Agenda Document Pack - Clinical and Care Governance Committee - 29/08/2024
Moray Council · 29 August 2024
Back to Clinical and Care Governance Committee — 29 August 2024 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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Clinical and Care Governance Committee Thursday, 29 August 2024 Council Chambers NOTICE IS HEREBY GIVEN that a Meeting of the Clinical and Care Governance Committee, Council Chambers, Council Office, High Street, Elgin, IV30 1BX on Thursday, 29 August 2024 at 09:30 to consider the business noted below. AGENDA 1. Welcome and Apologies 2. Declaration of Member's Interests 3. Minute of meeting of 30 May 2024 5 - 8 4. Action Log - 30 May 2024 9 - 10 Leadership and Accountability 5. Strategic Risk Register - June 2024 11 - 48 Effective Communication and Information 6. Complaints Report for Quarter 1 2024-25 49 - 64 7. Draft Health and Social Care Moray Annual Complaints Report 2023-24 65 - 90 8. Inspection of the Moray Supported Lodgings Project in May 2024 91 - 180 Safe and Effective Practice Page 1
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9. Health and Social Care Moray Clinical and Care Governance Group Escalation Report 181 - 192 Accessible, Flexible and Responsive Services 10. Progress Report on Moray Unpaid Carers Strategy 193 - 198 11. Items for Escalation to MIJB Page 2
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MORAY INTEGRATION JOINT BOARD SEDERUNT Mr Derick Murray (Chair) Councillor Peter Bloomfield (Voting Member) Councillor Scott Lawrence (Voting Member) Mr Alex Stephen (Voting Member) Mr Ivan Augustus (Non-Voting Member) Professor Duff Bruce (Non-Voting Member) Mrs Sheila Brumby (Non-Voting Member) Dr Robert Lockhart (Non-Voting Member) Mr Jim Lyon (Non-Voting Member) Ms Elizabeth Robinson (Non-Voting Member) Dr Malcolm Simmons (Non-Voting Member) Mr Kevin Todd (Non-Voting Member) Ms Janette Topp (Non-Voting Member) Clerk Name: Caroline O'Connor Clerk Telephone: 07779 999296 Clerk Email: committee.services@moray.gov.uk Page 3
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MORAY COUNCIL Minute of Meeting of the Clinical and Care Governance Committee Thursday, 30 May 2024 Council Chambers, Council Office, High Street, Elgin, IV30 1BX PRESENT Mr Ivan Augustus, Councillor Peter Bloomfield, Mr Simon Bokor-Ingram, Mrs Sheila Brumby, Mr Sean Coady, Councillor Scott Lawrence, Dr Robert Lockhart, Mr Derick Murray, Ms Deborah O'Shea, Mr Sandy Riddell, Ms Tracy Stephen, Ms Janette Topp APOLOGIES Professor Duff Bruce, Ms Fiona Robertson, Ms Elizabeth Robinson, Dr Malcolm Simmons, Mr Kevin Todd IN ATTENDANCE Clinical Lead Nurse, Vaccination Programme; Allied Health Professional, Sector Lead Moray; Carl Campbell, Social Work Service Manager and Caroline O'Connor, Committee Services Officer. 1. Chair The meeting was chaired by Mr Derick Murray. 2. Thanks The Board, in noting that Fiona Robertson had retired, joined the Chair in thanking Ms Robertson for her contribution to the Board and wished her well for the future. The Board, in noting Simon Bokor-Ingram had resigned as Chief Officer due to health reasons, joined the Chair in paying tribute to Mr Bokor-Ingram for his leadership and dedicated service and substantial contribution to the Board and wished him well for the future. The Board, in noting Sonya Duncan who was moving onto a different role and Jeanette Netherwood would be returning to the position of Corporate Manager, joined the Chair in thanking Ms Duncan for her contribution to the Board and wished her well for the future. 3. Welcome The Board joined the Chair in welcoming Audrey Steele-Chalmers, Allied Health Professional Lead; Sheila Brumby as Service User Stakeholder and Janette Topp as Third Section Stakeholder to their first meeting of the Board. 4. Order of Business Item 3. Page 5
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The Chair sought agreement from the Board that Item 8 "Vaccination Uptake Amongst Health and Social Care Moray Staff" would be taken after Item 4 "Action Log-28 March 2024" on the agenda. This was unanimously agreed. 5. Declaration of Member's Interests There were no declarations of Member's interests in respect of any item on the agenda. 6. Minute of meeting of 28 March 2024 The Chair stated that Mr Riddell was not included in those present at the meeting however noted the minute would be amended. Subject to the amendment above, the Committee unanimously agreed the minute of the meeting. 7. Action Log - 28 March 2024 The Action Log of the meeting of 28 March 2024 was discussed and updated accordingly. 8. Vaccination Uptake Amongst Health and Social Care Moray Staff Report The meeting had before it a report by the Consultant in Public Health informing the Committee of the levels of vaccination uptake in Moray amongst health and social care staff. Following consideration the Committee unanimously agreed to:- i. note the uptake of COVID and flu vaccinations amongst front line health and social care staff as at 14 March 2024; and ii. support the Moray Immunisation Team in their efforts to increase uptake of vaccinations amongst health and social care staff. 9. Quarter 4 Complaints Report The meeting had before it a report by the Allied Health Professional - Sector Lead, Moray informing the Committee of complaints reported and closed during Quarter 4 (1 January 2024 - 31 March 2024). In response to a question from the Chair as to the reason for the rising trend in complaints received, the Allied Health Professional Lead advised there had been a drop in complaints previously during the covid pandemic due to many services being suspended and the amended delivery of other services. She further advised Children's Services and Justices Social Work are now included in the figures. Following consideration the Committee agreed to note the totals, lessons learned, response times and action taken for complaints completed within the last quarter. 10. Moray Portfolio Assurance Report to NHS Grampian Clinical Governance Committee Page 6
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The meeting had before it a report by the Chief Officer informing the Committee of an assurance report presented to NHS Grampian Clinical Governance Committee on 14 May 2024. Mr Riddell, with reference to the numbers of noting reports generally and specifically the value and purpose of those reports where no feedback or commentary is provided, queried whether all reports are essential or should be reported by exception. In response the Chair agreed that he and the Vice Chair would raise the issue at the next Chairs meeting of NHS Grampian. Following consideration the Committee unanimously agreed to note the contents of the report. 11. Clinical and Care Governance Group Escalation Report The meeting had before it a report by the Allied Health Professional - Sector Lead, Moray informing the Committee of progress and exceptions report to the Clinical and Care Governance Group since the last report to Committee in March 2024. Following consideration the Committee unanimously agreed to note the contents of the report. 12. Moray Physiotherapy Musculoskeletal Service The meeting had before it a report by the Physiotherapy Uni-Professional Lead informing the Committee on the current position of the waiting times for the Moray Physiotherapy Musculoskeletal (MSK) Services, current performance in achieving the National HEAT (Health Improvement, Efficiency and Governance, Access and Targets and Measures) Target of 4 weeks and providing assurance in how the service leads are effectively addressing the waiting times. Following consideration the Committee unanimously agreed to note:- i. the local waiting times against the National recommended standard; ii. the local service performance against other national locations' service performance (Scottish NHS Board Comparisons); and iii. the continued work within the service towards reducing waiting times by continuously reviewing and improving methods of effective service delivery. 13. Update on Recommended Allowances for Kinship and Foster Carers Report The meeting had before it a report by the Head of Service and Chief Social Work Officer providing an update for the Committee of the recommended allowances for kinship and foster carers. Mr Riddell queried in terms of governance why the report had been brought to this Committee rather the Moray Integration Joint Board. In response the Chief Social Work Officer advised that the report had first been reported to this Committee before being approved by Moray Council due to being in a shadow year for Children's Services and the report was presented to Committee today for courtesy as a noting report. She further confirmed the most appropriate channel for future Page 7
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reporting would be to include as part of the financial reporting to the Moray Integration Joint Board. Following consideration the Committee unanimously agreed to note the adoption of the proposals regarding the recommended allowances for kinship and foster carers and the update on the financial position for 2024/25. 14. Items for Escalation to MIJB The Committee noted there were no items for escalation to the Moray Integration Joint Board. Page 8
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MEETING OF MORAY INTEGRATION JOINT BOARD CLINICAL AND CARE GOVERNANCE COMMITTEE THURSDAY 30 MAY 2024 ACTION LOG ITEM NO. TITLE OF REPORT ACTION REQUIRED DUE DATE ACTION BY UPDATE AUGUST 2024 1. Strategic Risk Register Unpaid Carers to be woven into the risk register at a strategic level. Discussion to take place between Chief Officer and Unpaid Carer Officer on whether specific mention of Unpaid Carers Strategy should be included in controls section. March 2024 Corporate Manager Work commenced on refreshing the Risk Register. Agreed any emerging risks will be presented August 2024. 2. Progress Update in Relation to Unpaid Carers Strategy 2023-27 Chief Officer, Self Directed Support Officer and Unpaid Carer Officer to discuss and agree the frequency of the progress reports to Committee. November 2023 Chief Officer Annual review presented to MIJB June 2024 Quarterly progress reports will be presented to CCG Cttee – on today’s agenda 3. Complaints Reports Narrative to be added to future reports to understand intelligence and provide analysis of the data. Ongoing Corporate Manager On today’s agenda Item 4. Page 9
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REPORT TO: MORAY INTEGRATION JOINT BOARD CLINICAL AND CARE GOVERNANCE COMMITTEE ON 29 AUGUST 2024 SUBJECT: STRATEGIC RISK REGISTER – JUNE 2024 BY: INTERIM CHIEF OFFICER 1. REASON FOR REPORT 1.1 To provide an overview of the current strategic risks, along with a summary of actions which are in place to mitigate those risks, updated June 2024. 2. RECOMMENDATION 2.1 It is recommended that the Committee: i) consider and note the updated Strategic Risk Register included in Appendix 1; and ii) endorse the new format applied to the whole Strategic Risk Register and the updated content therein. 3. BACKGROUND 3.1 The Strategic Risk Register is reviewed regularly by the Senior Management Team as part of a robust risk monitoring framework, to identify, assess and prioritise risks related to the delivery of services in relation to delegated functions, particularly any which are likely to affect the delivery of the Strategic Plan. 3.2 The Moray Integration Joint Board (MIJB) Strategic Risk Register is attached to this report at Appendix 1 and sets out the inherent risks being faced by the MIJB, together with a current assessment on the level of the risks and mitigating actions being taken to reduce the impact of the risks. This report is also presented to Clinical and Care Governance Committee for their oversight and comment. 3.3 Risk scores are weighted, based on assessment according to their likelihood and corresponding impact, as per Section 5 of the MIJB Risk Policy. Item 5. Page 11
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3.4 The Strategic Risks received an initial review to ensure they align to the Moray Partners in Care 2022-2032 strategic plan which was agreed at MIJB on 24 November 2022 (para 14 of minute refers). 3.5 The format presented today was formally presented to this Committee on 28 March 2024 (para 5 of minute refers). 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 The Risk Management Framework review was completed and outcome was approved by the Board on 25 June 2020 (para 9 of minute refers). The approved Risk Appetite Statements have been included in Appendix 1. 4.2 A review of the Risk Management Framework will commence during 2024. 4.3 The senior leadership teams continually consider the appetite for risk whilst planning and effecting transformational change and redesign, despite operating within a very finite budget. 4.4 Mapping of the recently delegated services is required to ensure all statutory and regulatory governance arrangements are being met, without unnecessary duplication. 4.5 There is significant financial risk in the system. A reviewed Financial Recovery Plan was presented to MIJB 30 May 2024 (para 5 of minute refers), further updates will be presented to MIJB throughout the year. 4.6 Recruitment and retention continues to provide challenges across all disciplines. 4.7 Work continues to give partnership wide overview of all operational risk registers. 4.8 A Project Office has been established to support the Financial Recovery Savings work presented to the board in May 2024. 5. SUMMARY OF IMPLICATIONS (a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and Moray Integration Joint Board Strategic Plan “Partners in Care 2022-2032” The MIJB requires effective governance arrangements for those services and functions delegated to it and Risk Management systems are integral to this. (b) Policy and Legal As set out in the terms of reference, the Board has responsibility to provide assurance of the adequacy of the risk management framework. There are no legal implications arising from this report. (c) Financial implications Page 12
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There are no direct financial implications arising from this report however the Board should note the failure to manage risks effectively could have a financial impact for the MIJB. (d) Risk Implications and Mitigation This report forms part of the governance arrangements for identifying and managing strategic risks of the MIJB. The risks are outlined in the body of the report in section 4. (e) Staffing Implications There are no additional staffing implications arising from this report. (f) Property There are no property implications arising from this report. (g) Equalities/Socio Economic Impact An Equalities Impact Assessment is not required because there are no service, policy or organisational changes being proposed. (h) Climate Change and Biodiversity Impacts There are no impacts arising from this report. (i) Directions None arising from this report. (j) Consultations Consultation on this report has taken place with the Senior Management Team. 6. CONCLUSION 6.1 The report outlines the current position and recommends the Committee note the revised and updated version of the Strategic Risk Register. Author of Report: Sonya Duncan, Corporate Manager Background Papers: held by HSCM Ref: Page 13
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APPENDIX 1 RISK SUMMARY – JUNE 2024 1. The Moray Integration Joint Board (MIJB) does not function as set out within the Integration Scheme, Strategic Plan and in-line with Standing Orders and fails to deliver its objectives or expected outcomes. 2. There is a risk of MIJB financial failure in that the demand for services outstripping available financial resources. Financial pressures being experienced by the funding Partners will directly impact on decision making and prioritisation of MIJB. 3. Inability to recruit and retain qualified and experienced staff to provide safe care and providing capacity to deliver on planned strategic aims. 4. Inability to demonstrate effective governance and effective communication and engagement with stakeholders. 5. Inability to cope with unforeseen external emergencies or incidents as a result of inadequate emergency and resilience planning. 6. Risk to MIJB decisions resulting in litigation/judicial review. Expectations from external inspections are not met. 7. Inability to achieve progress in relation to national Health and Wellbeing Outcomes. Performance falls below acceptable level. 8. Inability to progress with delivery of Strategic Objectives and Transformation projects as a result of inability to resolve data sharing and data security requirements. 9. Requirements for support services are not prioritised by NHS Grampian and Moray Council Item 5. Page 15
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Risk Assessment Table – Multiply likelihood score by impact score to determine the risk rating (score). Risk No Lead Officer Current Risk Rating Last Reviewed Position Change Key 1 Chief Officer Medium 13/6/24 Risk improvement 2 Chief Finance Officer Very High 13/6/24 No change to risk 3 Senior Management Team High 13/6/24 Risk deterioration 4 Senior Management Team Medium 13/6/24 5 Chief Officer High 13/6/24 6 Senior Management Team Medium 13/6/24 7 Chief Officer High 13/6/24 8 Senior Management Team High 13/6/24 9 Chief Officer High 13/6/24 Page 16
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Description of Risk 1: The Integration Joint Board (IJB) does not function as set out within the Integration Scheme, Strategic Plan and Scheme of Administration and fails to deliver its objectives or expected outcomes. Risk Rating: Medium Consequence: Legal and Regulatory Implications, Stakeholder Trust, Resource Challenges, Service Disruption, Not delivering Health Outcomes Risk Movement: Rationale for Risk Appetite The Board, staff and providers across Moray are all committed to ensuring high standards of clinical care & governance through operational policies. Innovation and new ways of working may mean traditional regulations do not exist, or are contradictory. We will only take regulatory risks knowingly, following consultation with the relevant regulatory body and where we have clear risk mitigation in place. Rational for Risk Rating The strategic plan “Partners in Care 2022 to 2032” was approved by MIJB in November 2022. An amendment to the Scheme to increase membership by one from each of the partner organisations was ratified in March 2022 by the Scottish Government following due process and approval by Moray Council and NHS Grampian Board. There is a schedule of weekly meetings with the Chairs/Vice Chair of MIJB and Committees, Chief Officer, Chief Financial Officer, Heads of Service and Corporate Manager. The delivery plan for the new Strategic Plan “Partners in Care” 2022-32 was presented to MIJB in September 2023. Mitigations / Current controls in place 4 5 20 Integration Scheme is in place 2 2 4 Strategic Plan “Partners in Care” 2022-32 Governance arrangements formally documented and approved by MIJB January 2021. Performance reporting mechanisms. Untreated Likelihood Untreated Impact Untreated Score Current Likelihood Current Impact Current Score Page 17
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Assurances: Audit, Performance and Risk Committee oversight and scrutiny. Internal Audit function and Reporting Reporting to Board. The Moray Transformation Board and Strategic Planning and Commissioning Groups have recommenced and will support an oversight of planned business across HSCM. Gaps in Assurance: The new strategic delivery plan will incorporate the work being taken forward for Self-Directed support, Hospital at Home and Locality Planning. Mapping of the recently delegated services will take place to ensure the statutory governance requirements and those of MIJB are robust. Current Performance: The Scheme of Administration is reported when any changes are required. The Governance Framework was approved by IJB 28 January 2021. Re-appointment of Standards Officer agreed by IJB 28 March 2024. Members Handbook has been updated and circulated to all members in June 2022. Comments: Strategic Planning and Commissioning Group approved the generic Terms of Reference and Chairs of the transformation boards at the meeting on 19 December 2019. The financial savings programme will utilise the SPCG for decision making where appropriate. Consultation with legal representative for all reports to committees and attendance at committee for key reports. Standing orders have been reissued to all members Induction sessions are held for any new IJB members. Further sessions are arranged for new appointees. Conduct and Standards training held for IJB Members in June 2022 and February 2024 provided by Legal Services. SMT regular meetings and directing managers and teams to focus on priorities. Regular development sessions held with IJB and Operational Management Team Page 18
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Further Controls Required m Further Controls Owner Review Date Review Notes / Decisions Target Date Target Likelihood Target Impact Target Score Page 19
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Description of Risk: Financial There is a risk of MIJB financial failure in that the demand for services outstrips available financial resources. Financial pressures being experienced both by the funding Partners and Community Planning Partners will directly impact on decision making and prioritisation of MIJB. Risk Rating: Very High Consequence: Inability to deliver its strategic priorities, statutory services and identified projects. Risk of overspend affecting financial stability. Risk Movement: Rationale for Risk Appetite The Board recognises the financial constraints all partners are working within. MIJB has a low risk appetite to financial failure and recognises the significance of achieving a balanced budget. The Board also acknowledges the statutory requirements to provide services within the allocated budget. The cost of current service delivery is higher than available budgeted resources. Those risks will only be considered: • Where a clear business case or rationale exists for exposing ourselves to the financial risk • Where we can protect the long term sustainability of health & social care in Moray Rational for Risk Rating If the IJB's strategic plan and medium term financial plan are not prepared on a sustainable basis, there is a risk that the recurring cost base could exceed future funding allocations resulting in an underlying deficit. This will adversely affect both current and future service provision and will impact on the IJB's ability to deliver its strategic priorities and vision. Given the current level of uncertainty associated with civil unrest across the globe, cost of living crisis, tight financial settlements for local government and health and the impact of increasing demand, the magnitude of the potential costs involved represent a continuing significant financial risk. Additional consequentials have ceased and any recurring costs will have to be met from existing baseline budgets. National Care Service legislation also introduces a new area of financial uncertainty Mitigations / Current controls in place 5 5 25 1. Budgets delegated and managed by Service Managers with Head of Service oversight. 2. Vacancy controls via the Resource Management Group 3. CFO and SMT working to continuously identify additional savings. 4 4 16 Untreated Likelihood Untreated Impact Untreated Score Current Likelihood Current Impact Current Score Page 20
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Assurances: MIJB and Audit, Performance and Risk oversight and scrutiny of budget Reporting through MIJB, NHS Grampian and Moray Council A Project Office will support the Financial Recovery Savings work that was presented in May 2024. Gaps in Assurance: Some of the financial savings will take planning, consultation and implementing. SMT are identifying capacity within the current workforce to support this work. Current Performance: A working budget was approved by MIJB on 28 March 2024. The Revenue Budget Outturn for 2023/24 was presented with a balanced position and agreed by MIJB 30 May 2024 together with a comprehensive Revenue Budget and Recovery Plan for 2024/25 to address the significant funding gap. The recovery plan was approved by the board close monitoring will continue and be presented to the board at regular intervals, A Project Office has been established to manage the comprehensive plans to allow for regular and concise reporting to both Senior Management and the board. Comments: Further Controls Required Further Controls Owner Target Date Regular financial workshops with Service Leads to identify further savings Chief Financial Officer 2/2/24 - Completed 4. A reviewed Financial Framework was presented to MIJB on 30 March. 5. Financial information is reported regularly to MIJB, Senior Management Team and Operational Management Team. 6. The CO and CFO continue to regularly engage in finance discussions with key personnel of both NHS Grampian and Moray Council. 7. The CO and CFO will continue to engage with partner organisations in respect of the financial position throughout the year. Cross partnership performance meetings are with partner CEOs, Finance Directors and Chair/Vice Chair of MIJB. 8. A Project Office has been set up to support the Financial Recovery Savings work presented in May 2024. Page 21
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Financial development session with MIJB members Chief Officer 7/3/24 - Completed Reporting from Resource Management Group to SMT for oversight of agreed spend Chief Officer 4/3/24 - Completed Financial workshops with OMT looking at savings options Head of Service 2/2/24 - Completed Drop in finance sessions have been arranged for managers to speak with senior leaders and the CFO regards any proposed savings plans. Chief Finance Officer 31/5/24 - Completed Capacity within current staffing has been identified to support the collation and oversight of the financial savings plan for 2024/25 SMT 31/5/24 - Completed Review Date Review Notes / Decisions 8/3/24 A Recovery plan was submitted to IJB in January 2024, a development session took place to discuss options in 7/3/24 with the recovery plan going back to IJB in March 2024. 29/4/24 A Development Session was held with Service Managers, SMT and MIJB members (hybrid) on 18/4/24 to discuss the proposed savings plan, some topics were discussed with Q&A session for MIJB Page 22
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Description of Risk 3: Inability to recruit and retain qualified and experienced staff to provide safe care and providing capacity to deliver on planned strategic aims. Risk Rating: High Consequence: Service disruption, Increased Workload, Financial impact, Poor Staff Morale, Risk to Patient Safety, Negative Public Perception Risk Movement: Rational for Risk Appetite Safety risks that could result in harm to service users, staff or the public are inherent in Health & Social Care services. The safety of individuals is paramount therefore standards of safety management and clinical care have to be high, and the Board will continue to seek assurances this is the case. The Board’s ambition is for health & social care to be people centred. This means supporting people in decision making about their own health & care, which may expose individuals to higher risk where they make an informed decision. The Board will also seek to balance individual safety risks with collective safety risks to the community. Rationale for Risk Rating (change over once approved with appetite boxes) There continues to be issues with recruitment to front line services that require specific skills and experience. This continues to place pressure on existing staff. Allied Health Professions, Social Work and Nursing are some of the particular areas experiencing difficulties with obtaining people with the appropriate skills and training. Care at Home staffing levels are pressured for Internal services and externally with local providers all experiencing the same difficulties. There are also impacts on recruitment of Dentists and other graduates arising from the Covid-19 pandemic as the numbers graduating have reduced during that period. The various impacts of Covid-19 has placed a significant strain on the Partnerships resources across frontline and support functions and this has resulted in delays for the progress of projects relating to the achievement of strategic objectives. HSCM continues to review the large number of fixed term and seconded posts. This will continue as temporary contracts conclude. It is hoped that this will improve some of the instability within teams. This will also align with the significant transformation required to meet the financial recovery savings that are required across the partnership. This will continue to be reviewed by the Senior Management Team. Care Homes in Moray continue to face difficulties with recruitment and retention of staff. Efforts are being made to provide support but the situation remains challenging. The transition from EU membership has not presented any specific concerns for workforce and this will continue to be monitored. Page 23
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Capacity within the system will be required to effectively deliver the transformation required to meet the financial challenges of 2024/25. With no additional resource to effect the changes required this may require reallocation of roles for staff already in post. The impact of budgetary decisions by the Council in relation to reducing staffing levels has reduced levels of support provided in some key areas Health and Social Care Moray (HSCM), such as ICT, HR, Legal and design. The lack of suitable housing for Health and Social Care staff has contributed to people not being able to take up posts in Moray. GP sustainability remains a national issue. Mitigations / Current controls in place 5 5 25 Management structure in place with updates reported to MIJB 3 2 6 Council and NHS performance systems in operation with HSCM reporting being further developed and information relating to vacancies, turnover and staff absences is integral to this. Managers are highlighting any areas of concern and where appropriate this is identified in operational risk registers. Moray Council are carrying out a study of accommodation needs, including people working in the Health and Care sector. Staff Wellbeing is a key focus and there are many initiatives being made available to all staff, support, information and access to activities. Locality Managers have developed Multi-disciplinary teams in their areas and project officer support was been provided to develop the locality planning model across Moray. Lead Managers are involved in regional and national initiatives to ensure all learning is adopted to improve this position. Lead Managers and Professional Leads are linked to University Planning for intakes and programmes for future workforce development. Untreated Likelihood Untreated Impact Untreated Score Current Likelihood Current Impact Current Score Page 24
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Assurances: Operational oversight by Moray Workforce Forum has resumed and will report to MIJB in accordance with the agreed Governance framework. The HSCM Response Group continues to focus on leadership around emerging issues and resolving them, including staffing. The Heads of Service are co-ordinating and escalate to SMT where necessary. These meetings have been increased as service needs dictate. Gaps in Assurance: Further capacity will be required to develop and implement workforce plans to reflect updated delivery plans to reflect the financial savings required. Due to the various checks on vacancies, there continues to be a delay in recruitment processes often taking in excess of 8 weeks which causes additional pressure on staff and service delivery. There is often a lack of suitable applicants for various posts which is impacting on ability to appoint for some roles. Current Performance Discussions are underway with HR in both Council and NHS to develop access to appropriate HR information at a summarised level to facilitate the necessary workforce planning and subsequent monitoring of plans. The iMatter survey results for 2023 were received by managers for review and action plans are now in place for implementation and review. Comments Staffing issues are owned by the Operational Management Team (OMT) who will work collaboratively across the system to seek opportunities to make jobs more attractive where it has proved difficult to recruit in the past. For some professions there is a potential risk that staff move from one position to a new position within HSCM will just move the vacancy to elsewhere in the system, so Senior Management Team are aware of this risk and taking it into account in considerations for vacancies. This needs to be considered when fixed term contracts and secondments are planned, Incentives have been secured to try and attract additional NHS dentists and dental practices to our area. The Scottish Dental Access Initiative now includes Moray, with grants of £50,000 and above available to allow dental practices to be established or extended– provided there is a seven-year commitment to providing NHS treatment. A recruitment and retention bonus is also being offered to eligible new dentists in Moray GP sustainability Group and Primary Care Vison for the Future Groups now progressing across Grampian. Work is underway across the system to consider and implement the Health and Care (Staffing) (Scotland) Act 2019. Page 25
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consideration needs to be given to the whole of HSCM and not services in isolation. Many of our staff may have transferrable skills and experience. Further Controls Required Further Controls Owner iMatter survey results for 2023/24 will be released in June 2024 and managers will need to review and consult with staff to create actions plans for the forthcoming year. Team Leads/Managers 31/8/ 24 Communications & Engagement Strategy was approved in November 2019 and requires updating. Corporate Manager/ Corporate Programme Lead 31/1 2/24 Review Date Target Date Target Likelihood Target Impact Page 26
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Description of Risk 4: Inability to demonstrate effective governance and effective communication and engagement with stakeholders. Risk Rating: Medium Consequence: Poor patient outcomes, reduced trust, legal and regulatory risks, workforce dissatisfaction, missed opportunities Risk Movement: Rationale for Risk Appetite The Board is aware of the importance of good relationships with stakeholders. It recognises many of our ambitions require effective collaboration, co-production and partnership working with a range of stakeholders. The board also recognises that not all partners will be able to move at the same pace, all the time. We are aware of the need to protect and maintain good working relationships with all partners and stakeholders in order to deliver the outcomes set out in our strategic plan. Rational for Risk Rating Performance framework to be further developed from a planning perspective to show the links through operational service delivery to strategic objectives, whilst aligning with the financial savings plan. Feedback from community representatives and third sector organisations, across a variety of forums, highlighted issues. Clear focus and communications is required to ensure engagement and outcome needs are met. Mitigations / Current controls in place 4 3 12 Annual Governance statement is produced as part of the Annual Accounts 2023/34 and submitted to External Audit. The unaudited accounts and governance statement for 2023/24 will be presented to MIJB June 2024 and the audited accounts will return to committee in September 2024 for agreement. 2 3 6 Annual Performance Report for 2023/24 will be published in September 2024. Untreated Likelihood Untreated Impact Untreated Score Current Likelihood Current Impact Current Score Page 27
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Assurances: Oversight and scrutiny by Clinical and Care Governance Committee, Audit Performance and Risk Committee and MIJB. Summary reports of minutes of MIJB meetings are submitted to Council committee and NHS Board. Gaps in Assurance: Progress on implementation of the Communication and Engagement Strategy was impacted by the Covid 19. More use is being made of social media and Microsoft teams and other options and methods for engagement with staff are being used via NHSG such as videos on YouTube and one question surveys. Going forward there we will continue to use hybrid opportunities Where possible to ensure access is available to all, whilst accepting this can also be challenging to facilitate and manage at times due to infrastructure available to us within Moray. Current Performance Communication, Engagement & Participation Framework was approved by IJB November 2019. This will be reviewed by the Public Engagement and Communication Officer during 2024. The Unaudited Accounts for 2023/24 are being presented to MIJB and APR Committee in June 2024 they will then go for audit, with the audited accounts to be presented in September 2024. The Annual Performance Report for 2023/24 will be published in September 2024 after being presented to MIJB in September 2024. Comments A communication cell is now established as part of the Local Resilience Partnership response with representation from Emergency Services, Councils, HSCP and NHSG. This forum provides assurance that messages to all stakeholders are consistent. Performance reporting mechanisms in place and being further developed through performance support team, home first group and operational management team. Community engagement in place for key projects areas such as Forres, Keith and Lossiemouth with information being made available to stakeholders and the wider public via HSCM website. Participation of stakeholders in a variety of meetings such as Home First project, carer strategy, Strategic, Planning and Commissioning groups. Social media is actively used as a method of engaging with the public, with short videos focussing on particular services being trialled. SMT have considered the existing arrangements for engagement with stakeholders and work is being undertaken to align our framework with the Scottish Government “Planning with people” guidance updated 2024, and ensure that mechanisms are in place across services to evidence and evaluate their impact. The Public Engagement Communications Officer will work closely with the Corporate Programme Lead to ensure all programmes follow this criteria. Page 28
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Early conversations are planned to discuss a Grampian partnership communications group to ensure consistent messaging regards service redesign and changes, ensuring a consistent message to all citizens of Grampian, in particular for area wide changes. Further Controls Required Further Controls Owner Review Date Target Date Target Likelihood Target Impact Page 29
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Description of Risk 5: Inability to cope with unforeseen external emergencies or incidents as a result of inadequate emergency and resilience planning. Risk Rating: High Consequence: Potential to cause disruption of services, resource shortages, financial strain and increased vulnerability to service users and staff Risk Movement: Rationale for Risk Appetite The MIJB understand the requirement to meet the statutory obligations set out within the Civil Contingencies Act and the Category 1 status applied in March 2021, and work with partner organisations to meet these obligations. Rational for Risk Rating Senior Manager on Call (SMoC) information is updated, control room guidance updated and expanded, control centre protocols were implemented and remain in place and management teams have responded in an agile, responsive and collaborative way under very challenging conditions. Teams continue to do their best but there are still areas where staffing versus service delivery is challenging in areas during response where they still feeling overwhelmed and service delivery is challenging. With effect from March 2021 MIJB is defined as a Category 1 responder under the Civil Contingencies (Scotland) Act and there are additional requirements for preparedness that is being taken forward in partnership with NHSG and Moray Council emergency planning and civil contingency teams. Whilst there is a constant focus on improving our responses to the responsibilities of the Act, the potential impact remains high. Mitigations / Current controls in place 5 4 20 Winter Preparedness Plans are being updated (but not tested as in previous years) with a delivery element sitting alongside the strategic plans. This is being rolled out via monthly meetings across all operational teams. Annual planning continues to dovetail with NHSG plans, and addressing the priorities outlined by Scottish Government. 3 3 9 HSCM Civil Contingencies group meeting quarterly to address priority subjects. Updates are also provided at OMT on a regular basis. Untreated Likelihood Untreated Impact Untreated Score Current Likelihood Current Impact Current Score Page 30
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Assurances: Audit, Performance and Risk Committee and NHS Grampian Civil Contingencies Group oversight and scrutiny. HSCM Civil Contingencies group review specific risks and action plans to mitigate, developing plans and testing arrangements in partnership with NHSG and Council NHS Grampian Resilience Standards Action Plan approved (3 year). New standards are being drafted by Scottish Government and these are expected in 2025 and will replace the current standards. Business Continuity Plans are now updated for most services and this review continues across HSCM. A Resilience Newsletter is now embedded as part of the winter planning providing information to staff regards personal and service resilience. Work continues across various groups in Grampian to improve response to power outages. A review of the Festive season arrangements has now become business as usual for any extended holiday periods and all services are now required to share service cover information over holiday long weekends which enables a more collaborative and supportive approach. Daily Response Group continues, this allows the status of services across the whole system to provide information and contact details to the Senior Manager on Call (SMOC) over the weekend. If any potential issues are highlighted the relevant Persons at Risk Data is compiled and if appropriate, shared with relevant personnel. A short life working group will be established during the summer of 2024 to ensure all services delegated to HSCM to ensure oversight of all processes for the winter of 2024. NHSG have introduced system wide daily huddles to manage the flow and allocation of resources which require attendance from Dr Grays and HSCM. The format and regularity of these are under review. A System Networking Over Winter (SNOW) Event took place 28 September, the event was attended by health and social care partners across Grampian and also some Local Resilience Partner Agencies. A tabletop exercise event was carried out to exercise how the partners might work together. This has continued to develop throughout 2024. Page 31
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Gaps in Assurance: Moray Integrated Joint Board (MIJB) was designated as a Category 1 responder under the Civil Contingencies Act 2004 from March 18th 2021. That designation imposed a number of statutory duties in terms of the Act and the associated Scottish Regulations1. MIJB has no dedicated, specialist in post and is reliant on the Corporate Manager covering this increasingly demanding role in addition to other duties without the relevant background, knowledge, skills and experience. This presents a potential organisational risk in terms of compliance, and our ability to provide assurance on discharging our civil contingency arrangements. This has been highlighted to the Chief Officer and MIJB. The ‘Care for People’ strategic document was approved by HSCM SMT and CMT. It was presented to MIJB in September 2023. A further delivery response plan was presented to MIJB in November 2023. An information session including the ‘Care for People’ element was delivered on 2 May 2023, to senior managers who carry out the role of SMoC, this included input from Moray Council Emergency Planning Officer and NHS Grampian. An additional session was delivered 26 September 2023, with a specific focus on the draft Care for People framework. A further tabletop exercise was delivered in November 2023. A number of Table top style exercises were carried out and support continues to be provided to Service Managers where required. Development of a HSCM Persons at Risk Database (PARD) continues and all partners are now involved, looking to improve the quality of the data held. HSCM is also working with Aberdeen City, Aberdeenshire and NHS Grampian at a system wide approach. The system that currently records the data used for PARD is to be replaced, this function is integral to responding to incidents. Current Performance The Senior Management Team have undertaken ‘Strategic Leadership in a Crisis’ training since 2020 and continue to do so as the programme scheduling and capacity allows . A schedule of review and exercising of business impact assessments and plans has been scheduled for this year across services. All services have been requested to prioritise their Business Continuity planning with a particular lens on power outages. Annual report on progress against NHS resilience standards was presented to the APR committee on 30 March 2023. New standards are anticipated in 2025 and an updated report will be presented to the APR committee in due course. Report on the implications and risks of the designation as a Category 1 responder was presented to MIJB 25 November 2021. Comments The requirements of a Category 1 Responder continue to increase in demand placing increased pressures across already overstretched services and managers. The Manchester Arena Inquiry has resulted in a focus on Category 1 responders’ 1 Civil Contingencies Act 2004 (Contingency Planning) (Scotland) Regulations 2005 Page 32
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responsibilities, together with an increase of additional policies and procedures to be written and implemented with no additional resource. MIJB does not have a subject matter expert leading on these topics. Any replacement to the Care First database is crucial to the development of any improved PARD process and has been highlighted to the Head of Service and Project Officer. Further Controls Required Further Controls Owner Review Date Target Date Target Likelihood Target Impact Page 33
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Description of Risk 6: Risk to MIJB decisions resulting in litigation/judicial review. Expectations from external inspections are not met. Risk Rating: Medium Consequence: Public Reputation and confidence, legal challenges, judicial scrutiny, resource allocation Risk Movement: Rationale for Risk Appetite The Board, staff and providers across Moray are all committed to ensuring high standards of clinical care & governance through operational policies. Innovation and new ways of working may mean traditional regulations do not exist and require to be developed, no longer apply, or are contradictory. We will only take regulatory risks knowingly, following consultation with the relevant regulatory body and where we have clear risk mitigation in place. Rational for Risk Rating Resources are stretched across all services (internal and external) so there is a potential risk of expected standards not being achieved despite the best efforts of all concerned. Mitigations / Current controls in place 5 4 20 Clinical and Care Governance (CCG) Committee established and future reporting requirements identified Clinical Risk Management and Practice Governance group has oversight of their respective professional standards and links into Clinical and Care Governance Group, which escalates to CCG Committee as necessary. 3 3 9 High and Very High operational risks are reviewed by NHS Grampian Clinical Risk Management and the Operational Management Team monthly and a review of all risks will be undertaken as part of the risk management framework. A session on Risks and Risk Management was delivered to a wide ranging group of managers in HSCM in September 2023 by the NHSG Risk Advisor. Untreated Likelihood Untreated Impact Untreated Score Current Likelihood Current Impact Current Score Page 34
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Assurances: Audit, Performance and Risk and Clinical and Care Governance Sub-Committees oversight and scrutiny. The Clinical and Care Governance Framework was refreshed and presented to CCG Committee in November 2023. Gaps in Assurance: Process for highlighting recurring themes or strategic expectations from external inspections requires further development to ensure Committee has sight of significant issues. Current Performance: External inspection reports are reviewed and actions arising are allocated to officers for taking forward. The national tool, Day of Care Survey took place across Moray on 25th and 26th January, 2023 respectively. The findings of these events were compiled and outcomes are assessed by the relevant service leads and SMT. A summary of inspections is included in the Annual Performance report. Comments: No major concerns have been identified for HSCM services in any audits or inspections during 2023/24. Following an inspection carried out by Healthcare Improvement Scotland of Dr Gray’s Hospital, a number of learning points have been shared across nursing services in Moray Portfolio. An inspection of Children’s Services commenced in August 2023, the final report was presented to the board and a Service Improvement plan has been commenced and will be reported to APR on a quarterly cycle. A trial has been started to transfer service risks onto the Datix Risk Register platform to give oversight of all operational risk registers. This will be reviewed before rolling out across all services. IT access and training will be required to facilitate this if it is progressed. Complaints, compliments and enquiry procedures are in place and are being reviewed and monitored. Adverse events and duty of candour procedures in place and being actioned where appropriate and summary reports submitted to CCG committee. Reports from external inspections reported to appropriate operational groups and by exception to SMT for subsequent reporting to CCG or Audit Performance and Risk Committee as appropriate. Care Home Collaborative Support Group meets to oversee and manage risks in care homes. Children and Adult Protection services are being delivered and reported to their respective committee on a regular basis. Process for sign off and monitoring actions arising from Internal and External audits has been agreed Page 35
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Further Controls Required Further Controls Owner Focus on the strong links of Practice Governance Board and Clinical Care Governance Head of Service 31/7/ 24 Review Date Target Date Target Likelihood Target Impact Page 36
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Description of Risk 7: Inability to achieve progress in relation to national Health and Wellbeing Outcomes. Risk Rating: High Consequence: Health Inequalities, Loss of public trust, reputational damage Risk Movement: Rationale for Risk Appetite The Board is cautious but open about risks that could affect outcomes that are priorities for people in Moray. There is a slightly higher appetite to risks that may mean nationally set outcomes – that by design are not given a high priority in Moray - are not met. There is new focus on addressing positive risk taking to ensure the most appropriate and timely measure of care for the population of Moray, this is being supported through various work streams across the system. This will only be accepted where there is a clear rationale, and preferably also a way of demonstrating what the IJB is doing to meet the aspiration the outcome was created for. Rational for Risk Rating Potential impacts to the wide range of services in NHS Grampian and Moray Council commissioned by the MIJB arising from reductions in available staff resources as budgetary constraints impact. Unplanned admissions and delayed discharges place additional cost and capacity burdens on the service. The level of delayed discharges has remained challenging, reflecting the sustained pressure in the system and the lack of availability of care in the community. There are sustained focussed and collective efforts by all those working in the pathway. However this is a complex area and will require continued effort to realise reductions and maintain them. The financial recovery plan will require services to be redesigned to meet outcomes in alternative ways. It is hoped that this will always provide an improved service but it must be recognised that public expectations may be different to what can be delivered. Mitigations / Current controls in place 4 4 16 Performance Management reporting framework. 2022 to 2032 “Partners in Care” Strategic Plan was approved and the delivery plan is now complete and was presented to MIJB in September 2023. 3 3 9 Performance is regularly reported to MIJB. A Revised Scorecard is being developed to align to the new strategic priorities. Untreated Likelihood Untreated Impact Untreated Score Current Likelihood Current Impact Current Score Page 37
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Assurances: Audit, Performance and Risk Committee oversight. Operationally managed by service managers, summary reports to Practice Governance and Clinical and Care Governance Group (CCGG) and to OMT. Strategic direction is provided by the Senior Management Team. HSCM Response Group continues to meet and reviews the key performance information and actions that are required to deliver the priority services. Gaps in Assurance: Development work in performance to establish clear links to describe the changes proposed by actions identified in the Strategic Plan has recommenced but is at an early stage. This will be progressed as the revised outcomes are determined and associated KPI are identified. Progress will be reported to future Board meetings. Review of systems and processes will commence across HSCM to ensure they are fit for purpose and ensure that there are no indirect consequences of structure changes resulting in any gaps in assurance processes. Current Performance Services continue to recover from the pandemic and discover a new ‘battle rhythm’, taking into account all new learning and experience from the pandemic. Best practice elements from each body brought together to mitigate risks to MIJB’s objectives and outcomes. Chief Officer and SMT managing workload pressures as part of budget process. A daily Huddle and write up circulates the picture on performance across community and acute services for the Portfolio and service managers have a shared understanding of the pressures in the system and mitigations taking place. Work continues on refinement of G-OPES (Grampian Operating Pressures and Escalation System) led by NHSG but being developed locally to identify the triggers and resultant actions required in services to respond to pressure points. Service managers monitor performance regularly with their teams and escalate any issues to the Operational Management Team for further discussion to provide wider support, developing shared ownership and a greater understanding across the whole system. Key operational performance data is collated and circulated daily to all managers. A Daily dashboard is held on illuminate for managers to access to ensure any potential issues are identified quickly so action can be taken. This dashboard is being reviewed and will be further developed with the intention of further dashboards to provide a whole system overview. This has been discussed at OMT and agreed. Performance information is presented to the Performance sub group of Practice Governance Group to inform Social Care managers of the trends in service demands so that resources can be allocated appropriately. Page 38
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There are likely to be changes to ways of working and this may also have impact on the performance information required. The Unmet need report continues to show improvement in a number of Performance Indicators, with a number of them now showing continued improvement over the longer-term. Comments Locality profile information has been provided to Locality Steering Group/Locality Manager to inform potential priorities for consideration in Localities and work will be taken forward regarding development of performance monitoring and reporting of key performance indicators in relation to Localities once it has been determined what the intended outcomes are. Locality plans are now scheduled to report to MIJB on a quarterly basis. The Home First priorities are being taken forward and updates are reported to this committee or MIJB on a regular basis. This work is being undertaken across the Moray Portfolio to improve wider system flow. Progress in this area has been hampered due to the increased demand for urgent or critical services requiring staff resource to be prioritised to frontline service delivery. The Council has procured new modules for their performance reporting system Pentana and HSCM performance team have been developing its use for reporting. HSCM are working in partnership with the Rural Centre of Excellence on transformation projects, the foundation of planning is addressing how we can improve the delivery of health and wellbeing outcomes and also the strategic aims of ‘Partners in Care’. Further Controls Required Further Controls Owner Review Date Target Date Target Likelihood Target Impact Page 39
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Description of Risk: 8 - Inability to progress with delivery of Strategic Objectives and Transformation projects as a result of inability to resolve data sharing and data security requirements. Risk Rating: High Consequence: MIJB is unable to deliver its strategic priorities, statutory services and identified projects as outlined in the Strategic Plan published 2023. Risk Movement: Rationale for Risk Appetite The Board has a high appetite for risks associated with delivery of transformational redesign. The following should be considered when accepting these risks: We understand and can mitigate other risk types that may arise, e.g. safety or financial within appetite Service users are consulted and informed of changes in an open & transparent way We will monitor the outcome and change course if necessary Rational for Risk Rating There are many issues that will impact on the ability to progress to deliver Strategic Objectives. The Strategic Planning & Commissioning group has been refreshed and re-launched and key work is being progressed. There was an initial meeting held on 22 September 2021 to consider terms of reference and the proposed structure for oversight, prioritisation and assurance in relation to key developments, their fit with IJB strategy and enabling elements. One key aspect to facilitate transformation is the need for progress in relation to ICT infrastructure, data sharing and data security across the whole system. Work was undertaken by NHS Grampian and partners to address the needs for ICT kit and information during the response to Covid. Mitigations / Current controls in place 5 5 25 Integrated Infrastructure Group with representation from NHSG and Moray Council to consider and provide solutions to data sharing issues and ICT Infrastructure matters which is an areas that will be taken forward alongside the Moray Growth Deal projects. 3 4 12 The Moray Transformation Board has recently restarted and will link to all relevant groups. The Strategic Delivery Plan has been developed by the Heads of Service and Service Managers Untreated Likelihood Untreated Impact Untreated Score Current Likelihood Current Impact Current Score Page 40
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Assurances: Strict ICT and data sharing policies and protocols in place with NHS Grampian and Moray Council. A Moray Portfolio Infrastructure Programme Board has been established to support the operational delivery of the aims and objectives set e.g. Analogue to Digital changeover, Buildings and Assets oversight and Smarter Working will support this agenda. Gaps in Assurance: Protocol for access to systems by employees of partner bodies are in place. HSCM will taking on a collaborative role with Aberdeen City HSCP (ACHSCP) around Strategic Planning and Performance. The current lead for ACHSCP will employ and line manage the dedicated role for HSCM. Comments: Where national systems are involved it may not be possible to identify a solution however the issues will be raised at the appropriate level via the Grampian Data Sharing Group where all three partnerships are represented. Current Performance: Training to promote records management, data protection and related issues for staff working across and between partners using the learning and development resources of NHS Grampian and Moray Council. Further Controls Required Further Controls Owner Target Date Financial Savings plan will align with the Strategic Themes as set out in the Partners in Care 2022-2032, however new IT system requirements currently have no allocated funding identified Chief Financial Officer 31/10/24 Self-Directed Support standards move to outcomes based services – governance arrangements are being set up to facilitate the same oversight and communication that is in place for Home First programme Chief Social Work Officer 30/6/24 Collaborative approach to Strategic Planning and Performance, with ACHSCP employing and line managing the Performance Lead for HSCM. Chief Officer & ACHSCP Lead 31/7/24 Review Date Review Notes / Decisions Page 41
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Description of Risk 9: Requirements for support services are not prioritised by NHS Grampian and Moray Council. Risk Rating: High Consequence: Legal challenge from citizens of Moray and Staff, challenge from Scottish Government, Failure of some services e.g. IT Risk Movement: Rationale for Risk Appetite Low tolerance in relation to not meeting requirements. Rational for Risk Rating Changes to processes and necessary stakeholder buy-in still bedding in. Moray Council has now concluded its Smarter Working review and a number of HSCM staff have now relocated from Southfield to Moray Council Headquarters. NHSG have advised that staff should continue to work from home at present whilst policies and protocols are developed. ICT infrastructure service plans in NHS Grampian and Moray Council are not yet visible to HSCM and development of communication and engagement process is required. Both parent organisations are facing their own financial and staffing issues and there is a real risk that the available support provided to HSCM is less than is required. Many of the support services provided by parent organisations are specialist subjects such as Human Resources, IT, Legal and result in high consequences. Mitigations / Current controls in place 5 4 20 Chief Officer has regular meetings with partners. 3 3 9 Computer Use Policies and HR policies in place for NHS and Moray Council and staff. PSN accreditation secured by Moray Council Infrastructure Programme Board was established with Chief Officer as Senior Responsible Officer/Chief Officer is also a member of CMT. Process for submission of projects to the infrastructure board approved and implemented to ensure appropriate oversight of all projects Untreated Likelihood Untreated Impact Untreated Score Current Likelihood Current Impact Current Score Page 42
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Assurances: Infrastructure Programme Board functions to provide robust governance and assurance that proposed projects have a robust business case and meets requirements of the respective partner organisations. This board reports to Strategic Planning and Commissioning Group. Both of these groups have been recently refreshed and remobilised. Workforce Forum meeting regularly with representation of HR and unions from both partner organisations Gaps in Assurance: Further work is required on developing the process for approval for projects so that they are progressed timeously. Need to review all existing processes in relation to infrastructure changes/projects/investments and streamline to avoid duplication of effort. The Infrastructure Board continues to develop and priority issues are being addressed in relation to infrastructure and premises risk. Due to staff changes this work will now be incorporated into other roles. This will likely mean that this work will compete with other priorities of already busy roles. Legal services have reduced capacity to provide support due to budget cuts and vacancies so any requests are taking longer. Internal Audit Services have indicated that their capacity to complete all work required by MIJB may be an issue. This is being discussed with Moray Council. Recruitment for vacancies takes considerable time due to various factors and is presenting a strain on services to maintain normal service whilst covering vacancies. There have been several posts that have had to go out to advert more than once extending the time other staff are covering gaps. Current Performance No update. Comments Existing projects will be reviewed as part of the development of the transformation plans for the Strategic Plan to ensure resources are being dedicated appropriately and aligned to the emerging Strategic priorities. Our requirements for support will be communicated via appropriate channels underway in HSCM. The Board has only recently restarted, so in the interim, project requests are being processed via Senior Management Team. Membership of the Board was reviewed and revised to ensure representation of all existing infrastructure processes and funding opportunities. Process for ensuring infrastructure change/investment requests developed Page 43
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The delegation of Childrens and Families and Justice Services should continue to be supported by the corporate services within Moray Council. Further Controls Required Further Controls Owner Review Date Target Date Target Likelihood Target Impact Page 44
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Likelihood – What is the likelihood of the risk occurring? Assess using the criteria below. Rare (1) Unlikely (2) Possible (3) Likely (4) Almost Certain (5) Don’t believe this event would happen Will only happen in exceptional circumstances Not expected to happen but definite potential exists Unlikely to occur May occur occasionally Has happened before on occasions Reasonable chance of occurring Strong possibility that this could occur Likely to occur This is expected to occur frequently/ in most circumstances more likely to occur than not Impact – What could happen if the risk occurred? Assess for each category and use the highest score identified. The impact scale is from an organisational level perspective. It reflects the key areas that if impacted could prevent the organisation achieving its priorities and objectives. The scale is a guide and cannot cover every type of impact therefore judgement is required. Category Negligible (1) Minor (2) Moderate (3) Major (4) Extreme (5) Patient or Service user Experience Reduced quality patient experience/clinical outcome not directly related to delivery of clinical care Unsatisfactory patient experience/clinical outcome directly related to care provision – readily resolvable Unsatisfactory patient experience/ clinical outcome, short term effects – expect recovery less than 1wk Unsatisfactory patient experience /clinical outcome, long term effects - expect recovery over more than 1week Unsatisfactory patient experience/clinical outcome, continued ongoing long term effects Objectives/ Project Barely noticeable reduction in scope/quality/ schedule Minor reduction in scope/quality/schedule Reduction in scope/quality/project objectives or schedule Significant project overrun Inability to meet project/corporate objectives, reputation of organisation seriously damaged Injury /illness (physical and psychological) to Adverse event leading to minor Minor injury or illness, first aid treatment required Agency reportable, e.g. Police (violent and aggressive acts) Major injuries/long term incapacity /disability (e.g. loss of limb), Incident leading to death(s) or major permanent incapacity Page 45
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patient/service user/visitor/staff/carer injury not requiring first aid Significant injury requiring medical treatment and/or counselling requiring, medical treatment and/or counselling Complaints/Claims Locally resolved verbal complaint Justified written complaint peripheral to clinical care Justified complaint involving lack of appropriate care Claim above excess level. Multiple justified complaints Multiple claims or single major claim Complex Justified complaint Service/ Business Interruption Interruption in a service which does not impact on the delivery of patient care or the ability to continue to provide service Short term disruption to service with minor impact on patient care/service provision Some disruption in service with unacceptable impact on patient care Temporary loss of ability to provide Service. Sustained loss of service which has serious impact on delivery of patient care resulting in major contingency plans being invoked Permanent loss of core service/ facility Disruption to facility leading to significant “knock on” effect -- to function Staffing and Competence Short term low staffing level temporarily reduces service quality (less than 1 day) Short term low staffing level (>1 day), where there is no disruption to patient care Ongoing low staffing level reduces service quality Minor error due to lack of/ ineffective training/ implementation of training Late delivery of key objective/service /care due to lack of staff Moderate error due to lack of/ ineffective training / implementation of training Ongoing problems with staffing levels Uncertain delivery of key objective/service/care due to lack of staff Major error due to lack of/ ineffective training / implementation of training Non-delivery of key objective/ service/care due to lack of staff. Loss of key staff Critical error due to lack of/ ineffective training/ implementation of training Financial (including Damage/Loss/Theft/ Fraud Negligible organisational/ personal financial loss up to £1k Minor organisational/ personal financial loss of £1-10K Significant organisational/personal financial loss of £10- 100k Major organisational/personal financial loss of £100k- 1m) Severe organisational financial loss of more than £1m Page 46
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Inspection/ Audit Small number of recommendations which focus on minor quality improvement issues Recommendations made which can be addressed by low level of management action Challenging recommendations that can be addressed with appropriate action plan Improvement Notice Enforcement/prohibition action Low Rating Critical report Prosecution Zero rating Severely critical report Adverse Publicity/ Reputation Rumours, no media coverage Little effect on staff morale Local media coverage – short term. Some public embarrassment Minor effect on staff morale/public attitudes Local media – long term adverse publicity Significant effect on staff morale/public perception of the organisation National media adverse publicity less than 3 days Public confidence in the organisation undermined Use of services affected National/International media/ adverse publicity, more than 3 days MSP/MP/SEHD concern (Questions in Parliament) Court Enforcement/Public Enquiry/FAI Likelihood Consequences/Impact Negligible Minor Moderate Major Extreme Almost Certain Medium High High V High V High Likely Medium Medium High High V High Possible Low Medium Medium High High Unlikely Low Medium Medium Medium High Rare Low Low Low Medium Medium Review Timescales – When a risk rating has been assigned the criteria below should be used to assess the review timescales. Very High or High Requires monthly monitoring and updates. Medium Requires quarterly monitoring and updates. Low Requires 6 monthly monitoring and updates. Page 47
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REPORT TO: MORAY INTEGRATION JOINT BOARD CLINICAL AND CARE GOVERNANCE COMMITTEE ON 29 AUGUST 2024 SUBJECT: COMPLAINTS REPORT FOR QUARTER 1, 2024/2025 BY: ALLIED HEALTH PROFESSIONAL – SECTOR LEAD, MORAY 1. REASON FOR REPORT 1.1 To inform the Committee of complaints reported and closed during Quarter 1 (1 April 2024 – 30 June 2024). 2. RECOMMENDATION 2.1 It is recommended that the Committee considers and notes the totals, lessons learned, response times and action taken for complaints completed within the last quarter. 3. BACKGROUND 3.1 Within Health and Social Care Moray (HSCM), complaints received by NHS Grampian (NHSG) and Moray Council are recorded on 2 separate systems, in accordance with the appropriate policy and procedure of these organisations. 3.2 At the meeting on 27 February 2020 (para 7 of the minute refers), it was agreed that a combined report from NHSG and Council complaints systems be submitted to future meetings of the Committee. At the Committee meeting on 27 August 2020 (para 14 of the minute refers) it was requested that the procedures be explained to demonstrate the similarities and differences, if any. 3.3 NHS and Local Authority (LA) Complaint Handling Procedure/Policy requires all staff to deal with feedback and complaints in a person/client-centred way. The procedure has been developed working closely with the Scottish Public Services Ombudsman (SPSO). There is a standard approach to handling complaints across the NHS and Local Authority, which complies with the SPSO's guidance on a model complaints handling procedure and meets all of the requirements of the Patient Rights (Scotland) Act 2011, and accords with the Healthcare Principles introduced by the Act. 3.4 The complaints process followed by both NHSG and Moray Council have the same target response timescales. Early resolution, or front line, complaints will be responded to within 5 working days and complaints handled at the Item 6. Page 49
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investigation stage have a response time of 20 working days. Where it is not possible to complete the investigation within 20 working days an interim response should be provided with an indication of when the final response should be provided. 3.5 The decision as to whether the complaint is upheld or not will be made by the manager or Head of Service. If the person raising the complaint is not satisfied with the outcome, then they may contact the Scottish Public Services Ombudsman (SPSO) for an independent review and assessment, however prior to this, every effort is made to engage with the complainant to resolve the matter to their satisfaction. 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 The CCG Committee is presented with quarterly complaints performance information using the mandatory Key Performance Indicators (KPIs), published by SPSO in March 2022. These are: Indicator One The total number of complaints received The sum of the number of complaints received at Stage 1 (this includes escalated complaints as they were first received at Stage 1), and the number of complaints received directly at Stage 2. Indicator Two The number and percentage of complaints at each stage which were closed in full within the set timescales of five and 20 working days The number of complaints closed in full at stage 1, stage 2 and after escalation within MCHP timescales as % of all stage 1, stage 2 and escalated complaints responded to in full Indicator Three The average time in working days for a full response to complaints at each stage The average time in working days to respond at stage 1, stage 2 and after escalation Indicator Four The outcome of complaints at each stage The number of complaints upheld, partially upheld, not upheld and resolved at stage 1, stage 2 and after escalation as % of all complaints closed at stage 1, stage 2 and after escalation 4.2 The qualitative indicator on learning from complaints has been removed. However, Part 4 of the SPSO Model Complaints Handling Procedure on Governance stresses the importance of learning from complaints, and the requirements to record and publicise learning. Therefore learning from complaints will continue to be included in quarterly complaints performance reports and annual complaints reports. 4.3 HSCM Complaints performance data for Quarter 1 is attached at Appendix 1. Page 50
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4.4 Information about complaints referred to the Ombudsman are also included along with any complaints relating to the actions and processes of Moray Integration Joint Board (MIJB). 4.5 Figures reported do not include complaints raised regarding the vaccination appointments or processes as these are being dealt with through a dedicated team covering the Grampian area. Any complaints or comments regarding the Moray Vaccination Centre in Elgin are included in reported figures. 4.6 Following ministerial approval, Children and Families and Justice Social Work Services were formally delegated by the Local Authority to MIJB on 16 March 2023. All complaints and enquiries received regarding these services and recorded on Lagan are captured in Appendix 1 and the figures below. Complaints 4.7 Overall, a total of 28 complaints were received during Quarter 1. Total Rec’d Q1 23/24 Total Closed Q1 23/24 Total Rec’d Q2 23/24 Total Closed Q2 23/24 Total Rec’d Q3 23/24 Total Closed Q3 23/24 Total Rec’d Q4 23/24 Total Closed Q4 23/24 Total Rec’d Q1 24/25 Total Closed Q1 24/25 LA 17 21 16 9 26 20 22 16 13 12 NHS 14 13 21 25 16 17 15 22 15 10 31 34 37 34 42 37 37 38 28 22 4.8 The table below sets out HSCM complaints received and closed by Quarter. Children and Families and Justice Social Work services figures are included from Q1 2023/24 onwards: MP/MSP Enquiries 4.9 There were 6 MP/MSP enquiries received regarding council services, under HSCM (including Children and Families and Justice), and recorded on the Council system, Lagan. These were allocated as follows: 21 18 15 23 32 18 17 26 32 24 25 31 37 42 37 2825 15 14 19 24 22 22 21 21 35 29 34 34 37 38 22 0 5 10 15 20 25 30 35 40 45 Q2 20/21 Q3 20/21 Q4 20/21 Q1 21/22 Q2 21/22 Q3 21/22 Q4 21/22 Q1 22/23 Q2 22/23 Q3 22/23 Q4 22/23 Q1 23/24 Q2 23/24 Q3 23/24 Q4 23/24 Q1 24/25 Received Closed Page 51
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Service Number of Enquiries Access Team 2 Occupational Therapy 2 Children and Families and Justice 1 Community Care Finance 1 4.10 One of these enquiries was closed as it was out of jurisdiction. 1 case has been resolved. At the time of reporting, the remaining 4 are being investigated. 4.11 As of 1 April 2024, all general MP/MSP enquiries received by NHS Grampian Chief Executive Office, regarding health services, and specific to Moray, are forwarded direct to Moray colleagues to handle, in their entirety. This new process aims to improve response times, reduce duplication and provide greater oversight to local management of the concerns and interests of constituents. 4.12 There were 5 MP/MSP enquiries received regarding health services, under HSCM. These were all in relation to Ward 4, Dr Gray’s Hospital. 4.13 Any patient specific MP/MSP enquiries continue to be logged on Datix, either as a complaint or a concern, and captured in figures presented today. 4.14 Five concerns were received during Quarter 1 and recorded on Datix, 2 direct from patients and 3 from MP/MSPs. These were all in relation to Adult Mental Health Services. 5. SUMMARY OF IMPLICATIONS (a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and Moray Integration Joint Board Strategic Plan “Partners in Care 2022 – 2032” As set out within Annex C of the Health and Social Care Integration Public Bodies (Joint Working) (Scotland) Act 2014 Clinical and Care Governance Framework. Effective handling of complaints is used to ensure the efficient and sustainable delivery of services to meet priorities. (b) Policy and Legal Clinical and Care Governance requirements are set out within the Moray Health and Social Care Integration Scheme. Appropriate arrangements must be in place to ensure and evidence good governance in meeting duties under the Public Bodies (Joint Working) (Scotland) Act 2014. (c) Financial implications None directly associated with this report. (d) Risk Implications and Mitigation There are systems and processes in place across service areas to support clinical governance, providing assurance to the HSCM Senior Leadership Team and to the Clinical and Care Governance Committee. There are platforms within Health and Social Care to discuss and share good practice, learning and challenges. Page 52
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(MIJB, Moray Council and NHS Grampian could find themselves exposed to significant risks if good governance is not in place. The purpose of this report is to oversee the processes to ensure that appropriate action is taken in response to adverse events, scrutiny reports/action plans, safety action notices, feedback, complaints and litigation, and those examples of good practice and lessons learned are disseminated widely. (e) Staffing Implications This activity is core to all practitioners in the front line both in terms of their professional competence and assurances in care delivery. (f) Property None directly arising from this report. (g) Equalities/Socio Economic Impact Not required as there are no changes to policy. (h) Climate Change and Biodiversity Impacts None directly arising from this report. (i) Directions None directly arising from this report. (j) Consultations Consultations have been undertaken with the following staff who are in agreement with the content of this report where it relates to their area of responsibility: • Corporate Manager • Caroline O’Connor, Committee Services Officer, Moray Council • Clinical and Care Governance Group 6. CONCLUSION 6.1 This report provides a summary of HSCM complaints received and closed during Quarter 1 (1 April – 30 June 2024). The governance and monitoring of complaints forms part of core business for teams and services and the provision of a good quality, effective and safe service is a key priority for all. Author of Report: Isla Whyte, Corporate Business Support Manager Background Papers: with author Ref: Page 53
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APPENDIX 1 Complaints Data (by closed complaints) Quarter 1 (01/04/24 – 30/06/2024) Learning from complaints Teams and services actively review all forms of feedback to see where improvements can be made and share any learning. The tables 1, 2, 3, 4, 5 and 6 below set out the outcomes of closed complaints, what service received the complaint and any actions taken /learning. Table 1 Complaints Information Extracted from Datix – 10 complaints were closed during Quarter 1, 2024/25. Actions Taken/Outcome of complaints closed during Quarter 1, 2024/25: Fully upheld: Complaint is accepted Partially upheld: Complaint is partly accepted Not upheld: Complaint is not accepted Total Access - Improvements made to service access 1 1 0 2 System - Changes to systems 1 0 0 1 Action plan(s) created and instigated 0 1 0 1 Communication - Improvements in communication staff-staff or staff- patient 0 3 0 3 Share lessons with staff/patient/public 0 1 0 1 Education/training of staff 0 1 0 1 No action required 0 0 5 5 Total 2 7 5 14* *this figure does not represent number of complaints closed as complaints may have more than one action Item 6. Page 55
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Table 2 Complaints Information Extracted from Lagan: 12 complaints were closed during Quarter 1, 2024/25 Directorate Department Service Upheld Partially Upheld Not Upheld Resolution Grand Total Health and Social Care Moray Children and Families and Criminal Justice Access Team 0 0 1 0 1 Children and Families Area Teams 1 2 2 1 6 Fostering and Adoption and Supported Lodgings 0 1 1 0 2 Health and Social Care Moray Access Team 1 0 0 0 1 Care at Home 0 1 1 0 2 Table 3 Complaints Information Extracted from Datix: 10 complaints were closed during Quarter 1, 2024/25 Fully upheld: Complaint is accepted Partially upheld: Complaint is partly accepted Not upheld: Complaint is not accepted Tota l Allied Health Professionals 0 1 0 1 General Practice 1 0 1 2 GMED 0 2 0 2 Mental Health - Adult Mental Health 0 1 3 4 Vaccination Transformation Programme 0 0 1 1 Total 1 4 5 10 Page 56
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Table 4 Complaints Information Extracted from Datix – Action Taken by Service (complaints closed during Quarter 1, 2024/25) Allied Health Professionals General Practice GMED Mental Health - Adult Mental Health Vaccination Transformation Programme Total Access - Improvements made to service access 1 1 0 0 0 2 Action plan(s) created and instigated 1 0 0 0 0 1 Communication - Improvements in communication staff-staff or staff- patient 1 0 1 1 0 3 Education/training of staff 0 0 1 0 0 1 System - Changes to systems 0 1 0 0 0 1 No action required 0 1 0 3 1 5 Share lessons with staff/patient/public 0 0 0 1 0 1 Total 3 3 2 5 1 14* *this figure does not represent number of complaints closed as complaints may have more than one action. Page 57
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Active review of complaints through reporting and investigation is a useful tool to identify learning and improve services. Below are some of the actions and learning from complaints closed in Quarter 1 2024/24. Information provided is kept brief to ensure no patient identifiable information is shared. Table 5 Actions and Lessons Learned (Datix) Education/ training Expand on differentials and consider other possibilities Communication Improvement in communication – ensure patients have clear understanding of procedure they will have Inconsistency of approach from staff – addressed Improvement in communication with patient – addressed So far this year, a thematic analysis shows, Communication Improvements (staff to staff or staff to patient) continues to be the most common theme arising from complaints. There is no trend in the data showing repeat complaints – from same people or the same complaint. Table 6 Learning Outcomes (Lagan) Process / Procedure Continue to look at alternative options for family Procedures will be put in place to facilitate timely decision making for similar cases in future Communication Reminder to staff about importance of timely communication with service users Manager to work with staff to ensure all information provided is clear and transparent Communication and following procedure continue to be the main themes arising from complaints, again there is no evidence of repeat complaints. Page 58
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Indicator 1 – The total number of complaints received The sum of the number of complaints received at Stage 1 (this includes escalated complaints as they were first received at Stage 1), and the number of complaints received directly at Stage 2. Table 7 – Total number of complaints received in Quarter 1, 2024/25 System recorded Early Resolution / Frontline Investigation Not Marked Total NHS – Datix 9 marked early resolution 6 marked investigative 0 15 Moray Council - Lagan 1 marked frontline 4 marked investigative 8 not yet marked 13 Total 10 10 8 28 Table 8 – Allocation of complaints received in Quarter 1, 2024/25 NHS Service - Datix Allied Health Professionals 3 Community Hospital Nursing 1 GMED 4 Community Nursing 1 Mental Health - Adult Mental Health 3 Mental Health – Old Age Psychiatry 1 General Practice 2 Total 15 Table 9 – Allocation of complaints received in Quarter 1, 2024/25 MC Service - Lagan Children and Families and Criminal Justice Children and Families Area Teams 4 Access Team 3 Health and Social Care Moray Learning Disability 1 Access Team 1 Care at Home 4 Total 13 Page 59
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Indicator 2 - The number and percentage of complaints at each stage which were closed in full within the set timescales of five and 20 working days The number of complaints closed in full at stage 1, stage 2 and after escalation within MCHP timescales as % of all stage 1, stage 2 and escalated complaints responded to in full. There were 10 Complaints closed on the NHS system Datix during Quarter 1, 2024/25 – breakdown as follows: Early Resolution/Stage 1 – 3 Investigation/Stage 2 – 4 Escalated Stage 2 – 3 There were 12 Complaints closed on the MC system Lagan during Quarter 1, 2024/25 – breakdown as follows: Frontline/Stage 1 – 4 Investigation/Stage 2 – 5 Escalated Investigative/Stage 2 – 3 Table 10 – number and percentage of complaints at each stage closed within timescales (based on complaints closed during Quarter 1, 2024/25) Frontline/Early Resolution within timescale Investigation within timescale Escalated Investigation NHS - Datix 2 out of 3 (66%) 0 out of 4 (0%) 1 out of 3 (33%) Moray Council - Lagan 1 out of 4 (25%) 1 out of 5 (20%) 0 out of 3 (0%) Whilst HSCM aim to respond to complaints within timescales this is not always achievable. Complaints received into Datix are often multi-faceted and include more than one service across NHS Grampian and other sectors, which can impact on response times due to the level of investigation and coordination required. Page 60
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Indicator 3 - The average time in working days for a full response to complaints at each stage Table 11 – average time in working days to respond at stage 1, stage 2 and after escalation (based on complaints closed during Quarter 1, 2024/25) Frontline Investigative (including escalated investigation) NHS - Datix 12 days 63 days Moray Council - Lagan 58 days 35 days Page 61
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Indicator 4 - The outcome of complaints at each stage The number of complaints upheld, partially upheld, not upheld and resolved at stage 1, stage 2 and after escalation as % of all complaints closed at stage 1, stage 2 and after escalation. Graph 2 below shows the number of complaints fully upheld, partially upheld and not upheld as recorded in Datix during Quarter 1, 2024/25. 10 complaints were closed during Quarter 1: 10% were upheld, 40% were partially upheld and 50% were not upheld. 0 0.5 1 1.5 2 2.5 Early Resolution Investigation Escalated Investigation Complaints Outcome (Datix) Fully Upheld Partially Upheld Not Upheld Page 62
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Complaints Information Extracted from Lagan: 12 complaints were closed during Quarter 1, 2024/25: 17% were fully upheld, 33% partially upheld, 42% were not upheld and 8% were resolved. Graph 3 below shows the number of complaints upheld, partially upheld and not upheld as recorded in Lagan from the 12 closed complaints during Quarter 1, 2024/25. 0 0.5 1 1.5 2 2.5 Frontline Investigation Escalated Investigative Complaints Outcome (lagan) Fully Upheld: Complaint is accepted Partially Upheld: Complaint is partly accepted Not Upheld: Complaint is not accepted Resolution Page 63
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REPORT TO: MORAY INTEGRATION JOINT BOARD CLINICAL AND CARE GOVERNANCE COMMITTEE ON 29 AUGUST 2024 SUBJECT: DRAFT HEALTH AND SOCIAL CARE MORAY ANNUAL COMPLAINTS REPORT 2023/24 BY: CHIEF NURSE, MORAY 1. REASON FOR REPORT 1.1 To provide the Committee with the Draft Health and Social Care Moray (HSCM) Annual Complaints Report for 2023/24. 2. RECOMMENDATION 2.1 It is recommended that the Committee: i) consider and note the contents of the annual report; and ii) request the annual report is submitted to MIJB in September for approval prior to publication. 3. BACKGROUND 3.1 A report to this Committee on 25 August 2022 (para 6 of minute refers) provided information on the agreed Complaints Key Performance Indicators (KPIs) for the Model Complaints Handling Procedures for Local Authorities (LA), which were published in March 2022 on the Scottish Public Services Ombudsman (SPSO) website (this includes Health and Social Work Partnerships, in relation to social work functions delegated from LAs). The Committee also received information detailing the 9 NHS performance indicators. 3.2 In March 2022 the SPSO confirmed the annual report publication deadline is the end of October each year, with the KPIs applicable for data collected from 1 April 2022. 3.3 The NHS Grampian Annual Complaints report provides information on all complaints, concerns, comments and feedback recorded on Datix, this includes any recorded under HSCM. The Annual Complaints Report produced by the Council includes all council related complaints recorded on lagan, this includes any Council related services under HSCM. Item 7. Page 65
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3.4 The SPSO have advised to ensure there is no double reporting of figures, but it should be made clear where partnerships’ complaints performance information is published. 3.5 Given the importance HSCM places on receiving comments and feedback to use to continuously improve services, the experience and satisfaction of service users, along with their families and carers, the Committee agreed, at their meeting on 25 August 2022 (para 6 of minute refers) to continue to publish annual complaints performance information to demonstrate HSCM’s commitment to valuing complaints. 3.6 The annual report pulls together and builds on the quarterly complaints’ reports produced for Clinical and Care Governance Committee. It includes details about the number of complaints received and information about the stage at which complaints were resolved, the time taken to do so, and the actions that have been or will be taken to improve services as a result of complaints. 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 The information from complaints from 1 April 2023 to 31 March 2024 has been collated and presented following the LA KPIs and NHS Performance Indicators. The draft HSCM Annual Complaints Report for 2023/24 is attached at Appendix 1. 4.2 This will be the fourth published HSCM Annual Complaints Report – all previous versions can be found on the HSCM Website - https://hscmoray.co.uk/complaints.html 4.3 The annual report includes links to Moray Council’s and NHSG’s Annual Complaints Performance Reports and provides supplementary information specific to Health and Social Care Moray. 4.4 There have been no complaints received relating to the dissatisfaction with the MIJB’s policies, decisions or administrative or decision-making processes followed by the MIJB. The MIJB’s definition of a complaint is: “An expression of dissatisfaction by one or more members of the public about the MIJB’s action or lack of action, or about the standard of service the MIJB has provided in fulfilling its statutory responsibilities.” 4.5 Figures reported do not include any complaints that might have been raised regarding the vaccination appointments or processes as these are being dealt with through a dedicated team covering the Grampian area. Any complaints or comments specific to the Moray Vaccination Centre in Elgin are included in reported figures. 4.6 Following ministerial approval, Children and Families and Justice Social Work Services were formally delegated by the Local Authority to Moray Integration Joint Board (MIJB) on 16 March 2023. All complaints received regarding these services, and recorded on Lagan, are captured in the HSCM Annual Complaints Report 2023/24, for the first time. This explains the increase in complaints received in Graph 2 of Appendix 1. Page 66
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4.7 A total of 147 complaints were received by Health and Social Care Moray during 2023/24. 4.8 Target response timescales are 5 working days for early response/frontline and 20 working days for investigation. Whilst every effort is made to meet these timescales, sometimes it is just not possible. There is added intricacy when complaints are muti-faceted and include more than one service and sometimes partner agencies. Resource constraints and complexity of complaints can impact response times. 5. SUMMARY OF IMPLICATIONS (a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and Moray Integration Joint Board Strategic Plan “Partners in Care 2022 – 2032” As set out within Annex C of the Health and Social Care Integration Public Bodies (Joint Working) (Scotland) Act 2014 Clinical and Care Governance Framework. Effective handling of complaints is used to ensure the efficient and sustainable delivery of services to meet priorities. (b) Policy and Legal Clinical and Care Governance requirements are set out within the Moray Health and Social Care Integration Scheme. Appropriate arrangements must be in place to ensure and evidence good governance in meeting duties under the Public Bodies (Joint Working) (Scotland) Act 2014. (c) Financial implications None directly associated with this report. (d) Risk Implications and Mitigation There are systems and processes in place across service areas to support clinical governance, providing assurance to the HSCM Senior Leadership Team and to the Clinical and Care Governance Committee. There are platforms within Health and Social Care to discuss and share good practice, learning and challenges. MIJB, Moray Council and NHS Grampian could find themselves exposed to significant risks if good governance is not in place. The purpose of this report is to oversee the processes to ensure that appropriate action is taken in response to adverse events, scrutiny reports/action plans, safety action notices, feedback, complaints and litigation, and those examples of good practice and lessons learned are disseminated widely. (e) Staffing Implications This activity is core to all practitioners in the front line both in terms of their professional competence and assurances in care delivery. (f) Property None directly arising from this report. (g) Equalities/Socio Economic Impact Page 67
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Not required as there are no changes to policy. (h) Climate Change and Biodiversity Impacts None directly arising from this report. (i) Directions None directly arising from this report. (j) Consultations Consultations have been undertaken with the following staff who are in agreement with the content of this report where it relates to their area of responsibility: • Corporate Manager, Health and Social Care Moray • Caroline O’Connor, Committee Services Officer, Moray Council • Clinical and Care Governance Group 6. CONCLUSION 6.1 The governance and monitoring of complaints forms part of core business for teams and services and provision of a good quality, effective and safe service is a key priority for all staff. Monitoring and learning from all feedback is an ongoing process. Author of Report: Isla Whyte, Corporate Business Support Manager Background Papers: with author Ref: Page 68
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APPENDIX 1 Annual Report on Complaints 2023 – 2024 01/04/23 – 31/03/24 Item 7. Page 69
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2 Table of Contents INTRODUCTION _______________________________________________________________________________________________________________________________ 3 BACKGROUND ________________________________________________________________________________________________________________________________ 4 COMPLAINTS HANDLING ________________________________________________________________________________________________________________________ 5 KEY PERFORMANCE INDICATORS _________________________________________________________________________________________________________________ 6 WHAT IS INCLUDED ____________________________________________________________________________________________________________________________ 8 SUMMARY ___________________________________________________________________________________________________________________________________ 8 LEARNING FROM COMPLAINTS ___________________________________________________________________________________________________________________ 9 COMPLAINT PROCESS AND EXPERIENCE ___________________________________________________________________________________________________________ 14 INDICATOR 1 _________________________________________________________________________________________________________________________________ 16 INDICATOR 2 _________________________________________________________________________________________________________________________________ 19 INDICATOR 3 _________________________________________________________________________________________________________________________________ 19 INDICATOR 4 _________________________________________________________________________________________________________________________________ 20 Page 70
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3 Introduction This Complaints Handling Annual Report summaries Health and Social Care Moray’s (HSCM) performance in terms of handling complaints during 1 April 2023 and 31 March 2024. Within HSCM, complaints received by NHS Grampian (NHSG) and Moray Council (the Council) are recorded on 2 separate systems, in accordance with the appropriate policy and procedure of these organisations. The NHSG Annual Complaints report provides information on all complaints, concerns, comments and feedback recorded on Datix (electronic risk management information system), this includes any recorded under HSCM. The Annual Complaints Report produced by the Council includes all council related complaints recorded on Lagan (communication management system), this includes any Council related services under HSCM. Datix is used by NHSG and is accessed by NHS employed staff, Lagan is used by the Council and is used by Council employed staff. Links to these annual reports can be found here: (TO BE ADDED WHEN AVAILABLE) Given the importance HSCM places on receiving comments and feedback to use to continuously improve services, the Moray Integration Joint Board (MIJB) have committed to continue to publish annual complaints performance information to demonstrate HSCM’s commitment to valuing complaints. Page 71
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4 Background The original Model Complaints Handling Procedures (MCHPs) were first developed by the SPSO in collaboration with complaints handlers and key stakeholders from each sector and were published in 2012. The MCHPs were produced taking account of the Crerar and Sinclair reports that sought to improve the way complaints are handled in the public sector, and within the framework of the SPSO’s Guidance on a MCHP. The MCHPs also reflect the SPSO Statement of Complaint Handling Principles approved by the Scottish Parliament in January 2011. Following recommendations from the Scottish Government’s social work complaints working group in 2013, a separate MCHP for social work was developed. The ‘Public Services Reform (Social Work Complaints Procedure) (Scotland) Order 2016’ (the Order) brought social work complaint handling under the remit of the SPSO Act and subsequently the separate documents for Local Authorities (LA) and Social Work sectors were combined into a single document, the LA MCHP. The SPSO revised and reissued all the MCHPs (except the NHS) in 2020 under section 16B(5) of the Scottish Public Services Ombudsman Act 2002 on 31 January 2020 to give public sector organisations time to implement any changes by April 2021. The revised Local Authority MCHP, published 2020, applies to social work complaints, whether they are handled by local authority or health and social care partnership (HSCP) staff. The NHS was the last public sector to adopt the MCHP on 1 April 2017 and it has not yet been revised since it was first published. Page 72
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5 Complaints Handling There is a standard approach to handling complaints across the NHS and Local Authority, which complies with the SPSO's guidance on a model complaints handling procedure and meets all of the requirements of the Patient Rights (Scotland) Act 2011, and accords with the Healthcare Principles introduced by the Act. The complaints process followed by both NHSG and the Council have the same target response timescales. Early resolution, or front line, complaints will be responded to within 5 working days and complaints handled at the investigation stage have a response time of 20 working days. Where it is not possible to complete the investigation within 20 working days an interim response should be provided with an indication of when the final response should be provided. The decision as to whether the complaint is upheld or not will be made by the manager or Head of Service. If the person raising the complaint is not satisfied with the outcome then they many contact the Scottish Public Services Ombudsman (SPSO) for an independent review and assessment, however prior to this, every effort is made to engage with the complainant to resolve the matter to their satisfaction. Page 73
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6 The governance and monitoring of complaints forms part of core business for teams and services and the provision of a good quality, effective and safe service is a key priority for all. Key Performance Indicators Performance Indicators are measures and targets that help assess and demonstrate how functions are carried out. In March 2022 the agreed Complaints Key Performance Indicators (KPIs) for the Model Complaints Handling Procedures for Local Authorities (LA) were published on the SPSO website. There are four mandatory KPIs for LAs (this includes Health and Social Work Partnerships, in relation to social work functions delegated from LAs). These are: Indicator One The total number of complaints received The sum of the number of complaints received at Stage 1 (this includes escalated complaints as they were first received at Stage 1), and the number of complaints received directly at Stage 2. Indicator Two The number and percentage of complaints at each stage which were closed in full within the set timescales of five and 20 working days The number of complaints closed in full at stage 1, stage 2 and after escalation within MCHP timescales as % of all stage 1, stage 2 and escalated complaints responded to in full Indicator Three The average time in working days for a full response to complaints at each stage The average time in working days to respond at stage 1, stage 2 and after escalation Indicator Four The outcome of complaints at each stage The number of complaints upheld, partially upheld, not upheld and resolved at stage 1, stage 2 and after escalation as % of all complaints closed at stage 1, stage 2 and after escalation Page 74
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7 The qualitative indicator on learning from complaints was part of the published draft indicators but has now been removed. However, Part 4 of the SPSO Model Complaints Handling Procedure on Governance stresses the importance of learning from complaints, and the requirements to record and publicise learning. With regard to Indicator Four the updated MCHP has provided a definition of “resolving” a complaint. “A complaint is resolved when both the organisation and the customer agree what action (if any) will be taken to provide full and final resolution for the customer, without making a decision about whether the complaint is upheld or not”. This focusses efforts to, wherever possible and appropriate, resolving complaints to the service user’s satisfaction. To do this it is necessary to identify and clarify what outcome the service user wants at the start of the process which maybe a change in process for some people currently involved with complaints. It will also change the number of categories of outcomes for complaints to:- • Upheld • Not upheld • Partially upheld and • Resolved The above KPIs are applicable for data collected from 1 April 2022. Complaints about a service that is provided by HSCM on behalf of the NHS, require to be captured using the 9 NHS performance indicators. These are: • Learning from complaints • Complaint process experience • Staff awareness and training • The total number of complaints received • Complaints closed at each stage • Complaints upheld, partially upheld and not upheld • Average time to close complaints at each stage • Complaints closed in full within the timescales • Number of cases where an extension is authorised The data detailed in this report is based on the four KPIs detailed above and also includes information pertaining to some of 9 NHS performance indicators. For detail on staff awareness and training and the number of cases where an extension is authorised please refer to the NHS Grampian Annual Complaints report. Page 75
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8 There is a challenge for reporting of complaints for HSCM due to the fact that there is a need to use two recording systems which then requires collation and as the systems hold data in slightly different ways. This means that there are differences in how the information is reported for some of the indicators. What is Included This is HSCM’s fourth published annual complaints performance report. It includes performance statistics, in line with the complaints performance indicators detailed for complaints received about community health and social care services under the direction of the Moray Integration Joint Board. Any complaints received relating to the dissatisfaction with the MIJB’s policies, decisions or administrative or decision-making processes followed by the MIJB will be reported, even if the number is nil. The MIJB’s definition of a complaint is: “An expression of dissatisfaction by one or more members of the public about the MIJB’s action or lack of action, or about the standard of service the MIJB has provided in fulfilling its statutory responsibilities.” Information about complaints referred to the Ombudsman are also included. Figures reported do not include complaints raised regarding the vaccination appointments or processes as these are being dealt with through a dedicated team covering the Grampian area. Summary Complaints provide valuable information that can be used to continuously improve services, the experiences and satisfaction of people along with their families and carers. Our Model Complaints Handling Procedure reflects the partnership’s commitment to serving the public by valuing complaints. It seeks to resolve issues through local, early resolution and, where necessary, to conduct thorough, impartial and fair investigations of complaints. This will enable us to address dissatisfaction and should prevent the problems that led to the complaint from occurring again. Page 76
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Complaints Data 2023/24 – Annual Report (01/04/23 – 31/03/2024) Learning from Complaints Teams and services actively review the outcomes of complaints to see where improvements can be made and learn from the feedback. Complaints provide valuable information which can be used to continuously improve services, the experience and satisfaction of people along with their families and carers. The tables 1a, 1b, 2 and graph 1 below set out the stages the complaints were closed and what the complaint was about and what action taken. Table 1a Complaints Information Extracted from Datix – Actions Taken/Stage (closed complaints) Stage 1 - Early Resolution Stage 2 - Escalated Stage 2 - Non Escalated Ombudsman Total No action required 3 6 18 1 28 Communication - Improvements in communication staff-staff or staff- patient 2 12 17 2 33 Share lessons with staff/patient/public 0 3 4 1 8 Education/training of staff 1 3 5 0 9 Access - Improvements made to service access 0 0 2 0 2 System - Changes to systems 0 1 3 0 4 Conduct issues addressed 0 1 0 0 1 Action plan(s) created and instigated 0 0 4 0 4 Waiting - Review of waiting times 0 0 4 0 4 Risk issues identified and passed on 0 0 1 0 1 Total 6 26 58 4 94* *figures do not directly correlate with number of closed complaints Page 77
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10 Table 1b Complaints Information Extracted from Lagan – reason for complaint (closed complaints) Early resolution Investigation Total Complaint against service – assessment 4 4 8 Complaint against service - residential care 1 1 2 Complaint against staff 5 4 9 Other 7 5 12 Policy and Procedure 1 3 4 Process / Procedure 11 20 31 Total 29 37 66 The governance and monitoring of complaints forms part of core business for teams and services and the provision of a good quality, effective and safe service is a key priority for all. Noted below are some actions arising from the review of complaints received during the last financial year (data extracted from Lagan). Decision Note / Learning Outcome (lagan) Process / Procedure Reflective learning sessions held Plan made with family regarding involvement and rationale Review of processes Review of processes around timescales and information being available in timely manner Reflective practice around engaging with families at all stages of process Refresher training around Initial Referral Discussion procedures for staff Reminder about staff adherence to timescales Policy Clearer guidance relating to foster or residential care required Child Protection Planning meeting leaflet to be finalised Communication Answer phone message re-recorded to ensure it is clearer Page 78
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11 Development of communications strategy between complainant and social worker Improvement action plan around communication Consider language used when making statements Complaint handling training provided Page 79
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12 Table 2 Complaints Information Extracted from Datix – Actions Taken by Service (closed complaints) Allied Health Professionals Community Hospital Nursing Community Nursing Continence Service General Practice GMED MacMillan Nursing Service Mental Health - Adult Mental Health Mental Health - Old Age Psychiatry Mental Health - Specialisms Primary Care Total Action plan(s) created and instigated 2 1 0 1 0 0 0 0 0 0 0 4 Communication - Improvements in communication staff-staff or staff-patient 4 2 2 1 0 14 1 7 0 0 2 33 Education/training of staff 1 1 1 0 0 2 0 2 0 0 2 9 System - Changes to systems 1 0 0 0 0 2 0 0 0 1 0 4 No action required 2 0 0 0 1 9 0 13 1 1 1 28 Conduct issues addressed 0 0 1 0 0 0 0 0 0 0 0 1 Access - Improvements made to service access 0 0 0 0 0 1 0 1 0 0 0 2 Share lessons with staff/patient/public 0 1 0 0 1 3 0 3 0 0 0 8 Waiting - Review of waiting times 0 0 0 0 0 2 0 2 0 0 0 4 Risk issues identified and passed on 0 0 0 0 0 0 0 0 0 0 1 1 Total 10 5 4 2 2 33 1 28 1 2 6 94* *Figure more than total number of closed complaints as there could be multiple actions taken for each complaint Page 80
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13 Active review of complaints through reporting and investigation is a useful tool to identify learning and improve services. Below are some of the actions and learning from complaints closed between 01/04/2023 and 31/03/2024 (data extracted from Datix). Communication Communication process review between NHSG and Community Pharmacies Further promotion to advise members of public to telephone or complete an e-consult form to arrange appointment for Forres Health and Care Centre Staff to reflect on consultation manner Further promotion of use of e-consult forms Learning taken regarding how staff approach difficult conversations and how patients may perceive these Processes between primary and secondary care services to be reviewed Teams to continue to attempt follow up despite communication difficulties Liaise with SAS to improve communication regarding delays Share lessons Reflection around restrictions for informal patients System/Process change Review of triage protocol Education / training / share lessons learned Staff signposted to relevant NHS training materials to refresh knowledge Reiterating guidance to all teams around checking names and addresses prior to sending correspondence Teams discussed need for timely note keeping Staff made aware of the importance of seeking consent for any physical help being offered to patients Relaunch of Self Discharge Against Advice policy to all staff Reflective practice / supervised practice Reminder to clinicians regarding clear communication with patients around dosage of medication Reminder of policies and procedures Page 81
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14 Complaint Process and Experience NHS Grampian paused the experience survey during the pandemic and recommenced in the second quarter of 2023. This survey is sent out to participants 2 months after their complaint was closed. Data is available from complainants whose complaint was closed in this reporting period and is included in NHS Grampian’s Annual Complaints Report. NHS Grampian are also signed up to Care Opinion. Through this website patients and carers can share their stories, experiences and thoughts online. To find out more about Care Opinion and to see stories shared about NHS Grampian, please visit https://www.careopinion.org.uk/opinions Moray Council issue a customer satisfaction survey to all complainants once their complaint is closed. Many of the customer satisfaction surveys are completed as anonymous. Unless the customer chooses to insert their complaint reference, there is no way of knowing who the return survey is from or which service it was about. More information on this can be found in the Moray Council Complaints Performance Report. Page 82
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15 Graph 1 Complaints Information Extracted from Datix – Action Taken by Service (closed complaints) 0 2 4 6 8 10 12 14 16 Complaints and Feedback by Service and Actions taken Access - Improvements made to service access Action plan(s) created and instigated Communication - Improvements in communication staff-staff or staff-patient Education/training of staff Share lessons with staff/patient/public System - Changes to systems Waiting - Review of waiting times No action required Conduct issues addressed Risk issues identified and passed on Page 83
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16 Indicator 1 - The total number of complaints received The sum of the number of complaints received at Stage 1 (this includes escalated complaints as they were first received at Stage 1), and the number of complaints received directly at Stage 2. Table 3 – total number of complaints (received) System recorded Early Resolution / Frontline Investigation Total NHS - Datix 23 44 67 Moray Council - Lagan 30 39 At time of reporting 11 not yet marked 80 Total 53 83 11 147 Graph 2 - Complaints Received by Year 0 20 40 60 80 100 120 140 160 2018/19 2019/20 2020/21 2021/22 2022/23 2023/24 Complaints Received by Year Datix Lagan Combined Page 84
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17 Datix – Complaints Received by Year: Lagan - Complaints Received by Year: There was a drop in the number of complaints NHS received during 2020/21, for health services, which is likely due to the Covid-19 pandemic; in 2020 there were many services that were suspended and many others where service delivery was altered in some way to accommodate the requirements for social distancing. A total of 108 complaints were received during 2022/23 which is a slight increase on the previous year where a total of 92 complaints were received. This may be attributed to an increase in activity, for example GMED activity increased in 2022 and it is the busiest year on record. This increase in clinical demand could reflect pressures and subsequent complaints. A change in re-triage protocol led to a decrease in GMED activity in 2023. A total of 147 complaints were received by Health and Social Care Moray in 2023/24. The figures in this reporting period include Children and Families and Justice Social Work Services, for the first time, as these services were delegated to the Moray Integration Joint Board on 16 March 2023. This explains the increase in complaints recorded on Lagan from 30 in 2022/23 to 80 in 2023/24. A breakdown of complaints received is detailed on the next page. Year Total 2018/19 31 2019/20 25 2020/21 32 2021/22 24 2022/23 30 2023/24 80 Year Total 2018/19 62 2019/20 62 2020/21 33 2021/22 68 2022/23 78 2023/24 67 Page 85
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18 Table 5 – combined data from Datix and Lagan (complaints received) for 2022/23 Health and Social Care Moray (Datix) Allied Health Professionals 6 Community Hospital Nursing 1 Community Nursing 3 Continence 1 General Practice 4 GMED 24 Mental Health - Adult Mental Health 21 Mental Health - Old Age Psychiatry 1 Mental Health - Specialisms 1 Primary Care 4 Vaccination Transformation Programme 1 Health and Social Care Moray (Lagan) Access Team 18 Care at Home 11 Community Care Finance 1 Day Care 1 Mental Health 1 Occupational Therapy 2 Children and Families and Justice Social Work Access Team 7 Children and Families Area Teams 23 Criminal Justice 2 Fostering and Adoption and Supported Lodgings 11 Reviewing Team 2 Throughcare 1 147 Page 86
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19 Indicator 2 - The number and percentage of complaints at each stage which were closed in full within the set timescales of five and 20 working days The number of complaints closed in full at stage 1, stage 2 and after escalation within MCHP timescales as % of all stage 1, stage 2 and escalated complaints responded to in full Table 5 – number and percentage of complaints at each stage closed within timescales Early Resolution/Frontline with timescale Investigation within timescale Escalated Investigation within timescale NHS - Datix 5 out of 6 (83%) 3 out of 37 (8%) 7 out of 21 (33%) Moray Council - Lagan 11 out of 29 (38%) 8 out of 25 (32%) 1 out of 10 (10%) Indicator 3 - The average time in working days for a full response to complaints at each stage Table 6 – average time in working days to respond Early Resolution/ Frontline Investigative Escalated Investigation NHS - Datix 3 days 54 days 37 days Moray Council - Lagan 13 days 29 days 33 days During 2023/24, HSCM were not able to achieve the targets timescales for responding in all cases. Complaints received into HSCM are often multi-faceted and include more than one service which can impact on response times due to the level of investigation and coordination required. There were two particularly complex investigations recorded on Datix which has impacted the average time in working days to respond. Investigating and responding to complaints is an ongoing area for improvement and work continues to identify obstacles preventing and opportunities to improve response times, raise awareness of the need to seek how to resolve matters to the complainants’ satisfaction and to streamline processes. Some complaint investigations require other processes to be followed before the complaint can be responded to and closed i.e. adverse event reviews, HR processes or information governance processes, this too can impact on response times. In some cases, complaint responses are issued within target timescales, then a further contact from the same complainant about their complaint is received (sometimes months later) and the complaint is reopened. The figures reported against Indicators 2 and 3 above do not account for this and response times are calculated from the date the complaint was first received to being finally closed the second time. Page 87
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20 Indicator 4 - The outcome of complaints at each stage The number of complaints upheld, partially upheld, not upheld and resolved at stage 1, stage 2 and after escalation as % of all complaints closed at stage 1, stage 2 and after escalation Graph 3 below shows the number of complaints fully upheld, partially upheld and not upheld as recorded in Datix during 2023/24. Out of 73 closed complaints on the system 1 complaint recorded was a duplicate, and 5 were closed as consent was not received. From the remaining 67 complaints closed during 2023/24 - approximately 24% were fully upheld, 42% were partially upheld and 34% were not upheld 0 2 4 6 8 10 12 14 16 Fully Upheld: Complaint is accepted Partially Upheld: Complaint is partly accepted Not upheld: Complaint is not accepted Datix - Outcome of Closed Complaints Early Resolution Investigation Escalated SPSO Page 88
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21 Complaints Information Extracted from Lagan: 66 complaints were closed during 2023/24: 27.5% were upheld, 36.5% were partially upheld, 30% were not upheld and 6% were resolved. Graph 4 below shows the number of complaints upheld, partially upheld and not upheld as recorded in Lagan. 0 2 4 6 8 10 12 Upheld Partially Upheld Not upheld Resolution Lagan - Outcome of Closed Complaints Frontline Investigative Escalated Investigated SPSO Page 89
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REPORT TO: MORAY INTEGRATION JOINT BOARD CLINICAL AND CARE GOVERNANCE COMMITTEE ON 29 AUGUST 2024 SUBJECT: INSPECTION OF THE MORAY SUPPORTED LODGINGS PROJECT IN MAY 2024 BY: HEAD OF SERVICE AND CHIEF SOCIAL WORK OFFICER 1. REASON FOR REPORT 1.1 To update the Committee on the outcome of the recent full inspection of the Moray Supported Lodgings Project by the Care Inspectorate in May 2024. 2. RECOMMENDATION 2.1 It is recommended that the Committee scrutinise and note the outcome of the full inspection of the Moray Supported Lodgings Project by the Care Inspectorate in May 2024. 3. BACKGROUND 3.1 The Moray Supported Lodgings Project was last inspected by the Care Inspectorate in 2018. 3.2 The Moray Supported Lodgings Project is a service which offers accommodation and support for care experienced young people in a family setting. This provides an opportunity for young people to develop their independent living skills and support their transition to living independently in the community. The service is part of the Throughcare and Aftercare Team which is situated within Children and Families and Justice Social Work. 3.3 The staff complement for the Moray Supported Lodgings Project is one part- time Social Worker. This role is supervised by the Senior Social Worker in the Throughcare and Aftercare Team. 3.4 In the last eighteen months the Moray Supported Lodgings Project has undergone significant changes. This is as a result, primarily, of the service now supporting Unaccompanied Asylum Seeking Children via the National Transfer Scheme. Alongside this, there has been a greater use of Continuing Care which allows for young people to remain in their care placements up to the age of twenty-one. As such, young people have remained in their care Item 8. Page 91
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placements via Continuing Care rather than transferring to the Moray Supported Lodgings Project. This increased use of Continuing Care has resulted in a reduction in the number of Moray-based young people within the Moray Supported Lodgings Project. 3.5 As a result of the changes to the Moray Supported Lodgings Project, it is a markedly different service to that which was inspected in 2018. This was acknowledged by the Care Inspectorate during the most recent inspection in May 2024. 4. KEY MATTERS RELEVANT TO THE RECOMMENDATIONS 4.1 The Care Inspectorate undertook a full inspection of the Moray Supported Lodgings Project in May 2024. 4.2 The Moray Supported Lodgings Project was notified by the Care Inspectorate on 11 April 2024 that it would be undertaking a full inspection of the service commencing on 3 May 2024. 4.3 The Care Inspectorate identified that it was continuing with the new style of hybrid inspection following the Covid-19 pandemic. 4.4 This new model provided the Moray Supported Lodgings Project with three weeks to gather documents and information requested by the Care Inspectorate. This was then followed by four weeks of the inspection itself. The first week of the inspection was an off-site reading week, with the second and third weeks comprising of both online and face to face meetings, where appropriate, with young people, carers and staff. 4.5 The inspection was undertaken by one inspector, there was a positive working relationship with her and effective communication via telephone, email and weekly catch up meetings. It was reported by young people, carers and staff that the inspector was kind, professional and respectful. 4.6 The Care Inspectorate assessed the Moray Supported Lodgings Project against seven quality indicators set out in “A quality framework for fostering, adoption and adult placement services” (May 2021) (Appendix 1). 4.7 In the three weeks of preparation time the Moray Supported Lodgings Project formed a short life working group with the purpose of gathering, collating, reviewing and sending documents and information to the Care Inspectorate. This group then oversaw the process and management of the inspection period itself. 4.8 The working group undertook its role successfully where the Care Inspectorate praised the service’s open, transparent and organised approach to the inspection. 4.9 The Care Inspectorate provided initial verbal feedback on 29 May 2024. The Moray Supported Lodgings Project were then provided with the draft inspection report with an opportunity to give feedback to the Care Inspectorate prior to final publication. Page 92
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4.10 The final report for the Moray Supported Lodgings Project is attached (Appendix 2). 4.11 The gradings provided by the Care Inspectorate for the Moray Supported Lodgings Project are as follows: Quality Indicator Moray Supported Lodgings Project 1.1 4 Good 1.2 4 Good 1.3 4 Good 1.4 3 Adequate 2.2 3 Adequate 3.2 2 Weak 5.1 4 Good 4.12 The Care Inspectorate use a Six-Point Scale for grading as follows: Grading Description 6 Outstanding or sector leading 5 Major strengths 4 Important strengths, with some areas for improvement 3 Strengths just outweigh weaknesses 2 Important weaknesses - priority action required 1 Major weaknesses - urgent remedial action required 4.13 The table at 4.11 identifies that Moray Supported Lodgings Project was graded as Good in four areas, Adequate in two and Weak in one. 4.14 Overall, this was a fair outcome where there was significant positive feedback. This was in relation to the quality of carers, the outcomes for young people and the support provided for Unaccompanied Asylum Seeking Children. There was also positive feedback from carers, young people and stakeholders/partners. It was encouraging that a service which had not been inspected since 2018 and which had undergone significant changes in the last eighteen months received four Good gradings. 4.15 However, the Care Inspectorate identified significant areas of development. These related to:- (i) updating policies and procedures; and (ii) training and support for carers. 4.16 The grading of Weak related to a Social Worker vacancy in the service. This grading was challenged by the Service Manager on the basis that an experienced Social Worker had been recruited to the vacant post and was due to start during the period of the inspection. This was within the context of local and national recruitment difficulties. This challenge was not successful but was fully discussed with and considered by the Care Inspectorate. As a result of the Weak judgement for 3.2 the Care Inspectorate identified that they would return for a follow up inspection within one year. Page 93
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4.17 Importantly, the Care Inspectorate highlighted that the Moray Supported Lodgings Project knew itself well as a service in relation to its strengths and areas of development. As such, the inspection did not identify any areas of development which were not already known to the service. 4.18 Following the inspection, the Moray Supported Lodgings Project has maintained its improvement activity via the Service Improvement Plan. This is a programme of continuous improvement and is supported by a working group which meets on a fortnightly basis. 4.19 The Moray Supported Lodgings Project is committed to building on the strengths and supporting the areas of development identified by the Care Inspectorate in the inspection of May 2024. In this respect, it identifies itself as a learning service with a focus on continuous improvement. 5. PROPOSALS 5.1 It is requested that the Committee scrutinise and note the outcome of the full inspection of the Moray Supported Lodgings Project by the Care Inspectorate in May 2024. 6. SUMMARY OF IMPLICATIONS (a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and Moray Integration Joint Board Strategic Plan “Partners in Care 2022 – 2032” The Corporate Plan 2024 makes a commitment to improving outcomes for Moray’s most vulnerable young people and families and that more children will live with their families, being cared for in strong safe, communities across Moray. (b) Policy and Legal The Care Inspectorate assessed the Moray Supported Lodgings Project against seven quality indicators set out in “A quality framework for fostering, adoption and adult placement services” (May 2021) (Appendix 1). (c) Financial implications There are no financial implications. (d) Risk Implications and Mitigation There are no risk implications and mitigation. (e) Staffing Implications There are no staffing implications. (f) Property There are no property implications. (g) Equalities/Socio Economic Impact There are no implications in relation to equalities/socio economic impact. (h) Climate Change and Biodiversity Impacts Page 94
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There are no climate change or biodiversity impacts. (i) Directions None. (j) Consultations Interim Chief Officer, HSCM; Chief Social Work Officer and Head of Service, Social Work; Head of HR, ICT and Organisational Development; Chief Financial Officer; Caroline O’Connor, Committee Services Officer and the Equal Opportunities Officer have been consulted in the preparation of this report and are in agreement with the content relating to their areas of responsibility. 7. CONCLUSION 7.1 It is recommended that the Committee scrutinise and note the outcome of the full inspection of the Moray Supported Lodgings Project by the Care Inspectorate in May 2024. Author of Report: Carl Campbell, Service Manager Ref: APPENDICES Appendix 1 – A quality framework for fostering, adoption and adult placement services Appendix 2 – The Moray Supported Lodgings Service report Page 95
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A quality framework for fostering, adoption and adult placement services For use in self-evaluation, scrutiny and improvement support May 2021 APPENDIX 1Item 8. Page 97
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2 A quality framework for fostering, adoption and adult placement services 1. Changes to our inspection We are developing new approaches to scrutiny. We want to make sure that inspections and our other scrutiny work are strongly focused on assessing the extent to which people experience wellbeing, and on understanding the difference care and support makes to their lives. Since 1 April 2018, the Health and Social Care Standards have been used across Scotland. They have been developed by Scottish Government to describe what people should experience from a wide range of care and support services. They are relevant not just for individual care services, but across local partnerships. The Care Inspectorate’s expectation is that they will be used in planning, commissioning, assessment and in delivering care and support. We will use them to inform the decisions we make about care quality. This means that we are changing how we inspect care and support. From 2018, on an incremental basis, we have been rolling out a revised methodology for inspecting care and support services. The changes build on approaches we have introduced in the past three years: an emphasis on experiences and outcomes; proportionate approaches in services that perform well; shorter inspection reports; and a focus on supporting improvement in quality. The core of the new approach is a quality framework that sets out the elements that will help us answer key questions about the difference care is making to people and the quality and effectiveness of the things that contribute to those differences. The primary purpose of a quality framework is to support services to evaluate their own performance. The same framework is then used by inspectors to provide independent assurance about the quality of care and support. By setting out what we expect to see in high-quality care and support provision, we can also help support improvement. Using a framework in this way develops a shared understanding of what constitutes good care and support. It also supports openness and transparency in the inspection process. In developing this framework, we have involved both people who experience or have experienced care and those who provide care and support. It is based on the approach used by the European Foundation for Quality Management, specifically the EFQM Excellence Model, which is a quality tool widely used across sectors and countries. We have adapted the model for use in care settings and have used the new Health and Social Care Standards to illustrate the quality we expect to see. Our frameworks are tested and evaluated to hear the views of people experiencing care, their carers and care providers. This helps us refine the framework and the way we will use it. Page 98
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A quality framework for fostering, adoption and adult placement services 3 How is the framework structured? The quality framework is framed around six key questions. The first of these is: • How well do we support people’s wellbeing? To try and understand what contributes to wellbeing, there are four further key questions: • How good is our leadership? • How good is our staff team? • How good is our setting? • How well is care and support planned? Under each key question, there are a small number of quality indicators. These have been developed to help answer the key questions. Each quality indicator has a small number of key areas, short bullet points which make clear the areas of practice covered. Under each quality indicator, we have provided quality illustrations of these key areas at two levels on the six-point scale used in inspections. The illustrations are the link to the Health and Social Care Standards and are drawn from the expectations set out in the Standards. They describe what we might expect to see in a care service that is operating at a ‘very good’ level of quality, and what we might see in a service that is operating at a ‘weak’ level of quality. These illustrations are not a definitive description of care and support provision but are designed to help care services and inspectors evaluate the quality indicators, using the framework. The final key question is: • What is our overall capacity for improvement? This requires a global judgement based on evidence and evaluations from all other key areas. The judgement is a forward-looking assessment, but also takes account of contextual factors which might influence the organisation’s capacity to improve the quality of the service in the future. Such factors might include changes of senior staff, plans to restructure, or significant changes in funding. We think this an important question to ask as part of self-evaluation. In each quality indicator, we have included a scrutiny and improvement toolbox. This includes examples of the scrutiny actions that we may use in evaluating the quality of provision. It also contains links to key practice documents that we think will help care services in their own improvement journey. Page 99
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4 A quality framework for fostering, adoption and adult placement services How will this quality framework be used on inspections? The quality framework will be used by inspectors in place of the older approach of ‘inspecting against quality themes and statements’. Inspectors will look at a selection of the quality indicators. Which, and how many quality indicators will depend on the type of inspection, the quality of the service, the intelligence we hold about the service, and risk factors that we identify, but it is likely that we will always inspect quality indicators 1.1, 1.2, 1.3 as well as 5.1. In our professional evaluations of the care and support we see, we will use the quality illustrations. One of the quality indicators, 1.4, looks beyond the practice of an individual care service and introduces elements about the impact of planning, assessment and commissioning on people experiencing care. This is important because these practices impact on people’s experiences and the extent to which they experience wellbeing. This quality indicator may help us during an inspection to find information or intelligence which is relevant to practices in commissioning partnerships, but our overall inspection evaluations (grades) will reflect the impact and practice of the care service itself. We will provide an overall evaluation for each of the key questions we inspect, using the six-point scale from ‘unsatisfactory’ (1) to ‘excellent’ (6). This will be derived from the specific quality indicators that we inspect. Where we inspect one quality indicator per key question, the evaluation for that quality indicator will be the evaluation for the key question. Where we inspect more than one quality indicator per key question, the overall evaluation for the key question will be the lower of the quality indicators for that specific key question. This recognises that there is a key element of practice that makes the overall key question no better than this evaluation. How we will use the six-point scale? The six-point scale is used when evaluating the quality of performance across quality indicators. 6 Excellent outstanding or sector leading 5 Very good major strengths 4 Good important strengths, with some areas for improvement 3 Adequate strengths just outweigh weaknesses 2 Weak important weaknesses – priority action required 1 Unsatisfactory major weaknesses – urgent remedial action required An evaluation of excellent describes performance which is sector leading and supports experiences and outcomes for people which are of outstandingly high quality. Page 100
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A quality framework for fostering, adoption and adult placement services 5 There is a demonstrable track record of innovative, effective practice and/or very high-quality performance across a wide range of its activities and from which others could learn. We can be confident that excellent performance is sustainable and that it will be maintained. An evaluation of very good will apply to performance that demonstrates major strengths in supporting positive outcomes for people. There are very few areas for improvement. Those that do exist will have minimal adverse impact on people’s experiences and outcomes. While opportunities are taken to strive for excellence within a culture of continuous improvement, performance evaluated as very good does not require significant adjustment. An evaluation of good applies to performance where there is a number of important strengths which, taken together, clearly outweigh areas for improvement. The strengths will have a significant positive impact on people’s experiences and outcomes. However, improvements are required to maximise wellbeing and ensure that people consistently have experiences and outcomes which are as positive as possible. An evaluation of adequate applies where there are some strengths, but these just outweigh weaknesses. Strengths may still have a positive impact but the likelihood of achieving positive experiences and outcomes for people is reduced significantly because key areas of performance need to improve. Performance which is evaluated as adequate may be tolerable in particular circumstances, such as where a service or partnership is not yet fully established, or in the midst of major transition. However, continued performance at adequate level is not acceptable. Improvements must be made by building on strengths while addressing those elements that are not contributing to positive experiences and outcomes for people. An evaluation of weak will apply to performance in which strengths can be identified but these are outweighed or compromised by significant weaknesses. The weaknesses, either individually or when added together, substantially affect children’s experiences or outcomes. Without improvement as a matter of priority, the welfare or safety of people may be compromised, or their critical needs not met. Weak performance requires action in the form of structured and planned improvement by the provider or partnership with a mechanism to demonstrate clearly that sustainable improvements have been made. An evaluation of unsatisfactory will apply when there are major weaknesses in critical aspects of performance which require immediate remedial action to improve experiences and outcomes for people. It is likely that people’s welfare or safety will be compromised by risks which cannot be tolerated. Those accountable for carrying out the necessary actions for improvement must do so, as a matter of urgency, to ensure that people are protected, and their wellbeing improves without delay. Page 101
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6 A quality framework for fostering, adoption and adult placement services How can this quality framework be used by care services? The framework is primarily designed to support care services in self-evaluation. We are working with care services and sector-wide bodies to build the capacity for self-evaluation, based on this framework. We have published ‘Self-evaluation for improvement – your guide. The guide is available here. Self-evaluation is a core part of assuring quality and supporting improvement. The process of self-evaluation, as part of a wider quality assurance approach, requires a cycle of activity based around three questions: • How are we doing? This is the key to knowing whether you are doing the right things and, as result, people are experiencing high quality, safe and compassionate care and support that meets their needs, rights and choices. • How do we know? Answering the question ‘how are we doing’ must be based on robust evidence. The quality indicators in this document, along with the views of people experiencing care and support and their carers, can help you to evaluate how you are doing. You should also take into account performance data collected nationally or by your service. • What are we going to do now? Understanding how well your service is performing should help you see what is working well and what needs to be improved. From that, you should be able to develop plans for improvement based on effective practice, guidance, research, testing and available improvement support. Page 102
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A quality framework for fostering, adoption and adult placement services 7 Using this quality framework can help provide an effective structure around self- evaluation. The diagram below summarises the approach: Irrespective of our role as the national scrutiny and improvement body, care providers will want to satisfy themselves, their stakeholders, funders, boards and committees that they are providing high quality services. We believe this quality framework is a helpful way of supporting care services to assess their performance against our expectations of outcomes for children and young people, outwith the assessment process. What are we going to do now? How are we doing? How do we know? • How 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 our care and support planned? Page 103
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8 A quality framework for fostering, adoption and adult placement services Key question 1: How well do we support people’s wellbeing? Key question 2: How good is our leadership? Key question 3: How good is our staff team? Key question 4: How good is our setting? Key question 5: How well is our care and support planned? 1.1 Children, young people, adults and their caregiver families experience compassion, dignity and respect. 2.1 Vision and values positively inform practice. 3.1 Staff have been recruited well. Not currently being assessed for these service types. 5.1 Assessment and care planning reflects the outcomes and wishes of children, young people and adults . 1.2 Children, young people and adults get the most out of life. 2.2 Quality assurance and improvement are led well. 3.2 Staff have the right knowledge, competence and development to support children, young people, adults and their caregiver families. 5.2 Parents, carers and family members are involved. 1.3 Children, young people and adults’ health and wellbeing benefits from the care and support they experience. 2.3 Leaders collaborate to support children, young people, adults and their caregiver families. well. 3.3 Staffing arrangements are right and staff work well together. 1.4 Children, young people, adults and their caregiver families get the service that is right for them . 2.4 Staff are led Key question 6: What is the overall capacity for improvement? 2. The quality indicators This framework is for fostering, adoption and adult placement, including shared lives services. It sets out outcomes for children, young people, adults and their caregivers across the whole range of these service types. Family-based services provide a highly personalised form of care that supports people with a wide range of ages and support needs to live within a family setting. It differs from other types of care provided in a home setting as the person being cared for becomes part of the caregiver’s family. Page 104
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A quality framework for fostering, adoption and adult placement services 9 In order to identify outcomes that are relevant to the service, you should consider the aims and objectives of the service when looking at the quality illustrations and evaluating it using the quality indicators and key questions. The use of the term ’people’ Thoughout the development of this framework, there have been various discussions around the status of caregivers, a term we have assigned collectively to adult placement carers, foster carers and adoptive parents. We considered including the quality of caregivers within the staffing section however the Independent Care Review took a much more holistic view of family. They refer to families as ‘biological, kinship, adoptive, foster and others’. This was in response to children and young people often feeling a sense of family when living within these situations. The review goes on to address the need for responsive, flexible, timely, intensive supports being available to children, young people and their families to support stable living situations. We have tried to address this view within the framework and decided that ’key question 1’ would include the extent to which children, young people, adults and their caregiver families were supported. Collectively we have used the term ’people’ to capture all these groups within the quality illustrations. We have spoken about people throughout this framework and have separated this into: • People who live within caregiver families - These are the children, young people and adults who are looked after or being cared for. • People – everyone being supported by the service. This includes the people above and additionally, the caregiver and their family. Page 105
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10 A quality framework for fostering, adoption and adult placement services Key question 1: How well do we support people’s wellbeing? This key question has four quality indicators: 1.1 Children, young people, adults and their caregiver families experience compassion, dignity and respect. 1.2 Children, young people and adults get the most out of life. 1.3 Children, young people and adults’ health and wellbeing benefits from the care and support they experience. 1.4 Children, young people, adults and their caregiver families get the service that is right for them. Page 106
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A quality framework for fostering, adoption and adult placement services 11 Quality Indicator 1.1: Children, young people, adults and their caregiver families experience compassion, dignity and respect. Key areas include the extent to which children, young people and adults: • experience compassion • have their rights respected, and experience dignity and a life free from discrimination • are involved in decision making. Quality illustrations Very good Weak People develop meaningful, affectionate and secure relationships with their caregiver families. Relationships are based on empathy, compassion, trust, predictability, love and fun. Caregivers and staff within the service have a very enabling attitude and foster belief in the potential of the individual child, young person or adult. People living within caregiver families have a strong sense they are part of the family. Caregiver families enjoy enduring, positive relationships with staff within the service. They are actively supported and encouraged, through training and reflective practice discussions, to provide loving, nurturing families for people who may have experienced a range of broken attachments and difficult early lives. People who live with caregiver families do not feel that the family looking after them like, know or value them as individuals. They feel excluded from family life such as celebrations, holidays and outings. They may feel alone, unsupported and uncertain about their place in the family. Staff do not recognise the need to continue to support caregiver families throughout their experience of caring. Support is limited to times when they are caring for people and is not available when people have moved on or when family circumstances change. Staff do not know about the Health and Social Care Standards, or they are not clear about how the principles should inform their practice. Page 107
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12 A quality framework for fostering, adoption and adult placement services Quality illustrations Very good Weak People experience a high level of respect from everyone involved in their care and support. Caregiver families and staff within the service understand the importance of safeguarding the privacy and confidentiality of the people in their care. People who live in a caregiver family feel accepted and valued regardless of their individual circumstances, physical or emotional needs. They know that their caregiver family and staff within the service will recognise and challenge any form of discrimination. People who live in caregiver families, experience unnecessary or insensitive intrusions on their privacy. Their personal records and information may be inaccurate, not stored securely or be shared inappropriately with others either by their caregiver family or by staff within the service. They receive limited support or information to understand their rights. Caregiver families are not supported to understand or take enough account of diversity. They do not appreciate a person’s culture, language, religion or spirituality, sexuality or gender identity. The very good quality of relationships actively supports people who live in caregiver families to know and fully exercise their legal and human rights including their rights as a citizen, for example voting in elections. Caregiver families recognise and embrace the unique circumstances of each individual and support people to explore different aspects of their lives whether these are cultural, religious or sexual orientation. Restrictions on choices and independence are not based on the needs of the child, young person or adult. Page 108
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A quality framework for fostering, adoption and adult placement services 13 Quality illustrations Very good Weak People who live in caregiver families are well informed about and actively involved in decisions about their care in ways which are meaningful to them. Ready access to specialist services and tools ensures that where there are communication difficulties or disabilities, people continue to be fully included in all aspects of their support, family life and decision making. Caregiver families advocate passionately and effectively on behalf of people living in their family. They are recognised as significant people in the decision-making process and, as such, have their views listened to and respected in relation to the people for whom they are caring. Advocacy services including independent advocacy is available to people should they wish this The approach to inclusion and participation for people living in caregiver families is superficial or their views do not consistently make a difference. They have limited access to either informal or independent advocacy. People feel powerless or not listened to in decision making because staff fail to give appropriate regard to or act on views which are seen as challenging. Attempts to involve people who are seen as difficult to engage are not given sufficient priority. Involvement in decision- making of those with additional needs is tokenistic or limited because of perceived challenges or time constraints Page 109
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14 A quality framework for fostering, adoption and adult placement services Scrutiny and improvement toolbox Scrutiny and improvement support actions Key improvement resources • Obtain the views of people, caregiver family, birth family (where appropriate), friends, visitors, staff, managers and other professionals. • Seek confirmation of positive relationships through visiting the caregivers home and meeting the caregiver, their family and people they are supporting. • Examine records for evidence of how people’s rights are respected and their views obtained and acted on. Consider complaint and duty of candour records for the service’s response to issues and concerns. • Review the extent to which relevant policies and procedures, for example confidentiality, equality and diversity, are implemented and influence care and support. • Consider people’s access to advocacy and the use of communication support tools in obtaining their views. • Examine any restrictions to people’s liberty and freedom of choice, whether these are justified, and how they have been explained. • Review how people are informed about their rights, for example in admission information. The Health and Social Care Standards: Health and Social Care Standards: My support, my life (www.gov.scot) The Independent Care Review: https://www.carereview.scot/ The Love Inc Project: https://www.aberlour.org.uk/services/love-inc- project/ Scottish Human Rights Commission: https://www.scottishhumanrights.com/ Mental Welfare Commission • Rights, risks and limits to freedom • Advocacy • Covert Medication • Working with the AWI Act • Decisions about Technology. https://www.mwcscot.org.uk/publications Scotland’s national action plan for human rights: CELCIS: The power of human rights to improve people’s health and care Practice Guide - involving children and young people in improving services: https://hub.careinspectorate.com/media/1582/ practice-guide-involving-children-and-young- people-in-improving-services.pdf Charter for Involvement charter-for-involvement-2019.pdf (arcscotland. org.uk) Page 110
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A quality framework for fostering, adoption and adult placement services 15 Scrutiny and improvement toolbox Scrutiny and improvement support actions Key improvement resources 7 golden rules or participation and other rights information: https://www.cypcs.org.uk/rights Your Rights to Care: Rights-To-Care-Booklet.pdf (cypcs.org.uk) Who Cares? Scotland: www.whocaresscotland.org Page 111
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16 A quality framework for fostering, adoption and adult placement services Quality Indicator 1.2: Children, young people and adults get the most out of life Key areas include the extent to which children, young people and adults living within caregiver families: • make decisions and choices about their lives and how they spend their time • lead active and fulfilling lives. And the extent to which everyone being supported by the service: • have positive learning experiences, achieve their goals and aspirations and reach their potential • feel safe and are protected from abuse, harm, neglect and bullying. Quality illustrations Very good Weak People living within caregiver families routinely exercise a high degree of choice in all aspects of their day-to-day lives within an overall family context. They experience highly personalised care and support that is enriched by caregiver families who understand their individual strengths and preferences. People who want or need to spend time away from their caregiver family can develop a range of relationships out-with the family. Short breaks are planned in advance. Consistency and stability are prioritised and people view short times of being cared for by others, as part of an extended family experience. People living within caregiver families have little autonomy and are expected to fit in with what is happening within the home with little opportunity to influence family life. The quality of their experiences is lessened by assumptions about what is safe or possible. Caregivers do not consider the changing needs and preferences of the people in their care. Time away from the caregiver family is poorly planned, inconsistent and stressful. People may not know or have met the family who is going to care for them and this can have a significant detrimental impact on wellbeing. Page 112
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A quality framework for fostering, adoption and adult placement services 17 Quality illustrations Very good Weak Positive relationships with others including family and friends are encouraged and promoted by the caregiver family. Where these arrangements are determined by a legal order, people are supported to understand the decisions and their rationale. People can choose to be active members of their own local community or the community in which their caregiver family live. They are routinely supported to meet new people, develop individual interests and have fun. As a result, they have a strong sense of belonging and worth. They are enabled to feel fulfilment in life, and to create positive memories. This includes planning and taking part in holidays with their caregiver family. Children and young people are living with their siblings, unless this has been assessed as not appropriate. In these situations, the rights of children and young people to have meaningful relationships, celebrate special family occasions and make new treasured memories with siblings is recognised and actively promoted. People who live with caregiver families do not feel part of the family or local community. Their sense of belonging and identity are compromised because they are isolated from their birth families and local community without justification. People are not supported to form friendships. They are less able to benefit from the opportunities provided by a diversity of relationships or membership of groups and networks Opportunities to take part in meaningful activities are limited or aimed at whole family activities rather than based on individual need and choice. Siblings are separated due to a lack of understanding of the complexity of their relationships given their shared early experience. Meaningful contact, including sharing special occasions, between separated siblings is regularly interrupted due to poor planning or a lack of resources. Page 113
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18 A quality framework for fostering, adoption and adult placement services Quality illustrations Very good Weak When in education, people living in caregiver families receive individually tailored support to engage fully in learning and maximise attainment as well as attendance. This may include additional or individual tuition. Where challenges or barriers exist, caregiver families and staff successfully champion the right to a high quality, inclusive education. Caregivers understand the need to provide educationally rich environments with appropriate space and resources to study and learn. People living within caregiver families making a transition from one education setting to another, receive high quality, planned support to do so successfully. When they leave school or college, they receive support to move to positive and sustained destinations. Being meaningfully engaged in education, work or planned activities is the norm for everyone living within a caregiver family. With the support of their caregiver families, at the right time and pace, people develop a wide range of life skills. These promote confidence and help them to get the most out of life. There is a culture of ambition and celebration when people living within caregiver families strive for and achieve. These successes are used to build optimism and foster further progress.. When in education people are disadvantaged because there is no perceived value placed on learning or the support they receive is limited or takes little account of individual needs or strengths. School and college attendance is low, or people receive limited targeted support for successful learning and may fall behind. They are not enabled to play a full part in school life. There is limited collaboration with schools and other learning providers to help reduce the impact of adverse experiences or overcome stigma. People and their caregiver families have low expectations about what they should aspire to and can achieve. There is a lack of clarity about what is available or what is expected. They feel they do not receive enough encouragement to reach their potential and the quality of learning resources is stale and uninteresting. People living in caregiver families have limited opportunities to practise the skills they will need in adulthood or to live interdependently. There is an over-emphasis on them achieving ‘independence’ rather than living interdependently. Learning and development programmes for caregiver families are service-led or based on what is already available rather than the development of suitable, individualised approaches to learning needs Page 114
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A quality framework for fostering, adoption and adult placement services 19 Quality illustrations Very good Weak This ambition extends to caregivers who embark on ongoing learning and development to support them to continue to provide therapeutic, nurturing family environments and better meet the needs of the people they look after. People living within caregiver families are kept safe both emotionally and physically. This includes caregiver families ensuring that people can access the internet and social media safely. Caregiver families benefit from staff supporting them to identify any concerns early and to take action to support the people in their care. Caregiver families are encouraged to actively engage and work in partnership with other agencies. The service fully implements national guidance and best practice in child and adult protection, including sexual exploitation and challenges decision making if necessary or appropriate. People living within caregiver families are supported by their caregiver family to develop the skills and knowledge they need to understand risk, make informed decisions and make their lives as safe as possible. Adults understand their right to make choices and take informed personal risk. People living within caregiver families always have access to responsible people outside the service or in other organisations, who consistently act in their best interests and provide additional support and safeguards. Children, young people and adult’s safety and wellbeing, and the extent to which they feel protected, may be compromised by a failure to identify and respond to indicators of concern. The needs of those with disabilities or who are less able to communicate their experiences do not receive enough attention. People who live in caregiver families may not feel involved in, or well-informed about decisions that are made about their protection. People living in caregiver families do not learn how to promote their own safety and wellbeing. Networks of support for children, young people and vulnerable adults outside the home are limited and do not provide the additional safeguards required. Children, young people and adults experience bullying or may be hurt, feel threatened, afraid or excluded. Their wellbeing is affected by insensitive or inconsistent responses when bullying occurs. The service does not have a preventative approach to bullying. Page 115
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20 A quality framework for fostering, adoption and adult placement services Quality illustrations Very good Weak People living within caregiver families are confident that their caregiver family will be supported by staff to recognise and effectively challenge all forms of bullying, including prejudice-based bullying. Caregiver families benefit from staff who support them during times of difficulty, including where allegations have been made against them. Scrutiny and improvement toolbox Scrutiny and improvement support actions Key improvement resources • Speak with people living in caregiver families, family members, visitors, staff, managers and other professionals. • Seek confirmation of positive relationships through visiting the caregiver’s home and meeting the caregiver, their family and people they are supporting. • Review people’s suggestions, comments and requests and how the service responds. • Examine people’s records, including assessments, plans and reviews, and the extent to which they demonstrate they are safe, active, achieving, respected and responsible. • Review the effectiveness of support for people to attend school, college or work. Consider how the service supports wider learning and achievement outside the formal education setting. Autism strategy for Scotland: https://www.scottishautism.org/about-autism/ strategy-policy-initiatives/scottish-strategy- autism Care…about physical activity: Care...about physical activity | Care Inspectorate Hub The Keys to Life: https://keystolife.info/ Adult support and protection: https://www.gov.scot/policies/social-care/ adult-support-and-protection/ Disability rights UK– doing sports differently: DoingSportDifferentlyJune2017.pdf (disabilityrightsuk.org) Wellness recovery action plan: https://mentalhealthrecovery.com/ Page 116
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A quality framework for fostering, adoption and adult placement services 21 Scrutiny and improvement toolbox Scrutiny and improvement support actions Key improvement resources • Consider the relevance, variety and quality of caregiver learning and development, adherence to core training requirements and the impact of training on supporting positive outcomes for people • Review relevant policies and procedures, child and adult protection records, incident records, staff and caregiver training and their understanding of their responsibilities. • Consider people’s access to protective adults and supports outside the home. Promoting excellence in dementia care (includes people with a learning disability and dementia): https://www.sssc.uk.com/supporting- the-workforce/self-directed-support-and- integration/dementia-learning-and-promoting- excellence/ Mental Welfare Commission – good practice guidance: https://mwcscot.org.uk/publications?type=39 Information on supporting people with complex needs and sight loss: https://www.rnib.org.uk/professionals-social- care-professionals/complex-needs-social-care Good communication standards: https://www.rcslt.org/wp-content/uploads/ media/Project/RCSLT/5-good-comms- standards-easy-read.pdf Stand up for siblings: https://www.standupforsiblings.co.uk/ Useful resources on contact for children: https://www.nuffieldfjo.org.uk/resources Learning in care: https://hub.careinspectorate.com/media/1546/ learning-in-care-activities-for-professionals- who-work-with-children-in.pdf Celebrating success: what helps looked after children succeed. https://www.celcis.org/files/3814/6669/2296/ celebrating_success_2006.pdf Page 117
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22 A quality framework for fostering, adoption and adult placement services Scrutiny and improvement toolbox Scrutiny and improvement support actions Key improvement resources National guidance for child protection in Scotland: https://www.gov.scot/binaries/content/ documents/govscot/publications/ advice-and-guidance/2014/05/national- guidance-child-protection-scotland/ documents/00450733-pdf/00450733- pdf/govscot%3Adocument/00450733. pdf?forceDownload=true Child sexual exploitation: definition and practitioner briefing paper: https://www.gov.scot/publications/child- sexual-exploitation-definition-practitioner- briefing-paper/ National guidance for child protection in Scotland: additional notes for practitioners: protecting disabled children from abuse and neglect: https://www.gov.scot/publications/national- guidance-child-protection-scotland-2014- additional-notes-practitioners-protecting- disabled-children-abuse-neglect/ National Missing Persons Framework for Scotland: https://www.gov.scot/publications/national- missing-persons-framework-scotland/ On Risk (IRISS): A publication about risk being a natural part of decision making, the complexity of sharing risk between professionals and people using services and our personal and organisational tolerance to risk. https://www.iriss.org.uk/resources/irisson/risk Scotland Works for You Guidance Pack https://www.mygov.scot/scotland-works-for- you/ Page 118
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A quality framework for fostering, adoption and adult placement services 23 Scrutiny and improvement toolbox Scrutiny and improvement support actions Key improvement resources Managing allegations against foster carers: https://www.gov.scot/publications/managing- allegations-against-foster-carers-approved- kinship-carers-agencies-respond Page 119
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24 A quality framework for fostering, adoption and adult placement services Quality Indicator 1.3: Children, young people and adults’ health and wellbeing benefits from the care and support they experience Key areas include the extent to children, young people and adults living in caregiver families: • experience care and support based on relevant research, guidance, standards and good practice • have the highest attainable standards of physical and mental health • have good nutrition, enjoy their food and learn about healthy eating. Quality illustrations Very good Weak People living in caregiver families thrive, develop a strong sense of identity and positive mental health. This is supported by stable living situations, positive, predictable relationships with caregivers and appropriate timely, supportive interventions. Staff support and equip caregiver families, to share information sensitively and creatively with people about their life story. People living within caregiver families are supported to understand their history in a manner which is right for them. People living in caregiver families consistently experience care and support that reflects their developmental stage and needs, and is nurturing, attachment-based and trauma aware. A range of credible, high-quality interventions enables them to build emotional regulation, resilience and self-esteem. Their capacity for growth and change is recognised and promoted. People living in caregiver families have their emotional wellbeing and development compromised by a lack of stable, secure attachments with adults. They may feel that consequences are used inconsistently or arbitrarily or receive a message that being valued and loved is conditional on their behaviour. The care and support they experience is driven by processes or tasks or are at a basic level. Support for them to maintain, re-establish or repair family and other significant relationships is lacking. People’s sense of identity is compromised by poor quality information about their history, and a lack of priority or skill and creativity in engaging with them. People experience a number of moves due to caregiving families being ill prepared and ill equipped to support their needs. Page 120
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A quality framework for fostering, adoption and adult placement services 25 Quality illustrations Very good Weak Where caregiver families experience difficulty, staff actively listen and involve them in planning responsive, tailored and timely interventions to support stability. People living in caregiver families benefit from a positive and enabling culture which allows them to cope with distress and frustration and resolve conflict in a safe and healthy way. Staff support caregiver families to make early and effective use of strategies for preventing escalation of harmful or challenging behaviour. People receive high quality support when they experience significant changes in their lives, including loss and bereavement. Caregiver families are not properly supported to anticipate and prepare for key events and situations which may cause harm or distress. Contingency planning for such times is not evident increasing the likelihood of family crises or breakdowns. Staff and caregivers understand their role in supporting people’s access to healthcare and addressing health inequalities, even where the role of the service in this is minor. This includes ensuring that relevant information is shared with the right people. All people being supported by the service are as healthy as possible. They benefit from comprehensive, holistic health assessments and primary and specialist healthcare. There are a range of opportunities which promote health education, including sexual health. Where necessary and with support, they make best use of the right technology and specialist equipment. People living in caregiver families affected by disability or a long-term illness or condition, enjoy as full a life as possible. There is a continuous review of their needs. Healthcare is disjointed. There are unmet needs, delays, or information about health needs may not be up to date at the point of moving in. This compromises the caregiver’s ability to make decisions about, or to meet, these needs. Children, young people and adults have limited opportunities to develop an understanding of what contributes to a healthy lifestyle. Their right to have their views taken into account and make informed decisions about their physical, emotional and mental health and wellbeing are not respected. Page 121
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26 A quality framework for fostering, adoption and adult placement services Quality illustrations Very good Weak Caregiver families support the people they care for to be well-informed about how to lead a healthy lifestyle, including health promotion activities. They are enabled and encouraged to make informed health and lifestyle choices by adults who are positive role models. Daily routines and structures, including good sleep patterns, support their health and wellbeing. Positive mental health is a high priority for all people living within caregiver families. This might include the use of a range of credible self-help strategies for relaxation and stress-reduction. Those with additional mental health needs benefit from the support of skilled, informed and confident caregiver families and staff. They have timely access to appropriate specialist services for support in recovering from trauma, abuse and neglect. Where challenges exist, staff and caregiver families advocate persistently on their behalf. People have as much control as possible over any medication, treatments and interventions required for their wellbeing. People’s lives are enhanced by being around and caring for animals. This may include having pets. The service does not have a robust, preventive approach to children, young people and adult’s mental health. Caregiver families are not supported to understand the impact of trauma on physical or mental health. A lack of access to specialist intervention or effective advocacy may compromise their health, wellbeing or recovery. People living with caregiver families benefit from a tasty, varied and well-balanced diet that promotes their health and wellbeing and a positive body image. Mealtimes are social occasions which lead to people feeling nurtured and instil a sense of belonging. There is a proactive approach to meeting their cultural and dietary needs and preferences. People living with caregiver families report a diet which lacks variety and balance. They may have limited choice or receive little of the food they enjoy. They do not benefit from the important social aspects of sharing food an eating together. Food practices may be insensitive and do not consider their previous experiences of food or their cultural and medical needs. Page 122
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A quality framework for fostering, adoption and adult placement services 27 Quality illustrations Very good Weak Children, young people and adults play an active role in family life and are fully involved in a range of activities such as menu planning, the family shop, and preparing meals where appropriate. They acquire the necessary practical skills and knowledge for life, to look after their food and dietary needs including food safety. Scrutiny and improvement toolbox Scrutiny and improvement support actions Key improvement resources Discussions with: • people living in caregiver families • the manager and staff • caregiver families • child/young person/adults social worker/care manager • parents • other professionals. Observation of interactions between caregiver families and people being cared for. Review: • Records, including contact records, carer supervision records, life story work, risk assessments, reviews and evaluations • records of complaints, accidents and incidents, including restraint • relevant policies and procedures including medication A Guide to youth justice in Scotland: Policy, practice and legislation: Section 3: Theory and methods: http://www.cycj.org.uk/resource/youth-justice- in-scotland-guide/ Life story information https://www.celcis.org/knowledge-bank/ search-bank/blog/2021/02/how-life-story- work-can-help-care-experienced-children/ Guidance on health assessments for looked after children and young people in Scotland: https://www.gov.scot/publications/guidance- health-assessments-looked-children-scotland/ Practice guide: suicide prevention for looked after children and young people: https://hub.careinspectorate.com/media/1630/ suicide-prevention-for-looked-after-children- and-young-people.pdf Supporting psychological wellbeing in adults with learning disabilities and educational framework on psychological interventions: https://www.nes.scot.nhs.uk/media/ngcha50t/ ldframworkpdf.pdf Page 123
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28 A quality framework for fostering, adoption and adult placement services Scrutiny and improvement toolbox Scrutiny and improvement support actions Key improvement resources • carer training records on meeting the physical and emotional health needs of people and promoting healthy lifestyles • staff training records on meeting the physical and emotional health needs of people and promoting healthy lifestyles. Transforming psychological trauma: A knowledge and skills framework for the Scottish workforce: https://transformingpsychologicaltrauma. scot/media/x54hw43l/ nationaltraumatrainingframework.pdf National health and wellbeing outcomes: https://www.gov.scot/publications/national- health-wellbeing-outcomes-framework/ Mental health strategy for Scotland: https://www.gov.scot/publications/mental- health-strategy-2017-2027/ Safe administration of medication: Modules 1-3: http://learn.sssc.uk.com/sam/ Animal Magic: The benefits of being around and caring for animals across care settings: http://www.careinspectorate.com/images/ documents/4476/Animal%20Magic_2018.pdf Insights: Children, food and care: https://www.iriss.org.uk/resources/insights/ children-food-and-care SCLD - Healthy eating, health living pack https://www.scld.org.uk/healthy-eating- healthy-living-pack/ Eating well for looked after children and young people: https://www.cwt.org.uk/publication/eating- well-for-looked-after-children-and-young- people/ Page 124
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A quality framework for fostering, adoption and adult placement services 29 Scrutiny and improvement toolbox Scrutiny and improvement support actions Key improvement resources Holding Safely: A guide for residential child care practitioners and managers about restraining children and young people: https://hub.careinspectorate.com/media/1213/ holding-safely-a-guide-for-residential-child- care-practitioners-and-managers.pdf Insights: trauma sensitive practice with children in care: https://www.iriss.org.uk/resources/insights/ trauma-sensitive-practice-children-care Insights: Attachment-informed practice with looked after children and young people: https://www.iriss.org.uk/resources/insights/ attachment-informed-practice-looked-after- children-young-people Insights: supporting positive relationships for children and young people who have experience of care: https://www.iriss.org.uk/resources/insights/ supporting-positive-relationships-children- young-people-experience-care Leading for outcomes: https://www.iriss.org.uk/sites/default/files/iriss_ leading_for_outcomes_a_guide_final-1.pdf Page 125
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30 A quality framework for fostering, adoption and adult placement services Quality Indicator 1.4: Children, young people, adults and their caregiver families get the service that is right for them Key areas include the extent to which children, young people and adults: • are involved in a comprehensive assessment of their holistic needs • exercise choice in the care and support they experience • experience high-quality care and support at all times. Quality illustrations Very good Weak Caregiver families are comprehensively assessed to ensure they have the capacity to meet the needs of the children, young people and adults they are caring for. The conclusions of the assessment are evidence based and support clear recommendations with regard to the carer strengths and potential vulnerabilities. Children, young people and adult’s views and choices are central to a comprehensive assessment of their needs. Staff creatively seek the views of children or adults where communication is compromised due to age or disability Decisions reflect the needs and wishes of the people involved. Staff and caregiver families understand their role and contribution to ensuring the assessment is comprehensive, even where their role is minor. Where children and young people are in need of permanent alternative care, assessments are completed without unnecessary delay. Any delays in decision making, assessments or processes are identified by the service who take proactive steps, including advocacy to address these. The assessment and review process lacks clear conclusions or planning. Approval ranges for caregiver families are informed by the service’s need for resources rather the skills and experience of the carer family. Training needs are likely to be identified from existing training provided rather than what is required. This compromises the ability of caregiver families to provide stable, nurturing care for people who need family care. Children and young people experience significant delays in planning for permanence and this is likely to significantly adversely impact on their childhood and stability. Page 126
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A quality framework for fostering, adoption and adult placement services 31 Quality illustrations Very good Weak Everyone using the service has the support they need to be fully involved in reviews of the quality of care being provided and future planning. This includes any review of the caregiver family or the child, young person or adult living in the caregiver’s family. Assessment and reviews always involve all key partners, including family members, carers, representatives and professionals. Young people and adults receive meaningful support to enable them to be full and active partners in how their choices and needs are met. They are well-informed about and understand the reasons for any decisions affecting their lives. Decisions about young people’s care and support may be service-led or based on what is already available rather than the development of suitable, individualised responses. Their changing needs and preferences are not taken into account. People being supported by the service benefit from strong links between the service provider, commissioners and the health and social care partnership to ensure that their care and support needs are fully met. Decisions are strongly informed by the matching of the needs of the person requiring family care and the capacity of the caregiver family to meet those needs. Strengths and potential vulnerabilities are recognised and supports put in place to address these. The needs of those already living in the family are fully considered, and they experience minimal disruption as a result of someone new joining the family. Wherever possible, children, young people, and adults have sufficient time and support to visit the caregiver family prior to moving to live there. The security and wellbeing of people living in caregiver families are compromised by poor planning around new people joining the family. These may be crises led or short notice arrangements where little thought has been given to people already living in the family. The caregiver family do not have access to the full range of information to allow them to meet people’s needs. Children and young people are not empowered, encouraged or enabled to exercise their rights to choose to ‘stay put’ into adulthood under continuing care. They have limited access to independent advice about their options. Decisions may be based on monetary considerations rather than what is best for the individual. Page 127
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32 A quality framework for fostering, adoption and adult placement services Quality illustrations Very good Weak Children, young people and adults benefit from well-managed and positive pathways and transitions throughout their care experience. Their care and support is enhanced by creative solutions to conflicts and challenges and adapts to their changing needs and circumstances. Where relevant, they are proactively well-informed about their rights and empowered to make decisions about options for continuing care. The service ensures that young people have been involved in the development of a comprehensive welfare assessment to support their current and future needs. They are encouraged and enabled to remain in their care setting for as long as possible, and until they wish and feel ready to move on. Where relevant, people are full partners in regular reviews of their care and support In addition to high-quality practical and emotional support when they have left care, children and young people benefit from the continuity of relationships with people who matter to them. If children and young people will eventually require the support of adult services, the process of consultation, assessment and planning begins well in advance. There is a strongly collaborative approach between children’s and adults’ services, in which they are fully involved at all stages. The transition is implemented at a pace that suits them and reflects best practice. When they leave their care setting, young people experience unnecessary disruption in their lives and in key relationships. They may be unprepared or lacking in the support they need to sustain them at this critical time. The consequences may be life-limiting and lifelong. Page 128
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A quality framework for fostering, adoption and adult placement services 33 Scrutiny and improvement toolbox Scrutiny and improvement support actions Key improvement resources Discussions with: • people living in caregiver families • the manager and staff • caregiver families • child/young person/adults social worker/care manager • parents • other professionals. Observation of interactions between caregiver families and people being cared for. Review: • people’s records including assessment reports, panel minutes, contact records, carer supervision records, risk assessments, reviews and evaluations. • welcome and introductory information for caregiver families and people living with caregiver families. • relevant policies and procedures including referrals and admissions. Staying put Scotland: Providing care Leavers with connectedness and belonging: https://www.gov.scot/publications/staying-put- scotland-providing-care-leavers-connectness- belonging/ Children and Young People (Scotland) Act (2014): Guidance on Part 11: Continuing Care: https://www.gov.scot/publications/guidance- part-11-continuing-care-children-young- people-scotland-act/ Continuing care and welfare assessments: Practice Note: https://www.celcis.org/files/7116/0569/2849/ Continuing_Care_and_Welfare_Assess_-_ Practice_Note_FINAL_proofed.pdf Children and Young People (Scotland) Act (2014): Guidance on Part 10: Aftercare: https://hub.careinspectorate.com/media/1136/ children-and-young-people-scotland-act-2014- guidance-on-part-10-aftercare.pdf Throughcare legislation and guidance: https://www.gov.scot/publications/supporting- young-people-leaving-care-scotland- regulations-guidance-services-young/ Permanence and care excellence (PACE) resources: https://www.celcis.org/our-work/key-areas/ permanence/pace-homepage Permanently progressing research: https://www.stir.ac.uk/about/faculties/social- sciences/our-research/research-areas/centre- for-child-wellbeing-and-protection/research/ permanently-progressing/ Page 129
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34 A quality framework for fostering, adoption and adult placement services Scrutiny and improvement toolbox Scrutiny and improvement support actions Key improvement resources The Scottish care leavers covenant: https://www.staf.scot/scottish-care-leavers- covenant Continuing care and co: Conversation openers: https://www.iriss.org.uk/sites/default/ files/2018-04/continuing-care-co-web.pdf Inform: The Children and Young People (Scotland) Act 2014: Parts 10 and 11 (Aftercare and Continuing Care): https://www.celcis.org/files/9114/3878/4824/ Inform__Children_Young_People_Act_Part_10- 11.pdf Getting it right for looked after children and young people: https://www.gov.scot/publications/getting- right-looked-children-young-people-strategy/ pages/1/ Practice guide to chronologies: https://www.careinspectorate.com/images/ documents/3670/Practice%20guide%20to%20 chronologies%202017.pdf Principles of good transitions 3 - including the autism and life shortening conditions supplements: https://scottishtransitions.org.uk/7-principles- of-good-transitions/ Understanding personal outcomes: https://www.sssc.uk.com/supporting- the-workforce/self-directed-support-and- integration/personal-outcomes/ Page 130
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A quality framework for fostering, adoption and adult placement services 35 Scrutiny and improvement toolbox Scrutiny and improvement support actions Key improvement resources Supported decision making: https://www.mwcscot.org.uk/sites/default/ files/2021-02/Supported%20Decision%20 Making%202021.pdf Assessment of prospective carers and permanence planning during COVID-19: https://www.celcis.org/knowledge-bank/ search-bank/assessment-prospective- kinship-foster-and-adoptive-carers-progress- permanence-planning-during-covid-19- lockdown/ Page 131
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36 A quality framework for fostering, adoption and adult placement services Key Question 2: How good is our leadership? This key question has four quality indicators associated with it. They are: 2.1 Vision and values positively inform practice. 2.2 Quality assurance and improvement is led well. 2.3 Leaders collaborate to support children, young people, adults and their caregiver families. 2.4 Staff are led well. Page 132
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A quality framework for fostering, adoption and adult placement services 37 Quality Indicator 2.1: Vision and values positively inform practice Key areas include the extent to which: • vision, values, aims and objectives are clear and inform practice • innovation is supported • leaders lead by example and role model positive behaviour. Quality illustrations Very good Weak The vision, aims and values are clear, understood by all, fully implemented and embedded in the culture of the service. They are inspiring, inclusive and embrace equality. Leaders are ambitious in actively seeking to achieve the best possible outcomes for people using the service. Any review of the service aims and objectives is strongly influenced by the voices of those who use and work in services. For example, care experienced ambassadors, mentors or champions. This is central to the way in which care and support is provided and experienced. The vision for the service lacks clarity or collective ownership and does not focus sufficiently on improving outcomes. An inclusive, rights-led and personal outcomes approach is not fully embedded in the culture and systems of practice. Staff have limited awareness of the service’s ethos, values and aims. The culture encourages and supports creative contributions from people using the service, staff and other stakeholders. Care and support is person-centred and fosters a culture of positive and informed risk-taking. Leaders and staff respect human rights and embrace the service’s vision, values and aims to ensure these are met. Where improvements are needed, there is limited strategic or innovative thinking. The management culture is focused on organisational goals, which are prioritised over the needs of people using the service. Staff do not feel confident about making suggestions or implementing improvements. They do not adapt practice and tailor care and support in order to meet people’s needs and wishes. Page 133
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38 A quality framework for fostering, adoption and adult placement services Quality illustrations Very good Weak Leaders ensure that the culture is supportive, inclusive and respectful, confidently steering the service through challenges. They are visible role models and guide the service’s strategic direction and the pace of change. Leadership is shared to support creative approaches to problem solving, effective policy implementation and to support stability during times of change and staff turnover. Leadership is weak or lacks stability, energy or effectiveness. Shared leadership is not in evidence. There may be a blame culture. Leaders may not be sufficiently well known to either people being supported by the service or staff. Page 134
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A quality framework for fostering, adoption and adult placement services 39 Scrutiny and improvement toolbox Scrutiny and improvement support actions Key improvement resources Discussions with: • people using the service • managers and staff • parents and carers • stakeholders. Observation of staff practice and interactions. Review: • statement of aims and objectives/ vision • participation records • risk assessments • evidence of resilient leadership to account for staff absence or staff turnover (deputising/management team/shared leadership. Step into leadership: https://www.stepintoleadership.info/ Insights: achieving effective supervision: https://www.iriss.org.uk/resources/insights/ achieving-effective-supervision Supervision learning resource: https://www.stepintoleadership.info/index.html Guidance for providers on aims and objectives: https://www.careinspectorate.com/images/ Guidance_for_providers_and_applicants_on_ aims_and_objectives.pdf Page 135
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40 A quality framework for fostering, adoption and adult placement services Quality Indicator 2.2: Quality assurance and improvement are led well Key areas include the extent to which: • quality assurance, including self-evaluation and improvement planning, drives change and improvement • leaders are responsive to feedback and use learning to improve • leaders have the skills and capacity to oversee improvement. Quality illustrations Very good Weak There is continuous, robust evaluation of people’s outcomes and experiences to ensure they receive the best possible care and support. Quality assurance also leads to improved inputs and processes for delivering the service. People’s views are central to the process of evaluation and they are well-informed about any changes. Leaders empower others to become involved in comprehensive quality assurance systems and activities. This leads to the development of a dynamic improvement plan which is continuously evaluated and successfully drives the future direction of the service. This process is well-managed, with research and best practice used to benchmark measurable outcomes. There are robust, transparent, safe and effective approval processes in place for applicants who wish to become caregiver families. Where services must or choose to have a panel as part of this process, the panel are appropriately skilled and experienced. There are some systems in place to monitor aspects of service delivery and their impact on how people experience the service, however, these may be disorganised or haphazard and fail to provide an assurance of quality within the service. There is a lack of clarity about roles and responsibilities. Quality assurance processes, including self-evaluation and improvement plans, are largely ineffective. The approaches used do not allow accurate assessment of performance or have effective review arrangements to assess the likely impact of any planned improvements. Staff and people’s contribution to quality assurance is minimal or peripheral. They have limited awareness of the methods used or the intended outcomes. Page 136
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A quality framework for fostering, adoption and adult placement services 41 Quality illustrations Very good Weak They provide good quality, professional advice, guidance and challenge to the service in relation to how people experience the service and decision making. The agency decision maker role is well defined and provides a clear overview of decision making. There is a lack of external oversight to support good quality practice and outcomes. People being supported by the service may not know what the external oversight arrangements are or rarely have opportunities to share their views at that level. External leaders’ lack of contact with and knowledge about the service make them less effective in providing additional safeguards and assurance. Approval processes for new care giver families lack the necessary transparency to ensure that decision making is appropriate and well recorded. Panel members and the agency decision maker may lack the appropriate skills and experience to fulfil their responsibilities effectively. People being supported by the service are well-informed about the standards they should expect from the service. There is a culture of learning within the service which genuinely values the voices of people being supported. People who use the service feel empowered to give feedback and raise concerns. They know their views are valued, inform future planning and will be acted on promptly without negative consequences. Where things go wrong with a person’s care and support, or their human rights are not respected, leaders learn from this and offer a genuine apology. Reflecting on complaints, concerns and significant events is fully embedded in the service and leads to improvement. Leaders fail to motivate staff and others to contribute to positive change. Lack of information regarding the rationale for improvement may inhibit change. Changes may happen as the result of crisis management rather than through robust quality assurance. People are not encouraged to have high expectations of their care and support, are unsure how to raise concerns, or do not feel supported to do so. If complaints and concerns are upheld, or mistakes are made, there is limited learning to drive sustained and meaningful change. Page 137
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42 A quality framework for fostering, adoption and adult placement services Quality illustrations Very good Weak Leaders know what is working well and what needs to improve. They communicate this effectively to staff and to people using the service. They ensure that the needs and wishes of people being supported by the service are the primary drivers for change. Leaders at all levels successfully direct and support improvement activities and are confident about where to obtain support and guidance. The pace of change reflects the improvements needed. The inclusive culture and enabling leadership of the service allows caregiver families and staff to nurture relationships with the people they care for. There is insufficient capacity to support improvement activities effectively or to embed change. The pace of change may be too slow or is unsustainable. Page 138
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A quality framework for fostering, adoption and adult placement services 43 Scrutiny and improvement toolbox Scrutiny and improvement support actions Key improvement resources Discussions with: • people who use the service • parents and carers • managers and staff • stakeholders. Review: • quality assurance records • self-evaluation records and improvement plan • records of complaints and incidents • feedback from people who use the service The model for improvement and associated resources: http://hub.careinspectorate.com/improvement/ Organisational duty of candour: https://www.gov.scot/publications/organisational- duty-candour-guidance/ National occupational standards (NOS): https://learn.sssc.uk.com/nos/index.html EFQM Excellence model: https://www.efqm.org/index.php/efqm-model/ Learning from adverse events through reporting and review. A national framework for Scotland 2019: http://www.healthcareimprovementscotland.org/ our_work/governance_and_assurance/learning_ from_adverse_events/national_framework.aspx Fostering and adoption legislation and guidance: The Looked After Children (Scotland) Regulations 2009 (legislation.gov.uk) Adoption and Children (Scotland) Act 2007 (legislation.gov.uk) Guidance on Looked After Children (Scotland) Regulations 2009 and the Adoption and Children (Scotland) Act 2007 - gov.scot (www.gov.scot) Notifications about controlled drugs: Guidance for providers: https://hub.careinspectorate.com/media/1566/ notifications-about-controlled-drugs-guidance-for- providers.pdf Page 139
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44 A quality framework for fostering, adoption and adult placement services Quality Indicator 2.3: Leaders collaborate to support children, young people, adults and their caregiver families Key areas include the extent to which: • leaders understand the roles and responsibilities of other partners • services work in partnership with others to secure the best outcomes for everyone being supported by the service • leaders oversee effective transitions for children, young people and adults. • leaders have the skills and capacity to oversee improvement. Quality illustrations Very good Weak Leaders overcome barriers to enable people using services to be the central focus of decision making. A culture of joint responsibility and effective information sharing creates a positive climate for decision making. This takes into account each person’s whole life including their physical, mental, cultural and emotional and spiritual needs. Because leaders have a sound knowledge of the key roles and responsibilities of partner agencies, they quickly identify when to involve them. Partner or multi- agency working is supported by a clear strategy to facilitate working together so that people get the right support when they need it. Leaders recognise the benefits of sharing ideas and successes both within the service and further afield. Leaders ensure that services are delivered efficiently and effectively. They monitor the effectiveness of joint work with other providers and agencies. Leaders lack understanding of how people may benefit from the involvement of external organisations. They do not ensure that care and support is provided collaboratively. There is an absence of strategy and guidance to inform this approach. Leaders lack the knowledge, skills and confidence to access and harness additional or specialist support and expertise. Page 140
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A quality framework for fostering, adoption and adult placement services 45 Quality illustrations Very good Weak Where people are supported by more than one organisation, they benefit from all of them working together effectively. This includes sharing information appropriately and coordinating care and support so that they experience consistency and continuity. Where information is being shared between agencies for specific purposes, consent is obtained, except where to do so is likely to cause harm. Communication with partners is ineffective. Progress is constrained by leaders being unclear about the principles of consent and information sharing. Leaders do not implement learning from other organisations to influence and improve the services they provide. Leaders ensure that commissioned services are delivered efficiently and effectively. They will monitor the success and suitability of living situations to ensure that that caregiver families can meet the needs of children, young people and adults. When people are moving on, leaders contribute to the clear processes that support the person with this. The culture, knowledge and experience of people within the service ensure that planning and decision making is effective, involves all relevant people and supports positive destinations. There are no, or poorly managed, commissioning arrangements in place meaning that positive outcomes for people are compromised. Transition processes are experienced as disconnected and complex. For young people this might mean they are constrained in their ability to move on to adulthood by difficulties in accessing suitable services such as mental health and wellbeing services and housing options. This results in uncertainty or distress. Page 141
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46 A quality framework for fostering, adoption and adult placement services Scrutiny and improvement toolbox Scrutiny and improvement support actions Key improvement resources Discussions with: • people using the service • parents and carers • managers and staff • stakeholders. Observation of staff and carer practice and interactions. Review: • children and young people’s records for evidence of inter- agency working • information sharing policy and practice. Step into leadership: http://www.stepintoleadership.info General Data Protection Regulation (GDPR) guidance: https://www.gov.uk/government/publications/ guide-to-the-general-data-protection- regulation Partnerships and co – conversation openers: https://www.iriss.org.uk/resources/tools/ partnerships-co Page 142
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A quality framework for fostering, adoption and adult placement services 47 Quality Indicator 2.4: Staff are led well Key areas include the extent to which: • leaders at all levels make effective decisions about staff and resources • leaders at all levels empower staff to support children, young people, adults and their caregiver families • leadership has a positive impact on staff. Quality illustrations Very good Weak Leaders engage meaningfully with staff, people being supported by the service, their families and others, taking a collaborative approach to planning and delivering care and support. They are skilled at identifying and delivering what is needed to provide the best care, support and protection. They understand any limitations the service may have. Leaders do not anticipate the type and level of resources needed for people or identify potential barriers. This has a detrimental impact and fails to prevent difficulties arising or escalating. There is a lack of vision and creativity in identifying resources or interventions which meet the unique needs of each individual. Leaders model a team approach, encouraging and appreciating the contributions and expertise of others. They provide a working environment where people are encouraged to curiously question, supportively challenge and critically reflect on their own and other’s practice. This approach promotes a supportive, learning culture which recognising that people are often experts in identifying their own needs. Leaders ensure equality of opportunity both among staff and for people supported by the service. They use successes as catalysts for further improvement in the quality of each individual’s outcomes and experiences. Staff are not empowered to help identify solutions for the benefit of people being supported by the service. Leaders do not always engage staff, leading to confusion and a lack of clarity of roles and responsibilities. The service may have a culture of blame. Communication and direction are lacking, and the steps required to make improvements are not sufficiently detailed. The rationale for change is not always clear to staff, and this has a negative impact people’s experience. Equality and inclusion are not embedded within policies, procedures and plans. There is a lack of understanding of staff and caregiver’s role in delivering high quality care and support. Page 143
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48 A quality framework for fostering, adoption and adult placement services Scrutiny and improvement toolbox Scrutiny and improvement support actions Key improvement resources Discussions with: • people using the service • parents and carers • managers and staff • stakeholders. Review: • service improvement plan • quality assurance policy, procedure, practice and outcomes • staff learning and development records • staff supervision and appraisal records. Step into leadership: http://www.stepintoleadership.info/ Leadership development activities: http://23leadership.sssc.uk.com/ Everyday leadership from the frontline: https://www.iriss.org.uk/news/ news/2019/09/11/everyday-leadership-frontline Guidance on development of policy and procedure: https://hub.careinspectorate.com/media/1530/ health-related-policy-and-procedure-template- policy-for-all-services.pdf Quality illustrations Very good Weak Leaders are aware of the need to be flexible and adapt their leadership style to help motivate staff to deliver high quality care and support. They promote a good work-life balance which has a positive impact on both staff and people being supported by the service. Opportunities for staff to use their initiative, take responsibility and influence change are limited. They seldom adopt leadership roles. The extent to which professional learning is linked to organisational priorities is limited. Staff may work in isolation rather than as part of a team with shared responsibilities. Page 144
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A quality framework for fostering, adoption and adult placement services 49 Key question 3: How good is our staff team? This key question has three quality indicators associated with it. They are: 3.1 Staff have been recruited well. 3.2 Staff have the right knowledge, competence and development to support children, young people, adults and their caregiver families. 3.3 Staffing arrangements are right and staff work well together. We are considering staff employed by the service. This does not include carers or panel members. Carer recruitment is under 1.4. Panel member recruitment is under 2.2 Page 145
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50 A quality framework for fostering, adoption and adult placement services Quality indicator 3.1: Staff have been recruited well Key factors include the extent to which staff: • the service implements safer recruitment principles and practice • recruitment and induction is tailored to reflect outcomes for children, young people, adults and their caregiver families • induction is tailored to the training needs and roles and responsibilities of individual staff member. Quality illustrations Very good Weak Recruitment and selection is informed by national guidance and best practice. There is a strong emphasis on values- based recruitment. High quality recruitment information including contractual agreements ensure that candidates are fully aware of the conduct, capabilities and qualities that are required of them. The process is well organised and documented so that core elements of the procedure are followed consistently. Staff are appointed and start work only after all pre-employment checks have been concluded. People being supported by the service have opportunities and the necessary support to be actively involved in recruitment and selection. This is done in a meaningful and appropriate way which takes their expertise and views into account. There is insufficient understanding of the principles and practices of safer recruitment and the part they play in preventing unsuitable people from entering the workforce. This may lead to key elements of the process not being fully implemented, even when good quality recruitment policies are in place. Recruitment and selection is not informed or enhanced by people’s views and active involvement. Page 146
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A quality framework for fostering, adoption and adult placement services 51 Quality illustrations Very good Weak The values of staff recruited are compatible with the service’s aims and objectives. The skills, knowledge and values of the staff being recruited reflect the needs of the people being supported by the service. The values and motivation of potential staff may not have been explored as part of the recruitment process and may not inform recruitment decisions. The service may not fully understand the essential characteristics required by staff. New staff may therefore not have the appropriate attitudes and values or the potential to gain the necessary knowledge and skills to support high quality outcomes. All staff take part in a comprehensive, well planned induction that has been developed to ensure they are able to perform their work to a high standard. This includes significant emphasis on implementing the Health and Social Care Standards, Independent Care Review, legislation and good practice. The pace and length of induction ensures that staff become familiar with expectations and demonstrate competence in all key areas. Throughout the recruitment process, individual learning needs and styles are taken into account. There is likely to be a range of learning styles, for example the opportunity for face-to-face discussion and shadowing of more experienced staff. Induction provides limited opportunities for genuine learning. There is no expectation that staff will perform to a required standard and demonstrate potential for continuous development. Induction policies, procedures, guidelines and structures of support do not provide an adequate framework for new staff to develop confidence in their new role. There may be a lack of clarity about their role or the provider’s responsibilities for promoting their development. Formal supervision is limited and there is no shared understanding of next steps. The induction may be generic, have not been reviewed recently, or may not include effective input about the Health and Social Care Standards. Page 147
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52 A quality framework for fostering, adoption and adult placement services Quality illustrations Very good Weak Staff are clear about their roles and responsibilities and conditions of employment. They have written information to which they can refer and a named member of staff for support. There is additional supervision during the induction and probationary period. This allows them to receive the necessary opportunities to discuss learning needs or other issues. People who are supported by the service are enabled to contribute their views to the evaluation of staff performance during the induction phase. Scrutiny and improvement toolbox Scrutiny and improvement support actions Key improvement resources Discussions with: • people being supported by the service • the manager and staff (including new staff) • parents and carers • other professionals. Review: • recruitment and induction policy and procedure • recruitment and selection and induction records • analysis of staff skills • staff turnover information and action plan. Safer recruitment through better recruitment: https://hub.careinspectorate.com/media/1608/ safer-recruitment-through-better-recruitment. pdf The national health and social care workforce plan: https://www.gov.scot/publications/national- health-social-care-workforce-plan-part-2- framework-improving/ Independent Care Review: https://www.carereview.scot/wp-content/ uploads/2020/02/The-Promise.pdf Page 148
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A quality framework for fostering, adoption and adult placement services 53 Quality indicator 3.2: Staff have the right knowledge, competence and development to support children, young people, adults and their caregiver families Key factors include the extent to which staff: • staff competence and practice lead to improving outcomes for children, young people, adults and their caregiver families • staff learning and development lead to improving outcomes for children, young people, adults and their caregiver families • staff practice is supported and improved through effective support, supervision and appraisal. Quality illustrations Very good Weak Staff practice strongly reflects the values and principles of the Health and Social Standards and relevant professional codes. Staff consistently form enduring, trusting and genuine relationships with people being supported by the service. They use their authority appropriately and are highly skilled in supporting caregiver families to manage challenging situations such as resolving conflict. The workforce is trusted and expected to use their values and professional judgement to enable appropriate caring and loving relationships. Staff are empowered and equipped to deliver the best quality practical and emotional care and support. Their competence is regularly assessed to ensure that learning and development strategies support the highest quality outcomes and experiences. Staff may be registered with relevant professional bodies but do not fully understand their responsibilities for continuous professional development or how they can fulfil this. They may lack confidence or support in taking responsibility for their own learning and development. Staff adopt an overly procedural approach to their work, which is not based on relationships and values. They may have limited understanding of the symptoms of trauma or the impact of adversity on people’s life experiences. Arrangements for assessing staff practice are under-developed. There is limited support for staff to reflect or for identifying and meeting learning needs. Page 149
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54 A quality framework for fostering, adoption and adult placement services Quality illustrations Very good Weak There is a strong culture of reflection and learning in the service. Staff have high quality learning opportunities based on research evidence and good practice. These are regularly evaluated to meet changing needs. The needs of people being supported by the service influence staff development and training and they may be directly involved in its delivery. There is a range of approaches to learning, including the opportunity for group and face-to-face training, staff coaching, mentoring and peer review. A clear structure of training and learning and development is in place for each staff role and all staff have individual plans. They consistently implement their learning to provide high quality care and support. Continuous learning has a low priority in the service. There is limited access to best practice and research or opportunities to ensure knowledge is consolidated and embedded into practice. Learning opportunities lack breadth and scope, with little reference to values and codes. There is no effective training analysis for the service or individual staff. This means the plan for training is static and may not reflect people’s needs. Staff do not take sufficient responsibility for their own learning and development or for reporting misconduct or unsafe working practices. They have few opportunities for exercising autonomy, using their initiative or developing leadership skills. Staff benefit from a framework of support which reflects the demanding nature of their work and promotes high quality, sensitive care and support. Regular, high quality supervision and appraisal are used constructively by staff. These contribute to their professional development and enable them to become competent, confident and reflective practitioners. Supervision and appraisal inform the development of the service’s staff skills analysis and training plan. Insufficient attention is paid to staff self-care and support. As a result, they may regularly experience stress, or their ability to manage setbacks and challenges and promote attuned care and support is compromised. Supervision takes place infrequently or is given insufficient priority as a key element of a staff support and development framework. It is limited in its breadth and scope and provides few opportunities for reflection. Supervisors and staff are unclear about the purpose and principles of professional supervision. Records do not reflect discussion and decision-making. . Page 150
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A quality framework for fostering, adoption and adult placement services 55 Quality illustrations Very good Weak The views of children, young people, adults and their caregiver families inform and enhance the quality of supervision and appraisal. Systems for identifying and meeting learning needs are not robust enough and result in gaps remaining unfilled. The potential for children, young people, adults and their caregiver families to contribute their views to the staff support and development process is not recognised. Scrutiny and improvement toolbox Scrutiny and improvement support actions Key improvement resources Discussions with: • caregiver families, children, young people and adults • the manager and staff • parents and carers • visitors • other professionals. Review: • training analysis, plans and records • records of observation of staff practice • records of supervision and appraisal • disciplinary records • staff support/learning and development policies and procedures • system for monitoring staff registration. Codes of practice for social service workers and employers: https://www.sssc.uk.com/the-scottish-social- services-council/sssc-codes-of-practice/ The framework for continuous learning in social services: https://lms.learn.sssc.uk.com/pluginfile.php/64/ mod_resource/content/1/clf.pdf Common core skills and national occcupational standards: http://learningzone.workforcesolutions.sssc. uk.com/course/view.php?id=83 Insights: achieving effective supervision: https://www.iriss.org.uk/resources/insights/ achieving-effective-supervision Supervision learning resource: http://www.stepintoleadership.info/assets/pdf/ SSSC-Supervision-learning-resource-Sept-16. pdf SSSC open badges: https://www.badges.sssc.uk.com/ Page 151
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56 A quality framework for fostering, adoption and adult placement services Quality indicator 3.3: Staffing arrangements are right and staff work well together Key factors include the extent to which staff: • there is an effective process for assessing how many staff or staff hours are needed • the skill mix, numbers and deployment of staff meet everyone’s needs • staff are flexible and support each other to work as a team to benefit children, young people, adults and their caregiver families. Quality illustrations Very good Weak A process of assessment determines the numbers, experience, qualifications and skill mix of staff required within the service to promote positive outcomes. It takes into account the level of workload, the complexity of the task, the recruitment of caregiver families, the overseeing and delivery of learning and development for caregiver families, and a range of other factors. The number of staff or staff hours being deployed does not reflect changing needs within the service. There is an over-reliance on agency or sessional staff, or caseloads are continually changing between staff. This leads to people being supported by the service experiencing a lack of consistency and stability in how their support is provided and limits their ability to build trusting relationships with staff. Staff have time to provide care and support with compassion, and to spend meaningful time with individual families. Staff are clear about their roles and are deployed effectively. They help each other by being flexible in response to changing situations to ensure care and support is consistent and stable. There is a minimal number of staff at any one time and this is sometimes insufficient to fully meet diverse needs. Staff frequently work excessive hours or under pressure, leading to some aspects of support being neglected, with negative outcomes. Families perceive staff to be too busy to provide effective support and some activities such as support groups may be cancelled. Page 152
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A quality framework for fostering, adoption and adult placement services 57 Quality illustrations Very good Weak Families being supported and staff benefit from a warm atmosphere created by good working relationships, support and mutual respect. There is effective communication between staff, with opportunities to discuss and reflect on their work and how best to improve outcomes for people using the service. High levels of motivation and good team working mean that families experience a team approach to support and feel they can speak to anyone in the team for support or advice. Staff resilience helps to support and guide caregiver families through times of change. There is recognition of the important role played by staff who are not involved in providing direct care for families, for example administration staff. They are empowered to contribute to the overall support available to families and to build positive relationships with them. Pressure on staff leads to an over-emphasis on completing designated tasks without regard for the wider needs of either people being supported by the service or colleagues. Care and support is at a basic or superficial level, with little time for meaningful communication and support. Communication and team building may suffer due to lack of time and affect staff motivation and morale. This has a negative impact on families. There is proactive use of a range of methods for retaining skilled and experienced staff so that families benefit from stable, enduring relationships. There is a lack of understanding of attachment and the importance of continuity of relationships for people. The service does not use targeted actions to address high turnover, based on accurate data and analysis. Page 153
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58 A quality framework for fostering, adoption and adult placement services Scrutiny and improvement toolbox Scrutiny and improvement support actions Key improvement resources Discussions with: • caregiver families, children, young people and adults • the manager and staff • parents and carers • visitors • other professionals. Observe staff practice and interaction as a staff team. Review assessments of staffing levels (workload capacity). Records that all registered care services (except childminding) must keep and guidance on notification reporting: https://www.careinspectorate.com/images/ documents/2611/Rcds%20services(except%20 cm)%20must%20keep%20and%20guidance%20 on%20notification%20reporting%20(300420). pdf Workforce information: https://hub.careinspectorate.com/national- policy-and-legislation/policies/workforce/ Page 154
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A quality framework for fostering, adoption and adult placement services 59 Key question 4: How good is our setting? Currently not assessed for this service type. Page 155
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60 A quality framework for fostering, adoption and adult placement services Key question 5: How well is our care and support planned? This key question has two quality indicators: 5.1 Assessment and care planning reflects the outcomes and wishes of children, young people and adults. 5.2 Parents, carers and family members are involved. Legislation does not require fostering or adoption services to produce personal plans for children, young people or caregiver families. Planning referred to in this section relates to a range of planning processes including: Fostering • Fostering agreements (SSI 2009/210) • Fostering placement agreements (SSI 2009/210) • Pathway plans • Welfare assessments • The child’s plan Adoption • Adoption support plans • Coordination meetings Adult placement services • Carer agreements • Placement agreements • Personal plans Page 156
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A quality framework for fostering, adoption and adult placement services 61 Quality indicator 5.1: Assessment and care planning reflects the outcomes and wishes of children, young people and adults. Key factors include the extent to which staff: For all services • children, young people and adults are involved in directing and leading their own care and support • all plans are reviewed and updated regularly, and as circumstances, needs and desired outcomes change. For fostering services • the fostering service actively seeks involvement in multi agency planning for children and young people. For adoption services • the adoption service proactively plans the need for post adoption support services for families. For adult placement service • the adult placement service uses personal plans to deliver care and support effectively. Quality illustrations Very good Weak For all services: People lead positive, heathy enjoyable and meaningful lives through the implementation of high quality, SMART planning. People are at the heart of planning for their care and support. They are enabled to lead and direct their development so they feel a real sense of ownership and can clearly recognise their own voice. For all services: People have limited involvement in the care and support planning and review process. This means they do not consistently experience care and support in line with their wishes and preferences. When plans conflict with their wishes, there is no clear legal justification, they do not receive a proper explanation and the service fail to advocate on their behalf. Page 157
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62 A quality framework for fostering, adoption and adult placement services Quality illustrations Very good Weak For all services: They receive full support to communicate what their outcomes should be, including advocacy where required. Planning is clearly understood by all involved. Where people are not able to fully express their wishes and preferences, individuals who are important to them, or who have legal authority, are involved in shaping and directing planning. Where planning is the responsibility of other agencies, such as the child’s plan for children and young people using fostering services, the service strongly advocates for and supports the involvement of people being cared for and their caregiver family. The service challenges situations where people they support are not involved in planning. For all services: Plans and reviews are not routinely made available or provided in an accessible format to children, young people, adults and their representatives. For all services: People benefit from planning that is regularly reviewed, evaluated and updated involving relevant professionals. including independent advocacy, and take account of good practice and their own individual preferences and wishes. There is a range of methods used to ensure that people are able to lead and direct the development and review of their plans in a meaningful way. For all services: Multi-disciplinary professional involvement in the care planning and review process may be limited. People may not benefit from professional advice because this is not taken account of in the planning and review process. Plans do not reflect up-to-date good practice guidance. Care reviews may not be carried out in line with legislation. Where people are supported in crisis, staff are unable to respond flexibly when they identify what is and is not working for the person. Page 158
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A quality framework for fostering, adoption and adult placement services 63 Quality illustrations Very good Weak For fostering: Very good outcomes are supported by high quality multi-agency planning and individualised safer caring approaches. These are underpinned by a robust assessment of need and risk. People benefit from a dynamic and aspirational approach which consistently informs all aspects of care and support. The service actively seeks and supports multi-agency involvement in the planning process and takes appropriate steps to ensure that all children, young people and their caregiver families have appropriate plans in place. Children and young people’s records are of a consistently high standard and are informed by rights, values, principles and codes of practice. For fostering: Children and young people’s wellbeing is compromised by admissions that are inadequately planned. Staff and caregiver families do not have access to the relevant information to allow them to meet their needs. The standard of assessment or planning is weak, with insufficient attention to children, young people’s needs, strengths and potential. The quality of their outcomes and experiences may be limited by the low expectations of those involved in planning or plans may be out of date. Leaders do not maintain oversight of the assessment and planning process, and there is a lack of effective quality assurance. Plans are static documents rather than tools to inform care giver families of approaches to care and support. They may not reflect the care and support provided, experienced, or needed by children, young people adults or their caregiver families. Page 159
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64 A quality framework for fostering, adoption and adult placement services Quality illustrations Very good Weak For adoption: Very good outcomes for families are supported by high quality multi-agency and individualised adoption support planning. This identifies the need for current and future supports which might be needed at different times. These are underpinned by a robust assessment of need and risk. Adoption support plans are of a consistently high standard and are informed by rights, values, principles and codes of practice. People benefit from available current and future support, which is responsive, timely and creative. This recognises the need to support families to nurture children throughout their lives and overcome the difficulties that get in the way. For adoption: Family stability is compromised by poor quality coordination and planning. Practical and emotional support needs are not available or inadequately anticipated or planned. Poor information exchange means families lack the ability to fully meet their children’s needs. The standard of assessment or planning is weak, with insufficient attention paid to the family’s strengths and vulnerabilities. Leaders do not maintain oversight of the assessment and planning process, and there is a lack of effective quality assurance. Plans are static documents rather than tools to inform staff practice and approaches to care and support. They may not reflect the care and support provided, experienced or needed by families. For adult placement: Very good outcomes for families are supported by high quality care and support planning. People, and where relevant, their families are fully involved in developing their personal plans. Strong leadership, staff competence, meaningful involvement and embedded quality assurance and improvement processes support this happening. Care and support planning maximise people’s capacity and ability to make choices. This includes the potential for people to reduce the support they receive and to maximise independence. For adult placement: Personal plans are basic or static documents and are not routinely used to inform staff practice and approaches to care and support. People may not know whether they have a personal plan, or it may be in a format that is not meaningful to them. The standard of care and support planning is inconsistent and is not supported by the strong leadership, staff competence and quality assurance processes. Personal plans focus entirely on people’s needs or a deficit led approach rather than on building an enabling approach based on assets or outcomes. Page 160
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A quality framework for fostering, adoption and adult placement services 65 Scrutiny and improvement toolbox Scrutiny and improvement support actions Key improvement resources Speak to people being supported by the service: • family members • visitors • staff • managers and other professionals. Review people’s assessments and planning including (where appropriate): • child’s plan and reviews • welfare assessments and reviews • pathway plans and reviews • adoption support plans and reviews • adoption coordination planning • personal plans and reviews. • foster care agreements • placement agreements Public Services Reform (Scotland) Act 2010, asp 8: https://www.legislation.gov.uk/ sdsi/2013/9780111020234 Mental Welfare Commission guidance on: • personal plans • advance statements • power of attorney • supported decision making https://www.mwcscot.org.uk/ publications?type=39 Scottish Independent Advocacy Alliance – companion guides: https://www.siaa.org.uk/publications-category/ companionguide/ Think local act personal – personalised care and support planning tool: https://www.thinklocalactpersonal.org.uk/ Latest/Making-it-Real-how-to-do-personalised- care-and-support/ Children and Young People (Scotland) Act 2014, asp 8: https://www.legislation.gov.uk/asp/2014/8/ contents/enacted The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, SSI 2011/210: http://www.legislation.gov.uk/ssi/2011/210/ pdfs/ssi_20110210_en.pdf A guide to youth justice in Scotland: Policy, practice and legislation (section 3: Theory and methods): https://www.cycj.org.uk/resource/youth- justice-in-scotland-guide/ Page 161
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66 A quality framework for fostering, adoption and adult placement services Scrutiny and improvement toolbox Scrutiny and improvement support actions Key improvement resources Leading for outcomes: children and young people: https://www.iriss.org.uk/sites/default/files/iriss_ leading_for_outcomes_a_guide_final-1.pdf Personal outcomes approaches: https://personaloutcomes.network/ Person-centred support planning information: http://helensandersonassociates.co.uk/person- centred-practice/care-support-planning/ Continuing care and the welfare assessment: practice note: https://www.celcis.org/files/7116/0569/2849/ Continuing_Care_and_Welfare_Assess_-_ Practice_Note_FINAL_proofed.pdf Throughcare legislation and guidance: https://www.gov.scot/publications/supporting- young-people-leaving-care-scotland- regulations-guidance-services-young/ Page 162
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A quality framework for fostering, adoption and adult placement services 67 Quality indicator 5.2: Parents, carers and family members are involved Key factors include the extent to which staff: • parents, carers and family members are involved in delivering care and support • the views of parents, carers and family members are heard and meaningfully considered. Quality illustrations Very good Weak The service is proactive in gaining the views of parents, guardians, previous carer families and family members where appropriate. Their views and wishes strongly inform the individual assessment, planning and review process, even where this challenges previous approaches. Where they have additional communication needs, or English is not a first language, they have ready access to the right services and tools to ensure they are fully included. Parents, guardians, previous carers and family members may feel overlooked or are not given enough encouragement and support to make their views known or contribute to decision-making. The quality of assessments, plans and evaluation may be compromised because insufficient weight is given to their knowledge about what is or is not likely to work for people being cared for. Where relevant, there is a supportive and inclusive approach to working in partnership with parents, guardians, carers and family members in the delivery of care and support. They make suggestions, comments or complaints, knowing that these are always listened to and acted on in an honest and transparent way. Leaders and staff always sensitively manage any conflicts between children, young people, adults and their caregiver families and family members’ and guardians’ views and wishes. This shows due regard for consent and other legal considerations. Leaders and staff either seldom engage with people’s families or fail to do so in a meaningful way. There are limited ways for parents, guardians, carers and family members to be actively involved. Changes to how care and support is provided are rarely made as a result of their involvement. Leaders and staff are not well-informed about who has parental responsibility or other legal powers such as guardianship or power of attorney arrangements and may fail to fulfil their legal obligations in relation to information sharing and consent. Page 163
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68 A quality framework for fostering, adoption and adult placement services Quality indicator 5.4: Involving individual children, young people and families The extent to which: • The views, wishes and expectations of children, young people and families are sought, listened to and taken into account. • Children, young people and families participate in the key processes. • Information sharing procedures are in place. • Systems are in place to enable and support children, young people and families to give feedback and make formal complaints. To what extent can we demonstrate: • All children, young people and families’ views are recorded and taken into account in their assessments, plans and decision making. • All children, young people and families are given the opportunity regularly to update their views. • All children, young people and families are treated in a fair and inclusive manner. • Information that is provided about services is helpful and transparent. • Children, young people and families know what information is held about them and understand that some information will need to be shared without their consent if it concerns safety. • Children and young people are offered independent advocacy and any supports that they need to fully participate in processes about their lives. • Complaints and feedback are encouraged and welcomed by the service and are acted upon within agreed timescales with the outcome being shared. • Children and young people’s records. • Policies and procedures. • Participation strategy and annual report. • Complaints policy and communication of the procedures. • Records of complaints and responses. • Information and leaflets for children, young people and families including accessible online content. • Buildings: how does the layout, interview rooms facilities and available technology help to provide an inclusive environment and how do staff give a welcome? Possible evidence to consider: Quality illustrations Very good Weak At all times, high expectations, aspirations and the best interests of children, young people, adults and their caregiver families are at the forefront of the way care and support is delivered. Scrutiny and improvement toolbox Scrutiny and improvement support actions Key improvement resources Speak with: • people • family members • visitors • staff • managers and other professionals. Review assessments, personal plans and reviews. Observe staff working with parents, carers and family members. Parental rights and responsibilities under Children (Scotland) Act 1995: https://www.legislation.gov.uk/ukpga/1995/36/ contents Carers Act: http://www.gov.scot/Topics/Health/Support- Social-Care/Unpaid-Carers/Implementation/ Carers-scotland-act-2016 Equal partners in care: http://www.ssks.org.uk/equalpartnersincare Carers Trust: Triangle of care, carers included: https://carers.org/downloads/resources-pdfs/ triangle-of-care-england/the-triangle-of-care- dementia-england.pdf Scottish Social Services Council guidance: www.sssc.uk.com Mental Welfare Commission – Carers and confidentiality good practice guide. https://www.mwcscot.org.uk/publications/ good-practice-guides/ Page 164
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© Care Inspectorate 2021 I Published by: Communications I COMMS-0521-340 @careinspect careinspectorate Headquarters Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY Tel: 01382 207100 Fax: 01382 207289 Website: www.careinspectorate.com Email: enquiries@careinspectorate.gov.scot Care Inspectorate Enquiries: 0345 600 9527 front cover image © freepik.com Page 165
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MorMoraay Sy Supportupported Led Lodgings Prodgings Projectoject Adult Placement Service The Moray Council Room 213 High Street Elgin IV30 1BX Telephone: 01343 563 568 Type of inspection: Announced (short notice) Completed on: 29 May 2024 Service provided by: Service provider number: The Moray Council SP2003001892 Service no: CS2006139238 APPENDIX 2 Item 8. Page 167
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About the service The Moray Supported Lodgings Project offers semi-independent accommodation in shared properties to young people, aged between 16 and 21 years, who have been 'Looked After and Accommodated' by the Local Authority. Supported lodging families have a distinct role where they offer opportunities to young people to live in a safe, caring environment whilst being supporting to develop skills they will need to successfully transition to living independently in the community. In the last two years the need to provide support to unaccompanied asylum-seeking young people has increased, and it is anticipated this need will continue to grow. The project team structure consists of one supervising social worker and one team leader. Both positions are based in the Moray Council's 'Through Care and After Care' (TCAC) team. The team leader supervises workers from both teams. This may change as plans are to develop a 'Young People's Hub' progress. The project recruits, assesses, approves, and supports supported lodging families to meet the assessed needs of vulnerable young people. Moray Supported Lodging Project was registered with the Care Inspectorate on 01 April 2011. About the inspection This was a short, announced inspection which took place between 3 and 29 May 2024. The inspection was carried out by one inspector from the Care Inspectorate. To prepare for the inspection we reviewed information about the service. This included previous inspection findings, registration information, information submitted by the service and intelligence gathered since the last inspection. In making our evaluations of the service we spoke to • Eight social work professionals, including senior managers • The panel chairperson • Six supported lodging providers • Four young people living in supported lodgings. We reviewed and analysed survey responses from • 13 professionals • Five supported lodging providers • All the young people currently living in supported lodgings. We case tracked three young people living with supported lodging providers, reviewing all relevant documentation. We reviewed supported lodging documentation, which included policies and procedures. We observed one Panel. We attended one 'Through Care and After Care' team meeting. Inspection rInspection reporteport Inspection report for Moray Supported Lodgings Project page 2 of 13 Page 168
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Key messages • The management team evidenced insight to service gaps and provided a service improvement plan, which is in the early stages of implementation. • The impact of a six-month vacancy of the only supervising social worker post has had a negative impacted on predictable support for caregivers and taking forward service improvement plans. • Supported lodging caregivers provide young people with a safe and stable home base. • Young people are supported to reconnect with family and establish a positive network of support that aligns with their ethnicity, culture, traditions, and beliefs. • Educational attainment is a high priority with young people, who are enrolled in 'English as an additional language' lessons, and secondary and further education provisions. • Young people benefit from leading and directing their own support within a multi-agency approach to care planning. From this inspection we evaluated this service as: In evaluating quality, we use a six point scale where 1 is unsatisfactory and 6 is excellent How well do we support people's wellbeing? 3 - Adequate How good is our leadership? 3 - Adequate How good is our staff team? 2 - Weak How well is our care and support planned? 4 - Good Further details on the particular areas inspected are provided at the end of this report. How well do we support people's wellbeing? 3 - Adequate We identified some strengths, but these just outweigh weaknesses. Strengths still have a positive impact but the likelihood of achieving positive experiences and outcomes for people is reduced significantly because key areas of performance need to improve. We evaluated this key question as adequate. Inspection rInspection reporteport Inspection report for Moray Supported Lodgings Project page 3 of 13 Page 169
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Caregivers were skilled at developing positive relationships with young people, whilst offering them a safe and stabile living environment where they felt valued and accepted. They evidenced respect, dignity and compassion in their approach, recognising young people in their care were vulnerable adults who had experienced significant adversities and trauma in their lives. Young people's rights were respected, and they were treated as young adults. Many of the young people were used to a high degree of independence and autonomy and it took time for some to accept the need to be accountable and keep their caregivers informed of their whereabouts. One young person said, 'I want to be free and it is time to move. (I have) out grown the placement', (and) would prefer to share a house.' Other young people were less inclined to seek independence, expressing a desire to feel included and part of the family. Provision of regular, planned and predictable support to the caregivers who were supporting the young people was impacted by the six-month vacancy in the only supervising social worker post. This has meant placement agreements and the six to eight weekly caregiver/placement reviews which explore caregiver and young people's needs and wishes have not occurred. Caregivers and young people explored each other's expectations which has not been an easy task, however one caregiver said, 'We have been without a named social worker for support since Christmas time, but we know that someone will be filling that post very soon but in the intervening months (staff member) filled the role of supporting us and has been excellent for us and our young man.' The recent appointment of a supported lodgings supervising social worker will provide caregivers and young people with opportunities to explore expectations and establish an appropriate balance of nurture, care, support, and autonomy. The supported lodging project sits within the Through Care, After Care (TCAC) team structure. Social workers in the TCAC team provided support to the young people and have established positive relationships with caregivers, who were confident they would receive support if required. We were told, 'The support staff have been responsive, efficient and supporting when we have had questions or have felt the need to share information.' A multi-agency approach to support young people was evident, with caregivers invited to young people's meetings. We were confident young people's needs were assessed and plans were implemented to reach goals identified by young people. Welcome packs in several languages provided young people with key information about the supported lodgings project, their local area, and community resources. A checklist for staff provided a step-by-step guide to support young people integrate to the area and access to a wide range of resources and services. This included referrals to a guardianship service to access legal advice, and a list of local businesses and community members who may have a shared culture, tradition and religious belief with the young people. Young people were active in their community. They attended school, were provided with lessons in English as an additional language, applied for further education courses and independently navigated travel to and from home and education services. Young people made choices in day-to-day living. They followed a healthy lifestyle, attending various sporting activities and the local gym. They prepared, cooked, and ate healthy and nutritious food according to their dietary preferences. Young people were supported to re-establish and maintain contact with family members, and to visit friends who lived in other authorities. We heard of one example where a young person was supported to travel to England and spend time with family members. Young people's health needs were met. They were registered with local primary and secondary health care specialists and offered health appointments and/or check-ups. One young person received support from specialist mental health services, in a neighbouring city. A shortage of dentists in the area meant young people were unable to have regular dental appointments, although an emergency dental service was accessed as and when required. When asked what the service does well one person told us, 'Offering care, Inspection rInspection reporteport Inspection report for Moray Supported Lodgings Project page 4 of 13 Page 170
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demonstrating an ethos of acceptance for young people arriving from overseas (unaccompanied asylum- seeking children) and actively involving other specialist professionals in developing plans and practice.' In recognition of the vulnerabilities of young people in need of supported lodgings, some improvements to the caregiver assessment, approval and review processes have been identified. Robustness and completion of assessments were compromised when young people identified their own caregiver, and referrals of young people necessitated new caregiver placements to be available. Ensuring all caregiver assessments are comprehensive and robust with clear strengths and potential vulnerabilities will form a requirement (1) in the key question. It had been suggested that assessment, report and caregiver/placement review templates used for these processes required to be reviewed and updated, and this will be supported with area for improvement (1). Caregiver reviews were undertaken annually and included feedback from young people and other stakeholders, offering opportunities to highlight good practice, standards of care and influence service improvements. We heard that policies and procedures are scheduled to be reviewed and updated and noted practice guidance was incomplete. Developing and updating a suite of supported lodging policies and procedures will form a requirement (2) in this key question. Reviewing and updating the supported lodging caregiver's handbook to ensure information aligns with the updated policies and procedures will form a requirement (3) in this key question. Supported lodging caregivers have a background of professional employment in the provision of services to children and young people. Through this they have completed relevant training and professional development which is transferrable to their role as supported lodging caregivers. They have not received training specific to their role as supported lodging caregivers from the service. Plans to develop a training calendar were identified as a service improvement, and this will form an area for improvement (2) in this key question. Caregivers expressed a desire for a peer support groups and regular contact with other supported lodging caregivers. One caregiver reported, 'We would appreciate opportunities to meet other supported lodgings providers and would enjoy building a supportive community with the other young people, their lodging carers and the wider support team. This has been listed as an action point in the service improvement plan and progressing this will be support with an area for improvement (3). Requirements 1. By 31 July 2024, the provider must ensure that caregiver assessments are robust and comprehensive, with a clear identification of their ability to meet the needs of young people. To do this the provider must as a minimum ensure: • Caregiver assessments accurately reflect strengths and vulnerabilities in relation to meeting the needs of vulnerable young people. • Assessment reports are quality assured and are consistently of a high standard. • Planning/matching meetings take place when young people join caregiver households. • Caregivers are provided with appropriate support and supervision when potential vulnerabilities are identified. This is to comply with Regulation 4(1)(a) of The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011(SSI 2011/210). This is to ensure that care and support is consistent with the Health and Social Care Standards (HSCS) which state that: ‘My care and support meets my needs and is right for me’ (HSCS 1.19). Inspection rInspection reporteport Inspection report for Moray Supported Lodgings Project page 5 of 13 Page 171
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2. By 31 July 2024, the provider must have engaged with relevant services to review and update all supported lodging policies and procedure. To do this the provider must, as a minimum: • Identify the suite of supported lodging policies and procedures required. • Implemented an action plan to review and update the policies and procedures identified. • Engage stakeholders in the consultation and review processes when updating policies and procedures. This is to comply with Regulation 4(1)(a) of The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011(SSI 2011/210). This is to ensure that care and support is consistent with the Health and Social Care Standards (HSCS) which state that: ‘I can be meaningfully involved in how the organisations that support and care for me work and develop’ (HSCS 4.6). 3. By 31 July 2024, the provider must have engaged with relevant stakeholders to review and update the caregiver’s handbook. To do this the provider must, as a minimum ensure relevant stakeholders are: • Informed of this improvement plan. • Invited to be party to improvement planning . This is to comply with Regulation 4(1)(a) of The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011(SSI 2011/210). This is to ensure that care and support is consistent with the Health and Social Care Standards (HSCS) which state that: ‘I am actively encouraged to be involved in improving the service I use, in a spirit of genuine partnership’ (HSCS 4.7). Areas for improvement 1. To support young people’s health and wellbeing the provider should ensure caregivers are provided with an annual training schedule. This should include, but not be limited to adult protection and the impact of trauma. The provider should maintain an overview of caregiver training attendance and future training needs. This is to ensure that care and support is consistent with the Health and Social Care Standards (HSCS) which state that: ‘I have confidence in people because they are trained, competent and skilled, are able to reflect on their practice and follow professional and organisational codes’ (HSCS 3.14). The Promise Plan 21-24 states: ‘Organisations that have responsibilities towards care experienced people and those on the edge of care will be able to demonstrate that they are embedding trauma informed practice across their work and within their workforce.’ 2. To ensure a culture of learning where caregivers have opportunities to share relevant information within a supportive peer, the provider should develop and organise caregiver support groups. These should be facilitated on a regular basis, in line with caregivers needs and wishes. Inspection rInspection reporteport Inspection report for Moray Supported Lodgings Project page 6 of 13 Page 172
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This is to ensure that care and support is consistent with the Health and Social Care Standards (HSCS) which state that: ‘I experience high quality care and support because people have the necessary information and resources' (HSCS 4.27); and, ‘My care and support is consistent and stable because people work together well’ (HSCS 3.19). 3. The supported lodgings service has evolved over time as demand for the service has changed. Caregiver assessment and placement review documentation should be updated to ensure they accurately reflect and record strengths, vulnerabilities and needs. This is to ensure that care and support is consistent with the Health and Social Care Standards (HSCS) which state that: ‘I experience stability in my care and support from people who know my needs, choices and wishes, even if there are changes in the service or organisation’ (HSCS 4.15). How good is our leadership? 3 - Adequate We identified some strengths, but these just outweigh weaknesses. Strengths still have a positive impact but the likelihood of achieving positive experiences and outcomes for people is reduced significantly because key areas of performance need to improve. We evaluated this key question as adequate. The Supported Lodging Project management team recognised service need and delivery has changed over time, partly due to the evolving landscape of continuing care legislation. Referral criteria include unaccompanied asylum-seeking young people who have been arriving in, or sent to, the local area. A strategic approach to welcoming the young people involved community engagement activities and developing a list of community members the young people may want to identify with, due to a commonality of culture, traditions and beliefs. The impact of a six-month supervising social worker vacancy was acknowledged, and recruitment of suitable, qualified and experienced staff was recognised as a nationwide issue. During the inspection a supervising social worker, employed by Moray Council children's services, commenced in this post. The management team had identified clear tasks to take forward, with 16 action points in a recently developed Service Improvement Plan. This plan was specific, measurable, achievable, realistic and time bound (SMART) in approach and evidenced the management team's insight and honesty towards self- evaluation. It was in the early stages of development and implementation. Moray Children's Services management team have evidenced capacity and motivation to develop and lead improvement action plans in other projects, and we are confident improvement needs in the supported lodging project will be prioritised and implemented. Stakeholders' views are collated and the benefits of ensuring the needs and wishes people supported by the service are the primary drivers for change are recognised. Supporting the management team to approach and drive changes within a co-production model of improvement planning and implementation will form an area for improvement (1) in this quality indicator. To ensure planned changes lead to improved outcomes for young people using the service, the management team expressed a desire to evidence the impact. To support this continuous robust evaluation of people's outcomes and experiences to ensure they receive the best possible care and support is an area for improvement (2) in this quality indicator. Inspection rInspection reporteport Inspection report for Moray Supported Lodgings Project page 7 of 13 Page 173
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Moray Council Child Protection Policies are clear and comprehensive and include definitions of current issues. Introducing adult protection alongside, or complementary to, child protection training is supported with a training schedule requirement outlined in key question 1. We saw evidence of appropriate responses to matters required to be notified to the Care Inspectorate but identified a failure to comply with the notification guidance. Ensuring practices adhere to the Care Inspectorate guidance on notification reporting will form a requirement (1) in this quality indicator. Requirements 1. By 31 July 2024, the provider must ensure they access the up-to-date Care Inspectorate guidance on notifications. They must notify us of all incidents, accidents and allegations of abuse in accordance with this guidance. This is to comply with Regulation 4(1)(a) of The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011(SSI 2011/210). This is to ensure that care and support is consistent with the Health and Social Care Standards (HSCS) which state that: ‘I am protected from harm, abuse, bullying and exploitation by people who have a clear understanding of their responsibilities’ (HSCS 3.20); and 'I benefit from a culture of continuous improvement, with the organisation having robust and transparent quality assurance processes' (HSCS 4.19). Areas for improvement 1. To ensure service improvement planning is shaped by staff and stakeholders, the provider should actively consider the contribution and expertise of others. The provider should be able to evidence a genuine partnership approach to stakeholder engagement. This is to ensure that care and support is consistent with the Scottish Social Services Council (SSSC) Codes of Practice which identify the organisation should 'Have systems in place to listen to and consider feedback from people who use services, carers and other relevant people, to shape and improve services and the performance of social service workers’ (SSSC 2.3); and The Health and Social Care Standards (HSCS) which state that: ‘I am actively encouraged to be involved in improving the service I use, in a spirit of genuine partnership’ (HSCS 4.7). 2. The management team should have oversight how service delivery and improvement planning is impacting young people. This should include how young people’s needs are met and outcomes improved. This is to ensure that care and support is consistent with the Health and Social Care Standards (HSCS) which state that: ‘My needs, as agreed in my personal plan, are fully met, and my wishes and choices are respected’ (HSCS 1.23); and ‘I am confident that people are encouraged to be innovative in the way they support and care for me' (HSCS 4.25). Inspection rInspection reporteport Inspection report for Moray Supported Lodgings Project page 8 of 13 Page 174
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How good is our staff team? 2 - Weak We evaluated this quality indicator as weak. Strengths were identified but these were outweighed or compromised by significant weaknesses. We identified that without improvement as a matter of priority, the welfare or safety of people may be compromised, or their critical needs not met. The Supported Lodgings Project employs one supervising social worker, supervised by a team leader who supervises the TCAC team. We noted the previous supervising social worker's training record identified one entry in the year they left. To ensure staff learning and development is prioritised, having access to and attending appropriate training to their role and responsibility will form a requirement (1) in this quality indicator. We saw evidence of the previous supervising social worker role supporting caregivers and young people. They attended young people's meetings, reviewed placements and provided monthly supervision to caregivers and received eight weekly supervisions from their line manager. This ensured young people's needs were known and plans were progressed, and caregivers' strengths and potential vulnerabilities were identified and they were supported to provide high quality day-to-day care. Over the last six months the Supported Lodging Project has been without a supervising social worker. The absence of this crucial role has meant that caregivers have not had a dedicated worker assisting them to understand and prepare for their role, or planned meetings to explore effective strategies to deal with issues which may arise as caregivers and young people get to know each other. To ensure caregivers receive regular supervision, and placements are reviewed in line with supported lodging policies and procedures will for a requirement (2) in this quality indicator. Including the views of young people and adults to enhance support provided will also be a requirement (3) in this quality indicator. Requirements 1. By 31 July 2024, the provider must ensure that all staff receive relevant training, and that an accurate training record is maintained. This is necessary in order to comply with the Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 - Regulation 3 15(b)(i) ‘Ensure that person's employed in the provision of the care service receive training appropriate to the work they perform.’ This is to ensure that care and support is consistent with the Health and Social Care Standards (HSCS) which state that: 'I have confidence in people because they are trained, competent and skilled and are able to reflect on their practice and follow their professional and organisational codes' (HSCS 3.14). 2. By 31 July 2024, the provider must ensure high quality support, in line with the policies and procedures, which consistently meets the needs of caregiver households is provided. To do this the provider must, as a minimum ensure: • Support needs and vulnerabilities are identified at an early juncture. • Supports needs identified are provided in a timely manner. • Regular high-quality supervision and placement reviews with caregiver households are well recorded. This is to comply with Regulation 4(1)(a) (welfare of users) of the Social Care and Social Work improvement Scotland (Requirements for care services) regulations 2011 (SS1 2011/210). Inspection rInspection reporteport Inspection report for Moray Supported Lodgings Project page 9 of 13 Page 175
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This is to ensure that care and support is consistent with the Health and Social Care Standards (HSCS) which state that: ‘I experience high quality care and support based on relevant evidence, guidance and best practice’ (HSCS 4.11). 3. By 31 July 2024, the provider must ensure that care and support provided to young people and caregivers is enhanced by their views. To do this the provider must, as a minimum: • Ensure young people and their caregivers have regular opportunities to express their views. • Evidence how young people and caregiver’ views have been considered when providing care and support. This is to comply with Regulation 4(1)(a) of The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011(SSI 2011/210). This is to ensure that care and support is consistent with the Health and Social Care Standards (HSCS) which state that: ‘I am recognised as an expert in my own experiences, needs and wishes’ (HSCS 1.9); and ‘I am empowered and enabled to be as independent and as in control of my life as I want and can be’ (HSCS 2.2). How well is our care and support planned? 4 - Good We identified a number of important strengths which taken together outweigh areas for improvement. We evaluated this quality indicator as good. Young people led positive, healthy, enjoyable and meaningful lives. Care plans were reviewed regularly by an independent reviewing officer, with new plans developed as needs changed. Young people were involved in directing and leading their own care and support, with the option to attend meetings or have their views represented if that was their preference. Young people openly expressed their wishes, and their voice was evident in their plans. One professional said, 'As with all care planning processes, it can be hard for young people to engage with formal meetings or fully understand all of their options, but in Moray they certainly feel seen and listened to as individuals and generally the service offers a really high level of support and care.' Welfare and Pathway plans were specific, measurable, achievable, realistic and time bound (SMART) in approach. They highlighted a multi-agency approach and effective partnership working to meet young people's needs. Strong positive relationships with the local community were evident. These practices are crucial elements of partnership working to improve outcomes for young people, which aligns with 'The Promise'. Developing detailed 'My Future My Plan' (MFMP), based on young people's need for safety, healthy, achieving, nurtured, active, responsible, respected and included (SHANARRI) was facilitated by the TCAC team. Young people and caregivers were invited to share their views in each topic. An analysis of this information informed a more detailed SMART action plan. We were told, 'The communication is clear and all young people are treated with respect when supporting them through their life choices, including education. I have only minimal contact but when I do I am very happy with the outcomes being provided. I also know who to speak to if there are concerns so that they can be quickly addressed, with minimal impact on the young person.' Inspection rInspection reporteport Inspection report for Moray Supported Lodgings Project page 10 of 13 Page 176
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Risks and safety needs are discussed with young people and safer caring plans, signed by the young people, identified concerns and outlined ways risk could be reduced and safety increased. Placement agreements between caregivers and young people were in place, although we noted the content and quality of those declined during the six-month absence of the supervising social worker. We identified that placement agreements could include safer caring principles and practices. Some caregivers said they were not sure they knew what was in a young person's plan. We concluded that care planning with young people was undertaken by the TCAC team, and with a supervising social worker now in place sharing information and effective partnership working with caregivers in day-to-day planning and support provided will be enhanced. Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at www.careinspectorate.com. Inspection rInspection reporteport Inspection report for Moray Supported Lodgings Project page 11 of 13 Page 177
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Detailed evaluations How well do we support people's wellbeing? 3 - Adequate 1.1 Children, young people. adults and their caregiver families experience compassion, dignity and respect 4 - Good 1.2 Children, young people and adults get the most out of life 4 - Good 1.3 Children, young people and adults' health and wellbeing benefits from the care and support they experience 4 - Good 1.4 Children, young people, adults and their caregiver families get the service that is right for them 3 - Adequate How good is our leadership? 3 - Adequate 2.2 Quality assurance and improvement are led well 3 - Adequate How good is our staff team? 2 - Weak 3.2 Staff have the right knowledge, competence and development to support children, young people, adults and their caregiver families 2 - Weak How well is our care and support planned? 4 - Good 5.1 Assessment and care planning reflects the outcomes and wishes of children, young people and adults 4 - Good Inspection rInspection reporteport Inspection report for Moray Supported Lodgings Project page 12 of 13 Page 178
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To find out more This inspection report is published by the Care Inspectorate. You can download this report and others from our website. Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and help services to improve. We also investigate complaints about care services and can take action when things aren't good enough. Please get in touch with us if you would like more information or have any concerns about a care service. You can also read more about our work online at www.careinspectorate.com Contact us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com 0345 600 9527 Find us on Facebook Twitter: @careinspect Other languages and formats This report is available in other languages and formats on request. Tha am foillseachadh seo ri fhaighinn ann an cruthannan is cànain eile ma nithear iarrtas. Inspection rInspection reporteport Inspection report for Moray Supported Lodgings Project page 13 of 13 Page 179
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REPORT TO: MORAY INTEGRATION JOINT BOARD CLINICAL AND CARE GOVERNANCE COMMITTEE ON 29 AUGUST 2024 SUBJECT: HEALTH AND SOCIAL CARE MORAY (HSCM) CLINICAL AND CARE GOVERNANCE GROUP ESCALATION REPORT BY: ALLIED HEALTH PROFESSIONAL – SECTOR LEAD, MORAY 1. REASON FOR REPORT 1.1 To inform the Committee of progress and exceptions reported to the Clinical and Care Governance Group since the last report to Committee in May 2024. 2. RECOMMENDATION 2.1 It is recommended that the Committee consider and note the contents of the report. 3. BACKGROUND 3.1 HSCM Clinical Governance Group was established as described in a report to this Committee on 28 February 2019 (para 7 of the minute refers). 3.2 The assurance framework for clinical governance was further developed with the establishment of the Clinical Risk Management Group (CRM) as described in a report to this Committee on 30 May 2019 (para 7 of the minute refers). 3.3 As reported to this Committee on 29 October 2020 (para 5 of the minute refers) Social Care representatives attend the Clinical Governance Group, so the group was renamed HSCM Clinical and Care Governance (CCG) Group. 3.4 A refresh of the Terms of Reference for the HSCM CCG Group was undertaken in 2023 and reported to this Committee on 30 November 2023 (para 6 of the minute refers). 3.5 This report contains information reported to HSCM CCG Group from Clinical Service Groups / departments. This report also contains further information relating to incidents / adverse events reported via Datix and areas of concern / risk and good practice shared during the reporting period. 3.6 The reporting schedule of the CCG Group does not always align to quarterly reporting to the committee. It has been agreed that the Escalation Report should include the CCG Group meetings between committee scheduling; this may not always be quarterly. 3.7 The CCG Group have met 3 times during this reporting period. Item 9. Page 181
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4. KEY MATTERS RELEVANT TO RECOMMENDATION Audit, Guidelines, Reviews and Reports 4.1 Relevant Audits, Guidelines Reviews and Reports are tabled and discussed. These include local and national information that is relevant to HSCM, for example, recommendations from Health Improvement Scotland (HIS) reports from other areas which require to be discussed and assurance given that services in Moray are aware of these and have processes in place to meet / mitigate the report recommendations. Overview of items discussed during this reporting period are listed below: • CRM Minutes • External Reports • Service Updates • Adverse Events and Duty of Candour • HSCM Risk Register • Complaints / Feedback • Update from Practice Governance Group Areas of achievement / Good Practice MSK 4.2 Since the Moray Physiotherapy MSK Service Report was presented to Committee on 30 May 2024 there has been significant positive impact resulting from the service changes detailed within the report, resulting in the longest wait decreasing from 68 weeks to 44 to 22 weeks over recent months. 90% of patients continue to be seen within 2-3 weeks. Public Dental Service 4.3 An online Toothbrushing Monitoring module was developed by Moray Childsmile Team to replace one of two face-to-face toothbrushing support sessions delivered to all participating Moray schools and nurseries annually. During test of change – rolling out in one Associate School Group (ASG), Speyside, saved 94 hours of Childsmile staff time. 100% completion rate and very positive feedback received from school and dental teams. Moray’s Dental Clinical Lead has shared the project report across NHS Grampian, with City and Aberdeenshire Health and Social Care Partnerships reviewing option to implement. Joint Inspection of Adult Support and Protection – Review of progress in the Moray Partnership area 4.4 HSCM received formal notification on 15 July 2024 that the Care Inspectorate, his Majesty’s Inspectorate of Constabulary in Scotland, and Healthcare Improvement Scotland will undertake a joint review of Adult Support and Protection (ASP) in Moray. The review is to assess the progress of the Multi- Agency Improvement Plan following the Joint Inspection of ASP in Moray Page 182
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completed in June 2022. The progress review is now underway. The Care Inspectorate will publish their findings on 29 October 2024. Clinical Risk Management (CRM) 4.5 The CRM group continues to meet every 2 weeks to discuss issues highlighted on the HSCM Datix dashboard. This includes Level 1 and Level 2 investigations, Complaints, Duty of Candour and Risks. 4.6 The group is attended by members of the Senior Management Team, Clinical Leads, Chief Nurse and relevant Service Managers. The purpose is to ensure that senior managers are assured of the standards of services and that where necessary investigations are carried out appropriately, and learning opportunities identified and shared following adverse events and complaints. 4.7 Any learning identified is presented and discussed at all relevant operational meetings. Complaints and Feedback 4.8 HSCM complaints information for Quarter 1, 2024/25 is included in a separate report on today’s agenda. Adverse Events (AE) 4.9 Information about AE reported on Datix during Quarter 1, 2024/25 is available at Appendix 1. 4.10 There was a significant rise in AE recorded on Datix during Q3 of 2023/24. The increase can be attributed to our mental health inpatient areas. Some inpatients can display higher levels of distress, violence and aggression, and this results in more recorded incidents. Findings and Lessons Learned from incidents and reviews 4.11 A Level 1 review consists of a full review team who have been commissioned to carry out a significant event analysis and review, reporting findings and learning via the division/service governance structures. 4.12 There are currently 3 Level 1 reviews in progress (at the time of reporting). 4.13 One Level 1 review has concluded since the last update to Committee. Agreed actions are underway which includes sharing the outcome and associated learning at all relevant meetings. HSCM Risk Register 4.14 Each Clinical Service Group/Department highlights risks associated with their service, which are then discussed at CRM. The risk register is routinely reviewed with leads with guidance and support provided regarding updates. Work is ongoing to review and improve this process and this will be discussed at OMT every month. Page 183
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4.15 New risks identified on Datix are discussed at CRM. There is an ongoing review of the operational risk registers. At the time of reporting, there are 43 risks on the risk register. These are monitored and reviewed as appropriate, by the service managers. Duty of Candour 4.16 At the time of reporting there is 1 ongoing Duty of Candour incident. Items for escalation to the Clinical and Care Governance Committee GMED (the NHS out of hours service) 4.17 In July, the GMED service faced significant challenges in maintaining safe fill rates for all rotas, including admin, drivers, and clinicians. The average rota fill rate for the month was 79% (GOPES Level 3), with some weekends dropping to as low as 50-60% (GOPES Level 4). The primary factors contributing to this issue were the high percentage of bank staff and the extended summer holiday period, which led to fewer staff picking up shifts during the popular school holiday period. 4.18 Due to the extremely limited rota coverage during various weekends in July, GMED activated the surge plan on the weekend 20th and 21st of July. The activation of the surge plan involves a list of clear priorities for the service to action but also necessitates the reduction or cessation of some service elements, impacting other services, such as redirection from other parts of the system. However, patient safety remains the primary focus of all decision- making. 4.19 This situation prompted broader discussions about the surge plan, redirection policies, the benefits of a whole system meeting, and escalations into the wider system to address some of the issues faced by the services involved. 4.20 Rota coverage is now improving as the region approaches the end of the school summer holiday period, with the rota now averaging 80-83% coverage, and the pressures on service delivery decreasing. 4.21 The GMED Service is currently undergoing a service redesign, which is anticipated to address some, if not all, factors affecting staffing levels and future rota coverage, including extended holiday periods. 5. SUMMARY OF IMPLICATIONS (a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and Moray Integration Joint Board Strategic Plan “Partners in Care 2022 – 2032” As set out within Annex C of the Health and Social Care Integration Public Bodies (Joint Working) (Scotland) Act 2014 Clinical and Care Governance Framework. Page 184
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(b) Policy and Legal Clinical and Care Governance requirements are set out within the Moray Health and Social Care Integration Scheme. Appropriate arrangements must be in place to ensure and evidence good governance in meeting duties under the Public Bodies (Joint Working) (Scotland) Act 2014. (c) Financial implications None directly associated with this report. (d) Risk Implications and Mitigation There are systems and processes in place across service areas to support clinical governance, providing assurance to the HSCM Senior Leadership Team and to the CCG Committee. There are platforms within Health and Social Care to discuss and share good practice, learning and challenges. Moray Integration Joint Board (MIJB), Moray Council and NHS Grampian could find themselves exposed to significant risks if good governance is not in place. The purpose of this report is to oversee the processes to ensure that appropriate action is taken in response to adverse events, scrutiny reports/action plans, safety action notices, feedback, complaints and litigation, and those examples of good practice and lessons learned are disseminated widely. Adverse events and complaints provide significant information on trends relating to risk and an encouraging opportunity for learning across the system. Regular monitoring of this is critical to ensure continuous improvement and the ambition of achieving excellence in our delivery of high quality care and treatment. The local CRM group reviews all events logged on Datix, ensuring risk is identified and managed. (e) Staffing Implications This activity is core to all practitioners in the front line both in terms of their professional competence and assurances in care delivery. (f) Property None directly arising from this report. (g) Equalities/Socio Economic Impact There is no requirement for an equality impact assessment because there is no change to policy required as a result of this report. (h) Climate Change and Biodiversity Impacts None directly arising from this report. (i) Directions None directly arising from this report. Page 185
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(j) Consultations Consultations have been undertaken with the following staff who are in agreement with the content of this report where it relates to their area of responsibility: • HSCM Clinical and Care Governance Group members • Sonya Duncan, Corporate Manager • Caroline O’Connor, Committee Services Officer, Moray Council • Dental Clinical Lead • Consultant Practitioner, Adult Support and Protection Lead • Service Manager, Out of Hours Primary Care (GMED) 6. CONCLUSION 6.1 The HSCM CCG Group are assured that issues and risks identified from complaints, clinical risk management, internal and external reporting, are identified and escalated appropriately. The group continues to develop lines of communication to support the dissemination of information for action and sharing of good practice throughout the whole clinical system in Moray. This report aims to provide assurance to this Committee that there are effective systems in place to reassure, challenge and share learning. Author of Report: Isla Whyte, Corporate Business Support Manager, HSCM Background Papers: with author Ref: Page 186
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APPENDIX 1 Adverse Events by Category and Level of Review Reported on Datix (Quarter 1, 2024/25) Table 1 Level 3 - local review by line manager in discussion with staff Level 2 - local management team review Level 1 - significant adverse event analysis and review Total Abusive, violent, disruptive or self-harming behaviour 100 0 1 101 Access, Appointment, Admission, Transfer, Discharge (Including Absconders) 15 1 0 16 Accident (Including Falls, Exposure to Blood/Body Fluids, Asbestos, Heat, Radiation, Needlesticks or other hazards) 72 2 0 74 Clinical Assessment (Investigations, Images and Lab Tests) 2 0 0 2 Consent, Confidentiality or Communication 3 0 0 3 Diagnosis, failed or delayed 2 0 0 2 Financial loss 4 0 0 4 Fire 6 0 0 6 Implementation of care or ongoing monitoring/review (inc. pressure ulcers) 8 3 0 11 Infrastructure or resources (Staffing, Facilities, Environment, Lifts) 6 0 0 6 Medical device/equipment 3 0 0 3 Medication 21 1 0 22 Other - please specify in description 39 1 0 40 Patient Information (Records, Documents, Test Results, Scans) 4 0 0 4 Security (no longer contains fire) 5 0 0 5 Treatment, Procedure (Incl. Operations or Blood Transfusions etc.) 1 0 0 1 Total 291 8 1 300 Item 9. Page 187
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Adverse Events by Type and Result Reported on Datix (Quarter 1, 2024/25) Graph 1 0 20 40 60 80 100 120 140 160 180 AdverseEvents by Type and Result Near Miss (event prevented) Event resulted in NO injury, harm or ill-health Event resulted in injury, harm or ill-health Page 188
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Adverse Events by Service and Level of Review Reported on Datix (Quarter 1, 2024/25) Table 2 Level 3 - local review by line manager in discussion with staff Level 2 - local management team review Level 1 - significant adverse event analysis and review Tot al Allied Health Professionals 13 1 0 14 Community Hospital Nursing 82 1 0 83 Community Nursing 21 2 0 23 Community Pharmacy 0 1 0 1 Community Therapy Services 3 0 0 3 GMED 10 1 1 12 Mental Health - Adult Mental Health 89 0 0 89 Mental Health - Old Age Psychiatry 53 0 0 53 Mental Health - Specialisms 4 1 0 5 Primary Care 2 0 0 2 Public Dental Service 7 0 0 7 Vaccination Transformation Programme 6 1 0 7 Administration 1 0 0 1 Total 291 8 1 300 Page 189
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Adverse Events by Type and Severity Reported on Datix (Quarter 1, 2024/25) Table 3 NEGLIGIBLE: Negligible/no injury or illness, negligible/no disruption to service, negligible/no financial loss MINOR: Minor injury or illness, short term disruption to service, minor financial loss MODERATE: Significant injury, externally reportable e.g. RIDDOR, some disruption to service, significant financial loss MAJOR: Major injury, sustained loss of services, major financial loss Total Breach of Information / IT Security 0 1 0 0 1 Patient / Client / Resident 192 40 5 0 237 Staff (including Volunteers) 16 6 1 1 24 Student or Trainee 3 0 0 0 3 Visitors, Relatives or member of the Public 3 0 0 0 3 Provision of Service 22 1 0 0 23 Property / Equipment 16 2 0 0 18 Issue for discussion at M&M or Risk Man. mtg 1 0 0 0 1 Inadequate Discharge 3 0 0 0 3 Total 256 50 6 1 313 Page 190
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All adverse events by result by Quarter on Datix Table 4 2021/22 Quarter 4 2022.23 Quarter 1 2022/23 Quarter 2 2022/23 Quarter 3 2022/23 Quarter 4 2023/24 Quarter 1 2023/24 Quarter 2 2023/24 Quarter 3 2023/24 Quarter 4 2024/25 Quarter 1 Occurrence with NO injury, harm or ill-health 189 218 214 283 200 210 270 327 235 217 Occurrence resulting in injury, harm or ill-health 79 89 98 78 60 73 76 71 70 69 Near Miss (occurrence prevented) 31 29 40 38 20 22 26 50 31 27 Property damage or loss 0 0 0 0 0 0 0 0 0 0 Death 0 0 0 0 0 0 0 0 0 0 Total 299 336 352 349 280 305 372 448 336 313 Adverse Events by Severity Reported by Quarter on Datix Table 5 2021/22 Quarter 4 2022/23 Quarter 1 2022/23 Quarter 2 2022/23 Quarter 3 2022/23 Quarter 4 2023/24 Quarter 1 2023/24 Quarter 2 2023/24 Quarter 3 2023/24 Quarter 4 2024/25 Quarter 1 Negligible 231 259 264 283 226 240 305 388 274 256 Minor 64 70 78 60 48 58 61 52 53 50 Moderate 2 4 8 5 6 5 6 8 9 6 Major 2 1 2 0 0 1 0 0 0 1 Extreme 0 2 0 1 0 1 0 0 0 0 Total 299 336 352 349 280 305 372 448 336 313 Page 191
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REPORT TO: MORAY INTEGRATION JOINT BOARD CLINCAL AND CARE GOVERNANCE COMMITTEE ON 29 AUGUST 2024 SUBJECT: PROGRESS REPORT ON MORAY UNPAID CARERS STRATEGY BY: SERVICE MANAGER PROVIDER SERVICES 1. REASON FOR REPORT 1.1 This report provides an update to the Committee on the progress in delivering on the objectives within the carer strategy. The Carers (Scotland) Act 2016 requires the Moray Integration Joint Board (MIJB) to prepare and review a local carer strategy. 2. RECOMMENDATION 2.1 It is recommended that the Committee: i) note the progress made in meeting the objectives within the strategy; ii) note the challenges in delivering the key objectives for Year 1 of the strategy; and iii) instruct the Lead Officer for Unpaid Carers to report back to Clinical and Care Governance Committee on a quarterly basis, as a minimum, to monitor the progress of the actions within the strategy. 3. BACKGROUND 3.1 Unpaid carers provide vital support to the people they care for and are fundamental to Moray’s health and care system. It is estimated that around 16,200 people in Moray are likely to be providing some form of care to a partner, family member, friend or neighbour who could not manage without their support. 3.2 The local strategy launched on 1 April 2023 supports the national vision of Valuing, Recognising and Supporting Carers. The key strategic outcomes for Scotland include: • Carers are recognised and their contribution is understood and valued by society. Item 10. Page 193
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• Carer’s voices are heard, and their views and experiences are taken into account in decisions which affect them. 3.3 The three strategic priorities for Health and Social Care Moray’s Unpaid Carer Strategy are: • Recognition for Carers • Valuing Carers • Supporting Carers 3.4 Following on from engagement with carers our year 1 priorities focussed on Recognition for Carers, predominately our focus to raise the profile of all carers of all ages in Moray, and support individuals to both recognise carers, and be recognised as carers, as early as possible in their caring role as the first step to support. 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 A Health & Social Care Moray (HSCM) Unpaid Carers Strategy Group has been established to monitor on a regular basis the progress of the Unpaid Carers Strategy Implementation Plan, with the next meeting due to take place on Thursday 5 September 2024. Challenges that are currently being faced have been highlighted to the group along with outcome achievement dates reviewed within the implementation plan 4.2 Moray is continuing to recognise and support unpaid carers through the work undertaken by the Day Opportunities team, where a Self-Directed Support (SDS) Enabler has been identified as a dedicated unpaid carers champion, who will collaborate closely with the Social Worker for Unpaid Carers to deliver on the Strategic objectives. The post for the Social Worker Unpaid Carers has been vacant since November 2023 and has impacted on the ability to directly support unpaid carers resulting in a back log of both Adult Carer Support Plans and Young Carer Statements needing actioned. There has now been successful recruitment to the post of Social Worker for Unpaid Carers, with a start date of 12 August 2024. An action plan has been developed for the post holder to progress the outstanding work. The post of Social Worker for Unpaid Carers has allocated responsibilities to within the strategy to support the achievement of objectives and this has been delayed due to the post vacancy. 4.3 It can be confirmed that the unpaid carer support contract has gone to tender and awarded to Quarriers to deliver information, support, advice and to offer both Adult Carer Support Plans and Young Carer Statements. The contract commenced on 1 January 2024 for a three-year period. The Carers Team have been closely working alongside the Carers Support Service and Commissiong to try and ensure that the key outcomes are delivered in line with the Unpaid Carer Strategy. 4.4 Work has been undertaken by the Carers Team, alongside the Commissioning Team to support the Unpaid Carer Contract outcomes to be embedded within the commissioned Unpaid Carer Service practice. This includes establishing robust monitoring of data and efficiency management against the strategic outcomes of the Unpaid Carers Strategy. The Service Manager Provider Services and the Unpaid Carers lead will take the delivery plan to Audit, Page 194
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Performance and Risk Committee and will provide a full update based on the challenges in year 1 and completed actions for year 2 on 30 January 2025. 4.5 Work has also been undertaken with the aim of identifying a true budget for Carers when eligibility is met for SDS in their own right. Following on from the collaborative work undertaken with Social Work Scotland (SWS), an in-depth analysis was undertaken using the SWS draft self-evaluation framework. This has provided the foundations to develop the systems and processes required in order to meet our duties within the Social Care (Self-Directed Support) (Scotland) Act 2013. This work will now be considered through the overarching workstream looking at receiving the SDS Resource Allocation System (RAS) and price point. Through incorporating the carers work into this workstream, it ensures efficiency, avoids duplication of work ensuring the two processes complement each other. 4.6 There have been some challenges in embedding the new contract related to compliance with General Data Protection Regulations (GDPR) in relation to the current forms being used for referrals, registration and the data collected on the Adult Carer Support Plans. A significant amount of time has been invested to resolve concerns and ensure compliance both with data protection and the sharing of data between the Commissioned Service and Moray Council 4.7 There has been limited capacity within the Carers Team over the previous 2 years, which has impacted the ability to meet the Unpaid Carer Strategy objectives of year 1. This is due to the necessary focus on operational delivery specifically relating to the vacant Social Work post. The day-to-day compliance with the Carers (Scotland) Act 2016 and supporting the tender process of the commissioned carers service through to embedding the requirements of the new contract has taken significant staff time to manage which has subsequently directed the focus away from the strategic objectives. 4.8 The actions identified within the implementation plan for year 1 that are related to young carers have not been achieved due to having a vacant Young Carer Strategy Officer post. This post has been vacant since August 2022, and whilst the remaining staff within the Carers Team have been trying to sustain operational support, it has been challenging to deliver on the key objectives in relation to Young Carers. Discussions around recruitment to the vacant post are ongoing. 4.9 The Carers Team have commenced a collaborative project with Elgin Health Centre to support the early identification and recording of unpaid carers, and to ensure unpaid carers can access the support they require in a timely manner. The collaborative work between the Carers Team and Elgin Health Centre will primarily focus on awareness raising for practice staff to support the identification of unpaid carers, and to improve data collection through the promotion of Equal Partners in Care (EPiC’s) unpaid carer training on TURAS and SSSC badges. A project lead within the practice has been identified to work alongside the Carers Team to take the project forward. 4.10 Identification of unpaid Carers within Elgin Health Centre will be further supported through the creation of a GP Practice Unpaid Carer Pathway which is currently in draft, alongside the promotion of annual health checks and encouraging unpaid carers to share contingency planning with their GP should Page 195
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they not be able to provide care for a period of time. l. The GP project will initially focus on adult carers, with a vision to expand this to young carers as the project progresses. A project brief has been created and a draft project implementation plan is in place to take the initiative forward. It is anticipated that following an evaluation of the project, the learnings could be rolled out to other GP practices. 4.11 Whilst the report has highlighted the challenges faced in achieving year 1 priorities, it should also be acknowledged that some positive steps have been made and the foundations laid to build upon going into year 2. 5. SUMMARY OF IMPLICATIONS (a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and Moray Integration Joint Board Strategic Plan “Moray Partners in Care 2022 – 2032” Carers who are supported to carry out their role in a way that supports their own health and wellbeing and their educational and economic potential, are key to achieving the ambitions of the Moray IJB Strategy Plan, the Corporate Plan and LOIP. The strategy will support HSCM to demonstrate impact on Outcome 6 of the National Health and Wellbeing Outcomes. Involving unpaid carers, the person they care for, and workers from health and social care services work together as partners they increase the chances of better outcomes for all involved, this aligns with Realistic Medicine, putting people at the centre of decision about care and support, alongside the key priorities highlighted through the work of EPiC. (b) Policy and Legal Having a local carer strategy in place meets the legal obligation on the Moray IJB as prescribed in the Carers (Scotland) Act 2016. It also supports carers right to: • Access a local information and advice service. • Be included in the hospital discharge of the person they are caring for. • Request and Adult Carer Support Plan (if over the age of 18) or a Young Carer Statement (if under aged 18 or younger) • Access Support if they have eligible needs. • Be consulted on services for them and the person they are caring for. (c) Financial implications Annual Carer Act funding is in place to support delivery of the strategy. The actions outlined within the Strategy and Action Plan, including the commissioning of the local information and advice service, require to be delivered within the existing resource envelope and through additional, applied for, funding streams where available. (d) Risk Implications and Mitigation The provisions of the Act are considered to contribute to overall risk Page 196
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management across the responsibilities of the health and social care partnership. Demand for support is likely to increase significantly as more people are identified as carers. Local eligibility criteria is in place to determine whether a carer should receive formal support. (e) Staffing Implications The strategy will be delivered by the workforce in partnership with unpaid carers, the public, third and independent sectors, and the wider community. The vacant post has impacted the ability to achieve the priorities identified for year 1. (f) Property None arising directly from this report. (g) Equalities/Socio Economic Impact Carers are more likely to experience inequality of outcome and more likely to be in poor health than people who do not undertaken a caring role. The strategy aims to enhance equality of opportunity for all carers. (h) Climate Change and Biodiversity Impacts None arising directly from this report. (i) Directions No Direction required. (j) Consultations Consultations have taken place with the Carer Representative on the Board, Assistant SDS & Carers Officer, Provider Service Manager, Carers Strategy Implementation Group, Operational Management Team (OMT), Clinical and Care Governance Group (CCGG). 6. CONCLUSION 6.1 To acknowledge and recognise the importance of our unpaid carers in Moray and the significant work that is required to be undertaken to fully meet our vision of recognising, valuing and supporting unpaid carers. 6.2 For the Committee to note the challenges faced in delivering the objectives as set out in year, but to also acknowledge the work that has been progressed during this period to lay the foundations to build upon in year 2. A full report will be presented to Audit, Performance and Risk Committee towards the end of year 2 on 30 January 2025. Author of Report: Michelle Fleming, Self-Directed Support & Unpaid Carers Team Manager (SDS & Carers Lead Officer) Background Papers: Ref: Page 197
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