Agenda item

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

Report to follow.

Richmond Kessie, Specialist Commissioning Officer, introduced the report on this item and responded to questions from the Panel:

• Cllr Iyngkaran noted that 23 out of 86 in-Borough providers remained were not yet rated by the CQC and queried how the Council could be reassured about the quality of care being provided. Richmond Kessie clarified that the Council only commissioned with providers rated ‘Good’ or higher and that, should an existing provider fall below this threshold, a social worker would carry out a welfare visit to establish that clients were receiving good quality care. He added that, of the 23 providers referred to, around half were dormant and not currently providing any services and the Council was encouraging the CQC to inspect the others. He confirmed that Haringey did not commission from any of them. Cllr Connor and Cllr Brennan requested that clarification be sought from the CQC on when these providers would be inspected. (ACTION)
• Cllr das Neves, Cabinet Member for Health, Social Care and Wellbeing, commented that Council also had a quality assurance role with all providers. Richmond Kessie added that there were currently five providers rated as ‘Requires Improvement’ that the quality assurance team was working with and felt that they were ready for reinspection with a high chance of acquiring a Good rating.
• Cllr Iyngkaran expressed concern that the number of providers commissioned by Haringey had declined from 250 to 220 in one year. Richmond Kessie responded that there were enough providers available for the Council to be able to place clients. He explained that some providers had left the market because they felt that the previous uplifts provided by the Council were not sufficient for them to be able to provide a good enough service.
• Cllr Iyngkaran requested a written breakdown of the number of private sector providers and voluntary sector providers. (ACTION)
• Asked by Cllr O’Donovan whether the quality assurance team engaged with residents, Richmond Kessie confirmed that they did and that any issues of concern were fed back to the CQC and may also be addressed as part of an improvement plan.
• Asked by Cllr O’Donovan about the process for following up written complaints, Richmond Kessie explained that the quality assurance team could investigate concerns and could suspend any further placements with the providers if serious issues were proven. In addition, the care management team could review service users currently placed with that provider.
• Asked by Cllr Mason whether the public could access a full list of providers and ratings, Beverley Tarka, Director of Adults, Health and Communities, said that the CQC published this information on their website.
• Asked by Cllr Mason about the recording of complaints, Richmond Kessie confirmed that these were recorded and taken through right to the end, including by informing the complainant of any actions taken.
• Cllr O’Donovan noted the complaints against the Newham provider on page 9 of the report and asked about the support being provided to the Haringey resident placed there. Beverley Tarka said that it was not possible to comment of the specifics of the case as the individual would be identifiable. In general terms, the host Borough would lead on any safeguarding concerns and Haringey’s social workers would be closely involved in the support of the individual.
• Helena Kania asked about the knock-on effect of providers having low CQC ratings on the hospital discharge process. Richmond Kessie explained that, if local providers did not meet the required standard then the Council would look to commission with providers outside of the Borough. There could be circumstances where discharge delays arose from placements out of Borough, sometimes because of complications resulting from client choice. Jo Baty, Service Director for Adult Social Services, added that there were London-wide and nationwide challenges with hospital discharge delays and so it was necessary to work closely with NHS colleagues and the brokerage teams to try to secure the best place for each resident. She also confirmed that people placed out of Borough could be brought back in Borough when places become available.
• Cllr Connor noted that, according to paragraph 6.3 of the report, no new care homes had been registered in Haringey in the previous 12 months and queried whether this trend was specific to Haringey. Richmond Kessie responded that this was a nationwide issue. He added that the Council would explore ways of keeping residents at home with support and also had a number of step-down flats as alternatives to placing people in care homes. However, there were some Haringey residents who required care home placements and wished to remain in Haringey, but had to be placed out of Borough due to the shortage of places in Haringey. Beverley Tarka added that providers were being impacted by the recent changes to National Insurance and the Living Wage so there was a national conversation about the impact on the stability of the provider market and the knock-on effects on hospital discharge. Cllr das Neves added that the Council had written a response to a recent consultation on the future of the NHS which had included concerns around social care and community services. Cllr Connor suggested that the Panel note this shortage of places in Haringey and ongoing pressure on the sector as ongoing risks to be monitored. (ACTION)
• Asked by Cllr Iyngkaran about the capacity of the quality assurance team to visit providers, Beverley Tarka explained that visits were based on an assessment of risk and would often be prioritised when issues had been raised about specific care homes. She added that the Council had long-standing relationships with providers across the North Central London area and there were also annual reviews of individuals carried out by social workers. Prioritisation was therefore based on an overall risk assessment informed by multiple sources of information.
• Cllr Connor referred to paragraph 6.4 of the report which stated that 15 providers commissioned to provide care by Haringey had been identified as high risk and expressed concerns that they had a significant number of residents placed with them. Beverley Tarka explained that there had been past occasions when the Council had worked in conjunction with the CQC to close down premises where there was considered to be high risk but that these are rare incidences. More often the approach was to work with providers through a service improvement plan and working with individuals and their families about meeting their needs. Richmond Kessie added that individuals were offered a choice about whether they would prefer to stay with their current provider or switch to a different provider.
• Cllr Connor referred to paragraph 6.5 of the report regarding the Employers Sponsorship Licence and noted that three out-of-Borough providers had their licenses suspended in the past 12 months querying what happened to the clients. Richmond Kessie explained that the clients would still have their allocated support workers and that the Council would visit the provider to ensure that they were doing what was required by the Home Office to get their licence reinstated. One of the three providers referred to in the report had now already had their licence reinstated.
• Cllr Connor referred to paragraph 6.6 of the report  which stated that only two CQC-registered locations in Haringey had undergone inspections in the past 12 months compared to seven in the previous year. Cllr Connor requested that a written response be obtained from the CQC on the reasons for this. (ACTION) She also reiterated the Panel’s concerns about the providers that had not yet been inspected by the CQC and that a response should be obtained on this point.