Report to LINk Southwark Steering Group regarding continuing

							  Report to LINk Southwark Steering Group - Update on the work of the
                      Scrutiny Task Group so far



Introduction:

On December 3rd, 2009, the ‘Care Quality Commission’ named eight local
authorities as failing to provide a good enough service for the elderly and
disabled, and said that it wanted to know why they were using homes judged as
poor or just adequate.

Southwark council, which dropped from “excellent” in 2007 (CSCI report) to one
of the eight worst authorities in the country, (CQC report) called for an urgent
parliamentary review of the regulator.

The furore surrounding the CQC report and its findings regarding Southwark
Health and Social Care provision of services for older people required that LINk
Southwark address its remit to scrutinise such provision and hold
commissioners to account.

At their meeting on December 14th, 2010, the LINk Southwark Steering Group
established a Scrutiny Task Group with the remit to address the specific issues
raised in the CQC report ‘Southwark Council’s Commissioning and provision of
Care Services for Older People in Care Homes and in their own homes’. The
outcome of the Task Groups work was to produce a report that:

    describes both the process and the conditions as they are found to be in
     the course of Scrutiny
    recommends the action that is thought would be likely to help remedy any
     discovered adverse situations
    reassures residents that there is no cause for concern should this be the
     outcome of the Scrutiny and, therefore, the appropriate conclusion to be
     drawn from it


Summary of actions taken so far:

January 2010        - Barry letter to Annie Shepperd informing of LINk
                    Scrutiny
                    - Initial meeting with CQC
                    – Annie Shepperd letter response to Barry and Claire

February 2010       -   Initial analysis of CQC assessment and LBS response

March 2010          -   Initial questions sent to LBS and CQC.

April / May 2010    - Advert put in LINk Southwark News to request
                    information on care home issues from public
May 2010           - Follow up email on CQC questions. 2nd reminder –
                   Duncan Paterson replied to chase up on this.
                   - Felicia Boshorin and KH – produced ‘primer’ on process
                     of people placed into care homes
                   - Alvin met with Bessie Okoro, CH Paid Representative,
                     about Care Plans.

July 2010          - Reminder to James Postgate on LBS response to initial
                   Questions
                   - Response from James Postgate that a response will be
                   sent to the interim Steering Chair (NB: Never received!)

August 2010        -   CQC response to questions received (NB: Incomplete!)

September 2010     - Meetings with:
                   - John Darby, LBS Procurement Development Manager
                   to further understand procurement procedure.
                   - John Wiltshire, CQC Performance Assessment
                   Manager
                   - CH (LD Advocacy) / Alzheimer’s Society
                   - OP Community Groups / SMWA / Over 60+ tea party
                   - Mail out to local older people community groups
                   - Presentation at Grove Vale Library
                   - Submitted advert to the Southwark Pensioners
                       Newsletter
                   - Analysis of the Care Home Inspection / Grading
                       process
October 2010       - Lay Inspector
                   - Dementia Café – Carers and service-users
                   - Age Concern (Southwark and Lambeth)
                   - CH IMCA Advocacy

November 2010      - Andy Loxton, LBS Lead Commissioning Manager for OP
                   - Unison Trade Union– to discuss staff/carer experiences
                      in Care Homes

(NB: All related documents are listed at the end of this report and are
available to all Steering Group members upon request).


Where we are at now:

CQC versus CSCI reports: We have done a comparison on the methodology
and assessment outcome.

Care Home Pathway: We have established the service user journey from initial
access to assessment and provision of services.

Enter and View: After much discussion with lay inspectors, the CQC, Older
People Community Groups, we chose not to conduct an ‘enter and view’. This
was first and foremost because the information needed already exists in
secondary formats and it was felt that ‘another inspection’ would not be in the
best interest of the residents.

Home Care: After initial scoping it was agreed that this was a much different
area than care homes from the point of view both of the Commissioning
process and the service user pathway. This is a potential area for the proposed
‘Personalisation’ Task Group to examine.

Commissioning: We have established in a reasonably clear way the current
procedures for the commissioning of Care Homes. There are two main
procedures for commissioning – bulk contracts and spot purchase. We are
relatively clear on how the process for commissioning bulk contracts is followed
but still have some outstanding questions related to spot purchasing. We have
submitted these to Andy Loxton, Lead Commissioning Manager for Older
People. However, during the course of the scrutiny it has become apparent that
the shift of Commissioning has increasingly geared towards fulfilling the
Personalisation Agenda – which will affect both how ‘Homecare’ and ‘Care
Homes’ will be provided in the future.


Next Steps:


The Scrutiny Task Group will produce the draft report of its initial findings which
will be presented to the Steering Group at their February meeting. The report
will be split into 3 main parts:

       Part 1: Stand alone information piece about the CQC report vs the CSCI
       report. This concludes by addressing this years CQC report (released
       November 2010) and the ending ‘Annual Performance Assessments’.

       Part 2: The Commissioning Process itself. What triggers a care home
       placement, how is it purchased and how is it monitored.

       Part 3: How the Commissioning Process is changing with the increased
       focus on Personal Budgets and now the Personalisation Agenda is likely
       to impact on how all Social Care support is delivered.

The Scrutiny Team is now primarily focussing on ‘Part 3’ of the report and will
be meeting with the Directors of Blackfriars Settlement and Cambridge House
Settlement to gather their views on the impact of Personalisation Agenda on
the ability to deliver care services in the future. The commissioning of care
services for Older People has highlighted the need for ongoing scrutiny in light
of the accelerating implementation of the Personalisation Agenda. However,
the commissioning of care services under the Personalisation agenda will have
a more significant effect on all services and not just services for older people. It
is therefore suggested that the Scrutiny Task Group accept this wider remit to
form the Personalisation Task Group endorsed by the Steering Group at their
October meeting.
Appendix

  1.   4th January – Barry’s letter to Annie Shepperd informing of LINk Scrutiny
  2.   29th January – Annie Shepperd letter response
  3.   March - Initial questions sent to CQC and LBS
  4.   May – Primer ‘ Access to Care Homes’
  5.   August – incomplete question response from CQC
  6.   CQC and LBS Questions partial response/deduction