Southend City Council: Adult social care preparation for assurance peer challenge report

Southend City Council requested that the Local Government Association undertake an Adult Social Care Preparation for Assurance Peer Challenge at the council and with partners. The work was originally commissioned by Terry Dafter as interim executive director, adults and communities, although the scope was later agreed with Mark Harvey as the new executive director, adults and communities at Southend City Council. The purpose of the peer challenge was to seek an external view on the readiness of the Adult Social Care Service for the arrival of the Care Quality Commission’s Assurance inspections, with specific focus on what is already in place, visible and understood by staff, partners, and stakeholders, after a time of change and with new developments still embedding.

• A peer challenge is designed to help an authority and its partners assess current achievements, areas for development and capacity to change. The peer challenge is not an inspection. Instead, it offers a supportive approach, undertaken by friends – albeit ‘critical friends’ with no surprises. All information was collected on a non-attributable basis. To promote an open and honest dialogue, feedback from the team of peers is given in good faith. 
• Prior to the onsite peer challenge work Southend’s Adult Social Care team completed a self-assessment about the work of the service. A report summarising the self-assessment was shared with the peer challenge team and formed the basis of their enquiries. At the conclusion of the peer challenge visit the peer challenge team provided their feedback based on triangulating what they had been able to read and had heard and seen from the staff team and their partners and from people who use the services provided and their carers.

The members of the peer challenge team were: 

• Laura Gaudion, Director of Adult Social Care and Housing Needs Isle of Wight Council
• Dale Birch, Previously Deputy Leader and portfolio holder for Adult Social Care, Health and Housing at Bracknell Forest Council. 
• Sue Wilson, East Midlands ADASS Regional Improvement Lead
• Valentine Nweze, Head of Service Adult Mental Health, previously PSW, London Borough of Croydon, 
• Hannah Soetendal, Head of Commissioning, Milton Keynes City Council,
• Sarah Nickson, Head of Mental Health and Complex Needs, Milton Keynes City Council
• Craig Derry, ADASS Associate
• Kathy Clark, Challenge Manager, Local Government Association

Two members of the team visited on the 8 and 9 June 2023 to undertake case file audits and to meet stakeholder groups.  The whole team were onsite between 14 and16 June 2023. The programme included activities designed to enable members of the team to meet and talk to a range of internal and external stakeholders. These activities included: 

• interviews and discussions with councillors, officers, and partners.
• meetings with managers, practitioners, frontline staff, people with a lived experience and carers. 
• reading documents provided by the council, including the self-assessment report and a range of other material.
• consideration of the information and data provided and completion of a case file audit.

The framework the peer team used was that of the Care Quality Commission’s proposed four Domains of Assurance for the up-coming adult social care inspection regime. They are:  

Theme 1 – Working with people:

• Assessing needs
• Planning and reviewing care.
• Arrangements for direct payments and charging.
• Supporting people to live healthier lives.
• Prevention
• Wellbeing
• Information and advice
• Understanding and removing inequalities in care and support
• People’s experiences and outcomes from care

Theme 2 – Providing support:

• Market shaping
• Commissioning
• Workforce capacity and capability
• Integration
• Partnership working.

Theme 3 – How the Local Authority ensures safety within the system:

• Section 42 safeguarding enquiries
• Reviews
• Safe systems
• Continuity of care.

Theme 4 – Leadership:

• Strategic planning
• Learning
• Improvement
• Innovation
• Governance
• Management
• Sustainability.

The peer challenge team would like to thank councillors, staff, people with a lived experience, carers, partners, and providers for their open and constructive responses during the challenge process. All information was collected on a non-attributable basis. The peer team was made very welcome and would like to thank Mark Harvey, executive director for adults and communities, Sarah Range, Head of Quality Practice and Principal Social Worker, Julie Thompson, regulated workforce practice manager, Aimee Dowler, social care workforce officer, and Nicola Mickleburgh, for their invaluable assistance and for their support to the peer team, both prior to arrival and whilst onsite. 

Prior to being on-site team members met nine people with a lived experience and 11 carers. Twelve case files were reviewed, from across the areas of Adult Social Care. The peer team read relevant documentation including a self-assessment. Throughout the peer challenge the team had more than 25 meetings with over 150 different people from Adult Social Care and its partners. The peer challenge team have spent over 200 hours with Southend City Council and its documentation, the equivalent of 28 working days. 

Our feedback presented to the council on the last day of the challenge gave an overview of the key messages. This report builds on the initial findings and gives a more detailed account of the peer challenge. 

Based on the evidence gathered through the Peer Challenge process the peer team identified a number of key findings. We have been guided by the strengths and areas for improvement and direction of travel identified by you in your self-assessment report. We have set out what the evidence we have seen suggests for each of these areas, at the end of our key findings for each theme. For ease the key findings have been outlined in this report linked to the CQC domain against which they most closely align. Where our findings impact on multiple domains they have been duplicated and where our findings fall outside of the CQC domains they have been included for your consideration as they relate to matters which may assist in your preparation.

In summary we found:

• You have a positive and passionate staff group who want to do the right thing for the people of Southend.
• Your new leadership and executive team have already made an impact and are giving confidence to staff and partners on the potential for improvement in Southend.
• Your community and voluntary sectors are very strong.
• There are, as everywhere, challenges around workforce and market stability but you have some good initiatives already under way to address the challenges.
• Your providers and partners are ready for a reset of the way you work together in partnership with them and see positive signs for this.
• You know the areas where you need to develop, including, and crucially, the availability and use of data, but have corporate support to address the transformation needed.
• You have a number of new strategies and plans, which would benefit from clear delivery plans, with targets, timescales and the resources available identified.
• There is more work to do to understand the feedback from people with lived experience, including carers, and to develop your co-production approach to ensure you are focussed on the outcomes people want.
• At times we thought your staff could be better prepared about what they wanted to get across, particularly about their impact and the outcomes for people.
• You may want to review your evidence library to ensure it includes all the documents that CQC will be looking for. We know that this list is changing, through the pilots, but we were not able to see all the evidence suggested in the LGA Guidance manual, and some of the information we asked for as not easily to hand for you.

This relates to assessing needs (including that of unpaid carers), supporting people to live healthier lives, prevention, well-being, and information and advice.

Strengths

You have a passionate, positive, and dedicated staff team, with a new strong and safe leadership now in place. There was clear evidence of the department and staff commitment to putting the people of Southend first.

You have some great work being undertaken in culture, arts and leisure around inclusion, which could support the development of your Adult Social Care EDI approach. 

Staff were universally positive about their work and viewed new developments, including changes to case recording as helpful, giving them more time to spend with people. They consider they are working with a strength-based and positive risk-taking approach. Demand is high, complexity is growing, and capacity stretched, but your staff team reported good support from managers, and good team working.  

We felt that sometimes where there are positive stories about the range of support and impact for local people you could be bolder in sharing these. In more than one session we asked what the people in Southend might say about the support and experience they have – the responses were vague. We found that if we probed a little, for example asked something specific like “what might you offer me if I was a carer moving to Southend?” the answers to the specific questions were much more forthcoming and very detailed showing real understanding of needs and the support that could be provided. Helping staff to think about and be ready to showcase what you can do to CQC could be useful.  

For consideration

Communication and engagement could be better developed and stronger. We think that when people get to the right person, the service they get is positive, but accessing the right person, or finding a consistent person to deal with can be problematic for local people and partners. Whilst your staff group was very positive, we were not confident that they have a level of awareness of the areas for improvement, particularly around customer experience. 

Whilst undertaking the Peer Challenge people with a lived experience, carers and staff talked to us about waiting times. We saw your triaging guidance for unallocated cases, which was helpful. Staff told us that urgent cases do get a better response now. We were told the DASS and PSW review the unallocated case lists on a weekly basis but did not see any data or numbers. Given that we understand CQC will want to look at data, numbers, waiting times and complexity we would suggest reviewing how you can present the information and approach you use, to ensure it is robust, supported by easily accessible evidence, with a clear explanation of how risk is managed.  

We heard from people with lived experience, from carers and from providers that it is often not easy to contact you. Examples included: having to wait for extended periods for phone calls to be answered; finding online access difficult; speaking to a different person each time and having to repeat the story; complaints not being addressed in a timely manner; not getting feedback on safeguarding issues and having to chase for responses. In one session we were told that “we now put read receipts on emails”. We did not hear any of your staff talking about these issues when we asked about any gaps or areas for improvement and so based on our evidence, we were concerned they were not as alert to this issue as they could be. This will impact on customer experience. We did hear other reports where services were described as supportive and helpful, so we think that once support is in place the experience could be more positive. 

The strengths you identified in your self-assessment and our comments:

Assessing needs – strong and innovative information, advice and prevention offer with P&V providers through SAVS

We found strong evidence of strengths-based community activity through the culture and arts programmes and the Third Sector. We saw evidence of the strong leadership from SAVS and the inclusive approach that Arts Culture and Leisure have developed. Public Health spoke of the positive relationships they have with the voluntary sector and with Adult Care. 

There are some areas where we heard there may be gaps in support, including community and financial advocacy.  People with lived experience were clearly worried about the cost of living, and were looking for more support with this, which you have identified and are looking to address through your poverty strategy. Monitoring the impact of the strategy, and ensuring you have feedback from your citizens will help you demonstrate outcomes for CQC. 

We thought there was potentially a disconnect between some of the information and prevention offer with what is going on in SW practice. This is because we did not have sight of the pathway connection between the community offer, SW practice and ‘front door’. Your self-assessment talks of your own Access Team and a separate CAB Information Advice and Guidance, which works with social prescribers and the VCSE. We think if this is used as a strength around assessing need it would be helpful to be more explicit about how the pathway works across the sectors and with partners to avoid gaps and duplication. 

Assessing Needs - Quality of our relational practice with people 

Your staff and your caseload audit would support this as an area of strength, but the feedback we heard from people with lived experience and carers did not reflect the same views. Staff came across as confident and competent about what they are doing and most seemed to feel they are allowed the time needed to work with people, to address complex issues. They reported good support from managers and good team working. They all want to do the right thing and were strong proponents for strength - based working and positive risk taking. 

Feedback from people with lived experience and carers was noticeably different to the staff views. We know we only met with a small number of people, but they reported experiencing the impact of a shortage of staff, waiting lists, people not reading notes and having to tell their story time and again, not feeling heard and wanting more face-to-face contact instead of phone and online. The carers we met appeared not to be aware of their rights to an assessment or a direct payment. This may be linked to what we later heard that direct payments may be seen as a ‘last resort’ and offered if there are no other options. Positive relationships for both groups seemed to be with specific support providers. We did hear one report of feeling supported to live the life the person wanted.  

The case file audits, both the external ones in your evidence file and the ones we undertook indicated good practice in most cases. We found some cases where a strength-based approach was not strongly evidenced and some, where capacity assessments were not clearly recorded, but most recorded the outcomes people wanted. We were pleased to see the new Practice Assurance framework has started to look at practice, but understand this is mainly through case audits, and so wondered if it could be strengthened to look at for example, supervision practice and customer feedback.

We thought staff were not clear about why the 3-conversation model has been pulled. Some say they are still using the approach but talked about new paperwork. We did not hear much about the impact on practice of the change, other than freeing up more time because of the changes to paperwork. If you are showcasing your practice as a strength, it would be helpful to have a clearer story around the changes, why you have dropped 3 Conversations, what approach you have replaced it with and most importantly why you think this will improve the outcomes and experience for people.

Supporting people to live healthier lives – collaboratively developed and joint working model of support for those leaving Hospital through SEDS.

SEDs was seen as very positive and a good example of joined up working. It was good to see the community focus of the team and to hear of the reduction in delays. We heard that other LAs are looking at replicating it, which is a strong recommendation. 

Your ASCOF performance for the proportion of older people still at home after 91 days seems to have reduced slightly from 82 per cent in 2021- 22 to 79.2 per cent in 2022-3, so you may need to watch this, and if it continues, be able to explain any reduction.  

We heard that demand and capacity is a growing issue, and if this is to be seen as a strength you may wish to think how you describe this as well as the plans for future funding, because we heard some concerns that future funding has not yet been identified, which could impact on the stability of the service. 

Areas for improvement you identified in your self-assessment: 

Assessing needs – we continue to develop our statutory assessment process and professional standards as well as people being able to self- direct their assessment and support.

We felt a plan with actions and targets could help develop your evidence around direction of travel.  

We were not confident that we had seen specific plans and targets to support local people with self-directed support.  We did hear that staff appreciate recent changes made to documentation and your self- assessment talks about embedding Making it Real and Making Safeguarding personal within the new forms, and reference in your section on digital transformation to a commitment for self- serve options.  

We were told your staff believe financial assessment processes work well but carers reported being overcharged, being wrongly told they were in debt, and spoke of delays to resolve issues.  

Although your ASCOF data indicates good outcomes for carers, the data suggests you have been relying heavily on joint assessments for carers and the person they care for. We thought your proposal to work with Carers First to enable them to undertake assessments for you should improve people's experiences. We noted you have a low number of carers’ direct payments, and we heard of a perception that direct payments are only offered if there is no commissioned service that can meet needs, which needs to be understood and addressed. 

Supporting people to live healthier lives - consolidate and improve info advice and prevention and enablement service.

Intentions to improve information and access to information were shared with us Your self - assessment refers to a review to identify gaps in the prevention offer, and a corporate review of your IAG offer on the council website.  We heard that prevention and reablement is one of your commissioning priorities, but it would be helpful to be able to show a clear and resourced plan.

Equity in experiences and outcomes - to develop and implement a clear approach to co-production and citizen voice in our operational and strategic delivery.

Staff we met with were positive about the co-production work they are engaged in and about your plans. We read and heard about some examples where you have engaged and begun to co-produce on key strategies. Staff recognise there is more to do to build the infrastructure and culture around this, including funding to compensate citizens for participating, training for staff and a longer-term investment in the post leading the work. It would also help if you were able to demonstrate the impact of co-producing these strategies. We heard that the voluntary sector is seen as having the ability and willingness to help with this, and we heard there may be opportunities to work with Health Partners’ Citizen Panel, which we thought may not have been picked up so far.

This relates to markets (including commissioning), workforce equality, integration, and partnership working.

Strengths

You told us that you were proud of your community and voluntary sector and the work they do to prevent, reduce, or delay the need for care. We agree, you should be proud.  We found a strong and vibrant sector, enabled by your innovative funding through the Investment Board, to identify needs at a local level and to respond quickly to that need. They are confident and we heard of good working relationships with both Public Health and Adult Social Care.  We think they understandably get the credit for their valued services, but we felt you could make more of the work you do in partnership with them, including the way you enable them to be responsive, the funding you provide and the way you have changed your contracts to offer more sustainability.

We heard, and you know, that care and support service quality and the diversity of services needs to improve, but we saw evidence that providers value the support you can and are offering. Relationships with providers have room to improve, but there is good potential and a keenness from providers and your own staff to work collaboratively. 

We felt that sometimes where there are positive stories about the range of support and impact for local people you could be bolder in sharing these. In more than one session we asked what the people in Southend might say about the support and experience they have – the responses were vague. We found that if we probed a little, for example asked something specific like “what might you offer me if I was a carer moving to Southend?” the answers to the specific questions were much more forthcoming and very detailed show in real understanding of needs and the support that could be provided. Helping staff to think about and be ready to showcase what you can do to CQC could be useful. 

CQC ratings show that the quality of some care services in Southend has been improving, and we heard from providers that they have valued the work of the Quality Improvement Team helping to turn round failing providers. Some of the services you commission were highlighted by people with lived experience and carers as being very supportive.  

The feedback on the integrated development and joint working in SEDS was strong, with some clear indications of its impact in reducing delays for hospital discharge and offering better outcomes for returning home after a hospital stay. We did not hear of a plan to support development of more integrated working, although we were told that on the ground people talk to each other and there is some sharing of facilities between health and social care, and the links between GP practices and social workers was welcome. 

For Consideration

Formal integration was observed to be patchy – SEDS is impressive, but we did not see other intentions progressing as well. We are aware that your Health system locally is in the top five 'financially challenged', and this will no doubt impact on efforts to develop integration. We would suggest you consider how you how you can frame your narrative and manage developing the relationships/services against this backdrop. 

Your workforce strategy is seen as a positive development, but we suggest you may need to manage expectations about how or whether this will deliver immediate solutions.

Whilst with you we heard from your stakeholder groups about some very poor experiences with care providers and the lack of some more specialist services, for example: care and support for people with visual impairment; palliative care; and early onset dementia. We were told that this lack of more specialist services is influencing the quality-of-care people that local people are able to access.  

Providers say they want to work with you, and we heard more than one person suggest the time is right for a reset.  In the past providers expressed that they feel they have not been heard, and there has been no easy way to offer feedback. They like the new newsletters and the workforce forum, but some still feel you are talking to them, rather than working with them. The engagement over the new Shared Living framework was promising but the outcome and fee structure resulted in providers telling us that they did not feel as though they had been listened to, as the fee structure is not seen by them as likely to deliver the benefits sought because of funding constraints. The local providers told us that they would like more bespoke information about what your market position statement and commissioning plans will mean for their businesses, and they want better ways to offer you feedback - positive as well as negative. 

We were not sighted on your commissioning plans beyond the discussions which took place. We heard that you have plans to reshape your market and would recommend that your commissioning plans are reviewed to ensure that in this regard they are clear, have identified milestones and that there is a structure in place to support delivery and accountability. Your local providers told us that they feel that your MPS is not offering them the detail needed to support their business development. We were also not shown the commissioning plans following your three new strategies. We believe that these strategies may provide comfort in terms of describing your future plans and vision for the care market locally. A key example is in the area of PAs and DP options where peers heard very little other than recognition that it needed to change. We think you would benefit if you could demonstrate impacts and outcomes you are working on with housing partners. We also heard no mention about how you will approach the challenge that self-funders and out of area placements bring to your market. Both are areas that are likely to be of interest to CQC. 

External partners would like to see a more extensive training and development programme on offer, but we were encouraged that the council is working with health partners to develop a shared training offer. We heard of good examples and case studies around workforce being shared by Southend Care. Again, we heard that there is a wish and an opportunity for more co-design and partnership working with providers going forward. 

The council’s decision to end the Section 75 agreement for integrated mental health services, taken earlier this year has caused some consternation. Health partners told us that they feel the decision was taken without discussion with them. 

We heard that in partnership working, with health and with providers, although there are some good examples of frontline partnership working, Southend has historically been seen as inward looking. We heard that this is beginning to change, and that Southend City Council’s engagement in the new Chief Executives Forum and executive contributions to the Alliance helping to find joint solutions to issues is seen positively. 

The strengths you identified in your self-assessment and our comments

Care provision, integration and continuity - investment in providers, stimulation of the market to increase choice and quality.

Providers appreciated the increase in fee rates, but they remain concerned that whilst it has helped to some extent, it doesn’t go far enough to ensure sustainability. We didn’t hear that the fee increases had resulted in greater choice or better quality.

The work of the Quality Improvement Team and the emerging work on workforce has been seen as very positive by the market and appears to have helped improve quality ratings. We heard that you have good arrangements which bring operational teams, health colleagues, and quality / contracts together to resolve issues before escalation to more formal ISG processes. 

It might be useful to have some ‘story boards’ prepared and agreed with willing providers, which can showcase the impact of the work of your teams and their support to providers.

Care provision, integration and continuity – a clear understanding of the challenges facing the local care market and planning to address these challenges.

Providers were clear they still face huge challenges but did feel the council understands some of the pressures, even though they recognise it does not have the money to address them. Providers felt there is still some work to do to improve responsiveness from the council.

Your self- assessment and your MPS and MSP show your understanding of the market. We heard that some providers are not aware of or did not find the MPS easy to follow or specific enough to support the future development of their businesses. 

Supported Living Providers welcomed the engagement over the development of Supported Living tender, but felt commissioners failed to understand the challenges the financial model brings, which they believe will push providers to a shared housing model to make schemes viable. Providers said that the definition of 'enhanced' rate covers a level of complexity that you would not usually find in the group that SCC commissions Supported Living for. There is also a risk that your model offers no incentives for providers to achieve progression, as reducing support hours just means reduced profits with the standard rates.

Partnerships and communities - provision of a range of community initiatives alongside the VSCE.

We have already commented on and agree about the strength of the voluntary sector.

Contracting for sustainability with the VCSE sounded good – we heard of five plus five contracts, but we were told funding can occasionally be last minute and there was a perception that commissioner links could be strengthened.  You may not be benefitting from the wealth of information that the sector holds, for example we heard of some groups who could help you with EDI, Social Value and outcome information.

Your self- assessment includes some good examples of the work you and partner agencies are doing, around street prostitution, food poverty and the Community Builders initiative. We heard positive views about the Street Prostitution project, and we saw one of the food poverty offers in action outside your offices, with people using it telling us how valuable a support it is.

Areas for improvement and direction of travel you identified in your self-assessment

Care provision, integration and continuity – to look at providing additional methods for provider engagement to inform key commissioning decisions.

As we have said above, providers seemed keen to develop new ways to work with you and for more mature conversations. 

We wondered if you may find there are opportunities for more co-production or shared chairing the engagement arrangements with your providers. We heard providers say they would like more ways to share feedback, which we think will include some positive messages, they want to be heard and to co-produce with you. 

Care provision, integration and continuity – develop commissioned services that are evidenced from our engagement with people and community groups including those that are culturally appropriate.

During our visit we didn’t hear specifically about your plans to develop inclusive and culturally appropriate services. 

Your awareness of the need to shift your market offer to one that is less traditional will inevitably result in a large commissioning agenda, which will be demanding, particularly as we understand there is currently no additional funding and so services will need to be transformed within current budgets.

We heard that you recognise the need to have robust plans in place to ensure the best use of your resources and we agree with this as we heard that previous transformation and savings plans have not been delivered. Your approach to the discovery phase of this programme of work was encouraging as you ensure you understand the current offer and the opportunities. 

We heard from health colleagues that they would be interested in exploring opportunities for more joint commissioning. 

Care provision, integration and continuity – development of the workforce strategy for the wider care market. 

We found enthusiasm and determination in your staff team, to do the right thing for your external workforce and evidence of initiatives to address the challenges together. The investment in a dedicated post, the newsletter and the email bulletin have been very well received by the sector and we think are therefore already evidencing impact. 

Your team recognise that the councils learning and development offer for the independent sector is limited, which is what we also heard from providers. Plans to work with health partners to establish shared training and support together with sharing of good practice should provide a good start to improving the offer; Southend Cares sharing good examples has been received positively.

Providers confirmed that they are looking for more opportunities to help drive the workforce agenda with you.

This area relates to safeguarding, safe systems, and continuity of care.

Strengths

External partners would like to see a more extensive training and development programme on offer, but we were encouraged that the council is working with health partners to develop a shared training offer. We heard of good examples and case studies around workforce being shared by Southend Care. Again, we heard that there is a wish and an opportunity for more co-design and partnership working with providers going forward.

You have the opportunity to understand the needs of young people as they transition, because so many of them are supported in the city. This has not yet translated into robust information, but your new draft protocol should help with this.

For consideration

Communication and engagement could be better developed and stronger. We think that when people get to the right person the service they get can be positive, but accessing the right person, or finding a consistent person to deal with can be problematic for local people and partners. Whilst your staff group was very positive, we were not confident that they have a level of awareness of the areas for improvement, particularly around customer experience.

Whilst undertaking the Peer Challenge people with a lived experience, carers and staff talked to us about waiting times. We saw your triaging guidance for unallocated cases which was helpful. Staff told us that urgent cases do get a better response now. We were told the DASS and PSW review the unallocated case lists on a weekly basis but did not see any data or numbers. Given that we understand CQC will want to look at data, numbers, waiting time and complexity we would suggest reviewing how you can present the information and approach you use, to ensure it is robust, supported by easily accessible evidence, with a clear explanation of how risk is managed. 

We heard that in partnership working, with health and with providers, Southend has historically been seen as inward looking. We heard that this is beginning to change, and that Southend City Council’s engagement in the new chief executives forum and executive contributions to the alliance helping to find joint solutions to issues is seen positively. However, we were of the view that there will be times when keeping the focus on Southend may be what is needed, for example with the Safeguarding Board, where your capacity is being stretched and the broad partnership and agenda appear to not be able to offer you the assurance you need on the effective discharge of your statutory duties.

The strengths you identified in your self-assessment and our comments:

Safeguarding – effective safeguarding pathways developed by practitioners and partners that has been subject to themed audits.

We didn’t have a lot of opportunity to explore your safeguarding pathways and the safeguarding session focused on the board and partners. Our observations of practice and from the case file audits revealed no significant concerns. We note that you commissioned an external audit, and this shows an openness and transparency to seek assurance. The feedback we have received raises concern in terms of the responsiveness of your safeguarding offer and highlighted recent staff turnover resulting in duplication. 

Safe system, pathways, and transitions – our Able 2 OT service, enabling people to live independently and achieves the goals they want to achieve. Taking a risk positive approach with professional intervention.

The risk positive approach of your OT’s was highlighted by the staff group. We are clear on your strategy commitment to support people to live independently but we have been unable to triangulate this through the sessions that we have participated in. There appears to be a really positive approach to risk through the development of the SED’s service. ASCOF data suggests that you are actively reducing your reliance of traditional bedded care models. We heard that there are waiting lists for assessments and for DFGs, but there is now a better response to urgent needs. It would be helpful to have some data on this, and on the reduction in care that has been delivered by the Able 2 service, with any information about longer term outcomes for people who have received this support, together with some case stories and feedback from people.

Safeguarding- our development of a poverty strategy and street prostitution strategy with action plans are now operating across both.

You have clearly identified the need for the development of your Poverty Strategy and the Street Prostitution Strategy based on the needs of Southend. We have seen evidence of strong multi-agency working and of the voluntary sector delivering fast responses in relation to poverty both during and after covid utilising council funding. It could assist your evidence if you include information about impact and outcomes in improving safety here, and to include some case stories and feedback from your citizens who have benefited from new approaches. 

Areas for improvement you identified in your self-assessment: 

Safe systems, pathways and transitions - development of a new and forward-looking transitions protocol.

Whilst the new protocol is available in draft, we are unclear as to when it will be finalised and implemented. Plans are in place to ensure that you are aware of the people needing to be supported through transition through monthly monitoring. You recognised that families’ feedback might be inconsistent and that this is an area where more work would be helpful. Although there is clarity in strategy, we saw no evidence that this is reducing cost or ensuring that the highest level of independent living is achieved for ASC as young people transition. There are still some traditional models in operation that may need more refection to ensure that they best meet the needs of local people, including the education offer.  

Safeguarding – improve our CPD offer, launch our safeguarding competency framework and training, and monitor staff compliance levels.

We have not looked at this area in any detail. There is evidenced work underway to improve your workforce learning and development offer. It may help to keep focussed on how this will improve outcomes and tie your work back to the CQC I and We statements.

Safeguarding- to continue the work with care providers in the co-production of a care provider investigation template for use within safeguarding investigations.

We have not looked at this area in any details. We did hear that there are clear pathways in place to review and assess quality and provider performance. The feedback we did receive from providers in relation to safeguarding focused on the need for greater levels of responsiveness and we question whether this will be addressed through a new template.  

This relates to capable and compassionate leaders, learning, improvement, and innovation.

Strengths

After a period of what seems to have been more limited activity for the council and department, we could see there are now lots of changes, with lots of plans at very early stages. Those plans were consistently based on a clear shared corporate vision. We heard how the arrival of a permanent new director, the new chief executive, and other changes at senior level have given more confidence amongst partners in the prospects for partnership working, and staff were positive about the new direction being followed.

The development of your workforce strategy is seen positively by internal staff and external providers. You know that the lack of data is limiting you at present, but there are some valued and welcome initiatives which are already underway. Internally we heard about your staff wellbeing offer, the opportunities for hybrid working, career progression and succession planning. We felt there is a risk that adults services may get left behind compared to children’s services, where there appears to be more investment opportunities.

Digital transformation is helpfully seen corporately as being necessary. You told us that you know you have some data gaps.  We heard reference to ‘manual systems’ across multiple groups and we found that information was not readily to hand in sessions when we asked about performance. In addition, on occasion, staff and managers were not able to articulate headline information or show how they use data and intelligence to shape delivery. We suggest that in order to create an environment for the successful implementation of new ways of handling data consideration is also given to creating a robust learning and development offer for staff and to ensure data literacy. We endorse your view that there are better ways of doing things that provide better use of staff time, deliver efficiencies, and improve outcomes. We see that the corporate digital transformation programme will bring benefits to enable you to: use real time and accurate data; improve systems; deliver efficiencies; make better use your resources.

Within the council and with partners we were told that councillors were seen as having a strong influence over policy, funding decisions and decision making. Reference was made to politicians ‘taking the heat’, including an acceptance about budget overspends within the directorate. 

For consideration

You have some ambitious new strategies, with a clear vision. These do not yet have resources or delivery plans behind them, but we recognised the value of the discovery phase you have been following. We heard that at present the strategies will need to be delivered within existing budgets and have some concerns that you may find it difficult to meet all of you ambitions. ASC will need to be very robust in planning and prioritising, the delivery plans will need to be clear on how you will reshape the Care Market as there is clearly significant work to be undertaken here.

Some Southend councillors were said to be very proactive and engaged but we heard that this can sometimes feel overwhelming for partners. We noted that councillors are not represented on the ICS Alliance Board.

You could benefit from distinguishing where a more outward approach would help to further the objectives of the people of Southend, for example in joint working with health partners to deliver better pathways and services for local people, and where a more place-based focus is essential in discharging statutory duties that are specific to Southend – for example with your Safeguarding Adults Board.

You recognise there is work to do to improve your approach to EDI, both corporately and within Adult Social Care. Your workforce data is limited as you know, but we heard that staff from BAME communities are more likely to work in frontline positions than in managerial or leadership ones. We did not hear of any work to develop inclusive or culturally sensitive services, but we think your Arts and Culture services have some great examples you could learn from and build upon, including work on digital inclusion, accessible events and spaces, mental health first aid and dementia friendly approaches, and outreach to marginalized groups and areas.

The strengths you identified in your self-assessment and our comments:

Governance, management and sustainability – strong leadership within VCSE organisations within Southend through Southend Association of Voluntary Services (SAVS). 

The strength of your voluntary sector was evidenced throughout our discussions. The value that the sector place on SAVS was also evident. 

Governance, management and sustainability – effective project management for transformation and improvement

We did not see the programme plans and programme management governance structures evidenced in the documents or discussions we were part of. We accept that this is often ‘behind the scenes’ and suggest that the approach and processes could better be demonstrated.  We heard some suggestions that previous plans have not been robustly monitored and for example planned budget savings had not been realised. We recognise this may now be changing with the new management culture and leadership but would emphasise the importance of strengthening your delivery culture and processes. 

Learning, improvement and sustainability – robust approach to service planning

Reference was made to service plans in our meetings although we were not able to identify how the plans are influencing practice. It would be helpful to be able to demonstrate how the robust approach that was described to us, translates to accountability and delivery. In your self-assessment, although you have identified this as a strength you have also highlighted there are significant areas of learning, and a need for new cohesive model, which may need further explanation if you do see this as an area of strength.

Areas for improvement you identified in your self-assessment: 

Governance, management and sustainability – to utilise the experience and diversity of the ‘new’ senior leadership team in driving through operation redesign to meet strategic aims and objectives and service plans.

We saw evidence that the new senior leadership team are clearly aware of the need to modernise the service. The drive to align activities, structures, and operations to strategies to ensure delivery was also evident – we know that this isn’t something that is easy to deliver. The senior leadership team are acknowledged by key partners to be engaged and keen to collaborate for the benefit of local people. 

Learning, improvement and sustainability – establish the ACS Workforce Strategy to complement the Learning and Development Plan for staff to provide a more stable and motivated workforce.

The ASC workforce strategy was raised in most of the sessions we attended and is being seen to be a hugely beneficial development. The activity to ensure more stability and a more motivated workforce is progressing alongside the strategy development ensuring that the needs of staff are being met. The L&D offer, including investment in learning and commitment to ‘growing your own’ were highlighted by Peers as positive additions. 

Learning, improvement and sustainability – develop performance management capability and use data analytics strategically and operationally.

The investment in systems and processes as part of both the corporate transformation and departmental transformation programmes will support the shift in culture to being more intelligence led. Our conversations in many group have suggested that people may not be at a point where they are able to describe what they need and how they might use it moving forward.

We appreciate the senior political and managerial leadership will want to reflect on these findings and suggestions in order to determine how the organisation wishes to take things forward. 

As part of the peer challenge process, there is an offer of further activity to support this. The LGA is well placed to provide additional support, advice, and guidance on a number of the areas for development and improvement and we would be happy to discuss this. Rachel Litherland, LGA Principal Adviser is the main contact between your authority and the Local Government Association. Her contact details are email: [email protected], Telephone: 07795 076834. There is also Claire Bruin, Care and Health Improvement Adviser who can be contacted at email: [email protected]  or Tel: 07584 272635. 

In the meantime, we are keen to continue the relationship we have formed with the Council throughout the peer challenge. We will endeavour to provide signposting to examples of practice and further information and guidance about the issues we have raised in this report to help inform ongoing consideration. 

For more information about the Adult Social Care Preparation for Assurance Peer Challenge at Southend City Council please contact: 

Kathy Clark
LGA Associate and Peer Challenge Manager
Email: 
Tel: 07769814722[email protected]

Marcus Coulson
Senior Advisor – Adults Peer Challenge Programme
Local Government Association
Email: 
Tel: 07766 252 853[email protected]

For more information on the peer challenges and the work of the Local Government Association please see our website: Council improvement and peer support | Local Government Association.