consultation at the end of the year. There are now over 3000 people in
Scotland who benefit from direct payments and while this has increased, One potentially
contentious aspect of the proposed new system is that SDS would become the “default
position” within social care with people offered the choice of opting out of SDS rather than
opting in. The Bill also proposes to extend the eligibility of SDS to more user groups, by
removing the current ban on direct payments for people detained under some mental health
orders, by providing support carers in their own right, and by allowing payments to be used
to purchase residential as well as community care.

Learning disability and autism
A programme to implement the Same as You strategy has now been running for 10 years
and the Scottish Consortium for Learning Disability is examining the difference the policy
has made to the lives of people with a learning disability and their families. The report will
be completed by the summer of 2011 and submitted to the Minister for Public Health and
Sport. The report will focus on the success of the policy, identify any gaps in policy that
remain to be filled and what needs to happen next.
A Private Member’s Bill has been proposed in the Scottish Parliament designed to develop
an autism strategy for Scotland with associated guidance and annual reporting on progress.
Jean said this is being resisted by the Scottish Government The Scottish autism strategy
consultation was launched on 9 September and will close on 9 December. Scotland has
also made progress in other areas, becoming one of the first countries in the world to
conduct a needs assessment for people with autism. There are concerns about waiting
times for diagnosis and assessment and Jean said this is one of the critical areas that needs
to be resolved.

Sensory impairment
Funding has been allocated to develop local “one stop shops” to provide care, support and
information for people with hearing and sight problems. The aim is to move these away from
traditional NHS services such as GP surgeries and hospitals. This is being done in
partnership with voluntary organisations and will help to improve the quality of life of people
with sensory impairments while reducing pressure on the NHS.

Adult survivors of childhood abuse
A pilot forum, Time To Be Heard, established to hear testimony from former residents of
Quarriers homes, has completed its hearings. The Chair, Tom Shaw, will now produce a
report making recommendations to Ministers. This report is expected early in 2011. An
update from Tom Shaw can be seen at http://www.survivorscotland.org.uk/nationalstrategy/about-time-to-be-heard.html

Adult Support and Protection
The work on implementing the Adult Support and Protection Act has been funded to date
from the NHS budget and discussions have been held with COSLA on further support
funding. Funding for the current year will be at last year’s level. A new survey is being
conducted on current activity to provide information on the progress being made. Work is
also planned to gather more qualitative data. Jean also said there is an expectation that
Acts of Parliament are reviewed after a certain period of time to examine the success of the
legislation and any additional action that needs to taken. A review of the ASP legislation is
expected to take place by 2012.
Session 1: Information gathering
Mary Notman, Perth and Kinross Council, provided an overview of the challenges involved in
gathering information to advance knowledge and using it to improve practice. A wide range of
information is required and it needs to be put into a format that enables comparison.
This includes quantitative data such as the number or referrals, actions taken, performance
indicators and information from other agencies like the police and NHS. Gathering qualitative
data on such things as outcomes and the impact of interventions on adults at risk is more
challenging. The important aspect is how the information is analysed to help identify local issues
that can improve practice.
Other challenges are developing information management systems that do not place an undue
load on staff, ensuring the reliability of data, recognising the limitations of systems and getting
information from partner agencies. Focus groups or evidence focused tools can be used to
gather outcome data but, even with this, it can be hard to capture the complexity and scale of
some cases. Presenting this information in a form that gives qualitative data that has operational
significance is a continuing challenge. There is a need for agreement on definitions and
thresholds across all agencies to ensure data consistency.
Information can be used to improve practice through presenting case examples which allows
staff to discuss and reflect. This can help to identify local issues of significance that can then be
addressed through staff training and support.
On a national level, there are a number of supportive resources such as
o
the protection order data that has been produced
o
adult support and protection practitioner forum webpage
o
Learning exchange organised by Institute for Research and Innovation in Social
Services (IRISS).
o
The adult protection officer network is a good source of support and advice
o
national conferences such as the lead officer event provide opportunities to share
and learn.
In conclusion, there are many challenges in information gathering but work is progressing on
adjustments to information systems, development of outcome focused tools and guidance on
relevant issues
Workshop discussion
These are the main issues discussed in the workshop groups.
Challenges in information gathering:

lack of consistency in the information being gathered;

thresholds differ depending on personnel;

benchmarking is impossible if different authorities adopt different standards;

different authorities have different systems, some electronic, some manual;

what is an investigation in one area is seen as an inquiry in another;

information from partner agencies is variable;

outcomes are captured differently;

ASP is a broad spectrum task but the Act is very narrow;

at what point is a referral called adult protection?

protection orders are not a good measure of adult protection activity on their own;

how do we assess the impact of services on users and carers?
Potential solutions:

identify a core data set and agree definitions to achieve consistency;

ensure systems support practice, not drive it;

develop mandatory fields on systems;

identify leads to help engagement with partners;

ensure staff compliance on information gathering and partnership understanding;

use audits and multi-agency reviews to help inform practice;

support the development of regional clusters of practice;

use information to identify strengths and weaknesses;

gather information needs about the use of resources against the outcomes being
achieved;

learn from comparing the results of biennial reports;

balance the rigidity of a standardised approach against the complexity of individual
cases.
Session 2: Self harm
Kate Fennell, Edinburgh City Council, said the issue of self harm throws up a number of
dilemmas in relation to the Adult Support and Protection Act. The Act seeks to strike a balance
between an individual’s right to choose what they consider to be right for them and the duty of
the state to protect them. The threshold for intervention for people who self harm is difficult to
define and many in this group will not meet the Act’s three-point test. She said some doctors
have been disappointed that the Act cannot be used to get an individual to accept a package of
care. One of the challenges for us is to manage people’s expectations of what can/cannot be
done under the legislation.
She presented a series of case examples to highlight the challenges and the potential solutions.
One involved a man with serious hoarding behaviour who ended up living in unsafe conditions.
Kate said the beauty of the Act is that it places a duty on different agencies to co-operate. That
aspect was used to develop a multi-agency response which resulted in a protection plan being
agreed for the individual.
Similarly, a multiagency solution was developed to respond to a woman who regularly takes
overdoses of paracetamol. Prior to this, the accident and emergency service dealt repeatedly
with the immediate problem of the overdose while mental health services were left to address
the chronic underlying problem. A joint protocol has now been developed to address this
situation more effectively.
Kate said it is common to get referrals from housing agencies seeking action in cases where a
person’s alcohol misuse is causing hygiene problems for neighbours or a fire risk. However, in
many cases the alcohol dependency in itself will not be sufficient reason to intervene using the
Act.. The key to managing such cases is, once again using a multi-agency approach to
identify and manage risk.
Self harm as a category of harm under the act throws up many difficult dilemmas. said Kate.
Many cases will not easily meet the ASPA threshold but this should prevent agencies from
acknowledging a shared responsibility or working together creatively to address the difficulties.
Workshop discussion
Challenges in responding to self harm:
 self harm creates a lot of referrals but few meet the three-point test;

ASP is all or nothing;
 there is a high volume of “in crisis” referrals from the police;
 other agencies have withdrawn and left this to social work;
 the lack of referrals from the NHS is a concern;

variance exists in interpreting the criteria for adult protection;
 too many assumptions are made that problem behavior is a lifestyle choice when there
may be underlying factors;
 there remains a duty of care even if people do not qualify for help under ASP.
Potential solutions:
 joint working and a multi-agency approach is the key to success;
 develop a management strategy on which all agencies agree;
 promote training across agencies;
 share information, hold regular multi-agency meetings;
 define the role of the NHS in all of this;
 promote shared discussion between the NHS, social work and addiction services;
 adopt models of good practice such as the Aberdeen “drop off” centre;
 develop protocols for repeat referrals;
 develop alternative places of safety
 involve adult protection committees in the redesign of alcohol and drug services;
Session 3: Capacity
Anne Thompson, East and Midlothian Councils, said she would like to put a sticker on
everyone’s computer with the message - “ASP is not only about capacity.” Often the stock
response is that, if someone has capacity, then it is not an ASP matter. However, Anne said
establishing capacity is far from simple or easy.
She illustrated this with case examples. One involved an elderly woman who was in hospital
after having a stroke. Her son had returned home from abroad and wanted to care for his
mother. The woman was clear that she wanted to return home but there were concerns about
the son’s ability to care properly for his mother. An application for a compulsory treatment order
was rejected and the woman was discharged into the care of her son. The woman’s health
deteriorated under her son’s care and a removal order was granted to allow for an assessment
of her capacity. There were difficulties in arranging an assessment within the seven day period
and it was eventually carried out by two doctors who had no previous knowledge of the woman.
The council’s solicitors were reluctant to take the application to court because in their view the
assessment was weak. In the end they were persuaded to do so mainly on the grounds that the
woman’s condition had improved in the time she was away from her son. It resulted in an
interim welfare guardianship order being granted. Anne said this all involved a huge amount of
work. The woman is now safer but she still says she wants to return home.
Anne said capacity is a hugely complex issue. It is still talked about in absolute terms even by
people who know it is not an absolute concept. Some people will have capacity to manage most
of their day to day lives but may lack the capacity to take specific decisions. It can also be very
difficult to establish if they are being subjected to undue pressure from others. Cases involving
personal relationships, particularly of a sexual nature, and financial matters are among the most
complex.
The Adults with Incapacity legislation gave GPs the power to assess capacity. However, Anne
said that GPs are often assessing people they do not know. Frontline social care staff assess
capacity all the time and she would like to see a tool being developed that would allow staff to
produce their own evidence of an individual’s capacity. That could be given to a GP to help
support their decision. At the same time, more could be done to improve the skills of both social
care staff and GPs in making assessments. She said the multi-disciplinary approach laid out in
the ASP legislation provides the framework for taking things forward.
Workshop discussion
Challenges:

no consistent protocols;

no central guidance, only local procedures;

huge variations in medical assessment;

legal definition of capacity is not always helpful;

capacity needs to be reviewed regularly;

lack of capacity can often be just temporary;

there can be problems and delays in accessing assessments;

who assesses and what is assessed;

doctors can be reluctant to undertake assessments;

concern that not all GPs have the skills to assess capacity;

not all staff are confident to make decisions on capacity;

GPs are self employed and not bound by local protocols;

payment for GPs is an issue.
Potential solutions:

arrange joint training with GPs;

establish local protocols setting out pathways to access assessments;

examine if the English tool for assessing capacity can be adapted for Scotland;

establish a framework for professionals to use (Bristol University have developed a
framework);

allow more time for assessments of capacity – seven days is too short;

develop and agree clear timescales for completion of assessments;

develop a role for council officers to contribute to assessments;

review tools used to capture clinical assessment to reflect level of complexity;

ensure communication/support needs are given prominence as opposed to compulsion;

develop joint working as route to better co-operation.
Session 4: Police referrals
Sally Wilkins, Aberdeen City Council, gave a breakdown of police referrals to the council’s
adult protection unit and what has been done in response to them. Of the total of 326 referrals,
163 required no further action. There was council officer involvement in 104 and a further 56
were referred on – mostly domestic disputes – leaving three other unspecified cases.
Sally said the 163 that required no action fell into two main categories - people referred on the
grounds of vulnerability who did not meet the three-point test and other referrals that were seen
to be completely inappropriate. Inappropriate referrals included a number of prostitutes, sex
offenders still in custody, domestic disputes and in one case, a male from an ethnic background
who was considered to be at risk of radicalisation. Self harm was the biggest source of referrals
on the grounds of vulnerability. If these individuals also had a diagnosis of mental illness, they
may have met the criteria for action under ASP. Sally said that ASP is not a gateway into
services and if there is not a clear ASP need, there is nothing that can be done under the ASP
legislation
She added that services are under so much pressure that resources cannot be wasted in
responding to referrals that are inappropriate. As a result, discussions have been held in
Aberdeen with the adult protection operational group, with the offender management unit and
with individual police officers to try to improve matters. Grampian Police have established a new
Force Referral Unit which they say will improve things. This is a recent development and Sally
said it is still too early to be able to judge its impact. Discussions are also continuing with the
police and NHS Grampian on the issue of self harm.
Workshop discussion
Challenges:

most police referrals are not ASP;

definition of three-point test varies across agencies;

councils vary in how police referrals are received;

thresholds differ from area to area;

only a small number of police referrals meet the three point test;

the number of referrals varies significantly from area to area;

lack of NHS referrals is a bigger issue than too many police referrals;

the NHS is not always prepared to get involved in a multi-agency response
Potential solutions:

review referral patterns regularly with the police;

organise more multi-agency training and multi-agency meetings;

learn from the English experience in terms of triggers;

establish police co-ordinators who can screen referrals;

review the forms being used which may be partly responsible for inappropriate referrals;

promote a dialogue between the Scottish Government and ACPOS to improve practice;

promote greater use of the three point test among the police;

ensure that repeat referrals for the same individual result in action;

examine models of good practice – Tayside police are developing an ASP unit to screen
referrals
Session 5: Looking forward
Jean Maclellan thanked everyone for their contribution throughout the day and for exploring the
issues and potential solutions to some of the current challenges. She said that regional
networks are now developing and wanted to know if lead officers felt there is still a place for a
national meeting. A show of hands revealed strong support for continuing with such an event.
Jean then asked what topics people would like to see examined in future meetings. The
suggestions that came forward were:

involving service users;

using case examples as teaching/training tools

investigations into care homes

financial harm including the role of the Office of Public Guardian

the interface between SDS and ASP

feedback from APC Chairs to Lead Officers
On this last suggestion, Jean said that a joint Lead Officers and APC Chairs event is being
organised in March when this could be discussed. She also said it may be useful for lead
officers to get a presentation from Tom Shaw who is chairing the commission reporting on the
support being provided to adult survivors of sexual abuse.
It was also suggested that there is a need for more national guidance on common issues to
ensure a most consistent approach across Scotland. Jean agreed and said there is a
commitment to update the guidance to assist with this.
One theme raised throughout the day was difficulties in engaging with the NHS. Jean said that
is an issue that will be addressed, starting with a multi-agency event that has been planned for
November.