Devon County Council adult social care preparation for assurance peer challenge

1. There is a clear vision for Adult Social Care in the council, and the Peer Team heard about areas of good practice, innovation, and things that should be celebrated and built on. There are many good ideas, and staff are incredibly enthusiastic, committed, and supportive of the Directorate and its work. This provides an essential foundation for the transformation of approach and delivery that may need to be embedded over the coming years.  Scaling up pilots and change at pace when there is evidence these are working (or have been found to work elsewhere) may involve some risk, but offset against the risk of rolling good work out too cautiously. This will include some change in practice (for instance around asset- and strengths-based approaches), and an increased focus on practice assurance and consistency (already in train with e.g. new supervision policies, or future plans around quality assurance). 

2. Good plans have been developed to back up the vision for transformation and sustainable delivery. These would benefit from greater evidence of how they will be, and are being delivered, not only to provide assurance against risk, but also to evidence improving outcomes for local people. These include plans relating to waiting lists and development of the provider market due to a current reliance on smaller single location providers, savings and mitigations for these, practice assurance, and wider service transformation. Detailed plans will be required for Senior Management and Transformation Teams, and need to be disseminated to, and used with, relevant staff across wider teams. At the same time higher level summaries and progress reports will be needed to raise the profile of risks and opportunities for Adult Social Care and its partnerships, both within and beyond the council, and to maintain Corporate, Political and stakeholder support. 

3. Listening to and engaging with people who use council services provides a strong foundation for coproduction. However, there is now a need to move from “you said we heard” to “we said we did” in order to embed co-design and coproduction in the approach to both service design and delivery; and to be in a position to feed back to people involved in coproduction, and wider stakeholders and communities what the impact of their involvement has been. Embedding coproduction as an approach will begin to see greater engagement not only in service planning and delivery, but also within individual care planning, assessment and review (and aggregated learning from these), all of which will support improved outcomes in future assurance.  

4. Adult Social Care is working in a very challenging financial environment, with extensive savings targets. There is clear recognition of the wider council need for savings and efficiencies, and the significant part that Adult Social Care will need to play in these (given the proportion of the overall council budget that it is responsible for). However, it is equally important to recognise that the more sustainable service transformation that is needed is not just an “in year” saving. Longer-term transformational work, including around asset- and strengths-based approaches, has the opportunity to deliver greater financial sustainability than only looking at short-term benefit; but this will require development to drive culture change and equip the workforce with the necessary skills, and time to embed and fully realise the benefits. Consideration should be given as to how best to balance the risk that a focus on short-term savings may impact on delivery of those things that will arguably support longer term sustainability in adult social care, improved outcomes for the people it supports, and which the Care Quality Commission (CQC) are likely to look for in future assurance, preparedness for which is the purpose of the present Challenge.

5. Whether short- or longer-term, savings and improvement will need to be delivered in partnership with the NHS, Districts, communities, providers, and the Voluntary and Community Sector. Corporate support from other council directorates, and Executive and Political Leadership, will also be essential to finding opportunities for collaboration and synergies in the work of Adult Social Care and its partners, as well as to manage expectations and the purpose, impact, and pace of change. The CQC will want to see evidence of supportive leadership at all levels; there is a very new Corporate Management Team and Integrated Care Board leadership, and it will be important that time and space is available to further develop an environment of mutual understanding and trust in order to deliver system change and sustainability.   

6. Preparations for this Peer Challenge have been excellent, and everyone has been welcoming, honest, responsive, and well-coordinated throughout the process. This is good preparation for future statutory assurance, and the proposal to incorporate action planning arising from the Challenge into wider transformation plans will help to maintain focus on outcomes, quality, and innovation.  
 

7. Devon County 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 Devon was led by Tandra Forster, Director of Integrated Adult Social Care at the council, and supported on-site by a dedicated team. 

8. 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. 

9. 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 improvement planning, and with particular reference to: 

• Practice quality, assurance, and safeguarding
• Outcomes including around self-directed support and support to carers
• Front door prevention and early intervention 
• Market Sustainability Plan (and delivery against it).

10. The members of this Adult Social Care Preparation for Assurance Peer Challenge Team were:  

• David Watts, Executive Director of Adults, Health Partnerships & Housing (DASS), North Northamptonshire Council 
• Councillor Sue Woolley, Cabinet Member, Lincolnshire County Council for NHS Liaison, Community Engagement, Registration & Coroners and Chairman of the Lincolnshire Health & Wellbeing Board. 
• Kate Sibthorp, Co-Chair of the National Coproduction Advisory Group, peer with lived experience 
• Moira Wood, Principal Social Worker, Gloucestershire County Council 
• Dawn Bowman, Lead Occupational Therapist, Hampshire County Council  
• Helen Style, Assistant Director, Hampshire County Council  
• Niki Shaw, Assurance Lead, Somerset Council 
• Chris Rowland, Challenge Manager, Local Government Association 

11. The team was on site from 19th – 21st July 2023. 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 44 meetings were on the timetable, and the team gathered views from over 300 people within these;  
• preparatory work including a bespoke case file audit covering 23 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 40 documents; 

12. The Peer Challenge was based on the four Assurance themes confirmed by the CQC in February 2023; the Challenge Team grouped evidence with reference to these questions, and this report is structured around them. They are:

Care Quality Commission Adult Social Care Assurance Themes

1: Working with people 

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

2: Providing support 

• Care provision, integration and continuity 
• Partnerships and communities 

3: Ensuring safety 

• Safe systems, pathways and transitions 
• Safeguarding     

 4: Leadership 

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

13. The findings and recommendations in this summary report are based on the presentation delivered to the council on 21 July 2023, and should be read with reference to it. The supporting detail and recommendations that it contains are founded on a triangulation of what the team have read, heard, and seen. All information was collected on the basis that no recommendation or finding is directly attributed to any comment or view from any individual or group. This encourages participants to be open and honest with the team. The report covers those areas most pertinent to the remit of the challenge only, and has been structured around the CQC Themes as outlined in paragraph 12 above. 

14. 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 friends, albeit ‘critical friends’, and an overview of key findings, with the intention of supporting the council to form its own view, and to continue its improvement journey where necessary. It is designed to help to assess current achievements and areas for development, within the agreed scope of the Challenge. It aims to help identify the council’s current strengths, and examples of good practice are included under the relevant sections of the report. But it should also provide the council with a basis for further improvement in a way that is proportionate to the remit of the Challenge, and recommendations where appropriate are included within the relevant sections of the report (as well as highlighted in the Recommendations section at the end of the report).  

15. The Peer Challenge process offers an opportunity for a limited diagnostic approach to material which is provided (whether through written materials, or through on-site interviews, focus-groups, or observations), as well as a critical appraisal and strategic positioning of this. It reflects a balance of views within the team, based on their experience, and the material made available to them.  However, the level of “assurance” (whether of quality, outcomes, or good / poor practice, etc) which can be provided through this format is strictly limited. A Peer Challenge is, whilst intensive, 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.  

16. The LGA Peer Challenge Team would like to thank Councillors, people and carers with lived experience, 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 Tandra Forster, Director of Integrated Adult Social Care, who sponsored the Challenge; and Damian Furniss, Gabrielle Lester-Smith, Lorna Cook, and Sarah Ford for their invaluable and excellent support to the peer team, both prior to and whilst on site.

17. There is a robust structure of external engagement groups for service user and carer engagement (including a Learning Disability partnership Board, Autism Involvement Group and Carers’ Partnership Board), and the council commissions service user and carer engagement activities from partners including Healthwatch, Living Options Devon, and Advocacy services. These groups meet regularly and come together on a quarterly basis as the Joint Engagement Forum with a dedicated involvement manager. This demonstrates an organised approach to hearing from people who access services, with stakeholder feedback contributing to the Assurance Board. Similarly, there are examples of good practice, and coproduced work across the service, including the Carer Ambassador role (an example of people who access services and people working for a partner organisation (Devon Carers) working together and actually co-delivering); or the initial coproduction work that has been done on the new assessment process, with the intention of improving people’s experience of this. 

18. All this offers a strong foundation for co-production to evolve beyond consultation and have a wider reach. People who access services want to know the importance of their contribution, how it has effected change and improvement, and how it is leading to people being enabled to live their best lives. Ongoing conversations which include timely feedback and detailed actions taken and impact for people (of work they and others have been involved in) can help to build mutual trust and therefore stronger and more effective coproduction. The peer team described this during the challenge as a way that coproduction could evolve from ‘you said, we heard’ to ‘we said, we did’, with ‘we’ being people who access services, work in services, and work for partnership organisations including providers.  

19. It is important that the council can demonstrate more evidence of understanding diversity in communities, and plans to evidence equity of access, involvement and outcomes. Perhaps in keeping with the more general concern about routinely evidencing outcomes for people who use or come into contact with council services, it is also not easy to be sure that the offer and its impact are universal, or have full and effective reach for groups with protected characteristics; the fact that CareFirst does not capture some protected characteristics makes this even harder to track. One example of this might relate to coproduction (processes and groups), where certain groups are less or not involved, for instance refugees and other protected characteristic groups. A query was raised whether groups from ‘seldom heard’ backgrounds and experiences are less involved now than pre-pandemic, with the council’s ‘reach’ impacted following the COVID pandemic (after which a number of small groups appeared to lose funding). 

20. There is good practice in ensuring people who access services aren’t out of pocket when working for the council; they can claim travel expenses and the cost of replacement care. However, there didn’t appear to be a policy or process for paying fees to recognise the value of their contribution. This is something which is not straightforward to budget for or process, but is nevertheless an important direction of travel in more formally recognising the contribution of coproduction. Consideration might be given therefore as to whether relatively small investment in this area could develop substantial benefits in terms of coproduction and ownership of local services (and decisions about them) by local people.  

21. It is positive that in most cases the case file audit found that people receive a timely response, and in the case of Occupational Therapy are being appropriately referred for specialist input. Where people are able to self-advocate there was evidence that for the most part, positive conversations were taking place and people’s own goals and aspirations were being noted and supported where possible; this was most evident in review work with people with Learning Difficulties using the PATH (Planning Alternative Tomorrow with Hope) model, and for those accessing the Reaching for Independence service, where strengths-based and person-centred practice was evident.  However, for older people or those with a cognitive impairment this was less evident, and the audit identified missed opportunities to improve a person’s experience and involvement through using appropriate involvers and/or advocacy services.   

22. The council’s pre-populated assessment, support plan and review templates positively use the language of “goals” when considering the person’s outcomes. However, practitioners in the main used the language of the specified Care Act outcomes and a person’s other outcomes or goals were rarely noted.  Often clinical and deficits-focussed language was in use; but where a person’s own words were used, and acknowledgement made of their strengths and aspirations, this added a powerful dynamic and was more reflective of strengths-based practice.  Progress against goals was well evidenced where the PATH model in conjunction with use of a Direct Payment was noted, and similarly where the Reaching for Independence service was present; otherwise there remained a propensity for goals to be termed as “ongoing”, and aligned with the provision of traditional commissioned services.  There was minimal opportunity to see how support might prevent, reduce or delay future need, or how the person might draw on either universal services or community networks in achieving some or all of their outcomes. Similarly, there was minimal evidence of feedback being gathered directly from people at the time of receiving input from the locality teams, or through any quality assurance auditing activities thereafter, in order to understand the effectiveness or impact of practice and intervention on people’s outcomes.  The annual review was largely used as an opportunity to review the services in place, rather than the person’s outcomes and progress toward achieving such.  Whilst there was positive reporting by Care Direct Plus of the number of contacts they are able to resolve at the point of contact, they were unable to evidence the impact of their advice and guidance for the person’s outcomes, such as might be gathered through follow up calls to the person, or otherwise implied through data reporting of repeat contacts and frequency thereof.  

23. The CQC will look for evidence of impact and outcomes for people and carers (in case files, in how staff talk about their work, and in what people say about council services). This will be something to build into routine work and recording, monitoring of both formal and informal complaints, and feedback and responses to these, but also how all staff engage with people who use services to build an evidence base for future assurance. Similarly, having paused case file audit work during the pandemic, the case file audit associated with the present Challenge could be used as a starting point to begin evidencing effective practice assurance in the future, and to underpin the approach to quality.  

24. In case file audit, strengths-based practice, and personalised models of support, is noted in some areas of the service, particularly with younger people with mental health needs, people with Learning Disabilities and those who access the Reaching for Independence service; remaining service areas appear to continue to practice in a task centred, service delivery driven manner with there being an over-reliance on traditional commissioned services. Good practice was noted in relation to information sharing between agencies in the context of Safeguarding work and reviews involving providers, however applying the Making Safeguarding Personal principles in practice, and consistency and quality of safeguarding practice could be further improved. Whilst there was some evidence of assessors gathering information about a person’s identity and protected characteristics, this was not consistent and further there was a lack of evidence of how this information was being considered in the context of the person’s assessment and care and support planning.  This is a key area of practice to ensure an effective understanding of the person’s life experience, strengths and goals and can be responsive in developing services, and tailoring the person’s care and support in a way that supports equity in experience and outcomes. To support effective practice, and reflecting the case file audit findings, a refreshed focus is suggested on strengths-based, legally literate practice, together with reviewing the systems and mechanism’s available to assure the quality and effectiveness of practice. 

25. The challenge of managing waiting lists has been recognised and action is being taken on reviews. It is important for assurance that you are clear on how people “wait well”, and that there are triggers to respond accordingly to changes in need of people on any waiting lists. The Peer Team heard about positive changes in the review process: for instance, there was creativity and a person-centred approach in the different ways review plans were shared with the person and taking in consideration of the person’s preferred way of communicating, and the team saw evidence of these being created with audio feedback of their conversations, or pictorially. People described improvement in the review process more generally, in particular the PATH (Planning Alternative Tomorrow with Hope) model for some working age adults which promotes the person’s goals and aspirations. There is an opportunity to roll out the PATH approach, piloted for people aged 18-64, to people aged over-65, so that older adults can be supported to live their best lives in their communities, especially as the model has been so successful. This would encourage equity of opportunity, choice, experience and outcomes for adults of all ages. 

26. Staff are aware of the need to manage the council’s finances but didn’t think this was impacting individual care and support. However, this was not necessarily consistent with the experience of providers or people who use services, who (variously) spoke of the challenges trying to get people’s support reviewed when changes are needed (it can take a long time and providers are left ‘holding the issue’); or that reviews are felt to rarely result in an increase in support (which would have to go to panel, which is seen as time-consuming and bureaucratic, with the “V8 form” referenced). It was questioned whether aspects of the process were needs-led or cost savings-led, with someone describing losing “half their care package during COVID”, and reference made to someone from audit attending direct payment reviews, with a concern that this is about seeking opportunities to reduce support?  

27. There is a larger piece of work around practice transformation, moving more towards asset-based and community approaches, and promoting independence based on assessed needs – something both staff and service managers are aware of and seeking ways to progress. This could release savings in the medium term, but will take time, training, and potentially investment up-front to embed. It was also noted that there is lots of duplication in recording i.e. Care Act / Panel Form / V8 which takes staff time, and thereby reducing time with the person; it may be the case that the new Care Management System (once procured) may address some of this, and its implementation and roll-out could be used as a mechanism for reviewing practice-focussed discussions.  

28. Effective arrangements for out of hours contacts and emergency preparedness appear to be in place, with several examples provided to demonstrate this. Care Direct Plus includes brokering arrangements and uses a duty system during Saturday daytime hours. The Peer Team understand that it is planned to evaluate the effectiveness of these arrangements alongside the introduction of recent changes to front door access, and would suggest the extent to which the Voluntary and Community Services sector is able to contribute and/or sustain their contribution is also considered. The LGA Audit tool used for the case file audit largely provides opportunity to audit work with people receiving services directly commissioned by the Local Authority; as such this perhaps missed the opportunity to see other aspects of the council’s practice that might demonstrate earlier interventions and opportunities taken to provide advice, or to prevent, reduce, or delay the need for future care and support. It will be important to evaluate the impact on people’s experience and outcomes of the recently implemented change in how adult social care contacts with the council are processed. Care Direct Plus are not aware of repeat contacts or how to measure effectiveness of intervention. Supporting people to maintain their independence and not rely on council services unnecessarily will be a win-win in terms of both outcomes for people and budgets; but it needs to be supported by evidence of positive outcomes for those who do not go on to utilise care services, as well as equity of access, provision, and outcome across protected groups.  

29. Developing an understanding of how people experience the assessment processes will help to improve people’s experience, and the effectiveness of the process itself. Comments to the team included lack of flexibility in the (IT) system to record joint assessments, and concern as to whether the default approach of telephone / online self-assessment could be quality assured. Currently choice is offered to the individual when it comes to who they choose to provide their commissioned care; and although the policy regarding user choice of provider is currently under review within planned changes to brokerage arrangements (to ensure it is in line with Care Act and other statutory guidance), Direct payments are made available to and widely used by those who wish to maximise their choice and control. Coproducing work on the assessment and review process might support more focus on goal setting (e.g. the three conversations model could be used to move the service towards an asset-based approach). There has been some co-production work on the new assessment process, but there are further opportunities for greater co-production i.e. people co-writing their My Plan Summary which is circulated to providers. 

30. Carers are being recognised in the Care Act assessment but are not consistently being fully identified or note made of the carer being offered a carer’s assessment. There is training provided for carers and a scheme called ‘Time for you’ which provides contingency planning and alert card, and peers also heard about some innovative approaches to carer support, for example robopets. Carer Ambassadors described feeling heard by the council including elected members; some highlighted choice and discretion in the use of personal budgets, and whilst this was not universal, it provides a positive starting point for future work.  However, carers expressed that they don’t understand how the system works or the options for support (and suggested that they were informed of a legal right not to care, as opposed to being asked if they will continue their caring role and exploring any support required to enable them to do this). There remains a need to enhance the experience of and support offer available to unpaid carers, and ensuring they benefit from timely access to high quality replacement care when this is needed; the Peer Team heard of the ambition and need to expand the Carers’ Sitting service, but equally of concerns relating to quantifying and covering the associated costs.  Similarly, concern was expressed that the out-sourcing of carer assessments could mean that the council don’t see carer needs. In summary, existing engagement with Carers’ groups and representatives (including the Carer Ambassadors approach) provides a good basis for further work with carers, and whilst feedback to the Peer Team suggests that there are some key areas that need to be addressed through these, there are also potentially some quick wins in terms of outcomes in this area of support.  

31. Devon benefits from a consistently high proportion of Good or Outstanding CQC-rated social care provision. This is supported by a robust and well-established offer from the Quality Assurance and Improvement Team (QAIT) within the council’s Adult Social Care Directorate; the team monitors and responds to care provider resilience, development and sustainability risk, including that of provider failure.  The Peer Team heard an example from a care provider of how the supportive QAIT team approach, with ‘positive challenge’, had directly helped them improve their service quality. 

32. The council’s investment alongside other Local Authorities across the south west region in PAMMS (Provider Assessment and Market Management Solution) demonstrates a clear commitment to enhancing and further developing market oversight both locally and regionally to support effective commissioning practice and intelligence.  Weekly locality ‘huddles’ involving multi-agency/disciplinary staff within and external to the council are a very effective means of enabling the system to act on early indications of provider quality, safety or sustainability risk or need, and involve the most suitable team/individual to respond to it. 

33. Care providers in Devon made clear in their feedback to Peers that the pandemic response from the council was “outstanding” in terms of their communication with the sector, “going the extra mile” in dealing with incidents, and offering pragmatic support in helping providers respond to frequent changes in government guidance. Peers heard that there was a “superb response during the pandemic, way above other Local Authorities, coupled with a clear understanding of what the market needed to support both care homes and the NHS.” 

34. The Adult Social Care Directorate has developed choice in the market through the growth of small and medium enterprises and has a thriving market of Personal Assistants which has grown since the pandemic; this helps offer opportunities to those using Direct Payments but has recognised limitations especially when it comes to coverage and contingency. 

35. Market sufficiency and capacity to meet the growing complexity of need remains a challenge, in common with many Local Authorities across the country.  There is a significant reliance on smaller, single location providers. Whilst this provides quality now, there will come a point where current owners and managers move on, and commissioners need to be mindful of this and develop strategies to broaden the market for greater resilience. Adult Social Care commissioners benefit from an excellent suite of detailed data reports and intelligence that will help them monitor and take informed decisions when it comes to shaping the care market.  However, the precedent and dependencies in part created by the robust pandemic support offer may have led to losing sight of - or capacity for - some of the core commissioning strategy work and delivery of the Market Sustainability Plan (MSP). The Market Position Statement – as evidenced in the Challenge self-assessment – “predates the pandemic and needs updating” to align to more recent analysis of need, and to focus more co-design work on adopting a strengths-based way of working with people. Presently the care offer remains quite traditional, focusing on “time and task” over “outcomes” (particularly the older person’s care market); this was attributed partly due to where the care market is at this time, but also to the way in which the council describes things and contracts/procures provision.   

36. Whilst communication channels with the care sector have been maintained post-Covid-19, there were references made to a notable shift in engagement over the last six months, with some care providers either unclear of the council’s care market commissioning intentions and vision, or feeling that it lacks the depth and detail to enable them to meaningfully respond or develop effectively in response. Work done by council teams with its provider market has fostered a reported culture of “pulling together” to manage risks, and using lessons learned to inform responses in the event of home closures or business failures. This is an excellent foundation for further work, however, it needs to be protected and renewed.

Recognising care providers as equal and vital partners in supporting the health and care system’s efficiency and effectiveness will be critical, with the potential to revisit or explore conversations around ‘trusted providers’ and ‘trusted assessors’ as a means to collectively explore shared areas of interest. In general care provider experience and feedback appear to form a key component of the CQC’s assessment framework and approach to determining Local Authority assurance, and so will be an area to remain sighted on from an assurance, as well as market management perspective.  

37. Understanding current and future workforce needs is an essential aspect of effective Local Authority commissioning at the present time, and it is evident that workforce remains a big focus of Devon’s Market Sustainability Plan. It will be important to maintain as much focus on retention within the care sector as recruitment. The council has worked hard to address care market capacity challenges, evidenced by their work developing wider social care capacity (including Proud to Care, Love Care, and the ‘Unleashing Potential’ programme and initiatives). This work has been recognised as good practice by the Department of Health and Social Care who have visited Devon on a number of occasions in recent years.   

38. Over recent months the Directorate has been able to significantly reduce previously high numbers of cases where domiciliary care capacity has been insufficient; and contingency arrangements have been made by increasing the availability of provision, primarily through overseas recruitment activity.  There is a recognised need by Adult Social Care commissioners to now pause, consolidate, and understand the impact of bringing so many new providers into Devon, and with consideration given to wider care market occupancy levels, viability and quality oversight. Concerns were expressed by some providers regarding vacancy levels or having more capacity than is currently needed by the Local Authority, with associated risk of business failure. 

39. The Peer Team understood that a system-wide External Workforce Development Plan is being drafted. Noting the recent levels of successful international recruitment achieved in the external care provider market, it would appear appropriate that this plan take account of the experience of international recruits into Devon communities and how the system continues to support their integration and contribution to safe and high-quality care and support. The Peer Team was advised that there can be an inconsistent approach to new staff’s inductions and that the standards of mandatory training varies.  Similarly noting the challenges of affordable housing in Devon consideration could be given with Housing providers as to opportunities that might be created to further support expansion of the social care workforce in light of the known ageing local population. 

40. The Peer Team heard about examples of good practice in the way the service is collaborating with local housing forums across District Council areas.  Through both operational and commissioning representation on these forums, and the sharing of data, intelligence and commissioning intentions, the service is able to help shape and influence local housing plans.  This work is helping to align priorities and provide opportunities to address the needs of local communities, and the council could look to build on these and other collaborative approaches with partners, importantly including NHS partners.  

41. Whilst strategies commit to enabling community groups to directly design and deliver support, and to work in partnership with the voluntary sector, commissioners have not yet explored fully with them the many opportunities and solutions they can offer both adult social care and system partners in helping to better meet people’s needs and wishes. Working within local communities their offer can help the council in preventing or delaying demand for statutory/costed services.  Growing the community support offer to enable people to remain safe, well and able to stay within their own homes for longer, and promoting information about this, will be fundamental in helping evidence diversity in provision across Devon, as well as to defer or reduce costs in commissioned care.  There was the indication that whilst Adult Social Care commissioners are very keen to invest and engage with the VCS, sustaining the viability and vibrancy of the sector, they “don’t have the reach” and therefore may not be funding or supporting those organisations they might wish to. Furthermore, since voluntary groups are generally funded via grants, they no longer have a contract and there is no contract monitoring; this is a lost opportunity for people who access these services to have their voice heard, and to consider how outcomes from this sector could be developed and included in future market shaping.  
 

42. The Challenge found pockets of very positive practice and development of new service models, including the Urgent Intervention and Review approach that provides opportunity for forward and contingency planning with individuals that will offer supportive structure in the event of a move between services, settings or areas. However, this Urgent Intervention and Review approach is limited to work undertaken with younger adults, the majority of whom have learning disabilities, and its evaluation should consider whether there is a case for extending it to other groups including older people. Similarly, the development of the Transitions Adult Social Care (TASC) team offers the opportunity to engage with young people from the age of 14 and should lead to improving outcomes for young people and their families as they transition from Children’s to Adult Social Care services. Development of support plans in a timely manner and a consistent approach to transition across county has reduced the number of teams people need to work with, and has received positive feedback from staff in children’s services. The practice with older adults who may develop progressive impairments and frailty as they age, and subsequently experience transition through multiple areas of service, needs to be similarly considered to ensure they are afforded equity of opportunity to support their aspirations for later life, in ageing well, and having choice and control in the provision of the right care, provided at the right time, in the place that is right for the person.  

43. Where Community Teams are co-located with health and voluntary sector services, this promotes collaborative working and enables support to be well co-ordinated between services engaged with the person. However, this opportunity of colocation is not currently available for two of the Community Health and Social Care Teams across Devon (although it remains the partnership’s aspiration to find suitable accommodation to facilitate this), and with different ICT recording systems in place there is a need to consider how information can be effectively shared and available to relevant partners to promote safe working across the system for the benefit of the individual and carer. 

44. There was limited opportunity for the Peer Team to explore the safety and effectiveness of hospital discharges which can be a significant point of transition for individuals.  It is understood that discussions are underway to explore opportunities to mitigate risk and provide assurance to providers who may be supporting individuals on discharge for the first time.  Currently, council staff are engaged in daily calls with hospital colleagues to support flow and accountability within the system.  The case file audit provided one example of practice in this area which was felt to have resulted in an over-provision of support largely based on a person’s circumstance rather than unmet eligible needs, perhaps driven by a desire to avoid a social admission to hospital and appeared to be a missed opportunity to either sustain or enhance the level of independence previously experienced by the person. 

45. During the Peer Challenge on-site visits there was a clear example given of work completed with an individual to understand some of the risks that needed to be considered in order for the person to achieve one of their goals.  The model of practice applied was the PATH model, with the person receiving a copy of their personal plan in pictorial and audible form bespoke to their needs and preferences. This was evidence of excellent person-centred practice. In contrast evidence drawn from the case file audit demonstrated a higher propensity for risk-averse practice with limited evidence of meaningful discussion with older individuals to understand their risks and ways these might be mitigated.  Strengthening assessors’ approach to identifying and managing risk can help to ensure that proposed support does not impose unnecessary restriction in the person’s life or lead to greater dependency and reliance on commissioned support. 

46. Peers were able to meet with the Independent Chair and Business Manager of the amalgamated Torbay and Devon Safeguarding Adults Partnership as part of the peer challenge process. It is important to note that for CQC there is likely to be an expectation to have the chance to engage and hear from other members of this key statutory partnership. The current Chair has been in post on an initial two-year contract with an extension for a further two years being recently actioned. This allows for consistency of leadership and further opportunity for the Safeguarding Adults Board (SAB) to work effectively on agreed plan objectives. It appeared that the SAB Chair adopts a very proactive approach in building and maintaining relationships and knowledge to support assurance, including meeting senior leaders and attending other meetings outside of the Board’s own arrangements, and this is acknowledged to be a strength.  The Board Chair had previously been described in a separate meeting as “strong and good to work with, offering good challenge and support”. 

47. There was evidence of the current Safeguarding Adults Board delivering the statutory requirements of a SAB in relation to a) having a 3 yearly strategic (business) plan in place (with annual review); b) a published annual report – although the 2022/23 plan was not yet available at the time of the peer challenge; and c) commissioning Safeguarding Adults Reviews (SARs)for cases which meet the criteria for these. The Chair described SARs as being the “engine room” in helping drive the focus and direction of the Board.  

48. Engagement by SAB partners at Board level was reported to be good and it was suggested that all partners would report feeling equal, though opportunity to test this was not present during this Challenge; however, it was also reported that there had been “a lot of change and churn in staff” and perhaps a sense of “pulling back” by some partners over the last 3-6 months as they come under their own and external pressures and demands. This mirrored some feedback heard at another meeting with council staff involved in safeguarding governance, who referred to sub-group engagement being more robust than engagement at the Board itself, with an over-reliance/focus on the Local Authority. To enable the SAB to remain effective, all members should demonstrate their shared commitment to engagement, contribution and accountability. 

49. It was of particular concern to hear that whilst at SAB level there is good engagement by partners (particularly at subgroup level), at a frontline practice level this was not felt to be the case leading to adult social care staff feeling left to hold and manage complex and high-risk safeguarding concerns, without necessarily having the appropriate expertise or being the right resource to do so.  One example cited was the difficulty in engaging Mental Health services, with the requirement for an individual to be referred to Mental Health services by their GP as a referral from Adult Social Care is not acceptable.  This presents not only a barrier for the individual who may be in need of support, particularly if not registered with a GP practice, but also stifles relationships within the partnership.  Whilst there is an escalation process available, the extent of its effectiveness has not been explored during this challenge.

50. Peers sought to understand how the Board understands and can demonstrate its own effectiveness and learnt of work currently underway to gather 360-degree feedback from its members to help inform its development. There is an opportunity to repeat this ‘health check’ annually or with new members to afford the Board chances for reflection and continuous learning and development.  It was positive to hear of how the community reference group has contributed to the Partnership’s annual report and previous awareness raising campaign activity to support co-production. 

51. It is important to develop a clear and shared understanding of the key safeguarding risks and issues in the area. With this in mind, the SAB will want to review and enhance the performance information/reports it receives so it considers a broader range of intelligence beyond the core LA Safeguarding Adults Collection metrics – for example, safeguarding and mental capacity training compliance, the quality of local regulated health and care settings, wider risks associated with waiting lists, overdue assessments or reviews.  There was acknowledgement that this is “work in progress” with recognition that the current approach is very council focused. 

52. It was noted the SAB currently has a high number of Safeguarding Adult Reviews (SARs) in progress and this has been a significant demand for all to manage, coupled with an inherited 
“legacy of SAR recommendations”.  Peers heard examples of shared learning, for instance when asked how learning emerging from SARs had made a difference, the Chair made reference to being able to provide an account to a coroner inquest of practice change within early intervention teams, as well as working to address domestic abuse in partnership with others - as a common theme emerging from SARs – including the hosting of an event on elder abuse. There is a need to create some stability, commitment and capacity to support and effectively demonstrate how learning from SAR’s is taken into the relevant organisations, with appropriate assurance mechanisms in place to understand the impact of learning in driving improvement across the partnerships; data intelligence is available but this is largely populated with Local Authority data and there is perhaps an opportunity, and need, to improve intelligence from other partners engaged in safeguarding work.  

53. At present arrangements for responding to incoming Safeguarding Concerns involves three separate Safeguarding Hubs located separately across Devon.  These were clearly stated to the Peer Team to be “Triage hubs”. These appear to be significantly resourced, primarily with registered professionals undertaking the triage decision-making.  The recent addition of an Advanced Practitioner role was reported to be positive in that it will afford increased opportunity for quality assuring and supporting Safeguarding practice. These hubs provide the mechanism for “causing enquiries” to relevant partners and provide a tracking and practice quality assurance role for those enquiries caused to other agencies. Where it is anticipated a Safeguarding enquiry will require a multi-disciplinary or multi-agency approach, these enquiries are sent to, and undertaken by, the Community Health and Social Care teams alongside their other Care Act Assessment, Support Planning, and review responsibilities.   

54. Despite the significant staff resource in place the Peer Team understood that managed waiting lists remained within the hubs, a process which may not be efficient/effective given the time needed to keep each concern under review (i.e. risk assessing and reviewing the risk assessment whilst it awaits full triage and onward allocation). There is a current pilot to better manage the timeliness and appropriateness of response, and avoid waiting lists within the Triage Hubs; this approach would sift out (and divert for more appropriate response) “quality concerns” or other concerns that didn’t require a Safeguarding response – so this should then speed up full triaging decision-making and onward allocation and hopefully eradicate any waiting list at the Hub.  However, it was noted that this pilot has required additional staff resource with a consequent risk of impact on staffing elsewhere in the wider service (e.g. in availability of registered professional resources in the operational teams).  It is important therefore that the pilot is evaluated swiftly, and its impact understood both in terms of outcomes for individuals, practice consistency and quality, and use of [staff] resources: are professionally registered staff resources available in the right place, where they can be most effective? The PSW might consider seeking feedback from regional and national peers, to compare and contrast the experience of operating with dispersed Triaging Hubs, a single centralised Triaging Hub, or other approach used to manage incoming Safeguarding concerns and resulting enquiry activity. 

55. Staff reported having appropriate structures in place to support effective safeguarding practice, with obvious passion and commitment from relevant practice and strategic leads. However, peers also heard of the impact on staff wellbeing in the Community teams because of workload demands and capacity, with reference being specifically made at a number of meetings attended to the high volume of, and increasing complexity of, safeguarding concerns.  Whilst non-registered staff reported being assigned to largely supportive administrative duties, initial information gathering and some management of “low-level” concerns under the oversight of a Team Manager, the Peer Team also understood that in some cases due to an absence of registered practitioners, safeguarding enquiry work is undertaken by non-registered practitioners under the oversight of a registered professional likely already managing their own complex workload.   

56. There was insufficient time during the peer challenge process to fully understand the effectiveness of structures and support in place to support not only good practice, but also ensuring manageable workloads. The impact on practitioner wellbeing needs to be clearly understood and supported, and reviewing the effectiveness of current arrangements in managing both incoming safeguarding concerns, and subsequent safeguarding enquiry or non-statutory safeguarding work, can help in this regard. One of the findings of the case file audit was poor management of multiple/repeat safeguarding concerns and associated decision-making and the council may want to consider if its current model and arrangements are effective in supporting robust and consistent safeguarding practice: ensuring that a timely and consistent approach is taken, by appropriately resourced teams of skilled staff, who receive effective oversight, support and development of their practice, and which evidence their application of Making Safeguarding Personal principles. Whilst being informed paperwork has been amended to support practice in this area, this should only be one mechanism utilised alongside supporting behaviour and culture change; ensuring the workforce are engaged and understand that safeguarding remains everyone’s business, and all have equally valid contributions to bring to safeguarding prevention as well as responding to safeguarding concerns.   

57. The Peer Team did not find systemic cause for concern around safeguarding practice, but would note that the Peer Challenge process is limited in scope, so would encourage further and ongoing local assurance to take place. Case file audit identified weakness and inconsistency in practice from initial application of s42 criteria, use of Advocacy, related Mental Capacity Act practice, through to demonstration of Making Safeguarding Personal being embedded in practice. Latest 2022/23 safeguarding performance data also reveals that the conversion rate between concerns and enquiries has fallen to 20.3% (well below many comparator authorities) and warranting further investigation as to whether this is an issue given the triage arrangements in Devon and if so what the possible cause or solution to address is. The use of a Practice Quality Review tool in safeguarding supervision, future case file audit once restarted, together with the development of a new Supervision policy, will all help assure and promote the quality of safeguarding practice and the embedding of Making Safeguarding Personal principles in practice. However, taking a preventative approach to safeguarding also needs embedding in practice with staff understanding how their relationship building with individuals and carers, and exercising professional curiosity, can enable early preventative work with individuals to support them to live lives free from abuse or the risk of abuse. 

58. Practice in relation to Transitional Safeguarding was noted as being included in the Transformation programme; this is an important area for adult safeguarding and more widely for improving outcomes for people moving through services. It is important to be able to demonstrate action in progress, not just in planning. The CQC are likely to expect the Local Authority to provide evidence relating to local processes and pathways for managing safeguarding alerts, enquiries and investigations, and arrangements for monitoring, internal and external oversight and quality assurance arrangements of safeguarding cases, and trends. So being able to provide a strong, consistent and evidence-based narrative accounting for local approach and performance outcomes will be essential. 

59. The Peer Team did not have opportunity to see what Safeguarding training is in place, but this was reported to be comprehensive ranging from awareness raising through to managing whole service Safeguarding enquiries. However, consistency in induction of new staff and standards of mandatory training were reported to vary in quality, and further development in this area will support improved practice (and assurance), and evidence of what is in place and evaluation of its impact in improving practice will support (and be needed) in future assurance processes. 

60. Peers heard of the positive relationship with providers that developed during and following the Coronavirus pandemic and the support the Specialist Safeguarding Hubs provide to providers and teams to support good safeguarding practice.  It was reported that previously care providers were Devon’s highest source of Safeguarding concerns referrals, but following the provision of revised guidance, some concerns are instead diverted for Quality Assurance and Improvement Team (QAIT) response and support.  The involvement of the QAIT in supporting providers during whole service safeguarding enquiries was reported and recognised as a positive and supportive development helping to bolster the quality and safety of services. The weekly locality ‘huddles’ were again referenced as an effective means of helping providers manage concerns outside of safeguarding. 

61. Devon appears to have good strategic governance arrangements in place; these are well-established and help to enable place leadership across a wide range of issues and a large, rural geography. This was evidenced through conversations with Councillors, NHS leads, providers, and other partners such as the VCS. The Peer Team heard of this being a key juncture in developing a refreshed strategic direction and leadership across the County with recently appointed (within the last 12 months) Chief Executive, Director of Adult Services, Director of Children’s Services, Director of Finance and HR Director; as well as Integrated Care Board senior leadership roles recently appointed in the NHS. New relationships and directions will take time to form and shape which represents a challenge given the (necessary) pace of change. But it can also offer an opportunity to raise the profile of Adult Social Care and what is needed to deliver sustainable transformation within its partnerships and service models going forward. Maintaining a high profile and strong voice within Corporate and wider management structures of the council, and in key partnership governance arrangements such as the ICB, will therefore be an essential investment of senior management time over the coming months.

62. Partnerships appear to work well within governance arrangements across Devon, and give an impression of a can-do approach that is enhanced by partners but not disproportionately driven by them. The peer team heard of examples of excellent partnership working through these governance structures (such as work with health partners to address key locally identified mental health issues). Direction and challenges are clear and there is a sense of long-standing relationships that will help the respective organisations deal with difficulties. Joint leadership during Covid was cited as an example of the tested partnerships working under strain to agree new ways of working that were tailored to Devon’s care market and geography. There was a sense of challenges being managed locally with subsequent escalation to strategic leadership or a partnership board if local single agency solutions need to be enhanced or can be better funded or resolved by joint working. Conversely, leaders seemed to be able to disagree and decline to proceed on a recommendation and this is a signal of a mature partnership: of partners that work well together, but equally well “apart”. 

63. The council’s governance combines horizon scanning from differing perspectives and provides a structure for joint discussions about strategic priorities. This is supported and informed by good data and intelligence to help agree and set informed priorities for combined efforts and better outcomes. Peers saw evidence of joint intelligence on key issues. More generally the Peer Team were very impressed by the excellent suite of detailed data reports and intelligence that Adult Social Care commissioners have access to; these can be used within the Directorate, and with partners to inform planning, and to help them monitor and take informed decisions when it comes to shaping the care market, managing risk, and wider service transformation and delivery. 

64. Elected Members are engaged in understanding the challenges facing Adult Social Care and are represented on key governance groups. It will be important to maintain this engagement and support (and across the council) over coming months, and to raise awareness of the adult social care agenda, including its opportunities and risks and their mitigations, in available council structures such as Scrutiny and wider member engagement activities. 

65. The Devon Audit Partnership expressed confidence in relation to how the Adult Social Care Directorate “manages risks and seeks support”, with a risk ‘champion’ who serves as an effective corporate ambassador in role modelling routine risk identification and mitigation. Risk management is a key part of assurance activity and reports into the Assurance Board, and it was good to hear Audit describing Adult Social Care as “not a Directorate we are concerned about [in terms of their approach to risk and its management]”.

66. The Peer Team heard an awareness of the scale of the challenge for the council in delivering sustainability, both financially and in terms of e.g. workforce. Savings associated with Adult Social Care are challenging, both in-year and for future budget cycles, and are compounded by both cost and performance pressures from Children’s Services (whose poor OFSTED Inspection and subsequent Intervention necessarily requires improvement focus and resource, including financial support, within this area). It will be equally important as resources become more stretched in Adult Social Care that the political and officer leadership of the council continue to maintain as rigorous a focus on quality and outcomes in provision as it does on sustainability. Developing plans for sustainability and savings in Adult Social Care that are owned and delivered across the council and with partners can help not only to demonstrate and mitigate associated risks, but can also develop buy-in from both internal and external partners, including District and Borough councils that play an important role in planning accommodation for their populations that include people that draw on social care services. This could help to demonstrate how (with wider support) medium-term savings can be developed which align with improved practice and support better outcomes for people (focussing on asset- or strengths-based models of support for example). 

67. Despite the extensive governance meetings being available, reference was also made to some of the more detailed and in-depth work that has been and is being undertaken on reducing costs, and plans to achieve savings; and that, to some extent and through necessity, preparatory work on the council’s savings was undertaken within the council, with less early warning for trusted partners than they might have hoped for. Cited examples of this included District and Borough Councils reacting adversely to a proposal for reduction of support for homelessness and housing (regarding what the local impact of that reduction may be); and care providers referencing cuts that will significantly impact preventative work that helps stop people from reaching crisis point. There is a risk during times of financial stress of retrenchment, just at a time when better solutions may lie in the greater and more transparent sharing of risk with partners, and managed transitions of reductions in funding. Consideration might therefore be given to whether leadership discussions with a small core group of Place leaders may enhance the governance arrangements to ensure as far as is possible a “no surprises” culture remains. 

68. There is further opportunity to evidence wider partnership working with health system partners so services work seamlessly for people. The council leads and delivers outcomes across a large and complex geography – working very closely with eight districts, four Acute hospitals and one ICB as an example. The Peer Team heard of examples of integration with NHS and wider health partners that have been in place for many years in some instances: integration of local delivery is working well at an operational level, and has been happening for the past 15 years with joint funding panels, management and team meetings. Evidence was provided for the peer team of joint budgets and pooling of discharge to assess (D2A) funding for discharges. These examples of extensive and in-depth working between the council and the NHS and secondary care partners are particularly positive in a climate where D2A funding has a hard stop and is being withdrawn in neighbouring ICB areas and across other parts of the Country. And it is testament to the hard work of senior managers working on joint solutions for the front line that a significant winter fund for 2023/24 is going to be made available for joint discharges across Devon.

69. It was good to meet with leads in jointly integrated posts but practical challenges remain. Whilst teams benefit from being co-located, they struggle with information sharing because of the use of two different systems and recording mechanisms, and lack of system access from the council through into NHS systems and vice versa. Staff articulated some frustrations on systems and access, and these can become disproportionate barriers to further success, as energy is dispersed on unnecessary steps to retrieve data from more than one system. Whilst budgets are to some extent shared at patient level, executive posts and strategic budgets are not wholly joint. 

70. It is important to create and sustain a culture of innovation and positive risk taking through creating an environment of trust, and with an equal focus on medium term transformation as on short term benefit. Delivering cultural change will need investment in people, training, and sufficient timescales. Overall, the council feel very connected to good practice and national initiatives: following feedback, the council website is at 98% rating for accessibility, with the council using a Digital by design and not default methodology; and staff demonstrate ambition to try new things and do things better, and DHSC and Skills for Care showcase local work with external providers. 

71. What was less in evidence is a deep dive into innovations for solutions and to some extent, this is accepted as the norm. Whilst there is significant pilot activity the translation of successful pilots into business as usual and new ways of working was cited as being low. There is a sense that more radical solutions for the challenging years ahead will be needed to try to stem demand and increase prevention activities (for instance, around asset- or strengths-based practice, or upstream prevention). Officers have worked together in Devon for many years in some teams and whilst this provides a foundation for trust and acceptance, some challenge through leadership is also needed to help engender a stretch factor for the significant challenges ahead. Leadership in that context needs to help to establish a framework for some positive disruption and managed risk taking, to allow strong ideas to take hold and to extend trials for the medium term - to provide a chance for results to embed. 

72. Ceding some control through recognising the strengths of other statutory and non-statutory partners, communities and people, might support or facilitate innovation. A good start has been made in developing a culture of collaboration with VCS and communities, and the council might consider how it could better engage the creative energy and community-engaged offer of the sector through dialogue, or a more “open” approach to grant and other funding. 

73. Whilst peers heard of some concerns from staff that corporate colleagues do not fully understand the pressures facing adult social care (particularly in relation to the fragility of the social care workforce, housing challenges, and the impact of cost of living and inflation on communities, the care market and individuals), staff mainly exhibited trust in senior managers and provided examples of feeling supported to redirect and adapt. The Peer Team heard that despite a focus on achieving savings, client outcomes were maintained as being central. This style of supportive leadership will be fundamental in approaching the challenging years ahead for social care in general, and successful achievement of savings in particular, including setting the tone for new ways of enabling more commercially astute social care in Devon. Staff and people who use services recognise a council with stable workforce which promotes continuity, and the Peer Team met and heard about committed and able staff who want to problem solve and improve their service offer. Clear and values-led professional leadership can be supported to deliver ideas for improving practice and how to deliver transformational change, backed up by strong data, information and intelligence to inform and support decision-making.

74. The Peer Team were not able to assess the success or outcomes on leadership of new savings plans as this had only recently been announced. However, the Team heard about successful attainment of reductions of costs of care for older adults through review work, and this offers a foundation for wider practice development. Adaptive leadership of key issues was also evidenced through teams tackling challenges of managing packages of care (hours) in different ways across client groups – lessons from Older Adults reviews being ported across to reviews of Learning Disability clients, for example. 

75. The council worked very hard to prepare for and facilitate an excellent Peer Challenge process. Dedicated time and resource and leadership were identified at an early stage and were consistently available throughout the process. There can be a risk of under-estimating both the lead-time (including for different aspects of the preparations) and necessary resources needed to prepare for a Peer Challenge (or future CQC assurance process); whilst this was not the case here, those involved nevertheless described the degree of “stretch” during the process itself, which might suggest a need for increased resource whilst an assurance team is on-site.

76. The council developed an excellent online Position Statement which helped to guide the Challenge Team in their thinking, along with a comprehensive set of supporting materials. These were delivered in a timely way, and connected through the Position Statement with clickable links, which provides a helpful means of aligning evidence to key statements or sections. Whilst there were some issues for the Peer Challenge Team in accessing some of the online resources (in particular those maintained within the confidential Sharepoint site) this may not present an issue in a future CQC Assurance process if they (for instance) develop a secure portal to upload evidence and information to. However, other mechanisms for communicating materials are worth considering as a fall back.

77. Further consideration could be given as to how to more routinely develop evidence of outcomes for people who use or have contact with your services, and how to align this to your position statement and other evidence as part of an assurance process. Similarly, for evidencing the impact (or progress) of changes or improvements that you are planning, for instance around strengths-based practice, or coproduction. Some of this might be developed through your care management system and future case file audits, as well as through regular reporting on transformation and improvement plans. But evidence of this kind will also come through contact and conversation with front-line staff, and more time to engage with staff groups in any future assurance process would help the team to build a picture of this.

78. There was a specific request to include a Peer with lived experience in the Challenge Team, and funding made available to support this. This was facilitated by the LGA and was a very positive part of the Challenge overall, both in planning and delivery, and a positive reflection on the Directorate’s intent and approach to it. However, further consideration could be given as to how to more fully involve people with lived experience in the preparation for future assurance processes, as well as in the process itself. The team felt there was less opportunity to hear from people who rely on or may need to use council services than they would have found helpful. For future planning purposes the council might want to consider how to increase access to these groups, either during the Challenge, or indeed through bespoke or more routine focus groups in advance of it, thereby increasing the range and impact of the voices of people with lived experience.

79. 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 provide security lanyards each day; car parking access was made available; there were no access issues; refreshments and lunch were made available each day (and access provided to a shared kitchen area); and IT resources and wifi were made available whilst the team were on-site.

80. The council office where the team were situated is a recently renovated office space, which allowed plenty of room for the Peer Team, along with dedicated meeting rooms nearby for interviews and focus groups. Whilst the dedicated space was helpful, it did however restrict the Peer Team in their informal or situational interaction with wider council staff, which may have both pros and cons for a formal assurance team (and the council) in terms of building a sense of staff and culture.

81. The Challenge Team were aware that a thorough communications approach to the Peer Challenge was developed, including briefings and updates (for staff and more widely), and with a plan for communication following the Challenge itself. This resulted in a good level of engagement from those invited to attend the Challenge, with the very large majority of invitees arriving for both interviews and focus groups. All participants showed good engagement with and understanding of the interview and focus group process, as well as of the wider Challenge.

82. The Team noted that there was a process for debriefing staff following meetings on-site, and that feedback from this was used to inform a sense of how the Challenge was progressing and any issues arising. However, this was less “formalised” or in real time than e.g. for an OFSTED Inspection. There was therefore less rigorous oversight of the process as it developed than may be needed or desirable in a future CQC assurance visit.  

83. There was generally positive feedback about the process / on-site team, but some sense that not all peers were as fully prepared for individual meetings or focus groups as participants might have expected.  This might be a learning point in terms of an assumption of particular expertise carried by any given member of a peer (or inspection) team, and that some preparation of the key messages for communication to peers in any given session might be helpful to maximise the chances of an assurance team being able to find out about the outcomes or key points they may be looking to hear about (or that the council may wish them to hear about!). However, the engagement and positivity with which the Challenge was received was certainly evidence of the positive attitudes of staff towards the process, and indeed more generally within and around the council.

84. Whilst the initial presentation from the council was kept “in house”, the final presentation from the Peer Challenge Team was open to wider invitees (including partners and staff) who had been involved in the Challenge. This showed an openness and transparency in the process, and a desire to engage with stakeholders around assurance and improvement. We understand that there is a plan in place to swiftly disseminate key messages from the Peer Challenge and to take both the findings, and the resulting action plan, through formal Cabinet and then public council processes.

85. The council would benefit from quantifying the resources deployed in terms of staff time, and at all levels, both in preparation for the Challenge (e.g. in preparing the Position Statement and supporting evidence, development of timetable and diary management for invitations, etc), and whilst the team were on-site. Whether this may need to be built into CQC preparation either as a standing resource, or some kind of “on call” team with responsibility, experience, training, and allocated time as and when called on, could be something for future budgetary and role considerations. Those who were involved in preparing for and supporting the Challenge will have developed good knowledge both of the process, and of resources in the council which are required to prepare for and support it, and consideration might be given as to how to harvest and grow this knowledge in advance of any future assurance process.

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 these forward. In due course the LGA will be pleased to work with the council to consider progress in line with wider Sector Led Improvement work, and there is an offer of further activity to support this, including through ongoing engagement with the South West Region Care and Health Improvement Advisor (CHIA), and 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 visit: 

86. Continuing work across the council and with partners to raise the profile of Adult Social Care, and its role within the wider work of the council and local communities, will be central over the coming months. Key messages from this report, updates on preparation for Adult Social Care assurance, as well as on progress against both savings and transformation plans, will all provide an important framework in which council and wider system leadership can understand and balance risks and opportunities for Adult Social Care, and notably the importance of work to mitigate the risk of receiving a less than good judgement from any future CQC assurance process.  The quarterly cycle of review and refresh for the Adult Social Care Position Statement (mentioned as planned following the Challenge) along with regular internal council and wider presentation of this, might help to raise the profile and ambition of this work, as well as developing wider and fuller understanding of its purpose, impact, risks and mitigations.  

87. There are a range of different plans across the Directorate, including around savings, transformation (in different service areas), assurance, improvement work (for instance around waiting lists or practice), etc. Bringing these plans into alignment will help not only to develop synergies and avoid duplication, but can also help to balance and manage risks and priorities, identify mitigations to key risks (where there are inter-dependencies), and where possible to identify initiatives or pilots that could be scaled up at pace, or accelerate where they are shown to work (in Devon or elsewhere).  

88. Developing better and more varied ways to routinely create and collect evidence of outcomes for people will help to prepare for future assurance. This might include the aggregated out-turn from reviews, feedback from people and communities and partners, or formal coproduction. A clear focus on delivery of outcomes, through transformation and innovation, can also help to maintain quality and values in the service offer, with equal priority to the management of risk and financial out-turn.   

89. Alongside this a renewed approach to regular case file audit, and other processes for peer learning at a practice level, should underpin a refreshed approach to quality assurance, wider practice and approach and efficacy, and safeguarding practice. This can also be used as a means to embed practice change, and to bring challenge to frontline teams in line with these changes, in particular relating to outcomes, savings and independence.  

90. Building on existing work on coproduction will help to engage with wider communities, and to develop services (at both individual and macro-levels) that best meet their needs. It will allow staff and system leaders to learn from those who have lived experience of using adult social care and other public services, and to develop an offer in line with what works best for local people. And it can help to build capital with those who will continue to rely on local services in the coming years, and whose support will be needed when making difficult decisions, or managing significant transformation in how services are offered.

For more information about this Adult Social Care Preparation for Assurance Peer Challenge in Devon County Council please contact: 

Tandra Forster 
Director of Integrated Adult Social Care and DASS 
Email: [email protected] 

The LGA Programme Manager for this programme of Adult Social Care Preparation for Assurance Peer Challenges is: 

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.