Agenda item

To provide details of recent commissioning and quality assurance activity carried out by the Council in partnership with the Care Quality Commission (CQC), Integrated Care Board (ICB) and other local authorities.

Jon Tomlinson, Senior Head of Service for Commissioning, Brokerage and Quality Assurance, introduced the report for this item noting that there was a challenging environment currently for providers across the country. He informed the Panel that Commissioning for Adults had now been integrated into Adult Social Care with the team covering commissioning, brokerage and quality assurance. This was a relatively small team but they were looking to strengthen this with additional resource to help drive improvements.

Jon Tomlinson commented that, the more that people were able to participate in input, including friends and relatives, the better this was for maintaining high quality services and keeping people safe. This also required close working relationships with the Care Quality Commission (CQC), the Integrated Care Board (ICB) and other local authorities. He explained that there were some really good providers in Haringey but that some required additional work to get to Good or Excellent quality levels.

Jon Tomlinson and Richmond Kessie, Quality Assurance Officer, then responded to questions from the Panel:

• Cllr Peacock raised concerns about the quality of care in sheltered housing and how issues could be raised. Jon Tomlinson said that the role of Councillors was a good example of the input that could help with quality assurance and that referrals were taken very seriously. Depending on the nature of the concerns that were raised, a referral could lead to the setting up of a providers concern process and the monitoring of improvements. If improvements were not made to the required standard, then this could potentially lead to the Council stopping commissioning with that provider. In response to a question from Cllr Connor, Jon Tomlinson clarified that Councillors could make referrals through the Members Enquiries process.
• Cllr Brennan asked about the process of registering a care home with an outside body or regulator and whether there was a high level of complaints or problems. Jon Tomlinson explained that commissioners worked closely with regulators, including by sharing information and horizon scanning to tackle issues quickly and effectively. He added that the scale of issues in Haringey were not at a level then would raise serious concerns and that, with the challenges currently faced by providers, it was inevitable that there would be some slips. The role of his team was therefore to monitor and quality control with the safety and well-being of residents in mind.
• Cllr Iyngkaran raised the issue of whistleblowing as a theme across a number of cases and emphasised that staff must feel safe to raise concerns in order to maintain high quality services. Jon Tomlinson agreed and said that the team took such cases very seriously. He confirmed that there had been one whistleblower incident since he had been appointed to his post recently and that this had led to the organisation being challenged about the issues that had been raised. In such cases, evidence would be gathered about the concerns and then assurance would typically be sought with mitigations put in place until the required standards had been met.
• Asked by Helena Kania about the quality of GP practices, Jon Tomlinson said that, although his team did not commission GP services, their understanding was that the GP support to residential nursing homes was quite robust in Haringey and any significant issues would be picked up quickly. Cllr das Neves, Cabinet Member for Health Social Care and Well-being, asked for confirmation that GPs did not always visit care homes in person. Paul Allen, Head of Integrated Commissioning (Integrated Care & Frailty) for the Council and ICB, explained that there was a community health solution with GPs going routinely into care homes to identify individuals that needed a greater level of support. This would usually be in person, though GPs did have some virtual presence and there would also be visits from community health professionals. There had not been any particular concerns raised about this process through the feedback received. Cllr Connor asked for reassurance that there were no care homes in the Borough that were relying only on virtual support and Paul Allen agreed to obtain a summary position for the Panel on the current position from the primary care team. (ACTION)
• Cllr Iyngkaran referred to the nine providers mentioned in the report that required improvement and asked for further details about the requirements of the service contract. Richmond Kessie explained that the team received regular CQC reports which set out the homes that they had visited and the ratings that they had applied. Where necessary, the providers were asked to provide an improvement plan with timescales, and they would then be monitored on progress. When the team had seen sufficient evidence of improvements, they would then ask the CQC to revisit to establish whether they were satisfied. This process would continue until improvement was achieved and clients would have the option in the meantime to move to a different provider. Jon Tomlinson added that it would be difficult to decommission in circumstances where clients were happy to remain with a provider but that the team were working to strengthen the contracts to make the requirements more specific. Cllr das Neves concurred with this, noting that some providers offered specialised services and so there would be risk in withdrawing services that were valued by residents. This therefore needed to be balanced with the drive for improvements.
• Cllr Connor asked whether all residents within care homes had been asked whether they wanted to remain with that provider while it was rating as inadequate or requiring improvement and it was confirmed that this was the case.
• Vicky Murphy highlighted that while the CQC was the body that regulates providers, local authorities also had a statutory duty under the Care Act and so there was a dual system for quality assurance. Either body could take regulatory measures with providers.
• Cllr Connor noted that, according to the report, 85% of the locations in the borough that Haringey did not currently commission with were uninspected, which was concerning given that other residents would still be using these services. Jon Tomlinson said that this reflected the backlog of inspections but agreed that it was important to make information about providers available to residents as much as possible to enable them to make a judgment. Vicky Murphy added that alongside the dual process for assurance, the CQC had also started doing online assessments. In addition, social workers had been conducting annual reviews and picking up any issues with providers which could be referred to the CQC or the Council’s Quality Assurance Team.
• Asked by Cllr Brennan whether there were plans to check the uninspected providers, Richmond Kessie explained that many of them were domiciliary care agencies which wouldn’t typically be inspected by the CQC until they had at least five clients with them.
• Asked by Cllr Peacock whether the details of the required improvements were made available, Jon Tomlinson said that this was specified in the action plans and also summarised in section 6 of the report.

Cllr Connor requested further information about how many Haringey residents were placed outside of the NCL area and the ratings of the providers that they were placed with. (ACTION)

Cllr Connor requested that a CQC colleague be present at the following year’s Panel meeting for the report on this item. (ACTION)

RESOLVED – That further information be provided to the Panel on in-person GP visits to care homes and on Haringey residents placed outside of the NCL area.

RESOLVED – That the CQC be invited to participate in the next update on quality assurance issues, scheduled for November 2023.