Sector Led Improvement Peer Challenge. of the. London Borough of Haringey Direct Payments Support Services. May 2013

Transcription

1 Sector Led Improvement Peer Challenge of the London Borough of Haringey Direct Payments Support Services May 2013 Peer Challenge Authors Barry Holland Justin Walker December 2013

2 Document Control Version Date Description of edits Author First draft V1 13/07/13 BH/JW Second draft V2 Third draft V3 1/12/13 BH/ AC Final V4 19/12/13 BH LBH DP Peer challenge v4

3 Sector Led Improvement Peer Challenge of the London Borough of Haringey Direct Payments Support Services 1.0 Introduction 1.1 A Peer challenge of Direct Payment Services including the financial processes was requested alongside the LGA and ADASS London Sector Led Improvement programme. London Borough of Sutton Adult Social Services Housing and Health Directorate agreed to take part in the review with the expectation of identifying and sharing best practice and learning between both Authorities. 2.0 Challenge process 2.1 A peer challenge is not intended to be an inspection. It is a collaborative joint self improvement activity intended to stimulate reflection, discussion and recognise areas of good practice that can be shared and identify areas for improvement. The outline terms of reference for the peer challenge were agreed at a planning meeting on 8 April 2013 as set out in Appendix A comprehensive range of background data was collated in advance to support the peer challenge on site work at the end of May The full schedule of the requested evidence is contained in Appendix Three themes were identified as the focus of the review:- Leadership theme encompassing overview and scrutiny arrangements as well as the direct leadership of the service Resource and workforce management theme including file audits, qualitative and quantitative measures of performance and how they are reported. Staff appraisal and performance including training plans and staff survey results. Within the theme the policy and procedure and guidance infrastructure was to be assessed as well as their visibility and utilisation by staff. Service Delivery and Effective Practice theme identifying where action has been taken to address inadequate performance and including examples of individual and team performance targets and attainment. 3.0 Areas of good practice Within each of those themes a number of observations of good practice were noted:- 3.1 Leadership The established Quality Board provides overall governance and direction of all quality related matters LBH DP Peer challenge v4 3 of 7

4 Regular meetings with Care Quality Commission Area Inspector to keep communication lines open and provide early warning of any emerging issues within the provider network Active management and tracking of delivery of audit recommendations is in place Relationship with User Group are generally healthy and built on the good reputation of Officers for openness and honesty. 3.2 Resources and workforce management Real time entry of panel decision onto systems avoids delay and the potential for confusion or error. The Integrated Access Team (IAT) central referral point provides management of professional appointments at first point of contact reducing handoffs and delays to completion of assessments or reviews. Adoption of mobile working and specific use of 3G provides Social Workers with real time remote access to system again mitigating process delays and errors. Financial Assessment referral at the earliest point in process with quick turn around helps prevent abortive work on Direct Payment and traditional packages of care that are later deemed by the citizen to be unaffordable. The no cash payment policy that has been introduced provides strong audit controls and trails that in turn support the reconciliation process. 3.3 Service delivery and effective practice Strong local provider market for personal care as well as a number of other support services including payroll services Allocation of named member of staff to manage individual provider relationship facilitates quick resolution of queries avoiding protracted, costly and disruptive disputes Holding the respite care budget outside of Personal Budgets provides a closer match to full year outturn projections as respite care is often not accessed by clients or family for whom it is available Building liability insurance costs into Direct Payment budget beyond the first year reduces the likelyhood that annual insurance will not be purchased. 4.0 Areas of potential improvement During the Peer challenge some areas were identified where further improvement activity could be considered:- 4.1 Leadership / Governance The Vendor Team notification process was unclear to staff and consequently inconsistently applied. The use of the notification template appears not to provide effective separation of duty as the second signature is pre-printed on the form. Recommendation 1 Review the process for sign off to ensure that a supervisor has authorised the set up of a payee account. LBH DP Peer challenge v4 4 of 7

5 The Direct Payment User Group which has expressed interest in developing its role. Recommendation 2- There may be scope to further develop and strengthen the empowerment of the voluntary sector especially supporting approaches to sustainable User Led Organisations (ULOs). The monthly financial commitment reporting methodology appeared not to be fully explained and consequential potential variations for projections could be usefully further clarified (Figures based on Resource Allocation System (RAS), Personal Budget (PB) or Service cost will all lead to differing outturn projections. Recommendation 3 - These variations could be estimated and provide confidence levels for projections strengthening the basis for management decisions. Several policies were identified that had not been reviewed by the scheduled review dates. Recommendation 4 - Implementing a policy / procedure for a scheduled review tracking system similar to that used to track audit recommendations could be considered Aligned to the observation above it was not apparent that there was a clear protocol for triggering a policy review. Recommendation 5 - establishing a realistic policy review protocol would help ensure that reviews are meaningful and useful as well as timely. 4.2 Resources and workforce management Prospective Direct Payment recipients are cross checked for any outstanding social care debt, however this check did not extend to non social care related debt. Recommendation 6 the process could identify broader issues if the debt check were carried out across all council services. During the comprehensive reconciliation programme previously undertaken, cases of significant financial variations and adjustment were identified. Recommendation 7 - In order to maximise the use of customer data it is recommended that a referral for a social worker review is considered for all cases of significant financial reconciliation adjustment. This will prevent inappropriate recovery of funds and ensure that services remain safe and effective. The Direct Payment User Group appear to be willing and open to consider developing their terms of reference further towards a User Led provider for some support. Recommendation 8 - Exploring what further commissioning of the User Group to provide support, say in production of regular newsletter or other LBH DP Peer challenge v4 5 of 7

6 core support, may prove economical whilst at the same time stimulating the voluntary sector and wider employment opportunities. Recommendation 9 - Providing enhanced training to members of support group may help in developing their capacity to self help so that they can provide a useful supplemental point for Direct Payment user enquiries Supporting paperwork, such as signed agreements bank details and mandates, are held off Frameworki. It was unclear from discussion with staff how these documents were stored and processed. Recommendation 10 - In order to comply with data protection legislation relating to the retention and destruction of data it is suggested that an actively managed solution is put in place. This could take the form of a small central database as a repository and register of all Direct Payment documentation or be part of an overall document management solution. 4.3 Service delivery and effective practice Recent changes to Social Worker access permissions to create and amend services have led to an increase in anomalies and reconciliation errors, Recommendation 11 - it would be beneficial to avoid the cost of rework / failure either by providing further guidance / training or review of current access permissions. It was noted that some services are being commissioned / amended outside of Frameworki i.e. via authorisations. Recommendation 12 - Although this may be necessary to safeguard critical service provision it is recommended that these incidents are reported and monitored separately within the regular performance reporting to the Quality Board One of the most highly valued aspects of the support service support expressed by the user group was the ability to ask questions during the surgery normally facilitated after a user group meeting. Unfortunately staff can not always attend these sessions. Recommendation 13 - an alternative that may be worthy of consideration would be to offer scheduled drop in sessions with support service staff at HUBs. Recommendation 14 - A Customer Charter for support service to define response times etc. may help in managing expectation of the user group and help in balancing resources available There is inconsistency in the detailed application of process or interface with other sections e.g. the Vendor team making it diffixcult for work to be redistributed mid process in times of sickness or other absence. Recommendation 15 A Service Level Agreement or Memorandum of Understanding defining team/ service interfaces would help define the workflow with more detail and precision than appears to be documented as part of the Frameworki mapping already completed. LBH DP Peer challenge v4 6 of 7

7 The Section 5 hospital discharge notice timescales don t provide enough time to set up Direct Payment. Recommendation 16 - There may be ways to provide more notice to the support team (possibly sharing Section 2 notices or additional referral from hospital / reablement teams) 5.0 Overall conclusion 5.1 The peer challenge team were very impressed with the professional approach and engagement with the peer challenge process shown by all those that took part. Support staff and partners both internal and external appeared to have good healthy working relationships which were founded on an understanding that the client was and should be at the heart of all that they do. 5.2 The challenge team are confident that the Direct Payment service is being delivered by competent and confident staff and management. The areas for improvement identified do not present any urgent threat to the service or its reputation. 5.3 There were many excellent aspects of the service that should be a source of pride for all those involved 5.4 The challenge team would like to thank everyone for their openness and frank contributions and would like to make special mention of Sima Khiroya who coordinated the preparation of evidence, organised the interviews and generally made the site work well organised and extremely productive. LBH DP Peer challenge v4 7 of 7