Protecting and supporting vulnerable adults in Scotland: Impacting public policy, services, health and welfare

This research, led by Professor Hogg, was used in the development of the Adult Support and Protection (Scotland) Act 2007 which now guides practice with all vulnerable adults in Scotland. This was used to develop a multiagency Adult Support and Protection (ASP) self-evaluation methodology and toolkit.

Over 50% of adult protection committees in Scotland have adopted its use. The Unit’s research has led to the development of a national strategy and practice guidelines to ensure that all vulnerable adults with profound and multiple learning disabilities (PMLD) in Scotland have a right to appropriate health care provision, including invasive procedures.

Though a wide range of research within the unit relates to supporting and protecting vulnerable adults and their carers, this impact case study focusses on three linked research projects.

The first area of research (Hogg et al 2009 a & b) examined cases entailing adult protection in Scotland prior to the implementation of the Adult Support and Protection (Scotland) Act 2007. The study examined the agency and interagency working in adult protection cases, provided a baseline to compare such activity before and after implementation of the Act, and provided the groundwork for future audit in such cases after implementation of the Act.

The study utilised a multiple methods, in-depth case study approach. Each case study involved documentary analysis of service user/patient files (primarily social work), followed by semi-structured interviews with all involved professionals. Detailed chronologies were then compiled of events and interactions over the course of each case, supplemented by professionals’ explanations and reflections on the process of response. This information was synthesised in a tabular chronology with agency and interagency communication and activity coded and organised into key themes.

This research led to the following insights underpinning the impact:

• occupational cultures affected adult protection activity
• how cases were conceptualised or framed as adult protection cases or otherwise impacted response
• operational considerations impacted adult support and protection

The second area of research (Hogg & May, 2012 & 2011) followed on directly from the research outlined above. A self-evaluation resource for adult support and protection activities was developed and pilot tested in 15 of the 28 multi-agency partnerships across Scotland. This research used a survey methodology of all pilot sites. The utility of the resource was demonstrated as a mechanism for enabling multi-agency partnerships to evaluate the effectiveness of their own policy and practice and as a benchmarking resource.

The third area of research focused on health care procedures viewed as invasive by the family members and paid carers of people with profound and multiple learning disabilities. Specifically the research aimed to establish the extent to which barriers exist which precluded the delivery, of such procedures in service settings and what these barriers were. The research identified ways in which barriers may be overcome and to described examples of good practice in which barriers have been overcome. The research consisted of three components:

1. Symposium - A review by experts of evidence and workshops with practitioners to elicit their views
2. A national survey of policy and practice in Scotland with respect to delivering invasive procedures in educational, health and social care facilities
3. Synthesis of information by an expert committee and a national reference group.

The results identified healthcare procedures judged by professionals and family carers as “invasive” and examined barriers to their delivery in service settings. 

Practice guidelines have been developed based on the research and have been included in the Scottish Government’s strategy for improving the lives of people with learning disabilities.

Details of the impact

The findings of the initial study into multiagency Adult Support and Protection (ASP) activity contributed to the work of the Steering Committee for the Adults Support and Protection (Scotland) Bill of which Professor Hogg was a member.  The outcome of the research is reflected in the subsequent Act and the work of the Implementation Committee of which he was also a member. 

This Committee was established to ensure continual engagement with stakeholders during the implementation of the Act. Membership of the group included representatives from regulatory bodies, local authorities, NHS Boards, police and a number of voluntary organisations.  After the Act was passed, it was agreed that the group should continue through the implementation period in recognition of its much - valued role in informing the work of the Government.  Members represent the views of their organisation and report back to their organisations, as appropriate, the outcome of discussions held at the meetings.  Throughout this process the principal investigator contributed to the development and implementation of the Act.

In the light of the findings, and at the instigation of the Scottish Government:

• a resource for self-evaluation of multiagency ASP activity was developed by Professor Hogg in discussion with a wide range of agencies, including the Social Work Inspection Agency, the Scottish Government, and ASP multiagency partnerships;
• two national conferences of stakeholders were held on the ASP resource in 2010/11.

The outcome was a Resource handbook which has been piloted in 14 ASP Partnerships (50%) in Scotland and revised in the light of feedback. 

The evaluation of the Resource has:

• indicated that seven ASP partnerships had changed their practice as a result of shortcomings revealed through self-evaluation (see Hogg & May 2012, p.183)
• influenced the chair of the National Adult Protection Committee Convenors Committee to subsequently recommended adoption of the Resource as a benchmarking tool for reporting to the Scottish Government
• the Care Inspectorate has indicated that the Resource would be used in a modified form from 2013 to evaluate the adult protection component of adult services

The Resource has been published on the Scottish Government’s website. In 2010, 13 of the 29 Adult Protection Committees in Scotland had undertaken self-evaluation and audit activity of their work, mostly using the approach developed in Dundee. In 2012 all but one of the 29 Adult Protection Committees had undertaken self-evaluation and case file audits (Ekosgen, 2013).

The invasive procedures research led to the establishment of a Short-Life Working Group which developed a Scottish quality framework for the delivery of invasive procedures in health, education and social care setting. The recently launched strategy for improving the quality of life for people with learning disabilities is recommending that all service providers follow these guidelines (Scottish Government, 2013). The current impact has been on policy development and initial implementation.

References to the research

Hogg, J., & May, D. (2012). The development and piloting of the self-evaluation of adult support and protection activity in Scotland: Resource handbook. Journal of Adult Protection, 14(4), 176-187.

Hogg, J., & May, D (2011) Self-evaluation of Adult Support & Protection Activity in Scotland: Resource Handbook. Edinburgh: The Scottish Government.

Hogg, J., Johnson, F., Daniel, B., & Ferguson, A. (2009a). Interagency Collaboration in Adult Support and Protection in Scotland: Processes and barriers. Volume 1: Main Report. Dundee: White Top Research Unit, University of Dundee.

Hogg, J., Johnson, F., Daniel, B., & Ferguson, A. (2009b). Interagency Collaboration in Adult Support and Protection in Scotland: Processes and barriers. Volume 2: Recommendations. Dundee: White Top Research Unit, University of Dundee.

Garrard, B., Lambe, L. & Hogg, J. (2010) Invasive Procedures: Minimising Risks and Maximising Rights: Improving practice in the delivery of invasive procedures for people with profound and multiple learning disabilities Project Report and recommendations. Dundee: PAMIS and White Top Research Unit, University of Dundee