The eldery do the Council care?

 

Another topic which has been raised by people contacting Angry of Havering is the provision of care for the elderly. We will be bringing you more on this very soon. In the mean time please feel free to leave a message in the forum or email angry@domain-solutions.co.uk .

Below is a copy of the Summay Report for 2006-07 of Social Care Services for Adults Services for Havering.  As you will see there are a lot of areas where the report findings are only adequate and we have only been awarded a one star rating.

21 st October 2007

SUMMARY REPORT OF 2006-2007 ANNUAL PERFORMANCE ASSESSMENT OF SOCIAL CARE SERVICES FOR ADULTS SERVICES FOR HAVERING

Introduction

This report summarises the findings of the 2007 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 discus relevant issues.

Attached is a revised copy of the performance assessment notebook which provides a record of the process of consideration by CSCI, leading to an overall performance rating. You will have had a previous opportunity to comment of the factual accuracy of the evidence notebook following the Annual Review Meeting.

The judgements outlined in this report support the performance rating notified in the performance rating letter. The judgements are.

• Delivering outcomes (formerly Serving People Well) using the LSIF rating scale

       And

• Capacity for Improvement (a combined judgement from the Leadership and the commissioning & use of resources evidence domains)

The judgement 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 2008 ) and to make available to the public, preferably with an easy read format available.

ADULT SOCIAL CARE PERFORMANCE JUDGEMENTS FOR 2006/07

Areas for judgement	Grade Awarded
Delivering Outcomes	Adequate
Improved health and emotional well-being	Adequate
Improved quality of life	Good
Making a positive contribution	Adequate
Increased choice and control	Adequate
Freedom from discrimination or harassment	Adequate
Economic well-being	Good
Maintaining personal dignity and respect	Poor
Capacity to Improve (Combined judgement)
Leadership	Promising
Commissioning and use of resources	Promising
Star Rating	One Star

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.

KEY STRENGTHS AND AREAS FOR IMPROVEMENT BY PEOPLE USING SERVICES

Key Strengths	Key areas for improvement
All people using services
Organisation refocusing of adult social care within the council Initiatives to promote health and well-being Joint work on long term conditions Rates of help at home and residential activity suggested a shift in the balance of care in 2006/07 Full implementation of single assessment, including the electronic summary Progress on mobile working, and direct single and self-assessment Improvement indicated by Supporting People re-inspection Establishment of central safeguarding machinery late in 2006/07 High than planned numbers of staff trained in safeguarding Overall improvements in PAF Performance indicators, signifying steady progress in 2006/07 while still requiring consolidation and further modernisation	Early establishment of senior management continuity Within the next stage of the re-abling policy, review hospital admission avoidance opportunities  Develop an explicit preventive policy Review the acceptability of a low rate of intensive home care before setting a new target Encourage partnership and participation with representative client-led groups Continue to address under-performance within the assessment system, especially on promptness but also ethnic monitoring Improve systems and increase numbers receiving a review Further increase in provision of statements of need Strengthen multi-agency Safeguarding Adults Committee, especially police involvement Performance manage safeguarding activity to avoid repeat of 2006/07 assessment backlogs and poor practice Improve a range of significant workforce indicators (turnover; vacancies; sickness rates; training and development)
Older People
Re-commissioning of non-residential intermediate care Developments in telecare Re-provision of in-house residential homes New extra-care at Painesbrook Court involving telecare, intermediate care and floating support Income maximisation by the Joint Visiting Team with the DWP (PATH)	Continue to jointly re-commission residential intermediate care Reduce social care delayed transfers of care Resolve reimbursement dispute with the acute trust Increase target for older people helped at home Progress the modernisation of home care, emphasising re-abling and direct payments
People with learning disabilities
The reprovided service at Neave Crescent development used a person-centred model of care The ROSE employment project in partnership with Havering College was effective and influential	Reduce numbers in residential or nursing home care, including joint work on PCT-funded long-stay care
People with mental health problems
“Nothing about us without us” a new client participation initiative Improved access to residential treatment for drug users Dedicated HIV/AIDS care manager New S31 management arrangements agreed with NELMHT	Continue action plan from 2006 CSCI service inspection
People with physical and sensory disabilities
Increase in direct payment activity A range of advocacy services included Havering Association for People with Disabilities Use of residential solutions decreased Disability Conference for council residents in June 2006	Progress plans to commission a client-led disability organisation Develop quality assurance systems and evidence base for all client groups, with priority to self-directed care Work jointly to reduce disputes over eligibility for NHS continuing care
Carers
Increase in support reflecting high levels of breaks New Carer's Forum Consultation of the Carers' Strategy New carers/employees group within the Council	Repair partnerships with some key stakeholders Review benefits of a more corporate approach to carers within the Council

KEY STRENGTHS AND AREAS FOR IMPROVEMENT BY OUTCOME

Improved health and emotional well-being

The Council makes an adequate contribution to improving peoples health and sense of well being.

The Council had made progress in reconfiguring intermediate care resources, and had identified options for embedding a more preventive approach (e.g. linking roll-out of telecare with extra-care housing and intermediate care developments, which was already happening at Painesbrook Court ). The next stage of reconfiguration would involve a joint commissioning project group, progress on the home care modernisation work and formalisation of a written preventive strategy. Some progress was made on reducing delayed transfers of care in 2006/07 but there was room for improvement which the Council said was already visible in 2007/08. A dispute with the acute trust over reimbursement payment had been lengthy.

Key strengths

• A range of strategic and partnership initiatives took forward the promotion of health and well-being and reduction of health inequalities.
• The Council and PCT invested significantly in intermediate care through re-commissioning, achieving above average levels of non-residential activity.
• Extra-care housing activity was linked with the significant development of telecare.
• The Health and Well-Being group (part of the LSP) was an important driver in delivering a joint needs assessment.

Key areas for improvement

• Further increase the number of clients receiving an annual review.
• Continue to re-commission in relation to the still relatively high level of residential intermediate care activity.
• Further reduction in the level of delayed transfers of care attributable to the Council.
• Resolve the longstanding dispute with Havering PCT about reimbursement payments.
• Consider a joint hospital admission avoidance agreement within the next stage of implementing the re-abling policy.
• Continue to progress the action plan following CSCI's service inspection of mental health services in 2006.

Improved quality of life

The contribution that the Council makes to this outcome is good.

Measured by a range of key performance indicators including residential activity and help for people at home, the Council made progress during 2006/07 in shifting the balance of care towards community-based support. It recognised the need for further service modernisation and consolidation in order to sustain this trend. As well as further development of preventive and re-abling strategies (see Outcome 1), the Council needed to develop activity supporting older people to live a home and holistic reviewing. In particular it should address its historically low level of intensive home, which normally acts as a brake on diversionary potential. Support for carers, such as through respite breaks, was provided at a good level as measured by PAF C62. Nonetheless, relations with some carers' stakeholders were strained. A significant work programme begun late in 2006/07 included consultation on Havering's carers' strategy and the possibility of a carers' centre.

Key Strengths

• The provision of extra-care housing increased through the opening of Ethelburga and Painesbrook Courts, with links with telecare and PCT inputs.
• Neave Crescent , which opened for people with learning disabilities in May 2007, maximised person-centred care and self-determination.
• The development of extra-care housing reflected the Council's strategy of decommissioning its in-house residential care homes.
• Service patterns suggested that in 2006/07 the balance of care in Havering had shifted towards community-based support.
• Telecare developments were positive. They included 21 complex, diversionary applications for individuals.
• Support for carers increased, reflecting the provision of high levels of breaks.

Key areas for improvement

• Improve the rate of older people helped to live at home through a more suitable target than in 2006/07.
• Review and improve the very low rate of intensive home care. Intensive services are closely associated with diversion from residential care.
• Develop an explicit preventive strategy which links the issues of effective preventive inputs, activity supporting older people to live at home, the rate of intensive home care and potential benefits from the Joint Visiting Team with the DWP.
• Consolidate partnership working relationships with carers stakeholders that have been under strain.

Making a Positive contribution

The outcomes in this area are adequate.

The Council had taken forward developments in mobile working and supporting people (e.g. extra-care housing) that were likely to facilitate positive involvement by clients and carers, such as by direct input of self-assessments. Nonetheless, there was work to do both to repair some relationships with stakeholders (particularly carers) and to move strategically towards new partnership arrangements involving client-led representative local organisations.

Key strengths

• Progress on mobile working in clients homes, direct single assessment and direct self-assessment.
• Consultation with carers on the carers' strategy and a prospective carers' centre.
• The Painesbrook Court extra-care development included healthy living projects within sheltered housing and the roll-out of floating support.
• Nothing about us without us', a wider London initiative, was being implemented in partnership with NELMHT to promote client participation in planning and service development for people with mental health needs.

Keys areas for improvement

• Develop participation opportunities by addressing the absence of representative client-led organisations.

Increased choice and control

The outcomes in this area are adequate.

Although single assessment had been implemented fully and mobile working created new opportunities, other aspects of the assessment system were under-performing and subject to improvement work with CSED. Good progress was made on expanding the coverage of direct payments, with a significant increase in numbers, although the spread of activity needed to be adjusted. Little systematic evidence of quality and satisfaction was available, showing the need for future initiatives to be taken forward by the new Quality and Performance Section. The Council had yet to begin planning to implement individual budgets.

Key Strengths

• Full implementation of single assessment, including the electronic summary.
• Doubled take-up direct payments, including good use by older people.
• The rates of older people aged 65 or over and adults aged 18-84 admitted on a permanent basis to residential or nursing care decreased.
• A range of advocacy services was available.

Key areas for Improvement

• Continue to address with the Care Services Efficiency Delivery Team (CSED) many underperforming aspects of the assessment system.
• Further improve the number of assessments of adults and older people leading to a provision of service, and the provision of statements of need.
• In developing direct payments coverage improve the spread of activity by size of care package, including more intensive packages for older people.
• Develop quality assurance activity and increase the evidence base about quality, satisfaction and outcomes, especially in relation to self-directed care.
• Reduce the number of people with learning disabilities funded by the Council in nursing home or residential care.

Freedom from discrimination or harassment

The outcomes in this area are adequate.

Ethnic monitoring of assessment and service provision improved but the number of adults whose ethnicity was not known was significantly above the London average. The Council had largely implemented the Disability Equality Scheme in 2006/07.

Key Strengths

• The Council had largely implemented the Disability Equality Scheme in 2006/07.
• A Disability Conference for Havering Residents and Local Groups in June 2006 influenced the action plan of the Disability Discrimination Scheme.

Key areas for improvement

• Reduce the number of adults assessed, and those with one or more services in the year, whose ethnicity is ‘not stated'.

Economic well being

The outcomes in this area are good.

The Council developed a good practice employment initiative for people with learning disabilities (ROSE – Realistic Opportunities for Supported Employment), encouraging similar developments within other service areas. Havering's Joint Visiting Team with the DWP (PATH) was well-established, maximised individual incomes and could make a wider contribution to a future preventive strategy.

Key strengths

• Modernisation of learning disability services emphasised the move away from traditional day services towards employment-based alternatives.
• The ROSE employment project for people with learning disabilities.
• This project had influenced similar developments, such as in mental health services, involving the support, Time and Recovery Team and the Small Works Project where a social enterprise scheme was envisaged.
• The Joint Visiting Team (Pension and Assessment Team – “PATH”) with the DWP was well-established and maximised incomes.

Key areas for improvement

• Work jointly to reduce disputes with the PCT over eligibility for continuing care.

Maintaining personal dignity and respect

The outcomes in this area are poor .

Safeguarding practice had been inadequate in 2006/07, reflecting late development of the specialist team and so capacity to respond to a rise in alert. This led to assessment backlogs and poor practice within 2006/07, in particular safeguarding investigations, while the multi-agency Safeguarding Committee was not firmly established and needed to be consolidated. These issues were being addressed in 2007/08 through improved capacity, new performance management systems and scrutiny by elected members. The strategic involvement of the police required corporate attention.

Key strengths

• The Council established its Adult Protection Team in January 2006/07.
• The number of staff trained in awareness, and safeguarding processes, was higher than planned.

Key areas for improvement

• Achieve and monitor good safeguarding capacity levels and systems.
• Ensure 2006/07 safeguarding assessment backlogs, and poor practices, are not repeated.
• Strengthen the multi-agency Safeguarding Adults Committee, especially by ensuring the contribution of the police.

Capacity to improve

The Council's capacity to improve services further is promising.

Strategic and joint commissioning needed progressing, although recent framework documents had laid the foundations for further work. Nonetheless, significant service modernisation programmes had been commissioned in 2006/07 (reprovision of in-house older people's and learning disability homes; Painesbrook extra-care housing; reconfiguration of intermediate care). Modernisation of home care was at an earlier stage. The local provided service market was generally of good quality, especially in relation to domiciliary care. A significant budget overspend for 2006/07, with similar commitments in 2007/08, was being managed corporately. The Council had recently agreed an initial £5m to support the adult social care budget with 07/08. Further support was expected in future years, subject to final budget decisions including efficiency targets. There were no plans for service reductions or tightening of eligibility criteria.

Following the Council's initial difficulty in responding to Priority Improvement Council status, and senior management charges since June 2007, the Council was committed to an imminent return to substantive senior management arrangements that would increase overall capacity. Clarity about the version of modernisation and strategic direction had increased since January 2007. There was still much to be developed. The recent strategic and joint commissioning documents established intentions in principle rather than detail, while further strategic work was planned on preventive and re-abling work, quality management, partnership relationships and client/carer involvement. Nonetheless the sense of strategic direction and improvement was clear.

Key strengths

Leadership

• Organisational refocusing within the Sustainable Communities Directorate brought adult social care together with housing and regeneration services.
• Renegotiation of the S31 agreement with the North East London Mental Health Trust refocused borough and social care leadership.
• Organisational restructuring towards the end of 2006/07 involved setting up a new Quality and Performance Team and a Modernisation Team.
• Integration of health and social care was taken forward by joint governance roles with Havering Primary Care Trust and Health Act Flexibilities, most of which were led by the Council
• The percentage of staff whose ethnicity was “not stated” decreased.

Commissioning and use of resources

• In-house residential services were re-provided, despite a judicial challenge, partly through modern extra housing development.
• Plans for the substantial modernisation of home care were subject to consultation.
• A strategic commissioning outline framework had recently been developed.
• A joint commissioning strategy framework had recently been developed with Havering PCT.