Agenda item

Cllr Tim Bearder, Cabinet member for Adult Social Care, and Karen Fuller, Corporate Director for Adult Social Care, have been invited to present a report setting out information on preparations for CQC Assurance and the development of a self-assessment for Adult Social Care.  The report is also to provide an update on the recent Local Government Association Peer Challenge.

The Committee is asked to consider the report and raise any questions, and to AGREE any recommendations it wishes to make to Cabinet arising therefrom.

Cllr Liz Leffman, the Leader of the Council, attended to present a report setting out the Council’s preparations for Care Quality Commission (CQC) Assurance and the development of a self-assessment for Adult Social Care. The report also provided an update on the recent Local Government Association (LGA) Peer Challenge.  The Leader was accompanied by Karen Fuller, Corporate Director for Adult Social Care, Victoria Baran, Deputy Director Adult Social Care, and Alison Enever, Project Manager.  Stephen Chandler, Executive Director for People, also attended for some of the item.

The Committee noted its disappointment that, for the second consecutive meeting, Cllr Bearder had declined the Committee’s invitation to present a report relating to his portfolio.

The Leader introduced the Adult Social Care Assurance Update and thanked officers for the excellent work that was evident in the recent Peer Review.  The Leader emphasised the need to further embed The Oxfordshire Way across the organisation’s thinking.  There were also areas where areas for improvement were suggested and the Council was committed to addressing those.

The Corporate Director for Adult Social Care reminded members that, whilst the date was unknown, the Assurance assessment was impending and would consider the Council as a whole rather than simply Adult Social Care.  The Peer Review had usefully highlighted areas of strength and of opportunity.

The Deputy Director for Adult Social Care gave an overview of the CQC Assurance and set out key findings from the recent Peer Challenge.  Since the introduction of the Health and Care Act 2022, CQC had a duty to assess how local authorities met their Care Act 2014 duties. CQC had also published their guidance and assessment framework. Upon notification of an inspection there would be three weeks to submit data requested in the Local Authority Information Return (LAIR).  This enabled CQC to review key documents, information, and data in advance of its arrival. CQC would arrive for an on-site assessment within six months. CQC focused on four key themes: i) working with people, ii) providing support, iii) how the local authority ensures safety within the system, iv) leadership.

The LGA Peer Challenge provided lots of data on these key themes which also provided a wide range of evidence for the LAIR. The peer review included 250 people with a range of experience throughout the organisation, from frontline staff to leadership.

The LGA Peer Challenge identified several strengths within the Oxfordshire Adult Social Care System including improvements in waiting list times, the outcomes-focused Safeguarding Adults Board, and the passion and pride of. The review highlighted areas for development including the need to further embed an understanding of the Oxfordshire Way into staff culture, to develop work done around co-production, and to improve the data and intelligence dynamic.

Feedback from those involved in the experience was to be gathered. A programme approach was to be adopted to identify, track, and drive delivery on key areas.

The Committee had wide-ranging discussion and a number of issues were raised, including the following:

·       The Committee sought further clarification on the purpose of CQC Assurance and its benefits for Oxfordshire residents.

The Committee were informed that CQC, as care regulators, considered Adult Social Care in its entirety and sought to ensure a consistent and high standard of care was provided to residents. CQC Assurance was also seen as an opportunity to share learning across the country and to follow best practice from other councils.

·       Members suggested that a greater level of communication was needed from the service to change the narrative around adult social care and to promote the good work that had been done.  It was explained that the directorate did distribute ‘stories of difference’ which demonstrated its work and stories had appeared in the press previously.  There was a desire to broaden the communications and engage with wider partners.

·       The executive summary of the self-assessment which had been provided with the report gave a number of headline figures.  One of these was that “23.2% of residents are from non-“white British” backgrounds.”  Without context or explanation, members considered this an oddly worded statistic and questioned its purpose.  The Committee was also interested in how Equality, Diversity, and Inclusion (EDI) had been measured.

The CQC expected organisations to have an understanding of the demographics of their areas.  There was a level of expectation that workforces should reflect the local population and this was a good reminder of the EDI work necessary, particularly with regard to recruitment.

This was a key area of development for Adult Social Services. It was also noted that there were opportunities across the Council, and this was seen as an organisation priority. There was an action plan to ensure the Council made progress on this.  The Committee requested a copy of the action plan.

·       Concern was expressed that a lack of flexibility was resulting in stress for families where there was no obvious need for a reassessment.  The Committee was advised that many reassessments were a statutory obligation and that a reassessment was always intended to meet people’s needs. 

·       The Committee praised the positive changes in the service and established that this had not been the result of additional staff.  Instead, it followed from a significant team effort with focused attention to detail and frontline staff following the Oxfordshire Way to ensure all opportunities to support service users had been fully explored.  There had been a reduction in agency staff with a successful push to ‘grow our own’ and successful use of the apprenticeship schemes. A bespoke recruitment campaign for the service had a good response for occupational therapists and social workers.

Whilst the Council was not a housing authority, it had sought to influence Local Plans to take account of concerns about the affordability of housing, particularly for key workers. Working with Age UK, Home Sharing had been explored with many schemes working successfully.

The importance of co-production was discussed and had been a theme of the Peer Review.   A key example of successful coproduction was the Carers Strategy, which had been coproduced with carers.  The Health and Wellbeing Board had also emphasised the importance of the strategy across all services.

There had been work with domiciliary providers to initiate provider led reviews which enabled carers to use their expertise and knowledge of the individual to provide the best service. It was hoped that the increased use of technology would allow carers to spend more time with individuals.

There was a review of contracts with providers which was intended to ensure the most appropriate care was available to service users. 

Whilst it was an issue relevant to the whole system, Adult Social Care had always been mindful of the digital divide which was an issue that did not only affect the elderly or only social care. The Council had provided a great deal of support to people who wanted to be digitally-enabled. The library service was highlighted as a good example of this work being done.  The Council had worked with Age UK to support those without digital access to ensure they had still received the support they needed. The work of community volunteers was also noted, a key part of the Oxfordshire Way.

·       The Committee explored how the CQC Assurance preparations were being shared by the Council as an whole.  Much of the work in preparation for the CQC Assurance was ‘business as usual’ and there was a culture of continuous improvement in the service.  The Senior Leadership Team had been briefed and this ensured that information was disseminated throughout the Council.  There was a wide programme of work, which required support from colleagues in many departments, which helped everyone know what needed to be achieved. Examples were provided of the work which had already been done with IT services to demonstrate the wider work around CQC across the organisation.

There had been a strong push for senior leaders to work together to overcome barriers and find solutions for individuals. Weekly cross-service meetings, including Social Healthcare teams, called ‘Meaningful Measures’ meetings, had taken place to share learning to improve the service provided to individuals.

With an expected increase in Oxfordshire’s elderly population, the Committee explored how the service was future proofing itself.  Members were reminded that not all elderly people needed social care and it was emphasised that the Oxfordshire Way built vibrant communities and looked at how Oxfordshire supported residents to live as independently as possible for as long as possible. It was believed that empowering the community had been more effective in supporting individuals.  There was also an emphasis on prevention so that residents would not need the services.

The Committee was remained of the open invitation for members to shadow Adult Social Care teams and a visit to the Luther Street Medical Centre after the next Committee was suggested.

The Committee requested the following ACTIONS:

·       A more detailed breakdown of the demographic figures “23.2% of Oxfordshire residents are from non-“white British” backgrounds.”

·       A breakdown of the 23% of people living in Oxfordshire with a disability

The Committee resolved to make a RECOMMENDATION under the following heading:

·       That the Council should publicise the successes of Adult Social Care more widely.