Agenda item

To provide details of recent quality assurance activity carried out in Haringey.

Report to follow.

Jon Tomlinson, Senior Head of Service for Commissioning, Brokerage and Quality Assurance, introduced the report for this item which provided an annual update on the recent quality assurance work and the current challenges faced including upward pressure on costs, recruitment and retention, and increased acuity and demand. Regular meetings were held with both domiciliary care and residential care providers to discuss key issues and a new uplift process had been introduced to reflect the challenges faced by providers. He explained that the Council and the Care Quality Commission (CQC) worked closely with providers to develop action plans when issues had been identified through the quality assurance process. In Haringey, the majority of providers had been assessed as being in the ‘good’ or ‘outstanding’ categories and the general approach of the Council was not to commission providers that were assessed as requiring improvement, although there were cases where there were already residents using those services.

David Harris, Operations Manager for Islington, Camden & Haringey at the CQC, explained that his role covered a range of health and social care services and that, from January, there would be an allocated CQC inspector for adult social care in Haringey. With regard to the report, he concurred that there was a lot of pressure in the system at present and noted that there were particular concerns about the demand on ambulance services coming into the Whittington and North Middlesex hospitals.

Jon Tomlinson and David Harris then responded to questions from the Panel:

• Cllr Iyngkaran referred to Provider G in Table 1 in the report which was listed as having two open Safeguarding Adult Reviews and 30+ safeguarding concerns. He asked why the Council had lifted its suspension on further placements while the Integrated Care Board (ICB) had continued with a suspension. Jon Tomlinson responded that the Council had developed an action plan with the provider and that all of the required quality assurance actions had been complied with. The Council had a block contract with the provider and it was deemed appropriate to lift the suspension. Vicky Murphy, Service Director for Adult Social Services, added that the provider had 106 beds, 61 of which were for residential and lower needs nursing. She explained that there were also some intermediate care beds and that the ICB would also spot purchase beds for Continuing Healthcare (CHC). The requirements on CHC had been around intensive nursing support and changes were ongoing in this area. Further information was expected to be available on this in the coming weeks which could be provided to the Panel. (ACTION)
• Referring to Table 5 on page 8 of the supplementary agenda pack, Cllr Iyngkaran asked why nine of the Out of Borough placements were at uninspected premises. David Harris explained that not every adult social care service was inspected by the CQC (e.g. supported living) and that some services may have registered but not been inspected yet. When registering, they would have to go through a rigorous process including many of the same details as an inspection so they would be a perfectly usable and safe service. Similarly, a change of ownership could also lead to situation where a service had not yet been inspected. Jon Tomlinson added that the Council would also liaise closely with the host authority and would not place anyone with a provider that the host authority had highlighted issues about.
• Referring to page 7 of the supplementary agenda pack, Cllr Connor noted that there were 13 locations in the Borough that Haringey Council did not currently commission and asked whether there was any oversight of self-funding Haringey residents who might be using these services. Jon Tomlinson explained that their quality assurance approach was based on risk due to their current capacity, although they were expecting to be able to expand the quality assurance team early next year. This meant that the quality assurance activities would typically be prompted if issues were raised with the Council or if information was received from other sources such as the CQC, other local authorities or residents/families. Vicky Murphy added that any service providing direct care would also be CQC-regulated, as opposed to services such as supported living services which were not CQC-regulated. The non-commissioned services would be a mix of these two categories. Cllr Connor suggested that clarification on this would be useful in future reports on this topic. (ACTION)
• Asked by Helena Kania how many of the 180 Out of Borough placements were outside of the North Central London (NCL) area and how these were monitored in terms of safeguarding, Jon Tomlinson said that typically around one-third of the placements would be outside of NCL. He explained that there would be an annual review for each individual carried out by a social worker and reiterated the close partnership working with the host authorities as previously mentioned. Vicky Murphy added that the host authority would have a statutory responsibility for safeguarding issues. Dr Adi Cooper, Independent Chair of the Haringey Safeguarding Adults Board (HSAB), commented that, when serious safeguarding issues arose, the HSAB would seek assurances from partners that immediate action was being taken to review similar cases. She added that a complicating factor was that placements were sometimes made through agencies so there needed to be careful monitoring. There was an added layer of assurance through the HSAB, in the ongoing monitoring reports and in the regular commissioning reports it received from adult social care and the ICB. David Harris commented that closed cultures could often be a factor in serious safeguarding events and that planned routine visits may not be sufficient to understand what was going on and so more unscheduled visits were required.
• Asked by Cllr Mason about the nine providers where risk had been identified and whether others were on the risk borderline, Jon Tomlinson said that, in addition to the nine providers highlighted in the report, there were a similar number where there was a watching brief.
• Asked by Cllr Mason about reports from family members as a part of assessing risk, Jon Tomlinson explained that the risk register was the main tool used for ensuring an overview of this in conjunction with other identified risk factors. He added that the quality assurance team would always investigate and take action/involve partners where necessary when family members raised concerns about care. Cllr Mason requested that an anonymised version of the risk register be provided to the Panel if possible or alternatively information about how many safeguarding complaints had been raised. Jon Tomlinson agreed to look at what information could be provided on this. (ACTION)
• Asked by Cllr Brennan about the background checks on placements with previously unused providers, Jon Tomlinson said that the team would always do background work with information gathered about CQC registration and other kinds of data in order to have a good understanding of a service before making a placement. He acknowledged that the market was particularly challenging at present and so the brokerage team was working to identify packages to meet the assessed needs of residents.
• Referring to paragraph 6.12 on page 8 of the report, Cllr Connor asked what difference the Quality Assurance and Contract Monitoring Framework was expected to make to residents. Jon Tomlinson explained that the Framework had only just been launched but that it would help to record and track quality assurance information from the beginning of the process. It would also enable the monitoring of contracts in a more organised and coordinated way. Haringey currently used quite a large number of providers due to the equivalent of spot purchasing but, by moving to more block contracts it would be possible to bring the number of providers down which would be more manageable in terms of quality assurance. The expected increase in the size of the team would also enable more proactive engagement with providers. Cllr Connor proposed that a further update be provided on the Quality Assurance and Contract Monitoring Framework at the quality assurance report to the Panel next year. (ACTION)
• Referring to an individual case that she was aware of, Cllr Connor asked whether investigations into safeguarding complaints were closed after a service user had died. Vicky Murphy confirmed that there was no policy that would require this and that, depending on the nature of the case, further action could be taken, for example as part of a Safeguarding Adults Review or by contributing to a wider system approach. She also indicated that she would be happy to provide a response regarding the individual case outside of the meeting if required. (ACTION)
• Referring to cases in the report of providers that had not yet shown sufficient improvement, Cllr Connor asked what reassurances could be provided for families of residents who remained placed with these providers. David Harris explained that there were different levels of CQC enforcement which included a formal notice of improvements required within a certain timescale which could be followed by requirements for documentary proof of changes or a further inspection. Jon Tomlinson added that an action plan would typically be agreed and that the Council would work with the provider until those improvements were attained. Quality assurance officers would make regular visits during this time in order to help manage the risk level. The social work team may also be involved if necessary to provide additional support to the service user and their family. However, if the provider did not appear to be making progress within the agreed time period, then decommissioning could be necessary. Vicky Murphy added that there was a lot of quality assurance during the social care assessments and that there would be close communication between the quality assurance team and the social work team.