Agenda item

This report updates the Community and Wellbeing Scrutiny Committee on the Council’s preparations for inspection by the Care Quality Commission (CQC).

Councillor Nerva (Cabinet Member for Public Health and Adult Social Care) introduced the report, which provided an update on preparations for CQC local authority Adult Social Care Assurance. The Committee heard that this would be the first formal statutory inspection of Adult Social Care that the Council had received in ten years, but there had been a peer review conducted the previous year to prepare. In concluding the introduction, Councillor Nerva highlighted that inspectors would be interested in the delivery and leadership shown across services, including partnership working with local health services.

The Chair thanked Councillor Nerva for his introduction and invited comments and questions from those present. The following points were raised:

The Committee asked whether there was any evidence of differences in performance and commitment for agency workers compared to permanent staff. Claudia Brown (Director of Adult Social Care, Brent Council) believed that there was a difference, and when the Council had permanent staff it had the ability to raise stability and the standard of service. The Social Workers employed through the Assessed and Supported Year in Employment (ASYE) went through a set of criteria and were trained in order to set the standard of practice going forward. There were also social work apprenticeships which helped the Council to grow its social care workforce.

In relation to agency workers, the Committee asked whether there was an inter-borough initiative to keep agency staff costs down across London. Claudia Brown responded that in Adult Social Care there was no London Pledge, but there was agreement by the Association of Directors of Adult Social Services (ADASS) that all boroughs would stick to a particular rate to pay agency. However, this had not been as successful as hoped, so ADASS was now looking towards the potential for a London Pledge for Adult Social Care.

The Committee noted that, in preparation for the CQC inspection, there had been an acknowledgement of funding constraints. The Committee asked what the impact of those constraints was on the Council’s ability to have a good judgement from the inspection, and how much of the result might be due to funding issues compared to other factors within the service. Rachel Crossley (Corporate Director Care, Health and Wellbeing, Brent Council) explained that some of those funding constraints impacted on workforce, for example, if the Council could pay staff more then it could retain more staff and invest in more training, but she felt that Brent had done good work in managing that market. Brent’s key focus was around practice standards by driving consistency and working with managers around supervision and case reviews, which did not cost money. Councillor Nerva added that the Council had made a commitment to ‘parity of esteem’ between children’s and adult’s social care and the local authority was now paying an enhancement to attract staff on a permanent basis. The Council was able to put resourcing into staffing in this way, but the other issue was around cost of care, and he felt there was a broken system in relation to care costs across the whole market that required work across the whole Integrated Care Board or national basis.

The Committee raised negative national media reports of abuse of care clients, and asked whether Brent Council sufficiently monitored and trained care providers so that the Council did not fall into that category. Officers explained that care provider contracts were monitored and there was specific mandatory training that the provider must undertake with their staff on an annual basis in order to comply with their contract, which could be checked when quality assurance visits took place. The Council also offered safeguarding awareness training for providers.

An area of concern the Committee raised was around transitions from childhood to adulthood. Members heard that transitions was an area the Council was working on and developing and there was now a Transition Officer working in the Children’s Disability Service. A transitions tracker had been developed which tracked all individuals coming through transition, which would enable to Council to know who was going through transition and plan with them their package going into adulthood.

In relation to carers, the Committee asked what support the Council provided. Claudia Brown explained that the Council commissioned Brent Carers Service to work with carers and undertake training and signposting and link back to Council services where necessary. The Council worked closely with Brent Carers Service to ensure it was identifying carers to support their needs and nobody slipped through the net.

The Committee asked how much oversight the Council had over the duty of care that housing and health services had towards vulnerable adults. Claudia Brown explained that Adult Social Care had developed a relationship with housing and held a housing surgery where housing colleagues would bring complex cases to Adult Social Care to discuss. Adult Social Care was also in the process of developing protocols and pathways with housing and other areas to ensure there was a clear pathway into Adult Social Care. A multi-disciplinary SMART Team was in place to pick up those individuals who did not meet the criteria for Adult Social Care at the onset of their presentation but who usually ended up needing Adult Social Care in the longer term. That team was now merged with the duty service to ensure quick and holistic responses to individuals and was made up of housing officers, social workers and occupational therapists.

Some Committee members had been told by carers that they were being employed by private companies and believed they had not received the correct training. The Committee was informed that Adult Social Care had a regular meeting with CQC so when companies like that were brought to the Council’s attention they could be highlighted to CQC who could then inspect those services. She thought it was good for the public and councillors to be aware that this happened so that they could let Adult Social Care know of any issues.

The Committee asked how Brent was performing in relation to Adult Social Care assessments. Rachel Crossley highlighted that assessments were a major priority and Adult Social Care was putting in more resources around that, as well as annual reviews, to ensure there were up to date assessments in every space. There were around 300 assessments on the waiting list but there was a plan in place to clear that and it was estimated that would be done by May 2024.

The Committee asked how Adult Social Care was involved in the discharge process with hospitals. Claudia Brown highlighted that Brent’s hospital discharge service was one of the best performing in NWL and could usually discharge patients within 2-3 days. In some cases, this may take longer if there were further arrangements to be done before an individual could be assessed. Adult Social Care would need to determine whether a person was Care Act eligible for Adult Social Care which could cause a blockage, or the person may not be fit for discharge in the opinion of Adult Social Care and require other issues to be addressed before the person was safe for discharge. Councillor Nerva added that there was always scope to do better in relation to discharge, but if there were issues that councillors came across he asked them to put forward a members enquiry. In his role as Cabinet Member for Public Health and Adult Social Care, he had been pushing the ICB to provide information to patients when they were admitted to hospital explaining what happens and the stages of discharge.

The Committee asked how the Health and Wellbeing Board assured themselves there was joined up working and oversight from the local system. Councillor Nerva highlighted that the most recent Health and Wellbeing Board had discussed the new inspection regime and what that would mean for the local NHS. The CQC was responsible for regulating both Adult Social Care and NHS, so it was expected the inspectors would take a good interest in hospital discharges where there was overlap between health and social care. He hoped that as the arrangements for inspection developed, there would be a place-based approach looking holistically at all of the system including social care, housing and the local NHS.

In concluding the discussion, the Chair asked how ready the Council was if there was a call for inspection imminently, and an estimate of how the Council may be judged. Rachel Crossley explained that the CQC would inform you that they would be visiting within the next 6 months, and then would provide 6-8 weeks notice within that 6 months before visiting. Once that notification was received, Adult Social Care would then have a 3 week period of information gathering and would engage staff and members on their self-assessment to test that. In being pragmatic, officers felt that a worst-case scenario judgement would be ‘requires improvement’ and a best case scenario judgement would be ‘good’.  Councillor Nerva added that, whilst it was Adult Social Care being inspected, the whole system had a role to play within that.

As no further points were raised, the Chair drew the item to a close.