APPENDIX B

Social Services Inspectorate

South East Region Group

Isle of Wight

Director of Social Services & Housing

Inspection of Best Value Review of:

Out-of-Hours Services

September 2001

Summary

1.1 The scope of the Best Value Review Out of Hours Services was broad and comprehensive. It embraced the out-of-hours responsibilities of the joint Social Services and Housing Directorate and made explicit reference to a range of statutory duties. Account was taken of legislative requirements and the rationale for including the out-of-hours service in the first year of reviews was well made. The limits of the review were also clear.

1.2 The review team made good use of SSI standards which were acknowledged to represent good practice (a copy of which are attached to this report).

1.3 The review highlighted that while the service was valued, it was also costly and under pressure. It identified an inconsistent response to referrals and a mismatch between resources and expectations (other organisations, professionals and service users). For these reasons we judged the service to be a ‘Good’ 2 – star service which will definitely improve. This judgement is based on the evidence obtained during the inspection and is explained in greater detail in subsequent sections of this report.

1.4 Overall we were impressed by the thorough and professional approach to the review process, the resulting report and its recommendations. It was our view that services would change for the benefit of all concerned.

Inspection performance matrix

Recommendations

1.5 The social services and housing directorate should draw up criteria by which progress can be measured, preferably expressed in terms of outcomes.

1.6 The social services and housing directorate should make clear how the out-of-hours service would contribute to the council’s overall objectives.

1.7 The social services and housing directorate should consider ways to support senior managers in implementing the change programme identified by Best Value reviews. Senior managers might be supported by the creation of a project manager post. A short-term contract or a secondment as a development opportunity might be one approach.

Introduction

1.8 The joint social services and housing directorate provided an emergency out-of-hours service to the population of the Isle of Wight. The service included adult and childcare services, the joint inspection and registration service and homelessness.

1.9 The Isle of Wight has a population of about 130,000 people with a particularly high proportion of people over 65 years. The population between 18 and 64 years is lower than most comparator councils and lower than the England average. At the time of the review, the council was run by an all party executive. The council had adopted a model of cabinet/executive committee with select committees undertaking the scrutiny role.

Background

Best Value review programme:

1.10 The council’s Best Value review programme indicated an intention to review all major social care services. However, the programme could be subject to change as the council moves towards a more thematic approach to reviews. At the time of this inspection (September 2001), the review programme appeared comprehensive with the year 1 (2000/01) topics of care management and commissioning and out-of-hours services reflecting Joint Review action plan commitments, service plans, and also the scale of review topics, capacity and workload considerations.

1.11 The review of out-of-hours services had been given priority as managers and staff were concerned that the service was over stretched and of uncertain quality.

1.12 In our view, there was a logic to year 1 reviews focusing on access, care management and commissioning arrangements, prior to reviewing specific care services in their own right.

1.13 The scope of the review was broad and comprehensive, embraced the out-of-hours responsibilities of the joint social services and housing directorate, and made explicit reference to a range of statutory duties.

1.14 In conclusion, the simultaneous Best Value review of care management and commissioning was justified by reference to the Joint Review concerns about these areas of key activity. The review of out-of-hours services was linked to this larger review and was also underpinned by concerns about steadily increasing demand and the sustainability of the service.

BVR findings:

1.15 The Best Value review addressed the directorate’s own objectives and priorities. It was intended that the review would link to the council’s corporate objective. ‘To care for vulnerable and disadvantaged people’. As these objectives were reviewed and re-written there will be a need to up-date the ways in which Best Value reviews contribute.

1.16 The review was based on rigorous application of the 4C’s, (compare, compete, consult and challenge) the use of gap analysis techniques, and was underpinned by SSI standards relating to out-of-hours services. This approach ensured that a wide range of improvement themes were systematically identified and translated into action points within the improvement plan.

1.17 The inspection of the review documentation revealed clear links between findings, identified gaps, the conclusions drawn, and the recommended actions for improvement.

1.18 At the strategic level, six options for change were assessed against a range of factors and good use was made of a Chartered Institute of Public Finance and Accountancy decision making tool. A number of alternatives were actively considered in terms of both service delivery configurations and external providers. The review did not accept the status quo and made the case for investment and reform.

1.19 A strength of the review was the extent to which it clearly met the original review objectives, identified gaps, acknowledged weakness and translated these issues into the improvement plan. The review report is well written and logically presented.

Quality of service

Are the authority’s aims clear and challenging?

1.20 As a result of the challenge phase of the review, the council had clarified challenging aims for this service. This included a restatement of the emergency only nature of the service and emphasised improving information to the public and a more robust approach to performance management.

Does the service meet these aims?

1.21 The review process has led to the articulation of new and challenging aims for the service and the improvement plan was designed to deliver continuous improvement. The service did not currently meet the revised aims and challenges for improvement, but the improvement plan represented a strategy for doing so over time.

· Consultation

1.22 Consultation with social services users’ was undertaken with the assistance of Poole Social Services and was based on a recently used SSI national methodology. This facilitated comparison with national figures. The consultation indicated that the service was generally highly regarded by service users.

1.23 Consultation also involved a wide range of other stakeholders including:

· staff;

· the police;

· women’s refuge;

· NHS hospital trust;

· GPs;

· Housing associations;

· Benefits Agency; and

· community nursing services.

1.24 The review made use of the Council’s Citizen Panel.

1.25 In the main, the views of consultees were adequately summarised in the main report and some comments were selected to highlight both positive and negative views.

How does its performance compare?

· Comparison

1.26 The service was clearly described in the report and included data on:

· the nature and scope of the service;

· activity levels for each component of the service;

· the nature of calls, ie reasons for referral;

· workload trends;

· costs; and

· human resource issues.

1.27 The review acknowledged the difficulties of finding a suitable comparator authority with respect to the social work service. Comparison was therefore made with services which were identified as offering a good service or an alternative model of delivery. This is regarded as a reasonable and pragmatic basis for selecting comparator authorities. There was less difficulty identifying appropriate comparators with respect to homelessness and ASW services.

1.28 In relation to the social work service, the review made good use of Joint Review and national inspection reports, ie SSI report ‘Open All Hours’, and compared itself with a consortium approach to service delivery as well as to several other unitary authorities. The review also benefited from the application of a costing model which helped to expose the full costs of the service for the first time.

1.29 The comparison phase of the review examined quality, including out comes for service users and was strengthened by the use of the above mentioned SSI standards.

1.30 As a result of the difficulties of finding reliable and cost effective benchmarking information, the decision has been made by the directorate to join a benchmarking organisation. Of interest is the fact that the organisation in question currently provided support to Northern Ireland Health and Social Care Boards. This may well help the council with future Best Value reviews and projects which have linkages to the integration of health and social care services.

1.31 We concluded that the comparison phase of the review was undertaken with rigor; the analysis was balanced, well argued and demonstrated critical thinking. It was appropriate for the review team to take active account of strategic changes heralded by the NHS Plan, especially around service integration with health and the opportunities presented by initiatives such as Care Direct.

The review process

BVR Methodology:

1.32 The Best Value review report evidences a comprehensive and recognisable approach which follows the 4 C’s in an iterative way. The review made use of a wide range of appropriate methods (examples; surveys, benchmarking, case work audit etc), considered a number of improvement options, and the final report reflected both the rigor and clarity of thinking and evidences internal consistency and sound use of data.

1.33 The council also used a small team of Best Value facilitators, this appears to be a pragmatic way of introducing a degree of independence, quality assurance and conformity with corporate guidelines and standards.

Terms of reference/objectives:

1.34 As already noted, the scope of the review was broad and comprehensive, account was taken of legislative requirements and the rationale for including out-of-hours services in the year 1 programme was well made. The council also made use of relevant SSI inspection standards (standards that are deemed to represent ‘Best Practice’). The limits of the review were clear.

1.35 In our view, the objectives of the review could have been expressed in more explicit and measurable terms; we understand that this observation will be taken on board with respect to future reviews.

Review team:

1.36 A project team supported and advised the review. The membership of this team included a range of representatives of the directorate, the health authority and the community health council. There was also an appraisal group comprising councillors and trade union representatives.

1.37 The skill mix of the review team appeared reasonable and there was a mix of genders.

Other resources:

1.38 The European Foundation Quality Management (EFQM) model was used as a supplementary resource. It appeared that the council collaborated appropriately with Portsmouth City Council who undertook at the same time a review of care management.

Joint working arrangements:

1.39 The Health economy appeared to have had only one representative on the working group. Broader representation would have enriched the review.

Sampling:

1.40 Consultation took place with a wide range of stakeholders including service users.

1.41 The Council’s Citizens panel of more than 1,000 people selected by Mori was asked questions relating to social services which were pertinent to the review. The panel was regarded as representative of a cross section of the Island’s population.

1.42 A care management survey was also undertaken and this shaped the audit of casework.

1.43 Further data analysis was based on an interrogation of all referrals and case work over a 10 week period. This time consuming approach reflected the inadequacies of other sources of management information.

Will the service improve?

Does the BVR drive improvement?

· Challenge

1.44 The challenge phase of the review incorporated the fundamental challenge of whether or not there was a need for this service. The review noted that the service was provided within a complex statutory framework. The review team also justified the ongoing need for the service with reference to the fact that the needs of vulnerable service users ‘do not fit neatly into normal office hours’. Further justification for the service included the higher expectations of the general public for customer responsive services; partnership obligations owed to other statutory agencies; and central government policy drivers such as the NHS Plan commitment to establish Care Direct nationwide.

1.45 In terms of needs analysis, sound use had been made of both primary and secondary sources of data, including respectively analysis of demand (current and historic) as well as data relating to demographics and indicators of social need. There was not, however any investigation of latent need. Equalities issues received some consideration; this was clearly an area the directorate was struggling with.

1.46 To the extent that need was expressed as a demand for a service, the review examined demand trends and noted that the social work component of the service had experienced a growth rate of 14 per cent per annum over the past 3 years.

1.47 The challenge phase of the review also included a ‘gap analysis’ in relation to the social work service and compared performance against SSI standards. This resulted in the identification of a number of areas of weakness and opportunities for improvement.

1.48 The review clearly challenged the existing mode of operation of the social work element of the out-of-hours service, exploring and rejecting - with justifications noted - a variety of alternative options for service delivery. In all, six options for change, including alternative modes of delivery and alternative arrangements with external providers were considered.

1.49 The report noted that no other options were identified which would lead to significant improvement in the delivery of the ASW or homelessness services. The joint registration and inspection unit function of the out-of-hours service was due to transfer to the Care Standards Commission. We concluded that the challenge phase of the review had been conducted with rigor and candour and had resulted in the identification of a number of areas for improvement.

· Compete

1.50 The review examined the issue of competition by investigating the range of arrangements made by a number of other councils. This included consortium approaches whereby two or more councils pooled resources. The review team embarked on tentative discussions with a potential mainland consortium, but these discussions were abandoned when it became clear that costs would be incurred if the proposals were to progress beyond an informal stage.

1.51 The option of transferring at least part of the service to a mainland provider was also examined through the consultation process. This established that on the whole, Council Members were reluctant to see this course of action pursued, and the Mori survey indicated that a majority of members of the public were similarly opposed to external provision.

1.52 The review argued that the need to retain existing skills and knowledge on the island, coupled with potential opportunities to develop a Care Direct approach in conjunction with health, led to the conclusion that outsourcing the service would be inappropriate at the present time. It would appear important that this decision was kept under review as circumstances will inevitably change over time.

How good is the improvement plan?

1.53 The improvement plan was comprehensive and incorporated all of the actions required to address identified weaknesses and gaps in performance. Prioritisation was only evidenced in terms of different time scales. The plan was also flexible and allows for links with other emerging initiatives such as Care Direct.

1.54 The Council Executive had approved the plan and allocated the required financial resources. The plan was realistic, practical and would provide an impetus for change.

1.55 The improvement plan would have been enhanced by the inclusion of criteria by which progress could be monitored.

Monitoring:

1.56 The Council had established a monitoring process to check and monitor progress of improvement plans. The Social Services and Housing Select Committee would require regular update and reports of the conduct of each Best Value Improvement Plan. This has been noted in the public record of the Select Committee.

Will the authority deliver the improvements?

1.57 The plan was intended to drive improvement and deliver cost efficiencies.

1.58 Leadership, commitment, innovation and energy were needed to implement the plan successfully. Given the financial pressures faced by the directorate at the time of this inspection, there were concerns about management capacity to drive change. This was especially so as directorate lacked the infrastructure typically found in larger authorities.

1.59 We considered that the improvement plan would be delivered and that the service would change and improve and become more effective.

1.60 The capacity to lead this work is an issue to be addressed by senior management and councilors. They may wish to consider whether the present infrastructure can support the change agenda and whether to identify an additional post of project leader for the duration of the change programme.

STANDARDS AND CRITERIA

STANDARD 1: OUTCOMES FOR SERVICE USERS

Service users receive a prompt and effective social services out-of-hours response, which is adequate to deal with the need referred or is sufficient to support service users until mainstream services can be provided, if necessary.

Criteria:

1. Public information is provided on the emergency out-of-hours service, which includes access arrangements and any eligibility criteria that apply.

2. Service users can access the emergency out-of-hours service quickly.

3. Service users receive an appropriate response which is effective in reducing risk and stabilising an emergency.

4. Out-of-hours intervention is followed up efficiently by mainstream services, where necessary.

5. Service users are able to access the complaints procedure, if dissatisfied with the service they receive.

6. Service users express satisfaction with the service provided and are positive about the outcome of their enquiry.

STANDARD 2: PRINCIPLES AND POLICY

The social services department has a clearly written, up-to-date and comprehensive policy for securing emergency out-of-hours services.

Criteria:

1. The department’s policy is based on an assessment of the needs of the community, and other relevant organizations, for emergency services outside normal office hours.

2. The policy defines those emergencies to which the SSD will respond, and the range and nature of that response.

3. The policy includes all emergency services provided out-f-hours by the department, including those provided by a designated emergency duty team or staff on rota.

4. Explicit standards define the quality of service to be provided by the emergency out-of-hours staff.

5. The policy defines the links between out-of-hours and mainstream services.

6. Where services are provided by another social services department, or as part of a consortium of authorities, the out-of-hours policy is specified in contracts or service level agreements.

7. The policy is reviewed periodically, and updated to take into account changing needs in the community.

STANDARD 3: INTER-AGENCY COLLABORATION AND CO-OPERATION

The social services department works collaboratively with other agencies, and departments within the local authority, to ensure a co-ordinated approach to the provision of emergency out-of-hours services.

Criteria:

1. Protocols have been agreed that define the nature and extent of each agency’s contribution to shared out-of-hours responsibilities.

2. Inter-agency protocols include arrangements for access, exchanging information and maintaining confidentiality.

3. Regular reviews of inter-agency working are held and working arrangements are adapted as necessary.

4. Other agencies express satisfaction with the service provided by the social services department.

STANDARD 4: ASSESSMENT AND SERVICE PROVISION

Out-of-hours assessments are sufficient to determine the nature and extent of the response or services needed, which are then provided promptly.

Criteria:

1. Services provided by emergency out-of-hours staff are in accordance with statutory requirements and regulations, that apply to particular service user groups, and in accordance with the SSD’s policies and procedures.

2. Written, up-to-date procedures are available to support the emergency duty team, and are used by staff.

3. Decisions in response to service user requests are based on clear assessments of need, urgency and risk.

4. Emergency out-of-hours staff have access to adequate information about known service users, held by the SSD and other agencies, or departments of the local authority.

5. Emergency out-of-hours staff receive care or protection plans which include contingency arrangements for those existing service users who are likely to need an out-of-hours response.

6. Emergency out-of-hours staff are able to access an adequate range of resources to support their intervention, including those commissioned by the SSD and provided externally, which are provided promptly.

7. On-going casework is communicated effectively through out-of-hours staff shift changes, and with mainstream staff, in a manner that maintains consistency and avoids duplication.

8. Intervention demonstrates that emergency out-of-hours staff understand other agencies’ responsibilities, and promote co-operative working.

9. Case recording complies with the SSD’s recording procedures and gives a sufficient account of action taken and services provided.

STANDARD 5: EQUAL OPPORTUNITIES

Emergency out-of-hours services respond to the needs and preferences of service users, and services provided are sensitive to race, religion, language, culture, gender and disability.

Criteria:

1. The emergency out-of-hours policy and procedures demonstrate the department’s commitment to equal opportunities.

2. Information on emergency out-of-hours services provided is available publicly in a range of media and languages, which reflects the needs of the community.

3. A range of interpretation and translation services can be accessed by staff out-of-hours.

4. Choice is available in the services provided in response to the needs or requirements of service users.

5. Training in equalities issues is provided for emergency out-of-hours staff.

6. The department’s ethnic monitoring procedure includes requests for emergency out-of-hours services, and informs the development of future services.

7. Service users say that they were treated with respect and that services provided were appropriate to their particular needs.

STANDARD 6: STAFF COMPETENCE AND DEPLOYMENT

Emergency out-of-hours staff are appropriately recruited, trained, deployed and supervised.

Criteria:

1. The skills, knowledge and qualifications of out-of-hours staff are sufficient to provide an emergency out-of-hours service.

2. There are clear standards of competency for staff providing emergency out-of-hours services, which is supported by appropriate training.

3. Rotas provide adequate staff to deal with the level and nature of anticipated demand.

4. Staff receive regular and effective supervision , which includes monitoring of their performance.

5. Where services are contracted out, monitoring arrangements include evaluation of staff performance.

6. staff on duty can access managers for guidance, support and decision making.

7. Staff are aware of developments or changes in policy or procedures within the SSD, other departments, agencies or contracted services.

8. Adequate arrangements are in place to promote the safety and protection of staff providing out-of-hours services.

9. Accommodation for staff, which may include working from home, are satisfactory, and allow a rapid response to referrals or enquiries.

STANDARD 7: ORGANISATION AND MANAGEMENT

The SSD’s organization and management arrangements support effective emergency out-of-hours services.

Criteria:

1. The organization of emergency out-of-hours services is clearly stated and is adequate to implement the SSD’s policy.

2. The provision of emergency out-of-hours services demonstrates that best value for money is obtained.

3. The delegation of decision making authority is formally recorded and understood by staff and managers.

4. Management information is collected for monitoring and review purposes.

5. Information from complaints, both from service users and other agencies, is used to review the effectiveness of the service, and indicate any changes necessary.

6. Emergency out-of-hours services provided by other local authorities, or as part of a consortium, are supported by contracts that define management accountability and monitoring arrangements.

7. There are adequate administrative arrangements to support the provision of out-of-hours services.