CSCI Regional Office Caledonia House 223 Pentonville Road London N1 9NG Tel: 020 7239 0330 Fax: 020 7239 0318 Email: apa.london@csci.gsi.gov.uk Web: www.csci.org.uk Mark Charters Director of Adult & Community Services London Borough of Bexley Hill View Hill View Drive Welling Kent DA16 3RY 27 th October 2008 Dear Mr Charters, Performance Summary Report of 2007-08 Annual Performance Assessment of Social Care Services for Adults Services London Borough of Bexley 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.
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 Good Good Good Good Good Adequate Good Adequate Promising Promising Promising 2 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
Key Strengths and Areas for Improvement by People Using Services Key strengths All people using services Healthy lifestyles programmes in place with evidence of impact Steps taken to address concern about night time insecurity Good progress being made on user consultation Volunteering encouraged and providing benefits to users and carers Personalisation plans at centre of Change Programme. Development of personalisation is a corporate process and includes health partners. Assessments started quickly and completed in timely manner. Improved uptake of direct payments Improved database for ethnic monitoring Protocol in place for continuing care in place and working well. Good arrangements in place for provision of financial advice Safeguarding strategy published Council have updated their data protection arrangements All people admitted to care homes have their own room Positive response to recommendations made in the IWC Inspection report Extensive Change Programme in place Good corporate and Member involvement in social care Progress on JSNA is satisfactory CRILL data being used as part of contract monitoring / commissioning arrangements Good record of budget management and financial control Through the Change Programme ensure that the engagement of service users and carers is improved in underdeveloped areas. Increase the percentage of reviews carried out. Ensure awareness of out of hours services available and how they can be accessed Implement further levels of the Local Government Equality Standards Improve ethnicity monitoring of people using services Progress plans for a brokerage service Progress the action plan agreed following the IWC Inspection. Increase percentage of council staff receiving vulnerable adult training. Investigate the low level of safeguarding referrals Complete review of section 31 arrangements Progress initiatives to address potential staff retention problems Undertake planned review of sheltered housing services and support for older people Older people Delayed discharges from hospital are low Telecare take up high and key Progress the provision of more community based Intermediate Care
element of future personalisation plans Putting in place the foundation for a significant increase in home care capacity during 2008-09 People with learning disabilities High number of people with learning disabilities helped into work People with mental health problems People with physical and sensory disabilities Short waits for both minor and major adaptations Good service provided for people with a physical disability or sensory impairment by Inspire Carers Improve services for carers Develop project aimed at identifying people at risk of hospitalisation Progress extra care housing needs assessment Investigate reasons for reduction in number of complaints from older people and continue to use comments and complaints to quality assure services Progress work with Oxleas Mental Health Trust on work trials Drug and Alcohol misusers Local drug partnership assessed as good Progress improvement of drug treatment pathways and provision of greater variety of therapies. 4
Improved Health and Emotional Well Being The contribution that the council makes to this outcome is Good. The council provided evidence of progress in the provision of healthy lifestyles initiatives, jointly with health partners. Programmes include campaigns to reduce smoking, promote weight loss, and a keep warm, keep well initiative. Information is disseminated at public events, on the Internet and by the distribution of literature. Choice of programmes is made from a combination of Department of Health guidelines and local need, and there are mechanisms in place to evaluate the impact of these. Healthy lifestyle targets figure significantly in the new Local Area Agreement. Examples of impact were provided, including that of a leisure centre that had the highest usage by people with a learning disability in the country. The Healthcare Commission and National Treatment Agency assessed the council as providing a good local drug partnership. However, the number of drug misusers sustained in treatment programmes is lower than the average for comparator authorities. The council reports that it plans to increase numbers during 2008-09 by improving the treatment pathway and by broadening the variety of available therapies. Delayed transfers of care as measured by the relevant performance indicator, have fallen since 2005-06 and are below the average for London. The Self-Assessment Survey records a decline in Intermediate Care (IC) provision for older people in Bexley since 2006-07 with plans for 2008-09 indicating a further slight reduction. However there are plans in place to build up provision through the department s Change Programme, of which IC plays a key part. More people receive IC in a residential setting than the average for comparator authorities. The council has plans to provide more community-based solutions and make a timely improvement in provision via the Change Programme. A joint health and Social Services Department Best at Home service, was created during the year to provide a service aimed at preventing admissions and delayed discharges. This will be more widely adopted during the coming year. An integrated team project has also been developed aimed at identifying people at risk of hospitalisation and providing multi-disciplinary home support. Key Strengths Healthy lifestyles programmes in place with evidence of impact Local drug partnership assessed as good Delayed discharges from hospital are low Progress improvement of drug treatment pathways and provision of greater variety of therapies. Progress the provision of more community based Intermediate Care. Develop project aimed at identifying people at risk of hospitalisation 5
Improved Quality of Life The contribution that the council makes to this outcome is Good. People in Bexley have shorter waits for both major and minor adaptations than in similar authorities, substantially so in the case of major adaptations. A recent survey indicated that people receiving services experienced feeling insecure at nighttime. The council has taken steps to help overcome this by the provision of a 24-hour community alarm system (BELL). This provision has been evaluated and is appreciated by people using services as engendering a feeling of more confidence. It was confirmed that the council is committed to telecare as an alternative to residential care, support for long-term health conditions and hospital discharges. The number of new people provided with telecare equipment during the year was substantially higher than in similar authorities. People have been encouraged to take up telecare by allowing trials of equipment whilst they received re-ablement and preventative services. The amount spent on telecare equipment and infrastructure is below that of comparator authorities and plans for 2008-09 show only a modest increase. The council explained that the low spend on telecare is the result of the grant being used only to cover staff costs, other expenditure on assistive technology being met from the equipment budget. Services for carers, as measured by the appropriate performance indicator, have improved during the year but remain lower than comparable authorities. The number of carer breaks provided was also below the average of similar councils. The council states that services for carers is an area for development and expects to achieve improvement through current work taking place on the Change Programme. Bexley Care Trust is contributing by taking steps to raise awareness. Improvement in services for carers is predicted for 2008-09. No additional extra care housing places has been provided over recent years and none is planned for 2008-09. The council reported that the high level of owneroccupation in the borough and a preference for floating support have influenced service planning decisions. However, Bexley is currently working with Kent Community Housing Trust to assess the level of future need and will base future planning for extra care housing on the outcome of this specially focussed study. The level of intensive home care provided for older people, as measured by the appropriate performance indicator, has been lower than comparable authorities over recent years. Improvement was achieved during the year but remains considerably lower than similar councils. A big increase is planned for 2008-09, which the council states, will be achieved through the recently re-negotiated home care contract. This will provide an extra 500 hours of intensive home care per week. 6
Key Strengths Telecare take up high and key element of future personalisation plans Putting in place the foundation for a significant increase in home care capacity during 2008-09 Short waits for both minor and major adaptations Steps taken to address concern about night time insecurity Improve services for carers Progress extra care housing needs assessment 7
Making a Positive Contribution The outcomes in this area are Good. Volunteering is encouraged by grant funding local volunteer agencies to promote opportunities for local residents. It was reported that 68 people with a learning disability were helped into voluntary work in 2007-08. The Independence, Wellbeing and Choice (IWC) inspection report included comments that user and carer engagement was underdeveloped in some areas, but also that individuals and carers were generally very satisfied with the service they had received. As evidence of the council s engagement with carers and individuals using services CSCI has used information obtained during the IWC inspection and the briefing submitted. Details have been provided of consultation exercises held during the year and how they had impacted on service development. The council provided a copy of the report of a Your Independence user event held in July during which questions and answers were recorded for later consideration. A description was given of how the views of users and carers were being taken into account as part of the Care Audit Team s work of reviewing care packages. Overall the council appears to be making good progress in consulting with individuals and carers and there is evidence that their views are taken into account in shaping services and policies. Key Strengths Good progress being made on user consultation Volunteering encouraged and providing benefits to users and carers Through the Change Programme ensure that the engagement of people using services and carers is improved in underdeveloped areas. 8
Increased Choice and Control The outcomes in this area are Good. In recent years the council has been consistently better than similar authorities in the percentage of people who were assessed within 48 hours of first contact (98% in 2007-08) and whose assessment was completed within two weeks (approximately 88% during the year). This is projected to continue during 2008-09. There was a good increase in the overall number of people receiving Direct Payments during the year although the rate per 100,000 remains, as in recent years, slightly below that of similar authorities. The council will be seeking to develop direct payments within the context the Change Programme and its approach to personalisation. The number of people receiving a review declined slightly during the year and is now at a level below that of similar authorities. Plans for 2008-09 predict an increase, but still to a level below that envisaged by comparator councils. Pace needs to be increased to keep up with the improvement in similar authorities and progress needs to take account of the work on personalisation within the Change Programme. It was reported that the newly established Care Audit Team, an improved assessment tool and review processes will lead to an improved performance on reviews in 2008-09. The council received an adequate judgement for the delivery of personalised services to older people in the recent IWC inspection. The inspection report included comments on the good arrangements for people to access services and the need for improvement in the provision of information. The council reports that plans for the development of personalisation are at the centre of the Change Programme. Although this is a 3-year programme, key elements will be delivered during the coming year, including a greater number of individualised budgets and the development of an infrastructure to ensure choice is available for these individuals. Adult Social Care is ensuring that the development of personalisation is a corporate process that embraces partnership with health. In addition to forming a Bexley view about the way forward, the council has made efforts to keep abreast of initiatives taking place elsewhere. Bexley is also a member of a more local network of authorities in southeast London. The number of complaints Adult Social Care received declined during the year, but is at about the same level as in comparator councils. However the reduction in the number of complaints from older people was noted. The Annual Complaints Report demonstrates that analysis of complaints takes place. The council should continue to ensure people have the information they need to make and direct their comments appropriately and keep under analysis the issues raised by comments and complaints in order to contribute to the quality assurance of services. The IWC inspection report commented on a lack of services available out of hours and that awareness of the services offered by the Emergency Duty Team was low. This is being addressed within the inspection action plan and Change Programme work. 9
Key Strengths Personalisation plans at centre of Change Programme. Development of personalisation is a corporate process and includes health partners. Assessments started quickly and completed in timely manner. Improved uptake of direct payments Increase the percentage of reviews carried out. Investigate reasons for reduction in number of complaints from older people and continue to use comments and complaints to quality assure services. Ensure awareness of out of hours services available and how they can be accessed. 10
Freedom from Discrimination and Harassment The outcomes in this area are Adequate. The council implemented levels one and two of the local government equality standards by 2006-07. No additional levels have been implemented during 2007-08. It was reported that progress has slowed because the process for obtaining validation had now changed and was at some levels no longer one of selfassessment. Validation at level 3 was expected during November 2008 and the council hoped to be able to self-assess at level 4 by the end of 2008-09. Both key performance indicators relating to ethnic monitoring were well within the required thresholds. However, the indicator concerning users of services whose ethnicity was not stated remains at a level higher than similar authorities. The council informed CSCI that it had now improved the quality of its database and recording processes and that quarter one data for 2008-09 showed an improved level of recording. The IWC inspection report expressed concern about the level of work that had been undertaken to prepare individuals and carers for the impact of the revision of eligibility criteria from moderate to substantial during the year. The council reported on the measures taken to address these concerns. It was stated that the introduction of the raised eligibility criteria was phased, initially applying only to new users of services. Service withdrawal was also phased and people were being signposted to other services and sources of information. Plans were underway to provide a brokerage service. The council will be progressing the plan for a brokerage service and will need to monitor both its usage and whether the alternatives offered are appropriate to people s needs. Key Strengths Improved database for ethnic monitoring. Implement further levels of the Local Government Equality Standards Improve ethnicity monitoring of people using services Progress plans for a brokerage service 11
Economic Well-being The outcomes in this area are Good. Continuing care arrangements are operating satisfactorily. As reported in the 2006-07 performance assessment process, very few disputes arise between the council and the Care Trust and applications are dealt with jointly by health and social care on a multidisciplinary basis. As in previous years the council helped a high number of people with a learning disability into paid employment during 2007-08, the figure being well above the average for comparator authorities. The council informed CSCI that Inspire, a local organisation now operating as an independent trust commissioned by Bexley, is providing an impressive service for people with a physical disability or sensory impairment. It has expanded its service to help councils other than Bexley. It further informed CSCI about an initiative with Oxleas Mental Health Trust to arrange work trials instead of competitive interviews for people with mental health issues trying to get into work. There is a long-standing arrangement in place to signpost people to local organisations providing advice on welfare benefits. During the year the council and partner organisations have additionally been working to establish a system by which information is passed directly to the Pensions Service to ensure rapid assessment of individuals entitlements. This work has advanced to the point of final approval by the partners. Key Strengths Protocol in place for continuing care in place and working well. High number of people with learning disabilities helped into work. Good service provided for people with a physical disability or sensory impairment by Inspire. Good arrangements in place for provision of financial advice. Progress work with Oxleas Mental Health Trust on work trials for people with mental health issues 12
Maintaining Personal Dignity and Respect The outcomes in this area are Adequate. As in recent years, the council recorded low numbers of relevant council staff having received vulnerable adults training during 2007-08 compared with similar authorities. It was explained that this was due to the low number of relevant staff employed and the fact that a high proportion of staff are in joint posts with health. The council should keep the vulnerable adult training of relevant council staff under review to ensure that all receive training wherever they are working in the organisation. Access to vulnerable adults training by relevant staff in the independent sector is good, the percentage trained being well above the average for comparator councils. The council received an adequate safeguarding judgement in the recent IWC inspection together with an uncertain capacity to improve. An action plan has been agreed and this is regularly discussed at business meetings between the council and CSCI. Satisfactory progress is being made to implement the inspection report s recommendations and these have been taken into a special stream of work within the Change Programme. A safeguarding stocktaking event is about to be held that will provide an opportunity to review the department s activity in relation to vulnerable adults. When known, the outcome of this will be discussed at an appropriate business meeting. The number of safeguarding referrals received during the year reduced slightly from the 2006-07 figure and is substantially below that for similar authorities. One referral was received concerning an individual who was purchasing their own care, a figure that is also below that for comparator authorities. The council affirmed its commitment to safeguard all self-funding residents. It reports that initial indications for 2008-09 indicate that the number of referrals will increase from the previous year s performance. The council recently completed and published its safeguarding strategy and through training plans to make staff more aware of the need to take account of safeguarding issues within the care management and review process. However, the council should investigate reasons for the relatively low rate of referrals in order to offer reassurance that individuals and their carers are as safe as possible. Evidence was provided that data protection is given due importance and prominence. Procedures have been updated and rewritten and the Data Protection Act is taken account of in training. People using services are made aware of the information required by the council. Key Strengths Safeguarding strategy published Council have updated their data protection arrangements All people admitted to care homes have their own room 13
Progress the action plan agreed following the IWC Inspection. Increase percentage of council staff receiving vulnerable adult training. Investigate the low level of safeguarding referrals. Capacity to Improve The council s capacity to improve services further is Promising. The IWC inspection report referred to the need to develop effective quality assurance systems for safeguarding services. The council provided evidence that it has actively responded to this recommendation in a number of ways, including the development of a quarterly monitoring report for the Director on the progress of action plans and strategies; strengthening contract monitoring to enhance the importance of quality assurance and improving the system for analysing complaints. Further action will be taken during 2008-09, some resulting from the implementation of the Change Programme, for example the restructuring of commissioning. The council has also responded positively to the IWC report recommendation that the safeguarding partnership should be strengthened. A number of revisions have been reported, including the widening of membership and raising the profile both within the corporate structure of the council and with partners. The Partnership Board is also being reviewed. The percentage of staff turnover in Bexley has been rather higher than that of comparator authorities over recent years and remains so for 2007-08. The council stated that it was confident that there is no underlying reason for this and that the percentage represents a small number of staff. Nevertheless it is taking steps to ensure that Bexley remains competitive. Temporary or agency appointments cover vacancies causing risk. As reported in the performance summary report for 2006-07, the council and its health partners, following the departure of the former Chief Executive, took the decision not to continue as a formally constituted Care Trust. At the annual review meeting both health and social care gave an assurance that active partnership working continued to be a priority and that joint integrated teams would remain in place in mental health and learning disability services. A review of current Section 31 agreements was taking place to ensure their appropriateness to the revised working structures. Since the appointment of the new Director, and as a response to the planning required to implement Putting People First, the council has embarked on an extensive Change Programme. This has been referred to at various points in this report. The Change Programme involves some 14 major streams of work and will have a significant impact on the structure of adult social care in Bexley and its development. Although this is a three-year programme, key developments are taking place in a shorter time. Progress on this significant work programme will be discussed at future business meetings with CSCI. 14
The council provided evidence that the data from CRILL was being used to identify commissioning areas, which required more attention and where placement could present more risk. CRILL data showed that ASC was, as at September 2007, in some service areas commissioning from a high number of unrated services. The council will need to continue to keep services being commissioned under regular review to assure itself that these are providing a good level of service to people and their carers. No Bexley residents are currently being provided a service from zerostar providers. The council gave a summary of commissioning processes and demonstrated that mechanisms were in place to monitor the service given by contracted providers. It also reported that information from reviews was being used to inform the commissioning process. Early progress has been made on the Joint Strategic Needs Assessment, the stakeholders involved having collected data from a wide range of sources, begun the process of analysing this and recognising the need to bed the outcomes into the systems and structures that will manage the shift to personalisation The council has a record of good budget management, regularly bringing this in on target, and making savings when needed. Auditors have raised no issues. Key Strengths Leadership o Positive response to recommendations made in the IWC Inspection report o Extensive Change Programme in place o Good corporate and Member involvement in social care Commissioning and use of resources o Progress on JSNA is satisfactory o CRILL data being used as part of contract monitoring / commissioning arrangements o Good record of budget management and financial control Leadership o Complete review of section 31 arrangements o Progress initiatives to address potential staff retention problems Commissioning and use of resources o Undertake planned review of sheltered housing services and support for older people Yours sincerely, 15
Colin Hough, Regional Director Commission for Social Care Inspection 16