Calderdale Council Adults Health and Social Care Scrutiny Board

Calderdale Council

Adults Health and Social Care Scrutiny Board

Wards Affected

Date 29 May 2024

TITLE Buying Our Care- Update on recommendations.

Report of (name, job title, organisation)

Cath Gormally Director (DASS) of Adult Social Care

Exempt Reports

It is exceptional that reports to Scrutiny Boards will include exempt information.

Scrutiny Boards rarely need exempt information in order to examine an issue. If,

after discussions with the chair of the Scrutiny Board, it is agreed that the report

should be exempt, the reasons for that exemption should be stated here. There is no

need to include this section if the report is not exempt.

1 Introduction

In response to the publication of the Buying our Care - Hurdles and Grievances report

by Maria-Christina Vogler in collaboration with Equal Cares, a Governance and

Assurance Partnership Board (GAP) was established. The group agreed an action

plan to drive the delivery of improvement work to address the issues that had been

raised in the Buying our Care report. The Governance and Assurance Partnership

Board is chaired by the Director of Adult Services and Well-being for Calderdale

Council and is made up of community leaders and health and social care partners,

who are detailed in the Terms of Reference of the Board appended to this paper.

A public scrutiny review was led by Councillor Ashley Evans as the Chair of the Buying

our Care Working Party. A report of the scrutiny working party was produced in March

2023, detailing 10 recommendations to address the issues identified in the Buying Our

Care report.

This report provides an update on the work that has been completed to date, work that

is currently in progress and longer-term work which will be undertaken to ensure

continuous service improvement. The report will set out the progress made towards

achieving the outcomes identified in the action plan developed by the GAP Board,

against the recommendations of the Scrutiny Working Party.

Recommendation 1:

We recommend that the Adults’ Health and Social Care Scrutiny Board review

progress on implementing the Action Plan by July 2023.

Progress Update

The Adults’ Health and Social Care Scrutiny Board has consistently reviewed the

progress of the implementation plan. A further review is scheduled for May 2024.

Recommendation 2:

We recommend that there is an independent review of those cases. That review

should focus on whether procedures have been correctly followed in these

cases and to identify whether there are any changes need to those procedures.

Progress Update

All the individuals and families impacted by the issues in the Buying Our Care report

have had contact with the appropriate services. In June 2023, the Director of Adult

Services and Well-being, Principal Social Worker, Policy and Procedures Officer, and

the Deputy Director of Nursing and Complaints Manager in the Integrated Care Board,

(ICB), visited each of the families at their homes. This enabled the families to share

their experiences candidly with the senior staff in attendance, and to express their

expectations of future outcomes for their loved ones. Senior members of staff in the

Council and the ICB were appointed to work together to investigate the complaints

brought by the families and where formal complaints had not been made, individuals

were supported to lodge new complaints.

All the complaints have since been fully investigated and the outcomes shared with

the individuals and families.

In addition to this, an independent social worker was engaged on an interim basis to

oversee and review all cases. This was completed and the independent social worker

made recommendations which are being followed up by the All Age Disability Social

Workers.

In March 2024, the Director and Assistant Director of Adult Services and Well-being,

the Principal Social Worker, Service Manager and Co-production and Engagement

officer met collectively with the Nur e Sabil families. The strategic service

improvements that have been made were discussed with the families and their views

sought on the development of the Calderdale Social Care Quality Assurance

Framework, Practice Framework and Cultural and Religious Competence Flowchart

were shared with them. Their views and comments were listened to and included in

the development of the work.

Some of the families reported that their individual circumstances had not changed

significantly and social workers in the All-Age Disability Service will continue to work

with the individual families about specific issues that were raised at this meeting.

However, it should be noted that it may not be possible to resolve all issues to the

satisfaction of the families due to individual circumstances and wishes.

This meeting was felt by all concerned to be a positive and constructive one with family

members stating that they felt they had been listened to and confirmed their renewed

engagement with the Governance and Assurance Partnership Board.

Recommendation 3:

We recommend that Adult Services and the NHS at least annually review the

care provided by commissioned organisations to ensure that appropriate

personalised care is given to service users. Adult Services and the NHS should

welcome and respond to feedback from relatives.

Progress Update

Working in collaboration, the Commissioning Teams in the Council and ICB have

developed a joint Quality Strategy. Key to the quality strategy is the Integrated Quality

Assurance Framework, which sets out the systems and processes in place to achieve

the vision detailed in the Quality Strategy.

Monthly Provider Quality Monitoring Meetings including both ICB and Calderdale

Council are in place to review any high or medium risk providers, (judged by a set of

ley indicators), to agree and plan interventions to support providers and/or escalate

risks to the Governance and Quality Assurance Board. A Multi-disciplinary Risk

Assessment (MDRA) is the tool utilised by teams to assist in assessing providers

directly according to their risk considerations. The Quality Teams and the Continuing

Healthcare Team work closely together to monitor the quality of care provision in

Calderdale and systems are in place for rapid, early sharing of intelligence between

teams so that actions can be taken quickly to address any issues that may arise.

In addition, the Continuing Healthcare team are required to complete yearly reviews

of the care delivered to all patients in receipt of NHS funding. The delivery of annual

reviews is closely monitored by NHS England through quarterly reporting

mechanisms. Any issues regarding the quality of care identified as part of annual

reviews are shared and addressed with system partners through the quality reporting

mechanisms identified above. This is similar for Local Authority funded care and any

issues are escalated through internal governance arrangements and, where

appropriate shared with relevant partners.

Provider reviews- these take place at least every two years, only for low-risk areas.

There are a range of additional quality measures in place outlined below.

A Multi-Disciplinary Risk Assessment (MDRA) enables teams across the system

to assess providers directly according to their risk considerations or input into the

Quality Team assessment.

• Multi-disciplinary, Provider Quality Monitoring Meeting, monthly meeting to

review high and medium risk providers and agree interventions- escalate risk

to Governance and Quality Assurance Board

• Provider Quality Assurance visits - monitoring based on MDRA and

decisions made in the Provider Quality Monitoring meeting.

• Provider returns- annual and monthly depending on the sector (monthly for

supported living)

• Multi-disciplinary Provider Concern meetings- Safeguarding and Quality

alternate to Provider Quality Monitoring and ad hoc as required.

• Provider Quality Assurance and Contract meetings- escalation process

based on risk

Each provider, regardless of risk status, will receive a full Quality Assurance

Assessment (2 days on site and additional desk top reviews), every 2 years which

will generate an action plan where appropriate.

The Quality visit schedule is driven by the MDRA;

• Red escalated providers - weekly visits (alternating with ICB Quality)

• Red managed providers - monthly visits (alternating with ICB Quality)

• Amber providers - quarterly visits. (some homecare providers may be reduced

to 6 monthly visits depending on progress)

• Green providers - 2 yearly visits followed by 6 monthly checks if there is an

action plan until actions are completed.

• Focussed visits (announced or unannounced) may take place as directed by

Provider Quality Monitoring, Provider concern meetings or in response to

whistleblowing or quality concern forms or alongside the Safeguarding Adults

Team.

Advocacy escalation of complaints and concerns – There is a contract with

Cloverleaf to deliver statutory advocacy services in Calderdale. Monitoring meetings

take place every 3 months with the provider to review performance. This is an

opportunity to review and for Cloverleaf to escalate complaints and concerns and for

any themes and trends to be identified.

Diversity of homecare -Support is commissioned from around 40 providers to

deliver homecare. The brokerage team are aware of provider specialisms and are

able to broker provision that will meet individual needs. The brokerage team have an

overview of providers and are able to broker providers with workers who with a range

of languages and cultural backgrounds.

Recommendation 4:

We recommend that any dietary and/or religious needs raised or identified are

recorded on an individual’s care plan. We further recommend that there is

active review as to whether an individual’s dietary and/or religious needs are

being met. Where there is evidence that those needs are not being met, every

effort should be made to resolve the situation as quickly as possible.

Progress Update

The Commissioning Teams have carried out significant work with local care providers

to ensure they are equipped to offer people a choice of options to address dietary

and/or religious needs. In the ICB, mechanisms are in place via Quality Walk Abouts,

assessment tools, Continuing Healthcare Checklists and Decision Support Tool

assessments to ensure individuals dietary and/or religious needs are appropriately

captured with individuals care planning documentation.

Within Adult Social Care, it is a routine requirement that dietary and/or religious needs

are assessed, recorded within both assessment and care and support planning

documentation, and fully considered. In addition, in order to strengthen this and ensure

high standards of practice in this area are maintained, a number of measures have

been taken including:

• Training in Cultural Competence and Humility for staff has been provided.

• Several of the people trained have also been undertaking ‘Train the Trainers’,

so the training will continue to be rolled out.

• Adult Services and Well-being Directorate has recently launched:

o A Social Work/Care Practice Framework,

o A Quality Assurance Framework,

o A new strengths-based practice model, ‘8 P’s’

o A Cultural and Religious Competence Flowchart (which has been

reviewed by Nur e Sabil)

o A case file audit programme A Consistent Practice Framework to

support the embedding of the strengths-based ‘8 P’ approach,

including a specific requirement to consider promoting inclusion,

diversity, and equality (PRIDE).

Recommendation 5:

We recommend that the wishes and views of the family are recorded in all

service users’ care plans and, wherever possible, that those wishes, and views

are recognised and acted upon.

Progress Update

It is a standard requirement of professional practice across health and social care to

include record and act upon the wishes and views of families in assessments, care

and support planning and provision. Further actions which have been taken to

strengthen professional practice in this area are included in the progress update to

recommendation 4.

In addition to this, the Council and ICB have recently agreed to fund a post of Carers’

Lead to oversee and ensure the delivery of the joint Carers’ Strategy.

Recommendation 6:

We recommend a review of commissioning processes both by the Council and

the NHS locally to provide assurance that we are building religious and cultural

needs into all commissioning and that through internal quality assurance

processes, contract monitoring and independent CQC inspection we have

effective ongoing oversight of the care provided. We recommend that this

review is completed within 6 months. The Adult Health and Social Care Scrutiny

Board should consider this review when it has been completed.

Progress Update

An integrated ICB and Council Service Specification for the commissioning of

care is used in Calderdale. The Council and ICB have carried out a review of the

Service Specification and respective Service Level Agreements utilised by both

organisations to ensure that cultural and/or religious needs are appropriately

addressed through these documentations. There are established integrated

monthly contract monitoring meetings in place to regular monitor the effective

delivery of contracts by providers and agree and determine any actions to be

taken when required. There is an escalation route to Care Homes and Home

Care Programme Board

Recommendation 7:

We recommend that families are supported throughout the Court of Protection

process. The procedures of the Court should be explained to them in a clear

manner, and, if necessary, in the first language of the family. Independent

advocacy Services should always be clearly signposted to family members. The

Adults Health and Social Care Scrutiny Board should consider a report on the

use of the Court of Protection and the Mental Capacity Act at least once a year.

Progress Update

When Court of Protection processes are required, the process should be explained

to families, and they should be signposted to the relevant advocacy services to

obtain appropriate, independent support. An offer was made by the Council to

organise a community training event to be delivered by an Urdu speaking barrister,

however this offer was not taken up. Scrutiny Members may wish to ask that this

offer is repeated.

The Adult Services and Well-being Directorate holds and carefully reviews data to

support monitoring of the use of the Mental Capacity Act in relation to Deprivation of

Liberty Safeguards and the Court of Protection.

Recommendation 8:

The Council’s revised workforce strategy should address the need for the

Council’s workforce to be more diverse and representative of the communities it

serves. A report on actions proposed should be presented to the AHSC

Scrutiny Board by July 2023 and a further report presented to the Scrutiny

Board in March 2024 on improvements achieved through the workforce

strategy.

Progress Update

Both the Council and the ICB have dedicated Workforce Strategies in place. The

Adult Services and Well-being Directorate has signed up to the ‘Diverse by

Design Toolkit’ to improve the workforce representation of the population it

serves. There is a requirement and support to ensure diverse recruitment panels

are in place for all roles and there is a commitment to ensuring people with lived

experience of care are involved in all recruitment.

In the ICB, a diverse panel and/or the option to have diverse representation on

the panel from the NHS West Yorkshire ICB Race Equality Network is available

to ensure the organisation is meeting its responsibility around equality and

diversity.

Recommendation 9

The working party recommends that the complaints procedures are actively

reviewed and that it is recognised that complaints can be made in different

ways and not just using a formal complaints procedure. A robust mechanism

needs to be established to capture all concerns when they are raised so that

patterns and trends can be identified and resolved. Strategy and Performance

Scrutiny Board are requested to undertake a review of complaints procedures.

Progress Update

Health and Social Care system partners have worked together and agreed a multi-

organisational approach for the handling of complaints when a complaint is made

requiring the input of both the Council and the ICB. This has been formalised into a

policy document and is currently actively being used in the handling of multi-

organisational complaints. Processes have been developed to support individuals to

lodge a complaint when they face barriers such as literacy capability, language,

access etc. This is to ensure there is more than one route to accessing the complaints

process which makes it more accessible and easier to navigate for people and

families.

The Adult Services and Well-being Directorate receive a monthly report on complaints

and monitor activity, themes and trends through learning logs and case file audits.

There has also been a review of complaints specifically with regard to cultural

competence.

Recommendation 10

Both Healthwatch and CloverLeaf should have a specified point of access to the

Adults Services and Wellbeing Directorate to report of complaints and concerns,

and their resolution. It is recommended that ways to coordinate complaints

handling in both health and social care systems are explored.

Progress Update

The progress update to Recommendation 9 details the integrated process in place for

handling multi-organisation complaints. People can be signposted to Healthwatch and

Clover Leaf for additional support in airing their concerns or complaints. The Adult

Services and Well-being Directorate has a relationship with both Healthwatch and

Cloverleaf if they need to escalate any particular concerns.

Next Steps

• To embed and continue the strategic work of the Governance and Assurance

Partnership with Nur e Sabil representation.

• To continue to progress the action plan to ensure continuous improvement.

• To continue and develop community engagement and co-production events

with all community groups.

• To embed the use of the cultural competency tools and quality assurance

framework in everyday professional practice.

For further information on this report, contact:

Name: Cath Gormally

Job Title: Director (DASS) Adult Social Care

Phone Number:01422 393801

Email address: [email protected]

NB, this should be the actual author of the report if that is different from the Director /

Assistant Director named at the top of the report.

The documents used in the preparation of this report are:

• Appendix 1- GAP Action Plan

• Appendix 2- People Pathway Cultural and Religious Competence

• Appendix 3- 8 P’s Framework

• Appendix 4- ASW Practise framework

• Appendix 5- Operational Services Quality Assurance Framework (QAF)

• Appendix 6- Integrated Quality Strategy and Assurance Framework