ITEM 10 Quality Assurance Annual Report
North Lanarkshire Council · 27 September 2023
Back to Health and Social Care Integration Joint Board — 27 September 2023 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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1 REPORT Item No: 10 SUBJECT: Quality Assurance Annual Report TO: Integration Joint Board Lead Officer for Report: Maria Williamson, (Acting) Head of Performance, Planning & Quality Assurance Author(s) of Report Elaine McIntyre, Service Manager, Quality Assurance DATE: 27 September 2023 1. PURPOSE OF REPORT This paper is coming to the IJB for: For approval ☐ For endorsement ☒ To note ☐ 2. ROUTE TO THE BOARD This paper has been: Prepared By: Elaine McIntyre, Service Manager, Quality Assurance ☒ Reviewed By: Maria Williamson, (Acting) Head of Performance, Planning & Quality Assurance ☒ Endorsed By: Adult Care and Social Work Committee ☒
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2 3. RECOMMENDATIONS The Integration Joint Board is asked to endorse the contents of the report. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Quality Assurance have a wide and varied function including monitoring and evaluating key aspects of social work practice and performance. A central activity is the on-going contract monitoring of external social care providers. The environment in which we operate currently is complex and sharing of best practice and solution focused ideas are integral to ensure the people of North Lanarkshire receive good quality support to help meet their outcomes. 5.2 Our commitment is to provide an annual report on activity carried out in the preceding year. 5.3 This report highlights Quality Assurance activity over the period 1 April 22 to 31 March 23 and covers Contracts & Contract Management, Regulatory Activity, Procurement, Complaints, Duty of Candour, Information Governance, Communications, Adult Support & Protection, In House Monitoring, Participation & Engagement, Carer Developments and Risk Management. 5.4 Full detail of these activities is included in Appendix A. Contracts 5.5 The Quality Assurance Team work cohesively with Corporate Procurement colleagues to implement robust contract arrangements, which balance quality against cost, to achieve overall Best Value for services provided to vulnerable people living in North Lanarkshire. A range of organisations are commissioned through a variety of arrangements and a methodical and systematic approach has been developed, resulting in 95% of services purchased by social work now having contractual agreements in place with clearly defined terms and conditions. These agreements range from national framework arrangements to individual service agreements. Contract Management Framework 5.6 All organisations from whom North Lanarkshire Council social work purchase services are required to adhere to contract monitoring arrangements. Quality Assurance have Yes ☐ No ☒ N/A ☐
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3 a key role in the application of these arrangements to ensure that the terms and conditions of the contract are met. Information gathered from contract monitoring also informs continuous strategic planning and commissioning, improvement identification and enables early intervention and support should difficulties in providing and sustaining services become apparent. 5.7 During this reporting period the Contract Management Framework has been refined following evaluation. As a result, some of the processes and procedures have been amended to enhance performance reporting, data collection and the overall experience. The agreed changes are effective from 1 April 2023. Regulatory Activity 5.8 Care Inspection activity during the reporting period of 2022/23 was spread across all key questions within North Lanarkshire older people’s care homes. North Lanarkshire care homes performance measures slightly lower than Scotland wide care homes in that 55.6% of grades of 4 and above were awarded. Scotland wide care homes achieved 63.9% of grades of 4 and above. 5.9 During the reporting period 52 SDS contractors were inspected. 45 contractors were awarded grades of good (4) and above. This is a percentage of 86.5%, which reflects delivery of high-quality care and support across SDS contractors supporting people in North Lanarkshire. In House Monitoring 5.10 The Quality Assurance team have been working on the development of an In-House Monitoring Framework during 2022/23. The suite of documents included within this Framework are awaiting approval from the Senior Leadership Team. Market Facilitation 5.11 Our approach to market facilitation means we are responsive to the changing needs and aspirations of people living in North Lanarkshire, whilst also reflecting the changing social care landscape. 5.12 One of the biggest challenges currently, is the lack of capacity available to choose from when a care and support package is required. There are many factors contributing to these challenges, including workforce retention and recruitment, cost of living increases, increased demand, complexity of support required and quality of care falling below expected standards. Quality Assurance continue to liaise with internal and external partners to identify solutions to the challenges. Procurement 5.13 In collaboration with Corporate Procurement colleagues and Locality Social Work Teams, Quality Assurance assist in the planning, coordination, and implementation of processes to ensure that when contracting new or existing work, the requirements of the Procurement Reform Scotland Act 2014 and the Procurement (Scotland) Regulations 2016 are adhered to. By doing so there can be confidence that the care & support services commissioned are legal, safe and outcomes focused whilst demonstrating Best Value.
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4 Fair Work 5.14 In 2021/22, we reported that most contractors had indicated they were either already accredited as or were willing to become Scottish Living Wage employers. This year 100% of providers on our Self-Directed Support including Care at Home framework, reported paying the Scottish living Wage. Complaints 5.15 Quality Assurance retains an overview role in terms of complaints made about Social Work service provision. Regular quarterly reports on complaints activity are reported through our governance structures. The annual summary and analysis of complaints received over the period 2022/23 is available at appendix 1. Duty of Candour 5.16 Duty of Candour is a statutory duty on Scottish organisations providing health and social care. The responsibility is to remain 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 available is attached as appendix 2. 6. CONCLUSIONS n/a 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☒ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☐ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒
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5 7.2 ASSOCIATED MEASURE(S) None. 7.3 FINANCIAL This paper has been reviewed by Finance: There are no direct financial impacts in relation to this report. 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. Risks are identified and reported on via the relevant risk register. 7.5 ENGAGEMENT & PARTICPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details regarding the engagement and participation that was undertaken. Objectives Further Details ☐ Involve stakeholders in the development work aimed at achieving the national outcomes ☐ Provide stakeholders with information on how to get involved ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☐ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery Yes ☐ No ☐ N/A ☒
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6 ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☐ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership Residents across North Lanarkshire who access services, their families/carers and the community, third and independent providers operating in North Lanarkshire and wider stakeholders with a link to North Lanarkshire. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: EQIA added to website: Fairer Scotland – As part of the council’s commitment to Fair Work and social works 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. Equality Impacts are considered as part of procurement and contract monitoring. 8. BACKGROUND PAPERS N/A Yes ☒ No ☐ N/A ☐ Yes / Date added ☐ No ☐ N/A ☒
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7 9. APPENDICES 9.1 Appendix A: Quality Assurance Annual Report 2022/23. 9.2 Quality Assurance Annual Report 2022/23 - Appendix 1Complaints 9.3 Quality Assurance Annual Report 2022/23 - Appendix 2Duty of Candour CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Maria Williamson: (Acting) Head of Performance, Planning and Quality Assurance) WilliamsonM@northlan.gov.uk
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8 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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9 Appendix A Quality Assurance Annual Report 2022/23
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10 1. Introduction Quality Assurance have a wide and varied function including monitoring and evaluating key aspects of social work practice and performance. A central activity is the on-going contract monitoring of external social care providers. The environment in which we operate currently is complex and sharing of best practice and solution focused ideas are integral to ensure the people of North Lanarkshire receive good quality support to help meet their outcomes. The Quality Assurance Team work collaboratively with our internal Health and Social Care Partnership colleagues and with external stakeholders to ensure the delivery of services that are underpinned by human rights, inclusion, achieving potential, choice and control. The activities reported in this 2022/23 annual report reflects the commitment to a creative and dynamic approach that helps reduce resource barriers and promotes good outcomes for people. Our priorities are directed towards the Scottish Government’s nine national health and wellbeing outcomes, the ambitions of the Plan for North Lanarkshire and the Strategic Commissioning Plan. This report outlines activity over the period 1 April 22 to 31 March 23 and includes updates on our work in the areas of Contracts & Contract Management, Regulatory Activity, Procurement, Complaints, Duty of Candour, Information Governance, Communications, Adult Support & Protection, In House Monitoring, Participation & Engagement, Carer Developments and Risk Management. 2. Contracts The Quality Assurance Team work cohesively with the Corporate Procurement colleagues to implement robust contract arrangements, which balance quality against cost, to achieve overall Best Value for services provided to vulnerable people living in North Lanarkshire. A range of organisations are commissioned through a variety of arrangements and a methodical and systematic approach has been developed, resulting in 95% of services purchased by social work now having contractual agreements in place with clearly defined terms and conditions. These agreements range from national framework arrangements to individual service agreements. Tables 2a and 2b below illustrate graphically the extent of the work that has been carried out in engaging with providers from the community & voluntary sector, the independent sector and private contractors in a proportionate and balanced way to ensure service provision is provided safely and is of a high quality throughout the team of the contract. As of 31 March 23, 95% of all social work spend had the provision of a formal contracting arrangement. This is an increase from 93%, reported in year 2021/22. Work is in progress for the remaining 5%, which are awaiting formalisation of Individual Service Agreements. Quality Assurance continue to progress with the necessary arrangements to ensure all spend has robust contractual and legal agreements in place; however, it should be noted that due to the fluidity of contracting and commissioning, achievement of 100% compliance may not always be possible.
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11 Table 2a Table 2b We currently purchase services from 305 different provider organisations, which is a slight increase of 2 from 2021/22 when we reported purchasing services from 303 provider organisations. The biggest shift to note is in the number of providers operating as part of our Self-Directed Support, including Care at Home Framework, which has increased to 61 providers from 52 reported 2021/22. It is anticipated that this increase on the SDS Framework will create greater capacity with more choice available to people who access services. 3. Contract Management Framework (CMF) All organisations from whom North Lanarkshire Council social work purchase services are required to adhere to contract monitoring arrangements. Quality Assurance have a key role in the application of these arrangements to ensure that the terms and conditions of the contract are met. Information gathered from contract monitoring also informs continuous strategic planning and commissioning, improvement identification and enables early intervention and support should difficulties in providing and sustaining services become apparent. 160 14 0 12 0 10 Spread of Contractors 2022/2023 148 61 28 7 4 9 3 11 2 3 5 1 6 13 4
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12 North Lanarkshire Council value the services delivered by contractors and Quality Assurance Senior Officers link closely with contractors to establish transparent and honest relationships, through the application of regular monitoring activity as agreed within the Contract Management Framework. During this reporting period the Contract Management Framework has been refined following evaluation. Following consultation through workshops and provider forums, feedback from Quality Assurance Senior Officers and commissioned social care contractors was collated on the various tools within the Framework. As a result, some of the processes and procedures have been amended to enhance performance reporting, data collection and the overall experience. Consideration was also given to the resource implications for social care contractors; therefore, the revised approach has been streamlined to avoid duplicate reporting where possible. The agreed changes effective from 1st April 2023 are listed below: - The development of a Participation and Engagement Toolkit to support the inclusion of direct stakeholder feedback and engagement by Senior Officers, as part of Contract Monitoring arrangements. Contractors are central to the method of engagement implemented by Senior Officers to ensure feedback is collated in a person centred, responsive and flexible way. A 5% sample of people using the service being monitored has been defined. Creation of Key Performance Indicators to inform sampling areas during monitoring visits by Senior Officers. A monitoring report will ensue with a copy being provided to the contractor. Enhanced financial monitoring of block funded services. Modifications to qualitative and quantitative data being requested from contractors on a quarterly basis including reporting on notifiable and non-notifiable accidents and incidents and the achievement of supported people meeting outcomes. Addition of a ‘purple’ tier rating for if there is an on-going Large-Scale Investigation or there is significant risk of closure in the immediate 6-month period (See Table 3a) Risk rating criteria changed on Monitoring Prioritisation Assessment to better reflect level of monitoring activity required in turn effectively targeting resources. The Monitoring Prioritisation Assessment (MPA) is the key component of the Contract Management Framework. The MPA is the up-to-date position statement on the performance of commissioned contractors. The processes of monitoring and the accompanying report build evidence of real time accessible information regarding the quality-of-service provision, performance and outcomes over the life of a contract/framework. Table 3a – MPA Tier Levels & Monitoring Frequency STATUS INDICATED MONITORING LEVEL Purple Large Scale Investigation (LSI) or Service Closure Processes that are imminent within 6 months Red Significant concerns in relation to service performance, contract compliance. TIER 4 Contract monitoring visit frequency – 1 to 4 weekly. Amber (high) Moderate concerns in relation to service performance, contract compliance TIER 3 Contract monitoring visit frequency – variable, at least quarterly but no more than monthly. Amber (low) Minor concerns identified in relation to service performance and contract compliance TIER 2 Contract monitoring visit frequency – variable, at least bi-annually but no more than quarterly.
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13 Green Service performance, contract compliance and engagement are satisfactory. TIER 1 Contract monitoring visit frequency – annually in most cases. Each Tier suggests a minimum monitoring frequency (Table 3a). The basis of monitoring considers the commitments made by the contractor as part of their 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 3b below highlights Tier Levels for the reporting period 2021/22 and for the reporting period 2022/23. It is positive to see that Tier 1 services had increased from 72% to 85%. Due to the increase all other tiers show a reduction. Despite this, contractors continue to face increasing demands due to workforce recruitment and retention issues, higher level of Care Inspectorate scrutiny and challenges with financial sustainability. Contractor’s have reported the benefit from the monitoring role of Senior Officers and the early interventions and solutions offered. Table 3b 4. Regulatory Activity Care Inspection activity during the reporting period of 2022/23 was spread across all key questions within adult and older people’s care homes. Key Question “How good is our care and support during the COVID 19 pandemic” was embedded into the Key Question “How well do we support people’s wellbeing” by the Care Inspectorate. However, care homes for children and young people and school care accommodation continued with the COVID specific key question included within their specific Care Inspectorate quality framework. This is reflected in Table 4a whereby 5 care homes were inspected in this area. 4 care homes were awarded grades of 4 (Good) and 1 care home was awarded a grade of 3 (Adequate). Table 4b shows 83 Care Inspections assessing Key Question “How good is our care and support during the COVID 19 pandemic” haven taken place across Scotland and from this most care homes were awarded grades of adequate (3) and good (4) highlighting an equivalent position to North Lanarkshire.
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14 Care Inspection Grades - North Lanarkshire Based Care Homes As At 31/03/2023 16 14 12 10 How good is Table 4a below details an analysis of the key question “How well do we support people’s wellbeing”. The data has been extracted from Tables 4b and 4c below. North Lanarkshire Care Homes performance measures slightly lower than Scotland wide care homes in that 55.6% of grades of 4 and above were awarded. Scotland wider care homes achieved 63.9% of grades of 4 and above. Table 4a How well do we support people’s wellbeing Number of Care Homes Assessed Grades Awarded Percentage North Lanarkshire Care Homes (Table 4b) 27 0 x Excellent 4 x Very Good 11 x Good 10 x Adequate 2 x Weak 0 x Unsatisfactory 0% 14.8% 40.8% 37% 7.4% 0% Scotland Wide Care Homes (Table 4c) 97 3 - Excellent 23 x Very Good 36 x Good 33 x Adequate 2 x Weak 0 x Unsatisfactory 3.1% 23.7% 37.1% 34% 2.1% 0% Care Homes in North Lanarkshire: 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. Although there have been short term improvements there is little evidence of these improvements being sustained over a longer timeframe. Continuous monitoring and intensive engagement with each of these care homes continues. Table 4b How well do we support people's wellbeing? How good is our leadership? How good is our staff team? How good is our setting? How well is care and support planned? our care and support during the COVID-19 pandemic? Adequate 2022/2023 10 5 5 3 4 1 Good 2022/2023 11 15 10 6 8 4 Very Good 2022/2023 4 1 1 3 0 0 Weak 2022/2023 2 1 0 0 2 0
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15 During the reporting period 2021/22, 14 out of 22 care homes were assessed as adequate for the key question “How well do we support people’s wellbeing”. This was 66.6% in comparison to the reporting period 2022/23 when adequate grades achieved under the same key question were 37%. This change highlights a significantly improved overview of the quality of care being provided with 55.5% of grades being higher than adequate. Care Homes in Scotland (excluding North Lanarkshire): North Lanarkshire Council currently has people placed within 148 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 geographically located is responsible for care home contract monitoring, however, not all 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 4c Self-Directed Support (SDS) including Care at Home: Prior to the pandemic, the Care Inspectorate changed their quality inspection themes for registered services. It was reported in 2021/22 that this was fully implemented for Care Homes and some self- directed support contractors, but 40 SDS contractors were still to be inspected using the new themes as of 31 March 22. Although there remain some self-directed support contractors who have not been inspected using the new quality framework, the majority have now been inspected. Table 4d below illustrates activity.
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16 Care Inspection Grades- Self Directed Support including Care 20 18 16 14 12 10 8 6 4 2 0 How How How good Table 4d well do we support people's wellbein g? How good is our leaders hip? How good is our staff team? How good is our setting? well is care and support planned ? our care and support during the COVID- Care & Support Environ ment Staffing Manage ment & Leaders hip 19… Adequate 2022/2023 7 7 2 0 3 0 0 0 0 0 Excellent 2022/2023 1 0 0 0 0 0 3 0 0 1 Good 2022/2023 8 9 5 1 4 0 3 0 3 8 Very Good 2022/2023 11 6 3 1 3 0 19 1 9 10 Weak 2022/2023 0 0 1 0 0 0 0 0 0 0 From the 52 SDS contractors that have been inspected, 45 have been awarded grades of good (4) and above. This is a percentage of 86.5%, which reflects delivery of high-quality care and support across SDS contractors supporting people in North Lanarkshire. It should be noted that the percentage above is calculated from the grades awarded under “How well do we support people’s wellbeing” and Care and Support, reflecting the two different inspection methodologies. 5. In House Monitoring During this reporting period the Quality Assurance team have been working on the development of an In-House Monitoring Framework. The suite of documents included within this Framework are awaiting approval from the Senior Leadership Team and it is intended that a test of change across Home Care services will commence in August 2023. This test of change will inform any further refinements and modifications prior to roll out across all In House services including Locality Support services, Children’s Houses, and Integrated Day Services. The aim of the In-House Monitoring Framework is to support implementation of best practice and a culture of continuous improvement. Progress on the implementation will be reported in future reports. 6. Market Facilitation Sustainability arrangements remined in place to ensure social care services continued to operate in a financially secure and viable manner following the impact of the COVID pandemic. The criteria for which
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17 Social Care Providers were reimbursed was phased out gradually, with the arrangements ending on 31st March 2023. However, due to contractors reporting significant increases in their costs., there continues to be a requirement to provide support and guidance to ensure they remain financially sustainable, to enable the continuation of service delivery across the authority.
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18 We recognise that services provided by external organisations make an important contribution to our ability to offer choice in supporting the health and well-being of people who use social care services. Therefore, our approach to market facilitation means we are responsive to the changing needs and aspirations of people living in North Lanarkshire, whilst also reflecting the changing social care landscape. One of the biggest challenges currently, is the lack of capacity available to choose from when a care and support package is required. There are many factors contributing to these challenges, including workforce retention and recruitment, cost of living increases, increased demand, complexity of support required and quality of care falling below expected standards. Quality Assurance continue to liaise with internal and external partners to identify solutions to the challenges. Provider Recruitment Event – A co-designed large -scale recruitment event is planned to be held in April 2023 to promote the sector and attract and encourage new people to work within social care. The event will support our commissioned contractors to recruit suitable staff and in turn maximise their capacity to provide care to the people of North Lanarkshire. Building Capacity – A programme of activity to build capacity across the sector enabled us to work with providers over two phases. This approach was in recognition of the pressures contractors face due to ongoing recruitment and retention issues across the social care sector. Through non-recurring funding from the Scottish Government, proposals were invited from contractors on the Self-Directed Support including Care at Home Framework, to build capacity and upskill staff teams to support our communities across North Lanarkshire. 40 proposals were submitted to be considered, including requests to support recruitment drives, staff training and development, incentives including joining bonuses, driving lessons and IT investments. 7. Carer Developments To ensure robust and ongoing support for Carers, we have, in conjunction with South Lanarkshire Council and Lanarkshire Carers, developed a Joint Partnership Statement to build on existing trust and partnership working between the named organisations. It provides a common reference point; useful to guide collaboration on a daily basis, avoid confusion and provide clarity as and when required. The agreement supports mutual understanding and expectations between partners (Lanarkshire Carers; North Lanarkshire Social Work and South Lanarkshire Social Work) in relation to the delivery of Adult Carer Support Plans (ACSPs). The roles, responsibilities and boundaries of all partners are defined and agreed. The agreement also provides a staff information and awareness raising tool and ensures that carers have access to accurate information and are signposted and referred appropriately. 8. Participation and Engagement There is a strong history of engagement and participation within North Lanarkshire. To strengthen our approach and progress our next Participation and Engagement Strategy, over the reporting period we have proactively linked with a range of key stakeholders to explore options and agree a model that ensures supported people, including underrepresented groups or communities, can play as active a role as they choose, in helping shape services. This approach ensures that supports and services are informed and led by people with lived and/or relevant experience of support, and that policy and strategy reflects the views, wishes, needs and aspirations of supported people.
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19 9. Communications To actively promote services and support for people, we have been working with the Communications Manager to develop a robust communication plan that provides clear and timely information, provides easy access to publications, showcases good news stories and promotes the sector. Members of the quality assurance team have undergone training to enable them to populate the revised Health and Social Care North Lanarkshire website: https://hscnl.org.uk/ Development of this website will be continuous and additional resources will continue to be made available. 10. Information Governance Our Information Governance Framework enables the safe and secure use of sensitive and other information to support the health and wellbeing of the people across our communities. It ensures that we meet our legal and ethical duties in relation to handling and managing information to a high standard. The role of Quality Assurance in information governance includes, but is not limited to: 1. Advice, monitoring and supporting the processing of: Subject access requests (SARs) including Information Commissioner’s Office (ICO) reviews and complaints. FOISA (Freedom of information requests) including Scottish Information Commissioner reviews and complaints. GDPR breach notifications Data protection impact assessments (DPIAs) DSAs/ISAs and data protection terms and conditions in contracts Schedule 2 requests for information relating to criminal activity (usually from the police) Work with other services to support the information governance function for social work (risk assessments, legal data protection team, legal FOI team). 2. Manage and support: Corporate reporting of KPIs for Information Governance HSCNL contributions to the Corporate Data Management Team (DMT) HSCNL contributions to the Lanarkshire Data Sharing Partnership (LDSP) Development and maintenance of recording and reporting systems for information governance. Development and review of policies and procedures for information governance, both for social work and corporately via DMT. The Information Governance function in social work has undergone significant changes over the reporting year. Many of these changes have contributed to the improvement of how we process information requests and the reporting functions. Activities have included the following: - Development of a core group within Quality Assurance to support and maintain the functions of information governance. Enhanced promotion of skills and awareness of information governance within social work, including training of staff and awareness of the online mandatory training courses and development of service specific training in Subject Access Requests (SAR’s) Development of additional training for social work staff. Review and update of Subject Access Requests (SAR’s) recording systems.
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20 Review and update of GDPR breach notification process. 11. Procurement In collaboration with Corporate Procurement colleagues and Locality Social Work Teams, Quality Assurance assist in the planning, coordination, and implementation of processes to ensure that when contracting new or existing work, the requirements of the Procurement Reform Scotland Act 2014 and the Procurement (Scotland) Regulations 2016 are adhered to. By doing so there can be confidence that the care & support services commissioned are legal, safe and outcomes focused whilst demonstrating Best Value. Throughout 2022/23 this partnership approach has enabled our Commercial Pipeline to be further developed. Transparency is a fundamental principle of public procurement, helping to ensure best value and proper scrutiny of contract awards. The Commercial Pipeline brings valuable insight to support the planning and delivery of public procurements, whilst enabling the widest possible- population of potential suppliers to be sighted on upcoming public sector contracting opportunities. Further refinements have also been made to our Contract Mobilisation processes, to embed timescales and key stages from the award of contracts to contracts going live. Over the period, we have focused on stakeholder communication plans, regular implementation meetings and the roles and responsibilities of key social work staff throughout the term of contracts, which are integral to effective service delivery. This approach helps to minimise contract implementation delays & barriers and promotes effective partnership working and the achievement of successful outcomes for the people of North Lanarkshire. We have also introduced the inclusion of Contract Exit Strategies and defined this within the contracting terms and conditions. This approach will ensure clarity when terminating contracts during their term (if required), contracts coming to a natural end and contracts at risk of early termination. This improved guidance is helpful during the period when provider sustainability features on the Social Work Risk Register. Early in 2023 there was representation from Quality Assurance to support the Corporate Procurement team at Lanarkshire’s Meet the “Real” Buyer Exhibitor. This event enabled potential contractors to ask specific care related questions. There were 337 attendees on the day and the feedback from the supply base was very positive. Representation from the Quality Assurance team will attend future events. Quality Assurance leads on procurement activity for all social work services, including those focussed on children, families, justice services and adults. There are close links between departments to ensure joined up planning, clear procurement processes and subsequent contract monitoring arrangements.
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21 Table 11 describes a sample of procurement activity undertaken in 2022/23. Table 11 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 currently in Year 3 Secured an increase in the number of contracted providers, improving the choice and control for supported people 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 currently in Year 2 Secured an increase in the number of contracted providers, improving the choice and control for supported people Digital Counselling Service and Online Platform of Support £120,000 funding had been allocated from within Scottish Government’s Mental Health Services allocation to the Council to pay for the solution in year 1. Follows the ‘Light Touch Regime’ / Regulation 74 of PCSR2015 Anticipate that further years funding can be secured should the solution prove to be successful. Counselling Service for Care Experienced Young Funding available year 1 via Scottish Government (initial year £50k) subject to annual review. Options years included to give option to extend agreement. Follows the ‘Light Touch Regime’ / Regulation 74 of PCSR2015 Based within Intensive Services Hub, Cecil Street, Coatbridge and work with 16–25-year-olds who have experienced trauma and adversity. Lifelong Links £8000 plus VAT for the first year. Proposal for Funding Children in local authority care including children in residential care and care leavers ADL SmartCare £291,268.92 whole life budget over 4 years. (£71,041.20) GCloud 13, cloud software solutions GCloud 13 allows searching of software solutions. Hoists and Adaptations £12,000,000 whole life budget over 5 years. Split into Lot 1 and Lot 2 Supply, Installation, Removal and Servicing of Straight and Curved Stairlifts Supply, Installation, Removal, Servicing and Maintenance of Ceiling Track Hoists
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22 12. Fair Work The Fair Work Convention has been in place since April 2015 and acts as an independent advisory body to Scottish Ministers. The Convention’s vision is that by 2025, people in Scotland will have a world leading working life where fair work drives success, wellbeing and prosperity for individuals, businesses, organisations and society. As part of the council’s commitment to Fair Work and our ambition 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. Tracking Contractor progress has been included in the Social Work Contract Management Framework. Contractors report on community benefits activity and Scottish Living Wage compliance. The information provided contributes to the overall assessment of contract compliance. Community Benefits - During 2022/23 Quality Assurance increased focus on the delivery of community benefits, following new contract awards and implementation. Our approach means link senior officers meet with contractors to review, promote and encourage new initiatives that offer employment to people in the local community, youth training and training for people from disadvantaged groups, traineeships, apprenticeships, and volunteering opportunities. Scottish Living Wage - In 2021/22, we reported that most contractors had indicated they were either already accredited as or were willing to become Scottish Living Wage employers. This year 100% of providers on our Self-Directed Support including Care at Home framework, reported paying the Scottish living Wage. Across all contractors of commissioned services, 94% are now paying employees the Scottish Living Wage. The remaining 6% of contractors provide non-care related services or are within the cross-border category whereby the Scottish Living Wage does not apply. Table 12 13. 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. Contractors Paying Scottish Living Wage 6%
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23 Improved links and processes in joint working between Quality Assurance and Children & Families mean that the noted development areas reported in 2021/22 have been progressed and all children and young people placements are conveyed to the appropriate teams. Quality Assurance have been supporting the development of Children, Families and Justice risk management arrangements, whereby attendance at the Social Work Risk Forums and membership of same is promoted across these teams. The Governance arrangements for Children and Families risk arrangements have been defined within the Adult Health and Social Care Risk Management Local Strategy. 14. Complaints Quality Assurance retains an overview role in terms of complaints made about Social Work service provision. Regular quarterly reports on complaints activity are reported through our governance structures. The annual summary and analysis of complaints received over the period 2022/23 is attached as appendix 1. 15. Duty of Candour Duty of Candour is a statutory duty on Scottish organisations providing health and social care. The responsibility is to remain 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 and the report for 2022/23 is attached as appendix 2. 16. Adult Support & Protection The lead for Adult Support and Protection sits within the Adult Headquarters Social Work team; however, Quality Assurance have a key function to monitor the performance of social care contractors including care homes, so we work closely with our Adult colleagues. Adult Support & Protection activity can highlight patterns/trends and/or contract compliance concerns. Maintaining an overview allows for early intervention and support for contractors if required. A Senior Officer from Quality Assurance is identified as the Adult Support & Protection Link Person, which supports robust monitoring. Quality Assurance have representation on the Pan Lan Adult Support & Protection Care Home Task Group. The aim of this group is to identify and respond to feedback and address any inconsistencies that may arise in key messages being communicated by various professionals in relation to when an ASP referral should be made to the Local Authority. Adult Support & Protection Coordinators from North and South Lanarkshire Council and representation from both the Care Inspectorate and Scottish Care also participate in this group. To ensure a co-produced and partnership approach, a nominated care home manager participates the views of the wider care home population. Work is ongoing to support care home managers to have confidence in their decisions about when to make an ASP referral. We continue to promote attendance and participation with contractors, in North Lanarkshire Council Adult Support and Protection training. 17. Adult Health & Social Care Risk Management There is a nominated Risk Champion and depute for Adult Health & Social Care, as we all as range of risk facilitators across the service. A key function over the past months has been the implementation
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24 of the new Corporate Risk Management Strategy and the associated Adult Health and Social Care Risk Management Strategy. Significant progress has been made to update the risk register for Adult Health & Social Care. Quality Assurance have taken a lead role in coordinating the reviews of risks in partnership with risk owners. Throughout the reporting year several Risk Forums and a Risk Identification meeting have taken place. The current membership of the Risk Forum is under review at this time. Work continues to review individual risks, wordings and assessment to ensure they are clearly articulated in a way that means identification of controls and actions is more focussed and meaningful. 18. Quality Assurance Planned Developments 2023/24 There are several developments in progress or planned for the period 2023/24, which will be conveyed in future reports. Details of some of the planned developments are noted below: Roll out of In-House Monitoring Social Work Self Evaluation Chief Social Work Officer Report Quality Assurance Newsletter Review of Contract Management Framework & associated data analysis Development of Engagement & Participation Strategy Establish membership of Risk Forum & streamline current risks. Ethical Commissioning Self-Assessment & Action Plan Recommence Care Home Provider Forum Support Succession Planning Refine Induction Pack Establish systems around Contractor Capacity Reporting Embed the role of Locality Senior Officer Links Agree and implement post covid care home arrangements/forums. Further development of market facilitation plan Continued Large Scale Investigation involvement. This report has covered Quality Assurance activity undertaken during the period 1 April 2022 to 31 March 2023 and highlights progress made in key activities noted in the last reporting period. The additional resource of two Senior Officers to the team in January 2023 has had a positive impact on outcomes achieved in developing creative and solution focused approaches to performance and compliance both internally and externally.
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25 Appendix 1 Social Work Complaints Annual Report 2022/23
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26 Introduction This report provides an overview of Social Work’s performance in terms of handling complaints received between 1 April 2022 and 31 March 2023 and covers Adults and Education, Families & Justice. This report describes how complaints have been managed by social work services, details the number and nature of complaints received during the year and demonstrates our commitment to learning and improvement. There remained a residual effect of the Covid 19 pandemic in terms of the numbers of complaints received in 2022-2023, underlining the impact this unprecedented global event had upon service provision and the lives of those who use our services. Complaint activity Overall, complaint activity rose by 81% from 2021-2022. A significant increase: however, complaints are still slightly less than they were pre-pandemic. In terms of complaints per population, they stand at 0.35 per 1000. Overall complaints received for the reporting period were 221, an increase of 99 [58%] from former reporting period. A breakdown is provided below. Education and Families 81 complaints were received in relation to Education & Families services this year, 49 received last year, an increase of 32 [65%]. The chart below is a summary of locality complaint activity for Education and Families services. Of the 81 complaints received, 80 were assigned. One complaint couldn’t be assigned to any locality or service due to lack of information. Adult Social Work Services 140 complaints for adult services this year, 73 received last year, an increase of 67 [92%]. The chart below is a summary of locality complaint activity for Adult Social Work Services. 16 14 12 10 8 6 4 2 Locality/Service 15 11 10 6 6 6 5 4 4 2 1 1 0 Airdrie Bellshill Coatbridge Cumbernauld Motherwell Wishaw HQ
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27 Complaint Process We always aim to provide the highest possible quality of service across our communities and are committed to ensuring accountability and transparency. We recognise there are times when we get things wrong and fail to meet the expectations of those who use our services. We welcome feedback as it provides information that helps us to learn from complaints and shape and improve the way services are delivered. Complaints are viewed as a positive communication tool and are actively encouraged. As per the Scottish Public Services Ombudsman [SPSO] definition, we regard a complaint as any expression of dissatisfaction, by one or more members of the public, about our action or lack of action, or about the standard of service provided by us or on our behalf. Anyone can make a complaint, either verbally or in writing, face to-face, by phone, letter or email. People are directed and encouraged to use the North Lanarkshire Council online portal to make a complaint but retain the right to use any of the aforesaid options. A two-stage statutory social work complaints process was introduced on 1 April 2017, which harmonised complaint handling processes across all council services. The process is as follows: • Stage one – ‘frontline resolution’: we will always try to resolve complaints quickly, within five working days, and in exceptional circumstances extend for a further five days. • Stage two – ‘investigation’: if people remain dissatisfied with our stage one response, they can escalate their complaint to stage two. Complaints that are complex or need detailed investigation from the outset can be looked at immediately at stage two. These complaints will be acknowledged within three working days and a written response provided within twenty working days; this can be extended in exceptional circumstances. Following completion of the complaints process, if the person remains dissatisfied, they can ask the SPSO to consider their complaint further. We always advise of this entitlement and provide contact details. Performance Indicators The Complaints Standard Authority developed a suite of four mandatory performance indicators in association with the Local Authority Complaint Handlers Network on which we are represented. These indicators [undernoted] are a valuable source of information as they help to identify recurring or Locality/Servic e 30 25 24 22 20 15 15 12 11 10 10 9 10 6 5 4 5 3 5 4 0 Airdrie Bellshil l Coatbridge Cumbernauld Motherwell Wisha w H Q Stage 1 Stage 2
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28 underlying issues, derive/drive learning from complaints and highlight potential areas for improvement. Indicator One: the total number of complaints received. Indicator Two: the number and percentage of complaints at each stage that were closed in full within the set timescales of five and 20 working days. Indicator Three: the average time in working days for a full response to complaints at each stage. Indicator Four: the outcome of complaints at each stage. Education and Families – Performance Information Compliance with statutory timeframes to complete complaint 23.7% not within timeframes 22.7% not within timeframes 59.4% within timeframes 54.6% within timeframes 16.9% met with extension 22.7% met with extension Average S.1 – 6.2 working days Average S.2 – 23.3 working days
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29 Cause of Complaints Complaint Outcome
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30 Adult Social Work Services– Performance Information Compliance with statutory timeframes to complete complaint 24% not met within timescales 16% not met within timescales 52% met within timescales 63% met within timescales 24% met with extension 21% met with extension Average S.1 – 5.4 working days Average S.2 – 23.2 working days Cause of Complaints
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31 Complaint Outcome Learning from Complaints The learning from all social work complaints this year have highlighted: The importance of good communication. The need to ensuring that those who use our services and their carers are informed from the outset that they may need to contribute towards the cost of their care. The need to improving information and advice for those who need to contact and seek support from social work services. That people have the right to use their Self-directed Support (SDS) individual budgets as creatively as necessary to reach their agreed outcomes, as long as the use of public funds are legal and do not bring the council into disrepute. Outcomes are often specific to the complaint, but when there are organisational learning points that influence policy or procedure, we need to ensure these are acted upon. Individual learning is dealt with directly with the complainant and through supervision, and more general issues are managed through supervision with team members and reminders at team meetings. Learning from Complaints Communication Safe Driving Conduct Support Planning Importance of PPE Importance of ID N/A
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32 47% of all social work complaints recorded did not highlight any learning, while 33% were attributed to communication failure as the singular cause of complaints. Other issues cited were safe driving/parking, wearing appropriate PPE and ID badges, quality of service and conduct of staff. We recognise the importance of learning from complaints and acknowledge that having a learning outcome recorded is an area that requires immediate attention. We understand that complaints help organisations learn more about the experiences of people who use their services, and that complaints can be helpful to enable us to work in a better way. At present, learning from complaints is a non-mandatory performance indicator. However, the Scottish Public Services Ombudsman are interested in the systemic changes that are made following complaints. Going forward, we will work directly with our central and locality teams to ensure better recording and learning from complaints is embedded in practice to ensure quality services are delivered. Comment and compliments Across social work, seven compliments were made 2022-2023 in relation to complaint handling – all referred to quick actions by responsive staff to provide resolution. 5 other comments were logged but were mapped as neutral and non-critical. Training Training on the Dynamics system, where complaints are recorded, is offered as required. The licence allocation system has recently been reviewed, and licence permissions granted only to management support team members and to system administrators. Rationalisation of licence holders will increase opportunities to have closer collaboration and training across the service. Colleagues in Chief Executive’s office lead on training on system issues, and Quality Assurance Senior Officer leads on complaint handling training. The Scottish Public Services Ombudsman offer training on topics such as investigating complaints. Currently, this is only offered virtually, but there are plans to introduce in person training and to increase the number of training opportunities offered. We actively encourage participation in training on complaint handling and management. Scottish Public Services Ombudsman The SPSO considered seven complaints of which two are subject to ongoing enquiry, one had recommendations made for resolution, with the remaining four no actions taken.
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33 Child Friendly Complaints Procedure The SPSO are introducing a new Child Friendly Complaints Procedure, which will go live on 1 April 2024. This procedure will ensure that children’s rights under the United Nations on the Rights of the Child [UNCRC] are met through a child-centred complaint process. Their aim is to co-design and implement a public sector complaints service that meets children’s rights and needs. They are working in co- operation with children, young people, public bodies and wider stakeholders. Initially, it was envisaged that the new procedure would be fully implemented by 1 April 2023. However, following feedback from engagement and testing work, a more targeted pilot has been agreed. The pilot will focus on key services provided to children and young people, such as schools, social work services and children’s health services. The aim of this work will be to test the new approach in practical settings, both to ensure it results in the right outcomes for children, and that it is efficient, practical, and workable for the public sector bodies managing the process. Full guidance on the new process should be made available by summer 2023, with a soft launch of the new process in April 2024. Quality Assurance Quality Assurance senior officers provide training and support to social work managers and teams in relation to the complaint handling process. A suite of letter templates are available, which provide guidance on model answers and best practice when engaging with complainants. Complaints are often routed directly through the Quality Assurance officer who acknowledges receipt and assigns complaints to the relevant team manager. Guidance on response times and content is provided. Complaints that relate to both health and social work/social care services are routed through the relevant lead organisations complaints process, but there is an integrated approach to resolution and any joint learning outcomes are shared. Care Opinion Care Opinion is a non-profit organisation, funded mainly through subscriptions from health and care organisations. At present, 500 health and social care organisations use Care Opinion across the UK. Care Opinion have been sharing people’s experiences of health and care services online in Scotland since 2013 and have built a national and international reputation for their innovative and value-led approach to online feedback. Feedback is considered integral to quality improvement and for staff it is an opportunity to see the system and the service provided through the person’s eyes. Subscription to Care Opinion gives a further platform for people who use social work services to comment on the quality of the service that we provide but may also encourage people to make formal complaints. Usage of Care Opinion has been slow – however, there has been marked increases in comments posted about social care services over the course of the preceding quarter. Anecdotal information from our partners in NHS Lanarkshire suggests that in the early stages, uptake can be poor, but that sustained promotion will drive traction and momentum. There is a Care Opinion implementation group who meet regularly to agree plans for increased promotion and shared learning . To support the use of Care Opinion as a vehicle to promote feedback on services, our revised Contract Management Framework requires all contracted providers, through their quarterly monitoring return, to report on their use and promotion of Care Opinion as a method of seeking feedback.
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34 Conclusion The principal cause of complaints continue to identify poor staff communication, staff attitudes and quality of service. This is further reflected within the learning outcomes, which indicate the need to improve communication, practice and approach to those using social work services. As a partnership we are committed to improving learning from complaints which is also one of the key performance indicators that are reportable to the SPSO. We will, over the course of 2023-2024 place further emphasis on identifying and applying learning from complaints, recording learning outcomes and evidencing subsequent improvements. We will also emphasise the need to ensure that all complaints are dealt with in the identified timeframes, with clear communication of outcomes. Although 100% of complaints that were sent directly to social work were acknowledged by the due dates, only 58% overall were completed within statutory timeframes. Complexity of issues, new processes, staffing, IT systems and very tight time frames for resolution were the contributory factors in failure to complete all complaints within time. Improvement in these areas are expected in 2023-2024. Further actions – 2023-2024 Several key actions have been identified to strengthen our approach when dealing with complaints including using the learning to improve the quality of experience for those who use our services. The actions are: 1. We ensure a robust log and learning from complaints is implemented to support the improvement of services that support people across our communities. 2. We develop a programme of reflective learning sessions across teams - Complaint activity and learning remains an agenda item in team meetings and links across services and localities are maintained with Quality Assurance Senior Officer who will review complaint activity as required. 3. We continue to promote Care Opinion as one of the key mechanisms for engaging with members of the public and to generate meaningful feedback. 4. We provide system training to all members of the management support teams who now have responsibility for logging and tracking complaints. 5. We provide complaint handling training sessions on at least a quarterly basis as a refresher session, or for training for new staff. 6. We support the implementation of Child Friendly Complaints Handling Procedures.
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35 Appendix 2 Duty of Candour Annual Report 2022/23
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36 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 2022 and 31 March 2023. 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 A. 82 commissioned organisations were asked to provide information in relation to Duty of Candour activity in the reporting period. Of the 34 [41%] that responded, there were six reported incidents. Details of those who responded are noted in Appendix B. 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. Reporting of Duty of Candour incidents are an integral part of our Contract Monitoring Framework and all should be reported on quarterly contract monitoring returns. How many incidents happened to which the duty of candour applies? In the reporting period, six incidents have been reported to which the duty of candour applied, one in relation to maladministration of paracetamol, and five where a person fell and sustained physical
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37 harm. All incidents reported were from a commissioned care home service. No Duty of Candour incidents were reported by North Lanarkshire Council in-house social work services. The low number and type of reported incidents indicate that there may be some uncertainty over situations where Duty of Candour responsibilities should be invoked. Refresher sessions on Duty of Candour duties will be delivered to our in-house teams over the course of 2023-2024. Reminders and information slides will be sent to all our commissioned services to ensure that they are fully aware of the duties under the Act. Details of incidents where Duty of Candour applied. Nature of incident: Duty of Candour raised for accident where resident fell and fractured his femur. Incident fully investigated and reported. Relative invited to a Duty of Candour meeting but declined to attend. Nature of incident: Duty of candour raised for incident whereby a resident received an overdose of Paracetamol. No lasting harm occurred. Incident fully investigated and reported. Relative invited to Duty of Candour meeting but declined to attend. Nature of incident: Duty of Candour raised for an incident where a resident had staples to a wound in her head following an unwitnessed fall. No lasting harm occurred. Incident fully investigated and reported. Relative declined invite to attend Duty of Candour meeting. Nature of incident: Duty of Candour raised for incident where a resident had sutures to head wound following a witnessed fall. No lasting harm occurred. Incident fully investigated and reported. Family were invited to attend a Duty of Candour meeting but declined to attend. Nature of incident: Duty of Candour raised for incident concerning a resident who sustained a fracture due to witnessed fall. Incident fully investigated and reported. Family were invited to attend a Duty of Candour meeting but declined to attend. Nature of incident: Duty of Candour raised for incident concerning a resident who sustained a fracture due to an unwitnessed fall. Incident fully investigated and reported. Relatives were invited to a Duty of Candour meetings but declined to attend. Unfortunately, there were incidents where Duty of Candour duties should have been invoked but were not. Reasons for failure were inexperienced management and lack of familiarity with Duty of Candour procedures. Another factor was due to Police involvement in two serious incidents, where it was understood that Police involvement superseded Duty of Candour. Conclusion Within the reporting period, there were no Duty of Candour incidents reported from in-house home care or social work services and only six from commissioned care home providers. From those reported, none had lasting consequences for the person to whom the duty applied - appropriate action taken, lessons learned, procedures and training revised, and where applicable, families informed, and invited to discuss in more detail. In future, if any incidents occur that invoke Duty of Candour proceedings, there will be a review process to identify lessons learned, with the result of the review
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38 shared with the relevant person/persons. This approach will minimise the impact on the organisation and the vulnerable people that we strive to support. 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 prolong 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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39 Appendix B Organisations who provided a response: all but one returned a nil response. All New Beginnings Angels Aspire Beechwood Care Home Capability Scotland Care One Professional Care Solutions C- Change Cera Care Corners tone Deanston Care Home Enable Scotland Enhance Supported Living Services HRM Inclusion Scotland Invercare Keane Premier Support Services Key Housing Lanarkshire Association for Mental Health Lanarkshire Care Partners Local Lanarkshire Care Lochside Manor Love Partners in Play Penumbra PHEW Potential Living Quarriers Scottish Autism Support for Ordinary Living The Richmond Fellowship Scotland Thera Care Turning Point Scotland Wheatley Care