Agenda item

To provide an update on the provision of aids and adaptations following the recommendations made by the Panel in September 2022. Minutes from this meeting are available to view at: https://www.minutes.haringey.gov.uk/mgAi.aspx?ID=74001

A previous update was provided to the Panel in March 2023. Minutes from this meeting are available to view at: https://www.minutes.haringey.gov.uk/mgAi.aspx?ID=75471

Kerine Smith, Acting Head of Service, introduced the report for this item which provided an update on progress against the recommendations on communication issues and delays previously made by the Panel in September 2022:

• A key action was on initial assessments and ensuring that the family was fully involved. The occupational therapists were now providing more regular updates with a 4-6 week pathway review including details on their position on the waiting list. An additional occupational therapist (OT) and occupational therapist assistant (OTA) had been recruited. The OTs were working closely with those within the adaptation process and there was also an adaptation delivery manager overseeing the process and providing further support.
• Another recommendation was for the Council to offer advocates and this was now being done at the assessment stage with residents referred to Voiceability, Disability Action Haringey, POWhER and Connected Communities.
• On the recommendation that key decisions should be confirmed in writing, a series of communication actions carried out by the service was provided in the report including a summary of input to the resident following an assessment/review, support plans and a copy of the OT specification.
• On the recommendations that delays should be explained to residents and that details of a named contact should be provided to residents, everyone on the waiting list had been contacted in the past year and the additional recruitment had improved capacity for individual communications with residents.
• On the recommendation that suggestions made by residents/families should be recorded on the case file, the new case management system enabled this to be recorded using bespoke forms.
• A recommendation on recording and communicating delays and timescales to residents had been addressed through a new recording system for all adult social services.
• On the recommendation about widening provider choices for aids and adaptations, it was noted that standard equipment was provided through a contract involving a consortium of 20 local authorities. Further details about this were provided in the report.

Kerine Smith responded to questions from the Panel:

• Asked by Cllr Connor about further reducing the waiting list, Kerine Smith explained that the waiting list was for the OT assessment after which the recommendations were passed to the adaptation team which included the surveyors. In addition to the new recruitment, some of the OT assessments were being outsourced to speed this part of the process up.
• With reference to a specific case, Cllr Iyngkaran queried what happened where a Haringey resident was discharged out of the Borough because their current home was unsuitable. Beverley Tarka, Director of Adults, Health & Communities, said that it was not generally the policy of the Council to place people out of Borough but that she would be happy to look into the details of the specific case outside of the meeting. Cllr Lucia das Neves, Cabinet Member for Health Social Care & Wellbeing, highlighted the impact of the housing crisis and that the Council was consequently in a position of having to place some residents out of Borough when other options were unavailable.
• A local resident with experience of using the aids and adaptations service for her disabled son, disagreed that the service had improved, citing further delays, poor communications, lack of record keeping and difficulties in obtaining the correct information in meetings or updates on questions/actions. Cllr Connor asked how the team approached complex cases such as this where coordination with various other services was a factor. Kerine Smith explained that the meetings were held with families, Council staff and other organisations involved with supporting the family. Jon Tomlinson, Senior Head of Service for Commissioning, Brokerage & Quality Assurance, added that the actions and improvement plan had been put in place to change processes that had previously not worked well, particularly with communication, keeping people informed and responding to the issues that they raised. Cllr das Neves commented that, while she it would not be appropriate to share details of an individual case in the meeting, there were some points raised that she would take up with the team outside of the meeting.
• A local resident involved with the same case observed that interruptions in continuity could be an issue with useful, detailed discussions having taken place before an individual leaves the service and the issues then not being followed up. Cllr das Neves acknowledged that communications were not always good enough and that she had heard the frustration in relation to complex cases. She added that the waiting list was very high following the pandemic but that there had been successful recruitment of more staff and the waiting list had now been halved, meaning that a lot of people now had their adaptation and that it was working.
• Cllr Mason referred to an individual case which involved the installation of a stairlift where the family had been waiting for 12 months and said that the length of the wait time had not been made clear at the outset. She recommended that a clear expectation of timescales should be set out following the initial assessment. Cllr Connor added that there should a clear explanation of any delays and that the resident should be given the opportunity to discuss any changes. (ACTION)
• Cllr Brennan observed that the proposed changes on communications, as set out in the report, appeared to be very positive but asked how successful implementation would be achieved. Jon Tomlinson said that there was a performance management team meeting each month and that these issues could potentially be built into that performance report. (ACTION) Kerine Smith added that an Aids & Adaptations Board had recently been created to meet regularly and develop an action plan to deliver changes.
• Cllr Brennan asked about the use of agencies for advocacy and Cllr O’Donovan added that it was important to ensure that organisations providing advocacy services were active and well resourced. Beverley Tarka explained that advocacy services in Haringey, such as POWhER, Voiceability and Disability Action Haringey, were commissioned by the Council. She also noted that many people chose to use a family member to act as their advocate. Cllr das Neves added that, while the Council generally pursued a policy of insourcing, this was an example of a service where its users valued the independence brought by an external organisation. Kerine Smith confirmed that all those who took up the offer of an advocate were provided with one so there was not a shortage in terms of resourcing.
• A local resident highlighted the significant demands placed on Disability Action Haringey from casework such as the complex issues relating to her family’s case. Cllr das Neves responded that there was an issue about the sustainability of organisations such as this and that there were ongoing conversations with partner organisations about the different activities that they were called upon to do and how they should be supported.
• Helena Kania asked whether an electronic record was kept when a family member or friend was acting as an advocate. Kerine Smith confirmed that their system included a section for the details of the main person that should be contacted in relation to the case and that there was an option to select ‘advocate’ on the field showing the relationship status to the client.
• A local resident commented that it was the OT’s responsibility to write their report, including specifications, and send this to the resident but queried what process was in place to record this and ensure that it happened. Kerine Smith explained that these details were recorded on the case management system and that OTs and surveyors got supervision once a month where each of their cases was looked at and any necessary actions followed up. Cllr O’Donovan noted that some timescales for this were set out on page 69 of the agenda pack. Kerine Smith responded that the some of the exact specifications for timescales were still being worked on. Cllr Connor recommended that timescales should be specified, including details of actions to be taken if these timescales were exceeded, should be provided to the Panel. (ACTION) Cllr Brennan suggested that automated alerts could be added on an electronic system to trigger actions. Jon Tomlinson agreed to look into this further and commented that this could be picked up in the performance report process that he mentioned previously. (ACTION)
• Noting the progress cited in the report on individual communications with residents about the adaptation process, Cllr Connor asked about the timescales and monitoring for this. Kerine Smith said that residents were now contacted every 4-6 weeks to provide an update on where there were in the process. This had been made possible by the recruitment of the new OTAs and an adaptation delivery manager. Asked by Cllr Iyngkaran about the total number of active cases, Kerine Smith said that there were 289 cases on the waiting list. She added that, in March 2023, there had been 448 cases on the waiting list and that a piece of work was carried out to call all of them to provide an update. The further update calls every 4-6 weeks were a follow-up measure implemented after this initial work. These calls were primarily to update residents on where they were in the process but were also an opportunity to review any issues, for example if the resident’s needs had changed.
• A local resident commented that her preference was not to be contacted on a mobile phone as record keeping was more difficult and that it was important to keep an audit trail. Asked by Cllr Connor about the records of update phone calls, Kerine Smith said that these were added to the case management system. She confirmed that the preferred method of contact could also be specified on the case management system.
• Asked by Helena Kania about the recommendation to provide residents with a named person and contact details for their case, Kerine Smith confirmed that this was now happening, initially for the OT and then for the surveyor when the case reached that stage.
• Regarding the recommendation that suggestions made by residents/families should be recorded on the case file, Cllr Connor commented that this could be complicated when there were differences of opinion on how a case should progress. Kerine Smith explained that the initial meetings would involve the client (and their advocate if required), the OT and the surveyor and then, if agreement on a decision was not reached, then a panel meeting would be set up involving managers to look at the options and determine the best way forward. Beverley Tarka referred to a previous complex case where a family representative had been invited to participate in the panel meeting and it had led to a positive outcome.
• Cllr O’Donovan commented that, if there were undue delays, there should be a trigger for action to be taken. Cllr Iyngkaran asked whether apologies and/or compensation is provided to residents in such cases. Kerine Smith said that, where a complaint was received, and it was accepted that it was the fault of the Council then apologies were made and she confirmed that there had been circumstances where compensation had been paid.
• A local resident cited an example in her family’s case where an item had been cancelled without being reordered but that this had not been communicated to them. Cllr Connor highlighted the importance of keeping residents updated about changes relevant to their case.
• Cllr Opoku commented that service user representation could help with improvements to services and asked whether this had been considered for the new Aids & Adaptations Board. Kerine Smith explained that the Board had only just been set up and that a recent meeting had been held to discuss terms of reference and who would be involved. There was no service user involvement yet at this stage, but any future involvement had not yet been determined. Cllr Connor added that some residents may not know or may not have the confidence to put in complaints or escalate cases and asked how the experience of residents such as this would be considered. Kerine Smith responded that a future planned initiative was to hold a workshop with residents to look at their journeys and the issues that they had encountered. Cllr Connor emphasised the importance of providing feedback to residents who had participated in a workshop about the changes that were being implemented as a result of their input. (ACTION)
• Asked by Cllr Iyngkaran about the internal processes for learning lessons from mistakes, Beverley Tarka explained that there was a Quality Assurance Board that examined complaints and considered how issues could be prevented from happening again.
• Asked by a local resident how local ward Councillors provided feedback from their conversations with carers and others, Cllr Connor explained that she would regularly submit issues on specific cases or concerns raised about services through the Council’s Members Enquiry system. Cllr das Neves added that she met with Cllr Connor on a monthly basis and that she often received feedback from residents via these meetings. She would also receive feedback on these issues from other Councillors and from community engagement events such as roving surgeries or meetings with faith leaders and others.
• Asked by Cllr Connor whether it was possible to commission enough services through the contract involving a consortium of London local authorities, Jon Tomlinson said that they were currently working with a newly appointed manager in this area on how to widen choice and would need to come back to the Panel with some further details in due course. (ACTION)
• Cllr O’Donovan requested details of when the draft Aids and Adaptations Policy 2024-27 would be finalised and it was agreed that this information would be provided to the Panel in writing. (ACTION)

Cllr Connor then moved to invoke Committee Standing Order 63 to allow Committee Standing Order 18 to be suspended and allow the meeting to continue after 10pm. This was to complete the business on the agenda. The Panel agreed this motion without dissent.

RESOLVED – The Panel recommended that:

• A clear explanation of any delays to be provided to residents and the resident to be given the opportunity to discuss any changes.
• Feedback to be provided to residents who had participated in a workshop about the changes that were being implemented as a result of their input.
• Successful implementation of proposed changes on communications to be monitored (potentially built into the monthly performance management report).
• Details to be provided on how the coordination of complex cases involving multiple services will be managed.
• Target timescales for a standard adaptation to be specified, including details of actions to be taken if these timescales were exceeded (including the possible use of automated alerts), to be provided to the Panel.
• Details to be provided about how services could be commissioned through the NRS contract to widen choice.
• Details to be provided of when the draft Aids and Adaptations Policy 2024-27 would be finalised.