Visit our devolution and LGR hub for the latest information, support and resources
Feedback report: March 2024
Executive summary
The peer challenge found innovative practice in Somerset’s Adult Social Care service, strong performance in key areas of delivery, and commitment, culture, and values to support and extend this work. All those with whom the peer team met were enthusiastic to talk about their work, and open, honest, and frank about areas that are challenging or where they would like to see change or improvement. All of this represents a strong foundation for ongoing improvement and development.
The financial challenges affecting Somerset are well-documented and require difficult decisions to be taken at present and over the coming months. Whilst frontline delivery of core and statutory adult social care functions is protected, there will nevertheless be an impact from reductions in management and support functions (including across the wider council), future commissioning decisions around provider and other resources, and how uncertainty and additional processes will impact on staff energy and motivation. These impacts will need to be recognised, and built into existing plans as risks or mitigations, or where relevant as changes (to timescale or scope) and including through realistic prioritisation of transformation and improvement work.
The ambition and vision of the new unitary council needs time to be fully realised, for instance around community engagement and capacity, or integration or collaboration across wider service offers. Further work to develop corporate partnerships can support adult social care AND the wider work of the council, but this will need time to bed in and prove itself. Maintaining momentum and energy for this further development, or to consolidate existing gains, may be a challenge given the present financial situation and consideration should be given how to mitigate this, perhaps focusing on some concrete deliverables, including for instance the development of a shared housing strategy.
There is considerable ambition in the adult social care service in Somerset, and support to its development and improvement; this was demonstrated through the challenge in meetings with elected members, staff, senior managers, partners, and people with lived experience. This ambition could benefit from clearer articulation, and further clarification in terms of performance, outcomes, and the impact of any developments, and how these are felt, and owned, across the whole council. Finding ways to develop greater consistency across areas of strength (in delivery or leadership) can support improvement in those areas of performance that may be less strong; and showcasing positive stories may help to maintain motivation and energy for the necessary change. Prioritisation across key development or improvement areas could offer opportunities not only to prove their benefits, but also for “quick wins” which can build motivation, perhaps especially important when some challenges may feel or appear intractable.
The challenge found passionate, experienced, and committed staff and senior leadership which can be a huge asset for the council. However, there is also a potential risk in relying too much on strong individual leadership, perhaps especially at a time of acute financial pressure such as the council is presently experiencing. Finding ways to systematise and “diffuse” key knowledge, experience, or expertise, across a wider pool of staff, or in more standardised processes, would help to mitigate risks relating to the change or loss of key individuals within the management structure.
The challenge heard of strong partnerships with the local provider market, the Voluntary and Community Sector (VCS), and with the NHS, and there is a good foundation for coproduction. All of these can be used as a support for improvement, as well as to work collaboratively to address the financial challenge; market shaping development and links with the transformation plan will be of particular importance in this regard.
Background
Somerset Council (The council) requested the Local Government Association (LGA) to undertake an Adult Social Care Preparation for Assurance peer challenge within the council and with partners. The work in Somerset was led by Mel Lock, Director of Adult Social Care at the council, and supported on-site by a dedicated team.
The LGA was contracted to deliver the peer challenge process based on its knowledge and experience of delivering this type of work for over ten years. The LGA sourced the members of the peer challenge team and provided off-site administrative support.
The council was seeking an external view about the preparation and readiness of the Adult Social Care Directorate for the arrival of the Care Quality Commission’s (CQC) Local Authority Assurance inspections; as well as to inform their wider improvement planning.
The members of this Adult Social Care Preparation for Assurance peer challenge team were:
- Hilary Hall, Corporate Director, Community Wellbeing, Herefordshire council.
- Councillor Steve Darling, Torbay Council.
- Kayleigh Bradford, Principal Social Worker, Commissioning, Devon County Council.
- Juliette Garrett, Head of Commissioning – Older People, Adults and Health, West Sussex County Council.
- Dan Wilkins, Head of Adult Social Care Transformation and Quality, Wiltshire Council.
- Cheryl Hampson, Head of Quality & Performance Adult Social Care, Gloucestershire County Council.
- Peter Fairley, Director for Strategy, Policy and Integration, Essex County Council.
- Chris Rowland, challenge Manager, Local Government Association.
The team was on site from 5th – 7th March 2024, following supported access over two days earlier in February to carry out case file audits. The programme for the on-site phase included activities designed to enable members of the team to meet and talk to a range of internal and external stakeholders. These included:
- interviews, focus groups, and discussions, with councillors, people with lived experience, managers, practitioners, frontline staff, and partner representatives; in total over 40 meetings were included on the timetable, and the team gathered views from over 150 people within these.
- preparatory work including a bespoke case file audit covering 22 case files, and reading documents provided by the council both in advance of and during the challenge; this included a Self-Assessment of progress, strengths, and areas for improvement and more than 30 documents.
The findings and recommendations in this summary report are based on the presentation delivered to the council on 7th March 2024, and should be read with reference to it. The supporting detail and recommendations that it contains are founded on a triangulation of what the team have read, heard, and seen. All information was collected on the basis that no recommendation or finding is directly attributed to any comment or view from any individual or group; this encourages participants to be open and honest with the team. The report covers those areas most pertinent to the remit of the challenge only and has been structured around the CQC themes as confirmed by the CQC in November 2023; the challenge team grouped evidence with reference to these questions, and this report is structured around them. They are:
Care Quality Commission Adult Social Care Assurance Themes |
|
---|---|
1: Working with People Assessing needs Supporting people to live healthier lives Equity in experience and outcomes |
2: Providing Support Care provision, integration and continuity Partnerships and communities |
3: Ensuring Safety Safe systems, pathways and transitions Safeguarding
|
4: Leadership Governance, management and sustainability Learning, improvement and innovation |
Peer challenge is not an inspection, and it does not deliver a formal judgement; nor does this report suggest a definitive response against the CQC themes. Rather it offers a supportive approach, undertaken by ‘critical friends’, and an overview of key findings, with the intention of supporting the council to form its own view, and to continue its improvement journey where necessary. It is designed to help to assess current achievements and areas for development, within the agreed scope of the challenge. It aims to help identify the council’s current strengths, and examples of good practice are included under the relevant sections of the report. But it should also provide the council with a basis for further improvement in a way that is proportionate to the remit of the challenge, and recommendations where appropriate are included within the relevant sections of the report (as well as highlighted in the Recommendations section at the end of the report).
The peer challenge process offers an opportunity for a limited diagnostic approach to material which is provided (whether through written materials, or through on-site interviews, focus-groups, or observations), as well as a critical appraisal and strategic positioning of this. It reflects a balance of views within the team, based on their experience, and the material made available to them. However, the level of “assurance” (whether of quality, outcomes, or good / poor practice, etc) which can be provided through this format is strictly limited. A peer challenge, whilst intensive, is not comprehensive. peer challenge is not therefore an alternative to inspection, or indeed to routine or exceptional internal quality assurance, and the council is strongly encouraged to continue such work, hopefully informed by the findings of the challenge.
The LGA peer challenge team would like to thank councillors, people with lived experience and carers, staff, and representatives of partner agencies for their open and constructive responses during the challenge process. The team was made very welcome and would in particular like to thank Mel Lock, Director of Adult Social Care, who sponsored the challenge and Niki Shaw and her team for their invaluable and excellent support to the peer team, both prior to and whilst on site.
4. Leadership
Somerset is a new unitary council, formed in 2023 through the reorganisation of five councils into a new single organisation. This has involved bringing together two different types of councils – an upper-tier authority with responsibilities for services such as adult social care, and four district councils with responsibilities for services such as Housing and Planning. This brings big opportunities but also challenges, with multiple layers of change: becoming a unitary council; political and officer leadership changes; structural and staffing changes; and the context of emerging financial challenges. There has also been significant change external to the council, such as the development of a new Integrated Care Board (ICB) along with its own restructuring processes.
The leader and the lead members for adult social care are visible with officers and there is a positive culture of challenge and support between executive councillors and senior officers. There is understanding from the political leadership about the importance of adult social care for supporting vulnerable communities and unpaid carers, and officers have spoken consistently about the support and leadership that councillors give. Alongside this there is also a strong recognition from the political leadership that adult social care is the biggest area of council spend, and a significant driver of the financial pressures facing the council, and therefore there needs to be a focus on transformation, efficiencies, and ensuring that money is spent as well as it can be to achieve the best outcomes and sustainability.
More widely, all councillors across the board will need to understand the pressures, drivers and change priorities for adult social care, and how they can be supported to play an active and effective role in holding the service to account. This is particularly important because of the financial challenges facing the council, the significant proportion of council spending that any adult social care function accounts for, and the resulting danger that adult social care is regarded as a burden or a deficit, rather than as an asset. The new council has 110 councillors, coming from a variety of backgrounds and council experience, and with differing levels of exposure to adult social care. For some it may feel like a complete unknown; for others, it might be seen as an area of the council that is (negatively from a financial and demand perspective) impacting on other areas that they and their residents care about. For those councillors who do not sit on the Cabinet or on the relevant scrutiny committee, their exposure to, and understanding of adult social care might be limited, and there is an ongoing need to raise or consolidate awareness and understanding of the council’s new responsibilities and how these relate to adult social care. At the core of this is the legal responsibility to ensure that vulnerable people can be protected and supported. To promote this, consideration might be given to the development of an engagement plan that gives councillors at all levels opportunities to learn more about adult social care, through a variety of formal and informal engagement mechanisms.
The present peer challenge is explicitly designed to focus on preparation for CQC Assessment, and therefore, in line with that process, does not focus directly on finance. However, it would be short-sighted in the context of this process not to acknowledge the present financial context, the strain this places on the council, its leadership, and workforce, and the risks that it creates. The financial challenges affecting Somerset are well-documented and require that difficult decisions are taken; this includes a reduced workforce, and may well impact the scope of commissioned services, and the prioritisation of these. Whilst frontline roles in adult social care are being protected in the present round of voluntary redundancy (VR), adult social care services will depend for their effectiveness and efficiency, and for delivery of change and transformation programmes, on corporate support services and capabilities such as Business Intelligence, technology services, housing, finance and HR to name a few. All of these will be impacted in terms of capacity and maybe capability by the current VR process. It is important, therefore, that adult social care leadership defines the capabilities it needs and that the down-sized council can continue to support delivery of key change programmes that support not only adult social care improvement, but also the overall financial efficiency of the council.
Similarly, there is a risk that the impact of financial restrictions (for instance panel-controlled spending) or reducing services, or uncertainty, will affect both staff morale and energy, impacting on performance, transformation, or improvement processes. Alongside the transformation programme and preparation for CQC assessment, the financial position, unitarization, and ongoing recovery post-COVID will all impact, with a risk of cumulative fatigue. Maintaining momentum and energy for ongoing development in the new council, or to consolidate existing gains, may be a challenge given the present financial situation, and consideration should be given how to mitigate this. Prioritisation across key development or improvement areas could offer opportunities not only to prove their benefits, but also for “quick wins” which can build motivation, perhaps especially important when some challenges may feel or appear intractable. Similarly, finding ways to showcase positive stories of improvement or innovation may help to build motivation and energy for this change, as well as proving its benefits whether in terms of outcomes and lived experience, or return on investment or other efficiency measures.
There is an engaged workforce, and the DASS provides strong, positive, visible leadership for the service. The adult social care leadership team and DASS communicate this well with the wider workforce, clearly articulating the overall ambition and potential to change lives for the better, and the importance of adult social care continually improving and transforming. Officers have described the council as an open, supportive, and safe space. More widely, the challenge team found passionate, experienced, and committed staff and senior leadership which can be a huge asset for the council. However, there is also a potential risk in relying too much on strong individual leadership, perhaps especially at a time of acute financial pressure such as the council is presently experiencing. Finding ways to systematise and “diffuse” key knowledge, experience, or expertise across a wider pool of staff, or in more formal processes, would help to mitigate risks relating to the loss of key individuals within the management structure, whether through VR, retirement or moving on, or staff sickness and burnout (which is a risk when all are under pressure).
The council has started a transformation programme, ‘My Life, My Future’ which sets out ambitions for change and has significant savings targets attached to it; this is currently on track to delivery and there will be learning that can be applied to other parts of adult social care. There is comprehensive political and officer scrutiny over the progress of the transformation programme to ensure that it can, and does, deliver on the required benefits and changes. The work is being supported by Newton Europe and there was real positivity among the council officers with whom the peer team spoke about the programme. The programme started with a diagnostic phase which included surveys on change readiness among the workforce, and found a workforce that was receptive to change, and in some cases waiting for the change. council officers are being upskilled in the Newton Europe methodology and this provides a capability and skillset that can be further applied elsewhere on other adult social care and wider change programmes in the future. The council should consider how to retain and deploy its newly trained and experienced officers from this programme, creating a solid platform for transformation, identifying opportunities for improvements, transformational change, and savings, and self-sustaining approaches to such work in the future.
A Transformation Steering Group> has been set up, and this will encompass more than just the existing ‘My Life, My Future’ transformation programme. The challenge heard enthusiasm about many potential priority areas to work on, but also that people feel they lack “head-space”; and there was an acknowledgement from the adult social care leadership team that they need to remain on the front foot in terms of transformation so as to best support the council’s wider financial position. The challenge team felt that there might be a benefit for adult social care in setting out the next phase of transformation, focusing on a small number of priority or “big ticket” items as part of an overall plan. It is important that there is a co-ordinated process to define the biggest priorities and to protect the space and time to ensure the work can be scoped out, designed and delivered; and to work with the rest of the council to provide the capabilities that will be needed to support future and ongoing transformation. Similarly, it will be important that the council continues to get feedback from the workforce and also the voice of lived experience as these transformational changes are implemented, so that there is strong confidence not just that the savings are being delivered, but also that the changes are being embedded, and that the workforce and service users are ‘experiencing’ the benefits of these changes.
There is political and officer leadership support for EDI, and the leadership of the new administration, the new chief executive, and the DASS have all been particularly welcomed in this area of work. It was remarked that this leadership on EDI is “like we’ve never had before” and is helping to create a safe space and a consistent focus across the council. The peer challenge heard from both council officers and the voluntary and community sector (VCSE) that the council is responding to the changing demographics and profile of Somerset, and it was expressed by officers, members, and partners that EDI is now “at the core” of what the council does. The challenge team heard about a comprehensive approach to EqIAs as part of the council’s recent budget-setting processes and that councillors received training about how to use EqIAs and to ask questions on them. The approach to EqIAs appeared proactive and purposeful, helping to inform and shape decision-making, rather than simply a tokenistic add-on. All of this provides an excellent platform to build on.
There is now the opportunity to deepen the work on EDI using the voice of lived experience; Somerset’s population is changing and the council’s own workforce is also becoming more diverse. adult social care has been at the forefront of embracing overseas recruitment and has welcomed many new starters; this has helped the council to learn what support is needed for new recruits and also around the challenges that people settling into a new country can face. The council is working with the VCSE, including Diversity Voices, to promote EDI and to bring in the voice of lived experience. There is much good work going on but it was described by some closest to the work as an “invisible service”, showing that there are opportunities to make the work more visible and also embedded as “everybody’s business”, or business as usual, rather than be seen as the work of just one team or small group of people. The voice of lived experience – across the council’s workforce, service users and residents – can help to embed this work, encompassing all protected characteristics, so that these qualitative insights can be used to inform and shape thinking about how services and processes could be redesigned.
There are positive relationships with partners, including the Integrated Care Board (ICB) and the VCSE, but further work to do as leadership structures are consolidated, both in the new council, and in particular for the ICB. The Somerset Board brings together the Health and Wellbeing Board and the Integrated Care Partnership (ICP) in a committee in common, chaired by the leader of the council; this creates an opportunity to progress work on shared vision and priorities, with political oversight. There are some examples of strong integration, especially around the health interface service and intermediate care. The challenge team heard from the council and the VCSE that there are strong collaborative and trusted relationships and multi-year funding, and that the relationships have improved over recent years. These positive relationships between council and the VCSE are an excellent platform to build on and should not be taken for granted or taken lightly, and it felt important to acknowledge the potential risk to some of this work, and these relationships, in terms of the present financial situation.
The joint director of public health role between the council and ICB is also an excellent example of system collaboration and provides a good opportunity to address the wider determinants of health and improve population health, making optimal use of the Somerset pound. There is an ambitious programme around population health management and there are some potential opportunities for joint roles and teams being explored and advanced. Further opportunities for integration with the ICB are being, or might be explored, including around joint roles, a new data and intelligence function, and further development of joint commissioning of intermediate care.
The peer challenge team heard throughout the challenge of the opportunities afforded by bringing housing alongside adult social care responsibilities in the new unitary council and felt that it would be helpful for the council to clarify its ambitions in a Housing Strategy. The housing team were highly self-aware about the areas of strength (e.g. around housing revenue account) and around the challenges both of addressing housing provision for people with disabilities, and of bringing four separate housing authorities into one. There were some examples of innovative use of Disabled Facilities Grants (DFG) through Help to Move grants. Positive relationships between adult social care commissioners, OT’s and housing are also being formed. There was recognition from the housing team and from adult social care commissioners that it will take some time to realise the full benefits of unitarization, not least because of the four different starting positions of the previous housing authorities, and there is a risk of frustration if not everyone is signed-up to the same ambitions and delivery timescales. The development of a Housing Strategy to define and manage ambitions and delivery priorities, timescales, and political and officer ownership can help to ensure all parts of the council and partners are signed up to the journey, and the peer team felt that a clear timescale should be set out for the development and publication of this strategy and associated delivery plan.
Preparing for CQC Assessment
The council worked very hard to prepare for and facilitate an excellent peer challenge process. Dedicated time and resource and leadership were identified at an early stage and were available consistently throughout the process. There can be a risk of under-estimating both the lead-time (including for different aspects of the preparations) and necessary resources needed to prepare for a peer challenge (or future CQC assessment process), but this was not the case in Somerset.
The council developed a well-structured self-assessment which helped to guide the challenge team in line with the CQC Themes; this was supported by a prioritised, but nonetheless comprehensive set of further evidence materials. These were delivered in a timely way, and referenced in the self-assessment, providing a helpful means of aligning evidence to key statements or sections. All the materials were made available on the council website (but on a non-public-facing page), along with other materials pertinent to the challenge; this made the materials easy to access but might not be a fully secure way of sharing sensitive materials. (This is unlikely to be an issue with CQC assessment however, given that they have developed a portal for uploading all relevant materials in advance of the on-site work.)
Consideration had obviously been given how to provide evidence of outcomes for people who use or have contact with council services, aligned to the self-assessment and CQC themes, with video clips, and “stories” included where relevant. This might be further developed and linked with the routine use of care management systems and future case file audits, as well as through inclusion of lived experience feedback in regular reporting on transformation and improvement plans. Evidence of this kind will also come through contact and conversation with front-line staff, so ongoing support to all staff (not only those working in adult social care, but more widely across the council) to answer the “so what?” question, will support any future assessment team in hearing about positive outcomes, and the reason for, and impact of any changes or improvements that are happening.
Perhaps similarly, ongoing consideration could be given as to how to more fully involve people with lived experience in the preparation for future assessment processes, as well as in the process itself. This is work in progress for all councils at the present time, but early consideration of how to routinely engage a strong lived experience voice as part of ongoing work will support not only the developing approach to coproduction, but also provide good evidence of this in CQC assessment.
The team were made to feel welcome, and many small details were planned for and delivered: staff were available to support access to the council offices (and IT / care management system for the case file audit); car parking access was made available; access needs were appropriately addressed and supported; refreshments and lunch were made available each day; and IT resources and wi-fi were made available whilst the team were on-site.
The area of the council offices where the team were situated is presently not in regular use due to financial constraints and required the on-site leads to make a business case for their use in advance of the challenge. However, once on site the space that was provided allowed plenty of room for the peer team, along with dedicated meeting rooms nearby for interviews and focus groups.
The challenge team was aware that briefings for staff and partners supported engagement with the challenge, and this was to large extent successful: most of those invited to attend interviews or focus groups did so, and participants showed good engagement with and understanding of the interview and focus group process, as well as of the wider challenge, its process, and purpose. There did not appear to be a formal process for debriefing staff following meetings on-site, something which is sometimes included as part of a feedback loop in e.g. OFSTED Inspection, and this may be something that the on-site team may wish to consider in advance of a future CQC assessment visit.
There was very positive feedback about the process and the on-site team, and the engagement and positivity with which the challenge was received was certainly evidence of the positive attitudes and openness of staff towards the process, and indeed more generally within and around the council.
Whilst the initial presentation from the council was kept “in house”, the final presentation from the peer challenge team was open to wider invitees who had been involved in the challenge, including partners and staff. This showed an openness and transparency in the process, and a desire to engage with stakeholders around assurance and improvement. It is understood that a further briefing to disseminate key messages from the peer challenge was held immediately after its completion, and that plans are in place to further disseminate the findings, and the resulting action plan, through formal council processes.
The council would benefit from quantifying the resources deployed in terms of staff time, and at all levels, both in preparation for the challenge (e.g. in preparing the self-assessment and supporting evidence, development of timetable and diary management for invitations, etc), and whilst the team were on-site. Whether this may need to be built into CQC preparation either as a standing resource, or some kind of “on call” team with responsibility, experience, training, and allocated time as and when called on, could be something for future budgetary and role considerations. Those who were involved in preparing for and supporting the challenge will have developed good knowledge both of the process, and of resources in the council which are required to prepare for and support it, and consideration might be given as to how to protect, harvest and grow this knowledge in advance of any future assessment process.
Recommendations for next steps
The peer team appreciate that senior political and managerial leadership will want to reflect on these findings and suggestions in order to determine how the council wishes to take them forward. In due course the LGA will be pleased to work with the council to consider progress in line with wider sector led improvement work, and there is an offer of further activity to support this, including through ongoing engagement with the South West Region Care and Health Improvement Advisor (CHIA), and Paul Clarke, the LGA Principal Advisor.
Specific recommendations are included in the detailed report above, but the summary below outlines those areas where the peer team believe effort could best be concentrated in order to address the issues that they have seen during their visit:
The peer challenge found ambition and innovation in the council’s approach to delivering adult social care, but in a challenging financial situation, and at an early stage in its growth as a new organisation. Prioritisation across key development or improvement areas could offer opportunities not only to prove their benefits, but also for “quick wins” which can build motivation for the whole council. The next stage of the transformation programme might be used to clearly articulate this vision, to establish clear priorities around “big ticket” items, and to engage the whole council in this journey.
One of the “big ticket” items which can show the value of the new unitary structure is in the join-up across adult social care and Housing, and the development and implementation of a Housing Strategy for Somerset would be strongly encouraged.
The prevention agenda is well developed, but given the risks associated with the present financial situation it is urgent and important to prove impact and outcomes, and to maximise the effectiveness of this offer. This will include working with Public Health, first contact / information advice and guidance (and other early intervention), and the VCSE and wider community or whole population offer.
Consideration might be given how to ensure that everyone in the council (not just in adult social care) can answer the “so what?” question in relation to service developments and their impact; to be able to explain what good looks like for adult social care, why it is important for all people and communities in Somerset, and their part in this journey. Building on the work that has been done in preparation for this challenge, further work to collect and showcase positive stories from local people affected by council services can help to maintain motivation and energy.
Engaging more widely with local people and the voice of lived experience can support both improvement and transformation, and this is something adult social care can model and lead for the whole council. This should involve work to thread EDI through all the work of the council, including a strong voice for those with lived experience of accessing adult social care services, and engaging with all the diverse and sometimes disadvantaged communities across Somerset.
The peer challenge did not find any areas of immediate concern, but this is always a limited process, and the council will continue to benefit from ongoing quality and practice assurance work. This can help to further assure and mitigate risks associated with waiting lists, to improve consistency in practice, and to bring learning from areas of strength (in delivery or leadership) to support improvement in those areas of performance that may be less strong.
Contact
For more information about this Adult Social Care Preparation for Assurance Peer Challenge in Somerset Council please contact:
Mel Lock
Director of Adult Social Care<
Email: [email protected]
The LGA Programme Manager for this programme of Adult Social Care Preparation for Assurance peer challenges is:
Marcus Coulson
Senior Advisor – Adults peer challenge Programme
Local Government Association
Email: [email protected] Tel: 07766 252 853
For more information on LGA Adult Social Care Preparation for Assurance peer challenges please see our website: Adult social care peer challenges | Local Government Association