Early Indicators of Concern in Care Services

Conclusions and Questions Arising

• It is apparent from this project and from research undertaken elsewhere, that health and social care practitioners readily notice aspects of services that give them cause for concern. These Early Indicators of Concern appear to present in commonly occurring themes or areas which are easily recognisable to experienced practitioners. Evidence of such Early Indicators of Concern do not tell us that abuse and harm is taking place but do suggest that some form of intervention may be important to prevent further deterioration in service quality.
• The information about Early Indicators of Concern, generated in this project, has been warmly welcomed and found to reflect the observations and experiences of health and social care practitioners. This suggests that the information should be made available to all practitioners in Scotland, in some form or another. Findings from the project were presented to a national adult protection conference in May 2013. Numerous conference attendees expressed an interest in the work and the Early Indicator information and reported that the areas identified reflected their own individual observations as practitioners.
• Observations emerging from the ongoing pilot suggest that teams that have an existing focus on 'whole services' as well as on individual service users, can make much better use of information and processes such as these. For example, the Older People Review Team in Dundee have assimilated the information and made use of the process to a greater extent than any of the other teams concerned. This suggests that it may be helpful to consider the role and function of such teams when considering approaches to 'whole service' monitoring and development.
• Experiences thus far in Dundee suggest that successful organisation-wide take up of the Early Indicators of Concern is not likely without the development and implementation of specific policies, procedures and guidance. Practitioners may, individually, find creative ways of using research findings without such procedures. However, most will not give priority to perceived roles and tasks that do not form part of the explicitly directed 'core business' of their employing organisation, particularly when staff resources are stretched.
• Work in Dundee City Council is currently underway to develop such procedures and guidance. This guidance, for example, highlights the distinct roles that are required of individual practitioners, team managers and service managers. In addition, the Adult Support and Protection team, in partnership with other agencies, are leading a follow on project to develop multi-agency practice guidance which is focused on early intervention and prevention.

This multi agency project is also aiming to develop training materials to help to raise general awareness of the early indicators. In order to meet this objective a range of stakeholders will be involved including service users, family members, advocacy services and service providers. An important next step that has also been identified is to consider how the early indicators information might be used by people who receive services and their families. It is vital to re-examine each of these development strands to seek to establish whether or not early indicator information is indeed being gathered and shared about 'whole services'.

• An important question to arise from the project as a whole, concerns the positioning or situating of any work such as this, which is related to early intervention and lower level concerns about a whole service. Should 'whole service' concerns, which have the potential to result in harm, be addressed via an Adult Support and Protection Act route? Or, alternatively, is it more helpful to consider such concerns under the heading of care management, contractual compliance and regulatory processes. Such processes are underpinned by other pieces of community care legislation such as the Adults with Incapacity Act 2000 and the Regulation of Care Act 2001. Different agencies and authorities will take different views and there are advantages and limitations to each approach.

It is apparent from the Dundee work that despite the existence of robust legislation, there is much still unclear in respect of 'whole service' analysis. Perhaps, this lack of clarity is connected, at least in part, to the fact that the Adult Support and Protection Act 2007 is focused primarily on individuals and therefore offers less guidance in situations where deterioration in the overall quality of the service, is at the root of protection concerns?