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. 

Related links:  

• Read our previous update here. 

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).

1.  CQC 2023
2. Civil law
3. Common law