Official Report: Minutes of Evidence

The Chairperson (Mr McGuigan): We are joined by Dr Ciara McKillop, the interim director of community care in the strategic planning and performance group (SPPG), and Mr David Petticrew, the co-director of community care in the SPPG in the Department of Health. You are both very welcome.

Dr Ciara McKillop (Department of Health): Thank you.

Mr David Petticrew (Department of Health): Thank you.

The Chairperson (Mr McGuigan): I will hand over to you to make some opening remarks, and then we will take questions.

Dr McKillop: Thank you, Chair and Committee members, for the opportunity to attend today. I am the director of community care in SPPG. I am accompanied by David Petticrew, who is my colleague and co-director with responsibility for adult safeguarding. Today, we want to provide the Committee with an update on the work of the interim adult protection board (IAPB). We provided members with a briefing paper in advance, which sets out the background to the IAPB and some of the work that it has taken forward since its establishment in 2021, so I will keep this introduction brief. We have included in the briefing paper some learning from the IAPB to date, which, we think, will be helpful in informing the work of the new permanent independent adult protection board when it is established under the new legislation.

The IAPB has been in place since 2021. Part of my role as a director in SPPG has been to chair the IAPB. I have had that role since 2023, when I took over from my predecessor Brendan Whittle. I am also a board member of the Safeguarding Board for Northern Ireland (SBNI), which focuses on safeguarding and promoting the welfare of children and young people in Northern Ireland by coordinating the work of all the agencies that are involved in the child protection system. SBNI was established in 2012 and is very well established, with a 10-year head start on us. Whilst its focus is on children and families, there is very relevant learning for our adult-focused board.

As is noted in the briefing paper, the IAPB was designed as a temporary structure. It was a proof of concept or a precursor to a permanent, independent board. The IAPB has had an initial statutory focus, with a membership across statutory agencies that have a role in adult protection, and it meets bimonthly. Following the enactment of the Adult Protection Bill, the IAPB will be replaced by a new and fully independent board that will be established on a statutory footing. We recognise the need for that board to be and to be seen to be fully independent. The IAPB has, however, enabled the development and testing of key adult safeguarding and protection components, and it has taken forward preparatory work in anticipation of the new permanent board. For example, we have completed work on future training needs, and we have revised the joint protocol arrangements between health service staff and the police. We have improved the regional data set, and we have developed a preliminary model for serious case reviews. It is our intention that we get the new permanent board off to as strong a start as possible.

Like SBNI, we have adopted a model of identifying and prioritising key areas of work and of creating subgroups that are focused on specific areas in order to progress those areas of work: namely, a data and performance working group; one on training and development; one on how we engage user involvement; the implementation and development of statutory guidance; and the revision of the joint protocol process.

Some important learning for IAPB has been around the challenge of securing user and carer input to the board and its subgroups. The Patient and Client Council (PCC) is a member of the IAPB, and it greatly assists us in that work. It hosts a user engagement platform for us, but, it is fair to say that, whilst a number of approaches have been tried, input can be variable, and we are still working hard on that area. We remain fully committed to co-production, the involvement of people with lived experience, and broader stakeholder participation; we consider those to be essential for the independent board.

I turn to data and performance. To better understand adult protection activity, manage the service and drive service improvement, a new regional dashboard linked with Encompass is in development. Key metrics have been agreed, and we had a demonstration of the dashboard at our previous IAPB meeting. The next phase of work is to confirm standard data definitions and to build guidance on that into training for staff. In time, that will allow us a real-time understanding of adult protection work across the region and to understand regional variations and trends.

The Committee will understand from the contributions of other interested parties that, whatever the sector, the effectiveness of adult safeguarding and protection often hinges on the knowledge, training and support of the workforce. The IAPB's subgroup on training and development is working closely with the Department's Office of Social Services on the development of training pathways. Training will be delivered at different levels to individual staff, depending on their role and their contact with service users.

For example, awareness training will be widely available. Work on that has included the community and voluntary sector and the independent sector, both of which are engaged in the work of the training subgroup and will contribute to identifying and taking forward training in their sector. At the other end of the spectrum, the highest level of training will be for adult protection social workers. That training will focus on the powers and duties that they will have following the implementation of the Bill.

As we have progressed the work of the IAPB, we have listened to people who have lived experience, people who access our services, and families involved in the various IAPB subgroups, and we have learned from their experiences. One of our colleagues recently met Jill Manthorpe, professor at King's College London and a visiting professor at Queen's University Belfast, to help us focus on how we can improve our engagement, develop a hub, use focus groups more effectively and be better able to engage interested parties. We recognise that we have much work to do.

Whilst the IAPB was originally mandated to focus solely on statutory protection work, as we have moved through our original work plan and statutory focus, we are now broadening our focus to include adult safeguarding and prevention issues. Our next phase of work is towards being more closely engaged with the local adult safeguarding partnership groups (LASPs) and to bring safeguarding and prevention into the heart of the IAPB. The new board will also want to consider those things.

The SPPG adult safeguarding lead regularly meets LASP chairs and attends LASP meetings. In future, LASPs will attend the IAPB to inform us about their priorities and work plans. It is for the regional board to consider how we can support local work and have much more effective two-way communication.

As outlined in our briefing paper, the future chairing and staffing structure of the permanent board will require careful consideration to ensure its full independence and that it has sufficient capacity to carry out its functions effectively. In exploring potential models, the IAPB has, as I mentioned, examined the Safeguarding Board for Northern Ireland, which provides independent oversight of child protection. We have identified several practices that could be beneficial for the new independent board. I add to the benefits that I have mentioned the use of an online platform for updated policies and procedures; a five-year strategic planning cycle; a focus on emerging thematic priorities; and the delivery of annual learning events to embed learning in practice. There is potential for the adult protection board and the SBNI to collaborate and hold shared events on areas of shared interest.

The Chairperson (Mr McGuigan): Thank you very much for that; that has been useful. You mentioned the permanent board's being "fully independent" a couple of times. Your written submission states that the permanent board:

Some stakeholders have said and some of the evidence that we have taken suggests that that might not make it sufficiently independent to ensure accountability and change. I am trying to gauge your position on that.

My other question is about how the proposed board will differ from the interim board. It would be helpful if you could answer both questions, on the concerns that some — not all — have raised about the full independence of the board and on the difference between what it is now and what it will be when it is in its permanent form.

Dr McKillop: It is a challenge that we have wrestled with, because how do you get somebody who has the sufficient expertise, knowledge and gravitas to complete the work of the adult protection board in the way that you want it to happen, while also getting somebody who has not been involved in the development of those services during their career? The SBNI has an independent chair and a chief operating officer, who, historically, are from two different statutory agencies, and lay members who offer a level of independence. That is possibly something that the adult board could consider.

The Chairperson (Mr McGuigan): The suggestion — it was not a criticism — was that members needed to have no ties with the Department of Health. Having independent commissioners from the South or Britain or somewhere else was the kind of model that was suggested.

Dr McKillop: It reflects very much the discussion that you had when representatives from the PCC were here. They talked about how challenging it is to achieve truly independent advocacy. When you track it back, somebody is paying for it, and somebody is in charge of resourcing it. I argue that, if you are employed to be an independent chair of an adult protection board, you are employed to be independent and adult. Part of your role is to be a critical friend and to use that responsibility very thoroughly. It is not a straightforward one to answer.

The Chairperson (Mr McGuigan): The other thing that I picked up on was the importance of training when the legislation comes in. It is a question that I will ask the Department, but I want to ask you about it too, because the suggestion is that a resource of £8 million will be required for training. Members share the concern that we will get a great piece of legislation but that we will not have the resources to implement it. The suggestion is that we take a phased approach to implementing it, but staff training is vital at the outset, regardless of how you phase it. Do you have any concerns in relation to that?

Mr Petticrew: There are a couple of issues that I will flag up. First, training is going on at the moment, so we are not starting from a level playing field. However, I think that you are referring to training specifically in respect of the Bill.

With regard to the backdrop, there is staged training at the moment from early, general awareness up to the specialist roles in the joint protocol. There is three- to four-stage specialist training. In the model that is being worked up for the Bill, the training goes up to about stage seven. The higher and most expert level is the adult protection social worker, who will have responsibility for using some of the powers and authority in the Bill.

There will be two big asks. The first relates to human resources; that is, staff on the ground who are knowledgeable and available to deliver the service. The second relates to the impact of migration from different parts of the service to what may be, at the outset, a new and exciting area to move into. It is about how we keep the workforce and the skill base stable over that period. Investment is important to make sure that the people who will carry out very specific roles are skilled and competent. That is important right across the piece.

You mentioned the phased approach. You are absolutely right: the Bill will have to be phased because of the resource and because the system is probably not ready for a day-1 big bang. That is true of other legislation as well. Training is the starting point, but it will probably build on the training that we already have in place at the moment anyway.

The Chairperson (Mr McGuigan): OK. Thank you.

Mrs Dodds: I want your view on an issue that has cropped up about the board that will be established. There was a suggestion from some who gave evidence that, if the make-up of the board is not right, it could be seen as being poacher and gamekeeper at the same time. Do you see that as a real issue because of the nature of the people who will probably be part of the board?

In Northern Ireland, the same people appear on boards all the time, and I understand why that happens.

Concern was expressed about the true independence of the board. In this case, that is important, because the Bill transfers powers to the state over significant interventions in people's lives. Therefore, having a rationale for a truly independent board that looks at what is happening is also important and significant. That is my view: maybe others have a different view.

Dr McKillop: The —

Mrs Dodds: I do not want to put you on the spot. It is something that concerns me when it is mentioned, because there are such extensive powers in the Bill.

Dr McKillop: There are, and I think that they are needed. The Bill, in its entirety, is welcomed, because it addresses some of the deficits that have occurred in the past. To answer you, I will draw on my experience of SBNI, which plays the role of poacher and gamekeeper. It focuses on improving practice and understanding some of the new child protection concerns that have come up: it looks at areas such as online harm, child criminal exploitation and child sexual exploitation. It focuses on the development of practice and on understanding and addressing some of those harms. However, at the same time, it holds agencies to account for current practice and for things that they have done. It is able to do both those things: it is able to improve practice, but it is also able to address practices, and it does that.

Mrs Dodds: You have gone on to the second half of my question, which is on accountability. When the Muckamore families were here, they said that they felt that nobody is accountable and that there has been an attitude of, "See no evil, hear no evil, do no evil". That is a view that they expressed. Given what they have been through, it is a legitimate way to understand the system that their loved ones have been through. Concern was also expressed about others still going through a similar system. How is accountability managed in the situation? Who monitors the board on how it holds people accountable?

Dr McKillop: Who monitors the SBNI?

Mrs Dodds: Yes.

Dr McKillop: The SBNI is accountable to the Department of Health and the Office of Social Services. They look at its annual report and the model of case management reviews that are in place, and they periodically review those and audit against them. I have attended meetings to which the Chief Social Work Officer has brought the SBNI staff to receive assurances that learning is being implemented, that it is checking that learning is being implemented and that the Regulation and Quality Improvement Authority (RQIA) is being used to ensure that learning is being implemented.

There is accountability at all levels, as you will know: from the individual practitioner; to how they are managed within a team; to how services are provided; to how we in SPPG hold the trusts to account through the use of statutory functions, reporting and the statutory outcome measures and intervention framework. Through that, we receive performance management information from the trusts; take account of variations in trends; and match those with financial information and information from serious adverse incidents (SAIs) and complaints. We put all of that information to sense-check whether a service is healthy, effective and functioning. We meet the RQIA and the Northern Ireland Social Care Council (NISCC) so that we can have as holistic a picture of a service as possible.

I took the opportunity to watch the feedback from the Muckamore families. It is very powerful.

Mrs Dodds: It is very concerning.

Dr McKillop: It is very concerning. It makes us stop in our tracks to stress-test everything that we are doing and to think critically about what we are doing, how we are doing it and whether we are missing things. I go back to the centre of this, which has been a challenge for us: making sure that people who are being cared for and their families are completely central and are being listened to and heard. Some of the families have lost their trust in the system. The challenge for us is about how we are able to get that back.

Mr Petticrew: The messages from that session were very powerful. What the session reinforced for me, and maybe for others as well, was the importance of the individual level. The trusts have governance structures for how things work in a hierarchical way, but the really important thing is that you have well-trained, well-supported and well-supervised staff at operational level and that the management structures from there upwards are in place, being supervised and, frankly, being scrutinised as well. A lot of the difficulties that start to develop do so at the patient or client individual interface. If that is right, we do not get the SAIs or inquiries. If you deal at an operational level, where people are supported in their posts and doing their jobs well, we can probably avoid some of the very unhappy stories that we have had in Northern Ireland.

Dr McKillop: It is about whether care plans are well thought out and well resourced and people's behaviour is well understood for what it is trying to communicate and their needs are met effectively: if we get that bit right, the rest will flow.

Mrs Dodds: Thank you. I appreciate that everyone involved in this is trying to get to a situation where we are satisfied that we have a system that operates well but that is also accountable. In the light of the conversation with those families, I am not sure that we have done enough to gain their trust in that. That is not your fault: I am just expressing a view of what they said. It is a really serious point that we need to think about. The accountability for very stringent measures in the Bill should be really rigorous.

The Chairperson (Mr McGuigan): Before I bring Danny in, let me say that it is right that Diane has highlighted the evidence that we heard from Muckamore. Ultimately, with the Bill, if we do not gain the families' trust, at the very least, we must ensure that we do not have a situation like Muckamore again. We are having this conversation because of all of that. We need to be confident that, with the board and everything that flows from it, we have such strong legislation in place that we will never have a repeat of what happened in Muckamore. The training is really good and, hopefully, that ensures that everybody is focused on the work that they are doing but that, if somebody steps outside the line, it is identified and resolved early. The Committee needs to be satisfied that that is the case.

Mr Donnelly: I absolutely agree with that. It is worth noting that the final inquiry report is due in March, I understand. That is the context that we will be working in. I was struck by what Ciara said about the people who are being cared for and their families being the centre of this and that some have lost faith. That is very striking and sad, but it is where we are.

I will ask a couple of questions. The first is about the regional dashboard that was mentioned. Ciara, in order that you have a real-time understanding of adult safeguarding, what metrics feature on that?

Dr McKillop: I will have to drag my memory banks now. It begins with the reason for referral, the demographics of the person who has been referred, who received the referral and the outcome of the referral.

Mr Petticrew: The dashboard has been revised a bit, recently. It started as a very basic dashboard, which was really the number of referrals, and you could map that over the different places in Northern Ireland. It has become more sophisticated as work on it has been ongoing in the past couple of months. The domains are about the referral source and the trust area, and then you can mark that in terms of the outcome of the referral: whether it was signposted to a safeguarding approach, which is a more supportive approach, or an adult protection approach. If it went down that route, it will show how many ultimately led to care planning and case conference outcomes as well.

It is work in progress, but, ultimately, in terms of oversight and standardisation across Northern Ireland — the Committee has been very interested in that — it is about having high-quality data. We have mentioned training, but really good quality data will give the current interim board and the permanent board regional oversight to look for bottlenecks, unexpected high points in referrals and, more particularly, what I would think of as conversion rates, where maybe a trust area would have a very high referral rate but a very small number of cases that might proceed beyond that. We would try to understand why that would be. There are reasons why that would be, but we could try to get to the root of that.

Mr Donnelly: My next point is about standardisation. The Committee has found time and time again that there is a difference between trusts and how they operate. What was your experience of working across trust boundaries?

Dr McKillop: We had a detailed debate last time because the number of self-referrals felt too high to the experienced practitioners around the table. We are at the stage now of working to agree data definitions so that we can record completely who is making referrals. When we have a standard agreed set of regional definitions, we will properly be able to look at regional variations and understand them. We were a bit concerned. For example, if you were working in ED and somebody disclosed something to you, and you filled in the APP1 form, we need to make sure that all hospitals record that that is a self-referral or a referral from a nurse and that it is being done consistently. We still have a bit of work to do to finalise that set of data definitions and then to make sure that they are built into Encompass and that everybody is recording the same thing. We will then have a proper data set that we can use to standardise and understand that. To be fair, it is not far away. We are confirming the metrics, and they will then go into the training platform to put them out.

Mr Petticrew: The data is a double-edged sword in a way, because teams in trusts naturally have peaks and troughs. You might say, "Living in trust A must be quite dangerous because the referral rate is really high in that trust, whereas it is really low in trust B". In fact, the converse might be true. You might have a really good system operating in trust A — a gateway team with lots of referrals that are screened in and sifted through — and that could be the safer service. In times when people have requested data and jumped on that and said, "Clearly, trust x is a very unsafe place", it might actually be quite safe because you have a service that is alert and proactively doing things about safeguarding. The data has to be seen. That is why the conversion rate that I mentioned is important. You might have a very high referral rate, but, when those referrals are interrogated, the number that proceed could be quite low.

Dr McKillop: One issue that was raised by Mr Glynn Brown when he was here was the families' frustration that the procedures that are in place are being implemented differently and that different forms are being used. We are working to address that and to understand and address regional variation, because we know that that perceived inconsistency creates a big sense of frustration for families.

Mr Donnelly: Absolutely. That was very clear in the evidence that we got. What we want to see is a uniform regional approach, and that should be grounded in best practice as well, so that we get the best practice right across.

The interim board has been going since 2021. What lessons have been learned to inform the provisions for the board in the Bill? Have any particular, big lessons jumped out?

Dr McKillop: No. We have done quite a bit of work around the area of serious case reviews. Our proposal suggestion is that they are not called "serious case reviews" but "adult protection learning reviews". There are already serious case reviews in the PSNI, and we have case management reviews and domestic homicide reviews, so we spent quite a bit of time making sure that they all work together and do not get in each other's way: that they are pieces of a learning jigsaw. We spent quite a bit of time looking at that.

Our next phase of work, when the Bill is confirmed, will be the whole area of the development of guidance, which is probably as important as the Bill, because that is how it will be translated from a piece of legislation into operation.

I do not know whether that answers your question, Danny. The other learning that we talked about is the centrality of people being involved. We are very much in agreement with and fully supportive of the Bill's principles.

Mr Petticrew: When I think back over the past couple of years, if I was asked, "What do you think are the wins or what are the things that you are starting to win?", I would say that data is starting to come into the frame now. That is an important one. Ciara mentioned the serious case reviews and adult protection learning reviews. We have that framework worked up, and, when the new permanent board comes in, it should be able to lift that and run with it. We were assisted by colleagues in Queen's University in doing that.

It is a good piece of work. It is in draft form, but it could be taken forward. The regional joint protocol arrangements have been entirely reworked and redrafted. They were approved by our board recently — within the past couple of weeks — so we have a brand new joint protocol document that has been signed off regionally and is absolutely ready to go. That has been good.

Sometimes we learn from things that do not work so well. Some of the user engagement pieces that we started did not work particularly well. It is hard to get consistent meaningful engagement with users and carers. We tried a couple of models and had a couple of faltering starts. That is still a work in progress. There have been a few wins and a few things that we would take forward that we will share with the new permanent board. The first thing to do to have meaningful user and stakeholder engagement is to start early and then repeat, repeat and repeat. That is my experience from the past couple of years.

Mr Donnelly: That is useful. Thank you very much.

Mr Robinson: I read through your submission last night. On the opening page, you refer, quite rightly, to the original review that followed the 'Home Truths' report. You note that it concluded:

As stupid as I am when it comes to this process, it struck me how few family voices or family advocacy groups are on the original interim board. There do not appear to be any family voices represented even on the subgroups, although the review encouraged that.

Your submission also refers to some of the challenges that you face with user involvement. What are those challenges?

Dr McKillop: The original remit of the IAPB was for it to be an 18-month project working solely in the statutory agencies. That was three years ago. Since then, I think that the only subgroup that does not have family or service user involvement is the subgroup that is looking at the joint protocol. They are involved in the other four subgroups.

Mr Petticrew: We have users and families on the subgroups.

Dr McKillop: The PCC hosts a user engagement forum for us. When we have something that we want to share with families and on which we want to ask their views and advice, that is how we do it, at the minute: through the PCC and the user engagement platform.

Our challenge, Alan, is that we think that we could do more and that we could do it better and differently. We are looking at ways to do that. There is a suggestion that we could use focus groups more effectively and that we could maybe buy in groups who could canvass views for us from interested parties. We have not done that, to date. We would like to get to the stage where we have the community and voluntary sector and service users on the interim adult protection board. We have not done that to date, because we have focused on statutory agencies. We know where we would like to get to over the next year, but it has proven to be a challenge for us to have people who will respond to things that we ask them. The PCC has tried to do that, but then nobody will respond to a question that we asked.

We think that we can do this better and differently. We have brought Jill Manthorpe in to ask her, "How is this working in other places? How have other adult protection boards, or other boards, harvested views, got engagement and had people involved and interested in the work that they are taking forward?". She has given us a few ideas, which we discussed at the board. That mirrors the mixed-method approach that SBNI takes: it has focus groups; it has those people on the board and employs groups to canvass the views of children and parents about things that the board is proposing to do. That is what we will have to do and what the permanent board will have to do.

Mr Robinson: The issue of trust has crept up at the meeting today, and the word "trust" crept up frequently when we had the Muckamore families before the Committee. How transparent — how public — are the interim board's proceedings?

Mr Petticrew: The meetings are minuted, and the minutes are hosted on a public website.

Mr Robinson: Fair enough. OK.

Dr McKillop: We have a precursor website, which, I imagine, will be used for the new board. All that information is available on that website for people to see, read and comment on.

Mr Robinson: Danny touched on the dashboard. When do you expect that to be fully operational?

Mr Petticrew: In the next month or so. It is well worked up. It is a matter of how we will host it and keep it updated. It is really good today, but it will be pretty good in six months' time. Servicing those types of database is very difficult, so we are trying to work out how to make sure that the data is coming as quickly as we want it to.

The Chairperson (Mr McGuigan): Thank you very much. That has been useful; we appreciate it.