1. ROLES & RESPONSIBILITIES AND INTERAGENCY WORKING IN THE PROTECTION OF ADULTS

2. Aims Adult Protection -Angus  Explore with others, their role and responsibilities in relation to the support and protection of adults.  Develop an understanding of the legislative framework for the support and protection of adults  Consider what is harmful to adults and how adults in need of support and protection can be identified  Consider how to respond to concerns about an adult at risk of harm  Develop knowledge of what facilitates good interagency working with adults, their carers, and their families.

3. WHY IS ADULT PROTECTION ON EVERYONE’S AGENDA NOW? Adult Protection -Angus

4. Enquiries  LOTHIAN AND BORDERS REPORT  CALEB NESS  VICTORIA CLIMBIE  BICHARD

5. Adult Protection -Angus Lothian and Borders enquiry  Failure to investigate very serious allegations of abuse  Acceptance of the poor conditions that people lived in  Lack of understanding of the law  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  Failure to communicate with service users  Lack of compliance with procedures  Lack of care plans, poor recording, infrequent supervision  Serious deficiencies in training and development  Lack of clarity of roles and responsibilities  Uninformed and inaccurate assumptions of expertise

6. Adult Protection -Angus Existing legislation Adults with Incapacity (Scotland) Act 2000 protected those with incapacity Mental Health (Care & Treatment) (Scotland) Act 2003 protected those with a mental disorder but those who are frail, older, or those unable to protect themselves from harm/abuse or subject to exploitation/neglect were still not covered. Human Rights Act 1998

7. ADULT SUPPORT AND PROTECTION ACT 2007 Adult Protection -Angus

8. Aim of the Act Intention of this legislation is to:  Provide the means to intervene & prevent abuse continuing  Put in place strengthened measures to give greater protection for those at risk from abuse  Improve inter-agency co-operation and promotion of good inter-disciplinary practice

9. Adult Protection -Angus What does the ASP Act do? The ASP Act introduces new adult protection duties and powers, including:  Councils duty to inquire and investigate  Duty to co-operate  Duty to consider support services such as independent advocacy  Other duties and powers - visits, interviews, examinations  Protection orders: assessment, removal, banning and temporary banning  Warrants for entry, powers of arrest and offences  Duty to establish adult protection committees across Scotland

10. Adult Protection Committees (APC) Adult Protection -Angus  To establish an APC  To review procedures & practices  To promote good practice  Identify inter-agency training needs  Improve co-operation between a range of public bodies  Appoint an independent chair

11. Membership Adult Protection -Angus Representatives of:  Council  NHS  Police Also from:  Care Commission  Mental Welfare Commission  Independent convener

12. Adult Protection -Angus Section 1: Overarching principles A public body or office holder must be satisfied that an intervention: a) will provide benefit to the adult which could not reasonably be provided without intervening in the adult’s affairs; and b) is, of the range of options likely to fulfil the object of the intervention, the least restrictive to the adult’s freedom.

13. Adult Protection -Angus Section 2: Guiding principles In addition public bodies or office holders must also have regard to: a) the adult’s ascertainable wishes and feelings (past and present); b) any views of  t he adult’s nearest relative,  a ny primary carer, guardian or attorney of the adult, and ny other person who has an interest in the adult’s well-being or property; and c) the importance of  t he adult participating as fully as possible in the performance of the function, and  p roviding the adult with such information and support as is necessary to enable the adult to participate.

14. Adult Protection -Angus Section 53: Harm Harm includes all harmful conduct and, in particular, includes: a) conduct which causes physical harm; b) conduct which causes psychological harm (for example: by causing fear, alarm or distress); c) unlawful conduct which appropriates or adversely affects property, rights or interests (for example: theft, fraud; embezzlement or extortion); d) conduct which causes self-harm.

15. Adult Protection -Angus Section 3(2): Risk of harm An adult is at risk of harm if: a) another person’s conduct is causing (or is likely to cause) the adult to be harmed, or b) the adult is engaging (or is likely to engage) in conduct which causes (or is likely to cause) self-harm N.B “conduct” includes neglect and other failures to act (Section 53)

16. ASP Section 3(1): Adults at risk Adult Protection -Angus The three point test: “Adults at risk” are adults who – a) are unable to safeguard their own well-being, property, rights or other interests; b) are at risk of harm; and c) because they are affected by disability, mental disorder, illness or physical or mental infirmity, are more vulnerable to being harmed than adults who are not so affected. In terms of Section 53 of the Act, “adult” means a person age 16 or over.

17. Considerations - Adults at risk Adult Protection -Angus The presence of a particular condition does not automatically mean an adult is an “adult at risk”. A person could have a disability, physical and/or mental health problem and be able to safeguard his/her well-being etc. All three elements of the definition must be met. (unable to safeguard/at risk of harm/because they are affected by) It is the whole of an adult’s particular circumstances which can combine to make her/him more vulnerable to harm than others and this could be very different from individual to individual.

18. Protection orders Adult Protection -Angus  Removal order  Assessment order  Banning order  Temporary banning order

19. Warrants Adult Protection -Angus  Entry  Powers of arrest  Offences

20. WHAT’S HARMFUL? Adult Protection -Angus

21. WHAT TYPES OF SIGNS OR CHANGES SHOULD YOU LOOK OUT FOR, WHICH MIGHT INDICATE …  Physical Harm  Sexual Harm  Emotional Harm  Financial Harm  Neglect

22. Adult Protection -Angus  Unusual/suspicious injuries  Misuse of medication  Anxious or disturbed behaviour  Important documents missing  Fear of going home  Unexplained physical deterioration  Bizarre behaviour Potential indicators of harm

23. Adult Protection -Angus WHO MIGHT BE THE PERSON / PEOPLE MOST LIKELY TO CAUSE HARM ?

24. Adult Protection -Angus Who harms?  Relatives41%  Paid carer26%  Friends/neighbours16%  Informal carer 5%  Others12%

25. Adult Protection -Angus Where does harm happen?  Home70%  Nursing home10%  Sheltered housing 8%  Residential homes 7%  Hospital 3%  Not identified 2%

26. Adult Protection -Angus The Care Standards  Dignity  Privacy  Choice  Safety  Realising Potential  Equality and Diversity How do these inform / affect Adult Protection ?

27. Adult Protection -Angus Who is harmed?  Socially isolated  Communication difficulties  Patterns of family violence  Behavioural problems  History of poor quality relationships  Impaired intellect, memory or physical function  High level care needs  Confused boundaries governing relationships  Over-protection

28. Adult Protection -Angus Other risk factors Where carer:  Has mental health problems  Has drug or alcohol misuse  Has history of offending behaviour  Is financially dependent on client  Is socially isolated  Suffers from external stress Where organisations:  Allow poor care practices to develop at all levels

29. Adult Protection -Angus Responses  Denial  Resignation/stoicism/acceptance  Withdrawal  Changes in behaviour  Inappropriate attachments  Fear  Depression/hopelessness  Mental confusion  Anger  Seeking attention/protection

30. Adult Protection -Angus Prevention  Providing advice and support  Ensuring services are aware of and sensitive to the needs of the vulnerable adult  Acknowledging that caring for someone is stressful and can be frustrating and that carers may feel guilty/anxious  Reflection on own and organisation’s practice

31. Adult Protection -Angus Your Role and Responsibilities: Recognising and Responding when Adults need Protecting

32. Key Message Adult Protection -Angus Every member of staff has a responsibility to recognise and respond to situations where an adult may be at risk of harm.

33. This means Adult Protection -Angus All staff must  refer concerns to the council’s social work service, following local adult protection procedures  Must work together in the assessment and decision making about adults at risk of harm who might need support and protection

34. Co-operation - practice implications Adult Protection -Angus  Duty of confidentiality, but if person is an adult at risk, and protective action is needed, then facts and circumstances must be reported to the council.  All relevant stakeholders should co-operate with inquiries.  A multi-agency and multi-disciplinary approach to inquiries and training is appropriate.  Staff should also be clear who they have a duty to report to within their own organisations.  Co-operation and information sharing required in adult protection case conferences and risk management.

35. Adult Protection -Angus  If possible - Ask the adult what happened and listen carefully  Record events – heard and observed  Take action – this may be the only opportunity  Discuss with your line manager Step 1 – initial concern

36. Step 2 An adult at immediate risk of harm Adult Protection -Angus  Contact the appropriate emergency service  Consent and capacity is not an issue in life and limb situations  Medical care must be sought and provided if needed  Staff must also be aware of the preservation of forensic evidence

37. Consent Adult Protection -Angus  Staff should be honest and open with the people they work with about their requirement to report to their line manager any concerns about their safety and welfare or the safety and welfare of others  Information should be passed on without the adult’s consent if necessary to Social Work and Health, particularly where it is known or suspected that any of the following apply:

38. Consent Adult Protection -Angus  adult may be at risk of harm  actual harm has been sustained  harm has been narrowly avoided and there is an ongoing risk of harm  others may be at risk of harm  there are public safety concerns  there are public health concerns  capacity is an issue

39. Step 3 – Consult your line manager Adult Protection -Angus  Ensure line manager knows and is kept informed  Obtain more information  Involve other agencies as required  Record all actions and decisions

40. Step 4 - Referral to Social Work and Health Adult Protection -Angus  name, address, date of birth, ethnic origin, gender, religion, type of accommodation, family circumstances, support networks, physical health, any communication difficulties, mental health and any associated statutory orders  the staff member’s job title and the reason for their involvement  nature and the substance of the allegation or concern  details of any care givers and/or significant others  details of the alleged perpetrator  details of any specific incidents (e.g. dates, times, injuries, witnesses and evidence)  background relating to any previous concerns  any information given to the person, their expectations and wishes, if known  the person referring must confirm the referral in writing but this should not delay or impede action

41. Six stages Adult Protection -Angus  Referral/concern  Consultation and planning  Assessment/investigation  Case conference and adult protection plan  Intervention and support  Monitoring and review

42. What may be expected of you Adult Protection -Angus  You may continue to work with the adult you have expressed concern about  You may be asked to attend case conference  You may be interviewed by police and asked to give a statement  You may be required to attend court and give evidence

43. Support Adult Protection -Angus  Dealing with any concerns where an adult is at risk of harm can be stressful  Doing nothing is not an option  Recognise that you may need support  Who can/should provide this?  Informal/formal support systems  Whistle-blowing

44. References Adult Protection -Angus  Adult Support & Protection (Scotland)Act 2007 www.scotland.gov.uk/Topics/Health/care/VAUnit/ProtectingVA  Code of Practice www.scotland.gov.uk/Publication/2008/07/17115228/0