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Final report: December 2023
Background
Rotherham Metropolitan Borough Council (RMBC) asked the Local Government Association (LGA) to undertake an Adult Social Care Preparation for Assurance Peer Challenge at the council, and with partners. The work was commissioned by Ian Spicer, Strategic Director Adult Care, Housing and Public Health who was seeking an independent perspective on how prepared adult social services are for a Care Quality Commission (CQC) assessment with a particular focus on learning about staff readiness and awareness in advance of CQC visit and to gain an external view of where Rotherham adult social care is now without prejudice following the Jay Report. The purpose of a peer challenge is to help an authority and its partners assess current achievements, areas for development and capacity to change. Peer challenges are improvement focused and are not an inspection. The peer team used their experience and knowledge of local government and adult social care (ASC) to reflect on the information presented to them by people they met, and material that they read.
As preparation for an assurance peer challenge teams typically spend three days onsite in addition to undertaking case file audits, lived experience interviews and a review of data. This process should be seen as a snapshot of the client department’s work rather than being totally comprehensive.
All information collected is non-attributable to promote an open and honest dialogue and findings were arrived at after triangulating the evidence presented.
The members of the peer challenge team were:
- Jennifer McGovern, previously Director Adult Social Services and Integrated Commissioning, Cheshire West and Chester Council (until 2022)
- Councillor Keith Cunliffe, Wigan Council
- Jane Myers Strategic Operations Lead (Adult Social Services), Rochdale Metropolitan Borough Council
- Sheila Wood – Head of Service and Principal Social Worker, Cheshire East Council
- Pippa McHaffie, Adviser - Adults Peer Challenge Programme, Local Government Association
- Penny Hynds Peer Challenge Manager, Local Government Association.
The team were on-site at RMBC for three days from the 5 to 7 December 2023. In arriving at their findings, the peer team:
- held interviews and discussions with councillors, officers, partners, and carers
- held meetings with managers, practitioners, team leaders, frontline staff, and people with lived experience
- read a range of documents provided by RMBC including a self-assessment and completed six case file audits with three follow up conversations plus spoke to 12 other people with lived experience.
The peer team were given access to at least 300 documents including a self-assessment. Throughout the peer challenge the team had more than 35 meetings with 143 different people. The peer challenge team spent around 200 hours with RMBC the equivalent of 30 working days. Invariably this is still a snapshot of RMBC.
Specifically, the peer team’s work focused on the CQC framework four assurance themes for the up-coming adult social care assurance process. They are:
Care Quality Commission Assurance themes
Theme 1: Working with people:
- assessing needs
- planning and reviewing care
- arrangements for direct payments and charging
- supporting people to live healthier lives
- prevention
- wellbeing
- information and advice
- understanding and removing inequalities in care and support
- people’s experiences and outcomes from care.
Theme 2: Providing support:
- market shaping
- commissioning
- workforce capacity and capability
- integration
- partnership working.
Theme 3: How the local authority ensures safety within the system:
- Section 42 safeguarding enquiries
- reviews
- safe systems
- continuity of care.
Theme 4: Leadership covers:
- strategic planning
- learning
- improvement
- innovation
- governance
- management
- sustainability.
The peer challenge team would like to thank Councillors, staff, people with a lived experience, carers, partners, and providers for their open and constructive responses during the challenge process. All information collected on a non-attributable basis. The team was made very welcome and would like to thank Dania Pritchard, Caroline Hine, and their team, for their invaluable assistance and for the support to the peer team, both prior to and whilst onsite, in planning and undertaking this peer challenge./p>
Initial feedback was presented to the council on the last day of the peer challenge and gave an overview of the key messages. This report builds on the presentation and gives a more detailed account of the findings of the peer team.
Key messages
There are observations and suggestions within the main section of the report linked to each of the CQC themes and quality statements. The following are the peer team’s key messages to the council.
1: Strong and clear strategic direction
Rotherham Metropolitan Borough Council adult social care has strong leadership with very strong relationships with partners across the system as demonstrated by the unique focus on “place” and the Rotherham Way. The council is committed to improving and this was the third peer review undertaken by the LGA within the year – with a Corporate Peer Challenge earlier in the year and a Safeguarding Adults Board Peer Challenge completed by the LGA in Summer 2023.
The refreshed Adult Social Care Strategy 2024-2027 is going to Cabinet in January 2024 and has a clear vision:
“Enable every resident with care and support needs to live their best lives, with the people they value, close to home and with access to the right support at the right time”. The peer team were impressed by the comprehensive consultation process in developing and “socialising” the emerging strategy. This aligns and reflects the Integrated Care System (ICS) and Integrated Care Board (ICB) strategic direction as well as RMBC strategy. The council may want to consider how they will operationalise the strategy through to front line staff, people with lived experience, and partners. Similarly, there are opportunities to highlight where there have been positive outcomes arising from the work that is happening.
A place based approach is embedded throughout the organisation with Rotherham Place being part South Yorkshire ICS which covers Barnsley, Doncaster, Rotherham and Sheffield. Rotherham Place is enhanced and enabled by coterminous arrangements with one acute trust (Rotherham Foundation Trust), one mental health trust (Rotherham, Doncaster, and South Humber - RDaSH) and Voluntary Action Rotherham.
The peer team were very impressed with the overall corporate approach, ownership, and direction of adult social care.
2: Positive workforce
The peer team were impressed by the number of front-line, managers, Heads of Service and Senior leadership that they met in several meetings. The overwhelming message they heard from the staff they met was how proud and happy they were to work in Rotherham, that they felt very supported within their teams and by their immediate managers. Many of the staff had been working in Rotherham for many years (over 40 years some of them!) but there was also an increasing number of newer staff the peers met too. It was clear that the staff had found strength within teams to manage the difficulties that Rotherham had experienced when commissioners had been brought in 2014. However, the team felt that this may result in a “silo” mentality and felt there would be a great opportunity when the ASC Strategy is implemented (if approved by Cabinet in 2024) to encourage a wider identity for front-line staff of being part of ASC and RMBC.
The heads of service and senior staff were committed and passionate with an aspiration to be the best for Rotherham and its residents. They seemed to have a good understanding of the council’s strategy and the vision and way forward for adult social care that was emerging. The peers heard excitement and enthusiasm about the ambitions going forward with the resident being the reason they were there to make a difference. This was articulated in the following quotes the peer team heard:
I feel proud to be part of my team, we are stretched but are a very supportive team – from high up and throughout the team. I really enjoy my job.”
It is great to make a difference to people’s lives”.
3: Senior leadership team
The adult social care senior leadership team is relatively new, with the Director of Adult Social Services (DASS) having been in place in his current role for just over 2 years (he came in 2018 as Assistant Director (AD)), the AD Strategic Commissioning since early 2022 and AD ASC and Integration being in position since Dec 2022. The team are energised, engaged, and ambitious. The DASS has significant personal credibility with members, staff, and partners and there is a confidence that he has established a strong Senior leadership team that will deliver improvements.
External relationships are excellent, and the peer team heard positive stories from several partners and people with lived experience. There is evidence of extremely strong relationships with the ICS with a culture of genuinely working together with a “no surprises” approach – that fosters transparency and is built upon trust to ensure all partners are aware of any issues within a partner that may adversely impact them, and they work together to address it minimalizing the risk across the system. The peer team heard of a good example of this regarding changes RMBC are implementing to relocate Adult Mental Health Professionals (AMHPs) and Mental Health Social Workers who currently are co-located within the mental health crisis team back into RMBC. The potentially negative impact on RDASH Mental Health Trust has been openly discussed and worked upon collaboratively to minimalise it.
These relationships, along with positive internal senior endorsement and partnerships, provide the team with significant opportunities in preparation not just for adult social care assurance but for ICS assurance.
The role of the Principal Social Worker (PSW) is a key position for CQC assessment and RMBC. The PSW in Rotherham was made permanent in April 2023 and the peer team were impressed by what she has already achieved in a relatively short period. It was evident that the PSW works closely with the AD ASC and Integration and the peer team were impressed by their close and complementary partnership which has already made significant improvements and recognised that there is an ambitious programme for further changes and improvement. The peer team were concerned that there were many moving parts and this needs to be managed and communicated very clearly to the workforce for effective implementation. The PSW is central to the development and promotion of practice and the peer team saw several examples of good practice that had been implemented to support the further embedding of strengths-based approaches and person-centred care. These included the safeguarding pathway with Liquid Logic, the introduction of 7-minute briefings and the drop-in sessions to ascertain the views of staff about what is important and new practice and supervision framework. There are well developed plans in place to launch several initiatives by the end of March 2024 such as the new practice framework, quality assurance framework, supervision and audit framework. This includes an opportunity to further develop a better understanding of organisational safeguarding in conjunction with commissioning.
4: Social work and reablement vacancy level
The peer team were concerned that the high vacancy rate for social workers (25 per cent) was having a knock-on effect on many areas across ASC in Rotherham such as waiting lists for assessments and safeguarding issues but recognised that the ASC senior team were aware of this issue and had put in mitigations to help manage it. The DASS explained that the vacancy level has been at a similar level since he came to Rotherham five years ago as Assistant Director Adult Care and that much work had been and was continuing to be done to try and attract new social workers to Rotherham. They are looking to learn from neighbouring councils who did not seem to experience the same issues. The council has successfully recruited Assessment and Review Coordinators (ARCs) but the team felt that the lack of social workers contributed to delays in decision making and this was evidenced by some of the lived experience interviews. The AD ASC and Integration supported by the PSW had recently established the role of advanced practitioners to provide career progression pathway for social workers in response to learning from exit interviews and they are currently recruiting for these roles. The peer team heard that a Principal Occupational Therapy (OT) role is being introduced and that this role is being jointly funded with Rotherham Foundation Trust.
The peer team heard of how the AD and PSW have recently revised the workload management and risk prioritisation tool to incorporate complexity, travel time and a wellbeing element in the case load weighting. The revised tool is currently being piloted in the central team. The peer team were particularly interested in the inclusion of wellbeing within the tool and felt that this was unique to Rotherham and could be shared among peers to disseminate good practice.
Another area of under establishment is reablement where the demand is greater than capacity. The reablement team has only come across into the RMBC provider service in the last year and they have set up a “task and finish” group that is looking at quickly addressing this – already they have offered current part-time staff to increase their hours and 14 had opted to do this. This is the first step in a programme of work to increase the capacity in the team.
The peer team heard from several managers and heads of service who felt that the recruitment process could be more timely and less bureaucratic. They felt that this meant that potential recruits opted for other positions in neighbouring authorities. The council may wish to examine whether this could be more streamlined to enhance recruitment and how ASC can be further supported in this area.
5: Streamline pathways and new models with the focus on the voice and experience of the resident
The peer team were informed of several initiatives, pathways, and models being introduced. For example, as part of the urgent and emergency care programme the transfer of care hub has recently been developed linking to the integrated discharge team and home from hospital. There were also a number of ways to access services involving different teams (contact centre, six locality teams and community occupational therapists for example) this could lead to duplication of care and handoffs and a lack of management oversight, as well as confusion for people and their carers who need to access services. This was reinforced in some of the conversations with people with lived experience which raised concerns with the peer team, these concerns were passed onto the PSW who dealt with the two individual scenarios immediately. Individual discussions with people with lived experience suggested that the streamlining of pathways together with greater clarity of expectations and timelines for processes could be beneficial for residents and staff. Visibility and communication is required to ensure that customers, and staff have clarity regarding access points as well as points of contact once a service is established and may also support the management and transparency of waiting lists particularly for the allocation of social workers.
ASC may wish to consider how new grant-funded initiatives will be continued (if evaluation shows they benefit resident outcomes) and become business as usual.
6: Communication and feedback loop
The ASC senior team were undertaking great efforts to communicate within ASC with a newly established newsletter since October 2023, 7-minute briefings, brunch and learn sessions. The peer team heard from some of the conversations with front-line and more junior staff that they could send feedback up to senior managers but did not feel there was communication back down around concerns that was timely or sufficient – two-way feedback may be an area where things could be improved. This seemed to be a particular issue lower down the organisation and there may be a training opportunity for team leaders to ensure cascade and signposting of information to staff.
Theme 1: Working with people
This relates to assessing needs (including that of unpaid carers), supporting people to live healthier lives, prevention, well-being, and information and advice.
Strengths
- Like many ASC services, RMBC are challenged by increasing demand, however there is a continued focus on waiting lists which has resulted in a significant reduction in time delay for assessment.
- There is strong evidence of strengths- based/personalisation approach within the cases viewed as part of the case file audit.
- ASC information provided via the council website proved to be accessible, intuitive and easy to navigate.
- The work of the public health team is impressive and it is well-integrated within ASC as demonstrated by a strong emphasis on a preventative offer.
Considerations
- The feedback communication loop could be strengthened – this was a repeated theme with staff, residents and providers and reported under key messages.
- Deprivation of liberty safeguards assessments (DoLS) within community teams need to be subject to the ADASS triage risk tool. Ensure that carers are consistently offered the opportunity for a carers assessment.
Case file audit findings
- The peer team considered six cases in the audit. Each case was reviewed by the peer team’s PSW alongside RMBC PSW.
- There were some good examples of strengths-based practice, within the case audits and workers going the extra mile to support outcomes for individuals.
- Recording was comprehensive demonstrating a good use of analysis, evidence of Care Act, Mental Health, Continuing Health Care (CHC) and mental capacity considerations and clarity of professional judgement.
- There was only one that raised questions about practice. It was in relation to joint working with children’s services and the need for the adult social worker to take a broader think family/multi-disciplinary team approach to support the family. The situation concerned a referral from a college tutor in respect of the wellbeing of a 17 year old young carer who was struggling to support her mum (who has some physical disabilities) with care tasks, while also trying to look after her two young siblings including taking and collecting them from school, while also trying to hold down a full time college course. There is a recommendation that more joint work could have been done with the family and with children’s services.
- Triangulation of case audits was undertaken by three telephone calls which provided feedback with two reporting positive outcomes and being very complimentary of the social work staff. The other identified areas of concern which the PSW followed up immediately and resolved but highlighted the difficulties with the handoffs and lack of timely feedback as stated previously in report. The learning from this for the peer team’s PSW and Rotherham PSW was the value of doing telephone follow up of cases audited and the value from this learning and it is recommended that this is included in the process going forward.
- Rotherham recently introduced a new safeguarding pathway in Liquid Logic. There is evidence to suggests that this is working well and it should lead to better quality safeguarding data, but it is also recognised that there is an ongoing need to support staff in the use of the documents in order to increase their confidence. Examples of learning from the case audits has been included within the relevant quality statements.
Quality Statement One: Assessing needs
Assessments
The self-assessment showed that RMBC are aware of the high waiting lists for assessments, and this was confirmed in conversations with staff. There has been a strong focus on reducing the waiting lists for assessments over the last year with a 50% reduction in Care Act Assessments. Community Occupational Therapists (OTs) assessments had shown a marked improvement in waiting times resulting from commissioning independent OT’s and skills matching to cases within the team. Concerns were raised about the number of retirements in near future in the community OT team and how this will impact both assessments and packages of care and although early planning is taking place the team will need to be mindful of the challenges in recruiting new OT’s The peer team heard that there was now a new transitions manager in place and the team was at full capacity.
The case file audits highlighted some good examples of strengths-based assessments with interventions tailored to individual outcomes and a commitment by the workers to provide support in ways that work for the person. Invariably there were also some cases with room for improvement and the council’s internal audit process was identifying improvements on an individual basis and the learning from the peer challenge telephone feedback was that this would be very valuable to do more regularly to triangulate the case audit work. Consideration of mental capacity within assessment and support planning was evidenced in interviews and there was clear evidence in the case files that were audited and that the consideration of mental capacity was embedded in practice along with evidence-based recording to support professional judgements.
A consistent theme that the peer team heard from the lived-experience residents was that communication could be improved – that there were often long gaps in being contacted which created anxiety for the person who then feared that nothing was being done or they had been “lost in the system”. There were some examples of handoffs between teams and the person with lived experience being told they would be contacted but then heard nothing – this was particularly true for some of the carers. The peer team recognise that there are delays from assessment to putting in packages of care or getting financial support, but concerns and anxieties of residents could be reduced by regular feedback (even if nothing is decided as yet but it is still being worked on).
The peer team heard in the initial presentation and within the self-assessment that preparing for adulthood assessments were started at 17.5 years and this concerned the peer team due to the proximity of them turning 18 and RMBC may wish to consider having these assessments initiated at an earlier stage to ensure smooth transition and support. It was identified in the operational safeguarding group that an area of development was around the “Think Family Approach” with the intention to build stronger relationships with children’s services around transitional safeguarding, leaving care and work with chaotic parents.
Carers assessment and support
RMBC had 50 carer assessments on a waiting list in August 2023 which has reduced from 116 in January 2023. The peer team were unable to get a full picture around carer assessments but felt that the number of carer’s assessment carried out are low as a proportion of the total number of people who RMBC provides services to and this is an area that ASC may wish to explore further to ensure itself that adequate carer assessments are being done. The peer team met with 6 carers in different lived experience interviews. The peer team heard that there was potentially confusion where there were multiple caring responsibilities across a family and both children’s and adults services where involved and there could be the opportunity to work closer with children’s social care to ensure a more joined up approach. The peers heard from the limited number of people they spoke to that the carer assessment and ongoing support was more traditional, not bespoke or ad hoc which carers would prefer. There were instances described where long-term care was being provided when more short-term and responsive care was required. The carers that were spoken to would value the opportunity to meet others to build peer support and reduce the isolation carers can feel alongside more timely and appropriate respite.
RMBC’s self-assessment outlined the strong system wide approach as outlined in the Borough That Cares – Strategic Framework 2022-25 – which brings together under the Health and Wellbeing Board a focus on unpaid carers.
The peer team heard how valuable some of the micro-social enterprises set up under community catalysts were to support carers alongside voluntary care sector initiatives, but these services could be advertised more to carers, so they take advantage of them. Unfortunately, no voluntary care sector groups were interviewed during the visit and given the importance of this sector to help keep people independent and provide support to residents and particularly carers, some consideration should be given to ensure they are more visible for CQC.
Quality Statement Two: Supporting people to live healthier lives
Preventative offer
The council is committed to enabling Rotherham residents to live healthier lives for longer and maximises their independence outlined in their refreshed ASC strategy by ensuring all residents have access to right information, access to support and services tailored to them, access to local communities and access to right services at the right time.
The peer team were impressed by the Rothercare offer which can be accessed by self-referral, OT referral, and reablement referral. The scale of the service, with 25,000-30,000 calls and 700 visits per month and 6,900 packages of Rothercare, was much larger than other councils of similar size. The peer team heard about the push model for people who have fallen and are assessed lower risk by the South Yorkshire Ambulance Service which is passed on to Rothercare who will visit if they have the capacity to and felt this was an example of true collaborative working but wondered if there was potential for transfer of funding to support Rothercare. The service is clearly very highly valued but is not cost neutral (or making a profit as the peer team would expect) and we understand that it is being reviewed currently.
There is a clear appreciation of deprivation, minority ethnic populations and long term population health risk issues within the borough, the multiplicity effect and potential impact on long term ASC demand. There is significant overlap of ASC priorities with public health long term conditions, exercise and clinical pathways. There was clear evidence of a vision across Rotherham Place to focus more on prevention with a view to reallocating resource further upstream to reduce this impact. The 'Moving Rotherham' Borough-wide Board has been relaunched post covid and is undertaking some impressive work linked to Sport England priorities. This includes linking physical well-being and activity with emotional wellbeing/mental health, improved links to social prescribing and a whole perspective/person approach to health coaching and healthier lifestyle coaching programmes.
The complex lives team has had success with their preventative approach to support people with complex lives, addiction and mental health issues, it was however recognised that as a small team their capacity is limited. A new prevention team at the front door seeks to ensure a robust prevention approach is being developed incorporating enhanced preventative safeguarding.
RMBC have worked with community catalyst who helped the community by setting up a number of micro enterprises which the peer team heard were very valuable – such artwork delivered at Conway Crescent and peripatetic services such as befriending.
The peer team heard how Complex Lives team is working very well in a preventative way. Currently a small team, the peer team felt the expansion of the team would result in reaching more people. The peer team heard a clear understanding of the complex lives journey within the housing interview and that individuals with multiple issues it starts at the property and place offer.
Information, advice, and guidance
Feedback from people with lived experience is that information, advice, and guidance is not always easily available. One member of the peer team tested out the on-line offer who felt it was clear and intuitive with clear pathways but does rely on having access to internet. The peer team heard how work is ongoing to develop “chat box” and provide information on common questions to support a reduction in the number of calls. Online referral and e-forms are increasing indicating that access to the website offer is helping people access to the right advice and information at the right time.
RotherHive - the well-being and mental health resource for Rotherham is an excellent resource and very easy to navigate and the peer team heard from the people with lived-experience who they met how helpful it is. There is a clear plan to expand RotherHive beyond a mental health resource to being a broader public facing one stop shop for information of advice.
Clearer pathways and criteria for teams
The peer team were able to interview staff from locality teams, learning disabilities and transitions, mental health, and community occupational therapists. They often heard of duplications between teams and the lived experience interviews highlighted the feeling of being “Ping ponged from pillar to post”. This was due to no team having a clearly defined criteria for the people they would support, therefore, meaning that there were instances where people weren’t deemed by any team as fitting in their scope. Consideration should be taken as to how criteria for each team should be strengthened to improve efficiency and effectiveness in allocating cases.
In addition, the team heard about a number of new initiatives such as the Transfer of Care Hub, and Virtual Ward which have been set up in last few months. This is part of the Urgent and Emergency Care workstream to address winter pressures and is a joint health and social care initiative. The teams are collocated at Woodlands Hospital which the peer team heard has reduced length of stays as communication is enhanced between the Integrated Discharge Team (IDT) and rapid response in particular.
In interviews, some staff showed a lack of understanding of the new pathways and although the initial reports seem very positive of the work being done by the Transfer of Care Hub. The peer team were concerned of the potential for duplication and hand-offs between ASC teams.
The new pathway for the Transfer of Care Hub is for all referrals to go through reablement. Given the high vacancy rate within reablement team mentioned previously in the report, the team heard how reablement is becoming a pinch point in the discharge pathway with waits for reablement being between 1-14 days for different individuals. This was thought to be further exacerbated by the wait for care act assessments and subsequent packages of care being made available for people who were therefore unable to move out of reablement despite them completing all the reablement support they can provide. The peer team felt there was an opportunity to consider the criteria for reablement and patient flow from hospital into reablement potentially to a community discharge-to-assess model to avoid reablement services being used as a general home care provision.
Use of Direct Payments
The number of people in receipt of direct payments in RMBC is around 21 per cent against a regional average of circa 19.31 per cent and a national average of nearly 27 per cent. This is lower than would be expected and the figure is somewhat distorted as it includes the use of direct payments for ad hoc purchasing of care packages rather than true direct payments. The peer team felt that this area should be an area of significant focus for the council especially to introduce alternative commissioning arrangements for ad hoc purchases. In particular the team were concerned that this practice was indicative of more traditional approaches to support planning and likely to have to promote a more person centred approach to care. As previously mentioned, the peer team did hear of work being undertaken in RMBC to improve direct payments and the Rotherham offer.
The peer team did not speak to any people who access direct payments and ASC may wish to undertake further review of how this is working within Rotherham.
Quality Statement Three: Equity and outcomes
Rotherham has a population that is ageing with over 52,400 people aged 65 years and over. It is a diverse community which includes 20,000 people from minority ethnic groups (8.1 per cent of the population). The Pakistani community is the second largest ethnic group after White British and 22% of residents live within the 10 per cent deprived areas of England. There is under-representation of people from ethnic minority communities for residents who access Rotherham’s services. The peer team did not see any groups from ethnic minority communities and recognise that can be hard to engage with these groups but feel that ASC may like to consider how they will communicate with them and share about CQC assessment to provide a more comprehensive picture. There was an example shared by public health of specific engagement work done with Apna Haq (meaning our right in Urdu) - an asian women's group to better understand their perspectives of services provided.
Unfortunately, the peer team were unable to visit a group of lived-experience residents with mental health issues, that had been planned, due to sickness within the venue to be visited.
The peer team became aware that Moving Rotherham had recently been approached by Sport England as a potential expansion area. Funding under this initiative is likely to be awarded to place development partnerships who demonstrate a good understanding of local issues and a focus on tackling health inequalities, ie to get the inactive, active, with a view to avoiding the onset of long-term conditions.
Robust process for Equality Impact Assessment
There is a recognition that there is a very robust process for Equality Impact Assessments (EqIA) in Rotherham and staff are familiar and well-trained in its use. The peer team saw good documentation as evidence but this was not reinforced in interviews with staff being unable to speak to it as confidently and this may be an area RMBC would like to enhance for the CQC visit.
The team was concerned that although the process for prompting EqIAs was comprehensive, staff appear to struggle to described actions taken or practice implemented by themselves or the organisation to ensure that equity was delivered consistently across the diverse populations across Rotherham. The council needs to consider further ongoing work to ensure that equality, diversity and inclusion is embedded across the organisation.
Advocacy
RMBC commissions with Absolute Advocacy who provide excellent service that is responsive, and staff refer people to them in a timely manner. They work closely with Speakup Self Advocacy – a self-advocacy group run by and for people with learning disabilities and autistic people. The peer team were fortunate to meet with a number of lived experience people from Speakup and were impressed by their work and the strong collaborative relationship with RMBC alongside Absolute Advocacy. The commissioner showed great understanding and strong relationships with them, and the peer team were impressed by how strong this area was within RMBC.
The Speakup website is a really helpful self-advocacy tool for Rotherham, the group provided examples of how they provide support to the community across a number of areas including day services, training offers, social events, access to health, wellbeing and employment information they also offer volunteering opportunities.
Public Health led decisions
The DASS has housing and public health within his directorate, and this resulted in very close working between ASC and both departments. The peer team’s PSW met with the public health consultant who was passionate and inspiring and demonstrated clear evidence of work to address health inequalities across Rotherham. Decision making is underpinned by a clear understanding of the effects of deprivation and the multiplicity effect with minority ethnic populations, health risk issues such as long term conditions that lead to increased demand on ASC services.
There is work being done across place leadership to move prevention upstream in order to reduce longer term demand on services linked to prevent, reduce, delay aspects of the Care Act. RotherHive web-based information “one stop shop” of support and resources is an invaluable resource to residents and staff alike.
RMBC Public Health team have supported engagement work with minority groups including Apna Haq Ltd – a group supporting minority women to escape violent situations in Rotherham. This work has resulted in a better understanding to barriers and to help adapt the current offer that are more acceptable to this group.
Public Health has a strong presence at the Health and Wellbeing Board and are linked to all four of the board’s aims. Joint public health work across South Yorkshire has taken place to change the narrative of health inequalities with a greater understanding of demographic information.
Co-production
RMBC is looking at increasing co-production in all its work and has a few excellent examples within Housing where any new proposals must evidence the voice of the user and their involvement. The Adaptations strategy was co-produced and the peer team heard of how partners are being involved at green/brown site stage for developments with the example of police information leading to a decision to reduce the size of balconies on new developments to reduce issues around having pets on larger balconies. The Homeless Strategy has also been developed with users and great efforts have been taken to hear the voice of these hard to reach group.
Another example the team heard about was Rotherham’s Autism Strategy where people were asked about their experience and how it could be improved. The co-production included minority groups, young people, adults and carers. This work can demonstrate strongly the autism voice and the action plan for next 12 months will also be co-produced. The team heard from a person with lived experience of autism that they felt included, valued, and listened as part of this process. The peer team recognised that RMBC like most councils has further areas to improve co-production but there is a good foundation and positive relationships with partners and residents to build upon.
Theme 2: Providing support
Theme 3: Ensuring safety
This area relates to safeguarding, safe systems, and continuity of care.
Strengths
- The Rotherham Safeguarding Adults Board (SAB) had requested a peer challenge from the LGA which was undertaken in July 2023. The feedback report from this peer challenge was shared with ASC preparedness peer team before their visit. The peers were assured that the SAB were actively working on an improvement plan and engaging with wider partners.
Considerations
- There should be active steps taken to ensure that community team DoLS are visible and subject to the ADASS triage tool as this issue presents significant risk.
Quality Statement Six: Safe systems, pathways, and transitions
The corporate approach to outcome delivery is impressive and will support and improve safe systems, pathways, and transitions.
The SAB chair is a non-executive on the ICB and has a social work and safeguarding background which has been used to ensure the profile of safeguarding is a high priority within the ICB. Consistent funding has been made available over the years from health to support the SAB. The SAB manager attends Yorkshire and Humber safeguarding managers network and has shared Safeguarding Adult Reviews (SARs) learning with this forum. There could be further work for the SAB to raise awareness in partner organisations on their responses to safeguarding and how safer systems can be achieved. The SAB chair showed awareness that there was a need to raise their visibility across ASC, the council and partner organisations – one way of doing this would be to have social worker’s attending the board to increase their knowledge base. This should include sharing the safeguarding messages and socialising and embedding them in partner organisations, an example of this was around embedding safeguarding training for nursing from abroad. The peer team were gratified to hear that the AD had recognised an opportunity to publicise the newly revised safeguarding pathway more widely to raise awareness across RMBC and had commenced this in October 2023.
As previously mentioned in this report RMBC appreciate that there is more work to capture the voice of people using services and the SAB had a development day since the SAB peer review where sub-groups were reconfigured to best capture the customer’s voice.
The peer team heard that RMBC has been unable to appoint to the dual diagnosis position and there were concerns that people are “falling between two stools”.
Waiting lists and actions to monitor, analyse and address these is reported earlier in this report. As previously mentioned in the report the ongoing social work vacancy level is impacting on these waiting lists especially in terms of DoLS and Community DoLS which are particularly high.
Waiting lists were analysed in the team in relation to DoLS and whilst assessments are subject to the application of the ADASS triage tool for managing risk the team’s attention was drawn to the fact that potential DoLS situations held by the community teams are not subject to this process. It was recognised by the AD that this needs to be urgently addressed and the peer team were concerned that there didn’t seem to be any oversight of the number of community DoLS going through the Court of Protection. There is an opportunity for this data to be collated to provide a more complete picture of the overall DoLS waiting list position.
The peer team heard how a focus on community DoLS has started with one worker working directly with their legal team, however due to vacancies it was reported that only high-risk cases are likely to be worked on with a watching brief in terms of risk.
A recent increase in the number of officers who are authorised signatories was supporting the management of DoLS applications.
The peer team could see that there is comprehensive data pack and reporting with oversight by the SAB of section 42 assessments and progress. The peer team suggest that a summary of key elements to accompany the pack maybe helpful to highlight key areas for SAB consideration.
The case audit and discussion with staff showed the benefit associated with the implementation new pathway incorporating the voice of the person throughout the safeguarding process - and staff reported that they found it helpful with the regular prescriptive prompts, and it is bringing consistency with risk being assessed at every level. Making Safeguarding Personal (MSP) is clearly embedded in ASC and was demonstrated through case audit as well as interviews with lived experience people and staff with a clear understanding.
Joint working with children’s social services has been highlighted previously in the report and there is an opportunity to improve outcomes for families and care leavers by having more close working processes and relationships.
The peer team were made aware of the detail of the of multi-agency risk management system around Community Multi-agency Risk Assessment Conference (CMARAC) and Vulnerable Adult Risk Management (VARM). and were assured it was becoming more robust since the SAB peer challenge review.
Quality Statement Seven: Safeguarding
There is strong engagement with partners and representation on subgroups of the SAB. The strength of partnership working as described through out this report has a positive impact on safeguarding within RMBC. There is a robust structure for managing risks and it is positive learning processes around SARs and pre-SARs. There are possibly further opportunities to share this learning in different forums particularly with providers and the peer team did hear that the timeframe for learning from SARs was currently too long.
The peer team were informed by PSW that a SAR protocol was currently being developed with in partnership with the SAB.
Theme 4: Leadership
Top tips for assurance preparations - for consideration
- Appoint an adult social care lead
- Political briefings
- Secure corporate support and buy-in
- Maximise the council’s adult social care business intelligence capacity to inform the self-assessment
- Get health partners and integrated services leadership on board
- Compare and learn from children’s inspections
- Gather insights from partners and providers
- Be clear on approaches to co-production and responding to diverse needs
- Encourage organisational self-awareness.
Lessons learned from other peer challenges
- Councils need an authentic narrative for their adult social care service driven by data and personal experience
- The narrative needs to be shared with those with a lived experience, carers, frontline staff, team leaders, middle managers, senior staff, corporate centre, politicians, partners in health, third sector and elsewhere
- Ideally this story is told consistently and is supported by data and personal experience - don’t hide poor services. This will probably take the form of:
- What are staff proud to deliver, and what outcomes can they point to?
- What needs to improve?
- What are the plans to improve services?
- In the preparation phases, consider putting it on all team agendas asking staff what they do well, what’s not so good and to comment on the plans to improve. Collate the information from this process and add to the self-assessment. Ensure the self-assessment is a living document that is regularly updated.
- Immediately prior to CQC arriving, ask staff what they are going to tell the regulator. How is their experience rooted in observable data and adds to the overall departmental narrative? These stories drive the understanding of yourselves and others.
- The regulator is interested in outcomes and impact from activity. The self-assessment needs to reflect this as do other documents.
- The conversation with the regulator is not therapy! For those interviewed it should be a description of what they do and the impact they have had in people’s lives. Case examples written in the authentic voice of those with a lived experience bring this alive.
Immediate next steps
We appreciate the senior political and managerial leadership will want to reflect on these
Whilst it is not mandatory for the council to publish their report, we encourage council’s to do so in the interests of transparency and supporting improvement in the wider sector. If the council does decide to publish their report, the date at which the council chooses to do so is entirely at their discretion and would usually be at the culmination of an internal governance process.
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 several the areas for development and improvement and we would be happy to discuss this.
Mark Edgell is the main contact between your authority and the LGA.
Email: [email protected]
Moira Wilson is the main contact for the LGA Care and Health Improvement Adviser for the South Yorkshire and Humberside Region. Their contact details are:
Email: [email protected]
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.
Find out more
Adult Social Care Preparation for Assurance Peer Challenge at RMBC
Penny Hynds, Peer Challenge Review Manager, Local Government Association
Email: [email protected]
Adult Social Care Preparation for Assurance Peer Challenges
Marcus Coulson, Senior Advisor, Adults Peer Challenge Programme, Local Government Association
Email: [email protected]
Adult social care peer challenges and the work of the Local Government Association
Adult social care peer challenges.