Official Report: Minutes of Evidence

The Chairperson (Mr McGuigan): Representatives from the Western Health and Social Care Trust are joining us remotely. I welcome, via videoconference, Dr Tom Cassidy, director of children and families and executive director of social work; Mr Stephen McLaughlin, assistant director of social work, learning development, governance and adult safeguarding; Ms Laura Coyle, acting head of the service for adult safeguarding; and Mr Gavin Hamilton, chief social work information officer and Encompass social work and social care professional lead. Thank you very much. You are all very welcome.

I will hand over to you for some brief opening remarks, and then we will take questions from members.

Dr Tom Cassidy (Western Health and Social Care Trust): Thank you very much, and thanks for the introductions. I am the director of children and families and executive director of social work, and, as you mentioned, my colleagues are with me. I will pass you over to Stephen McLaughlin, our assistant director with responsibility for adult safeguarding, to give a quick synopsis of our response, if that would be helpful.

The Chairperson (Mr McGuigan): Yes, go ahead.

Mr Stephen McLaughlin (Western Health and Social Care Trust): Thanks to the Committee for inviting us to give evidence. As Tom said, we are glad to be here.

We welcome the Adult Protection Bill and how it will further safeguard adults at risk and those who have experienced harm. There will be challenges, which include finances, workforce and the complexity of managing cases, including managing the subtleties of capacity and consent. We welcome the Bill's putting adult protection on a statutory footing, which will improve the consistency of practice across Northern Ireland. The powers to intervene and the powers to hold to account where harm has occurred are welcome. The principles of prevention, autonomy, empowerment, dignity, proportionality, partnership and accountability are critical to how we take forward the legislation and will provide the basis for protecting those at risk. It will also bring about professionally complex challenges that social work is best placed to manage.

The definition of "adult at risk" is central to the Bill. The continuum of safeguarding through to protection is everyone's business. It is critical that, when the thresholds of harm are met, adult protection services are able to respond in a timely manner to ensure that there is effective protection for those who need it; the Muckamore Abbey Hospital and Dunmurry Manor inquiries have taught us that. We will all have to communicate effectively on the matter. We highlight the fact that there is already a range of services better placed to deal with other safeguarding concerns, such as self-harm or self-neglect. The duty to report and the subsequent responsibility of the trusts in relation to their duty to make inquiries will have a significant impact on statutory agencies, which the business case recognises.

CCTV is useful, and we recognise and understand why it is so important to families and loved ones. However, it is not a silver bullet, and it will bring challenges, including dignity and privacy issues. CCTV should not be overly relied on to protect adults at risk. Unfortunately, to date, it has been used more in order to prosecute after the harm has taken place. We need to work proactively with service providers to ensure that we have a culture of high-quality care in which harm is an exception that is reported and dealt with effectively and quickly. That, ultimately, is what will ensure the best safeguarding of those who need it. The oversight of quality of care by families, care managers and the regulator will be of greater value in protection than CCTV. CCTV is simply unacceptable in some environments, such as supported living arrangements where the adult service user is the tenant.

Finally, we are conscious of the challenge that we all face from a financial and resource perspective, which includes workforce, in implementing the Bill. All stakeholders would prefer to implement the Bill in its entirely from its enactment. In the absence of that, we will work with the Department, the strategic planning and performance group (SPPG) and other key stakeholders to manage a phased implementation that will bring meaningful safeguards to those who need them.

The Chairperson (Mr McGuigan): Thank you very much. I thank you also for the written briefing that you provided.

As you finished, you talked about phased implementation and your preferred option of implementing everything at once. The Committee is concerned that we may get the legislation without the resources that it requires and that a phased implementation may therefore be needed. Your written evidence suggests that there could be an impact on workforce, and you finished by mentioning that. Among the things that you have said about workforce are that trusts will probably require additional staff to manage the workload caused by the implementation of the Bill and that there is a danger that increased demand for senior staff in adult protection will cause depletion in other areas of social work. You have raised issues with regard to the impact on your workforce. Are you building the Western Trust's workforce and resilience in preparation for the implementation of the Bill?

Dr Cassidy: I will take that question initially, if you do not mind. In the Western Trust, we have a workforce strategy that, in its generality, is really focused on recruitment and retention. If you are happy for me to do so, I will pass to my colleagues to answer on issues that specifically relate to the Adult Protection Bill.

Mr McLaughlin: I will follow on from that. Our workforce retention strategy in the past couple of years has largely focused on dealing with some of the vacancy issues that, as you will be aware, we have seen across children's services. We are in a better place, thanks to our work with the Department in particular and how we have recruited students directly from universities, commissioned extra places at universities and commissioned places as part of the OU's scheme. We have also piloted a model in Enniskillen. We are in a better place now than where we were three years ago.

We would have some concerns, if the Bill were implemented in its entirety tomorrow, about the number of social workers whom we would have to recruit for adult safeguarding in order to fully implement all the duties and powers and whether that would have an impact on the other services from which social workers could be recruited. We have been told that there will be a phased approach, and it will include how we manage the workforce issues. We want to work meaningfully with the Department to manage all those concerns. We cannot have a situation where we lose social workers from an area where they are needed, such as children's safeguarding. We have to manage the situation pragmatically and to work slowly through the issues.

The Chairperson (Mr McGuigan): It is a concern that we are robbing Peter to pay Paul. We will take that up with the Department.

You talked about the CCTV issue and said in your written evidence that the introduction of CCTV might make staff reluctant to work in challenging environments where there may be CCTV. Have your staff raised that concern with you? Have you raised it with the Department?

Mr Gavin Hamilton (Western Health and Social Care Trust): We are definitely paying attention to the issue. The Committee has heard a lot of evidence about CCTV over the past couple of months and has heard about the complexities associated with its use. We anticipate that it will create challenges for our staff. We already face recruitment difficulties in that sector. They are quite low-paid jobs. We do not want to create any more challenges in that arena. We anticipate that there will be challenges for staff when the CCTV is

for them.

We do not believe that CCTV is the thing that keeps people safe. We believe that our people keep people safe and that a safe culture keeps people safe. We do not believe that the focus on CCTV is all that helpful in those situations, and it will have an impact on our staff.

The Chairperson (Mr McGuigan): Thank you.

Miss McAllister: I have a follow-on question about the workforce issue. I may not have understood it properly, but I understand that there will be a greater emphasis on workforce in order to carry out the full implementation of the Bill, and children's services was mentioned a lot. In social work, there are two distinct roles, are there not? We have adult social workers and children's social workers; the training is different, as are the qualifications and placements. I do not understand why children's services has been mentioned. Is it more than the social work side? What will the impact be? Will you explain it again? It may be that I am thinking of it solely as social work when there are other issues.

Mr McLaughlin: Nuala, apologies if I have left you with any misunderstanding. First, there is only one pathway to a qualification in social work: regardless of whether you work in adult or children's services afterwards, there is only one pathway through university. You do not qualify as a children's social worker or an adult social worker. Once you qualify, you can go into either area, which most people do.

Miss McAllister: OK.

Mr McLaughlin: The reference to children's social work is about the fact that we have done a lot of work to address our vacancies in the past couple of years. We have been supported in that by the Department of Health, and we have worked with the universities to fill those vacancies. There has been additional funding for additional university places in preparation for the rolling out of the multidisciplinary team (MDT) project, which social workers will be part of, and in starting to think about the adult safeguarding legislation, as well as thinking about our legislation. We continue to work with the Department to think about the number of social workers who need to qualify for us to implement all the work.

Miss McAllister: OK. It was my misunderstanding, and that helps me to understand it a bit better.

My next question follows on from that point. We have talked previously about the shift and movement of social workers in regard to the MDT model. Will the Adult Protection Bill require greater experience, and, therefore, will you take your current experienced social workers? Will they come from the adult social work sector? How can we protect one area but not at the cost of another?

Mr Hamilton: Protecting one without that having an impact on the other will be complex. Ultimately, the Bill introduces the idea of an adult protection social worker. Currently, our adult protection social workers are designated as adult protection officers. They are at a higher grade than our children's social workers typically. That will create further, more senior opportunities in adult protection that, we anticipate, will be more attractive to our child protection social workers. What, we think, will happen and what we have seen happening through the introduction of the multidisciplinary model is that our experienced staff who have perhaps been qualified for three, four or five years and do not see as many band 7 opportunities in their service area will see a more attractive post in adult protection, if the Bill is introduced as it is, and will move over into those posts. We will not have control in selecting only staff from adult services, for example. Our worry is that it will have implications for our other services.

Miss McAllister: OK. I am glad that I asked that question, because that is important for seeing how the Department might seek to protect children's services. The Ray Jones review pointed to the fact that many areas were already in crisis.

Moving on, you mention in your written submission your experiences of the Mental Capacity Act (Northern Ireland) 2016. We have heard from many other organisations about the phased implementation of that Act and the fact that it has not been fully implemented. Do you have examples of any challenges that that has posed in practice?

Mr Hamilton: The biggest challenges are those of other professions not having been trained effectively under the Mental Capacity Act. We see particular challenges in our interfaces with the police. I know that you have also received evidence from GPs, who have also faced challenges in that arena. There are aspects of the Mental Capacity Act to do with advocacy, for example, that have not been implemented or have not been resourced. We do not want to mirror that in this legislation.

Our position is that the legislation is a huge opportunity if we do it right and implement it all. We know that we are financially challenged, but we do not want to squander that opportunity. We need to make the most of it. We know that confidence in adult protection has fallen, and we have seen that through the recent inquiries. This is a chance to change that, because we have good practice happening in this area.

Miss McAllister: As you said, we have heard about advocacy issues from many different organisations, so that is not new. However, we have not focused much on training; perhaps only a little. The learning from the Mental Capacity Act is that training is not sufficient in all sectors.

Mr Hamilton: Yes. It is down to the resources that have been allocated to training. There has been an acceptance of things such as thresholds around when the police can come with us in order for us to enforce our powers: work needs to go into which powers we enforce and which powers the police enforce, for example, along with the subsequent training that comes with that. That has definitely caused us challenges, and we continue to see those challenges.

Miss McAllister: OK. Thank you very much.

Mr Chambers: In your presentation and in your notes, you indicated your worries about CCTV having a negative impact on staff morale. Have you or your staff considered that it also provides them with protection against false allegations? You also mention that, in the absence of audio, you cannot get a context for what is going on in the video. Would you be more comfortable if CCTV systems had audio capacity built into them? Would you be happier with that sort of system?

Mr Hamilton: We are not opposed to CCTV. We can see the comfort that it brings to families and how it might make people feel more comfortable in facilities. We certainly see the benefits in that way. Our worry is that it is seen as a silver bullet and a panacea and the thing that will keep people safe. We do not believe that CCTV should be the first thing that we look at to keep people safe.

Certainly, the introduction of audio could provide context, but it also makes it more invasive for our patients and our service users, so it could also create challenges. We have heard evidence and views from other people that much more detail on CCTV is required in order to help us to think about governance and all the aspects of managing that.

I have said it already, but, ultimately, we do not think that CCTV keeps people safe. It will certainly help us with prosecutions. It is our people who keep people safe. We need a healthy culture, safe staffing, well-trained staff, robust inspections that are reviewed by statutory commissioners and a learning culture. All those things keep people safe, and I worry about our focus on CCTV. The Committee has also seen that focus.

Mr McLaughlin: When we refer to the quality of care, it is everybody's responsibility to think about it at an earlier stage, so that we are not over-reliant on CCTV. For example, without being required to do so and within our current resources, the Western Trust's adult safeguarding team allocated an adult protection worker to each independent facility across the trust. They go out, regardless of the visits from the care managers, and work with the home to help it to think about safeguarding and prevention issues and to pick up on quality of care issues at an earlier stage. It is proactive work to promote the experience that people have when they are in such facilities.

We understand what CCTV has done in getting prosecutions, but our position is that it is too late. We want to prevent harm.

Mr Chambers: I appreciate the fact that the CCTV will bring comfort to the families of people in care. Do you acknowledge that CCTV protects staff? Do you feel that CCTV offers no protection to staff?

Mr McLaughlin: We recognise that CCTV can provide protection for staff, as you said. If you have done nothing wrong, there is nothing to worry about. It is about balancing that against the rights, dignity and privacy of those who are being cared for. Yes, if you have done nothing wrong, it will not be on CCTV.

Mr Chambers: Thank you.

Mr Robinson: Thanks, folks, for your presentation. Today, we also had a presentation and a visit to Antrim Area Hospital, where we listened and learned about the pilot project there for body-worn cameras. We are aware that the Western Trust has piloted a similar project that started, I think, in October or November. Will that pilot project help to inform the implementation of CCTV going forward? Will the pilot project be of any benefit?

Dr Cassidy: I think that it would be. My understanding is that the pilot project is in the acute hospital sector. You are absolutely right: the pilot project will need to be reviewed and the lessons learned, and, as a result, those lessons could influence or impact on the discussions about CCTV. It should certainly influence it.

If my understanding is correct, staff feel a benefit from the body-worn cameras and that it is a protection for them. Again, it is my understanding that, while the body-worn cameras may not have stopped some of the recent assaults, it helps with prosecutions and issues of that nature. You would hope that, the more the public are aware of the issues that staff face, the more normal it will become for people to say that healthcare staff, including community staff, should not be assaulted and that it is not acceptable. The Health Committee has been clear that it is completely unacceptable, and the condemnation from the Committee and the Executive is helpful.

Mr Robinson: Given that the Bill is coming down the tracks, has there been any early assessment of the number of staff that you will require to deal with the workload that comes out of the Bill?

Mr McLaughlin: Yes. We have been working in partnership with the Department and the transformation board, and there is a business case. We refer in our submission to the options when it comes to implementation. We refer to that as option 5. We were saying, as an options appraisal, that that is the quality and level of staffing and training that would be required to implement the Bill in its entirety. That is with the Department, and those costings are available.

Mr Robinson: That is helpful. Thanks.

Mr Donnelly: I will build on what Alan talked about. Will you accept that there is a deterrent effect from CCTV being used in premises?

Mr McLaughlin: Again, we really want to say that we do not object to CCTV. That is not our position. We are saying that there are things that we can do even before using CCTV to ensure that facilities are well run; that people are well cared for and experience the kind of care that we expect them to get; that that is well regulated by the Regulation and Quality Improvement Authority (RQIA) and our care managers; and that, when families are not happy, they are able to report issues quickly and get them dealt with quickly. However, the points about the benefits of CCTV are also well made.

Dr Cassidy: You are right: there is a deterrent. You would certainly hope so. If my understanding is correct, part of the pilot in the Western Trust, in Altnagelvin Area Hospital, is with that perception in mind. Hopefully, it will be a deterrent if people are aware that staff are using body cameras. I know this only from reading newspaper reports and so on, but some of the assaults on staff, certainly in EDs, are carried out by people who maybe have alcohol problems, drug addictions or whatever. However, you are right that there is an element of deterrent.

Mr Hamilton: There is an important point to make. We know that when people want to abuse — unfortunately, such people sometimes exist in our systems — they will find somewhere to abuse. We are not expecting CCTV to be in private rooms such as a bedroom or bathroom, so whilst, on the one hand, there is a deterrent, on the other hand, if someone wants to abuse, there will be opportunities to continue to do that. There is something about the public perception and the narrative around CCTV. It is a balancing act.

Mr Donnelly: OK. Thank you.

The Chairperson (Mr McGuigan): Thank you all very much. That has been useful, and we really appreciate you giving your time to present to us and sending us your information in advance of the meeting. Thank you.

Dr Cassidy: Thank you very much. We appreciate it. Thanks a million.