CSCI Regional Office Caledonia House 223 Pentonville Road London, N1 9NG

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1 CSCI Regional Office Caledonia House 223 Pentonville Road London, N1 9NG Tel: Fax: Web: Ms Irene Findlay (OBE) Adult Social Services, London Borough of Barnet, North London Business Park, Oakleigh Road South, London N11 1NP 27 October 2008 Dear Ms Findlay Performance Summary Report of Annual Performance Assessment of Social Care Services for Adults Services London Borough of Barnet Introduction This performance summary report summarises the findings of the 2008 annual performance assessment (APA) process for your council. Thank you for the information you provided to support this process, and for the time made available by yourself and your colleagues to discuss relevant issues. Attached is the final copy of the performance assessment notebook (PAN), which provides a record of the process of consideration by CSCI and from which this summary report is derived. You will have had a previous opportunity to comment on the factual accuracy of the PAN following the Annual Review Meeting. The judgments outlined in this report support the performance rating notified in the performance rating letter. The judgments are Delivering outcomes using the LSIF rating scale And Capacity for Improvement (a combined judgement from the Leadership and the Commissioning & Use of Resources evidence domains) The judgment on Delivering Outcomes will contribute to the Audit Commission s CPA rating for the council. The council is expected to take this report to a meeting of the council within two months of the publication of the ratings (i.e. by 31 st January 2009) and to make available to the public, preferably with an easy read format available.

2 Adult Social Care Performance Judgments for 2007/08 Areas for Judgment Grade awarded Delivering Outcomes Improved health and emotional well being Improved quality of life Making a positive contribution Increased choice and control Freedom from discrimination and harassment Economic well-being Maintaining personal dignity and respect Capacity to Improve (Combined judgment) Leadership Commissioning and use of resources Performance Rating Promising Promising Promising Two Stars The report sets out the high level messages about areas of good performance, areas of improvement over the last year, areas which are priorities for improvement and where appropriate identifies any follow up action CSCI will take. 2

3 and Areas for Improvement by People Using Services Key strengths All people using services Strategic leadership continues to be strong within the Department and the strong political majority has enabled medium and long-term planning. Partnership working continues to be effective and work within the voluntary sector has enabled good quality reporting mechanisms to demonstrate value for money in grant-funded services. Positive progress has been made to provide services, that fully promote independence and choice through self-directed services. The fairer pricing tool, ensures good value for money. There are Joint Commissioning Strategies for each client group, which are starting to bring about improved outcomes for people. Strong culture of effective financial management continues, including the development of additional business intelligence posts and staff training. Well-developed performance assessment processes, which are the driver for improvement. The council was found to be mostly commissioning registered services from those rated as good or excellent and effective contract monitoring highlights service areas of concern. progress in the development of the Joint Strategic Needs Assessment, built on the health profile. Appropriate information and signposting for people who are selffunding, referrals to non-care managed services and some reimbursements through grantfunding. Intermediate care is working well work around the central modernisation programme but further work is required to fully develop a greater range of selfdirected care. Electronic single assessment tool is not available and needs to be resolved. The percentage of people who have been assessed where their ethnicity was not stated needs to be reduced further. The council should continue to progress the full implementation of the electronic social care record. Although there has been significant year on year increase on the number of reviews completed, the council remains one of the worst performers in the region and further work is still required. The cost of intensive social care and the unit cost of home care are high. The number of complaints that have been upheld/partially upheld has significantly increased. The council should explore this further. The council must continue to target the high cost of some residential care placements to ensure value for money. The council must ensure that all staff follow procedures for the timeliness of minutes and communication for safeguarding meetings.

4 and operates a single point of access. There has been a significant increase in the number of people supported through Intermediate Care to prevent admission to hospital. work in relation to the identification of people who are HIV positive and living in the borough, and the provision of funding to voluntary organisations to provide services and support to them. number of extra-care housing options available and appropriate support to applicants to support the move. Effective communication with people who use services and carers to obtain views and use of feedback to shape service provision. Information relating to direct payments is of a high quality and a very high number of people have been provided with a direct payment. Almost all assessments are started and completed within acceptable timeframes. Appropriate out of hours services in place. range of advocacy services available. The council has achieved level 4 of the local government equality standards. Strong history of effective joint working for continuing care. strategic and wide-reaching membership of the adults Safeguarding Board. High numbers of safeguarding referrals have been received through No Secrets, of which over a third were self-funding people. All people supported into residential or nursing care have access to a single room should they wish. Older people information on how to stay healthy and good use of events. information relating to See All People Using Services 4

5 Telecare and high numbers of people provided with equipment. Effective information in relation to falls and the podiatry service now involves advice & prevention. proportion of people from black or ethnic minority groups aged over 65 who have received and assessment or provided with a service. People with learning disabilities There has been effective work to reduce the number of people with a learning disability in residential care. The council should continue to work with the families to progress the re-housing of the There is effective transitional planning for young people moving to adult services. people in NHS campus accommodation whom are medically fit for discharge. range of specialist provision including a new resource centre to increase mobility and independence People with mental health problems More people are completing drug See All People Using Services treatment services. More people with a mental health problem have been helped into paid employment and further refocus of provider services will achieve more paid employment opportunities. People with physical and sensory disabilities There continues to be a focus on supporting more dependent service users at home rather than in residential care. More equipment and minor adaptations should be delivered within 7 days. Employment advisor for visually impaired people is in post and the council provides work experience opportunities. Carers Barnet is one of the top 3 councils nationally for providing services to carers and most GP surgeries have Carers Champions. The council has a high spend in providing breaks to carers and provides a good number of breaks to carers of people with a learning disability. Flexible respite policy supports carers to remain in employment. The length of time people have to wait for major adaptations on their homes remains too lengthy, and the council is the worst performer across London in this area. The council must continue their work to establish links with carers of people with drug and alcohol misuse. 5

6 Improved Health and Emotional Well Being The contribution that the council makes to this outcome is good. There is a wide range of information for people who use services and their carers to understand how to stay healthy and maintain emotional wellbeing. People are supported through clear and accessible information regarding healthy lifestyles, advice and support, and through Living Better events. The council has also published an essential guide for disabled people. Barnet demonstrates effective working with health partners and other relevant agencies. The council has developed and implemented a whole systems model for people with long-term conditions, which incorporates single assessment, and both the council and the PCT use documentation to support single assessment and integrated care planning. There is progression towards care pathways as part of self directed care for people with HIV/AIDS. Referrals are in a single assessment format and there is a shared goal for reducing unnecessary admission to hospital by all partners, which is effective. Patients in hospital and lengths of stay are now tracked through the use of a unique client identifier and the commissioning strategy implementation which will lead to more investment into rehabilitation. However, 3 people remain in NHS campus accommodation. These people are medically fit for discharge but are subject to legal challenge to remain by relatives and the council needs to continue to work to resolve the situation. A wide range of information for people who use services and their carers to understand how to stay healthy and maintain emotional wellbeing. Effective working with health partners and other relevant agencies. Referrals are in a single assessment format and there is a shared goal for reducing unnecessary admission to hospital by all partners, which is effective. The council should continue to work with the families to progress the re-housing of the people in NHS campus accommodation whom are medically fit for discharge. Reviews (see increased choice and control) 6

7 Improved Quality of Life The contribution that the council makes to this outcome is good. There is a consistent promotion of independence for people who use services and their carers, within a range of services. There has been an increase in extra-care options and high use of Telecare equipment. Although the number of carers receiving a break was low, spend on carers breaks was high and above regional averages and Barnet is also one of the top 3 councils nationally in the provision of carers services overall. There is a focus on early intervention that can be demonstrated by high use of assistive technology, prevention of falls and improvements in the podiatry services. However, the waiting times for major adaptations are too long and the percentage of equipment and minor adaptations delivered within a week is the lowest across London. Care managers refer on to relevant non-care managed services people who need them and there is also effective signposting for self-funders. Contacts and assessments of self-funders also continue, a home from hospital service is provided and there has been a further increase of 400 people to grant funded services. Increased specialist service provision for people with profound learning disabilities and a multi-disciplinary challenging behaviour service is being established. There are Living Longer, Living Better events, attended by the Fire Service, to help to consolidate and develop work in advancing awareness of the availability of fire safety checks and free smoke alarms for older people. Resident surveys also indicate that people are feeling safer in their own homes and the council has Safer Neighbourhood Teams in all wards across the borough. High numbers of services provided to carers and high spend on breaks Consistent promotion of independence for people who use services and their carers, within a range of services focus on early intervention within a range of services, and increased specialist service provision. Waiting times remain too long for major adaptations More people to be provided with equipment and minor adaptations within 7 days. 7

8 Making a Positive Contribution The outcomes in this area are good. People and their carers are supported in developing confidence in their ability to communicate and their own abilities. The council has a number of publications to advise and encourage people to make contributions, and better communication has also been enabled through the use of a feedback card. There is active involvement from people who use services and their carers in the development of work and planning and review of services. Residents are regularly surveyed to obtain views, publicity drives, rights days for carers, client involvement in safeguarding and liaison with Barnet s Gay Men s group. The council has identified that developing an effective carers group for people with drug and alcohol misuse, is a priority for 2008/09. There is a commitment to developing ways of expanding numbers of volunteers working in social care and support services. There is funding to Barnet Voluntary Service council to recruit volunteers, run training courses and other volunteer coordinators in other voluntary organisations. There is also a befriending service and the active volunteering project with BVSC has been successful. Feedback is sought from people who have used drug and alcohol services to inform commissioning and service delivery. People who use services and their carers are supported to communicate views and feedback is sought to inform commissioning and service delivery. There is a commitment to develop ways to expand the number of volunteers across all client groups. range of advisory publications The council must continue their work to establish links with carers of people with drug and alcohol misuse. 8

9 Increased Choice and Control The outcomes in this area are good. From the first point of contact most referral, assessment and care planning services are undertaken in a timely manner. The transition improvement group oversee person centred reviews, and the number of carers of people with a learning disability who received an assessment or review has been doubled. Despite good progress in increasing reviews year on year and high satisfaction rates from the majority of people who had a review, performance relating to reviews is poor and the worst in London. People generally are well informed about services. The council provides good quality information for all clients and carers in a number of formats which is distributed via the internet and in paper format. The complaints service is widely publicised. However, there has been a reduction in the overall number of complaints received and the number of complaints that have been upheld or partially upheld has significantly increased. Barnet operates appropriate out of hours services, including a dedicated mental health contact number. The council is making positive progress in promoting independence and choice through self-directed services. Information in relation to direct payments is comprehensive and the uptake is high and good. The council has developed a Fairer Pricing tool and is progressing the development of alternatives to residential care. Progress continues in relation to the modernisation programme, and the implementation plan for self-directed care received sign off by the cabinet in July The council remodelled their care management service and now have care brokerage staff appointed to drive forward personal budgets. Most referral, assessment and care planning services are undertaken in a timely manner People are generally well informed about services. The council provides good quality written information for all clients and carers in a range of formats. There has been positive progress to begin to develop services, which fully promote independence and choice through self-directed services. Information in relation to direct payments is comprehensive and the uptake is high and good More people need to have a review. Due to the increase in the number of complaints upheld (at least in part) the council should ensure that the learning from these complaints is fed through to drive service improvements. 9

10 Freedom from Discrimination and Harassment The outcomes in this area are good. The council has clear eligibility criteria and matrix, set to substantial. The council have a support service for people who at present, do not meet the criteria, but are may do in the future. There is a direct link to assessment and eligibility on the council website and the council provides assessments to all residents of the borough who contact them for a service regardless of financial circumstances. There is appropriate voluntary sector service provision to support people who do not meet the council s eligibility criteria. The social work duty team has an Access and Information Office to filter calls, offer advice and information and signpost callers on where appropriate. Due to the high levels of affluence in the borough a large number of people are able to self-fund. More assessments need to be provided for people who are from black or minority ethnic groups who live in the borough. Despite year on year reduction, more adults who have been assessed or receiving a service need to have their ethnicity stated. The council has opened two new resource centres during the last year to support people with profound learning disabilities and people with severe physical impairments. A multi-disciplinary challenging behaviour service is being established in 08/09. Four staff are trained in deafblind communication.. SENSE is a member of Barnet s Partnership Board. There has been increased investment in advocacy and advocacy is widely promoted to increase uptake. The councils policies are publicised on in relation to disability and race discrimination. The council has achieved Level 4 of the Equality Standards for Local Government. The council has undertaken equality impact assessments, and the findings are formally reported to Cabinet Members. A clear eligibility criteria and matrix is publicised and advocacy services are used to assist with the process and there is sufficient voluntary sector service provision where people self-fund. The council provides appropriate and inclusive support and services equally to people who meet their eligibility criteria or proactively signposts people onto appropriate care and non-care managed services. The council has reached Level 4 of the Equality Standards for Local Government. More assessments need to be provided for people who are from black or minority ethnic groups. More adults who have been assessed, or are receiving a service, need to have their ethnicity stated. 10

11 Economic Well-being The outcomes in this area are good. There is a clear policy for continuing care between the council and the PCT, due to a mature and effective working relationship. Where there are disputes these are resolved appropriately. The council has developed day opportunities and an employment strategy which covers and the number of people with a learning disability who were helped into employment has significantly increased to nearly double the regional and national average. The development of work opportunities is also specified in the council local area agreement. There is good work with a local college and a reaching out programme for mental health clients. The council provides a flexible respite policy to support carers to remain in employment and discussions are taking place with the Carers Centre to develop social enterprise. Joint commissioning strategies are in place to increase the reliability of interventions designing care based on what is known to work and that clients inform and influence. In April 2007 the joint visiting team was implemented with the Department for Works and Pensions to build on the work delivered by the dedicated Welfare Rights Team and to allow strategic targeting of take-up of benefits advice in more deprived areas and areas where there is poorer health. Clear continuing care policy and effective partner working resolves issues if they arise. Employment strategy is in place and has increased employment opportunities for a higher than average number of people. There is now strategic targeting around the take-up of benefits advice in more deprived areas and areas where there is poorer health None identified during this performance assessment. 11

12 Maintaining Personal Dignity and Respect The outcomes in this area are good. The council has systems in place to help to prevent adults who are vulnerable from being abused, neglected or embarrassed through poor care whilst using services. A multi-agency safeguarding group is in place and safeguarding workshops are held. There is effective joint work with children's services and the adult protection coordinator role is well established. The department provides an annual report in relation to safeguarding, which is reported to Cabinet Members and safeguarding is further promoted within a number of publications and events. The council ensures that front line staff have an awareness of how to identify people in vulnerable circumstances and respond appropriately to concerns. High numbers of people working within the independent sector have received training on protection issues. There are Train the Trainer programmes and Improving Dignity Care events. There is also a comprehensive training resource pack and a training DVD with powerful scenarios to illustrate and understand the impact of abuse. However, the council needs to ensure that staff consistently adhere to procedures regarding timeliness of invitation and minutes of meetings. There has been an increase in the incidences of reports of abuse. All people funded and supported in residential care have access to a single room upon arrival. The council has had a policy on relationships and sexuality for some time, which is due for review. Feedback from regulatory inspections informs that the council has actively supported a gay couple in a residential care home to enable their relationship to continue. The council has published their multi-agency procedures on the council website and membership of the safeguarding board is wide reaching. As of 2007, people who use services are also involved in safeguarding. range of strategic membership to the safeguarding board, people who use services are involved in safeguarding and the reporting of incidences has risen through heightened awareness and ongoing media items and publications. A comprehensive training resource pack and a training DVD is available. There is effective joint work with children's services and the adult protection coordinator role is well established. The council needs to ensure that staff consistently adhere to procedures regarding timeliness of invitation and minutes of meetings. The council has had a policy on relationships and sexuality for some time, which is due for review. 12

13 Capacity to Improve The council s capacity to improve services further is promising. There is effective leadership and direction in the council, resulting in a shared vision and sharply targeted priorities for improvement, which are understood within and beyond the organisation. Due to the strong political majority, the council has plans up to 12 years in place. The vision implementation is overseen by the Programme Board, chaired by another Corporate Director. Barnet is an award winning council. The community strategy is in place and demonstrates how local organisations and agencies will work together to improve the economic, social and environmental well-being of their area. The Cabinet has agreed a move towards the transformation of services and commissioned services are increasingly linked to the outcomes of Our Health, Our Care, Our Say. There is a mature and effective relationship with the Primary Care Trust, joint management teams work well together and an agreement has been reached on Section 256 arrangements. HR is a standing item on the SMT agenda and outcomes are reported annually. Although there is a higher than average number of vacancies within the council, these are reported as planned vacancies due to the extensive transformation agenda. All vacancies have been risk assessed. Performance management arrangements continue to be robust with quality assurance processes in place. The council operates FirstStat Meetings, which are held by the Chief Executive to challenge and discuss performance issues against corporate priorities. The council still needs to progress the delivery of the electronic social care record. The council has developed a Joint Strategic Needs Assessment in partnership with the Primary Care Trust which is due to be finalised in January Barnet has a Joint Commissioning Strategy for each client group within adults services and self funders are able to access block contracted services. Some support has also been provided through the Reimbursement Grant for privately funded care home placements. There has been considerable work reported on the development of the Fairer Pricing Tool to ensure that services are procured at justifiable cost. The cost of intensive social care and the unit cost of home care are high. The council must continue to target the high cost of some residential care placements to ensure value for money. There have been a number of improvements in financial management (e.g. development of Business Intelligence posts, monthly financial monitoring meetings, close monitoring of block contracts, section 75 agreement for mental health). The council has a user and carer involvement strategy supported by an officer who works to the Joint Commissioner. Performance management is in place for commissioned services. The council seeks feedback from the clients who have used services and this informs both commissioning and improvements in service delivery. The council works hard with providers to lift the quality of care where services are less than good. This is supported by the CRILL data return. The council runs 13

14 forums with providers and are committed to working with providers to raise the quality of care in commissioned services. Leadership o There continues to be effective leadership and direction in the council, resulting in a shared vision and sharply targeted priorities for improvement, which are understood within and beyond the organisation. The council has plans up to 12 years in place. o There is a mature and effective relationship with the Primary Care Trust, joint management teams work well together and an agreement has been reached on Section 256 arrangements. o Performance management arrangements continue to be robust with quality assurance processes in place. Commissioning and use of resources o The council has recently agreed to progress self directed care, of which a priority will be to improve independence and choice alongside the economy, efficiency and effectiveness of local services. o Self funders are able to access block contracted services and some support has also been provided through the Reimbursement Grant for privately funded care home placements. o The council has a user and carer involvement strategy and are committed to working with providers to raise the quality of care in commissioned services Leadership o The council still needs to ensure the implementation of the electronic social care record. o The council should continue to work with the PCT to ensure completion of the Joint Strategic Needs Assessment. Commissioning and use of resources o The council along with its partner should continue to progress the completion of the Joint Strategic Needs Analysis in partnership o The cost of intensive social care and the unit cost of home care are too high. o The council must continue to target the high cost of some residential care placements to ensure value for money. Yours sincerely, Colin Hough, Regional Director Commission for Social Care Inspection 14

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