Agenda item

This report provides the Health and Wellbeing Board with information on the progress on preparing for CQC inspection, the CQC assurance framework and the continued work to integrate CQC preparation work, improvement action, and transformation work within Adult Social Care.

Rachel Crossley (Corporate Director Care, Health and Wellbeing, Brent Council) introduced the report which detailed the process for the CQC Inspection of Adult Social Care Services. The new inspection process was focused on a single assessment framework, meaning that from a local authority perspective it would be focused on Adult Social Care. The slides included in the agenda pack aimed to ensure an understanding of the framework and would be used for briefings to get the message out about what the inspection was. Claudia Brown (Director of Adult Social Care, Brent Council) added the following points:

• The inspection would look at 4 main areas;
  • How Adult Social Care (ASC) worked with people and provided support to market providers, including the monitoring of contracts and ensuring services were equitable for users. As part of evidence gathering there would be interviews with service users.
  • Leadership of ASC including directors of the Council. Principle social workers would be spending some time looking at quality and standards as part of preparing for inspection.
  • Safety, particularly safeguarding vulnerable adults.
  • Feedback from partners, including councillors and health colleagues. The inspectors would be looking to see how ASC worked with other partners, and ASC could demonstrate that social workers were very much involved in Integrated Neighbourhood Teams and worked closely with GP surgeries.
• The inspectors would collect data through interviews with people who have lived experience of ASC services. The inspectors would also be using documentation from case file audits, chosen from a list of 50 cases selected by ASC, and the inspectors would then audit those cases and provide feedback on them.
• The inspectors would look at outcomes for service users and what service users had to say about their outcomes.
• Brent’s ASC had not been inspected for over ten years, so the department was being supported by colleagues in the children and young people’s department who were more accustomed to being inspected regularly.
• Work around engagement had begun, particularly with the multi-disciplinary team, staff, health and other organisations including providers. The information gathered from engagement would help to inform the ASC self-assessment, and ASC was now at a stage where there was a working self-assessment document that continued to be developed.
• Dr Haidar (Vice Chair) added that the CQC would focus on safety, care, responsiveness, effectiveness and leadership. He felt that responsiveness was key, and the borough team had been very responsive and engaged in the process. Brent was in a good position with a regular monthly meeting involving ASC, voluntary and community sector partners and health to address challenges. The CQC would be looking at the borough-based partnership to see if there was dialogue between ASC and health, and how the partners responded to each other and supported each other.
• It was likely that ASC would be inspected every two years, so there was a need to have a process in place that ensured preparedness at all times for inspection.

The Chair thanked colleagues for their introduction and invited the Board to contribute, with the following points raised:

• The Board asked whether the self-assessment had identified any strengths or weaknesses that might be expected to be picked up during inspection. Claudia Brown explained that one of the strengths identified through the self-assessment, as well as the peer-review that took place the previous year, was that the client voice was heard throughout case recordings, and the peer reviewer felt the service was responsive and leadership was good. One of the areas for development identified from the self-assessment was around service user participation, and ASC was developing a project to ensure service user participation ran throughout services as a ‘golden thread’.
• The Board highlighted that ASC worked with external providers, and asked how accountability could be sought if there were failures or weaknesses identified at inspection in relation to external provision. Claudia Brown explained that if there was a service failure then the inspectors would be looking at how ASC’s systems and processes put corrective action in place and how that was managed with providers. There was a regular Provider Forum and the Commissioning Team worked closely with providers to improve their offer and monitor contracts to ensure issues were addressed.
• The Board acknowledged that the SEND inspection, discussed in the item above, was a joint review of both the Council and local health service. The CQC ASC inspection was more focused on the local authority, but the Board highlighted that ASC was impacted by a range of other parts of the whole system, for example through the hospital discharge process where there would need to be a common approach. Claudia Brown responded that ASC had been meeting with NHS colleagues and provided a briefing on the inspection process where colleagues had been asked how best the Council could support them to prepare for CQC, as the inspectors would be talking to health partners and reviewing discharge data. Further briefings would also be disseminated, including to councillors, as the inspectors would look at anywhere that ASC had a role to play. Simon Crawford (Deputy CEO, LNWUHT) added that the Trust had been engaged as part of the process and had a strong story to tell in terms of the working relationship between ASC and discharge teams and the support the Trust received from ASC. Brent ASC had been flexible and responsive to support the Trust in a challenging environment during winter pressures and the junior doctor strikes.
• The Board highlighted there were cross-cutting themes between ASC and housing, such as Disabled Facilities Grants (DFG), and asked whether housing would be involved in the process.  Whilst officers could not guarantee that the inspectors would go in that direction, it was recognised that if they came across a case involving DFG then they could investigate that in more detail, so ASC was trying to be as broad as possible with the briefings they were offering and were also holding comprehensive focus groups, talking to colleagues across the whole Council. There was a communications plan in place so that everyone within the Council was aware that the inspection was happening.
• If the inspectors found that ASC was underperforming, the inspectors would have the authority to introduce support for the organisation to improve standards, which would mean reputational damage, so it was imperative that ASC was judged as good.

As no further issues were raised, the Board RESOLVED to note the report and recognise the significance of the local system adopting a whole system approach towards the upcoming CQC ASC inspection.