Vulnerable failed by Scots care system, says inspectorate

It says leadership "did not deliver consistent, competent, effective adult support and protection practice that ensured adults at risk of harm were safe, supported, and protected".

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It comes as fears have been raised that a ministerial pledge to revolutionise the care of young people in Scotland through The Promise was at risk with social workers at “a critical tipping point” as staff report increasing concerns that social work workloads have become unmanageable.

An analysis during the summer by Social Work Scotland (SWS) describes an ageing workforce - with some 19% reaching retirement age - and a staff group who are struggling with administrative burdens, fearful of making mistakes, and living with the "moral distress"of having to work in a way which does not align with their professional values.

One in four graduating social workers do not make it to six years in the job and were being pushed out by factors such as poor work-life balance, an overburden of administration tasks and high caseloads.

The health and social care partnership’s adult services had 30 vacancies for main grade social workers. At full complement, there would be 162 social workers And the inspectors found that social work services "lacked capacity" to carry out adult support and protection work promptly, effectively, and efficiently.

Inspectors in the latest scrutiny analysis fed to Scottish ministers have said the Edinburgh partnership should take steps to improve the quality of adult protection case conferences and have set out a plan of action.

They said not enough adults at risk of harm had special assessments including clear accounts of all significant events to establish those at risk "that was fit for purpose". There were concerns that there were no risk assessment when serious risks were present. It also raised red flags over significant risks not mentioned at all in the assessments. It also raised concerns that there was no conversation with the adult at risk of harm about their risks, and that there were delayed actions to stop harm.

The report found that social workers did not consistently interview adults at risk of harm about concerns raised. Other paid and unpaid carers and alleged perpetrators were often not interviewed.

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And social workers did not routinely carry out adult protection investigations when it should have.

They said that management oversight was "lacking" for initial inquiries into adult protection concerns as was the recording of application of the three-point test required through the Adult Support and Protection (Scotland) Act to discover those that are risk.

Almost all initial inquiries did not record application of the three-point criteria and most showed no sign of management oversight.

An adult at risk is defined as being someone who meets all three points in the test.

They are that they are unable to safeguard their own well-being, property, rights or other interests; that they are at risk of harm; and that because they are affected by disability, mental disorder, illness or physical or mental infirmity they are more vulnerable to being harmed than adults who are not so affected.

The inspectors warned: "The partnership’s approach and performance for carrying out investigations into adult protection concerns was a major area for improvement. There was no standard template for recording investigations, and one should be instigated quickly.

"Critically, for some adults at risk of harm there was no investigation when there should have been one. This impacted immensely on these adults at risk of harm as they were not interviewed about the adult protection concerns raised in their name.

"They might not have been aware they were the subject of the partnership’s adult support and protection procedures."

They added: "We concluded the partnership’s key processes for adult support and protection had important areas of weakness that could adversely affect experiences and outcomes for adults at risk of harm. There were substantial areas for improvement."

Staff survey results and a frontline staff focus group found that a lack of capacity to carry out adult support and protection work was a "critical issue".

One social worker said that understaffing was putting too much pressure on to carry out basic tasks.

"My personal caseload has become increasingly impossible over recent years. I came into this profession to make a difference, but I feel like I am fighting a losing battle with those I am responsible for losing out. I know of colleagues that will have thrown a sicky because they are so stressed with the current position. I just feel we are often fighting a losing battle and it has to change."

According to the latest partnership inspection, a staff survey of 530 from across the partnership proved to be damning over management, vision and strategy.

Just 45% agreed that local leaders provided staff with clear vision for their adults support and protection work and just 43% concurred that managers were effective.

Just one in three agreed that leaders evaluated the impact of what they do and that this informs improvement in adult support and protection services. And a similar proportion concurred that changes in services were integrated and well managed.

And just one in four felt leaders were effective in raising public awareness of adult support and protection.

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A series of priority areas for improvement included insisting that the partnership's leaders ensure there is "consistent, competent, effective adult support and protection practice that keeps adults at risk of harm safe and delivers improvements to their health and wellbeing".

Tim Pogson, chairman of the Edinburgh Integration Joint Board, comments said he acknowledged the findings and accepted the recommendations in full.

“I also want to provide reassurance to those in our care and their families that we remain absolutely committed to ensuring their safety and welfare and to provide the best possible service to them each and every day. We welcome careful and ongoing scrutiny to ensure that systems and practices are working effectively – and to make improvements when they’re not."

He says the inspectors had highlighted some areas where Edinburgh is "getting it right, such as relationships with partners and multi-agency working but also significant areas for improvement".

He added: “Despite the obvious challenges faced, particularly in resourcing and recruitment, Edinburgh needs to build on its strengths – most obviously the commitment of its hard-working colleagues across all sectors, who give their all day-in, day-out to support those in their care.

“It is on all leaders and partners to now act upon the report’s recommendations, and work is already underway between the Edinburgh Health and Social Care Partnership, the Council, Police Scotland and other partners to develop a detailed and robust action plan, focussing on improving the services for those who rely on us – and the selfless colleagues who deliver them.

“We’ll report back regularly on progress.”