Background

1. Presentation for Age Cymru 24.9.14ADULT PRACTICE REVIEWSMick Collinsadmin@mickcollinsconsultancy.co.uk

2. Background • Child Practice Reviews introduced in January 2013 replacing Serious Case Reviews (SCRs). • Deputy Minister wishes practice in Adult Safeguarding Services to align with Children’s Services. • Social Services and Wellbeing (Wales) Act : Adult Protection generally and Adult Practice Reviews specifically will be on a statutory footing in 2016

3. METHODOLOGY • Discussions and Literature Review August 2013 • Survey of Adult SCR participants September 2013 • Research and Draft Paper October / November 2013 • Workshopsand Analysis December / January 2013/14 • Draft Guidance January / February 2014 • Pilot APRs January - July 2014 • Formal Consultation April- June 2014 • Analysis July 2014 • Guidance completed and issued ???? 2014 • Implementation , ( training etc ) ???? 2014

4. The new APR framework is provided to recognise the impact of what are generally tragic circumstances of death or serious harm to adults at risk upon families and staff, and provide opportunities for serious incidents to be reviewed in a culture that is blame free, supportive and fair involve agencies, staff, victims, advocates and families in a collective endeavour to reflect and learn from what has happened in order to improve practice in the future

5. give insights into underlying issues such as the impact of organisational culture on professional decision making identify aspects of systems and practice that have worked as intended and can be built on, and identify if any systems and processes need to be changed or developed as a result of improved understanding about the needs of adults at risk  develop more competent and confident multi-agency practice in the long term, where staff have a better understanding of the knowledge base and perspective of different practitioners with whom they work strengthen the accountability of managers to take responsibility for the context and culture in which their staff are working and ensure that they have the support and resources they need

6. create a more streamlined, flexible and proportionate approach to reviewing and learning from what are typically complex cases  allow a more constructive and appropriate use of resources than in the previous system and works to shorter timescales so that reports are timely and relevant focus on key learning identified through the review process which results in relevant recommendations and action to improve future practice, recorded in concise, anonymised reports which are published by Safeguarding Adults Boards and are shared by the Boards

7. ADULT PRACTICE REVIEWS Each APR has independent Chair and two Reviewers Set of clear stages for the APR process, including : Victims and families ( and their advocates ) involved in the process, if willing Front line staff who were involved in case are directly engaged in the APR process Internal Management Reviews and Chronologies replaced with Timelines Individual Interviews of the staff involved ( if not available for Learning Event )

8. ADULT PRACTICE REVIEWS Learning Events Brief reports of findings and recommendations to inform learning and change Reports and work on their implementation to be disseminated widely so that learning shared Reviewers may be invited back to review progress Extensive set of appendices to support APRs

9. APR Criteria Criteria are needed for Adult Practice Reviews so that only those cases which have given rise to serious concerns are analysed and learned from using the thorough approach which Adult Practice Reviews require. The type of review chosen should be proportionate ( there are alternative review arrangements available for Safeguarding Adults Boards and single agencies to utilise such as local case reviews, serious incident reviews and inquiries). Criteria are also needed to promote consistency in the use of Adult Practice Reviews across Wales.

10. APR Criteria The criteria apply to adults at risk. A person is an adult at risk if he or she (a) is experiencing or is at risk of abuse or neglect, (b) has needs for care and support (whether or not the authority is meeting any of those needs), and (c) as a result of those needs is unable to protect himself or herself against the abuse or neglect or the risk of it.

11. APR Criteria Reviews must be commissioned where an adult at risk: dies (including death by probable suicide) or sustains a potentially life-threatening injury or serious long standing or permanent impairment of health and the implementation of the Wales Interim Policy and Procedures has confirmed that either abuse or neglect was a cause or contributory factor or that this was likely on balance of probability

12. SCOPE of APRs • A victim who lives in the community • Multiple victims • Institutional abuse • Multiple settings • Organised abuse eg trafficking, sexual exploitation and slavery Terms of reference, Panel membership etc must fit the type of APR

13. Stages of the Review Panel Process Stage 1 : Initial meeting of Panel, including the two Independent Reviewers. Confirm roles and responsibilities and terms of reference. Agree key agencies, work programme, time frame of Review and Review completion date. Stage 2 : Panel requests from key agencies: timelines, brief analyses and genogram. Stage 3 : Panel accesses and considers key documentation. Stage 4 : Reviewers meet victims/advocates and family members. Stage 5 : Panel develops hypotheses for Review and learning issues. Panel arranges briefings and conducts Individual Interviews with key practitioners

14. Stages of the Review Panel Process Stage 6 : Panel completes a Reconstruction from evidence gathered, identifying Key Themes. Learning Event is planned, including briefings for participants. Stage 7: Learning Event takes place. Stage 8 : Reviewers produce a draft report comprising an appraisal of an explanation of professional practice, ‘windows in the system’, key findings and recommendations. Stage 9 : Draft report is agreed by Panel. Stage 10 : SAB receives and approves draft report. It requires agencies to produce Action Plans for merging into the Board Action Plan and for periodic Reviewing. Circulated to Welsh Government and other Boards.

15. So, where do advocates fit in ? APRs are not for surviving victims or for families, (nor for the media), but must be highly respectful of them and involve them appropriately Advocates can play an important role in helping victims and families understand what to expect and the APR process and how they can contribute supporting them to do so helping them cope with the disappointment which they may experience with the Review