SERVICE INSPECTION OF INDEPENDENCE, WELLBEING AND CHOICE

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SERVICE INSPECTION OF INDEPENDENCE, WELLBEING
AND CHOICE

• HERTFORDSHIRE COUNTY COUNCIL
• Presentation of Report
• 5 March 2009

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Focus of the Inspection

• For all vulnerable adults
• Safeguarding From Abuse
• For adults with learning disabilities only
• Delivering Personalised Services

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The Inspection Team

• Lead Inspector Jan Clark
• Team Inspector Tim Willis
• Support Inspector Rachel Cheney
• Expert by Experience Darren Cunningham
• Support Worker Tracy Ward

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Delivery of Adults Safeguarding Arrangements

• We concluded that the councils overall
  performance in safeguarding adults was adequate.
• Key Strengths
• Responses to alerts were timely and appropriate
  to protect vulnerable adults
• There were examples of good practice
• The Serious Concerns Process was driving
  improvements in provider services
• The multi-agency arrangements had been
  strengthened
• The Adults Safeguarding Committee was leading
  developments
• Preventative services were being developed

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Delivery of Adults Safeguarding Arrangements

• Key Areas for Improvement
• Council reporting, scrutiny and governance
• Managerial decision-making, oversight of practice
  and outcomes
• The approach to protection planning
• Performance management and quality assurance
• Data collection and analysis of activity and
  trends
• Recording practice

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Delivery of Adults Safeguarding Arrangements

• Key Areas for Improvement (cont)
• Development of competency-based training
• Ensuring partners comply with procedures and
  expected investigative standards
• Involvement of experts by experience in
  developing arrangements
• Development of a Serious Case Review process

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Delivering Personalised Services

• We concluded that the delivery of personalised
  services for adults with learning disabilities
  was good.
• Key Strengths
• Referral and initial responses were sound and
  person-centred.
• Eligibility criteria were clear.
• Accessible information for people with learning
  disabilities was being developed DVDs were being
  increasingly used
• The implementation of Self-Directed support was
  progressing positively the NAQ and the dedicated
  PCP and SDS teams were playing a key role.
• Imaginative actions were being taken to promote
  some peoples independence.
• The Health Facilitation Service was highly
  effective in working across health and social
  care to promote responsiveness to vulnerable
  people resulting in improved outcomes.

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Delivering Personalised Services

• Key Strengths (cont)
• There was a strong overall approach to
  independent and self-advocacy, although take-up
  was inconsistent.
• Carers Contingency Plans were being introduced
  and were proving helpful when invoked.
• Day service modernisation was successfully
  enabling people with learning disabilities to
  participate increasingly in community life.
• Community services such as libraries and bus
  transport were becoming increasingly responsive
  to people needing extra support.
• People who used services were becoming
  increasingly involved in developing the range and
  quality of services that were available.
• The Single Assessment Process was well
  established.

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Delivering Personalised Services

• Key Areas for Improvement
• Capacity issues had resulted in delays in
  assessment work.
• Work was in hand to improve the experience of
  young people in transition from childrens to
  adult services.
• There was more to do to improve access to
  information about services and community
  opportunities.
• The approach to medium and longer-term planning
  for people with lower levels of need could be
  strengthened.
• There was more to do to secure good health
  outcomes for people more consistently.
• A stronger approach was needed to case reviews,
  recording practice and the assurance of quality
  in care management.
• Support to carers was not yet strong enough.

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Capacity to Improve

• We concluded that the councils capacity to
  improve was promising.
• Key Findings
• There was a strong vision in the council to
  develop modernised, self-directed community
  services this was supported by strong leadership
  in ACS.
• Councillors were supportive of the ACS leadership
  and agendathey could play a stronger role in
  governance and quality assurance, particularly
  for safeguarding.
• Staff were well engaged and enthusiastic about
  the direction of ACS creativity was being
  encouraged.
• Business planning processes could be further
  developed performance management and quality
  assurance were developing with some good
  initiatives but quite a lot more to do.
• A refreshed learning disability strategy was
  planned to reflect Valuing People Now. This would
  sit above the existing suite of commissioning
  plans.

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Capacity to Improve

• Key Findings (cont)
• Partnerships with all stakeholders were
  developing well and people using services and
  their carers felt they had real influence.
• The learning disability service had been
  successfully reshaped and was integrated.
• The Workforce Strategy lacked detail and
  workforce planning was underdeveloped.
• There had been a high investment in training and
  a good range of training and development
  opportunities were in place. Further work was
  needed to develop a competency-based approach
  linked to workforce planning this was
  particularly true for safeguarding and had been
  identified by the SAC as a priority.
• The SAC had identified and prioritised most key
  areas needing development to strengthen
  safeguarding and was driving improvements.

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Capacity to Improve

• Key Findings (cont)
• Joint commissioning was well established.
• There was more to do to ensure services were
  developed to reflect the participation and meet
  the needs of people from minority ethnic
  communities.
• More detailed work was underway on identifying
  the needs of people with learning disabilities.
  This would inform the new learning disability
  overarching strategy.
• The county had been awarded pathfinder status for
  its work on improving two-tier local government.
• Increasingly close arrangements between ACS and
  HPFT were evident.
• Contracting and performance monitoring of
  contracted services were being developed.
  Contracting was becoming more closely engaged
  with safeguarding work.

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Next Steps

• The Business Relationship Manager would normally
  monitor the delivery of the councils action plan
  through established reporting systems.
• The judgements from the inspection contribute to
  the Annual Performance Assessment.
• Monitoring arrangements will be determined by the
  Care Quality Commission (CQC).