Agenda item

To outline the actions Adult Social Care (ASC) is taking following the publication in August 2024 of the CQC Inspection Report into Brent ASC.

Councillor Nerva, as Lead Cabinet Member for Adult Social Care, Public Health and Leisure, introduced the report, which provided details of the Brent CQC Adult Social Care Inspection and the Adult Social Care (ASC) Improvement Plan. He highlighted that the local authority was last inspected over 10 years ago, and this was the first inspection Brent had received as part of the new CQC inspection regime for local authorities. The result from the inspection was that Brent Adult Social Care ‘requires improvement’, and it was highlighted that the Council was 1 percentage point from ‘good’. Councillor Nerva emphasised the importance of not dwelling on that one point and instead to take on board the feedback received from the inspectors. In addition, the authority was judged ‘good’ for both keeping residents safe and leadership. He added that, whilst the CQC Inspection was of Adult Social Care fulfilling its Care Act responsibilities, some of the services that were inspected ran right across the authority and interfaced with NHS services and the voluntary sector. In bringing his remarks to close, he highlighted that the Adult Social Care Improvement Plan and Adult Social Care Transformation Programme due to be considered in the following agenda item complimented each other and focused on the measures the local authority was putting in place to make demonstrable improvements.

Claudia Brown (Director Adult Social Care, Brent Council) added that the Improvement Plan focused on the areas identified by the CQC as requiring improvement whilst emphasising the importance of ensuring that systems and processes within ASC continued to be safe. She explained that, whilst safeguarding and leadership had been judged as ‘good’, ASC was not being complacent and was focused on ensuring safeguarding and leadership continued to do well and improve to ‘excellent’. The main areas of improvement included in the Plan and identified by CQC were around how ASC delivered services to individual users. Many of the areas identified by CQC were areas that ASC was already aware of and already had plans in place to deliver on. Overall, she felt the report presented to the Committee outlined a comprehensive plan to move ASC to a more qualitative service delivering good customer care, collaborating with other organisations and customers and continuing the trajectory of improving services towards excellent.

Harry Peacock (Head of Performance, Change and Assurance, Brent Council) provided more details about the improvements and actions outlined in the plan. He advised the Committee that CQC assurance fell within his remit and the Improvement Plan aimed to bring all actions together to understand the available data and Brent’s performance against benchmarked London boroughs. Prior to the CQC Inspection, the Council had completed a self-assessment of ASC and identified through the data and talking with partner agencies, staff and customers some areas needing improvement. The CQC Inspection then further reinforced those areas in terms of how Brent compared to national datasets and comparative London boroughs.

The Committee heard that one of the major areas of focus was on the customer experience and the way Brent Council worked with its customers, with emphasis on ensuring ASC supported carers appropriately in the borough. The Council had just developed and launched its Carers Strategy and its carers commitments and had been working with partner agencies to improve the experience of carer. Officers were now beginning to see the impact of that through the figures. For example, officers highlighted that the last set of data from the Carer’s Survey saw satisfaction rates move from 31% to 37%, putting Brent in the top 25 percentile in London for carers satisfaction. In terms of assessing need and providing the right support at the right time and in the right place, assessment waiting lists had reduced significantly over the last 6 months following the CQC inspection as a result of actions put in place. Harry Peacock advised the Committee that ASC’s approach had also moved to focus more heavily on community engagement and co-production, working with residents, user groups and community partners which was now beginning to embed. There was a Co-Production Forum and Co-Production Steering Group, and Co-Production Champions had been recruited from staff and resident groups. Four Resident Advisory Inclusion Groups had been set up to help improve the customer experience and understand life stories to help develop services. Within that approach there were 4 priorities; self-care, technology, loneliness and mental health. At an individual level, ASC were viewing every interaction with an individual as an opportunity to seek direct feedback from them and their carers so that there was no need to wait until the annual survey to understand service user’s views. ASC had also worked to understand the complaints that were coming through and identify themes that could be actioned to reduce the number of complaints and the timeliness of responses, resulting in significant improvement over the past 6 months. One key theme coming out of learning was the need for two-way communication between the Council and the service users and carers so that they understood where they were in their ASC journey. In addition, ASC was working with its wider providers and partners and had a number of actions in relation to that.

Concluding the introduction, Harry Peacock informed members that ASC was implementing an ambitious digital and assistive technology program to roll out tech enabled care, working with an organisation called Triple Value Impact to design a digital blueprint to deliver technology into people’s homes to support them to remain independent.

The Chair thanked presenters for their introduction and invited comments and questions from the Committee, with the following issues raised:

In noting that ASC was judged ‘requires improvement’, the Committee asked what ‘outstanding’ looked like to the Council and whether there were any areas where ASC were moving towards an ‘outstanding’ judgement. Claudia Brown emphasised to the Committee that, although ASC had been judged as ‘requires improvement’, it had been 1% from ‘good’, which demonstrated ASC was on a trajectory towards being ‘good’. She explained that some of the reasons ASC had been marked down was because, whilst an improvement plan had been established, many actions were in progress rather than fully implemented, and ASC knew from other boroughs that a Council could be marked down where plans had not been fully implemented. ASC had accepted the score by CQC and recognised the areas for improvement and now had plans in place to move forward, with improvement already being seen as a result of those plans in terms of working closely with partners, co-production, and a customer facing approach. In terms of what she thought outstanding looked like, she highlighted receiving minimal complaints, working closely with partners, communicating regularly with customers and receiving feedback on services, and delivering services in a timely way. As such, she felt ASC had a way to go, was confident that the performance data was starting to improve in the right direction and officers anticipated that over the next 6 months ASC would move into a solid ‘good’. 

In considering the CQC inspection regime, the Committee acknowledged the challenge in the CQC not having set themes or definitions, and asked whether the Council used its own measuring tool to assess itself. Officers confirmed that there was a framework that ASC was testing itself against, based on what CQC might have, and this could be shared with the Committee.

The Committee felt that the report was lacking in data and asked for future reports to include further performance information, metrics and benchmarks. In response, Rachel Crossley (Corporate Director Community Health and Wellbeing, Brent Council) referred to section 3.4 of the report, which highlighted the data used by the CQC, and advised the Committee that the full CQC inspection report showed the national benchmarking data ASC had been judged against. The CQC had identified that Brent had less people satisfied with their care and support, but there had been a low return rate on the survey, which she felt could mean that customers did not feel engaged and empowered to communicate with ASC. This was one of the reasons ASC was focused on getting deeper into communities, including through the recent Community Assessment Days that had been piloted with Brent Health Matters (BHM), to give a consistent experience to Brent residents. Councillor Nerva added that section 3.4.4 showed tangible areas where the Council had set itself targets for improvement, which he, as Lead Cabinet Member, would expect to be updated on regularly.

Harry Peacock provided a further explanation on the use of data, highlighting that the metrics benchmarked against came from annual surveys that all local authorities were required to undertake with their customers. That most recent survey had started in late January 2025, so over the next two months those results would be collated so that, once analysed, ASC could see any improvement made. Arrangements were being made with Co-Production Co-ordinators to go out into the community to assist people to complete those surveys where individuals were having difficulties completing them and customers were also being assisted to complete the survey over the telephone. Early indications suggested that the response rate was increasing as a result. August 2025 would be when all results were nationally co-ordinated and ASC would be able to see whether performance had improved and whether it compared favourably to other boroughs.

In response to requests for further benchmarking information, Harry Peacock added that the Council and other London boroughs had expressed strongly to the CQC that comparing London boroughs with the rest of England did not recognise the unique challenges and diversity of many communities in London compared to nationally. He informed members that the Association of Directors of Adult Social Services (ADASS) had engaged London Councils to do a piece of work around the uniqueness and challenges that London boroughs faced when benchmarked nationally. That work had since completed and showed stark differences in the experiences of people in London to people in other parts of the country.

The Committee asked what mitigations were in place to move the metrics identified in the table in section 3.4.4 forward. Officers confirmed that there were mitigations in place, and as a result this had seen carers satisfaction increase, bringing Brent into the top 25% of London boroughs for carers satisfaction. In terms of reviewing the performance metrics outlined in the table, the Committee asked whether there were governance and assurance processes in place to ensure further interventions were made if those figures did not improve. Rachel Crossley advised the Committee that there was a monthly Improvement and Assurance Board which she chaired, and that meeting included standing items reviewing performance areas, any provider concerns and statutory practice areas. As such, data was monitored monthly. There were also regular briefings with the Lead Cabinet Member and briefings with the Leader and Chief Executive to review CQC assurance. 

Regarding carers satisfaction, the Board queried the target on table 3.4.4, highlighting that the narrative stated the target had already been achieved. Harry Peacock explained that CQC had used the year before data to set their benchmarks, and over the last few months since CQC had inspected Brent the most recent national data had become available, showing carers satisfaction had increased to 37% and moving Brent into the top 25% in London. The Committee highlighted they would want to see satisfaction much higher than that, which officers concurred with. Officers acknowledged the possibility of revisiting the target as it had already been achieved and agreeing what the next step target should be. In terms of targets, Rachel Crossley expressed that Brent ASC would always want to be sitting in the top 25 percentile in London. To be considered ‘outstanding’ it would likely need to be in the top 10%. To fully understand both carer and ASC service user satisfaction and improve it, ASC was gathering its own service user feedback when residents had assessments and reviews so that information was being collated in real time. On the majority of performance targets, ASC had been setting ‘step’ targets to hit, which would then be increased once the ‘step’ target was met. Performance targets were due to be reset in March 2025, based on what outcomes Brent wanted to achieve and the resources available. As such, it was felt that ASC was aiming for continual and maintained improvement.

In relation to carers, the Committee asked how ASC identified carers in the borough. Claudia Brown explained that there were different ways to identify carers. For example, a carer might be identified through the hospital discharge process or conducting an assessment within the community, where in both circumstances they would be offered a carers assessment. ASC would look at carers needs as well and take on board any young carers needs. The Council had a contract with a carers organisation to help provide support to carers and part of their specification was to identify carers and refer them to ASC. Carers could also self-refer or be referred by an external organisation or individual.

The Chair then invited Brent Youth Parliament (BYP) representatives to participate. BYP asked what work was being done to support young carers and whether there were any young carers directly involved in the workstreams presented to the Committee. Officers advised BYP that ASC had signed up to ‘no wrong doors’ and as part of that included young carers on the Carers Board, and the carer support provider that ASC commissioned had provision for young carers with different activities targeted towards young people. ASC had an agreement in place with the Children and Young People department regarding transitions, so if there were young carers identified in their service they received a holistic transitions process so that they did not fall through the net. Councillor Nerva added that Council recently considered the implications of the 21-hour rule on young carers and their ability to claim carers benefits and remain in full time education. He and the Cabinet Member for Children, Young People and Schools had met with the Social Security Advisory Committee to express concerns about the new rule, and the Council was campaigning and lobbying around this to ensure young carers were not prejudiced regarding having to choose between money and full time education.

The Committee asked how ASC was seeking out underrepresented communities to ensure they knew about and could access services. Claudia Brown responded that ASC had recognised there were communities that it was not reaching, and so had partnered with BHM to pilot 2 ASC Community Assessment Days that were very successful and assessed around 200 individuals. As a result of those pilots, ASC would be looking to plan more events with BHM to go out to the community and open up the opportunity for individuals to receive an assessment and access various other services.

Noting the various existing frameworks for further engaging residents identified in the introduction, the Committee asked how effective those approaches had been. Officers advised that the implementation of the Co-Production Boards and the Carers Board had received very positive feedback. The people involved with those groups were fully engaged and the memberships were expanding and growing with increased participation. ASC had adopted a listening culture and any feedback received was brought back into the service to make changes as and when possible.

The Committee asked what the number of complaints being received by ASC was and the timescales they were being responded to in. Rachel Crossley confirmed that had access to that complaints data, and responded that, over the last quarter, 110 member enquiries, service requests, complaints and corporate complaints had been received across ASC. 96% of those had been completed on time (responded to within 20 working days).

In relation to the ASC restructure taking place outlined in section 5.5.5 of the report, the Committee asked what actions had already taken place. Claudia Brown explained that the consultation had just completed and ASC was working to implement the restructure from 3 March 2025. Within the restructure, there was work being done to ensure ASC was more closely aligned with neighbourhoods, with 3 social workers recruited to work externally within neighbourhoods to identify individuals in GP surgeries. The restructure aimed to streamline services and ensure ASC could be accessed much quicker, as well as ensure information and advice was available to the community through various sources, working closely with the neighbourhood service to do more outreach.

The Committee asked what impact the Improvement Plan was having on staff and carer wellbeing and workloads and whether there were any financial implications associated with the plan. Rachel Crossley advised the Committee that ASC had undertaken a restructure, moving some of teams around so that there was resource in the right places which had been positively received by staff. ASC had also responded to the feedback received during the staff consultation, and the staff survey results were positive overall. The Council always aimed to listen to people’s issues and understand pressure points, particularly around winter discharge. Claudia Brown also led wellbeing sessions and ASC had a suggestions box, ensuring staff could engage in this transformation. In relation to the financial aspects of the improvement plan, officers highlighted that there were no specific budgetary implications because ASC was using the resources it had and focusing on improvement areas, and there was no additional ask for a budget given the stretched financial position the Council was in.

The Committee noted the improvement plan priority to work collaboratively with partners, and asked how ASC would measure the success achieved through working with partners. They heard that the Better Care Fund (BCF) ensured ASC services were working with health partners to deliver support to the community, and data was collected through the BCF around how much integrated work was taking place. This information was then reported to the Department for Health and Social Care. In addition, Brent ASC benchmarked itself against other London boroughs and through national data and information returns. It was agreed that this data would be provided to the Committee.

The Chair thanked those present for their contributions and drew the item to a close. He invited members to make recommendations with the following RESOLVED:

i)               For ASC to improve the visibility and availability of data, including for staff, so that everyone understood how their areas were performing and what impact they were having.

ii)              For ASC to set more targets and specific benchmarks.

iii)             For future reports, to further outline mitigating factors if targets are not met and actions being taken to address that.

iv)             For ASC to compare with boroughs of similar demographics when making comparisons with other London boroughs.

In addition to recommendations, a number of information requests were made during the discussion, recorded as follows:

i)               To share the self-assessment tool ASC used to understand its performance.

ii)              To share carers satisfaction, including how Brent compared with similar boroughs, once the data was made available.