Orkney Adult Support and Protection - “positive steps” made but improvements still needed

Statement on behalf of the Orkney Partnership

The services inspected are provided by NHS Orkney, Orkney Islands Council, Police Scotland and third sector agencies.

Partners in Orkney have taken “positive steps” within Orkney’s Adult Support and Protection Service however there remains a significant amount of work to be done, according to a recent Joint Inspection report.

The Joint Inspection of the Orkney Partnership took place between October 2022 and April 2023 during which time Inspectors scrutinised the records of adults at risk of harm.

A number of key messages from the review found that:

• Most initial inquiries into the circumstances for adults at risk of harm were competent and effective.
• The vast majority of staff across partner agencies in Orkney are aware of Adult Support and Protection legislation, aware of what to do when encountering concerns and confident in their role in the process.
• Multi-agency working and information sharing was evident at all stages of adult support and protection. This included the effective deployment of second workers where appropriate.
• Critical adult support and protection key processes including the assessment and management of risk were not always carried out.
• Adults at risk of harm were not always involved in decision making when they should have been. Steps should be taken to improve involvement and how this is recorded in the records.

As part of the inspection process, a staff survey was carried out to gather the views of relevant health, police and social work staff across the Partnership who work directly with adults who are particularly vulnerable, in order to understand what differences adult support and protection is making to their lives. 172 staff members responded by the closing date.

A number of key messages from the staff survey were:

• 62% agreed that they were making a positive difference to adults at risk of harm, 30% did not know and 8% disagreed.
• 56% felt adults were getting the support they needed, 28% did not know and 16% did not agree.
• 59% said they felt adults experienced a better quality of life as a result of the support their received, 33% did not know and 8% disagreed.

Orkney Islands Council Chief Executive Oliver Reid said: “I welcome this joint inspection report which confirms our understanding of current service provision and also the focus of our improvement plans.  We are pleased that Inspectors confirmed, having examined every case dealt with over the last two years, that they found no adults in Orkney to have been left at risk - however, we acknowledge that some did not get the protection that they should have.

“There is a significant amount of critical work still to be done, but inspectors acknowledge that ‘positive steps’ have been made by the services provided by NHS Orkney, Orkney Islands Council, Police Scotland and third sector agencies to deliver effective adult support and protection.

“In fact, the report states that there has been significant activity across the Partnership over the last 12-24 months to address substantial deficits in Adult Support and Protection processes.

“We do not doubt the substantial effort that is required to make further progress, but it is positive that there were no surprises in the findings of the inspection and the report is reflective of where we believe ourselves to be and confirms the focus and direction of our improvement plans.

“The Orkney Partnership and all others across Scotland faced the unprecedented and ongoing challenges of recovery and remobilisation as a result of the Covid-19 pandemic – something which the Inspectors themselves highlight.

“The ongoing recruitment issues that we all face are also continuing to have an impact. However, the Inspectors praised the innovative work being done at the Council in collaboration with a higher education provider to develop a ‘fast-track’ opportunity for existing council staff to become qualified social workers. This ‘grow your own’ initiative is successful with a number of staff already enrolled and more waiting.

“The findings of the joint inspectors include a positive endorsement of the hard work being put in by employees across the partnership. Inspectors highlighted one of the Partnership strengths as the collaborative working to support and protect adults at risk of harm. They also highlighted the Partnership’s commissioning of an independent evaluation of multi-agency adult support and protection processes in 2021 - the findings of which had provided a baseline for some essential improvements.

“We know that there remains a significant amount of work to be done but the positive progress that has been made so far, through the hard work and commitment of employees, lays the foundations for our further improvement. Unlike the Children’s Services Inspection of a few years ago, we do not require a significant change of course and staff across the partnership have been on the right trajectory for the last few years.’

“It is critical that we ensure our services for our adults in need of support and protection in Orkney continue to leave no adult at risk of harm and continue to improve. We owe it to all our residents and that is why our Chief Officers are prioritising the necessary change and improvements.”

NHS Orkney Director of Nursing, Midwifery and Allied Health Professionals and Acute, Samantha Thomas added: “We are pleased that the Inspectors recognised that professionals from all agencies are working more effectively together to protect and support our most vulnerable people. Whilst the report recognises that some progress has been made, our collective focus remains on the significant work that is still to be done to ensure the services for adults in need of support and protection in Orkney are consistently of the high standard that we would wish to provide. We will ensure the helpful feedback from this report drives the further improvements that are necessary.”

Police Scotland’s Area commander for Orkney, Chief Inspector Scott Robertson, said: "Police Scotland, both locally here in Orkney, and in conjunction with colleagues in the Concerns Hub in Inverness, continue to work alongside NHS Orkney, Orkney Islands Council, Orkney Health and Care and many third sector organisations. We are committed to building upon and strengthening even further our effective partnership to protect people in Orkney.”

The Care Inspectorate and its scrutiny partners Healthcare Improvement Scotland and HMICS will continue to monitor progress and to offer support for improvement to community planning partners in Orkney.

Inspectors stated within the report: “Overall, adult support and protection practice had taken some positive steps over the last two years. But considerable improvement across critical areas of practice was still needed.

“We asked the Orkney Partnership to prepare an improvement plan to address the priority areas for improvement we identify. The Care Inspectorate, through its link inspector, Healthcare Improvement Scotland and HMICS will monitor progress implementing this plan.”

Mr Reid said the staff effort in achieving the improvements to date must be commended.

“We appreciate the efforts and contributions of our staff and realise the pace of some changes has been challenging but necessary. We must continue working together as a team to sustain and further develop the improvements we are making.”

Key improvement areas to take forward are:

• Strategic leaders should ensure the delivery of competent and effective adult support and protection key processes for all adults at risk of harm in line with their statutory responsibilities.
• Risk assessment, chronologies, investigations, and protection planning all require immediate improvement.
• Change and improvement following the independent review in 2021 needs to be accelerated.
• The Partnership’s strategic oversight of progress should be strengthened. Effective governance and quality assurance arrangements are needed to support improvements in practice.
• The involvement of adults at risk of harm at all stages of the adult support and protection process should be improved.
• Strategic planning and decision-making should be informed by the lived experience of adults at risk of harm and their unpaid carers.

The Partnership’s next steps:

• Share the findings of the Progress Review across the Partnership, followed by Individual Service Feedback to improve partnership effectiveness.
• Continue to engage the workforce in improving our approaches to adults in need of support and protection while maintaining momentum to sustain and further develop the improvements we are making.
• Remain committed to learning from feedback, findings from complaints, learning reviews, scrutiny, auditing, self-evaluation, individual service approaches, Inspections and progress reviews.

The findings from the recent inspection will inform a report to the Scottish Government giving the overall findings.

The Care Inspectorate Progress Review, will be published and available on 11 April 2023 from their website www.careinspectorate.com