2015-16 4 - Conwy Social Services Annual Report

Timeliness of initial and core assessments

Timeliness of initial assessments has decreased overall during 2015-16, however, there is improvement during the year on a quarterly basis.

An initial assessment is defined as a brief assessment of a child referred to social services with a request for services to be provided. Performance is monitored by the statutory measure “The percentage of initial assessments completed within 7 working days”. The target for this measure is 80%.

2013/14	2014/15	2015/16
82.1%	79.2%	76.1%

Whilst the performance during 2015-16 has seen a drop, we can see an overall trend of improvement across the year.

Q1 2015/16	Q2 2015/16	Q3 2015/16		Q4 2015/16
65.2%	80.7%	82.5%		77%

The steady improvement in performance can be attributed to the detailed action plan implemented across the Service.

This measure is linked with SCC/006 – “decisions made on referrals within 1 working day”. Any delay on initial decision making, has an inevitable impact on the chances of completing the assessment within 7 days. Actions taken include:

Capacity was increased to ensure swift decision making on referrals Assigning additional staff helped to reduce the risk of delays
Monthly monitoring meetings were held with the Head of Service, to continually monitor the performance
Regular audits conducted by the Quality Standards team identified good practice and led to action plans to address development needs

Part (b) of this indicator – ‘SCC/042(b) – the average number of days taken to complete Initial Assessments which were greater than 7 working days’, also demonstrates an improvement in performance. The average number of days taken to complete an Initial Assessment is now back down to 10 days (as opposed to 16 days at year-end). This also suggests that practice is improving with reduced delay in completing the assessment process.

We have improved upon our core assessment performance to date compared to last year, and have consistently exceeded the target in every quarter.

A core assessment is required to be completed within 35 days of the need for one being identified when Section 47 enquiries are initiated, when a child becomes looked after or when the initial assessment has identified that a further, more detailed assessment should be undertaken.

SCC/043(a) The percentage of required core assessments completed within 35 working days. The locally agreed target is 75%.

Performance regarding core assessments has consistently exceeded the target figure through 2015-16.

Q1 = 81.0%, Q2 = 88.5%, Q3 = 79.4% Q4 = 82.7%

Although we are exceeding the target with this measure, we wish to improve further.

The majority of assessments which took longer than 35 working days to complete, were only a couple of days out of timescale. This will be monitored closely over the next reporting period.

Timeliness and comprehensiveness of reviews

Whilst there was a good improvement early in the year in the timeliness of reviews, further work is planned to improve in this area, to achieve consistent results.

Our current target is that at least 90% of clients with a care plan at 31 March whose care plans should have been reviewed, were reviewed during the year. At present our performance is not meeting our ambition, with the latest data shown below:

2013/14	2014/15	2015/16
95.76%	88.9%	88.24%

Q1 2015/16	Q2 2015/16	Q3 2015/16	Q4 2015/16
91.25%	81.33%	73.38%	70.91%

After a positive first quarter, the performance through 2015/16 showed a decline, largely due to staffing issues.

In order to improve performance the Disability Team have addressed staffing issues, implemented ways to maximise capacity and reduce duplication, and are confident that performance will improve through 2016/17.

The Older People Team have reviewed how the Carers Team work and plan for additional capacity to carry out reviews due.

In addition, the new assessment framework (not yet live) will reduce the impact of the size of the review documentation, and presents a further opportunity to improve performance.

Further development of the website

Our web information has been reviewed and will be launched in the Spring as part of the new Conwy public website.
All of the web content has been reviewed in preparation to implement a new content management system for Conwy’s public website, to go live in Spring 2016. This will result in a more streamlined presentation of the information that users are most likely to be looking for, with clear links to communication channels such as phone, email or web based services.

We will review the web content during 2016-17 after implementation of the new Content Management System.

Managing applications for Deprivation of Liberty Safeguard authorisations within timescales

Management of applications for DoLS authorisations within time scales has seen a reduction of 32% over a six month period.

Conwy has placed “The risk of legal challenge” due to DoLS on the Corporate Risk register. Positive changes have been observed in the number of cases waiting to be assessed, and the number of assessments being signed off.

We have increased resources such that there are now three full time assessors and a commitment from the six Best Interest Assessors located in other services to undertake at least one assessment each per month.

Changes made to the renewals of authorisations are being processed differently with a positive effect but this is resulting in additional pressure on the team of up to 12 additional referrals per week. In addition, part of the assessment process involves GP’s, to assess Mental Capacity. In order to optimise our use of GP’s time, we have been concentrating our efforts within residential homes in order to complete any outstanding DoLS within each home. This has also had a positive impact.

The waiting list is now down to 309 (at the end of March 2016), which represents a reduction of over 32% over a six month period.

Mental Health Services

All Mental Health placements have been reviewed to ensure appropriate and proportionate services and commissioning has shifted to emphasise the recovery model.

A ‘Sustainable Mental Health’ framework will provide a vision and outline for the effective management, especially in light of growing demand and constrained resources. A review of all mental health placements is underway to ensure all service users are receiving appropriate and proportionate care packages. Commissioning with the Third Sector places an emphasis on the recovery model to enable service users to move out of statutory services into a more appropriate community setting for long term sustainability.

A “Memorandum of Understanding” has led to agreement being reached regarding improvements to services, and senior staff in Health and Social Care have given a commitment to meet every month to monitor progress on improvements and developments. A review of the Memorandum of Understanding will be undertaken in July to ensure that agreed improvements to the service from a Health and Social Care perspective have been achieved.

Community services for people with dementia

Mapping work and consultation work has been undertaken in order to identify gaps in the current provision of community services for people with dementia.

A detailed service mapping exercise was undertaken, which included consultation with the public. This helped to identify gaps in current provision and drive the commissioning process.

The Conwy Dementia Partnership, which aims to promote the wellbeing of people living with dementia in Conwy and their carers, completed a draft Market Position Statement in relation to dementia services. This has been used to inform the Social Care Commissioning Strategy development, particularly the chapter relating to Older Peoples Services. Key themes from the Regional Needs Assessment, data analysis and research reports have been identified. Engagement and consultation workshops on the themes for the population needs assessment and market analysis are being undertaken during May – July 2016 with service users, carers and Conwy citizens. A draft Conwy Commissioning Strategy taking in to account Engagement Feedback, will be available in Oct 2016 and will go through the final consultation and approval process Nov 2016 to Jan 2017.

The “Ageing Well in Conwy Action Plan 2015 – 2019” was approved by the Council in December 2015. This plan focuses on building and promoting “dementia supportive” communities, with the following key themes:

Conwy is an environment where people affected by dementia feel confident, valued and understood
People affected by dementia in Conwy note an improvement in the timely identification of dementia and support provided before, during, and after identification.
Enhanced and extended education, training, information and advice around dementia is established.

Development and implementation of commissioning strategies

Significant background work has been undertaken to take stock of current contracts, SLA’s and partnerships, and the Commissioning Strategy will be in place for consultation in December 2016.

The Commissioning team was established in the summer of 2015 with the appointment of:

Independent and Third Sector Relationships Section Manager
Commissioning Manager (Adults)

And supported by the realignment of staff:

Commissioning Manager (Families First Lead)
Information Officer
Administrative Support
Older People’s Strategy Officer
Third Sector Liaison Officer (CVSC)
Partnerships Facilitation team [from November 2015]

The team has reviewed existing documents from across services and met with Service Managers to review current services, undertake stock-take of current contracts, SLAs and Partnerships and discuss their on-going and future commissioning and support needs and intentions.

The Social Care Commissioning Strategy will be in first draft by December 2016. Market facilitation workshops will begin in May 2016, with Market position statements and a Population needs assessment complete by January 2017.

The Commissioning Strategy is an all-encompassing document which analyses needs, the current market, a shared vision for future service delivery, and our plans for service delivery in the next 1-5 years as well as the budgetary implications of these plans. We will be consulting with internal and external partners and stakeholders, current and potential service providers, as well as service users and their carers over the next few months and seeking their views on what social care services should be delivered in Conwy in the future, how they should be delivered and by who.

Performance in dealing with complaints

Good progress has been made within the complaints service to strengthen a number of areas.

The Complaints, Compliments and Representations 2014-15 Annual Report was positively received by Scrutiny committee in October 2015. It reflected upon issues raised within the 2014 internal audit, and evidenced significant progress against the improvement action plan.

Single Point of Access (SPOA) is now used to receive all SS complaints in the absence of the Complaints Officer.
There is now a clear management structure. The complaints service sits within the policy and audit service within Quality Standards which has two tiers of management support available full time to the complaints officer.
The Complaints Officer’s role has now been agreed and funded as a full time post (previously only part time funded).
Complaints are recorded and monitored on a dedicated spreadsheet to manage timeliness effectively.
Stage 2 complaints are sent to Section Managers which has improved their awareness, engagement and commitment with the process.
The Complaints Policy has been updated to reflect issues identified in the audit.
A programme of training is being delivered via team meetings.
Delivered a workshop for Managers highlighting lessons learnt and areas for improvement.
Complaints Officer will be attending Service Managers meetings.

The impact of the Edge of Care Panel

We have plans in place to evaluate the impact of the Edge of Care Panel.

The Edge of Care panel was initially held monthly to discuss complex cases where children and young people are most at risk of coming into care. However following feedback from the social workers it was agreed to provide a fortnightly panel. The panel has also established links with CAMHS (Child & Adolescent Mental Health Service) professionals, and the Youth Justice Strategic Manager, to discuss complex cases deemed to be at risk of escalating.

The effectiveness of the panel will be evaluated at the end of 2016/17, and it is anticipated that the evaluation will show evidence that children are prevented from escalating through risk factors, and indeed that risk is reduced

The impact of the vulnerable people service

We are evaluating ways of measuring the impact of the Vulnerable People Service.

The Vulnerable People structure is now in place and all appointments have been made. The service is developing a “whole-service” culture, sharing skills and best working practices to improve outcomes for vulnerable people.

The team has explored evaluative frameworks for measuring service user outcomes, to provide hard evidence of the beneficial outcomes being achieved. The established “Outcome Stars” system was considered as a possible solution to be purchased, providing a “before and after” assessment of service user outcomes, and providing direct evidence of the impact and effectiveness of the service in helping people to achieve their outcomes. Additionally, the system would provide direct positive feedback to individual clients regarding the progress they have made, thus reinforcing and consolidating their successes.

A decision has been made to develop an evaluation model within our client information system (PARIS), aligned to the new assessments required under the SSWB Act.

Developments within Mental Health Services

Whilst a number of risks have been identified within Mental Health, we are actively engaging with our Health colleagues to take mitigating action and manage these.

There have been concerns surrounding mental health services that have been identified as risks both for the service and for the Council corporately.

Concerns around the lack of integrated systems, processes, practice and culture between health and social care are being resolved via monthly Senior Management meetings, learning events and resulting action plan and follow up to ensure changes are embedded into practice. Improvements to the service have also been discussed and agreed.

There are also risks that poor performance information from Mental Health leads to operational difficulties (ie. those operational aspects of Community Mental Health Teams which are under CCBC control).

One potential solution that was trialled was the use of the Social Care Paris system by Health colleagues which worked well. However, Health will be using a different system and in the meantime have agreed to explore how performance data from their system can be supplied to support the data required by Social Care.

A report to Scrutiny in June 2016 will request support for the recommendation that we explore alternative models of delivery of mental health services.

SECTION 1: Progress made against priority areas

This first section of the report summarises the progress made against priority areas identified by CSSIW following the publication of our 2014-15 report.

The main priority areas highlighted were as follows:
• Development and implementation of commissioning strategies.
• Developments within Mental Health Services.
• The impact of the Vulnerable People Service.
• The impact of the Edge of Care Panel.
• Performance in dealing with complaints.
As well as the areas outlined above, some service area specific priorities were highlighted, as follows:

Adults services:
• Community services for people with dementia.
• Mental Health Services.
• Timeliness and comprehensiveness of reviews.
• Management of applications for DoLS authorisations within time scales.
• Further development of the website.

Childrens services:
• Timeliness of initial and core assessments.
• Recruitment of Foster Carers.
• Percentage of young people who are known to be engaged in education, training or employment at the age of 19.
• Stability of placements.

Leadership/Governance:
• Completion of Market Position Statements and commissioning strategies.

Introduction

This year has been a particularly challenging period for Social Services in Conwy, and whilst I review the incredible activity of work we have delivered and highlighted in the report, I do this with much admiration for the dedication and commitment of our staff. [Read more…]