City of York Council (Logo)

Meeting:

Health, Housing and Adult Social Care Scrutiny Committee

Meeting date:

30/01/2024

Report of:

Michael Melvin

Portfolio of:

Cllr Jo Coles – Adult Social Care and Integration


Decision Report: CQC Readiness December 2023


Subject of Report

 

1.           This paper provides an update to Committee members in regard to the upcoming CQC inspection and assurance process for us as a Local Authority.

 

Benefits and Challenges

 

2.           There are no decisions required – this report is for update purposes.

Policy Basis for Decision

 

3.           It supports two of the administration’s four key manifesto pledges: Equalities and Human Rights; and Health Inequalities

4.           Equalities: The focus on the assurances is to reduce variation and inequality of services across regional and local systems.

 

Financial Strategy Implications

 

5.           We will receive £26,730 as per grant conditions to be spent “…towards expenditure lawfully incurred or to be incurred by the new burden of engaging with Care Quality Commission review and assessment for the first time. This includes the time and resource needed for local authorities to familiarise themselves with and effectively engage with their first formal assessment.” This has been set aside as per discussions with finance, for utilising staff resources (as per pilot recommendation) and we know there will be a call to other directorates in particular, housing, public health, communities, and children to support the four themed areas. We will also be working closely with our ICS and place board around integration.

 

Recommendation and Reasons

 

6.           Recommendation: To note the report.

Reason: To support the key priority areas in preparation for upcoming CQC inspections.

 

Background

 

7.           Historical: During 2010 formal inspection for adult social care across England were stepped down in favour of sector led improvement approach. This approach led by the Local Government Association (LGA) supported local authorities to self-assess as well as further assessment through peer reviews and LGA reviews.

8.           Legislation: The introduction of the Care Act (2014) placed seven key duties on Local authorities:

-       Promoting Individual Wellbeing

-       Preventing needs for care and support

-       Promoting integration of care and support with health services

-       Providing information and advice

-       Promoting diversity and quality in provision of services

-       Co-Operating

-       Safeguarding adults at risk of abuse or neglect

 

9.           CQC Powers: During 2019-2022 extensive consultation has been completed regarding the implementation of The Health and Care Act 2022 which included the development of Integrated Care Systems (ICS). The Health and Care Act 2022 gives the CQC new powers that allow them to provide a meaningful and independent assessment of care at a local authority and ICS level. They will enable the CQC to start to understand the quality of care in a local area or system and provide independent assurance to the public of the quality of care.

10.        Approach: Specifically for Local Authorities, we will be inspected by the CQC to ensure we are meeting our duties under Part 1 of the Care Act 2014, with a focus on the following 4 Key Themes and 9 Quality Statements:

-      Theme 1: Working with people:

Quality Statement 1: assessing people (50 cases will be tracked)

Quality Statement 2: working with people to live healthy lives

Quality Statement 3: Equity in experience and outcomes

 

-       Theme 2: Providing Support:

Quality Statement 4: Community provision integration and continuity

Quality Statement 5: Partnerships and Communities

 

-       Theme 3: Ensuring Safety:

Quality Statement 6: Safe systems pathways and transitions

Quality Statement 7: Safeguarding

 

-      Theme 4: Leadership and Governance:

Quality Statement 8: Governance management and sustainability

Quality Statement 9: Learning improvement and innovation

 

11.       Pilots: The CQC have now completed 5 pilots (May - September 2023) and their overall ratings as well as scores (1-4) under each of the 9 Quality Statements are now available in the public domain. These were with: Birmingham City Council; Lincolnshire County Council; North Lincolnshire Council; Nottingham City Council and Suffolk County Council. Lessons have been learnt from these and the CQC are refining the process ahead of the next cohort.

12.       Dates for next cohort: The CQC have committed to completing a further 20 assessments from early 2024 onwards and we understand that they will communicate directly with the DASS before the 15 December 2023 to advise. At the time of writing this paper, CYC have not been notified of an upcoming inspection.

13.       Timescales: Once the CQC advise us as a Local Authority that we are to be inspected, we anticipate an 8-week lead-in time before the on-site visit and during this time we will be required to submit information to the CQC via email and a secure portal to support them in preparing for the on-site visit. Once on-site, pilot feedback indicates they will spend a maximum of 5 working days with us before continuing with remote data gathering.

14.       Single Assessment Framework: Key Differences and Similarities with the new Single Assessment Framework are:

·        4 Ratings (Inadequate; Requires Improvement; Good and Outstanding) remain.

·        Key Questions (Safe; Effective; Caring; Responsive and Well-Led) remain.

·        Legislation by which we will be inspected remains.

·        Key lines of enquiry (KLOE’s) have been replaced by Quality Statements based on people’s experiences and the standards of care they expect. 

·        There are 6 new evidence categories, of which just 5 will apply to Local Authorities:

o   People’s experience of health and care services;

o   Feedback from staff and leaders;

o   Feedback from partners;

o   Processes;

o   Outcomes and Observations

 

Consultation Analysis

 

15.        Progress: Our progress to date to prepare for inspection: -

a)   We have presented V1 and V2 of our Self-assessment framework to our regional ADASS group. Once in May 2023 and one in October 2023. We are using the feedback to update our self-assessment for V3 in early 2024.

b)   We have met with all internal stakeholders to identify who is responsible for relevant documents that will be requested as part of the information request and engagement will pick up in early 2024 to ensure all are aware of and working towards their targets.

c)   We have published our Market Position Statement; Commissioning Strategy; Workforce Strategy and PfA and Adult Social Care vision. 

d)   We have a Quality Assurance Framework, Service Improvement Plan and Practice Guidance and Model underway.

e)   We have commissioned Healthwatch to sample 20 cases and provide user and carer feedback, and we are expecting our final report early 2024.

f)     We have recruited a co-production lead to support with our All Age Commissioning and Contract and Quality monitoring.

g)   3 workshops have been held with 55 attendees; a further one to be held in January.  Key themes and quality statements are discussed, and staff have had an opportunity to feedback about what is going well, as well as suggestions for improvement. This will be fed back to SLT in January 2024. Feedback from the workshops has been positive and with many front-line staff stating that they have a better and clearer understanding of CQC.

h)   9 drop-ins have been held with 60-65 attendees; these have explored the assessment process; pilot feedback and our evidence list to date. Feedback has been that these have created a sense of calm and reduced anxiety about the inspection process and enabled staff to feel more ready to speak to a CQC Inspector.

i)     We have introduced a quality and contract management framework for our internal providers to ensure assurance of delivery and safety of care in line with CQC expectations.


Options Analysis and Evidential Basis

 

16.    Key Priorities: Preparing for CQC Inspection includes addressing several identified key priorities, amongst which are:

a)   Local Account to be developed.

b)   Updated Adult Social Care Strategy to be produced and published.

c)   A re-design of our ‘front door’ including further development and introduction of on-line options for self-assessment.

d)   To enhance our co-production and co-engagement offer.

e)   To further develop our partnership working with the ICB, TEWV and community partners.

f)     To continue the work to improve our Direct Payment process.

g)   To introduce, via corporate direction, an easy-read option for information to ensure we are meeting the accessible information standards.

h)   To improve on practice exchange and celebrating success stories and better evidence of how we embed the wellbeing principle.

i)     To commission an LGA Peer Review – booked February 2024.

17.    We are evaluating the learning from the pilots and cross referencing with our progress to date to identifying a workplan to take forward our preparation for inspection, anticipated to be in 2024.


Organisational Impact and Implications

 

18.     Organisational Impact and Implications:

·        Financial – Steve Tait (ASC Principal Accountant): ‘No comment to add from Finance. The grant is set aside to cover any expenses associated with future assessment.’

·        Human Resources (HR) – Claire Waind (ASC HR Manager): ‘No specific HR implications at this point. Staff will continue to be supported in preparation before, during and post inspection.’

·        Legal – Anna Wooding (Senior Lawyer) ‘References to the key duties under the Care Act 2014 and legislative framework are correct and the information provided in relation to the assessment framework is in line with the information available from the CQC. I have no additional comments in terms of this report.’

·        Procurement – nil comment.

·        Health and Wellbeing – nil comment.

·        Environment and Climate action – James Gilchrist (Director of Transport, Planning and Environment) - ‘No environmental implications.’

·        Affordability – report amended following discussion with Director of Customers and Communities.

·        Equalities and Human Rights – no comment available.

·        Data Protection and Privacy – ‘Data Protection and Privacy - As there is no personal data, special categories of personal data or criminal offence data being processed for the purposes of this report, there is no requirement to complete a DPIA.  This is evidenced by completion of DPIA screening questions - reference AD-02414.’

·        Communications – Megan Rule (ASC Communications Manager) – ‘Communications Service activity has already involved internal comms to staff to support preparation, and will also involve managing the implications of the outcomes of inspections with staff and media.’

·        Economy – not contacted for comment.


Risks and Mitigations

 

19.    CQC Lead is leaving the LA in mid-January. This is mitigated by handover to a new lead.

 

Wards Impacted

 

20.    All wards are impacted by this as the CQC conduct inspections across the whole local area.

 

Contact details

 

For further information please contact the authors of this Report.

 

Author

 

Name:

Michael Melvin

Job Title:

Director of Adult Safeguarding and Interim Corporate

Service Area:

Director of Adults and Integration

Telephone:

 

Report approved:

Yes

Date:

18/12/2023


Co-author

 

Name:

Gabriella Ashton

Job Title:

Head of Transformation

Service Area:

City of York Council

Telephone:

 

Report approved:

Yes

Date:

18/12/2023


Background papers

 

None.


Annexes

 

None.