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Feedback report: June 2024
Executive summary
The integrated care offered in Torbay over the last 20 years is unique in the country and should be celebrated. However, it is not without challenges, which will need to be met head on to ensure its continued effective delivery for all partners, and for local people over future years. The new S75 legal agreement governing the partnership offers a further period of commitment and stability and is an opportunity to consider how key areas of leadership and performance can be consolidated (including through the new S75 Executive Group). Further consideration of improved line of sight for the Statutory Director of adult social care (DASS), and Executive and Political Leadership of the council, including through the Integrated Care Organisation (ICO) Executive, will be essential for future assurance, to provide visible strategic leadership for adult social care which promotes key values and outcomes such as strengths-based practice and promoting people’s independence and choice and control, and to ensure that these can be evidenced in future assessment processes.
The Transformation Programme will be essential to this journey, including financial impact and management of savings (or existing budget pressures) within this. It is an extensive programme of work which needs prioritisation, and consideration of where there may be shorter-term “wins” to demonstrate delivery may be important. Longer term, consideration of what happens at the end of the present contract with the delivery partner and local transformation team (in March 25) should be an urgent priority; this coincides with the re-procurement of the care management system (work on which is at an early stage, but implementation of which will be a challenging medium-term project), and recruitment of a new DASS – which when taken as a whole present a set of risks that will need to be carefully managed.
The challenge found a commitment to providing quality care, with individualised care and support in general being well-provided through multidisciplinary teams which were felt to provide the right expertise and care at the right time. The case file audit undertaken as part of the challenge found good practice, including around legal decision making, and least restrictive practice. Professional practice and line management support was spoken well of within the challenge and can be used as a foundation for further work to promote a more strengths-based and risk-tolerant approach to delivering support.
There are some very strong areas of performance, for example in No Criteria to Reside (NCtR) and Length of Stay (LOS); however, it is recognised that targeted improvement is needed around residential care admissions, and direct payments. Whilst there are waiting lists (in common with many other adult social care services at the present time), including for DoLS, the council is aware of these, and they are being actively managed. Consideration of the balance of priorities across health and social care performance needs to maintain focus on wider outcomes for people who draw on care and support, and to quantify the benefits of more preventative or social interventions.
The challenge team did not hear about concerns relating to adult safeguarding practice or processes, but the limitations of the present peer challenge process for assurance should be noted in this regard, and recent work in this area used as the basis for ongoing assurance.
The challenge heard some positive Lived Experience (in particular from working aged adults), but also of some challenges experienced by others who draw on support (notably carers). There is work in progress to develop a more strategic approach to coproduction, and it will be important to maintain and develop this work to maximise learning from people who draw on care and support, and engagement with your local communities. This will need to include and build on the renewed focus on Equality Diversity and Inclusion (EDI), where more can be done to develop engagement with both staff and local communities. In particular the development of this work (both coproduction and EDI) through and within the ICO can help to ensure that those delivering adult social care assessment and support (whatever their professional assignation) can speak well of this agenda.
Background
Torbay 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 Torbay was led by Jo Williams, 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:
Alan Sinclair(Lead Peer), Director of Adults & Health, West Sussex County council.
councillor Izzi Seccombe(Member Peer), Leader of Warwickshire County council & LGA Vice-Chair.
Leire Agirre, Head of Safeguarding Adults, Quality Improvement & Principal social worker, Central Bedfordshire council.
Dr. Clenton Farquharson, Chair of the Think Local Act Personal Partnership & Member of the National Co-Production Advisory Group.
Tom Hennessey, Director of Health Integration (ASC), Hertfordshire County council.
Corinne Moocarme, Assistant Director for Community Services, Care Homes & Continuing Care, Lewisham Adult Commissioning Integrated team.
Victoria Baran, Deputy Director, Oxfordshire County council.
Chris Rowland, LGA Peer challenge Manager.
The team was on site from 17th – 19th June 2024, following two days supported access earlier in June 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 11 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 19th June 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, focused on the CQC Themes as confirmed in November 2023; the challenge team grouped evidence with reference to these themes and associated quality statements, and this report is structured around them. They are:
Care Quality Commission adult social care Assurance Themes |
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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).
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” which can be provided through this format (whether of quality, outcomes, or good / poor practice, etc) 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 Jo Williams, Director of adult social care, who sponsored the challenge and Cathy Williams and her team for their invaluable and excellent support to the peer team, both prior to and whilst on site.
4. Leadership
Governance, management and sustainability: We have clear responsibilities, roles, systems of accountability and good governance to manage and deliver good quality, sustainable care, treatment and support. We act on the best information about risk, performance and outcomes, and we share this securely with others when appropriate.
Learning, improvement and innovation: We focus on continuous learning, innovation and improvement across our organisation and the local system. We encourage creative ways of delivering equality of experience, outcome and quality of life for people. We actively contribute to safe, effective practice and research.
strong>Quality statements from the CQC Interim Guidance for Local Authority Assessments, November 2023
Quality Statement Eight: Governance, Management, and Sustainability
The integrated care offered in Torbay over the last 20 years is unique in the country and should be celebrated. The s.75 has now been agreed for another 5 years and offers a further period of commitment and stability. This provides a formalised structure that secures the Integrated Care Organisation (ICO) and integration programme for the medium term (albeit with a break clause on an annual basis with 12 months’ notice), and the opportunity to consider how key areas of leadership and performance can be consolidated, and potential risks identified and mitigated.
The support of the new s.75 joint executive group will be important to oversee this, including around delivery of the adult social care transformation plan, and associated financial savings. However, further consideration of leadership for social care in the ICO at senior level (including the line of sight of the DASS, and executive and political leadership in the council and the ICO) will be essential for further assurance that adult social care outcomes are achieved, that statutory duties are met, and that this can be evidenced to CQC as part of any future assessment process. To be clear: the peer challenge did not find (or take a view) that there were significant failings in these areas (although there were areas for improvement as noted elsewhere in this report); but it took the view that it was difficult to demonstrate that there could be thorough assurance at the present time, to feel confident that the council would know if there were failings, or have sufficient leadership presence to identify and argue for prioritisation of improvements. To this end, the challenge team would strongly recommend that formal representation (most probably by the DASS) be considered on the Integrated Care Organisation (ICO) Executive.
The integrated arrangement is not without challenges for adult social care and these will need to be met head on to ensure its effective delivery for all partners, and for local people over future years. Those most clearly identified by the present challenge related to ongoing support for social care values and outcomes; prioritisation of key performance measures; and financial pressures and oversight. Whilst there is strong professional leadership for adult social care in the ICO, more visible leadership at a more strategic level (as described above) can help to promote key values and outcomes (and their importance for local people). These include strengths-based practice and promoting people’s independence and choice and control, as well as wider social outcomes and determinants of health and wellbeing; and to help to ensure that these can be evidenced in future assessment processes. Such leadership can also support the effective prioritisation of (and risk assessment in relation to) key areas of adult social care performance, such as direct payments, or admissions into long term care – an area of current poor performance which will also contribute to increasing costs. In particular (in the context of the present challenge), the future cost and wider implications of a less than Good CQC judgement, both for adult social care & and the wider partnership, risks having less emphasis day to day than key health partnership metrics such as NDtR or LLOS (which are monitored “live” and are seen as an immediate “must-do”), but it should not be underestimated.
In relation to financial risk, the scale of the partnership (and extent to which it is now seen as the only way forward) represents a significant challenge, in particular the ongoing ability to realise the funding from both strategic partners. adult social care is seen by some as at risk of being lost in the ICO, or put behind health priorities; whilst for others, the financial pressures associated with adult social care are seen as being carried or subsidised by health. The council’s financial commitment to the five-year programme has been notionally structured on use of the adult social care Precept for three years, based on increases of 3 per cent, 3 per cent and 2 per cent – increases which have not as yet been secured through Government commitment, with the risk for the council of needing to identify this resource from core funding if the precept were not to continue. In addition, there is concern from finance colleagues regards the cost of the partnership, and whether accruing social care costs may be less visible within it; and more widely, a present question for the ICS concerning the overall affordability of the wider system, across what is a fairly small health and care footprint.
To some extent being “eyes open” to the financial interdependencies, and able to model some of these in contrast to more traditional NHS/Local Authority systems and dynamics might be helpful here. There are strong relationships with the DASS and more widely across senior staff who hold some of this knowledge and oversight and manage such tensions as they arise; these aid integration and partnership working (although this in itself poses a risk if roles or personnel or processes change). And the redesign and formalising of the S75 Executive Group is seen as a means of putting a structure in place to support this. Everyone is clearly committed to the model for many reasons including outcomes for local people – integration is seen as being “in the genes” of both NHS and Local Authority locally, and there are regular discussions and an openness between NHS and Local Authority colleagues, and relationships and colocation are seen as an important aspect to delivering timely and appropriate responses for people. But there was also some recognition that there is not an easy alternative at this stage (“there is no Plan B”), so there is a necessity to make this model work. There may be a danger that in seeing integration as the only or inevitable way, there is lack of clarity around risks or possible negative impacts of this approach in particular areas of delivery; or the work that needs to be actively done to mitigate these.
The Transformation Programme will be essential to this journey, including financial impact and management of savings (or existing budget pressures) within this. It is an extensive programme of work which needs prioritisation, and consideration of where there may be shorter-term “wins” to prove its benefit may be important. Given the financial risks noted above, it is essential that the transformation programme can deliver, and the challenge team suggested that there is a need for improved line of sight for the ICO and council Leadership of the adult social care Continuous Improvement Board and Transformation Programme. There was some evidence that senior staff across the council and ICO and ICB have an awareness and understanding of the improvements and transformation projects, but it was not clear that there was full buy-in or understanding from all senior leaders of the impact, outcomes, and timescales of delivery for the programme – especially within senior leadership of the ICO and ICB. Nor was it clear that all senior managers (or other staff) understood it, or their role in it, or the importance of this programme to support the financial position. In the short-term the challenge suggested that delivery plans need to be clearer and to start delivering, perhaps focussing on some quick wins that can build confidence and momentum. In the medium term, it was noted with concern that the present transformation partner and budget for this work (including the local transformation team, who are all seconded) are uncertain beyond March 25; consideration of what happens at the end of the present contract should be an urgent priority, especially given that much of the work is longer-term than in-year projects.
More widely, there are some good plans in place (some of which have been coproduced) including an adult social care strategy, market plan, and the Big Plan. But there was a sense in the challenge that there were a lot of plans, some of which were at an early stage, and will require further sign up from partners. The challenge team did not see clear delivery plans to follow up, and wondered whether without greater clarity and communication these might risk getting lost between the council and the ICO. Some work to align or consolidate the different plans, take stock of progress and timescales, and to prioritise across them for further delivery might help the council and its partners to identify key shorter- and longer-term deliverables, and to be clear about who is responsible for or supporting them. An evaluation of the transformation programme might also support planning for next steps, including through clarity of impact and outcomes.
The end of the present transformation programme (contract, and in-house support) also overlaps with the likely timescale for re-procurement of the Paris care management system (work on which is at an early stage). Getting the best specification for this procurement, as well as careful project management of implementation (which will be a challenging and costly medium-term project) will both be essential, not least because of the complexity of the necessary interoperability with local NHS systems. There are lessons that can be learned from other councils who have recently gone through similar re-procurements (in the South-West, or more widely), and members of the peer challenge team suggested that amongst other things it will be important not to lose the good “person history” of the present system in whatever is commissioned for the future. In whatever case however, a detailed road map for procuring and introducing the new system is needed soon and will need to be communicated and visible to all key staff.
A final significant risk in the second half of the present year relates to the recruitment of a new DASS, following the retirement of the present post-holder (whose long and in-depth experience of the local integrated arrangements, and as DASS more widely of the local leadership and context, is invaluable). Whilst on-site the team heard about and witnessed the leadership of the present DASS; her significant local (and historical) knowledge of the system, and its people, complexities, dynamics, and processes; and the respect and trust with which this was held by adult social care staff and partners. Her departure and recruitment to the post will therefore represent a significant change for the local system and services, and its management and leadership, and care will be needed in how this is approached and communicated (and noting that during the on-site challenge, whilst some were aware of this change pending, not everyone was).
The leader of the council and portfolio holder for adult social care were both engaged with the peer challenge and show strong understanding and commitment to the area. Introduction of a monthly Marketplace Stall allows people to be heard directly by them and this has been welcomed; and the challenge heard about the value felt by people who use services in the engagement of the leader and portfolio holder with them. As an example of this, during the development of The Big Plan, coproduced by people with a learning disability, the leader spent a whole day with the sector experiencing the different groups and providers. The portfolio holder describes herself as a “champion for the sector”, bringing experience and a clear passion to help people, and has grown in knowledge and experience since taking on the role a year ago. Quartet Meetings with the leader, portfolio holder, chief executive, and DASS are held regularly, and the leader attends regional-wide partners meetings, and meets with portfolio holder at least weekly. The hope was expressed that "we know ourselves good or bad, and that we are on the right track".
It was unclear to the present challenge how political leadership is working across the wider health and care system (including oversight of the ICO) or how it engages with the Integrated Care Board (ICB). There is a new ICB chief executive in post, and this (along with local NHS leadership) may take time to bed in, but this might be an area for further work. Whilst the challenge did not hear about the Health and Wellbeing Board, this may be another forum which has a role to play in supporting political engagement with the wider health system. At a more operational level (given the role of the ICO in adult social care delivery) it was suggested by the team that regular meetings for the portfolio holder (briefed and supported by the DASS and her team) with the ICO non-executive director could support and promote the ongoing work of social care within the ICO.
Scrutiny has been seen as positive in some areas, with themed meetings pre-coordinated, and often starting with a site visit to share wider learning. The peer team heard that whilst it has been subject to some recent political challenges, relationships are now found to be improving again, and fortnightly meetings with cross-party leaders have been used to resolve some of the tensions.
Quality Statement Nine: Learning, Improvement, and Innovation
Torbay's Integrated Care Organisation (ICO) is its unique selling point. The model for social care delivery is seen as a pathfinder and national leader, and there is much learning that can and should be shared from this experience. The culture and leadership across the whole sector supports the integrated arrangements, and the peer challenge found committed staff across the system, who spoke enthusiastically about the integrated model of service delivery in Torbay, and how this can deliver good outcomes for local people. Staff who met with the team were all positive and passionate about the integrated way of working – and the challenge team heard stories of people who had moved from other councils to work in Torbay.
Staff were in general completely committed to the partnership and the system, which is a huge strength, but as noted above, might at times risk eliding the question of whether there is anything risked (or lost) in this approach, or whether there is good practice that could be taken into the integrated model from non-integrated delivery elsewhere. Knowing “what good looks like” and how to measure this is as an important starting point to answer the question “why do we do this in this way here?” (rather than just “because we always have done”!). Being able to describe the rationale to key models, strengths, or risks, and in supporting staff to be able to do the same, is an important back-up to the self-assessment and introductory meeting with CQC (which starts the on-site assessment phase, as it does in the peer challenge). Supporting staff to engage with regional and national networks and groups where they can compare and contrast different aspects of what is possible in Torbay’s unique delivery, with what and how things are done elsewhere, could be helpful to avoid tunnel vision in any one part of the service (whilst accepting that the integrated model needs to be the vehicle for delivery of the whole). This might include for instance benchmarking against comparator authorities’ outcomes for key delivery areas; or learning from others in relation to best practice in delivery of wider social care outcomes; or involvement for middle and senior managers in SW ADASS regional networks or events, or as peers in LGA peer challenge teams elsewhere in the country.
There was a strong culture of “grow your own” in the local workforce, with good evidence from staff about opportunities for development and promotion, and low sickness, vacancies, and turnover rates. Staff who met with the team were very positive about the support they received from their colleagues and described good support from visible professional leadership and line management, including through supervision and appraisal, and more informally. Learning processes are in place to support improvements in practice, and more widely to assure it: this includes through SAR’s, Oliver McGowan Training, working with people who draw on care and support, and working with the voluntary sector. Training was described as good, and there was positive engagement with social work practice weeks, where a focus on sharing good practice has engaged staff and senior managers.
Further work is needed to improve staff’s awareness of priorities, plans and strategies, and how these will support future assurance and assessment processes, as well as adult social care delivery. Staff awareness of the major plans and strategies was variable, and a significant proportion of the staff who spoke to the peer challenge did not seem to know about (or at least be able to talk confidently about) these or have an understanding of their part within them, including for instance the self-assessment, or Big Plan. It also includes the strategic workforce plan (which builds on a "Grow your Own" workforce developed with the South Devon College who will be part of the delivery) Transformation is such an important part of the next five years, and whilst it has been “heard” by staff, there is not a plan that has been widely shared as yet and staff were not clear about the timetable or how it affects them. The peer challenge team wondered whether visibility of council plans across the ICO might be an issue, or at least could be perceived to be (on a future CQC assessment visit) on the basis of how staff presented to the team; it was certainly suggested that communication of new plans and strategies is not always strong and uncertainty remains in the staff about these.
Preparing for CQC Assessment
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. Some team members felt that the self-assessment could more clearly signpost to good practice evidence (something which will be important for an incoming CQC assessment team); and in particular that the initial presentation could better help an incoming team understand how strengths and areas for improvement connect with the local service model (and how this may be different from elsewhere); these are perhaps areas for review.
It was noted that the compilation of some of these materials (including data and other evidence) needed to be developed through the ICO teams and infrastructure, and that this presented some time-challenge. This would suggest the additional importance in Torbay of undertaking the preparatory work for the CQC Information Return in advance of a CQC notification, since the turn-around time for the Information Return is presently the tightest part of the process (at just three weeks). All the materials were made available by email, 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.)
The case file audit reviewed 12 case files, which had been selected by the Local Authority, but randomly so, and without prior audit (something which would not generally be the case for future CQC assessment, and which suggests a positive desire to learn and reflect from the present peer challenge process). The Case Files were drawn from across a variety of teams, and so represented the assessment of needs, and care and support provided, for a diverse range of people, including older people, those with a mental health diagnosis, people with a learning disability, people with complex needs, people admitted to hospital, a safeguarding enquiry, and a transition. The audit offers a limited “snapshot” of practice and processes, and some indicative findings; it is important to see these as the basis for further follow-up and assurance, and ideally more regular and thorough-going audit as part of ongoing practice development.
Consideration had obviously been given as to how to provide evidence of outcomes for people who use or have contact with council services, and 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 across the ICO who have roles touching on adult social care (given the unique delivery arrangements in Torbay) 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.
Ongoing consideration could be given how to involve people with lived experience in the preparation for and delivery of future assessment. This is work in progress for all councils at the present time, but early consideration of how to routinely engage a strong (and hopefully positive) 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 was arranged specifically to accommodate the team (and is not routinely used by adult social care ). This offered some positive aspects such as good accessibility, co-located meetings rooms, and waiting space for interview participants. However, it did mean that the team (and those supporting the team) were at a distance from the adult social care offices, with some logistical challenges for local staff associated with this.
The challenge team was aware that written 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. Staff received debriefing sessions with the Deputy Director of adult social care following meetings, something which is sometimes included as part of a feedback loop in eg OFSTED Inspection and which can help the council to respond to issues as they arise during the on-site phase of an assessment. During the challenge managers were present in most meetings, but this does not appear to be the case in recent CQC on-site assessments; so this may be something to consider in advance of a future CQC assessment visit.
There was generally positive feedback about the process and the on-site team, and the positivity and engagement with which the challenge was received was 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 plans are in place to further disseminate the findings, and the resulting action plan.
The council would benefit from quantifying the resources deployed in terms of staff time, and at all levels, both in preparation for the challenge (eg 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 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 Steve Peddie, 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:
Alongside the role of the new s.75 Joint Executive Group, senior adult social care representation (most probably by the DASS) should be considered on the Integrated Care Organisation (ICO) Executive. This can support greater visibility for adult social care leadership (including line of sight for DASS statutory duties, performance, and delivery of the adult social care transformation plan, and associated financial savings).
Urgent consideration should be given to capacity to support and deliver the transformation programme following the end of the present contract with the delivery partner, and the standing down of the local transformation team in March 2025.
In the meantime a piece of work should be undertaken to prioritise and communicate widely (to staff, managers, and partners) the deliverables and rationale of key parts of the transformation programme, and the risks of non-delivery. As part of this work, it might help to identify and prioritise some “quick wins” to build momentum and prove the benefits of the work in the shorter term.
To undertake a piece of data-led analysis of discharge pathways 0-3 for the local system, including modelling (against best practice), and shadow costings associated with the present outcomes for local people, and how these might contrast with best practice elsewhere.
To replicate work undertaken on the Big Plan for other client groups across the authority, and to use this as a means to develop good practice and improved culture around coproduction, including in the ICO partnership teams.
Work with frontline staff and partners to better communicate key aspects of adult social care transformation, and improvement priorities and plans, would support greater ownership of their role within these, and to be more confident in describing these in future CQC assessment. This should include the self-assessment, with focus on strengths and areas of improvement and the direction of travel for their own teams and services.
The peer challenge did not reflect back any areas of immediate operational 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, and locally or elsewhere) 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 Torbay, or more widely about the programme of adult social care Preparation for Assurance Peer challenge, please contact:
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