Remit from the Adult Care and Social Work Committee of 15 November 22 - Quality Assurance Annual Report
North Lanarkshire Council · 16 February 2023
Back to Audit and Scrutiny Panel — 16 February 2023 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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North Lanarkshire Council Report Adult Care and Social Work Committee Does this report require to be approved? ☐ Yes ☒ No Ref MD/MW Date 15/11/22 Quality Assurance Annual Report From Morag Dendy, Head of Planning, Performance & Quality Assurance E-mail WilliamsonM@northlan.gov.uk Telephone 01698 332093 1. Background 1.1 This report highlights Quality Assurance activity over the period 1 April 21 to 31 March 22 and covers Contracts & Contract Management, Regulatory Activity, Procurement, Complaints, Duty of Candour, Provider Sustainability and Children & Families. Full detail of these activities is included in Appendix One. Executive Summary The role of Quality Assurance covers a range of functions across social work by facilitating the delivery of high-quality services through effective business planning, maintaining quality standards and quality monitoring information. Our commitment is to provide an annual report on activity carried out in the preceding year. The purpose of this report is to update Committee on our Quality Assurance activity over the annual period of 1 April 21 to 31 March 22. Recommendations It is recommended that the Adult Care and Social Work Committee: 1) note and endorse the contents of the report. 2) Remit the report for information to the Integration Joint Board 3) Remit the report for information to the Audit and Scrutiny Panel 4) Remit the report for information to the Education, Children and Families Committee The Plan for North Lanarkshire Priority Improve North Lanarkshire's resource base Ambition statement (24) Review and design services around people, communities, and shared resources
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2. Report 2.1 Contracts - In partnership with colleagues from Corporate Procurement, the Quality Assurance Team is responsible for procuring and contracting with a wide variety of independent sector organisations who provide services to the most vulnerable people living in our communities. A methodical and systematic approach has been developed resulting in over 90% of services purchased by social work now having an agreement in place ranging from national framework arrangements to individual service agreements. 2.2 Contract Management - A key function of the Quality Assurance Team is to ensure and evidence that effective, rigorous, and consistent contract monitoring processes are in place with organisations from whom social work purchase services. This is to provide good quality and up to date information which will inform practice and strategic decision making in relation to the commissioning, contracting and compliance arrangements in place. 2.2.1 This approach provides evidence that each commissioned service is delivered as specified to the terms and conditions of the contract, relevant quality standards and provides value for money. 2.2.2 The Monitoring Prioritisation Assessment (MPA) is the key component of the CMF. The MPA is the up-to-date position statement on the performance of commissioned contractors. The MPA determines the monitoring status of each commissioned service based on a tier system which consequently determines the frequency of monitoring activity. The tiers range from Tier 1 (green) which relates to satisfactory performance and a monitoring frequency of annually, in most cases, to Tier 4 (red) which indicates significant concerns in relation to service delivery and a monitoring frequency of 1 to 4 weekly. 2.3 Regulatory Activity - During the COVID 19 pandemic, Care Inspection activity was focused around one key quality question “How good is our care and support during the Covid 19 pandemic?”. In late 2021, the focus slightly changed to include the quality question “How well do we support people's wellbeing?”. The inspections were predominately with Care Homes; however, a few Self-Directed Support providers were also inspected generally in response to complaints or increased notification activity to the Care Inspectorate. 2.4 Provider sustainability - Since the start of the pandemic there have been ‘sustainability’ arrangements in place to ensure Social Care services/facilities continued to operate in a financially secure and viable manner including provision of payments when services couldn’t be delivered. The sustainability principles were due to end in June 2021 but further extensions have been applied. There remains a requirement to ensure that Social Care capacity is sustained to achieve positive outcomes for clients, whilst also addressing the overarching need to demonstrate value for money, streamline payment arrangements and demonstrate the approach is fair, equitable and transparent. 2.5 Procurement - A fundamental aspect of the role of Quality Assurance is ensuring that the people North Lanarkshire Council (NLC) arranges support for can be confident that support is provided legally, safely, with their interests at the centre and that ensures Best Value for NLC. A key component of this work is carried out with our colleagues in Corporate Procurement. The collaboration with Corporate Procurement has enabled us to jointly pursue further refinements to commissioning and procurement.
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2.6 Children, Families and Justice - Quality Assurance monitors most Children’s services where a contract status has been secured either on an Individual Placement basis or as part of a Framework Agreement, generally through Scotland Excel. 2.7 Complaints - Quality Assurance retains an overview role in terms of complaints made about NLC Social Work service provision. Regular quarterly reports on complaints activity are reported through our governance structures. 3. Measures of success 3.1 Measures of success are contained within Appendix One of this report. 4. Supporting documentation 4.1 Appendix 1: Quality Assurance Annual Report 2021/22. Morag Dendy Head of Planning, Performance & Quality Assurance
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5. Impacts ( http://connect/report-template-guidance ) 5.1 Public Sector Equality Duty and Fairer Scotland Duty Does the report contain information that has an impact as a result of the Public Sector Equality Duty and/or Fairer Scotland Duty? Yes ☒ No ☐ If Yes, please provide a brief summary of the impact? As part of the council’s commitment to Fair Work and social work’s drive to adopt an ethical commissioning approach, Fair Work practices have been embedded in procurement processes to ensure contractors are paying the Scottish Living Wage and are committed to providing community benefits. If Yes, has an assessment been carried out and published on the council’s website? https://www.northlanarkshire.gov.uk/your-community/equalities/equality-and-fairer- scotland-duty-impact-assessments Yes ☐ No ☐ 5.2 Financial impact Does the report contain any financial impacts? Yes ☐ No ☒ If Yes, have all relevant financial impacts have been discussed and agreed with Financial Solutions? Yes ☐ No ☐ If Yes, please provide a brief summary of the impact? 5.3 HR policy impact Does the report contain any HR policy or procedure impacts? Yes ☒ No ☒ If Yes, have all relevant HR impacts have been discussed and agreed with People and Organisational Development? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact? 5.4 Legal impact Does the report contain any legal impacts (such as general legal matters, statutory considerations (including employment law considerations), or new legislation)? Yes ☐ No ☐ If Yes, have all relevant legal impacts have been discussed and agreed with Legal and Democratic Solutions? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact? Conformance with Procurement Reform Scotland Act 2014 and the Procurement (Scotland) Regulations 2016. The Health (Tobacco, Nicotine etc. and Care) (Scotland) Act 2016 and organisational duty (Duty of Candour) on health, care, and social work services. 5.5 Data protection impact Does the report / project / practice contain or involve the processing of personal data?
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Yes ☐ No ☒ If Yes, is the processing of this personal data likely to result in a high risk to the data subject? Yes ☐ No ☐ If Yes, has a Data Protection Impact Assessment (DPIA) been carried out and e- mailed to dataprotection@northlan.gov.uk Yes ☐ No ☐ 5.6 Technology / Digital impact Does the report contain information that has an impact on either technology, digital transformation, service redesign / business change processes, data management, or connectivity / broadband / Wi-Fi? Yes ☐ No ☒ If Yes, please provide a brief summary of the impact? Where the impact identifies a requirement for technology, has an assessment been carried out (or scheduled) by the Enterprise Architecture Governance Group (EAGG)? Yes ☐ No ☐ 5.7 Environmental / Carbon impact Does the report / project / practice contain information that has an impact on any environmental or carbon matters? Yes ☐ No ☐ If Yes, please provide a brief summary of the impact? 5.8 Communications impact Does the report contain any information that has an impact on the council’s communications activities? Yes ☒ No ☒ If Yes, please provide a brief summary of the impact? Requirement to publish an annual Duty of Candour Report 5.9 Risk impact Is there a risk impact? Yes ☒ No ☐ If Yes, please provide a brief summary of the key risks and potential impacts, highlighting where the risk(s) are assessed and recorded (e.g. Corporate or Service or Project Risk Registers), and how they are managed? Risks are identified and reported on via the relevant risk register.
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2021/22 Quality Assurance Annual Report 2021/22 APPENDIX 1
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1. Introduction The role of Quality Assurance covers a range of functions across social work by facilitating the delivery of high-quality services through effective business planning, maintaining quality standards and quality monitoring information. The team support the development and/or maintenance of robust practices that assist in achieving better outcomes for those who access services. Our cycle of monitoring and review ensures services meet the strategic aims of both the Council and the Health and Social Care Partnership. Our commitment is to provide an annual report on activity carried out in the preceding year. This report outlines activity over the period 1 April 21 to 31 March 22 and covers Contracts & Contract Management, Regulatory Activity, Procurement, Complaints, Duty of Candour, Provider Sustainability and Children & Families. 2. Contracts In partnership with colleagues from Corporate Procurement, the Quality Assurance Team is responsible for procuring and contracting with a wide variety of independent sector organisations who provide services to the most vulnerable people living in our communities. A methodical and systematic approach has been developed resulting in over 90% of services purchased by social work now having an agreement in place ranging from national framework arrangements to individual service agreements. Tables 1a and 1b below illustrate graphically the extent of the work that has been carried out in engaging with the independent sector in a proportionate and balanced way to ensure service provision has a legal basis, is provided safely and is of a high quality through our contracting arrangements. As of 31 March 22, 93% of all social work spend had the provision of a formal contracting arrangement, the remaining 7% will be reviewed and prioritised in the coming year and contracts agreed as appropriate. Table 1a
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Table 1b 3. Contract Management Framework (CMF) A key function of the Quality Assurance Team is to ensure and evidence that effective, rigorous and consistent contract monitoring processes are in place with organisations from whom social work purchase services. This is to provide good quality and up to date information which will inform practice and strategic decision making in relation to the commissioning, contracting and compliance arrangements in place. This approach provides evidence that each commissioned service is delivered as specified to the terms and conditions of the contract, relevant quality standards and provides value for money. In addition, this approach moves the emphasis of the Quality Assurance Team from a service improvement focus to a contract management arrangement to enhance the principles of consistency, efficiency and effectiveness at the heart of Best Value. The CMF was developed to align with contract development and this process will continue as contracts and procurement exercises change to reflect new models of provision and procurement. It is a whole systems approach which links commissioning, contracting, monitoring, reviewing and re/de- commissioning. The CMF is a redesign of previous and existing monitoring practice in parallel with the development of the Council’s digital systems to securely exchange and make available information to improve decision making at individual, practitioner and strategic level. For individuals using commissioned services it supports them to: • be confident their views are listened to, respected and used to influence service quality. • be confident that their best interests/outcomes are at the heart of the approach • be able to make informed choice
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The Monitoring Prioritisation Assessment (MPA) is the key component of the CMF. The MPA is the up- to-date position statement on the performance of commissioned contractors. The MPA determines the monitoring status of each commissioned service based on a tier system which consequently determines the frequency of monitoring activity. The tiers range from Tier 1 (green) which relates to satisfactory performance and a monitoring frequency of annually, in most cases, to Tier 4 (red) which indicates significant concerns in relation to service delivery and a monitoring frequency of 1 to 4 weekly. The processes of monitoring and the accompanying reporting build a body of real time and accessible information regarding the quality-of-service provision, its performance and outcomes over the life of a contract/framework. Table 2 STATUS INDICATED MONITORING LEVEL Red Significant concerns in relation to service performance, contract compliance. TIER 4 Amber (high) Moderate concerns in relation to service performance, contract compliance TIER 3 Amber (low) Minor concerns identified in relation to service performance and contract compliance TIER 2 Green Service performance, contract compliance and engagement are satisfactory. TIER 1 Each Tier suggests a minimum monitoring frequency (Table 3). The basis of monitoring will be the commitments made by the contractor as part of their contractual agreement with the Council including, but not limited to, Standard Terms and Conditions, Data Protection Terms and Conditions, Special Terms and Conditions, commitments made in relation to Fair Work Practices and Community Benefits and relevant national standards. Table 3 Tier 1 Contract monitoring visit frequency – annually in most cases. Tier 2 Contract monitoring visit frequency – variable, at least bi-annually but no more than quarterly. Tier 3 Contract monitoring visit frequency – variable, at least quarterly but no more than monthly. Tier 4 Contract monitoring visit frequency – 1 to 4 weekly.
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For the 2021/22 reporting period, monitoring activity was undertaken on 300+ contractor organisations. Despite a challenging environment in relation to the pandemic response, 72% of contractors had a Tier 1 monitoring status, with Tier 2 at 16%, Tier 3 at 8% and only 3% of contractors at Tier 4 (as of 31 March 22) indicating the value of having close and robust relationships with contractors. Table 4 4. Regulatory Activity During the COVID 19 pandemic, Care Inspection activity was focused around one key quality question “How good is our care and support during the Covid 19 pandemic?”. In late 2021, the focus slightly changed to include the quality question “How well do we support people's wellbeing?”. The inspections were predominately with Care Homes; however, a few Self-Directed Support providers were also inspected generally in response to complaints or increased notification activity to the Care Inspectorate. Care Homes in NL: 22 Care Homes were inspected in relation to 1 or more quality indicators in the year to 31 March 22. Key question 7 – ‘How good is our care and support during the Covid 19 pandemic?’ was applied to all inspections. The remaining care homes will receive a fuller inspection in 2022/23. It is worth noting that 2 care homes were the subject of Large-Scale Investigations, under Adult Support and Protection legislation, with significant support provided by the Care Inspectorate and Senior Council Officers to address and improve quality improvement measures. One of these care homes has subsequently closed with Care Inspection registration being removed. 221 49 22 11 Contractors Tier 1 Tier 2 Tier 3 Tier 4
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Table 5 Table 5 above illustrates the challenging environment care homes were operating in during the pandemic with 14 of the 22 homes assessed as ‘Adequate’ for the category relating to care and support during the pandemic. Care Homes in Scotland (excluding NL): North Lanarkshire Council currently has people placed within 141 care homes that are located elsewhere in Scotland. North Lanarkshire Council retains care management responsibilities for the people living in out of authority care homes. The host authority where the care home is located is responsible for care home contract monitoring, however, not all 32 local authorities operate in the same way. The Quality Assurance Team receives regular updates from host authority contacts in relation to out of authority care homes. Table 6 Table 6 above illustrates the position noted in North Lanarkshire care home settings is similar to the national picture of a sector struggling to meet the challenges posed by a pandemic. 46 of the 83 care homes inspected were assessed as ‘Adequate’.
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The Quality Assurance Team have worked in close partnership with colleagues from NHS Lanarkshire, the Care Inspectorate and the care homes themselves to support care homes to pursue an improvement agenda. This has included: - • Initially weekly meetings with Care Home Managers to provide a means of communication, to discuss issues arising, for example the developing guidance from the Scottish Government, and to seek solutions to local problems through discussion. The meetings are now monthly. • The Quality Assurance Team administered the Sustainability Payments Scheme for the care home sector (See Section 5). • A series of Collaborative Visits to care homes by Quality Assurance Senior Officers, NHS Lanarkshire Care Home Liaison and Infection, Prevention and Control staff took place to provide support and guidance to care home management and staff. Self-Directed Support (SDS) including Care at Home: Prior to the pandemic, the Care Inspectorate changed their quality inspection themes for registered services. This was fully implemented for Care Homes and some self-directed support contractors. However, 40 of these SDS contractors were still to be inspected using the new themes as of 31 March 22. As previously mentioned, Care Inspection activity has been predominately focused on Care Homes, however, there have been 10 inspections of SDS contractors because of increased notifications to the Care Inspectorate. There are also 10 SDS contractors that were still awaiting an initial inspection as their services have been registered within the past 2 years. Table 7 Table 7 above is primarily based on inspections carried out pre pandemic. However, for the 10 services inspected under the pandemic regime the majority were categorised as ‘Good’ or ‘Very Good’. It is interesting to note, that despite the inspections being because of notification to the Care Inspectorate, 6 out of the 10 inspected were classed as good or very good.
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5. Provider sustainability Since the start of the pandemic there have been ‘sustainability’ arrangements in place to ensure Social Care services/facilities continued to operate in a financially secure and viable manner including provision of payments when services couldn’t be delivered. The sustainability principles were due to end in June 2021 but further extensions have been applied. There remains a requirement to ensure that Social Care capacity is sustained to achieve positive outcomes for clients, whilst also addressing the overarching need to demonstrate value for money, streamline payment arrangements and demonstrate the approach is fair, equitable and transparent. The payments to care homes for underoccupancy have been the biggest proportion of the additional financial support provided through the principles. However, occupancy levels are increasing to pre pandemic levels except for some homes that have been more significantly impacted by outbreaks. For other community-based activity and provision, there has been less of an impact on service delivery, with most providers returning to normal (pre-pandemic) delivery levels. Table 8 6. Procurement A fundamental aspect of the role of Quality Assurance is ensuring that the people North Lanarkshire Council (NLC) arranges support for can be confident that support is provided legally, safely, with their interests at the centre and that ensures Best Value for NLC. A key component of this work is carried out with our colleagues in Corporate Procurement. As mentioned above, in the 2021/22 reporting period, we have managed to expedite a significant number of procurement exercises that have resulted in 93% of the spend on social care services being covered by some form of formal agreement, ranging from large scale contractual frameworks to individual agreements. The collaboration with Corporate Procurement has enabled us to jointly pursue further refinements to commissioning and procurement, none more so than the internal procedure established for the Council’s lower threshold, but regulated, procurement of various Health and Social Care contracts (value range £50-£552k), which in conformance with the Procurement Reform Scotland Act 2014 and the Procurement (Scotland) Regulations 2016, permits the Council to consider and award relevant contracts without the need for competition. This has helped immensely in terms of efficiency at a time when there are significant pressures on our resources. It’s also useful to note that Quality Assurance leads on procurement for all social work services including those focussed on children, families, justice services and adults. Table 9 describes a sample of procurement activity undertaken. PROVIDER SUMMARY NCHC Care Homes Other Total Total Number of Providers 28 45 73 Number in contact for support 26 31 57 Providers Supported to date 26 31 57
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Table 9 Contract Comments and Benefits Flexible Framework for Self- Directed Support and Care at Home Services + £900M value, 10 years, will result in less frequent re-tenders + follows the ‘Light Touch Regime’ / Regulation 74 of PCSR2015 + Annual entry and exit points for Contractors + Secured an increase in the number of contracted providers, improving the choice and control for supported people Direct Payment Support Service + £400k, 3 years, competitively tendered using new toolkit + Improved specification and implemented tighter controls supported by the new terms and conditions Befriending Services + £360k, 3 years, competitively tendered using new toolkit + Improved specification and tighter controls Advocacy Services + £1.8M, 3 years, competitively tendered using new toolkit + Improved specification and tighter controls Mental Health Services + £3M, 3 years, competitively tendered using new toolkit + Improved specification and tighter controls Provision of Taxi Hire and Private Hire Services to the Council throughout North Lanarkshire + £3.2M, 4 years, competitively tendered using new toolkit + Improved specification and tighter controls Flexible Framework for Non- Traditional Respite + £4M, 10-year agreement, will result in less frequent re- tenders + follows the ‘Light Touch Regime’ / Regulation 74 of PCSR2015 + Covers an existing gap within National ‘Respite’ Frameworks + Annual entry and exit points for Contractors + Secured an increase in the number of contracted providers, improving the choice and control for supported people Fair Work The Scottish Government’s Fair Work First policy initiative focuses on encouraging and supporting employers to create more diverse and inclusive workplaces where workers have security of pay and contract, can develop and utilise their skills and have an effective voice in the workplace. As part of the council’s commitment to Fair Work and social work’s drive to adopt an ethical commissioning approach, Fair Work practices have been embedded in procurement processes to ensure contractors are paying the Scottish Living Wage and are committed to providing community benefits. Potential contractors have committed to provision of community benefits within their tenders, which includes offering employment to people in the local community, youth training and training for people from disadvantaged groups, traineeships and apprenticeships, volunteering opportunities, supporting local supply chain and local community resources. All contractors have indicated they are either already accredited as or are willing to become Scottish Living Wage employers. Work is underway in determining how established contract monitoring processes can incorporate Scottish Living Wage compliance and progress in implementing community benefits commitments.
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7. Children, Families and Justice Quality Assurance monitors most Children’s services where a contract status has been secured either on an Individual Placement basis or as part of a Framework Agreement, generally through Scotland Excel. Quality Assurance has supported Justice Services with Scottish Government funding to secure services to support rehabilitation. Over the reporting period, links have been established with our colleagues in HQ within Education and Families to ensure that we monitor contracts with external service providers and incrementally develop and apply a quality assured approach. Links are well established with Scotland Excel where their Frameworks Agreements have been effective in ensuring optimum service delivery, under difficult financial pressures. Improvements are required to be made in respect of joint working with the council to ensure Children and YP placements are conveyed to the appropriate teams. Quality Assurance will continue to work with each locality to ensure this information is shared. 8. Complaints Quality Assurance retains an overview role in terms of complaints made about NLC Social Work service provision. Regular quarterly reports on complaints activity are reported through our governance structures. The detail below provides an annual summary and analysis of complaints received over the period 2021/22. • Overall, 123 complaints were made in the reporting period, a decrease of 21% from 2020/21. 41% were Children and Families complaints, 59% were Adult Social Work/Community Care complaints. • 76% of Children and Families complaints were handled at Stage 1, 24% at Stage 2. • 21% of Stage 1 complaints failed to meet target timeframes for closure. Average time for closing Stage 1 complaints was 5.3 days. • 17% of Stage 2 complaints failed to meet target timeframe for closure, Stage 2 average was 17.3 days. • 79% of Adult/Community Care complaints were handled at Stage 1, 21% at Stage 2. • 21% of Stage 1 complaints failed to meet target timeframe for closure. Average time for closing Stage 1 complaints was 5.5 days. • 7% of Stage 2 complaints failed to meet target timeframe for closure, Stage 2 average was 15 days. Overall, there was a slight improvement on performance levels from the previous reporting period. The complexity of the issues at hand, new processes, GDPR, staffing, IT systems and very tight time frames for resolution were some of the contributory factors for failure to close all complaints within the stipulated timescale. Table 10 highlights the cause of complaints about NLC Social Work throughout the reporting period. • 30% of all adult service complaints related to quality of the service, a further 27% were in respect to conduct of staff members.
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• 32% of all children, families and justice complaints related to quality of service, whereas 26% were in respect to conduct of staff members. Table 10 A significant number of complaints did not comment on expected learning outcomes and/or service improvements expected, therefore suggesting that there were no further actions to be considered. Comments that we did receive, in relation to learning outcomes, included improved communication, recording and staff training. To ensure compliance, further training related to complaint handling will be rolled out over the coming year. This will promote competency by enabling all staff managing complaints to comply with the process and capture learning and/or service improvement. Within the reporting period, eight social work complaints were sent to the Scottish Public Services Ombudsman for consideration, none of which were upheld. Those that were investigated found that the Council had acted reasonably. Duty of Candour The Organisational Duty of Candour is a statutory duty on Scottish organisations providing health and social care to be open and honest when something goes wrong that is not related to the course of the condition for which the person is receiving care. An annual report capturing Duty of Candour activity is a requirement of the Council. Appendix 1 provides a report for 2021/22. 9. To conclude The Covid pandemic challenged all services both in-house and commissioned to a degree not experienced before. Despite this, the Quality Assurance Team have been part of several developments, which have improved the operation of the social work service and the performance of independent social care contractors including: - • Procurement processes refined • Newsletter established for staff • Senior Officer links to Locality teams • Senior Officer link to Adult Support and Protection activity • Business Continuity • Sustainability payments 16 13 8 6 5 2 22 20 12 9 9 2 0 5 10 15 20 25 Quality of Service Conduct of staff members Dealt unfairly or wrong Didn't provide a service on time Didn't provide a service Unhappy with policy/procedure Complaint Cause Adults CFJ
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• Individual PA process • RaciQ developed for procurement process • Contract Monitoring Framework • Collaborative work with NHS Lanarkshire, Care Inspectorate, Scottish Care • Carer Developments, Partnership Agreement • Complaint sprint • Operational Risk Register • Involvement in LSIs • Council Website • Data Governance, FOIs/SARs and guidance • Development of market facilitation plan Planned developments for 2022/23 include: - • Further development of market facilitation plan • Further development of participation and engagement strategy • Plan for in-house service monitoring • Commercial pipeline refinement • Contract Management Framework development • HSCP website This report has covered Quality Assurance activity undertaken during the period 1 April 21 to 31 March 22. The pandemic has had a significant impact on the sector and over the coming year several developments to support and provide assurance will continue. It is expected that future annual reports will continue to update on Quality Assurance measures implemented across the service.
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Appendix 1 North Lanarkshire Health and Social Care Partnership Duty of Candour Report: 2021/2022 Introduction North Lanarkshire Health and Social Care Partnership recognises that when adverse events occur during the provision of treatment or care, openness and transparency is fundamental. The duty of candour arrangements, which we have implemented reflect the Scottish Government’s commitment to place people at the heart of health and social care services in Scotland. When harm occurs the focus must be on personal contact with those affected; support, and a process of review and action that is meaningful and informed by the principles of learning and continuous improvement. The Health (Tobacco, Nicotine etc. and Care) (Scotland) Act 2016 was implemented on 1st April 2018 placing an organisational duty (Duty of Candour) on health, care, and social work services to be open and honest with people in their care. The overall purpose of this duty is to ensure organisations are open, honest, and supportive when there is an unexpected or unintended incident resulting in death or harm as defined in the Act. All health and social care services in Scotland have a duty of candour, a legal requirement which means that when things go wrong and mistakes happen, the people affected understand what has happened, receive an apology, and that organisations learn how to improve for the future. A key part of this duty is that Health and Social Care publish an annual report about the duty of candour in our services. This short report describes how the services we commission, and our own services have operated the duty of candour during the time between 1 April 2021 and 31 March 2022. Information about policies and procedures All social care organisations have a Duty of Candour policy. All staff who are employed in the sector should be aware that all instances that necessitate implementation of Duty of Candour must immediately be reported. In such instances, a manager will then take the appropriate action, ensuring relevant bodies [depending on the sector] such as Social Work and Care Inspectorate are notified of the event. Where an incident occurs that triggers the duty of candour, managers have responsibility for ensuring that the duty of candour procedure is followed. Information on Duty of Candour and reportable incidents is described in detail within Appendix 1. 82 commissioned organisations were asked to provide information in relation to Duty of Candour activity in the reporting period. Of the 37 [45%] that responded, there were five reported incidents. All North Lanarkshire Council social work in-house services - home support, integrated day services, locality support services and children services were also asked to provide information. There were no Duty of Candour incidents reported from any of the council provided services. Duty of Candour incidents are an integral part of our contract management quarterly monitoring returns. How many incidents happened to which the duty of candour applies? In the reporting period, five incidents have been reported to which the duty of candour applied, one in relation to maladministration of medication, and four where a person fell and sustained physical harm. All incidents reported were from either care at home support or care home services. No Duty of Candour incidents were reported by North Lanarkshire Council in-house social work services.
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Details of incidents where Duty of Candour applied Nature of incident: Incorrect medication was administered to a service user, resulting in admission to Accident and Emergency. No permanent harm occurred. All procedures set down in Duty of Candour policy were followed – incident was fully investigated and reported. Procedures and training have been revised as a result. Nature of incident: Person fell and fractured hip – Duty of Candour criteria – The structure of someone’s body changes because of harm. All procedures set down in Duty of Candour policy were followed – incident was fully investigated and reported. A Duty of Candour meeting was called, the person’s family were invited, but did not wish to attend meeting. Nature of incident: Person fell and fractured hip (R) – Duty of Candour criteria – The structure of someone’s body changes because of harm. All procedures set down in Duty of Candour policy were followed – incident was fully investigated and reported. A Duty of Candour meeting was called, the person’s family were invited, but did not wish to attend meeting. Nature of incident: Person fell and fractured hip (L) – Duty of Candour criteria – The structure of someone’s body changes because of harm. All procedures set down in Duty of Candour policy were followed – incident was fully investigated and reported. A Duty of Candour meeting was called, the person’s family were invited, but did not wish to attend meeting. Nature of incident: Person fell – sustained a laceration to the head – Duty of Candour criteria – The structure of someone’s body changes because of harm. All procedures set down in Duty of Candour policy were followed – incident was fully investigated and reported. A Duty of Candour meeting was called, the person’s family were invited, but did not wish to attend meeting. Conclusion There were no Duty of Candour incidents from in-house social work services within the reporting period and only five from care home and care at home services, none of which had lasting consequences for the person to whom the duty applied. Appropriate actions were taken, lessons were learned, procedures and training were revised, and where applicable, families were informed, and were invited to meet to discuss in more detail. If in the future, if any incidents occur that invoke Duty of Candour proceedings, there will be a review process to identify any lessons learned and the result of any such review will be shared with the relevant person/persons. This approach will minimise the impact on the organisation and the vulnerable people we strive to support.
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Appendix A – Definition of Harm and appropriate level of response Grading of Harm Definition of Harm Level of Response No harm, incident prevented Any service user safety incident that had the potential to cause harm but was prevented. These incidents are outside of the scope of the duty of candour. Social work professionals may however feel it is appropriate to inform the person involved if it is in their best interest. No harm, incident not prevented Any service user safety incident that occurred but no harm was caused to the person involved. These incidents are outside of the scope of the duty of candour policy. Being open in a discussion between staff involved and the service user and their family is usually undertaken locally. Low Harm Any service user safety incident that led to the extra observation or minor treatment such as first aid or additional medication for the person involved. These incidents are outside of the scope of the duty of candour policy. Being open in a discussion between staff involved and the service user and their family is usually undertaken locally. Moderate Harm A level of harm that is not permanent but has led to a moderate increase in treatment or prolonged psychological harm of more than 28 days. For example, a return to theatre, an unplanned readmission to hospital, unexpected admission to critical care, a prolonged hospital stay or additional out service user visits. Duty of candour is a statutory requirement. Notification should be given to the person affected or their representative in person including an explanation of the incident, the process for investigation and an apology. This will be followed up in writing and on conclusion of the investigation the findings and outcome will be available to the service user of their representative. Serious Harm Any service user safety incident that has resulted in permanent harm that is directly related to the incident and not the natural course of an illness or the underlying condition of the person affected. Examples of severe harm are permanent lessening of bodily functions, sensory, motor, physiological or intellectual function, removal of the wrong organ or limb or brain damage. Duty of candour is a statutory requirement – see above. Death Any service user safety incident that directly resulted in the death of a person and is not related to their illness or underlying condition. Duty of candour is a statutory requirement – see above.
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Appendix B Organisations who provided a response: Aspire Invercare Love Crossreach Keane Premier Support Services Beechwood Care Home Support for Ordinary Living Quarriers PHEW Care One Professional Leonard Cheshire HK Care Angels Key Housing Local Lanarkshire Care Partners in Play All New Beginnings Lanarkshire Association for Mental Health Thera Care Wheatley Care The Richmond Fellowship Scotland HRM Potential Living Capability Scotland Cornerstone Care Solutions Lanarkshire Care Partners Inclusion Scotland C-Change Scottish Autism Cera Care Turning Point Scotland Potential Living Enable Scotland Enhance Supported Living Services Lochside Manor Deanston Care Home