Hertfordshire County Council adult social care preparation for assurance peer challenge report

Hertfordshire County Council (HCC) requested ADASS Eastern Branch to approach the Local Government Association to undertake an Adult Social Care Preparation for Assurance Peer Challenge at the council and with partners. The work in Hertfordshire County Council was led by Chris Badger, Director of Adult Care Services (DASS), Hertfordshire County Council.  He was seeking an external view on the readiness of the adult social care directorate for the arrival of the Care Quality Commission’s Assurance inspections and a view on how the council is able to deliver value for money, quality, effectiveness, and the most personal, outcome focused, offer for local people. 

The peer team made a series of findings and recommendations. Other comments and recommendations are included in the body of the report. 

1. Frontline staff across Adult Care Services are a real asset.  They spoke with passion and pride about their work in Hertfordshire County Council (HCC), this came out loud and clear. 
2. Frontline practitioners cited many examples of being enabled by managers to be creative in their support planning and spoke well of the Connected Lives Model supporting them to be creative and have a personalised approach. 
3. Commissioners and front line operational teams work well together and are pulling in the same direction There is evidence of good practice, for example close working with providers to develop services. 
4. There are good relationships with individual providers and the Hertfordshire Care Providers Association (HCPA) which has been invested in by the council over a number of years. 
5. The move to have the Safeguarding Team and decision making centralised has been positive, it is now seen as a single function which is working efficiently. 
6. There is good impact for transitions from children’s services to adult services, it is a continual journey that is joined up and has less of a cliff edge. 
7. There is much to be proud of in the leadership approach in Hertfordshire.  Elected members across the board, and regardless of their political persuasion, have demonstrated and spoken about their dedication to delivering the support and services that residents need. 
8. The council’s leadership and the DASS’s commitment to the implementation of the Equality, Diversity and Inclusion agenda was a genuine strength. Leaders could speak about, and had knowledge about, the inequalities of service provision to diverse groups, and what needed to be done to improve it.
9. There is a good amount of Integrated system working with health colleagues which has been developed over many years, but the work to integrate with Primary Care Networks and GP surgeries, who are so often the route into services and support, is less well developed. 
10. The Directorate is driving forward the Equality Diversity and Inclusion (EDI) agenda. It would be powerful in terms of community provision if Adult Care Services (ACS) could further utilise their influence and experience to deliver support to the health and care market with regard to challenges around EDI. 
11. Timely feedback to referrers, partners and people who have experienced safeguarding on the outcome of safeguarding should be strengthened to improve information flow, learning and communication. 
12. The interface between the Integrated Care Partnership (ICP) and the Health and Wellbeing Board (HWBB), both of which are chaired by the Leader could be strengthened by ensuring the work to clarify their respective roles is completed, and their ambitious work plans delivered so as to complement each other.

Background 

Hertfordshire County Council (HCC) 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 commissioned by 

1. ADASS Eastern Branch as part of their preparation for future Care Quality Commission Assurance inspections and to gain a view on how councils can deliver value for money, quality, effectiveness, and the most personal outcome focused offer for local people. 

2. 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 in order to promote an open and honest dialogue and feedback form the team of peers is given in good faith.

3. Prior to the onsite peer challenge work Hertfordshire County Council Adult Care Services Directorate team completed a self-assessment about the work of the service.  In advance of the peer challenge work, members of the team conducted a day of detailed case file audits with a small number of cases and allocated a day where they met with people with lived experience, front line practitioners, and carers. The peer challenge team arrived at their feedback after triangulating what they read, heard and saw whilst onsite with a view as to saying what needed to be said whilst being mindful of the multiple audiences for the work in the partnership.

The members of the peer challenge team were: 

• Mark Palethorpe NHS Place Director & Executive Director People (Adult Social Care, Children & Young People and Public Health, St Helens Council 
• Cllr Sue Woolley, Portfolio Holder / NHS Liaison & Community Engagement, Chairman Lincolnshire HWB - Lincolnshire County Council 
• Dina Adib, Head of Contracts, Milton Keynes City Council 
• Frood Radford, Head of Social Care & Health Programmes - East Sussex County Council 
• Jo Dyke, Principal Social Worker, Leicester City Council 
• Sarah Mackereth, Assistant Director for Health and Social Care in West Devon, Devon County Council 
• Nick Faint, ADASS Associate 
• Venita Kanwar, Peer Challenge Manager, LGA Associate 

4. The team engaged virtually between 29th and 31st March 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, partners and people with lived experience. 
• meetings with managers, practitioners, providers, and frontline staff 
• reading documents provided by the council, including a self-assessment and a range of other material, consideration of different data and reflecting upon the case file audit. 

5. The framework the peer team used was that of the Care Quality Commission (CQC) and their proposed four Domains of Assurance they will be using for the up-coming adult social care inspection regime.  They are:

Care Quality Commission Adult Social Care Assurance Four Domains

Working with People

•    Assessing needs 
•    Supporting people to live healthier lives 
•    Equity in experience and outcomes 

Providing support

•    Care provision, integration and continuity 
•    Partnerships and communities  

Ensuring safety

•    Safe systems, pathways and transitions 
•    Safeguarding     

Leadership

•    Governance, management and sustainability 
•    Learning, improvement, and innovation 


6. The peer challenge team would like to thank councillors, staff, those people and carers with a lived experience, and partners, for their open and constructive responses during the challenge process. All information was collected on a nonattributable basis. The team was made very welcome and would in particular like to thank Chris Badger, Director of Adult Care Services (DASS), Sharon Robinson Programme Manager, Adult Care Services, Lucy Rush, Director of Practice and Quality, Principal Social Worker, Adult Care Services Francesca Difato, Business Support Officer, Adult Care Services for their invaluable assistance for the support to the peer team, both prior to and whilst onsite, in planning and undertaking this peer challenge which was very well planned and delivered. 

7. Prior to being on-site peer team members looked at 12 case files in detail from across the areas of adult social care, including one case from the NHS mental health trust.  The onsite visit also involved the opportunity for face-to-face interviews, in addition to the virtual interviews mentioned in paragraph 4. These were held with two groups of front line practitioners, a group of people with lived experience and a group of carers.

8. The peer team read around 70 documents including a self-assessment statement. Throughout the peer challenge the team had more than thirty five meetings with at least one hundred and sixty different people from Adult Care Services (ACS), NHS, third sector and other partners. The peer challenge team have spent approximately 190 hours with HCC and its documentation, the equivalent of 28 working days.

9. Our feedback 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 detailed account of the peer challenge.

Support offered by service 

• 59 per cent Older People Service 
• 34 per cent Adult Disability Service
• 4 per cent 0-25 Service  
• 3 per cent Mental Health Service 

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

Strengths 

• The workforce is very passionate and proud to work in Hertfordshire. They are focused on a strength-based approach that reflects resident’s choices. 
• Integrated Mental Health services, the council and NHS are committed to work in partnership to deliver high quality services. 
• Examples of critical thinking are evident in the case file audits. 
• There is permission for innovation at case level, and examples of creative support planning. 
• Connected Lives is working well and established in places. 
• Relationships with the Voluntary Community Faith and Social Enterprise sector are strong. 

1. Frontline staff across Adult Care Services are a real asset.  They spoke with passion and pride about their work in Hertfordshire County Council (HCC), this came out loud and clear “I get a lot of support from my manager, it’s the best placed I’ve ever worked”.  There were multiple examples cited of practitioners working in a strength-based way to achieve the stated outcomes that people wanted for themselves. Examples of a strength-based approach included, working with an individual who had been in supported living for 8 years and who had recently moved into their own flat with a direct payment (DP). Discussion with management to explore risk had enabled this young individual to have their wishes respected for greater independence. 

2. There were some excellent examples of critical thinking in the small numbers of case file audits carried out.  It is evident that managers are auditing case files regularly and are constantly checking the quality of recording. Practitioners spoke about how feedback is given to them regularly on outcomes of Practice Audits and this directly informs their practice and professional development.   

3. Frontline practitioners cited many examples of being enabled by managers to be creative in their support planning and spoke well of the Connected Lives Model supporting them to be creative and have a personalised approach.  There was an example of someone with very complex needs who was supported by the council to buy a house, this approach demonstrates that practitioners step outside of what is seen as the usual boundaries and was regarded as innovative.  

4. The Integrated Mental Health services were seen as a real positive for people with severe and enduring mental ill health.  The Mental Health Trust enabled these people to receive a joined-up service across health and social care which removed some of the barriers, hand-offs and complexities that these people might experience. This is in addition to the council and the wider NHS being committed to working in partnership and this is seen at multiple levels not just at a strategic level but at frontline practitioner level too, and as a result of this, there is emerging evidence that Hertfordshire achieves good quality outcomes for residents. 

5. The Connected Lives model which is the council’s “strength-based practice model designed to help people to achieve their aspirations. With an emphasis on prevention, enablement and community opportunities”.  Connected Lives is delivering ACS’s aspirations to effectively deliver the Care Act at assessment and review requirements.  It was reported in the council’s self-assessment document that, “Since the introduction of Connected Lives, Hertfordshire’s nationally reported ‘Quality of life score’ (compiled from key national survey questions) improved in the first year of Connected Lives with a score of 19.4 out of 24 (2018-19) and again in 2019-20 19.7 out of 24. This was our best performance ever and placed us 15th nationally”. This is to be commended. The Connected Lives model is established in places, and it is the intention of HCC to go faster and further on this.  Examples of where the Model is working well was evidenced by the example of a couple where one person (the carer) was physically frail, and the other person had dementia.  They were living in a rural area but despite being isolated a range of services were put in place to enable both the carer and cared for person to regain freedom and independence without reliance on a long-term package of care. 

6. The relationships with Voluntary Community Faith and Social Enterprise (VCFSE) sector are strong.  The VCFSE are vocal and passionate and spoke of the relationship not being one of “a parent and child” relationship, but a relationship of equals which was very positive, supportive and productive.  

For consideration 

• Residents are eager to participate, build upon your existing mechanisms to seek wider feedback from people with lived experience. 
• What is the influence of co-production across the health and care system to inform practice? 
• Integrated working with Primary Care Networks and GP surgeries could be developed and rolled out across the county. 
• Outcomes need to be recorded consistently and progress towards the identified outcomes should be monitored. 
• Carers assessments and information for support for carers may not be routinely offered.  Does the client and carer base of ACS reflect the Hertfordshire population? 

7. HCC does an impressive amount of work on co-production and has worked at building co-production into day-to-day work via eight Co-production Boards which have existed and been nurtured for five years. Those that sit on the Boards have worked with HCC to develop for example the Carers Strategy and the 4 Year Plan.  However, if as a resident you are not on a Co-production Board but are keen to be involved, how could that be achieved?  The suggestion would be to build on the existing mechanisms that work and have real engagement with residents to seek wider feedback on lived experience.  This might be carried out in a less intense way on a wider scale with intelligent surveying or focus groups. Co-production is an embedded way of working and is a real strength at a more strategic level.  There appears to be scope for gaining more feedback at an operational and case level. 

8. There was evidence that co-production is the “standard work” approach for all new initiatives and developments, and that partners, stakeholders, service users, and operational staff are actively involved.  It would appear that coproduction is strategically important to HCC but there is a question around whether system partners are as passionate and active as the council in adopting this approach?   

9. There appears to be a good amount of Integrated Care working with health developed over many years at a strategic and operational level. The work to integrate with Primary Care Networks and GP surgeries, who are so often the route into services and support, is less well developed. There are some small positive examples of close working in existence which are working well and providing positive experiences for residents. There is an opportunity to learn from these pilots, engage fully with PCNs and agree sustainable models that could be rolled out at pace.  They will pay dividends in terms of a preventative approach and outcomes for people. 

10. The case file audits identified some good examples of recording outcomes and of progress towards the identified outcomes being followed up. However, outcome recording was partial as was the use of numerical scoring to provide a means of measuring progress in a reportable way. HCC may want to consider how the capturing of information on outcomes could be improved and made consistent across ACS.  It is also suggested that it would be best practice to write outcomes in case files in the language of the person for example using the “I Statements” as a guide.  

11. The small samples of carers spoken with as part of the peer challenge reported that they had not been offered the opportunity for a carers assessment and all carers interviewed, reported having found out about Carers in Hertfordshire by themselves – rather than being told about them by ACS.  The Carers in Hertfordshire service is highly rated by people once they get there, and it is well used with 37,288 carers supported by them currently.  There may be scope for ACS to be more proactive in directing people to the service, the pathway into the Carers Service may not be as obvious as ACS might want it to be. There is an opportunity to review the journey from a carers perspective to assure stakeholders of an outcomes-based service which enables carers to access support services in a manner in which they need to. ACS can do more to embed and review the data on the ethnicity of people offered a Carer’s Assessment and those that took up this offer.  It is suggested that ACS may wish to start reviewing this data in order to be sure that there are no hidden disincentives to people with protected characteristics taking up a Carers Assessment.
 

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

Strengths

• Commissioners provided good examples of co-production, and commissioning teams work closely with operational teams. 
• The Hertfordshire Care Provider Association is a co-ordinating point between the council and Care Providers. 
• There is a strong relationship with lead providers. 
• The Money Advice Unit has delivered £11M of benefits over first six months of 2022. 
• There is significant financial support and fees uplift to the care sector, against a backdrop of in-years savings. 
• A re-procurement of the new framework has helped to develop capacity in the home care market. 

12. Commissioners and front line operational teams work well together and are pulling in the same direction There is evidence of good practice, for example close working with providers to develop services e.g. by using an outcome based commissioning model, such as the Home Care Framework.  

13. The time and investment made in the Hertfordshire Care Provider Association (HCPA) has been considerable for example, HCC and worked with HCPA for years, this has been time well spent and has resulted in a really good relationship between providers and the council.  Providers value the connection with the DASS who they meet with regularly and who attends meetings and Provider Forums.

14. HCPA provides support and advice to providers, making a difference in the market. It provides information, webinars for tenders, facilitating change in policy, and a vast range of training for all levels and all sectors.  It also holds regular network events attended by more than 200 attendees. The information hub has dealt with 17,000 complex enquiries. 

15. The HCPA also recruits carers and holds initial interviews on behalf of providers. 

16. The HCPA acts as a conduit between the providers’ market and the Local Authority, raising their concerns and facilitating the discussions. The Local Authority also uses the HCPA to cascade information to providers (which proved very helpful during the Pandemic), improving the relationships with providers and the quality of care provision. 

17. HCC continues to invest in the HCPA and to fund activities, to build further on its success and impact on the care market. 

18. The good relationship with individual providers and the council has come across strongly. The lead providers have outlined that they are able to shape the offer of provision and spoke of the long term investment in them by the council and a long standing relationship. Providers have supported Discharge to Assess (D2A) and were extremely positive about HCC explaining they had not been “done to” as has been their experience in other places.  Providers described having a clear framework to work to with clear expectations and stable working conditions, which has fostered good working relationships. Providers commented positively that any issues around bed utilisation or issues with specific people are quickly resolved by HCC Commissioning Officers. Providers are involved in work around the future of long stay placements.  They have described working with HCC as “outstanding” and that it is “refreshing and very positive” to have this relationship with a local authority.  Providers informed that working with Hertfordshire’s Commissioners has always been on the basis of an equal partnership, communication is an area of strength, and this was best evidenced through Covid. The most recent tendering process was felt to work well in being inclusive to small/medium providers which has benefited the home care market and increased the available provision to meet the demand. Providers commented that they are paid a fair rate, this is rarely cited by providers. 

19. Providers have commented that the relationship built on trust has allowed them to have honest and open conversations when they encounter any quality problems, which leads to immediate responsive support. 

20. Lead providers have mentioned the benefits of having the HCPA working as a central hub, with fantastic training opportunities for staff. 

21. There are very few local authorities who have in-house benefit support services, in Hertfordshire this service is provided by the Money Advice Unit which has delivered £11M of benefits over the first 6 months of 2022.  ACS continue to invest in the service. The Unit has also set up contracts with McMillan Cancer Support. The service has clearly delivered much needed support for people and though not quantified at the time of the peer challenge will surely be having impact in terms of demand management. The Money Advice Unit also provides strong evidence of cross directorate working.  

22. The council has provided significant financial support and a fee uplift to the care sector against a backdrop of in-year savings.  Providers themselves were quick to acknowledge that HCC are “paying a really good rate for home care and have been flexible on the rates to allow for different business models, and to allow innovation”.  Providers who reported being positive about council rates informed that they want to work more collaboratively with the council.  It is clear that the council has prioritised the care sector and acknowledged the value of the wider workforce. 

23. The positive relationship with providers through HCPA and the change in contracting arrangements for home care has made a huge difference in capacity and has reduced waiting times.  The new framework has also adopted a new outcome-based model, moving away from a task and time model. The tender was a good example of co-production of the new specification with lead providers, supporting small new providers during the process, to be successful in joining the new model framework. 

For consideration 

• Improved data is required to achieve the commitment of culturally competent care. 
• The Directorate is driving forward Equality, Diversity and Inclusion, so why not use your influence and experience to deliver changes in the market and system? 
• Increased capacity into nursing care home is a planned development, however, how will HCC manage increasing demand and quality in the meantime? 
• Hertfordshire’s smaller VCFSE Organisations cannot find the capacity to engage with system partners. Can the council influence any mechanisms or options which might support this better?  

24. Improved data is required to achieve culturally competent care. ACS understand and are aware of this as a known area for development.  For example, work is underway to develop a culturally appropriate carers breaks service. Having the right data will help to inform what further may need to be done. The safe and well visit data for example, will help with risk stratification and analytics.

25. The Directorate is absolutely without doubt driving forward the Equality Diversity and Inclusion (EDI) agenda. It would be powerful in terms of community provision if ACS could further utilise their influence and experience to deliver changes in the health and care market with regard to EDI. The managerial and political level of experience that HCC has on EDI could act as a catalyst for change. There are an array of commissioned services in Hertfordshire, and it is worth ensuring that they are as committed to EDI as HCC is. 

26. There is to be an increase in capacity with the development of two nursing homes coming online soon. How will HCC manage the demand and quality in the meantime as there will be a lag in terms when the nursing home are ready.  What is the strategy to manage this in the meantime?  

27. Meeting the needs of specialist/complex care in care homes was raised as an issue by providers. There are options to look at this through the lens of coproduction.   

28. Hertfordshire’s smaller VCFSE organisations may struggle to find the capacity or service the Integrated Care System (ICS) or to engage with the wider system and the NHS. Smaller, grass roots organisations which are fundamental to ACS’s offer and Connected Lives Model in terms of the support they bring in, are at risk of being disadvantaged. There is potential for these organisations to lose out, they cannot then find out about, and access NHS funding easily. There are some incredible charities and organisations making a real difference to people’s lives for example the Head Injuries Service was particularly cited as making huge impact on residents who have been supported by them.

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

Strengths 

• The Safeguarding Team which is located centrally is a real strength, it is responsive and provides consistency in decision making. 
• The Safeguarding Portal is used by professionals, and they are really positive about it. 
• There is an effective audit process that is both internal and multi-agency which stimulates improvement and development.
• The 0-25 Team is making a good impact on transitions and it is a continual journey that is joined up. 

29. The move to have the Safeguarding Team and decision making centralised has been positive, it is now seen as a single point of contact. There is evidence of safeguarding being more efficient, for example following a referral being made, there is a call back within a few hours. It is responsive and provides consistency in safeguarding eligibility decision making across the County. It has also generated positive feedback from practitioners, providers, partners.

30. The Portal is used by professionals, and there is a high take up, and they speak very highly of it. The portal populates into Liquid Logic which ensures good recording.  The Safeguarding Adults Board (SAB) Chair has driven the use of the Portal and has encouraged all partners including Police partners to use it which they do. There is work underway to develop a similar portal for Deprivation of Liberty Safeguards (DoLS) to improve the quality of referrals and to help with managing and triaging them.  The work on the Portal and its demonstrable effectiveness and delivery of improved outcomes for people has paved the way for further systems change, and established confidence for partners for future change.  This is impressive and might merit an award if submitted as a case example to national social care journals.  

31. The audit process which is both internal and multiagency stimulates improvement and development.  It is viewed as a themed process at SAB level which helps when viewing it through a multiagency lens.  This can be followed through using an exploratory approach where the intelligence can be used to explore and deep dive further.

32. The 0-25 team has had a real impact for people transitioning from one service to another. The model is joined up which promotes the continuity of service for the young person with connected conversations happening much earlier. When the young person becomes 25 there is “transfer of care” rather than a transition from Children’s to Adults. There is a good handle on casework with all involved and practice is based on parents’ feedback. There is a cross service protocol in place which identifies the very clear importance of partnership working between adults and children services. Practitioners are clear about the importance placed on young adults not falling into an adult world that they are not prepared for.  Staff are working together around health and education and having an impact on Adult Social Care Outcomes Framework (ASCOF) performance. Young people are being moved into supported living and taking up Direct Payments, which is very positive.  

For consideration 

• Timely feedback to partners and those who have experienced safeguarding on the outcome of safeguarding, should be strengthened to improve communication. 
• There is potential for better information exchange between acute and community/ social care services to optimise the service offer on discharge. 
• How robust is the escalation process both for safeguarding and other situations where it may be difficult to secure engagement from all relevant partner agencies? 
• How can Hertfordshire County Council and Hertfordshire Safeguarding Adults Board ensure that the learning from Safeguarding Adults Reviews is routinely embedded in practice across all agencies?

33. Feedback to partners and people who have experienced safeguarding on the outcome of safeguarding should be strengthened to improve information flow, learning and communication. The ACS Directorate recognise this as an area that requires some improvement and in addition are making efforts to seek feedback from people who have experienced safeguarding in a two-way effort to continuously improve the safeguarding service. 

34. There is potential for better information between the acute services and community and social care services to optimise the service offer on discharge. It is not always the case that an accurate report is received on a patient’s needs and strengths upon their discharge. This will have an impact on their onward journey from hospital and the type of support they get on discharge. This could be occurring because of the pressurised working environment in hospital settings but should be considered to ensure best possible outcomes upon discharge, and safe transfer between services in the system.  

35. The agreed escalation policy in Hertfordshire is succinct, taking up only a couple of pages and therefore easy to understand and implement. Despite this, it may not be being implemented effectively by practitioners and partners.  This is not just an HCC issue. Assurance may be required by the SAB around the robustness of the escalation policy and process across partners. 

36. Is Hertfordshire County Council and Hertfordshire Safeguarding Adults Board confident that the learning from Safeguarding Adults Reviews (SARs) is routinely embedded in practice across all agencies?  For example, the learning from three Safeguarding Adults Reviews around fire safety and smoking in Hertfordshire was disseminated to partners. This is highlighted as a case study in Hertfordshire’s self-assessment document but there has subsequently been another SAR with the same theme. Is the council and the SAB assured that there is consistency of approach across partnerships and agencies? Ensure that learning is embedded at scale in a county as large as Hertfordshire.

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

Strengths 

• There are good cross party working relationships. 
• The leadership team is committed and active in the implementation of the Equality, Diversity and Inclusion agenda. 
• Staff and partners are committed to the Strength Based Model and are collaborating to focus on outcomes. 
• Financial management is strong and connected. 
• Great relationships with partners. 
• The Directorate is self-aware. 

37. There is much to be proud of in the leadership approach in Hertfordshire.  Elected members across the board and regardless of their political persuasion have demonstrated and spoken about their dedication to delivering the support and services that residents need.  They work collaboratively to do this.  Such an example is the use of sensitive information that had been shared by the administration at an early stage and all welcomed the trust placed in them for remaining discreet.  

38. The council’s leadership and the DASS’s commitment to the implementation of the EDI agenda was a genuine strength. Leaders could speak about and had knowledge about the inequalities of service provision to diverse groups, and the need to improve the reflection of the workforce of its communities, particularly at a senior level. More importantly leaders could articulate the measures they were taking to address EDI challenges and reflect upon their role in doing that.  This is reflected at officer and political levels. For example, the DASS is active in and chairs the EDI Board to ensure that resident experience is shaping service provision.  He is also in a coaching relationship with a member of the BAME workforce to better understand issues from the BAME perspective.  The Leader chairs the Member’s Inclusion and Diversity Board.

39. Staff and partners are able to see the benefit of the Strength Based Model (as delivered through Connected Lives) and able to talk about it.  For ACS staff in particular, it was not a tokenistic discussion, but a genuine reflection on it being an approach that had the best interests of the resident at heart to achieve the best possible outcomes for them.  There is a clear view about shared outcomes with partners and there are positive, high trust relationships and real areas of delivery and improvement as a result. The investment in training and opportunities for partners to be involved too, was good to hear. 

40. There was clear evidence that as a council, financial management within both corporate and ACS directorates is a strength which supports and informs decision making. 

41. Partners and council officers spoke about the respect and huge benefits of working collaboratively. Partners were very complimentary about the way council officers worked with them, and the council invest time with them, and the really good outcomes achieved with people as a result.  

42. It was evident that the council are self-aware, the feedback during the peer challenge reflected what was written in the self-assessment document. 

43. HCC have a leadership role in the ICS and ICB, demonstrated by having two directors and a project management officer team part funded by the ICB to transform working relationships and improve social care outcomes. 

For consideration 

• There is representation at the highest level of leadership.  Consider how to accelerate the successes achieved on your Equality, Diversity and Inclusion initiatives including gender. This is a recognised area for improvement. 
• Ensure the work to clarify the respective roles of the health and well-being board and the Integrated Care Partnership is completed, and their ambitious work plans delivered to complement each other. 
• Is your programme for supported accommodation and extra care housing sufficiently ambitious and are you confident that you are delivering at pace? 
• Assure yourselves that the “I Statements” are at the forefront of practice, design, co-production and delivery. 

44. Although there is a relentless pursuit of an inclusive, diverse and equitable offer across services and into provider services there is still more to do on representation of the community and the population at the most senior level.  This is a recognised area for improvement for the council.  

45. The interface between the Integrated Care Partnership (ICP) and the Health and Wellbeing Board (HWBB), both of which are chaired by the Leader could be clarified further.  How can the work around the wider determinants of health, employment, housing, lifestyle etc, be harnessed, to tackle demand and support the Connected Lives model? 

46. Is the programme for supported accommodation and extra care housing  sufficiently ambitious and is the council confident that it will be delivered at pace?  Extra care housing has been recognised as a route the council need to pursue to ensure there is sufficient housing in their system. However, there was concern the pace at which it was being delivered needed to be speeded up. However, this was a competing priority with other areas of council business. 

47. Are the “I Statements” at the forefront of co-production and does this then translate into delivery of services? This includes the work on training, audits and re-design and on co-production boards. Ensure there is triangulation back into outcomes and how this is measured in terms of lived experience.  

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]
Tel: 07795 076834

There is also Claire Bruin, Care and Health Improvement Adviser who can be contacted at:

Email: [email protected] 
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 Hertfordshire County Council please contact: 

Venita Kanwar
LGA Associate
Email: [email protected]
Tel: 07865 999 508

Marcus Coulson
Senior Regional Advisor
Local Government Association
Email: [email protected]
Tel: 07766 252 853

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