Professional

Joint inspections of adult support and protection

Background

Phase 1 of our programme of joint inspections of adult support and protection took place during 2020-2023. Twenty-five joint inspections were carried out, and individual partnership reports were published. An overview, summarising the findings in these reports was also published, and is available here. This shaped our subsequent phase 2 approach.

Phase 2

In June 2023, the Scottish Government asked the Care Inspectorate to lead further joint inspection work with our inspection partners including, Healthcare Improvement Scotland and His Majesty’s Inspectorate of Constabulary in Scotland. This commenced on 1 August 2023 and is scheduled to conclude in July 2025, and blends scrutiny activity with improvement support. There has been close collaboration with adult protection partnerships throughout.

The programme provides assurance on the quality of adult support and protection services in Scotland and promotes improvement activity through the development of a quality indicator framework and supported self-evaluation. Phase 2 of the programme comprises four workstreams.

Workstream 1

The joint inspection of the six adult support and protection partnerships first inspected in 2017.

The first year of our phase 2 programme included reviewing the progress of the six adult protection partnerships that were subject to adult support and protection inspections in 2017/18. The joint inspection team used the inspection methodology employed in Phase 1. These inspections focused on key processes and strategic leadership.

This programme of inspections was completed in May 2024 and included the North Ayrshire, Highland, Dundee, Aberdeenshire, East Dunbartonshire and Midlothian partnerships. Individual reports of the inspections have been published and can be accessed using the links above.

A joint inspection of adult support and protection overview report took account of the key findings from these six reports. This was published and can be accessed here.

Workstream 2

Development of a multi-agency quality improvement framework (QIF) for adult support and protection partnerships in Scotland.

Design of the QIF was undertaken in collaboration with The Scottish Government National Implementation Group self-evaluation subgroup. Four consultation workshop events took place, to which representatives from all health and social care partnerships across Scotland were invited. This included events in Glasgow, Edinburgh, and Dundee, as well as one online session. These were held to provide an opportunity for the sector to comment on, refine, and enhance the draft framework. The sessions were attended by approximately eighty-four delegates representing almost all Health and Social Care Partnerships and the feedback gathered was then used to inform the final document.

A working group was established that included joint inspection partners and representation from the national implementation group.
The working group took careful consideration of the views from people with lived experience to ensure it was trauma informed.
A communication plan was designed and implemented and four well attended engagement sessions were arranged
The joint inspection team undertook a ‘you said, we did’ exercise with the national implementation self-evaluation subgroup to review the key themes from the four engagement sessions. We refined the QIF following their feedback.
The QIF was published on 15 October and can be accessed here.
This document will be promoted widely across the sector after its launch at a series of national events.
This includes a formal launch at the Aspire event that took place on 28 November 2024
This framework will support partnerships multi-agency self-evaluation of their adult support and protection arrangements and is designed to lead to improvement in services.

Workstream 3

This review of progress activity provides assurance of improvement in those partnerships where areas of weakness outweighed strengths in phase 1. This programme involves the South Ayrshire, Moray, West Lothian, Edinburgh, Orkney, and Western Isles partnerships.

Our file reading tool had previously been updated to reflect the changes in methodology and take account of the Scottish Government revised code of practice for adult support and protection (July 2022).

Completed workstream 3 progress reviews include South Ayrshire, West Lothian, Edinburgh and Moray. Individual reports will be published in due course for all six partnerships.

In these progress reviews we are using the following evaluations to measure progress.

Minimal progress: Improvement is minimal. The partnership’s overall approach to improvement is not comprehensive or put into practice. Its deployment and implementation are limited. It has not embedded improvements or they are still at the planning stage. It does not communicate improvements effectively and they are not well understood by staff. It does not assess and review the effectiveness of its improvement progress.   

Some progress: Evidence of some improvement.  The partnership’s approach to improvement is moderate.  Its implementation and deployment of improvements are structured.  It is beginning to embed improvements in practice.  It communicates improvements partially and staff understand them reasonably well.   It has limited measures to evaluate and review impact and outcomes for adults at risk of harm.  It periodically assesses and reviews its improvement methodology. 

Significant progress: Significant improvement. The partnership’s approach to improvement is comprehensive and embedded. Its deployment of improvements is well structured, implemented and effective. It communicates improvements purposefully, and staff understand them fully. It has effective measures to evaluate and review impact and outcomes for adults at risk of harm. It continually assesses and refines its improvement methodology.

The joint inspection team will also be re-visiting the Renfrewshire partnership to complete their phase 1 inspection that was interrupted by Covid-19 restrictions coming into force in March 2020.

Workstream 4

The joint inspection of adult support and protection team aims to work with volunteer partnerships, using the quality improvement framework developed in workstream 2, to undertake a programme of supported self-evaluation. Our focus will be on quality illustration 5.7 and those cases where it is difficult to determine the three-point criteria. During phase 1 activity some partnerships had promising initiatives aimed at developing their early intervention, prevention, and trauma informed approaches to this complex group of adults at risk of harm. We will work jointly with partnerships to assess the strengths of these initiatives.

This is an opportunity for partnerships to work alongside the joint inspection team to develop and implement the methodology. We will share learning and promote a deeper understanding about self-evaluation approaches and its impact on improvement work.

We have invited all adult support and protection partnerships to formally express a confirmed interest in this opportunity week commencing Monday 11 November 2024. We will look to confirm the partnerships selected prior to the end of December 2024 and commence work with them in January 2025.

A communication and engagement plan will be put in place once we have identified the partnerships we will be working with.

Introduction

Everyone in health and social care has a role to play in upholding people’s rights. This includes the right to person centred and trauma informed care and support. Restrictive practice which includes restraint, seclusion, segregation and other less direct practices may form part of a person’s plan of care or support. This includes all people from infants and children, through to young people, adults, and older people. This policy states our position on the use of restrictive practice in all services, to ensure this being the ‘last resort’ and where the risks and benefits to the person have been considered within a legal, ethical and practical framework. This statement should be read in conjunction with the guidance for specific services.

Definition

Restrictive practice is defined as making someone do something they do not want to do or stopping them from doing something they do want to do, by restricting or restraining them, or depriving them of their liberty.¹

Restrictive practices relate to different types of restraint. This can be physical, mechanical, chemical, cultural, environmental or psychological restraint, surveillance or blanket rules.

Policy position statement

The Care Inspectorate is committed to upholding and promoting human rights and the rights of the child. These rights may only be restricted as a last resort, including in the use of restraint. The use of restrictive practices, including physical restraint, must be considered within a context of the conflict in the promotion of rights, independence and choice for children and adults, versus promoting and maintaining our duty of care.² In law³, the use of force in any form is required to be justifiable, reasonable and proportionate. Practitioners may be required to take protective action to keep children and adults safe from harm that may affect rights, including choice, dignity and freedom. However, this must be delivered within a context of positive risk taking and compassionate care.

Legislation and standards

Whilst there is no specific piece of legislation that focusses on restraint, the Care Inspectorate is guided by the following legislation and standards.

The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, which specifies:

under welfare of users that “A provider must ensure that no service user is subject to restraint, unless it is the only practicable means of securing the welfare and safety of that or any other service user and there are exceptional circumstances” (4(1)(c)).
under fitness of premises that “Accommodation must not be provided and used for the purpose of restricting the liberty of children in any residential premises where care services are provided unless such provision and use have been approved by the Scottish Ministers” (10 (3)).

The Health and Social Care Standards, which set out that:

“If my independence, control and choice are restricted, this complies with relevant legislation and any restrictions are justified, kept to a minimum and carried out sensitively” (1.3).
“My care and support meets my needs and is right for me” (1.19).
“Any treatment or intervention that I experience is safe and effective” (1.24).
“I experience warmth, kindness and compassion in how I am supported and cared for, including physical comfort when appropriate for me and the person supporting and caring for me” (3.9).
“I am protected from harm, neglect, abuse, bullying and exploitation by people who have a clear understanding of their responsibilities” (3.20).
“I experience care and support free from isolation because the location and type of premises enable me to be an active member of the local community if this is appropriate” (5.9).
“If I experience 24 hour care, I am connected, including access to a telephone, radio, TV and the internet” (5.10).
“I can independently access the parts of the premises I use and the environment has been designed to promote this” (5.11).
“If I live in a care home, I can control the lighting, ventilation, heating and security of my bedroom” (5.12).

CQC 2023
Civil law
Common law

Self-evaluation of performance and quality assurance in justice social work

This justice social work self-evaluation will focus on the current capacity of services to evidence performance, quality and outcomes in relation to community based sentences. The self-evaluation activities will be undertaken in two phases between September 2024 and March 2025. A national report will be published in May 2025.

The approach to this work will be informed by Quality Indicator 6.4 (Performance Management and Quality Assurance) which is drawn from the Care Inspectorate’s Guide to Self-Evaluation for Community Justice in Scotland. The aim is to develop a clear understanding of strengths and develop an evidence-base that informs local and national improvement initiatives.

By using a self-evaluation approach rather than a traditional inspection model, we hope to minimise the burden on local authorities whilst building capacity for improvement across the sector.

Useful links:

More information about this self-evaluation

We will undertake this self-evaluation in two phases.

Phase 1: National self-evaluation – 2 September to 20 November 2024

All local authorities will be asked to undertake a self-evaluation against Quality Indicator 6.4: Performance Management and Quality Assurance, using a specially developed tool. The below online briefing provides an overview of the approach, the templates and the submission process.

The Care Inspectorate team will analyse the responses to identify key strengths and challenges emerging from the evaluations.

Phase 2 – Validation activity – 20 January to 24 February 2024

The Care Inspectorate will select four local authority areas and will work with them to validate their self-evaluation. This will include review of documentary evidence and focus groups with staff and people who use services.

Participating local authorities will receive a validation letter and feedback on their self-evaluation.

A final thematic report will be prepared summarising the findings of the national self-evaluation and the key messages emerging from the validation activity. This will reflect national messages and share information about examples of innovative practice – findings will not be attributed to individual local authorities.

What you will need

We have developed a blank template, with guidance, to support you to undertake the self-evaluation. This template is available in word to allow you to develop your responses over time and share it with colleagues. However, final submission of the self-evaluation will be via the smart survey. If you have used the word version of the template to compile your responses, please paste your answers in to our smart survey using the link below.

This is the link to the smart survey for submission. This link will go live on Monday 2 September. Please make your final submission on or before Wednesday 20 November.

We have provided an exemplar of what a completed self-evaluation template may look like for your reference and guidance. We have also provided a Quality Indicator 6.4 illustration.

For further information on privacy in relation to how this review is conducted please see our privacy statement.

What will we do?

Between July 2024 and December 2024 we will carry out a review that will focus on social work governance and assurance in Scotland. We will answer the following question.

How well do social work governance and assurance arrangements support leaders to:

Ensure statutory duties are carried out safely and effectively?
Enable social work staff to be supported, accountable and effective in their practice?
Assist social work staff to uphold core social work values?

What is the purpose of the review?

The purpose of the review is to add to the understanding of the role, remit, effectiveness and the current challenges facing social work services. We will do this by exploring the impact of governance and assurance arrangements. The review will:

highlight the areas of influence for chief social worker officers, principal social workers and other key social work leaders as they provide governance and assurance
explore the support and assistance provided by leaders and managers to encourage staff to uphold social work values in practice
identify and disseminate information about what is working well
recognise the challenges faced by local leaders and staff across the country and identify areas where improvement is required.

How will we do this?

A team of strategic inspectors from the Care Inspectorate will carry out the review. The scope of the review is relative to the current pressures currently being experienced by the sector. It is designed to be mindful of the impact on those leading and working in social work services. We will take a collaborative, flexible and supportive approach when working with local areas. Each area is asked to nominate a co-ordinator to act as a main point of contact for the review. The timeline below (figure 1) illustrates the core tasks being undertaken through the review. The key dates are outlined below.

How will we report our findings?

The review will conclude in December 2024. Using the principles of the European Framework for Quality Management (EFQM) model, we will analyse all of the information gathered systematically and will draw together messages for the sector. A national report will be published on our website in March 2025. We will also use other methods, such as webinars, to share the learning from the review.

For more information, please visit our website here.

Review timeline

webpage graphic

Figure 1: Review timeline

Details about the review timeline

Date	Type of activity	More details
15 July 2024	Notification	Local authorities and HSCPs formally notified and asked to nominate a co-ordinator to act as a single point of contact by 19 July 2024.The following week co-ordinators receive detailed guidance about the review.
5 - 16 August 2024	Briefing sessions for co-ordinators	Co-ordinators invited to attend a virtual briefing session with the review team from the Care Inspectorate.Information about the review will be shared and there will be opportunities for co-ordinators to ask questions.
19 August - 4 October 2024	Staff survey	Local authority areas/HSCPs asked to share a staff survey for all frontline social work staff and first line managers.
27 August 2024	Document return	Co-ordinators asked to return a short list of documents to the partnership by this date.
30 September - 1 November 2024	Interviews with leaders and focus groups	Structured interviews with Chief Social Work Officers and a maximum of two other people during this period.Middle/senior managers (e.g. operations managers, service managers) from each local authority invited to participate in themed virtual focus groups.
17 March 2025	National review report publication	National review report published on the Care Inspectorate website. A local staff survey report will be provided to each area after publication.Further opportunities to discuss findings will be arranged, including webinars.

Key definitions

Some definitions to clarify the remit of the review:

By governance and assurance we mean: A robust system for assuring high standards in the delivery of safe, personalised and effective social work services [adapted from the definition in “Governance for quality social care in Scotland” SWS 2018]

By statutory duties we mean: those outlined in the “Role of the registered social worker in statutory interventions: guidance for Local Authorities” in relation to the wide range of statutory duties across children’s, adults and justice social work services [source: Role of registered social worker in statutory interventions: guidance for Local Authorities SG 2010].

By social work staff we mean: social workers and other staff employed to fulfil or support the delivery of statutory social work duties such as occupational therapists, paraprofessionals (social work assistants and justice assistants). For the purposes of this review, we will not involve staff who work in registered services (such as residential care home staff, housing support staff or similar), because they are already involved in inspections of regulated services.

By core social work values we mean: those outlined in the SSSC code of practice (May 2024) underpinned by the ethical principles of human rights and dignity, social justice and professional integrity [source: BASW Code of Ethics 2021]

Care Inspectorate