Agenda item

To receive an overview on quality assurance and service improvement within adult social services, covering both the Council’s internal quality assurance process and external mechanisms.

John Everson, Assistant Director for Adults, introduced the report on this item on the Quality Assurance and Service Improvement infrastructure within the department. Key points included that:

• The internal focus is regulated through the Quality Assurance Board which checks on both the practice within the service and the quality of the service that is delivered to service users and carers.
• This enables the team to look in more detail at individual practice through case file audits and to interrogate complaints and compliments, which helps to inform service improvement plans.
• There is a more robust service improvement management infrastructure recently put in place to focus on areas that face challenges such as getting assessments around occupational therapy.
• The Governance and Improvement team has, among other things, a role in safeguarding and on the outcomes for vulnerable people in the community.
• The external focus includes an audit service provided by Mazars, which carries out its audits in areas where the department feels could improve or needs to be tested. There are a number of these each year which informs future practice.
• The London ADASS network is used for peer review which comes in to look at one of three themes each year – Safeguarding, Commissioning and Use of Resources.
• The Adult Social Care Outcomes Framework (ASCOF) which provides local and national statistics on outcomes that care and support services should achieve and sets a benchmark for how well each Council is performing on these.
• The Local Government Association (LGA) also provides analysis and has recently been involved in some work to better understand demand and cost of care within Haringey.

John Everson then responded to questions from the Panel on each of the different sections within the report.

Quality Assurance Board

• On the criteria used by the Board, John Everson said that they look at benchmarks of what is considered to be good quality in adult social care such as the indicators used by the ASCOF for example. Considerations include the timeliness of assessments, feedback from service users and carers, compliments and complaints received and CQC ratings.
• Asked whether there is independent input on the Board, he acknowledged that it is an internal board but said that that there is external audit from Mazurs who assess the department’s practice in key areas as well as the input from London ADASS.
• Asked whether the Local Account (which details the performance and priorities of Adult Social Services) was an online-only document, he confirmed that it was but that it could be printed out on request. Helena Kania commented that paper copies should be made available to the public in libraries. The 2018/19 Local Account has recently been published and it was agreed that this document be shared with the Panel. (ACTION)
• On how the questions to service users were structured and whether they were based on pre-set questions or more in-depth interviews, he said that the infrastructure is set up to broadly look at the whole picture. The conversations with service users and carers through the review process is designed to tease out what is working well or not for individuals. There is clearly a need to triangulate the themes of that information with other broader data to identify areas of concern and look at these further, including by exploring them through the strong working relationship with the CQC. The broader data includes the Adult Social Care survey, which comprises of a set of questions that are standardised across the whole country and are used on a more strategic level to get a sense of how services are performing.

Audit Process

• Panel Members commented that paragraph 2.10 of the report explained only the process around recent audits but did not provide figures or RAG status indicators to demonstrate what the conclusions of the audits were. The Chair requested that recent figures/indicators from these audits be provided to the Panel, perhaps covering a 6-month period. (ACTION)

• Asked about the general conclusions that can be drawn from the audit tool, John Everson said that it varies as a random sample of 15 cases is used each month. There is also a high turnover of staff which can affect the results. In some months the indicators can be mainly green but basic mistakes are sometimes identified and, when that happens, clear plans are put in place with that team to mitigate the poor practice and to improve future performance.

Complaints and Compliments

• Challenged about the assumption in paragraph 2.13 of the report that learning and actions by the teams was the cause of certain issues not being repeated in the complaints, he took the point but said that, for example, the occupational therapy issue had been a particular concern for quite some time and complaints about these were not now being seen in the same way.
• Asked about the number of complaints, John Everson said that in Quarter 2, 12 complaints were upheld.
• Cllr da Costa commented that it would be useful for the Panel to have oversight of the reports that go to the Quality Assurance Board on a quarterly basis.
• In response to a question from the public gallery by Lauritz Hansen-Bay about improving access to information about services that are available, John Everson said it was important to recognise that people can find it difficult to get into a complex system. The Connected Communities programme and the ongoing work to develop a place-based approach North Tottenham is key to this and aims to find solutions to these issues by provided a coordinated first response service for people when they have issues.
• Cllr Connor asked whether a ‘suggestions’ option could be provided as a more neutral method of providing feedback rather than just compliments or complaints. John Everson said that this sounded like a positive idea and Beverley Tarka said that although this isn’t currently an option, there is feedback collated from forums which includes suggestions from service users and carers about what they might like to see being done differently.

Service Improvement and Business Management

• Asked what service improvements had been identified, John Everson said that one of the key things in the borough plan is on how the department makes sure that the information and advice provided by the first response team is good. However, it had been recognised that the customer experience was not particularly good with people struggling to get through or on hold for a long time for example. To improve that experience the team has put in place technological solutions, such as putting in place on automatic callback system instead of a hold system and improved triaging to direct people to the right areas.

External Quality Assurance

• On how improvement plans are being put in place following the Mazurs audits, John Everson said that the audits highlight areas for improvement including how the Council brokers and sets up care packages to ensure that the packages were achieving best value for money. The audits on Mental Health and Transitions were not yet published. Asked whether these audits could be shared with the Panel, Beverley Tarka said that she would look into this and report back to the Panel. (ACTION)
• Asked how Mazurs are appointed by the Council as a whole and when their appointment is next due to be renewed, Beverley Tarka said that she would check this and report back to the Panel. (ACTION)
• Asked whether the outline of the Mazurs audit planned for 2020 on reablement could be provided to the Panel, John Everson said that he would look into this and report back to the Panel. (ACTION)
• Asked whether the LGA analysis referred to in paragraph 3.9 of the report could be provided to the Panel, John Everson said that he would check this and report back to the Panel. (ACTION) The report had concluded that Haringey was an outlier for the costs paid for some learning disability placements which had helped the team to understand what other local authorities do in these areas. It has also informed work at NCL level around care home placements. These findings don’t necessarily always raise issues of concern but sometimes highlight areas where market conditions may be different.

Cllr Connor recommended that a report on quality assurance and service improvement should come back to the Panel again at the same time next year but with additional information including much more data from the internal and external audits. (ACTION)