Referral Process

Staff Reporting a Concern

Persons Responsible: Anyone who witnesses, suspects or receives information about an adult who may be an adult at risk being subject to, or at risk of, harm, mistreatment or neglect. We refer to the staff member for ease.

Concerns about possible abuse are identified:

If you are with the adult at risk, speak to the person about your concerns and the risk involved.

Action to be taken.

Do:

• Seek urgent medical attention, or police attendance, if it appears to be required.
• Listen to the adult.
• Offer reassurance and support whilst being clear to the adult that you may not be able to preserve the confidentiality of what you are told, if they are at risk.
• Ask simple non-leading questions to obtain the facts.
• Make careful notes (including date and time) and keep these in their original form, using the exact words of the adult as far as possible.
• Establish who was involved and whether anyone else was present in hearing/visual distance.
• Establish what the person would like to see happen next.
• Try to establish whether anyone else is at risk.
• Take precautions to preserve any forensic evidence.
• In the event of the person being injured make a note of the injuries.
• Inform your line manager (or other social work manager) immediately.

Do Not:

• Dismiss the adult’s concerns or be judgemental.
• Interview or investigate beyond what is essential to ascertain the basic facts.
• Make promises that cannot be kept, for example, around keeping a confidence, or that nothing will happen or that a certain set thing will definitely happen.
• Share the information with colleagues where the allegation involves another member of staff.

If you receive information from a third party, try to establish the same basic information. Record your conversation carefully and if possible ask the person to agree that you have made an accurate record. Explain to the person any subsequent steps you may believe are necessary. Advise of your responsibility to report concerns about possible abuse to your Line Manager (except in circumstances where your line manager is implicated in the alleged abuse) and if necessary to Adult Services and the Police.

Staff Member Discusses Concerns with Line Manager or Supervisor

Persons Responsible: Staff-member in consultation with line manager or supervisor (except where the line manager or supervisor is implicated in the alleged abuse).

Action to be taken.

Discuss concerns with your Supervisor or Line manager as soon as possible. If they are unavailable, find a suitable alternative manager. The full facts and circumstances of the situation should be identified and discussed.

The following points, amongst others, may be considered:

• What is already known about the adult’s capacity.
• Whether the adult has given consent to the information being passed on.

If the adult at risk consents to the information being passed on a referral must be made to the Adult Services Duty Worker during office hours (01856873535) or the out of hours Social Worker outwith office hours (01856888000). This referral will trigger the Local Authority duty to make enquiries and investigations under the Act.

Referrals can also be made directly to the Police on 999 or 101. In the case of physical or sexual abuse, immediate referral to the Police is essential to ensure that vital evidence is not destroyed. If the Police are contacted a referral must also be made to Orkney Health and Care using the usual route of referral i.e. to the duty worker.

It is also necessary to consider whether emergency action is likely to be necessary and if any steps are required to secure the adult’s immediate safety. If emergency action is required do not hesitate to provide this i.e. call an ambulance or NHS24, or the Police. Record discussion and any action taken.

If the adult at risk does not want action taken, his or her wishes should be respected unless any of the following applies:

• There is any doubt the person has capacity.
• He or she or others are or may be at risk.
• It appears likely that a criminal offence has been committed.
• It is a requirement of legislation.
• There are public health concerns.
• It is suspected that the adult may be under undue pressure.

Regardless of the adult’s views, if there is any doubt about any of the above the referral should be passed on and the person receiving the referral should be advised of the lack of informed consent.

If there is a child at risk contact should also be made with the Children and Families Service in accordance with Inter-Agency Child Protection Guidelines.

If the person is a resident of a care home or a patient in a hospital, it is important that any suspected or actual incidents of harm, mistreatment or neglect are reported in order to protect other residents or patients regardless of the adult at risk’s wishes. In these circumstances, it must be explained to the person that the referral has to be passed on to the Community Care Service.

Referral to Orkney Health and Care Adult Services or Police

Person Responsible: Staff-member and or line manager.

Action to be taken: Referral to Adult Services Duty Worker, Case Manager, Police or Out of Hours Social Worker.

• Adult Services Duty Worker – 01856873535.
• Police – 101.
• Our of Hours Duty Social Worker – 01856888000 and ask for ‘Duty Social Worker’. Where it has been concluded that it is appropriate, a referral to the Adult Services Duty Worker (or Case Manager if known) or Police should be made without delay. If the concern arises out with normal office hours, a referral must be made to the Police or the out-of-hours duty social worker.

The referral should include as many of the following details as possible:

• Personal details - name, address, date of birth, ethnic origin, gender, religion, GP, type of accommodation, family circumstances, support network, physical health and communication difficulties if any, mental health including whether the person is subject to any order under the Mental Health or Adults with Incapacity Acts.
• The referrer’s job title and reason for involvement.
• Nature/substance of the allegation.
• Details of care givers/significant others.
• Details of alleged abuser and current whereabouts and likely movements within the next 24 hours, if known.
• Details of any specific incidents, for example, dates, times, injuries, witnesses,evidence such as bruising.
• Background of any previous concerns.
• Awareness or not/consent or not by the person concerned, carers, alleged abusers of the referral • Information given to the person, expectations, wishes of the person, if known.
• Record discussion and any action taken.

The person who has received the referral will then initiate Adult Support and Protection procedures as appropriate.

What will happen next?

Once your concern is received it will be looked into in line with the procedures set out in legislation and Codes of Practice.

Following a referral an investigation might proceed like this:

At any point in the process there could be a decision to take no further action under adult protection procedures if they were no longer felt to be appropriate.

At any point in the process it might be necessary to apply for one of the available Protection Orders, to make use of one or more of the other legislative processes that are available, or to continue the support and protection work under normal case management procedures rather than under the Adult Support and Protection (Scotland) Act 2007.

Background information for each of the boxes numbered above:

Box 1: Report your concern to the Adult Services duty worker or police

You can report your concerns directly to the duty worker in Adult Services during office hours on 01856873535. Outside office hours report your concerns to the out-of-hours social worker via the Balfour Switchboard 888000. Alternatively, you can report the matter directly to the Police on 101. When you report the matter you will be asked to give a range of information, please give us much detail as you can.

Box 2: Initial Screening by the duty worker

The duty worker will carry out initial screening on the referral, in consultation with the duty senior or in an out of hours’ situation, the duty social work manager. This process will consider whether the adult appears to meet the criteria for the ‘three point test’, and progress the referral along the appropriate route. Available background information may be gathered as part of initial inquiries.

Box 3: Initial Planning Meeting with relevant agencies for example social work, police, health, and advocacy

The Principal Social Worker or Senior Social Work practitioner, Adult Services (or Duty Social Work Manager out of hours) will convene the Initial Planning Meeting. Key people involved in the potential investigation will be asked to attend such as the Police, a GP, a Case Manager and key staff from other relevant agencies if appropriate. This meeting will be held as soon as possible after the referral and at this meeting it will be decided whether and how an investigation should be carried out. If an investigation is to go ahead, a Council Officer will be allocated to the case at this meeting.

Box 4: Formal Investigation – Council Officer may request information or assistance

The Council Officer allocated to the case will carry out the investigation in the manner that best suits the circumstances. This might involve visits and interviews. It might also involve applying for one of the Protection Orders available under the Act. If you are a staff-member you have a duty to cooperate with a Council Officer carrying out an investigation, which includes enabling access to records. You might also be asked to assist with a joint visit if the Council Officer considers it to be appropriate. An example of where this might be appropriate is where the adult has communication difficulties and you know the adult well and can therefore assist in the communication. Remember, for staff members across agencies, it is an offence to obstruct an investigation or other lawful action under the Act and it is an offence not to cooperate with requests for access to records unless you have good reason for doing so.

Box 5: Further Planning Meeting with relevant agencies for example social work, police, health, and advocacy

The information that has been gathered through the investigation process will be brought back to a Further Planning Meeting, convened by the Principal Social Worker or Senior Social Work Practitioner, Adult Services (or Duty Social Work Manager out of hours) This meeting will generally involve the same people who attended the Initial Planning Meeting plus any other people that the investigation has found to be key to the decision-making process. The Further Planning Meeting will decide on the next course of action based on all the information available. This might include deciding to hold an Adult Protection Case Conference.

Box 6: Adult Protection Case Conference

If the Further Planning Meeting has concluded that an Adult Protection Case Conference is necessary this will be convened by the Council Officer and chaired by the Principal Social Worker, Adult Services. Case Conferences aim to bring together all the people with a role in the case, including the adult themselves, and in some cases the alleged abuser. The Case Conference aims to air all the relevant views, discuss what the perceived risks to the adult are and agree an appropriate means of protecting the adult from harm. This might involve drawing up a Support and Protection Plan. You may be asked to attend a Case Conference and contribute your views.

Case Conferences can be quite daunting, even for staff, as there are usually quite a number of people attending and they are quite formal, with questions and comments directed through the Chair and a formal minute taken. If you are asked to attend it can be worth spending some time in advance thinking about what the key points you would like to raise are, and making some notes to remind yourself during the meeting. If you are asked to submit a written report to the Case Conference take some time writing it, remembering to distinguish between fact and opinion, and make sure you have checked it with your line manager before you submit it.

Box 7: Adult Support and Protection Plan

A Support and Protection Plan may have been agreed at a Case Conference. A Support and Protection Plan is very much like a normal care plan in that it sets out needs and risks and outlines who is responsible for delivering on which aspects of the plan and when. A Support and Protection Plan will set out clear timescales for actions and how communications will be managed. Just as with any other type of care plan, a support and protection plan will be reviewed regularly on agreed timescales and more frequently if required, and will be changed and adapted as the circumstances change. The Support and Protection Plan will be led by a case coordinator, who may be the Council Officer who carried out the investigation, or another allocated Case Manager as decided at the Case Conference.

Box 8: Reviews with Core Group members

If a Support and Protection Plan has been put in place by the Case Conference a Core Group will also be established to implement and monitor the progress of the plan.

The Core Group members will usually be decided at the Case Conference. The Core Group will consist of people who are directly involved in the provision of care and support services for the adult. A Core Group is effectively a working group, tasked with implementing and overseeing the ongoing care, led by the allocated case coordinator (Council Officer or Case Manager, as allocated by the Case Conference).

Box 9: Review Case Conference

At agreed intervals, set at the Case Conference but not less frequently than every three months, a Review Case Conference will be held to monitor the effectiveness of the plans that have been put in place and to formally record progress (or lack of it) and further decision making. This meeting will hear information from the Core Group and will expect information about how the Support and Protection Plan has or has not worked and what if anything needs to be changed. The meeting will be chaired by the Principal Social Worker, Adult Services, in much the same way as the Case Conference and will be attended by a number of key people in addition to Core Group representatives. If you are part of a Core Group you may be involved in these Review Case Conferences and may well be asked to give your views in the meeting.

Protocol for dealing with Advocacy Referrals

This document is designed to clarify the roles and responsibilities of Orkney Islands Council, NHS Orkney and Advocacy Orkney in ensuring people affected by the Adult Support and Protection (Scotland) Act 2007 are dealt with in line with the guiding principles of the Act.

Adults at risk.

Section 3(1) of the Act states ‘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.

Duty to consider importance of providing advocacy and other services Section 6 of the Act states that:

1. This section applies where, after making enquiries under section 4, a council considers that it needs to intervene in order to protect an adult at risk from harm.

1a. Where this section applies, the council must have regard to the importance of the provision of appropriate services (including, in particular, independent advocacy services) to the adult concerned.

1b. Independent advocacy services has the same meaning in subsection (2) that it has in section 259 of the Mental Health (Care and Treatment) (Scotland) Act 2003, i.e. it is a service of support and representation made available for the purpose of enabling the person to whom they are available to have as much control of, or capacity to influence, that person’s care and welfare as is, in the circumstances, appropriate. It must be independent, which means that it must not be provided by the local authority, health board or National Health Service trust, or a member of any of these.

Purpose of Independent Advocacy

As identified in the Code of Practice, independent advocacy might assist an adult who is deemed to be at risk to express their needs and thoughts or to present their views. An independent advocate might help the person in everyday dealings in relation to their health and social care. The advocate may speak on their behalf in their dealings with, for example, the Council Officer, Mental Health Officer (MHO), Residential Medical Officer (RMO) or members of hospital or community-based staff. Independent advocacy can assist people:

• To make informed decisions.
• To increase their decision-making capacity by helping them to understand the issues being discussed.
• In communicating their views to others; and
• In representing the adult at risk’s interests to enable those to be taken into account in decisions made relating to their care and treatment

The Role of Independent Advocacy

Independent advocacy can enable an adult at risk to express their needs and thoughts and to make these known to those who are making decisions about their care and welfare. Many of those decision makers are required to take the adult at risk’s views into account and an independent advocate can play a vital part in ensuring that this can be done. The role of independent advocacy is to help an adult at risk understand the options and to convey their views. While it is not the role of the independent advocate to make decisions for the person, they are there to offer support to facilitate the adult at risk’s decision-making. For example the advocate may:

• Support an adult at risk to consider their previous experiences in relation to care in order to prepare an advanced statement.
• Assist an adult at risk to prepare for a meeting with other professionals who are involved in the processes under the Act.
• Support an adult at risk to access appropriate legal advice and representation.

The involvement of independent advocacy does not change the level of responsibility on other professionals involved with the adult at risk. Those professionals are still required to exercise their professional judgement in the adult at risk’s case. Nor does the involvement of advocacy affect an adult at risk’s rights with regard to seeking advice from a solicitor or access to legal aid.

Council Officer

There is no duty under the Act for a Council Officer, or any other person exercising functions under the Act, to inform an adult at risk of the availability of independent advocacy services or to take appropriate steps to ensure that adults at risk have the opportunity to make use of those services. However, it is clear from the principles and guidelines under the Act that the involvement of independent advocacy must be considered.

Referral Process

In line with the guiding principles of the Act and, in particular, where the adult at risk has a mental disorder a referral should be made to Advocacy Orkney, unless the adult at risk indicated their refusal of such a service. All referrals are treated in confidence. Referrals can be made to Advocacy Orkney via the following process:

1. Visit the Advocacy Website (from the Related Sites section of this page) and use the menu to select ‘Referral Forms’. Follow the instructions to print off the referral form. We need the referral form to be signed by the person making the referral.

1a. Complete and sign the form and post or Fax it to Advocacy Orkney.

1b. If required or considered necessary telephone, confirming consultation with the adult at risk and any relevant information required to establish effective contact, such as risk assessment. You will be advised to complete and sign a referral form.

1c. All referrals will be acknowledged in writing. Council Officer’s and others should not assume that a referral has been accepted without any acknowledgement or confirmation from Advocacy Orkney.

1d. If, when advocacy has been requested and a referral made, following the initial meeting, the adult at risk chooses not to proceed with advocacy support, Advocacy Orkney will advise the associated Council Officer as soon as is practicable.