OVERVIEW AND SCRUTINY COMMITTEE
THURSDAY 11 JUNE 2009 7.30 PM
COMMITTEE AGENDA
COMMITTEE ROOMS 1& 2 HARROW CIVIC CENTRE
MEMBERSHIP (Quorum 4)
Chairman: Councillor Stanley Sheinwald
Councillors:
Mrs Vina Mithani Mrs Margaret Davine Christopher Noyce Janet Mote B E Gate Anthony Seymour Mitzi Green (VC) Dinesh Solanki Jerry Miles Yogesh Teli Mrs Rekha Shah Mark Versallion
Representatives of Voluntary Aided Sector: Mrs J Rammelt/Reverend P Reece Representatives of Parent Governors: Mrs Despo Speel/Mr Ramji Chauhan
(Note: Where there is a matter relating to the Council’s education functions, the “church” and parent governor representatives have attendance, speaking and voting rights. They are entitled to speak but not vote on any other matter.)
Reserve Members:
1. John Cowan 1. Krishna James 1. Paul Scott 2. Mrs Camilla Bath 2. Phillip O'Dell 3. Ashok Kulkarni 3. Ms Nana Asante 4. Manji Kara 4. Asad Omar 5. Narinder Singh Mudhar 5. Graham Henson 6. Don Billson 7. G Chowdhury
Issued by the Democratic Services Section, Legal and Governance Services Department
Contact: Daksha Ghelani, Senior Democratic Services Officer Tel: 020 8424 1881 E-mail: [email protected]
HARROW COUNCIL
OVERVIEW AND SCRUTINY COMMITTEE MOVED FROM 9 JUNE 2009
THURSDAY 11 JUNE 2009
AGENDA - PART I
1. Attendance by Reserve Members: To note the attendance at this meeting of any duly appointed Reserve Members.
Reserve Members may attend meetings:-
(i) to take the place of an ordinary Member for whom they are a reserve; (ii) where the ordinary Member will be absent for the whole of the meeting; and (iii) the meeting notes at the start of the meeting at the item ‘Reserves’ that the Reserve Member is or will be attending as a reserve; (iv) if a Reserve Member whose intention to attend has been noted arrives after the commencement of the meeting, then that Reserve Member can only act as a Member from the start of the next item of business on the agenda after his/her arrival.
2. Declarations of Interest: To receive declarations of personal or prejudicial interests, arising from business to be transacted at this meeting, from:
(a) all Members of the Committee, Sub Committee, Panel or Forum; (b) all other Members present in any part of the room or chamber.
3. Minutes: (Pages 1 - 18) That the minutes of the meeting held on 21 April 2009 and the special meeting held on 11 May 2009 be taken as read and signed as a correct record.
4. Public Questions: To receive questions (if any) from local residents/organisations under the provisions of Overview and Scrutiny Procedure Rule 8.
5. Petitions: To receive petitions (if any) submitted by members of the public/Councillors under the provisions of Overview and Scrutiny Procedure Rule 9.
6. Deputations: To receive deputations (if any) under the provisions of Overview and Scrutiny Procedure Rule 10.
7. References from Council/Cabinet: (if any).
8. Lead Member Report: (Pages 19 - 28)
9. Harrow Local Involvement Network - Annual Report: (Pages 29 - 42)
10. Safeguarding Adults Annual Report: (Pages 43 - 106) Report of the Corporate Director of Adults and Housing
11. Joint Review Report - Commissioning Services and Support for People with Learning Disabilities and Complex Needs: (Pages 107 - 196) Report of the Corporate Director of Adults and Housing
12. Sustainability Review Scope and Interim Report: (Pages 197 - 214) Report of the Divisional Director of Partnership Development and Performance
13. Use of Resources Challenge Panel: (Pages 215 - 226) Report of the Divisional Director of Partnership Development and Performance
14. Scrutiny Annual Report: (Pages 227 - 256) Report of the Divisional Director of Partnership Development and Performance
15. Draft Scrutiny Work Programme 2009/10: Report of the Divisional Director of Partnership Development and Performance
16. Scrutiny Review - Extended Schools as Community Resources: (Pages 257 - 316) Report of the Divisional Director of Partnership Development and Performance
17. Improving Surgical Services for Children and Young People in Hospitals: (Pages 317 - 330) Report of the Divisional Director of Partnership Development and Performance
18. Any Other Business: Which the Chairman has decided is urgent and cannot otherwise be dealt with.
AGENDA - PART II - Nil
This page is intentionally left blank Agenda Item 3 Pages 1 to 18 OS 281
REPORT OF OVERVIEW AND SCRUTINY COMMITTEE
MEETING HELD ON 21 APRIL 2009
Chairman: * Councillor Stanley Sheinwald
Councillors: * Mrs Camilla Bath (7) * Narinder Singh Mudhar (3) * Mrs Margaret Davine * Phillip O'Dell (2) * B E Gate * Dinesh Solanki * Jerry Miles * Yogesh Teli * Mrs Vina Mithani * Mark Versallion * Janet Mote
Voting (Voluntary Aided) (Parent Governors) Co-opted: * Mrs J Rammelt * Mr R Chauhan Reverend P Reece * Mrs D Speel
* Denotes Member present (2), (3) and (7) Denote category of Reserve Members
[Note: Councillor Chris Mote also attended the meeting to speak on the item indicated at Minute 524 below. Councillors Christine Bednell and Anjana Patel also attended this meeting to speak on the items indicated at Minutes 525-529 below. Councillor Anjana Patel also attended this meeting to speak on the item indicated at Minute 530 below.]
PART I - RECOMMENDATIONS - NIL PART II - MINUTES
517. Attendance by Reserve Members:
RESOLVED: To note the attendance at this meeting of the following duly appointed Reserve Members:-
Ordinary Member Reserve Member
Councillor Mitzi Green Councillor Phillip O’Dell Councillor Manji Kara Councillor Mrs Camilla Bath Councillor Anthony Seymour Councillor Narinder Singh Mudhar
518. Declarations of Interest:
RESOLVED: To note that the following personal interests were declared and that all Members would remain in the room and take part in the discussion and any decision on the items:
Agenda Item Member Nature of Interest
11. Children’s Trust ) Councillor Janet Mote Portfolio Holder for Children’s ) Services from 2006-08, Chair of 12. Adoption Service ) Corporate Parenting Panel and ) daughter worked as a paediatric 13. Children Looked ) nurse for the National Health After Pan-London ) Service. Pledge ) ) 14. Safeguarding ) ) 15. Children and ) Young People’s ) Plan 2009-11 ) ) 16. Extended Schools ) Review – Final ) Report ) ) 17. Progress report ) 1 OS 282 OVERVIEW & SCRUTINY
on Harrow ) Scrutiny's ) response to ) Healthcare for ) London ) Consultation on ) Stroke and Major ) Trauma Services ) in London )
16. Extended Schools ) Councillor Dinesh Daughter being educated at a Review – Final ) Solanki school in Harrow. Report ) ) 18. Place Survey ) Results )
17. Progress report ) Councillor Stanley Chair of Carers’ Partnership on Harrow ) Sheinwald Board. Scrutiny's ) response to ) Councillor B E Gate Married to a health professional Healthcare for ) and daughter worked at a London ) General Practice. Consultation on ) Stroke and Major ) Councillor Mark Non-Executive Director of North Trauma Services ) Versallion West London Hospitals NHS in London ) Trust. ) ) Councillor Mrs Vina Worked for a Health Protection ) Mithani Agency.
519. Minutes:
RESOLVED: That the minutes of the meeting held on 16 March 2009 be taken as read and signed as a correct record.
520. Public Questions:
RESOLVED: To note that no public questions were put at the meeting under the provisions of Overview and Scrutiny Procedure Rule 8. 521. Petitions:
RESOLVED: To note that no petitions were received at the meeting under the provisions of Overview and Scrutiny Procedure Rule 9.
522. Deputations:
RESOLVED: To note that no deputations were received at the meeting under the provisions of Overview and Scrutiny Procedure Rule 10.
523. References from Council/Cabinet:
RESOLVED: To note that there were no references from Council or Cabinet.
524. Delivering a Strengthened Voluntary and Community Sector: In accordance with the Local Government (Access to Information) Act 1985, the minutes of the Harrow Partnership Board’s last meeting were admitted late to the agenda to allow the views of the Board to be taken into consideration in the context of the main report of the Director of Community and Cultural Services. The Board’s minutes had not been available at the time the agenda was printed and circulated as they were being consulted on.
The Chairman welcomed the Portfolio Holder for Community and Cultural Services and the Director of Community and Cultural Services to the meeting.
The Portfolio Holder for Community and Cultural Services introduced the report, which set out Cabinet’s response to the recommendations of the scrutiny review entitled ‘Delivering a Strengthened Voluntary and Community Sector for Harrow’. The Portfolio Holder congratulated Members and the Voluntary Sector representatives for producing 2 OVERVIEW & SCRUTINY OS 283
an outstanding report and commended their achievements. He saw the work of the review group as a good example of cross-party and cross-partnership working in which the partners felt fully involved.
The Portfolio Holder explained that out of the 22 recommendations of the scrutiny review group, seventeen had been implemented, one had not been agreed and the remaining four would be developed further as part of the development of a third sector strategy. The latter, once developed, would initially be presented to Cabinet and thereafter to Overview and Scrutiny Committee. In order to progress the four outstanding recommendations of the scrutiny review group, a Project Working Group had been established and had now had its first meeting.
The Chairman of the Scrutiny Review Group stated that the review group had been a pleasure to work on and all parties concerned had worked well together and felt involved. He questioned the Portfolio Holder on the scope for the Third Sector Strategy and the time line for the implementation of the outstanding recommendations. Other Members asked questions about the establishment of the Community Trust for the purposes of administering the Council’s grant giving function and whether this would emerge from the Third Sector Strategy. They also asked why the recommendation relating to the outsourcing of the management of ‘Harrow Heroes’ awards ceremony had been rejected and whether there were any financial implications relating to this particular recommendation. Members were also concerned about the ownership of the Third Sector Strategy, its composition, best practice elsewhere and the length of time a consultant would be employed to oversee this area of work. A question on the role of a relationship manager was asked.
The Portfolio Holder and the Director responded to Members’ questions and concerns. They advised that a project working group had been set up and a report on a third sector strategy would be submitted to Cabinet in autumn 2009. The four remaining recommendations would fall under the third sector strategy. The establishment of a Community Trust would be considered and if agreed, it would be established by April 2010 but its role for the purposes of the grant-giving function would become effective from 2011. Best practice elsewhere that would suit Harrow would be examined.
In relation to the outsourcing of ‘Harrow Heroes’, the event had been delivered by the Council for the first time last year and a bedding-in period was required. The possibility of outsourcing this event would be examined in the future. There was officer time attached to this event. It was noted that the decision to keep the event in-house at this early stage had been supported by the Harrow Association of Voluntary Services.
Members were informed that the Third Sector Strategy development was government-led. For Harrow, it was being driven by Council officers in partnership with voluntary sector. A number of the Council’s partners and Council officers at the highest levels, would support and oversee the development of the strategy and act as a critical friend. An officer added that every sector would be consulted and representatives from the voluntary sector forum had been tasked with consulting their groups. A further consultation exercise would be carried out at the Harrow Strategic Partnership Summit. The Primary Care Trust (PCT) was also represented and would engage with local communities to ensure that their views were represented and fed back.
The Director informed Members that a consultant had been engaged for a fixed term. It was her role to ascertain best practice. A number of London boroughs had developed a third sector strategy. However it was not intended pick one off the shelf but to tailor one that would suit Harrow. It would be submitted to Cabinet and the Harrow Partnership Board for approval in due course.
The Council would further reflect on the idenitification of a Relationship Manager because of the complexities involved. With regard to the issue of community lettings, further work was necessary amongst the Council’s Directorates. A report would be submitted to the relevant bodies in June 2009. The Portfolio Holder stated that the practicalities of applying the lettings issue to vacant shops were complex, and it was noted that guidance on the recent announcement from the government on the use of derelict shops and associated incentives was awaited.
RESOLVED: That Cabinet’s response to the 22 recommendations from the scrutiny review group be noted.
525. Children's Trust: The Corporate Director of Children’s Services introduced a report, which set out the key recommendations for a Children’s Trust and informed the Committee of the
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progress made in relation to this matter. The report described the role of a Children’s Trust on the basis of guidance issued by the government.
The report pointed out that whilst there were many types of Children’s Trust, the aim was the same, which was to work across professional and agency boundaries to tackle complex problems proactively and make a real difference to the experience and life chances of children, young people and their families.
In Harrow, the Children’s Trust would be made up of a Children’s Trust Board and the Children and Young People Strategic Partnership (CYPSP). The Board would continue to develop the commissioning element of the Trust and the CYPSP would focus on the delivery of the Children and Young People’s Plan. The Trust would be accountable to the Harrow Partnership Board. If there were disagreements amongst the partners that formed the Trust, the status quo would remain.
A Member queried the rationale behind the Trust and how it would alter the lives of children. He questioned how the Trust would benefit or even improve on the existing working arrangements amongst partners.
In response, the Portfolio Holder of Children’s Services and the Corporate Director acknowledged that a Children’s Trust would not alter the lives of children per se and that, in the case of Harrow where there were good working arrangements with partners, they had struggled to identify its potential benefits. However, the initiative would make it difficult for partners to withdraw from agreements in the financing of various projects. It was essential that young people were involved in this initiative from the outset.
A Member stated that she was pleased that the setting up of the Trust had not been fast tracked, however she was of the opinion that it would bring key partners together and raise the profile of the Every Child Matters agenda. The Corporate Director stated that, in Harrow, the focus of the Trust would be to deliver the Children and Young People’s Plan. Costs would be shared amongst the partners, funding would be aligned with CYPP priorities and the focus on outcomes for children would be consistent. The focus would be on children and young people between 0-18 years of age, and beyond if the young person concerned had special needs. Members questioned the liaison arrangements between various sectors where children struggled to move to adulthood. They were informed that the Council had worked strenuously to ensure that the transition arrangements were smooth but it was not complacent about the difficulties encountered by young people, which would be compounded by the current economic climate. The Portfolio Holder for Children’s Services advised Members to take the opportunity to attend a Learning Care Conference, which she considered to be inspirational. She commended the support that the youth of today provided to each other at these conferences.
RESOLVED: That the report be noted.
(See also Minute 518). 526. Adoption Service: The Committee received a report of the Corporate Director of Children’s Services, which outlined the adoption services provided by the Council.
The Portfolio Holder for Children’s Services complimented the work carried out by former Portfolio Holders on the provision of adoption services, on which she had been able to build. She spoke about the exceptional service provided by Children’s Services and informed Members that where it was not possible for looked after children to be reunited with their birth families, the children were provided with a permanent and stable alternative family. She was pleased to report that there had been an exceptional increase in the number of foster families in Harrow. The increase had been recognised by Ofsted.
The Portfolio Holder invited questions from Members of the Committee and responded as follows:
• looked after children were placed in a stable environment within six months. The partnership with Coram adoption agency had help reap benefits, and Harrow ought to be proud that some of its residents adopted two to three children at a time; 4 OVERVIEW & SCRUTINY OS 285
• there were occasions when siblings had to be split up;
• the adoption process was regulated with checks and balances. It was not considered as a contracting arrangement but it was a partnership built over a number of years between social workers and adoptive parents. Families wishing to adopt were counselled, trained and assessed, as a result of which there had been no adoption breakdowns in the last three years;
• in the previous six months, Harrow had seen a rise in the number of babies requiring adoption.
The Corporate Director of Children’s Services explained, in detail, the difference between foster care and adoption and how the two were sometimes interlinked. He informed Members that a care plan was prepared for every looked after child and reviewed on a regular basis.
Harrow did not suffer from the national shortage of foster carers and adoptive parents. The Corporate Director referred to the methods used by the Council to ensure that the problems experienced nationally were not reflected in Harrow. Previous poor relationships between the Council and foster carers had been improved, local and low key campaigns for attracting foster carers and adoptive parents had helped to reap benefits, and work carried out with faith groups and other locally based stakeholders had proved useful. Training, support and networking skills were also provided to prospective foster carers and adoptive parents.
Members were informed that Coram adoption agency had the lowest number of staff vacancies and did not appear to suffer from a lack of social workers. The Corporate Director assured Members that every social worker employed by Harrow was Criminal Records Bureau (CRB) checked. In response to additional questions, the Corporate Director stated that if any family had wanted to adopt through the Action for Children Charity, the Council would assist. Members commended the comprehensive report presented by the Corporate Director and were encouraged by the structures that were in place in Harrow for those wishing to foster and/or adopt. They were particularly pleased that the life storybook, which explained the reasons for their adoption, was available to all looked after children in Harrow. RESOLVED: That the report be noted.
(See also Minute 518).
527. Children Looked After Pan-London Pledge: The Committee considered a report of the Director of Children’s Services, which set out the progress made on the London Pledge that aimed to ensure that children and young people in care across London had equal access to the same range of key services. The report also set out the cost implications of implementing the Pledge and how it could be funded.
The Corporate Director of Children’s Services stated that the London Pledge was an initiative of London Councils and supported by the Mayor of London. Harrow was well placed to meet the demands of the Pledge in that it already provided much that was expected of a local authority.
The Portfolio Holder for Children’s Services stated that Harrow had appointed virtual head teachers who took a special interest in children looked after. A virtual children looked after team had been tasked with implementing the Pledge. When up and running it would become part of the direct work undertaken with each child looked after. Members were concerned about arrangements for children who ran away from home, budget arrangements for running the service and sought further information on whether there was a national pledge, and the type of support given to looked after children who attended further education.
In response, the Corporate Director and the Portfolio Holder stated that Harrow did not suffer greatly from children running away from home. Harrow did have children who ran away from foster carers or children’s homes in order to perform a parenting role for their siblings. Those missing were reported to the police. The Corporate Director undertook to provide details of the spend on running the service and a report on the Council’s corporate parenting role. Members were informed that the problems 5 OS 286 OVERVIEW & SCRUTINY
encountered in London were different from those nationally, as a result of which a London only Pledge had been drawn up. The Council’s role as a parent continued while looked after children were in further education and any money given to them by the Council would not need to be paid back. However, they would need to pay back any student loans taken in the same way as other students.
RESOLVED: That the report be noted.
(See also Minute 518).
528. Safeguarding: The Portfolio Holder for Children’s Services introduced a report, which set out the key actions taken by the Local Safeguarding Children Board (LSCB) following the unfortunate death of Baby P. It was noted that Baby P’s death had prompted a range of actions from central and local government and there had been considerable media comment. In Harrow, actions had been taken to audit cases, brief Councillors, support staff and respond to government guidance and Lord Laming’s report on Baby P.
The Portfolio Holder stated that Harrow had carried out a review of its cases relating to children to ensure that the systems in place were robust. She was confident that Harrow had a stable team of social workers who were well managed. In addition, regular monitoring was carried out by a team of senior managers who carried out random checks on cases. Following the Baby P case, a team of senior managers led by the Corporate Director of Children’s Services had carried out a review of all cases relating to Under 5s.
The Corporate Director of Children’s Services circulated a guide to safeguarding children compiled by the Harrow LSCB. He also circulated articles which had appeared in the national press, which set out Lord Laming’s main concerns and the call from the Society of Local Authority Chief Executives for cash for safeguarding children.
The Corporate Director explained the complexities relating to safeguarding children and the issues around child protection work. He confirmed that since the death of Baby P, the Council and the Police had carried out an audit of all cases and comparisons had been carried out. Training had been carried out at Member level and teachers were also asked to refer concerns for investigation. It was important to collect evidence and gain the trust of parents so that they were confident that assistance was available from social workers and the police. He offered to arrange visits for Members of the Committee to children’s centres, if requested.
In response to a question, the Corporate Director stated that there had been a 45% increase in referrals in the last six months. Early intervention with sensitivity was needed as social workers were viewed with suspicion. Work was also being carried out with hospitals with a view to establishing patterns within communities. The Portfolio Holder for Schools and Children’s Development stated that safeguarding of children crossed boundaries and it was important that the whole Council, particularly the Housing Service, were encouraged to raise the alarm if required.
A Member who was also a governor of a school in Harrow was complimentary of the support given by Children’s Services to governors and headteachers in this regard.
In conclusion, the Corporate Director of Children’s Services informed the Committee that the Vice-Chairman of the LSCB was an independent person who was a General Practitioner. The Corporate Director, as the Chairman of the LSCB, was responsible for routinely challenging the Chief Executives of the local health service providers. He would give consideration to inviting a Member of the Committee to serve on the LSCB.
RESOLVED: That the report be noted. (See also Minute 518).
529. Children and Young People's Plan 2009-11: In accordance with the Local Government (Access to Information) Act 1985, the Committee received a report of the Corporate Director of Children’s Services on the statutory Children and Young People’s Plan 2009-11, which was admitted late to the agenda to allow the Committee to comment on the Plan prior to its consideration by Cabinet and Council. The report had not been available at the time the agenda was printed and circulated in order to ensure that an up-to-date Plan was presented to the Committee.
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The report set out the draft Children and Young People’s Plan, which was a requirement of the Children Act 2004. The Plan represented an agreed list of priorities for children and young people, and provided a vision for what the Council and its Partners wanted to achieve by 2011.
The Corporate Director of Children’s Services described the contents of the Plan, and circulated a timeline and a poster which set out the vision for children and young people in Harrow. Members were informed that the Plan would be submitted to Cabinet on 23 April 2009 and thereafter to Council for approval. The Plan would be launched in May 2009.
It was noted that the Plan would be published electronically on both the Council and the Harrow Youth websites. Printed copies of the poster and the young people’s version of the Plan would be distributed throughout Harrow.
In welcoming the Plan, Members of the Overview and Scrutiny Committee and a co-opted member serving on the Committee asked questions about the consultations that had taken place, the age range of children and young people to whom the Plan applied, the types of assessments that would be carried out and by whom, and how some of the more challenging actions, for example, under the ‘Be Healthy’ agenda would be addressed in the light of staff shortages, particularly in the midwifery service.
In response, the Corporate Director stated that the Plan had been agreed with the Council’s Partners and various stakeholders had been consulted. Children and young people within the age range of 6-23 had also been consulted. The Council would ‘own’ the Plan and ensure that it was delivered on. The delivery of actions set out in the Plan would have to be debated by a Children’s Trust, a body that was in the process of being set up to enable and ensure joint working amongst Partners for the benefit of children and families. The government would assess the Council and its Partner, including schools, on the delivery of the Plan.
A Member stated that he was encouraged by the support available to children in Harrow, which he considered to be robust. It was important that children’s rights were defended and that the best possible protection was available for children in the 21st Century to ensure healthy adulthood. Another Member suggested that further changes to the Plan should only be made provided they were in the interest of children and young people. A co-opted member stated that the Plan did not address the needs of the most able pupils and that the support provided to those children ought to be reflected in the Plan under the ‘Enjoy and Achieve’ priority.
In response to these concerns, the Portfolio Holders and the Corporate Director assured the Committee that:
• the Council’s Achievement and Inclusion Team addressed and supported the needs of gifted children, including those pupils with special needs. The Portfolio Holder for Schools and Children’s Development undertook to provide details of the programme that underpinned this area. She acknowledged the observation made by the co-opted member in relation to the inclusion of support provided to gifted children in the Plan;
• changes to the Plan would be made on the basis that they were in the interest of children and young people.
The Corporate Director highlighted the role of the Council and its Partners in ensuring collective responsibility and accountability towards children and young people from conception up to the age of 25 years. RESOLVED: That (1) the report be noted;
(2) the comments of the Overview and Scrutiny Committee, as set out above, be submitted to Cabinet for consideration.
(See also Minute 518).
530. Extended Schools Review - Final Report: The Chairman of the Extended Schools Review Group informed the Committee that the report of the Review Group would be submitted to the June 2009 meeting of the Committee and explained the reasons for the delay. She explained that time was needed to produce a cohesive report, and provided a flavour of the recommendations of the Review Group.
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During the review, Members of the Review Group had been heartened by examples of good practice and ideas, such as the parent ambassador initiative. The level of performance across clusters had varied. A draft report of the Review Group would initially be circulated to the Members of the Review Group for comment prior to it being released widely.
The Portfolio Holder for Schools and Children’s Development stated that she looked forward to the report of the Review Group and how it would help Harrow schools, particularly children whose first language was not English.
The Portfolio Holder and the Chairman of the Review Group agreed to meet to discuss the preliminary report.
RESOLVED: That the report of the Scrutiny Review Group on Extended Schools be submitted to the 9 June 2009 meeting of the Overview and Scrutiny Committee.
(See also Minute 518).
531. Place Survey Results: In accordance with the Local Government (Access to Information) Act 1985, Members received a report of the Assistant Chief Executive, which was admitted late to the agenda to allow Members to be briefed on the results of the Place Survey. The report had not been available at the time the agenda was printed and circulated as comparative figures had been awaited for inclusion in the report.
An officer introduced the report, which set out the results of the Place Survey and highlighted the most significant outcomes. He stated that whilst London-wide results were not available at the time of writing the report to help put the survey into context, the net -30 percentage points rating for promoting the interests of local residents and a net -18 percentage points rating for acting on the concerns of local residents was not good news. As a result, the Council’s Corporate Strategy Board (CSB) had asked that these outcomes be addressed. A report setting out the actions that needed to be taken would initially be submitted to the CSB and thereafter to Overview and Scrutiny Committee.
The officer responded to questions from Members and a co-opted member and confirmed that for parks and open spaces, the net percentage point satisfaction rating was +40. He undertook to supply all members of the Committee with the comparative data for inner and outer London which had recently been released. In relation to personal safety, a significant visible presence of the Safer Neighbourhood Teams had improved outcomes. However, it was noted that a net -2% of Harrow’s population felt safe outside after dark.
Members were informed that the survey had been carried out between October and December 2008 and the officer agreed that if it had been conducted any later the results would have been different due to the economic downturn. He advised against comparing the recent Place Survey results with previous MORI surveys because of the use of different sample sizes.
It was noted that local authorities were required to conduct a Place Survey every two years but the view of Harrow Council was that this was insufficient. As a result, a survey would be conducted by the Council every year and appropriate remedial action taken to address issues. This course of action would help build patterns, trends and improve performance.
RESOLVED: That (1) the results of the Place Survey be noted; (2) a report be submitted to the 28 July 2009 meeting of the Overview and Scrutiny Committee on actions that had been taken to address issues relating to perceptions of public services in Harrow working to promote the interests of local residents, acting on the concerns of local residents and enabling people to influence decisions in their local areas. (See also Minute 518).
532. Progress report on Harrow Scrutiny's response to Healthcare for London Consultation on Stroke and Major Trauma Services in London: An officer introduced a report, which provided an update on the work of the pan-London Joint Overview and Scrutiny Committee (JOSC) and the Harrow Healthcare for London (HfL) scrutiny working group. She informed Members that the next meeting of the working group would take place on 28 April 2009 and would involve 8 OVERVIEW & SCRUTINY OS 289
discussions with stakeholders. Harrow’s response to the HfL consultation would subsequently be drafted for submission by 8 May 2009.
Members welcomed the comprehensive report.
RESOLVED: That (1) the progress made by the pan-London JOSC and Harrow HfL scrutiny working group be noted;
(2) local issues be given particular consideration by the Harrow HfL scrutiny working group in developing Harrow scrutiny’s response to the HfL consultation;
(3) Harrow’s response to the HfL consultation be signed off by the Chairman of the Overview and Scrutiny Committee in liaison with members of the scrutiny working group.
(See also Minute 518).
533. Scrutiny Work Programme 2009/10: In accordance with the Local Government Act (Access to Information) Act 1985, the Committee considered a report of the Assistant Chief Executive, which set out initial proposals for the Scrutiny Work Programme for 2009/10, and which was admitted late to the agenda to allow the initial proposals of the Scrutiny Work Programme to be agreed at the earliest opportunity. The report had not been available at the time the agenda was printed and circulated as it was being consulted on.
The Work Programme included work areas that were continuing and those that were evolving, some of which had been derived from the Performance and Finance Scrutiny Sub-Committee’s investigations. The scopes for the agreed Sustainability Review and the proposed Review of the Performance of the Council’s Contract with Kier were included in the report.
An officer asked for a steer from the Committee as to the projects that should form the Work Programme and informed Members that a further report would be submitted to the June 2009 meeting proposing a final Programme for 2009/10 for approval. She advised Members that capacity for carrying out in-depth reviews was limited. The Committee was mindful that the majority of the Work Programme ought to be completed by January 2010 in light of the local elections in May 2010. Members discussed the projects set out in the Work Programme. Particular attention was paid to the type of review that ought to be carried out in relation to the partnership arrangements between the Council and the Kier Group. Members were of the view that whilst Kier Group’s performance on the school programme was good, the work relating to housing maintenance was of concern and ought to be scrutinised. A time and motion study in relation to housing repairs carried out by the Kier Group would be helpful.
Members agreed that work on the current projects should continue and made the following observations in relation to the list of proposed projects:
Proposed Project Comments
Communications and Fear of Crime ) projects to be linked as one Young People and Crime )
Community Cohesion to be included as part of the current Sustainability Review project
Adults and Housing Transformation Plan Project agreed
Safeguarding Children Project agreed - To concentrate on the transition arrangements for Children’s Services
Preparing for CAA Project agreed
Residents’ attitude Survey Experion/ Project to be deleted Vitality Profiles Joint Analytical Group Community Engagement Process
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Community Lettings Project agreed pending the report of the Director of Community and Cultural Services in June 2009
Grants Criteria Project agreed with a view to a review being completed in May 2009
Equalities Project deleted
Housing Revenue Account Project agreed
Performance of the Kier Contract Project on Minor Works relating to Housing Repairs
RESOLVED: That (1) in the light of ongoing commitments and infrastructure projects being undertaken by the scrutiny team, the comments above be taken into consideration in relation to the scrutiny work programme for the period up to January 2010;
(2) the scrutiny team be authorised to undertake further consultation on the proposed projects;
(3) a further report be submitted to the June 2009 meeting of the Overview and Scrutiny Committee, to include further comment on the agreed projects and any additional projects identified during the consultation;
(4) the scope for the review of sustainability that was agreed as a part of the previous year’s work programme be re-affirmed;
(5) the review of the performance of the Council’s contract with the Kier Group on the basis set out above - a project on minor works relating to housing repairs - be expedited and the scope of the review which would need to be revised in the light of the discussion above, be not agreed;
(6) membership of the scrutiny review group for the review of the Kier Group be sought by scrutiny officers by email;
(7) membership of the scrutiny review group for the review of the Grants Criteria be sought by officers by email.
534. Minutes of the Performance and Finance Scrutiny Sub-Committee Meeting held on 31 March 2009: In accordance with the Local Government Act (Access to Information) Act 1985, the minutes of the Sub-Committee meeting held on 31 March 2009 were admitted late to the agenda so that actions arising from the minutes could be agreed and taken, as appropriate. The minutes had not been available at the time the agenda was printed and circulated as they were being consulted on. RESOLVED: That the actions arising from the minutes of the Performance and Finance Scrutiny Sub-Committee meeting held on 31 March 2009 be noted and, insofar as was necessary, agreed.
535. Report from Lead Scrutiny Members: The Committee considered a written report of the issues considered by the Scrutiny Lead Members for Sustainable Development and Enterprise meeting held 9 March 2009. It was noted that Scrutiny lead Members for Corporate Effectiveness and Finance had also met since the report was written and a written report on the outcomes would be submitted to a future meeting of the Committee.
RESOLVED: That (1) the Scrutiny Lead Members for Sustainable Development and Enterprise:
• monitor progress on Decent Homes and the Sustainable Design Supplemental Planning Document;
• monitor what is being done by and within the Council, as well as nationally, to provide assistance to enterprises and economic development;
10 OVERVIEW & SCRUTINY OS 291
• contact the Corporate Complaints Officer for any further queries, information regarding the complaint or the complaints process relating to the complaint received in February 2009;
(2) the Scrutiny Lead Members for Sustainable Development and Enterprise and other Members involved in the review group consider the Sustainable Communities Act during the sustainability review.
536. Report from the Performance and Finance Scrutiny Sub-Committee Chairman: The Chairman of the Performance and Finance Scrutiny Sub-Committee introduced a report, which set out the items that had been considered by the Sub-Committee at its meeting on 31 March 2009. A number of these items had also been set out in the report on Scrutiny Work Programme 2009/10, which was also on the agenda. He stated that it would not be prudent to carry out an in-depth investigation into the Kier Partnership.
Members considered the recommendations and it was
RESOLVED: That (1) the issues set out in the report of the Performance and Finance Sub-Committee meeting held on 31 March 2009 be noted;
(2) following on from the Performance and Finance Scrutiny Sub-Committee meeting held on 21/01/09 and subsequent discussions with the Divisional Director of Housing, an investigation into the Housing Revenue Account, dependent upon information received from Housing in July 2009, be approved;
(3) the Performance and Finance Scrutiny Sub-Committee carry out a review - a project on minor works relating to housing repairs - of the Council’s partnership with the Kier Group. (See also Minute 533).
537. Any Other Business:
(i) Cabinet Decisions The Chairman reported that concerns had been raised with the Leader. It was confirmed that hard copies of the decisions would no longer be circulated to the co-opted members of the Committee.
(ii) Care Matters – Harrow’s response to the Children and Young Person’s Bill 2007 – Mandatory Training Sessions The Chairman of the Corporate Parenting Panel stated that a training session for Councillors on their corporate parenting role would be included as part of a session scheduled to take place on 22 June 2009. A dedicated session would be considered and would depend on the popularity of the session on 22 June.
Members were disappointed that the session was not mandatory and it was
RESOLVED: That the Chairman of the Overview and Scrutiny Committee write to the Leaders and the Chief Whips of the political parties urging that Members be whipped to attend the training session on the corporate parenting role of Councillors scheduled to be held on 22 June 2009, or to a later session, to be held on another day, if required.
(iii) Overview and Scrutiny Committee – October 2009 It was reported that the October 2009 meeting of the Overview and Scrutiny Committee had been re-arranged and the Committee would now meet on 12 October instead of 7 October 2009.
(iv) Scrutiny Manager, Lynne Margetts The Chairman stated that Lynne Margetts would be running the London Marathon on 26 April 2009 in support of the Teenage Cancer Trust and he urged all to support her in this brave effort.
(v) Vote of Thanks The Chairman thanked Members and Officers for their support in the work relating to the Committee during the current municipal year.
11 OS 292 OVERVIEW & SCRUTINY
538. Extension and Termination of Meeting: In accordance with the provisions of Overview and Scrutiny Committee Procedure Rule 6.6 (ii) (Part 4B of the Constitution) it was
RESOLVED: At (1) 10.00 pm to continue until 10.30 pm;
(2) at 10.30 pm to continue until 10.45 pm.
(Note: The meeting, having commenced at 7.00 pm, closed at 10.40 pm).
(Signed) COUNCILLOR STANLEY SHEINWALD Chairman
12 OS 293
REPORT OF OVERVIEW AND SCRUTINY COMMITTEE
(SPECIAL) MEETING HELD ON 11 MAY 2009
Chairman: * Councillor Stanley Sheinwald
Councillors: * Ms Nana Asante (3) * Phillip O'Dell (2) * Mrs Margaret Davine * Paul Scott (1) * B E Gate * Anthony Seymour * Jerry Miles * Dinesh Solanki * Mrs Vina Mithani * Yogesh Teli * Janet Mote * Mark Versallion Voting (Voluntary Aided) (Parent Governors) Co-opted: † Mrs J Rammelt † Mr R Chauhan † Reverend P Reece Mrs D Speel
* Denotes Member present (1), (2) and (3) Denote category of Reserve Members † Denotes apologies received PART I - RECOMMENDATIONS - NIL
PART II - MINUTES
539. Welcome and Announcements: The Chairman welcomed former and new Members of the Overview and Scrutiny Committee to the inaugural meeting of the Committee for the Municipal Year 2009/10.
Members expressed regret at being informed of the death of the husband of Councillor Mitzi Green. The Chairman undertook to send condolences on behalf of the Committee. The Committee was pleased to be informed that Harrow Council had been shortlisted for the Annual Good Scrutiny Award.
540. Attendance by Reserve Members:
RESOLVED: To note the attendance at this meeting of the following duly appointed Reserve Members:-
Ordinary Member Reserve Member
Councillor Mitzi Green Councillor Phillip O’Dell Councillor Chris Noyce Councillor Paul Scott Councillor Mrs Rekha Shah Councillor Ms Nana Asante
541. Declarations of Interest:
RESOLVED: To note that there were no declarations of interests made by Members in relation to the business transacted at this meeting.
542. Appointment of Vice-Chairman:
RESOLVED: To appoint Councillor Mitzi Green as Vice-Chairman of the Overview and Scrutiny Committee for the 2009/10 Municipal Year. 543. Minutes:
RESOLVED: That the minutes of the meeting held on 21 April 2009 be deferred to the next ordinary meeting of the Committee.
544. Establishment of Sub-Committees for 2009/10: The Committee considered a report setting out the proposed memberships and Chairmen of the Sub-Committees for 2009/10 which, in accordance with the Local Government (Access to Information) Act 1985, was admitted late to the agenda in order to enable the scheduled meetings of the Sub-Committees to be convened. The 13 OS 294 OVERVIEW & SCRUTINY
report was not available at the time of the despatch of the main agenda, as it was being consulted upon.
RESOLVED: That the Sub-Committees of the Overview and Scrutiny Committee be established for the Municipal Year 2009/10 with the memberships and Chairmen detailed in Appendix 1 to these minutes.
545. Appointment of Lead Members for Scrutiny 2009/10: The Committee received a report setting out the proposed Lead Members for Scrutiny for 2009/10 which, in accordance with the Local Government (Access to Information) Act 1985, was admitted late to the agenda so that the appointments could be made and the Lead Members assume their areas of responsibility. The report was not available at the time of the despatch of the main agenda, as it was being consulted upon.
RESOLVED: That the Policy and Performance Lead Members be appointed for the Municipal Year 2009/10, as detailed in Appendix 2 to these minutes.
546. Dates of Meetings of the Overview and Scrutiny Committee for the Municipal Year 2009/10: Members received a tabled paper which set out a corrected list of the dates of Overview and Scrutiny Committee meetings in 2009/10.
RESOLVED: To note the dates of meetings of the Overview and Scrutiny Committee for the Municipal Year 2009/10, as follows:
2009 - 9 June - 7 July (Special) - 28 July - 3 September - 24 September - 12 October - 3 November - 24 November - 8 December (Special)
2010 - 28 January (Special) - 23 February - 16 March - 13 April - 27 April - 26 May
(Note: The meeting, having commenced at 6.45 pm, closed at 6.55 pm).
(Signed) COUNCILLOR STANLEY SHEINWALD Chairman
14 OVERVIEW & SCRUTINY OS 295
APPENDIX 1
SCRUTINY SUB COMMITTEES
(Membership in order of political group nominations)
Conservative Labour Liberal Democrat
(1) PERFORMANCE AND FINANCE SCRUTINY SUB-COMMITTEE (11)
(6) (4) (1)
I. Ashok Kulkarni Ms Nana Asante Christopher Noyce Janet Mote B E Gate * Members Anthony Seymour Philip O’Dell Dinesh Solanki Mrs Rekha Shah Yogesh Teli Mark Versallion (CH)
II. 1. John Cowan 1. Mitzi Green 1. Paul Scott Reserve 2. Manji Kara 2. Mrs Margaret Davine Members 3. Jeremy Zeid 3. Thaya Idaikkadar 4. Mrs Vina Mithani 4. Keeki Thammaiah 5. Stanley Sheinwald 6. Julia Merison
(2) CALL-IN SUB-COMMITTEE (5) (3) (2)
I. Anthony Seymour (CH) B E Gate Members Stanley Sheinwald Mitzi Green * Mark Versallion
II. Reserve 1. Janet Mote 1. Jerry Miles Members 2. Mrs Lurline Champagnie 2. Graham Henson 3. Dinesh Solanki 3. Keeki Thammaiah † 4. Narinder Singh Mudhar † 4. Mrinal Choudhury † 5. Julia Merison CH = Chair * = Denotes Group Members for consultation on Administrative Matters † [Note: The appointed number of Reserves for each Group is in excess of the Committee Procedure Rule 3.2 provision, by virtue of Resolution 17: Overview and Scrutiny Committee (18.7.06).]
15 OS 296 OVERVIEW & SCRUTINY
(3) CALL-IN SUB-COMMITTEE (Education)
(7) (2)
I. Mrs Lurline Champagnie B E Gate Members Janet Mote Mitzi Green * Anthony Seymour (CH) Stanley Sheinwald Dinesh Solanki Mark Versallion Jeremy Zeid
II. Reserve 1. Mrs Vina Mithani 1. Jerry Miles Members 2. Yogesh Teli 2. Graham Henson 3. Ashok Kulkarni † 3. Keeki Thammaiah 4. Eric Silver † 4. Mrinal Choudhury 5. John Cowan 6. Julia Merison 7. Narinder Singh Mudhar † 8. Mrs Camilla Bath † 9. Tom Weiss
Voting Co-opted Members: (1) Two representatives of Voluntary Aided Sector - Mrs J Rammelt/Reverend P Reece (2) Two representatives of Parent Governors - Mrs D Speel (Primary)/Mr R Chauhan (Secondary) CH = Chair * = Denotes Group Members for consultation on Administrative Matters † [Note: The appointed number of Reserves for each Group is in excess of the Committee Procedure Rule 3.2 provision, by virtue of Resolution 17: Overview and Scrutiny Committee (18.7.06).]
16 OVERVIEW & SCRUTINY OS 297
APPENDIX 2
LEAD MEMBERS FOR SCRUTINY 2009-10
Policy Lead Member Councillor
Adult Health and Social Care Councillor Vina Mithani
Children and Young People Councillor Mrs Margaret Davine
Corporate Effectiveness and Finance Councillor Stanley Sheinwald
Safer and Stronger Communities Councillor Anthony Seymour
Sustainable Development and Enterprise Councillor Jeremy Miles
Performance Lead Member Councillor
Adult Health and Social Care Councillor Mrs Rekha Shah
Children and Young People Councillor Janet Mote
Corporate Effectiveness and Finance Councillor Mark Versallion
Safer and Stronger Communities Councillor Ms Nana Asante
Sustainable Development and Enterprise Councillor Dinesh Solanki
17 This page is intentionally left blank
18 Agenda Item 8 Pages 19 to 28
Meeting: Overview and Scrutiny Committee
Date: 11th June 2009
Subject: Lead Member Report
Responsible Officer: Alex Dewsnap, Divisional Director, Partnership Development and Performance Portfolio Holder: Cllr Paul Osborn, Performance, Communication and Corporate Services Portfolio Holder
Exempt: No
Enclosures: Appendix One: Reports from the scrutiny lead councillors
Section 1 – Summary and Recommendations
This report sets out the items that have been considered by the scrutiny policy and performance leads at their quarterly briefings between July and August, and details the recommendations they would like the committee to consider with regard to further action/escalation
Recommendation: Councillors are recommended to: • consider the report from the Scrutiny policy and performance leads and • agree recommendations as included therein.
19
Section 2 – Report (Background (if needed) This report records the outcomes of quarterly briefings of scrutiny lead policy and performance councillors and seeks the endorsement of committee of the action proposed. Individual reports have been included in this report for: • Adult Health and Social Care • Corporate Effectiveness • Safer and Stronger Communities
No meetings have taken place since the last meeting of the Overview and Scrutiny committee for: • Sustainable Development and Enterprise • Children and Young People
Current situation Not appropriate to this report.
Why a change is needed Not appropriate to this report.
Main options Not appropriate to this report.
Other options considered Not appropriate to this report
Recommendation: To consider and endorse the reports from the scrutiny policy and performance leads.
Considerations Resources, costs and risks Any costs associated with these recommendations will be met from within existing resources. Where specific projects are escalated for more detailed consideration in the scrutiny process, specific implications of these projects will be considered during the scoping process
Staffing/workforce There are no staffing or workforce considerations specific to this report. Where specific projects are escalated for more detailed consideration in the scrutiny process, specific staffing implications of these projects will be considered during the scoping process.
Equalities impact There are no specific equalities implications in this report. Where specific projects are escalated for more detailed consideration in the scrutiny process, specific equalities implications of these projects will be considered during the scoping process.
20 Community safety (s17 Crime & Disorder Act 1998) There are no specific equalities implications in this report. Where specific projects are escalated for more detailed consideration in the scrutiny process, specific community safety implications of these projects will be considered during the scoping process.
Legal Implications None
Financial Implications Any costs arising from the recommendations will be contained from existing budgets.
Performance Issues There are no performance considerations specific to this report. Where specific projects are escalated for more detailed consideration in the scrutiny process, specific performance implications of these projects will be considered during the scoping process.
Risk Management Implications There are none specific to this report.
Section 3 - Statutory Officer Clearance Not appropriate for this report.
Section 4 - Contact Details and Background Papers Contact: Lynne Margetts, Service Manager Scrutiny 020 8420 9387
Background Papers: None
21 APPENDIX ONE
Notes of Quarterly Briefing for Scrutiny Leads for Adults Health and Social Care Friday 17 April 2009, 4.30pm
Meeting attendees: Bernie Flaherty (Divisional Director, Community Care) Councillor Vina Mithani (Policy Scrutiny Lead for Adult Health and Social Care) Councillor Rekha Shah (Performance Scrutiny Lead for Adult Health and Social Care) Nahreen Matlib (Senior Professional - Scrutiny)
Purpose of meeting As part of the support provided to the scrutiny leads, quarterly briefings on the leads’ subject areas are arranged. The purpose of these meetings will be to discuss key policy areas in social care, local priorities for the services, forthcoming issues that may be of interest to scrutiny or issues that could be suggested for scrutiny to pick up.
Issues discussed and key points arising
1. Adults and Housing Transformation Programme Plan (TPP) • Programme Area 1 - Continuous Service Improvement: the new Neighbourhood Resource Centres are still on track to open in July 2009. These use the typical model of a resource centre as the heart of the community. • The second learning disabilities (LD) inspection made similar observations to the first inspection requiring a number of the same actions. The two action plans have been cross-referenced. • Programme Area 2 - Developing Accommodation: an options appraisal paper on the community equipment store was presented to Cabinet in March. • Programme Area 3 - Developing Self Directed Support: see below for the evaluation of personal budgets and self-directed support. • Programme Area 4 - Well Being Early Intervention and Community Engagement: there has been an increase in the choice of providers in advocacy in LD services. Furthermore the ‘Slivers of Time’ initiative has been used as a mechanism for employment of people with LD within the Council. • Programme Area 5 - Effective Working Practice: the HARP (covering housing, revenues and benefits, and planning) programme was delivered on time. IT continues to be a challenge and the Directorate is working with Capita to resolve issues. • Programme Area 6 – People, Partnerships and Capacity Building: the workforce development strategy is currently in the process of being updated. • Programme Area 7 – Maximising Financial Resources: the transfer of the LD service from the PCT to the local authority has been agreed at a first stage.
22 2. Safeguarding adults • It is suggested that the annual report on safeguarding adults be presented to the Overview and Scrutiny Committee in June.
To action: the annual report on safeguarding adults to be presented to the Overview and Scrutiny Committee on 9 June 2009.
3. Personal budgets and self directed support – findings of pilot evaluation • The personalisation agenda started in Harrow in January 2008. The pilot has now been evaluated and the findings will be fed back to the users involved. Harrow is one of the leaders in London for personalisation. One in five personal budget holders in London live in Harrow. • It was the service users’ views that to be able to adequately evaluate the pilot, it would be necessary to have at least 100 individual budget users in the system. The targets were ambitious but on time/target nonetheless. • The evaluation found that 83% of people value the choice and control afforded by individual budgets. Particular successes were identified as safeguarding and risk management, the stakeholder reference group, mentoring, voluntary sector engagement. • Areas suggested for improvement/development included the tension between FACS (Fair Access to Care Services) and choice and control, the significant time needed to guide and support customers, the need for simpler forms, the need to develop a range of budget holding options and the development of the social care market. • There is a need to focus on market demand however it can be difficult to manage customer demands if the service is not available in the market, and therefore there is a need to seed the market. The community and voluntary sector has been engaged to broker these functions. • The target for individual budgets for 2009/10 (Local Area Agreement target) is 750 users, for 2010/11 this is 1300 users. In part, this will be achieved by ‘front-ending the process’ so that when a person approaches social care, an individual budget is the default option. The focus will be on older people as the main clientele. • The new Neighbourhood Resources Centre at Byron Road will be the base for the personalisation services (services for the users and also the support staff).
To action: The Scrutiny Lead Members for Adult Health and Social Care are invited to visit a new Neighbourhood Resource Centre when they are open. It is suggested that the new centre at Byron Road would be the best option.
4. Any Other Issues There were none.
Date of next meeting: To be arranged.
23 Corporate Effectiveness Lead Members Quarterly Briefing 20th April 2009 Meeting attendees: Councillor Stanley Sheinwald (Policy Scrutiny Lead for Corporate Effectiveness) Councillor Mark Versallion (Performance Scrutiny Lead for corporate Effectivenes) Mike Howes, Service Manager, Policy and Partnerships Lesley Clarke, HRD Strategy Manager
Purpose of meeting As part of the support provided to the scrutiny leads, quarterly briefings on the leads’ subject areas are arranged. The purpose of these meetings will be to discuss key corporate issues or policy changes, local priorities for the council and partners, forthcoming issues that may be of interest to scrutiny or issues that could be suggested for scrutiny to pick up.
Meeting 16th March 2009
An update on the LAA – specifically the ‘people from different backgrounds getting on’ indicator Councillors received an update on this indicator. The percentage of people who feel that people from different backgrounds get on well together has decreased to 48% which means, if performance remains the same, that no reward grant will be received. However, the indicator is not formally measured until September 09 and there is therefore time to pull the performance back. When this question is asked using the place survey methodology, which does not give respondents the option to respond that they ‘don’t know’ the figure rises to 76% which is more encouraging.
Councillors were advised that the council plans a programme of sports and arts activities in the 4 lowest scoring wards to try to ensure that this is addressed along with a publicity campaign. However, it is acknowledged that it is unlikely the performance can be addressed to resolve the difference between the recorded score of 48% and the target of 61%.
Councillors asked how the recession is impacting on the cohesion of the borough and were advised that as yet there does not appear to be any adverse impact as there has not been significant competition for public services. However, the council is not being complacent and both the ‘recession busting group’ and the scrutiny review of sustainability will help the council to understand the impact and resolve any difficulties.
Recommended Action: The report be noted.
Topline results from the place survey The topline results of the place survey were discussed. These are attached. The responses to question 2 ‘Which things most need improving’ are significant as these indicate where local people feel that the council should focus its improvement priorities. The comparisons with other boroughs will provide additional information.
24 Whilst overall satisfaction levels are encouraging, there are other concerns, in particular that local people have a perception that local public services do not promote the interests of local people. There are also concerns that expectations with regard to services are rising faster than the performance of these services and that the increase in dissatisfaction suggests that there is low visibility of what the council provides and concern regarding level of taxes.
The survey has also highlighted the issue of communications, in that residents are generally badly informed. The council is developing a communications plan to address this, which will include things such as retiming of street cleaning activities to increase their visibility
Recommended action: The report be noted and councillors to be provided with the unconfirmed comparative information.
Update on workforce planning issues The council’s strategy for people will need to be renewed for 2010. Each service area will be responsible for reviewing their own component of the strategy but will be supported by Human Resources and Learning and Development staff. There is generally good progress in terms of the production of departmental strategies across all of the council with the exception of Community and Environment. This probably reflects the range of services in the directorate. A new Corporate Director joins the council soon and this should help, particularly as his background is in human resources.
The departments’ workforce strategy groups also have responsibility for consideration of other issues human resources issues e.g. results of the staff survey and IIP planning.
The council is also moving towards workforce planning with partners.
The IPAD process now incorporates the CREATE values and the overall process has been improved.
Councillors enquired about the state of staff morale, which they were aware had suffered in recent months. This will be investigated further using the latest staff survey, which will also assist the council to understand how effectively cultural change is being achieved.
Recommended action: Results of the staff survey to be provided to councillors in order to determine whether further investigation is required.
Councillor Calls for Action Preparation for CCfA in the borough is well advanced, though national guidance has only just been published. The council hosted a launch for the guidance on behalf of the Centre for Public Scrutiny on 6th March attended by council representatives from London and the South East of England.
Recommended action: Maintain a watching brief on the implementation of this process
25 Comprehensive Area Assessment The method of assessing councils’ performance has been radically changed. In future, in addition an assessment of the council’s own performance, via an expanded ‘Use of Resources’ assessment, the council’s and our partners’ performance as members of the Harrow Strategic Partnership, will also be assessed via the ‘Area Assessment’. The partnership will be measured in terms of: • How well local priorities express community needs and aspirations • How well outcomes and improvements needed are being delivered • The prospects for future improvement
The council and partnership has decided to develop a self assessment for both assessments in order to establish a baseline and accurate improvement plan to guide activities in future. Scrutiny has been asked to offer a challenge to the development of the assessment and these have been scheduled. For the area assessment, the corporate effectiveness leads will receive copies of the relevant sections of the document and will be invited to comment, these comments will be fed back to the officers drafting the self assessment.
Recommended action: Special meeting of the corporate effectiveness leads will be timetabled to discuss the area assessment.
26 Notes from the Safer and Stronger Communities Leads Briefing
The Scrutiny Lead Members for Safer and Stronger Communities, Councillor Nana Asante and Councillor Anthony Seymour, met on 6 May 2009 with the Scrutiny Officer.
Community Safety Members received a briefing from the Scrutiny Officer on the new Crime and Disorder Overview and Scrutiny Regulations 2009. The new legislation further re-enforces the lines of democratic accountability and the official requirement for Overview and Scrutiny to scrutinise and ensure CDRPs are effectively tackling crime and disorder.
Councillor Call for Action (CCfA) Members reviewed the CCfA report that went to the Overview Scrutiny meeting on 16 March which provided details of the plans for implementation. The lead members are keen to review further details of the council’s plans as they are being developed to support and implement CCfA on the ground
Recommended action: to continue to monitor the development of CCfA
The Duty to Involve, Inform and Consult The leads expressed that they would like to look further into the Duty to Involve, Inform and Consult came into force in April 2009. The leads will be keeping a watching brief of how Harrow will be putting this in place and have requested to have further information on the network of empowering authorities who are working with the IDeA to develop this. The leads members are also keen to look into how this will fit with CCfA and CAA.
Recommended action: to continue to monitor the duty
Community engagement and empowerment in Harrow Members requested to have a matrix put together detailing how various divisions, bodies and organisation focused on developing community engagement and empowerment work together. This would be helpful in developing the stronger communities element of their remit as policy and performance leads.
Recommended action: further information be provided on how the responsible parts of the organisation work together to develop stronger communities
Hear Say Review Lead Members expressed that they would like to re-visit the progress of the Overview and Scrutiny, Hear Say Review. They will be looking at the progress of the implementation of the recommendations and the implications of the new policy developments such as CCfA.
Recommended action: the implementation of the recommendations of the HearSay review to be considered by the leads
27 Overview and Scrutiny work programme
Lead members discussed the Overview and Scrutiny work programme which featured two topics relevant to their remit including: Communications and fear of crime Young People and Crime
Future Meeting The lead members decided that they would hold their next quarterly meeting on Tuesday 28 July 2009.
28 Agenda Item 9 Pages 29 to 42
Harrow Local Involvement Network
Annual Report
1st April 2008 to 31st March 2009
Draft v1
Prepared by Jaswant Gohil
29
Contents Section One - Introduction
Foreword and Mission Statement Page 3
1. Introduction from Steering Group Page 4
2. Harrow LINk’s background Page 4
Section Two – Accomplishment 3. Work done Page 5 • Mapping and Database • Engagement and Meetings • Representation and Consultations • Events and Inspections
Section Three – Next Steps 4. Work in progress Page 8
Section Four – Participants 5. Participants Page 9
Section Five – Financial Summary 6. Account Summary Page 10
Section Six – Conclusion 7. Conclusion and circulation list Page 11
Appendices A – Voluntary Sector Page 12 Appendices B – Contact Details Page 14
Harrow LINk 2008/09 Annual Report (Draft v1) Page 302 of 14
Section One
Foreword
The reason for this report Local Involvement Networks (LINks) were established under the Local Government and Public Involvement in Health Act 2007 and under section 227 of the Act, there is a legal requirement for LINks to publish an annual report about their activities during the previous financial year (i.e. the period from 1 April to 31 March).
A copy of the Act can be found at: www.opsi.gov.uk/acts/acts2007/ukpga_20070028_en_1. The LINk has a duty to publish its annual report by 30th June after the end of the financial year concerned.
Mission Statement Harrow Local Involvement Network (Harrow LINk) is an inclusive network that will enable people and organisations in Harrow to have a voice and input to influence the planning, commissioning and delivery of health and social care services to improve the health and well-being of patients, carers, public and service users.
Harrow LINk 2008/09 Annual Report (Draft v1) Page31 3 of 14
1. Introduction from Steering Group
LINks first surfaced in January 2007, was consulted upon in November 2007 and became a reality on 6th March 2008. By April 2007, the Local Authority was already preparing for its task of appointing a Host Organisation for the LINk. We entered a period of “transition” between the PPI Forums and the new ways of governance. The regulations from Parliament came into force in March 2008 and by June 2008 the Host organisation had been appointed. Harrow Council had carried out their duties promptly and efficiently.
The Host immediately became active and very soon the transition became the reality. The past few months have seen a highly productive whirl of activity in determining the governance arrangements for the LINk. We have been witness to an exciting and creative development of ideas and ways of working by the Host and the dedicated people who have been party to the new model. Work did not stop as we transitioned – it merely got better! Everybody involved has to be thanked.
The initial notion, which has led to so much change, has become a dynamic reality, which will make significant contributions to the treatment and care of people in our community. Our LINk is up and working.
2. Harrow LINk’s background
Local Involvement Networks (LINks) were set up in each Local Authority area in England with Social Services responsibility under section 14 of the Act, to give communities a stronger voice in how their health and social care services are delivered. They replaced Patient and Public Involvement (PPI) forums nationally, which were disbanded on 31st March 2008.
A LINk is an independent network of local people from voluntary and community sector groups with an interest in local health and social care issues.
The role of a LINk is to promote involvement, find out what people like and dislike about local services, monitor the care provided by services and use the LINk’s legislative powers to hold service providers to account when required. Its role is also to work with commissioning bodies, produce reports and make recommendations and participate in “Enter and View” activities.
LINks are funded by the Department of Health. Funding is managed through Local Authorities, in our case Harrow Council. Each local authority had been tasked to procure a Host organisation through a complex tendering process and compliance procedure to develop a local involvement network and maintain a smooth transition until a Host was in place.
A LINk transition support group was set up in the interim (April to June 2008) to discuss how the LINk would develop. A report (LINks in Harrow 2008) was commissioned by Age Concern Harrow, with funding from Harrow Council to capture the essential work done by the PPI forums in the anticipation that the Host would be able to use the information to maximise benefits and engagement.
Harrow LINk 2008/09 Annual Report (Draft v1) Page 324 of 14
Parkwood Healthcare Limited, a private healthcare company and a subsidy of Parkwood Holdings was awarded a £120,000 per annum contract to act as the Host organisation for Harrow LINk by Harrow Council on 1st July 2008 until 31st March 2011. The Host employs two full time staff to develop and provide support to the LINk members/participants (see appendices B for contact details).
Section Two – Accomplishment
3. Activities Whilst the bulk of the Host’s work between July and September 2008 was finding a suitable base for its Harrow LINk office and staff recruitment, it was apparent from the work done by the PPI forums that engaging with the seldom heard or hard to access groups or individuals was a key requirement in making the LINk successful.
A Research and Information officer was recruited in September to conduct a mapping exercise and create a database. An interim LINk manager oversaw this activity. References were made to “LINks in Harrow 2008”, a report commissioned by Age Concern Harrow on behalf of the LINk transition group amongst other documents listed below to understand the diversity and complexity of the local population. a) Mapping To get a thorough idea of the profile and make-up of the population in Harrow, the following documents were consulted: • Harrow Census • Harrow Vitality Profile 2006 • NHS Harrow Annual Public Health Report 2008 • NHS Harrow Practice Based Commissioning Plan, (Oct 08 / Sep 09) Two different strands of organisations were mapped: • Voluntary Sector • Health and Social Care services b) Harrow LINk Database A database of local voluntary sector groups and organisations was created from an initial list of approximately 230 names of groups provided by the Local Authority LINk lead. This database now has approximately 400 groups or individuals and is constantly being updated.
Organisation of the database: Work is currently underway to categorise the data by: • Organisations • Wards • Work areas (community, youth groups, disability, education, faith, health services and housing etc).
Harrow LINk 2008/09 Annual Report (Draft v1) Page33 5 of 14
c) Engagement The LINk engaged with over 50 local organisations and statutory groups (appendices A). Through an adverting campaign, most notably through word of mouth, self-promotion and media (Harrow Time and Harrow People) the LINk has received numerous enquiries and invitations from local community members. d) LINk meetings To capture the essence of service users feelings on health and social care services in Harrow, the Host held their first meeting with members of the Harrow LINk Transition Group on 20th October 2008, this was followed by “Meet the Host” on 24th November. The objective of these meetings was to establish what the transition group members had done, advise the Host of the local issues and facilitate a working relationship with various local statutory and voluntary organisations.
Monthly Planning Group meetings were held between December 2008 and February 2009, to engage with local community representatives and individuals to promote the ethics of the LINk. At the February meeting, a Steering Group was formed, from which an Event Planning Task Group and a Governance Task Group were created on a time limited basis.
The Event Planning Task Group agreed on publicity material, method and engagement to launch the Harrow LINk on 26th March 2009 at Premier House Banqueting in Wealdstone. The Governance Task Group developed and agreed governance policies and procedures such as:
• Code of Conduct • Conflicts of Interest • Enter and View policy • Equality and Diversity • Governance Framework • Mission Statement • Protocol for Health care service providers • Protocol for Social care service providers • Register of Interests 2009 • Reimbursement Policy • Terms of Reference for Executive Committee • Terms of Reference for the Chair of the Executive Committee • Terms of Reference for the Vice Chair of the Executive Committee • Terms of Reference for Statutory Sector Liaison Group • Terms of Reference for the Steering Group
In the absence of a governing body, the group was empowered to make key decisions and report back to the Steering Group.
A Statutory Sector Liaison Group (SSLG) was formed with key personal from Harrow PCT (NHS Harrow), North West London Hospital Trust, Central and North West London Mental Health Foundation Trust and Royal National Orthopaedic Hospital and the Adult and Children’s Complaints and Service Users departments at Harrow Council.
Harrow LINk 2008/09 Annual Report (Draft v1) Page 346 of 14
The objective for the SSLG group was to: • To act as a conduit for information between the LINk and the health and social care provider partners across and beyond the borough. • To share information from individual partner agencies that might be of potential interest and use to the LINk. • To be available to support LINk development work by providing information to the Host and LINk Members/participants as required. • To test out and discuss new approaches and ideas. • To provide advice on the development of strategic procedures to support the dialogue with providers. • To support the development of the LINk by advising on appropriate training opportunities that may be available to LINk Members/participants. e) Wider Representation To gain a stronger understanding of issues and promote a wider recognition of the LINk, members attended various meetings, including: • Acute Service Review Project Patient and Public Panel meeting – 15th December 2008 • Statutory Sector Liaison meetings on 18th Dec 2008 and 24th March 2009 • Harrow PCT Board Meetings on 20th January and 3rd March 2009 • RNOH Board Meetings on 29th January, 26th February and 26th March 2009 • Patient and Public Involvement Stakeholders meeting – 30th January and 26th March 2009 • CLAHRC (Collaboration for Leadership in Applied Health Research and Care) on 13th February 2009 • London LINks Network meetings – 20th February 2009 • Harrow Overview and Scrutiny meeting – 16th March 2009 • Improvement to surgical care for 0 –18 years old in NW London – 17th March 2009 • London LINks Maximising Commentaries (feedback session) - 24th March 2009 • NWLHT Board meeting on 25th March 2009 • London LINks Consulting Chair meeting – 27th March 2009 • Mount Vernon Cancer Development Project – 30th March 2009 • Patient & Public Involvement and Partnership Committee (PPICO) meetings f) Consultations To support the views of the local carers and service users and gain a better understanding of the issues, Harrow LINk representatives participated in the following consultations:
Harrow LINk 2008/09 Annual Report (Draft v1) Page35 7 of 14
• Future Partnership Governance Arrangements for Adult Health and Social Care in Harrow on 16th March 2009. • Have your say on stroke and trauma services in London on 18th & 24th March 2009. Some even contributed individually to an online survey conducted by Kingston University student for her BA Honours degree’s dissertation on Local Involvement Networks. g) Events The LINk has also been represented by the Host at the following events: • One4One event (a volunteering scheme hosted by Harrow Council). • Healthcare for London in St Ann’s Centre, which was designed to improve local knowledge of local health services. • Practitioners Fair – Harrow Teachers Centre, which provided information about range of services available to children and youths. h) Patient Environment Action Team (PEAT) The LINk was invited to participate in PEAT inspections to see if the unit assessed complied with relevant infection prevention and control policies. Units assessed were: • Rosedale Court, Greenford Road on 11th March 2009 • Roxbourne Complex on 26th March 2009 Detailed reports were produced by the representatives from Harrow LINk and will be read by the Harrow LINk Executive Committee when it is formed in June. Section Three – Next Steps
4. Work in progress The LINk realise that there is still work to be done before major improvements are seen. Next steps The formation of a Harrow LINk Executive Committee in June will help the LINk to focus on specific issues and take a step forward in establishing a good rapport with the community and the statutory sector. • The LINk needs to engage with other LINks to understand wider issues and promote good practices. • The LINk needs to form a Work Plan, which has to be achievable and realistic. • The LINk needs to develop an Engagement and Participation Mechanisms by agreeing a community engagement strategy. • Develop Communication and Information Sharing Strategies in order for the LINk to meet the communication needs of a diverse community.
Harrow LINk 2008/09 Annual Report (Draft v1) Page 368 of 14
• Identify and Develop Relationships between the LINk and the Host Organisation develop relationships with key local stakeholders and develop working protocols with other LINks. • Create a Training and Support programme with the help of the Host. • Encourage Recruitment and Retention of LINk Members. This is an important step in keeping the LINk healthy and in touch with the local needs.
Section Four – Participants
5. LINk Participants As on 31st March 2009, Harrow LINk had 36 participants on their list from various communities and organisations to reflect its diversity and engagement. Besides having 10 Independent members from various communities, the LINk is also represented by the following groups: • Age Concern Harrow • Burnt Oak Christian Fellowship • Harrow African Caribbean Association • Harrow and Brent Campaign Group • Harrow Association of Disabled people (HAD) • Harrow Association of Somali Volunteers Organisation (HASVO) • Harrow Association of Voluntary Services (HAVS) • Harrow Crossroads • Harrow Humanist Society • Harrow Mencap • Harrow Public Transport Users Association • Harrow Rethink Support Group • Harrow Shop Mobility • Harrow Youth Service • Methodist Church • Older Persons Reference Group (OPRG) • Relate London North West • Royal National Orthopaedic Hospital Patient and Users group • Sangat Centre • Stanmore College • The Pension Service for Harrow
One member from the Harrow and Brent Campaign Group has since resigned.
Harrow LINk 2008/09 Annual Report (Draft v1) Page37 9 of 14
Section Five – Financial Summary 6. Income and Expenditure The Host receives £120,000 per annum for Harrow Council, which equates to £10,000 per month. From July 2008 to March 2009, the Host received £90,000. Parkwood Holdings takes 20% (£2,000 per month) from the funding as part of its overall management and operating share although this is not typical. A further £6,888 per month is deducted for Harrow LINk Staff salaries, travel and expenses, Rent and Rates, Utilities and Telephone charges, Printing, Stationary and Postage costs, and Building Insurance and Depreciation costs. Therefore £1,112 per month is left for the use of Marketing (publicity), venue hiring, members’ expenses, training costs, and recruitment advertising. A typical month is shown below: *Staff Salaries £4870 **Marketing (publicity) £333 **Venue or meeting room hire £217 **Members Expenses £333 **Training Costs £166
Operating Costs *Staff Travel & Expenses £75 *Rent and Rates £917 *Utilities £125 *Telephone £336 *Postage and Courier £50 *Stationary & Printing £200 *Insurance £200 **Recruitment Advertising £63 *Depreciation £115 Cost £8000 Host’s profit margin (20%) £2000 Grand Total £10000 *These are standard operating costs ** These are dependent on the LINk’s requirement
Harrow LINk 2008/09 Annual Report (Draft v1) Page 1038 of 14
Section Six - Conclusion This report summarises the work and the effort put in by everyone involved. It is a true reflection of what the LINk and the Host have done to engage with the local communities and voluntary organisations as well as statutory bodies. The LINk relishes the opportunity to engage with service users, carers and service providers in the ensuing year. The LINk acknowledges the effort of all the statutory bodies and voluntary organisations and individuals in assisting the LINk to establish itself and look forward to working with them.
Name:………………………………….. (Member of the Steering group)
Signature:…………………………….. Signed on behalf of the Steering group Date:
This report will be circulated to: • The office of the Secretary of State • The Care Quality Commission • Harrow Council • Harrow Overview and Scrutiny Committee • NHS Harrow • Royal National Orthopaedic Hospital Trust • Central and North West London Hospital Trust • North West London Hospital Trust • London Ambulance Services
It will also be uploaded on to the Harrow LINk website: www.harrowlink.org.uk
Harrow LINk 2008/09 Annual Report (Draft v1) Page 3911 of 14
Appendices A
The following Organisations were contacted: Voluntary Sector • Advocacy Voice
• Afghan Association of London • Age Concern Harrow • Anchor Trust (Care Homes)
• Anglo-Indian Council • Anjali Centre • Asian Foundation for Help
• Association of Jewish Refugees • Attention Deficit Hyperactivity Disorder (ADHD) Association Harrow • Bentley Day Centre • Buchanan Court (Care Home) • Burnt Oak Christian Fellowship • Business Link • Carer’s Support Harrow • Carlton House (Care home) • Children First • Community Link-Up • Consortium of Anti-Racist Refugee and Minority Ethnic Association • Contact the Elderly • Edo State Women’s Association • Fitz Health Club • Grange Nursery Centre
• Harrow African-Caribbean Association • Harrow Association of Disabled People • Harrow Association of Voluntary Services (HAVS) • Harrow Council of Racial Equality (HCRE) • Harrow Crossroads • Harrow Healthy Living Centre • Harrow Iranian Community Association • Harrow Muslims Collective
Harrow LINk 2008/09 Annual Report (Draft v1) Page 1240 of 14
Appendices A (cont)
• Harrow Refugee Forum
• Harrow Users Group • Harrow Women’s Centre • Horn Project
• Horn Response • Indian Association of Harrow • Jaago Punjabi Women’s Association
• Kenton United Synagogue • Kids Can Achieve • Kingsley High School Parents
• London Borough of Harrow Children's Information Service • Loud and Clear • Middlesex Association of the Blind • Middlesex Tamil Association • MIND in Harrow • Pakistan Women’s Association of Harrow • Partnership of Older People (POP) • Russian Immigrants Association • Special Connection • Wealdstone Youth Centre • Welldon Activity Centre • World Federation of KSIMC (Khoja Shia Ithna Asheri Muslim Communities)
• Youth Offending Team (YOT)
Statutory Sector Meetings have been held with:
• Harrow Primary Care Trust (NHS Harrow) • North West London Hospital Trust (NWLHT) • Royal National Orthopaedic Hospital (RNOH) • Central & North West London (CNWL) Foundation Trust NHS • Adult Social Care Services - Harrow Council
Harrow LINk 2008/09 Annual Report (Draft v1) Page 4113 of 14
Appendices B
Office Contact Details
Harrow LINk Office Host Organisation Head Office c/o Parkwood Healthcare Parkwood Healthcare Cervantes House The Tithe Barn Ground Floor Thorley Hall Farm 5-9 Headstone Road Thorley Harrow Bishop’s Stortford Middlesex Hertfordshire HA1 1PD CM23 4BE
Tel: 0208 863 3355 Tel: 01279 465 655 Fax: 0208 861 5533 Fax: 01279 465 955 Email: [email protected] Email: [email protected] Web: www.harrowlink.org.uk Web: www.parkwoodhealthcare.co.uk
Host Contact Details
Mr Tim Hayward-Smith Parkwood Healthcare LINk Operations Manager [email protected] Tel: 01279 465 655
Mr Jaswant Gohil Harrow LINk Development Manager [email protected] Tel: 0208 863 3355
Mr Nicholas Bradley Research and Information officer [email protected] Tel: 0208 863 3355
Harrow LINk 2008/09 Annual Report (Draft v1) Page 1442 of 14 Agenda Item 10 Pages 43 to 106
Meeting: Overview and Scrutiny Committee
Date: 11th June 2009
Subject: Safeguarding Adults Annual Report 2008/9 Responsible Officer: Paul Najsarek, Corporate Director of Adults and Housing
Portfolio Holder: Cllr. Barry MacLeod-Cullinane, Portfolio Holder for Adults and Housing Exempt: No
Harrow Safeguarding Adults Board Annual Enclosures: Report 2008/9
Section 1 – Summary and Recommendations
This report provides Scrutiny Committee Members with an overview of the Local Safeguarding Adults Board Annual Report for 2008/9. The annual report summarises safeguarding activity undertaken throughout the year by the Council and its key partners, sets out statistical information which analyses the referrals received and outlines priorities for the current year.
Recommendations: Scrutiny Committee is requested to note the work that has taken place in 2008/9 and the action plan for 2009/10.
Reason: (for recommendation) Preventing and appropriately dealing with the abuse of vulnerable adults is a key priority for the Council. Presentation of the Annual Report at this Committee allows for scrutiny of this critical statutory function.
43 Section 2 – Report
2.1 Introduction
This is the second Annual Report of the Local Safeguarding Adults Board (LSAB) and a copy is attached at Appendix 1 for information.
2.2 National Context
Although this report deals with abuse of vulnerable adults rather than children, there is no doubt that the tragic case of “Baby P” has raised the public’s level of awareness in relation to safeguarding issues.
This annual report should also be seen in the context of a number of national developments:
• Review of the “No Secrets” (Department of Health) guidance first issued in 2000 which requires local authorities to take a lead in developing and implementing multi-agency policies and procedures. Changes to the “No Secrets” guidance are expected shortly and will be implemented in Harrow under the governance of the LSAB • The Safeguarding Vulnerable Groups Act 2006 was introduced to respond to the Bichard Inquiry and creates a new body – the Independent Safeguarding Authority (ISA) which will register all those eligible to work with vulnerable adults or children and manage a vetting and barring system • The Deprivation of Liberty Safeguards (DOLS) under the Mental Capacity Act 2005 ensures protection for those vulnerable people who cannot make decisions for themselves • Personalisation or self directed support is to be welcomed as it provides more choice and control for vulnerable people to organise their own personal care, however there are anxieties that some will be exposed to a greater risk of abuse, particularly financial abuse
2.3 Local Context
In January 2008 an independent CSCI (Commission for Social Care Inspection) inspection of safeguarding adults’ in the borough reported that Harrow’s arrangements were “adequate rising to good”.
The annual report and its associated work plan aim to build on this positive outcome and further develop local systems and processes both internally and externally to the Council.
2.4 Key Messages
The CSCI inspection report commended Harrow for a number of areas of good practice, but also noted some areas for development. These became the basis of the LSAB’s 2008 action plan.
Considerable progress has been made in the following areas:
• Significantly strengthening the work of the LSAB
44 • Further embedding the strong local procedures • Spreading and raising the awareness of safeguarding adults • Strengthening evaluation and learning • Extending significantly the number of care workers trained in safeguarding issues across all sectors
Statistics
There was a 48% overall increase in referrals from 187 in 2007/8 to 356 in 2008/9. The rise is to be welcomed as it is not the view of officers that there is an increase in actual abuse taking place in Harrow, rather that the rise is linked to the increased volume of publicity carried out by the Department and its partners. In line with the national picture, a greater proportion of victims were female and a greater proportion of alleged perpetrators were men. In addition, the largest proportion of alleged perpetrators were family members. 65% of referrals were from white/UK other communities and 35% were from BME communities, highlighting the need to continue with targeted awareness campaigns amongst harder to reach groups. The highest number of referrals were about physical abuse. There was a small increase in the number of older people referrals, but a significant rise in those about people with a learning disability. Recent analysis shows that some of the statistics have been skewed by CSCI requiring registered care homes to report trips and falls as safeguarding referrals. These incidents will now be carefully monitored by the Contracts and Brokerage Team.
2.5 Action Plan for 2009/10
There are 11 actions for 2009/10 (arising from the inspections and analysis of the statistics) the majority of which build on progress already made in 2008/9. These are shown below with the details covered in the Action Plan attached at Appendix 2.
i. further develop the LSAB governance arrangements ii. further improve the care of vulnerable adults receiving community care services to minimise risk of abuse iii. through training and development to empower staff, carers and service users to identify, report and respond to allegations iv. to raise awareness amongst staff, users, carers and the general public through publicity and communications v. improve practice by learning from experience vi. use quality assurance systems to ensure consistent application of the Policy and to support continuous professional development vii. explore opportunities for involving users and carers in further improving safeguarding adults’ practice standards viii. further improve multi-agency working and information sharing ix. further develop systems for collecting and collating statistical data x. further work on the interface between self directed support (personalisation) and safeguarding xi. continue to address the under reporting from Harrow’s Black and other Ethnic minority communities
45 Section 3 Financial Implications
The Council has already invested an additional £150k (in 2009/10) to strengthen local safeguarding adults arrangements and respond to the increasing number of referrals.
Resources will be kept under review in light of required changes in procedures and workload.
Section 4 Risk Management Implications
Risk included on Directorate risk register? Yes
Separate risk register in place? No
Potential risks:
• failure to address CSCI (now Care Quality Commission) inspection requirements may affect the Adult Social care performance rating for 2009 • failure to ensure local safeguarding arrangements are robust could lead to a serious untoward incident e.g. death of a vulnerable person
Section 5 Statutory Officer Clearance
Not required.
Section 6 Contact Details and Background Papers
Contact: Paul Najsarek, Corporate Director Adults and Housing (0208 424 1361)
7. Background Papers:
Harrow Local Safeguarding Adults Annual Report 2008/9 and Action Plan
46 2008
and Partners Local Safeguarding Adults Board (L.S.A.B.)
Annual Report 2008
Seamus47 Doherty, Safeguarding Adults Co-ordinator, January 2009 Index Page No.
Introduction from the Chair 3 Guidance Framework; No Secrets 4 National Developments 5 Safeguarding Vulnerable Groups Act 2006 5 Deprivation of Liberty Safeguards 6 Self Directed Support 7 Comprehensive Area assessment 8 Baby P – Lessons for Adult Services 8 Local Developments 8 CSCI Service Inspection 8 Joint Review of Commissioning 10 Serious Case Review 10 Cornwall Report 11 Multi-Agency Contributions 11 Definition of a ‘Vulnerable Person’ 12 Definition of “Abuse” 12 Types of abuse 12 Implementation in Harrow 13 Review of Aims and Objectives 14 Safeguarding Adults Team 19 Data Collection and Statistics 19 Development of Work Streams 21 External Links with Partners 27 Multi-Agency Contributions 27 Statistics 34
Appendix 38
Local Safeguarding Adults Board Information and Terms of Reference 38
Page | 2 48 Harrow Council Local Safeguarding Adults Board
(L.S.A.B.)
2nd Annual Report.
Introduction from the Chair, Paul Najsarek, Corporate Director of Adult and Housing Services.
This is the 2nd Annual Report of the Harrow Council Local Safeguarding Adults Board (L.S.A.B) setting out the progress we have made locally in ensuring vulnerable people are treated with dignity and respect and safeguarded from abuse, exploitation and harm.
National Context
Safeguarding Adults continues to be a prominent issue and there are a number of positive new opportunities and challenges coming on line which will be discussed in more detail later in this report.
As the Safeguarding Vulnerable Groups Act continues in its passage to full implementation, as the Deprivation of Liberty Safeguards come into force and the Review of No Secrets nears its conclusion, Harrow looks forward to embracing these challenges and working with our partners to ensure that national developments make a positive contribution to the lives of local people.
Local Context
In January 2008 an independent inspection of Safeguarding Adults reported that Harrow’s Safeguarding work was adequate rising to good. This report and its associated work plan aims to build on this very positive news and further develop Harrow’s systems and processes both internally and externally to the Council.
Aims and Outcomes
The report commended us for a number of areas of good practice but also noted a number of areas for further development. These became the basis of the LSAB’s 2008 Action Plan.
I am pleased that we have made considerable progress in our Safeguarding work:-
- Significantly, strengthening the work of the LSAB - Further embedding our strong procedures - Spreading and raising awareness of Safeguarding - Strengthening evaluation and learning - Extending significantly the number of care workers trained in Safeguarding issues
All this work is reflected in the fact that Harrow Council has established supporting vulnerable people as one of its three top priorities.
Of course we have more to do to meet rising expectations and we can never afford compliancy in this most important area, but I am pleased that our partnership has made progress this year and we look forward to building on this success in 2009.
Paul Najsarek, Corporate Director of Adult and Housing Services. Page | 3 49 Guidance Framework - Background and Developments
“No Secrets”
In March 2000 the Department of Health and the Home Office issued “No Secrets” as Guidance under Section 7 of the Local Authority Social Services Act 1970.
One of the main objectives of this Guidance was to ensure that all local authorities in England take the lead in developing and implementing multi-agency policies and procedures to protect vulnerable adults from abuse.
“No Secrets” - A National Review
On 16th October 2008, The Department of Health, the Home Office and the Ministry of Justice launched the national consultation on the review of the No Secrets guidance.
The consultation, to be delivered by CSIP, has included a range of workshops and meetings, designed to engage those who use services and their carers, health and social care economies, including the community, voluntary and independent sectors, plus the Police, CPS, CSCI and the Healthcare Commission.
(Please note that in October 2008, the Department of Health made a decision that from 1st December 2008, that accountability for work currently commissioned through CSIP will transfer to Deputy Regional Directors in the regions or to the relevant policy teams in the Department of Health. CSIP will be gradually phased out by 31 March 2009)
On launching the consultation, Phil Hope MP said: 'This consultation paper is about learning. It is about how we as a society learn to empower people - both the public and the professionals - to identify risk and manage risk. It is about how we empower people to say no to abusive situations and criminal behaviour. It is about locating safeguarding in the wider agenda of choice and control. It is about recognising safeguarding as everyone's business. It is about identifying the tools we need for better safeguarding.'
Since No Secrets was published, there have been significant legal and policy changes relating to adult health and social care, such as the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards, and the Safeguarding Vulnerable Groups Act 2006.
Also, the gradual implementation of legislation like the Housing Act 1996 (which deals with vulnerable people who have support needs or are homeless) and the Youth Justice and Criminal Evidence Act 1999 (which deals with achieving best evidence from vulnerable and intimidated witnesses) has increased the need for local partner organisations to work together.
The review aims to stimulate a wide debate about how No Secrets can help to deliver the new vision for health and social care so that people feel empowered to take greater control of their lives and considers how this can be achieved in the context of personalisation.
There are particular questions emerging on what should safeguarding involve and who is responsible, and who manages the risks? The review also sets out issues around access to criminal justice and considers the challenges associated with the requirements for legislation. Page | 4 50 The consultation closes on the 31st January 2009 with the results to be published within 3 months of the closing date when the Action Planning stages of the process begins.
Other Important National Developments
Safeguarding Vulnerable Groups Act 2006
The Safeguarding Vulnerable Groups Act received Royal Assent on the 8th November 2006.
The Bill was introduced to respond to Key Recommendation 19 from the Bichard Inquiry into the murders of two ten year old girls, Holly Marie Wells and Jessica Aimee Chapman in Soham in 2002 and the associated failings that led to Ian Huntley obtaining a job as a care taker in a school.
Recommendation 19 of the Bichard Inquiry called for a registration scheme, preventing those who are deemed to be unsuitable from gaining access to children or vulnerable adults through their work.
The Safeguarding Vulnerable Groups Bill aims to significantly strengthen safeguarding by developing a central vetting process (Vetting and Barring Scheme) built on the Criminal Records Bureau (CRB), with a new Independent Safeguarding Authority (ISA) which will take decisions on including someone on the barred list where evidence suggests that they present a risk of harm to children or vulnerable adults.
Key measures of the cross-Government Bill include: x The creation of a new body, the Independent Safeguarding Authority (ISA) which will essentially be a register of all those eligible to work or volunteer with Children or Vulnerable Adults. x A legal requirement for all individuals who wish to work or volunteer with Children or Vulnerable Adults to be registered with the ISA. x A legal requirement on employers etc to check that a prospective employee or volunteer IS registered and NOT barred from working with vulnerable groups. x The new vetting and barring system will bring relevant information together in one place. This will integrate the current List 99 (for teachers), and the Protection of Children Act lists (for those working in childcare settings) and also provide for a new list of people barred from working with vulnerable adults to replace the Protection of Vulnerable Adults list. x Removing responsibility for barring decisions from Ministers entirely and transferring this to a new ISA which will take decisions on whether to include someone on the barred list. x Making it possible for domestic employers such as parents to check whether private tutors, nannies, music teachers and care workers are barred. x For the first time, enabling employers to make a ‘real-time’ instant check of whether a prospective employee is barred with secure online access rather than the current paper- based process. x Updating barring decisions as soon as any new information becomes available, and where possible, notifying relevant employers if an employee becomes barred.
Page | 5 51 As the full introduction and implementation of the Act (and its supporting infrastructure) is a hugely challenging logistical exercise, the bill will have a phased introduction.
From January 2009, the ISA took control of decisions based around the Vetting and Barring Scheme while the continued phased introduction of the Act will continue from Autumn 2009.
Harrow has set up a working group comprising of key representatives from Adult, Children and Human Resource Services to jointly address the implications of the Safeguarding Vulnerable Groups Act and to ensure that Harrow and our partners are prepared as the Act continues its phased introduction.
Deprivation of Liberty Safeguards (DOLS)
The Mental Capacity Act 2005 makes provision for the Deprivation of Liberty Safeguards (DOLS) which come into force on 1st April 2009.
The DOLS apply to all hospitals and care home that provide care for people who (for whatever reason) can’t make decisions about their own treatment or care.
This legislation arises from the European Court of Human Rights 2004 judgement in the case of H.L. v. the United Kingdom. The case is commonly referred to as the “Bournewood” judgement - so called because H.L's care and treatment took place in Bournewood Hospital.
In response, the DOLS makes provision for additional safeguards in situations where a person lacks the capacity to consent or make decisions about the sort of care or treatment they receive.
The principles of the DOLS make clear that individuals who lack capacity may often need more care and protection than others to ensure that they are not harmed or their human rights infringed.
Such safeguards are particularly important for individuals whose care or treatment may mean restricting their freedom to the point of depriving them of their liberty – i.e. locked wards or dementia units.
The aim of the DOLS is to strengthen the rights and protections for any such individual to ensure that any arrangements in place that meet the DOLS criteria are formally sanctioned, monitored and reviewed as and when information changes.
The law says the MCA DOLS must be used for each and any individual in a hospital or care home if he or she needs to have their liberty taken away in order to receive treatment and / or care that is in their best interests and protects them from harm.
As lead agencies, the PCT (for hospitals) or the local authority (for care homes) must be asked to carry out an assessment to decide if it is right to take away the person’s liberty – an “authorisation”.
Not every assessment will result in an authorisation, however, once a person in a hospital or care home has an MCA DOLS authorisation, a representative is appointed to support them and look after their interests. Page | 6 52 The hospital or care home (together with their PCT or local authority) must also regularly review an authorisation to ensure that it is still necessary and where it is not, formally remove it.
PCT’s and Local Authorities are also required to provide both the individual and their representative with information about the authorisation and their full rights and entitlements under the law – including the right to appeal to the courts to challenge an authorisation.
The MCA DOLS are for people who are aged 18 and over in NHS hospitals, or in private hospitals or care homes that are registered under Part 2 of the Care Standards Act 2000.
Harrow Council and Harrow PCT as the supervisory bodies tasked with implementing the independent scrutiny of deprivation of liberty are currently working together to implement the systems and processes to ensure compliance with this new legislation.
Awareness raising sessions are planned for March and April 2009.
Self Directed Support
Self Directed Support (also known as Personalisation, In Control, Individual or Personal Budgets, Self Directed Care etc.) represents the Governments approach to a radical new model for the reform and delivery of public services to vulnerable people.
The underlying principle for the development of Self Directed Support (SDS) is the desire to move to a system where adults have the ability to take greater control, of their lives and the social care that they receive, enabling them to make the decisions and manage (with appropriate support) their own risks.
SDS aims to empower individuals to live their lives as they wish while being supported by high quality services that are safe and promote their individual needs for independence, well-being, choice and dignity.
This holistic approach is set out in (amongst other) the Government’s range of “Putting People First” publications and aims to transform the provision and delivery of health and social services with the service user at the heart of all decisions that affect their lives.
SDS aims to put people at the centre of assessing their own needs, deciding how best those needs can be met, and tailoring care to meet these individual needs.
Individuals can then choose to manage their care or care package in a variety of ways to suit their willingness and capacity – including having a personal budget or employing their own personal assistant.
SDS and Safeguarding
The development of SDS, personal budgets and the ability of service users to become employers could, together with providing fulfilling opportunities, also increase the potential risks of abuse, harm or exploitation.
Risk (acceptable risk) is a part of everyday life and service users should be supported and empowered to take these risks as we all do. This does however highlight the need to Page | 7 53 further develop the relationships with safeguarding, preventative and risk assessment / management processes.
Although a complex balance, this also highlights the need to identify and effectively manage risk to strike the right balance between protecting vulnerable people and empowering individuals to take greater control.
The LSAB has been working with the SDS implementation leads to ensure that the issues of risk, risk management and safeguarding are given a high priority at every stage of the SDS process.
The LSAB will continue this work in 2009 and continue to support and influence the safeguarding aspects of the SDS agenda.
Comprehensive Area Assessment (CAA)
Comprehensive Area Assessment (CAA) will reflect the new era of public sector partnership working. This new assessment framework will provide a snapshot of how effectively local partnerships are working together to deliver local people's priorities.
The CAA framework document, published on 10 February 2009, sets out how CAA will be delivered from April 2009 and highlights how Safeguarding Adults will be a key indicator in how Council’s (and partners) will be assessed in future years.
Baby P Case
While obviously a Child Protection case, Baby P has undoubtedly raised the profile of abuse and safeguarding in the public’s mind. The NSPCC noted a significant increase in calls to its helpline following this case and we would hope that it has also raised the issues of Safeguarding Adults both with the public and also with Government.
With the introduction of the Safeguarding Vulnerable Groups Act (Adults and Children) and the review of No Secrets, together with a proposed review by the Social Work Taskforce (set up in December 2008 by the Secretaries of State for Health and for Children, Schools and Families in response to the Baby P case) this will consider, amongst other things, how to improve the quality and status of social workers across both adults’ and children’s services. Its findings will inevitably have an impact on the Department of Health’s forthcoming Adult Social Care Workforce Strategy which aims to help transform the adult social care workforce.
Coming at a time when there is widespread public and media attention on arrangements for safeguarding children, arising from the Baby P case, the issues in relation to safeguarding adults require a similar degree of attention and we hope the tragic circumstances surrounding Baby P’s death and the lessons learned will also be translated to adult services and help to improve safeguards for all vulnerable individuals.
Other Important Local Developments
CSCI Service Inspection Report – Independence, Wellbeing and Choice
In January 2008 Harrow was inspected by CSCI on 2 aspects of the Independence, Wellbeing and Choice agenda – Harrows ability to safeguard adults whose circumstances Page | 8 54 made them vulnerable and Harrow’s delivery of personalised services to adults with learning disabilities.
The safeguarding element of this inspection was positive and Harrow was assessed as being “adequate” in its safeguarding provision. The lead inspector did however note that although Harrow was assessed as adequate, that our approach and development was rising towards “good” and that had our strategic lead in 2007 been more robust, we may have achieved a higher rating.
The inspection report identified the following as some of the key strengths and areas for development in Harrow’s approach.
Strengths.
• Safeguarding alerts increasing due to greater awareness • Case practice was generally sound - some very good • Some skilful front-line staff and managers • Staff protected family carers, children and people funding their own care • Good written guidelines for staff to follow • Good joint casework with others, e.g., Police, Housing • Most safeguarding training was effective • Clear public information but….. • Privacy and confidentiality were properly kept • Clear leadership was making improvements on several fronts (but very new) • Safeguarding Adults Board being put back on track • Partner agencies being better engaged • First safeguarding strategic action plan being written • First adult safeguarding annual report had been to Members in 2007 • Data collection had improved • Effective links between safeguarding and contracting
The LSAB is not complacent about its strengths and will continue in 2009, to further build on these strengths to continue to Safeguarding Harrow’s vulnerable adults.
Areas for development.
• Not enough protection for self-directed care users • Too many safeguarding alerts about paid carers • Fewer alerts from black and minority ethnic communities • Not enough training courses to cover all partner agencies • No safeguarding champions across Harrow or staff good practice group • Not all staff acted skilfully • Some partner agencies still not sure what to do • No work with people with learning disabilities to stop bullying and harassment • Children could ‘fall though the net’ at transition • Strategic planning and partner engagement had faltered in 2007 • Poor attendance at, and direction for, the LSAB in 2007 • Formal links to other strategic plans and boards had yet to be set up • Governance for safeguarding had been lacking • No annual quality audit of safeguarding practice • Data was under-used for planning purposes
Page | 9 55 The above areas for development have all been addressed in the 2008 /09 Action Plan and work has already been started to improve in these areas. These actions will be reviewed in line with this report and will be further developed in a 2009 /10 Action Plan.
The LSAB can however report on some key developments to address the above, namely;
• Greater links established with the Self Directed Support Team • Undertaking a review of alerts about paid carers • Developing our publicity posters and fliers etc in community languages • Reviewing our training programme to include feedback from CSCI and partners • Developed a Safeguarding Champions role • Developed a BOEM (Black and Other Ethnic Minority) Safeguarding Champions role • Re-structured the LSAB • Introduced a Quality Assurance Audit Process • Developed formal links to other strategic plans • Improved the LSAB’s Governance arrangements • Developed 5 Work Streams to take these specific areas forward.
These (and other areas) will be discussed further later in this report but the LSAB aims to improve its Safeguarding rating in future years and has developed an Action Plan to take this work forward. This Action Plan will be further updated as a result of this report and form the basis of the LSAB’s aims and objectives for 2009 /10 and the coming years.
Joint Review of Commissioning for People with Learning Disabilities and Complex Needs (CSCI, HCC and Mental Health Act Commission)
In October 2008 Harrow was jointly reviewed under the above criteria. While Safeguarding was not the primary focus of this review it was highlighted in specific areas.
The report was pleased that Harrow is committed to delivering on the Personalisation agenda but found that our processes for identifying, assessing and managing risk required strengthening. It also found that the effectiveness of protection planning needed further development.
The LSAB is aware of these issues and will continue to work with the Self Directed Support Team to further address them in 2009.
Serious Case Review
In 2008 the LSAB commissioned its 2nd Serious Case Review (SCR) under Harrow’s Safeguarding Adults Policy and Procedures.
The SCR was carried out on a multi-agency basis and chaired by an independent chair, a registered social worker and former Director of Social Services, with over 30 years experience in social care and in partnership working with the NHS.
The SCR looked at the lessons to be learned following the death of an older person who lived alone and received a range of services from Harrow Social Services and partner agencies.
Page | 10 56 The SCR resulted in an associated action plan, which is being delivered to address the Learning Points identified. This action plan will be reviewed and updated at the February 09 LSAB meeting.
Cornwall Report - Joint CSCI and HCC Investigation – Harrow’s Action Plan
The LSAB has produced an Action Plan and response to the joint CSCI and HCC investigation into the provision of services for people with learning disabilities at Cornwall Partnership NHS Trust and the associated findings.
Harrow’s response makes it clear that the Council and its partners are committed to delivering safe quality services to all its stakeholders and totally condemn any form of abuse.
The LSAB does however recognise that abuse can happen in any situation, relationship or environment and as such we are committed to developing and implementing the systems and processes to protect vulnerable adults from abuse, harm or exploitation and to investigate concerns or allegations whenever they are brought to our attention.
The LSAB acknowledge the national recommendations made by the joint investigation and will action these through the proposed action plan.
Safeguarding Adults Team
This development will be discussed in more detail later in the report.
Multi-Agency Contributions
In 2007 the LSAB secured the following Multi-Agency contributions from partner statutory agencies to support the work and infrastructure of Safeguarding Adults in Harrow: -
Harrow PCT - £3000 Central and North West London Mental Health Trust (CNWL) £3000 Harrow Council £3000
In 2008 the LSAB made similar requests of partner organisation / agencies but difficulties in following this request up and subsequent budget limitations meant that organisations could not release funds in the 2008 financial year.
Throughout 2008 however, similar requests have been made of partners and to date there has been a positive response with the following partners having agreed / agreed in principle to contributing to a pooled budget in 2009 and it is anticipated that contributions will commence as soon as possible under the various agency budget timelines.
Harrow PCT - £5000 Central and North West London Mental Health Trust (CNWL) £5000 Royal National Orthopaedic Hospital (RNOH) £5000
Harrow Council continues to fund the Safeguarding Training Programme and in 2008/ 09 has also allocated £120,000 to further develop the Safeguarding infrastructure by funding 2 dedicated Safeguarding Adults professionals to work in the various care management
Page | 11 57 teams. Harrow will also be asking partners to further consider their financial commitment to the Safeguarding agenda in 2009.
These contributions have and will continue to be used to support the work and infrastructure of Safeguarding Adults in Harrow and in 2009 will contribute towards the further development of our publicity materials, training and learning resources and will allow us to review, revise and replenish these stocks.
Definition of a ‘Vulnerable Person’
The “No Secrets” Guidance adopts the following definition of a vulnerable person as being anyone over 18 who:
“ is or may be in need of Community Care Services by reason of mental or other disability, age or illness and is or may be unable to take care of himself or herself or is unable to protect themselves against significant harm or serious exploitation”
WHO DECIDES Lord Chancellor’s Office (1997) quoted in No Secrets Department of Health (2000)
People who may be included in a definition of a ‘Vulnerable Person’ x People with learning disabilities x People with physical disabilities x People with sensory impairment x People with mental health needs including dementia x People who misuse substances or alcohol x People who are physically or mentally frail
Definition of “Abuse”
The Council of Europe defines abuse as:
“ Any act, or failure to act, which results in a significant breach of a vulnerable person’s human rights, civil liberties, bodily integrity, dignity or general well being; whether intended or inadvertent; including sexual relationships or financial transactions to which a person has not or cannot validly consent, or which are deliberately exploitative.”
SAFEGUARDING ADULTS AND CHILDREN WITH DISABILITIES AGAINST ABUSE Council of Europe 2002 “No Secrets” Guidance defines abuse as:
“Abuse is a violation of an individual’s human and civil rights” x Abuse may be a single incident but is more likely to be part of a systematic pattern. x The risk of being abused depends upon the situation, the environment and the perpetrator, not primarily on the behaviour of the victims x Abuse can occur in any relationship and may result in significant harm to or exploitation of the person subjected to it resulting in the deterioration of a person’s physical, emotional, social or behavioural development.
Page | 12 58 x Abuse may be a deliberate act or may be the result of a failure to act appropriately x Abuse may constitute a criminal offence
Types of abuse:
“No Secrets” (DoH 2000) has identified the following types of abuse:
Physical abuse Sexual abuse Psychological abuse Neglect Discriminatory abuse Financial abuse
It should be noted however that these categories of abuse are not mutually exclusive and many situations will contain a combination of different kinds of abuse.
The Development and Implementation of “No Secrets” and Safeguarding Adults in Harrow
In August 2001 the Harrow Multi-Agency Adult Abuse Policy and Procedures for Vulnerable Adults was adopted by the main agencies which provide a service for vulnerable adults in Harrow; these included: x Harrow Social Services and Housing Department. x The Harrow Division of the Metropolitan Police x Harrow Primary Care Trust x North West London Hospital Trust x Central North West London Hospital Trust
In July 2004 Harrow established its first Multi-Agency Protection of Vulnerable Adults (POVA) Steering Group.
The POVA Steering Group was instrumental in introducing Harrow’s Multi-Agency Safeguarding Adults Policy and Procedure in 2006 and in taking the Safeguarding Adults agenda forward in Harrow.
In 2007, the POVA Steering Group was renamed the Local Safeguarding Adults Board (LSAB), this was in-line with national policy shifts and a vision of closer alignment with the approach and terminology of children’s services.
In 2007 the LSAB produced its first Annual Report. This is the LSAB’s 2nd Annual Report and it will focus on reporting on the aims and objectives from the 2007 report together with setting the priorities and challenges for 2009 and the years ahead.
Page | 13 59 Review of Aims and Objectives from 2007 Annual Report
1.) Aim
Ensure clear governance and ownership across the agencies in Harrow of their responsibly to Safeguard Adults with the view to achieving excellence in service provision.
Action / Outcome / Achievements
The LSAB continued in its responsibility to lead on the strategic delivery of the multi- agency safeguarding arrangements in Harrow.
The agreed primary responsibilities of the LSAB are to: x Provide a strategic lead with respect to the multi-agency management of safeguarding arrangements in Harrow. x Have overall responsibility and accountability for delivering on the safeguarding adults agenda x Monitor and review the implementation and impact of the policy and procedure x Maintain a scrutiny function x Make policy decisions x Co-ordinate activities between agencies x Ensure planning and development of services based on the analysis of local information and findings x Improve local ways of working in the light of the knowledge gained through national and local experience and research, and to make sure that any lessons learned are shared, understood and acted upon x Raise awareness with service users, carers and in the wider community of the need to Safeguard Vulnerable Adults from abuse and promote their welfare x Have lead responsibility for ensuring that the appropriate training and skills are available in participating agencies
Since 2007 the LSAB has recognised that membership of the group had declined and that there was a need to review the work and function of the group and refocus its priorities.
The LSAB commissioned a number of internal reviews to establish the challenges and propose a way forward.
In October 2007, a new Director of Adult Social Services came into post and took over the role of chair of the LSAB.
As the new Director and chair of the LSAB, Paul Najsarek ratified the proposals and made a commitment to refocusing the work and function of the LSAB.
The work began with reviewing the LSAB’s membership and re-structuring the board to ensure that it was fit for purpose and had the ability / capacity to deliver on our agreed aims and priorities.
Page | 14 60 Membership of the LSAB was broadened to include representation from all agencies and sectors across Harrow, who have a role in either commissioning or delivering services and in safeguarding and protecting Harrow’s vulnerable adults.
Representatives from Harrow’s major residential and domiciliary care agencies are now also represented on the LSAB.
Each organisation’s / agency’s representation on the LSAB was set at an appropriately senior level within that organisation / agency to be able to accept accountability, take and action decisions as appropriate and delegate staff / resources as appropriate to the various work streams to take specific pieces of work forward.
The organisation’s /agency’s representative would also be of sufficient seniority to have a “route” into their own Governance arrangements and be committed to embedding safeguarding adults within those structures, i.e. making it a regular agenda item, feeding back, getting sign-up and commitment etc.
These new arrangements have been in place since the beginning of 2008 and have shown success in refocusing the work of the LSAB and in increasing membership, sign-up and commitment.
Governance arrangements have been discussed at LSAB meetings throughout 2007/08.
The LSAB presented an item at Overview and Scrutiny in July 2008 and has used the current review of the Harrow Strategic Partnership Board to both establish and strengthen its governance arrangements.
The Director has worked closely with other strategic groups to raise the awareness and profile of safeguarding adults and to investigate routes into other areas i.e. the Local Area Agreement (LAA)
The LSAB is also involved in the current consultation on the future partnership governance arrangements for health and social care in Harrow. The LSAB has been given appropriate priority within this consultation with a proposal that the LSAB should sit at executive board level. The consultation closes in March 2009 with the proposals coming into effect in April 2009.
To further raise awareness, ensure a high profile and also further develop its Governance arrangements, the LSAB has included Safeguarding Adults within the following strategic documents: x Safeguarding is now included as 1 of Harrow Council’s 3 Corporate Priorities (Improve support for vulnerable people) x Harrow PCT’s Operating Plan x Total Transformation Programme x Community Safety Plan x Harrow’s Workforce Strategy x Draft Sustainable Community Strategy x Draft Integrated Commissioning Strategy x Joint Strategic Needs Assessment
Page | 15 61 Targets / Goals
To further develop the role, function and leadership of the LSAB To further explore and develop the LSAB’s Governance arrangements
2.) Aim
To improve practice and further clarify responsibilities
Action / Outcome / Achievements
Together with the actions detailed above the Chair of the LSAB provided a member / portfolio holder briefing in May 2008 and has continued to raise awareness and gain member support through regular portfolio holder briefings on safeguarding issues.
The member portfolio holder is also copied into the minutes of the LSAB and is briefed on important issues and updates.
The LSAB took a decision to postpone the review of our policies and procedures as a proposed Pan-London Policy and Procedure had received the approval for action.
A consultation policy and procedure was issued in September 2008 with a range of stakeholder events at which Harrow took full part.
A 2nd draft of the policy and procedure is due to be issued in early March 09 and the target date for implementation remains as April 2009.
Although a Pan-London Policy and Procedure, Harrow will be developing local protocols to both compliment the Pan London procedures and where appropriate account for local variances’ and lessons learned.
This project has been proposed by the London Adult Protection Network (Harrow is a member) and in agreement with the Greater London ADASS, sponsorship comes from the DH Policy branch and CSIP and the project is being co-ordinated by SCIE.
There will be a particular focus on cross border and cross organisational issues in managing the safeguarding of adults and it will be framed in the context of personalisation and taking positive risk into account.
Learning from this project will also be fed into the review of "No Secrets" and will also contribute to SCIE’s work on Restraint.
Harrow is also a member of the North West London Pan London Policy Reference Group.
Harrow’s Multi-Agency Safeguarding Adults Policy and Procedures applies to: x All vulnerable people over the age of 18 who are resident in the London Borough of Harrow whether or not agencies in Harrow are responsible for meeting the cost of their service x People who are no longer resident in Harrow but for whom an agency in Harrow still retains a statutory responsibility to provide them with a service or to meet the cost of Page | 16 62 that service. Although the Policy and Procedures applies to this group of people it may well be that in some circumstances some aspects of the duty to investigate an allegation of abuse may be undertaken by another local authority on behalf of Harrow Council x All agencies within the London Borough of Harrow who provide a service for vulnerable people or who are commissioned or have a contractual obligation to provide a service to such people on behalf of Harrow Council or any other signatory to the Safeguarding Adults Policy and Procedures
The Harrow Multi-Agency Safeguarding Adults Policy and Procedures should always be followed when there is an allegation or suspicion that a vulnerable person is being or has been abused or where there is a potential for harm to other vulnerable people
Targets / Goals
To continue to raise awareness with Portfolio Holders and Members To contribute to and support the implementation of the Pan-London Policy and Procedures To continue to contribute to associated implementation groups To develop local protocols where appropriate to compliment the Pan-London Procedures
3.) Aim
To further Improve the response to Vulnerable Adults who may be in need of Safeguarding
Action / Outcome / Achievements
Together with the actions detailed above the LSAB have further developed the Council’s Safeguarding website, further development will take place throughout 2009 with more focus being placed on the “Good Practice” Section of the Website.
A series of awareness raising events took place in support of World Elder Abuse Awareness Day 2008 (WEAAD) including: x Carer / user awareness raising event at Carer’s Week x Public awareness raising event in the Local Shopping Centre x Public awareness raising event in the Civic Centre x Launch of the 2008 / 09 Training programme x Article in our Staff newsletter and the Local Press approached to raise awareness around our events and the issues surrounding elder abuse
On-going dissemination of our posters, fliers and service user wallet cards for Providers, Direct Payment and Self Directed Care service users has also taken place and this is planned to continue in 2009.
Targets / Goals
To further develop the LSAB’s Quality Assurance Processes To audit a minimum of 30 safeguarding cases in 2009 To further develop the Councils Safeguarding Website
Page | 17 63 To work with partners on a joint response to WEAAD 2009 To continue to explore and develop further awareness raising opportunities To replenish existing stocks of posters, fliers etc. To produce this information in more accessible formats i.e. community languages To specifically target Harrow’s BME Communities by developing materials in Harrow’s most commonly spoken community languages
4.) Aim
To improve the care of Vulnerable Adults receiving Community Care Services and to minimise the risk of abuse
Action / Outcome / Achievements
Together with the actions detailed above, the LSAB has been working with Harrow’s Contracts and Brokerage Team to ensure that SLA’s / Contracts include appropriate reference to Safeguarding Adults issues.
Harrow Council has a zero tolerance policy towards abuse and aims to ensure that all services, either directly provided or commissioned by Harrow on behalf of vulnerable people have clearly defined protocols and local procedures in place that acknowledge and reference Harrow’s overarching policy and procedures.
These local procedures set out the organisations commitment to work in line with Harrow’s expectations and affirm their commitment to delivering safe and quality services to Harrow service users.
Service users accessing Direct Payments and Self Directed Care are advised and supported to access safe recruitment practices when employing staff to deliver their care package.
The LSAB continues to work with regulators and local providers to contribute to the delivery of safe services and supports this aim with its Training provision which is available to all services in Harrow.
Targets / Goals
To act on recommendations from the CSCI Inspection and Joint Review in relation to further developing contract monitoring arrangements for safeguarding To continue to work with the Self Directed Support Team to further develop the principles of risk and risk management as it relates to the Personalisation and Safeguarding agendas To review and update the LSAB’s Cornwall Action Plan
5.) Aim
To improve the ability to Safeguard and Plan for the future of Service Provision
Action / Outcome / Achievements
Together with the actions detailed above, the LSAB has made contact with the Senior Manager leading on the Work Force Strategy to ensure that due consideration is given to Safeguarding issues in the development and implementation of the strategy. Page | 18 64 Safeguarding Adult’s Team (building for the future)
In a significant development, Harrow Council has identified £120,000 to be used to build and strengthen existing approaches. This money has initially been used to recruit two new full time members of staff with a more dedicated Safeguarding focus and role.
The new positions will initially concentrate on co-ordinating safeguarding issues and responses at an operational level, monitoring the effectiveness of actions taken and promoting consistency of approach and response. They will also focus on leading on cases involving institutional abuse as these often require greater input and coordination.
These posts have been recently filled and while the role will be an evolving one, it represents Harrow’s commitment to taking safeguarding issues forward with appropriate priority.
Data Collection and Statistics (see end of report for the 2008 statistics)
The ability of Harrow’s IT system to robustly report on data collection issues needs further development. While the system can report on basic data, more sophisticated data analysis is still not possible.
This area remains a priority for the LSAB and in 2009 more concerted efforts will be devised to either improve our reporting capacity through Framework-i or to develop a separate monitoring database.
In June 08, Harrow volunteered to be part of the pilot project by the Strategic Information Group on Adult Social Care (SIGASC) to trial a proposed new data monitoring set.
Although a worthwhile experience, our ability to fully provide the range of complex data required did impact on our ability to provide a full return. This did however prove a useful exercise in identifying the areas where our recording and reporting needs to develop.
The LSAB will continue to work with Harrow’s Performance Management team to further develop this area.
Targets / Goals
To continue to address Safeguarding issues within the priorities of both the Council and partner Organisations and Agencies To further develop Harrow’s Safeguarding Adults Team To undertake a review of the role and function of the current Safeguarding Adults Team and learn / develop based on experience and practice To learn and develop policy and practice based on the feedback and experience of the Safeguarding Adults Team To further develop the LSAB’s ability to produce ever more sophisticated data and to use this data to inform priorities To develop Harrow’s data systems in line with the Department of Health’s and Information Centre’s proposed National Data Set
Page | 19 65 6.) Aim
Governance – To improve the responses of Organisations and Agencies across Harrow to Vulnerable adults
Action / Outcome / Achievements
Please see Aim 1 for a detailed status report on the LSAB’s Governance arrangements.
7.) Aim
Establish robust evaluation mechanisms to contribute towards improved practice
Action / Outcome / Achievements
Together with the actions detailed above the LSAB has completed a review of 2007/08 Training Programme with our Training Dept (OD), BILD as the providers and participant feedback. This review contributed towards the development 2008 /09 programme.
Similarly in February 2009, the LSAB will complete a review of the 2008 /09 Training Programme, again with feedback from stakeholders and partners and use this learning to develop the 2009 /10 Training Programme.
This review will also include the feedback, views and experiences of staff and multi-agency partners.
The development of the various Work Streams (see section on Work Streams) has also contributed towards learning and improved practice.
The LSAB continues to work with the Council’s Complaints department to separate out any potential Safeguarding Adults issues from complaints to ensure a clear demarcation between safeguarding issues and complaints and that each are dealt with accordingly.
The development of the Internal and External Audit Processes have also helped contribute towards learning and continuous development and these areas will be developed further in 2009.
The CSCI Safeguarding Inspection and the Joint Review of Learning Disability Services have also been useful in helping the LSAB to reflect and evaluate on our current position and to work towards continuous improvements in practice and development.
Targets / Goals
As detailed above in 5, 6 & 7 and To continue to action the recommendations from the CSCI Inspection and the Joint Review To further develop the LSAB’s various Work Streams To further develop the LSAB’s Quality Assurance Processes To continue to seek out mechanisms to reflect and evaluate on our current position and to work towards continuous improvements in practice and development.
Page | 20 66 The Development of Work Streams
Training and Learning Work Stream
The LSAB recognise that training and learning is a crucial factor in raising awareness
8.) Aim
To empower and enable staff, carers and service users with an improved ability to identify, report, and respond to allegations or suspicions that abuse is or has taken place.
Action / Outcome / Achievements
The LSAB, through the Training and Learning Work Stream, oversees the commissioning and delivery of multi-agency safeguarding adults training. This training has been commissioned from BILD, the British Institute for Learning Disabilities and is offered both in house to our own staff and also offered externally to our partner organisations and agencies.
Together with the review and evaluation of the 2007/08 and 2008/ 09 Training Programmes and developing the 2008/ 09 and 2009 /10 programmes, the Training and Learning Work Stream has delivered the following training in 2008 /09.
To date this Multi-Agency Training programme has trained approx. 274 staff across approx 357 places on the various courses run in the 2008 /09. (up 59% from 2007/ 08)
In 2008/ 09, the training department ran 25 courses providing 26 days of training. (up 32% from 2007/ 08)
This Multi-Agency Training has delivered approx 58 places to health service staff, (up 57% from 2007/ 08), approx 52 places to private sector staff (up 225% from 2007/ 08) and approx 71 places to voluntary sector staff. (up 255% from 2007/ 08)
One of the recommendations from the CSCI Safeguarding Inspection in 2008 was to increase the number of training places offered to service providers. The LSAB has worked hard in this area in 2008 to increase awareness and publicity of our training opportunities with both private and voluntary service provider organisations and as the figures above demonstrate, we have had some major successes in this area.
It must however also be noted that when Harrow staff working in voluntary sector establishments are counted (i.e. Support for Living Homes); this further increases the figure by 48 places. This is a complex arrangement (as to which category to attribute these figures) but the options and figures can be demonstrated below:
As a charity, (voluntary sector provider) = 71 places + 48 places (Support for Living Homes) = 119 places and an increase of 495% from 2007/ 08
OR
As a service provider (not public sector) = 52 places + 48 places (Support for Living Homes) = 100 places and an increase of 525% from 2007/ 08 Page | 21 67 The above figures for 2008/09 represents approx. 51% of the total training delivered – i.e. approx. 181 out of 357 places delivered to partner colleagues from across the health, private and voluntary sectors. (up 148% from 2007/ 08)
If we also include Harrow staff in voluntary sector establishments, this increases the figure to 229 out of 357 places and represents 64% of the total training delivered (up 137% on 2007/ 08
The training courses run in Harrow cover a range of skills and disciplines, ranging from Basic Awareness (and refreshers) to more in-depth training for those who undertake safeguarding adults investigations.
The vast majority of feedback from these courses have been extremely positive with favourable comments around the content, style and quality of the courses provided by BILD.
It must also be noted that 2008/09 has seen an increase in Safeguarding Adults referrals of approx 48%, from 187 in 2007/08 to 276 in 2008/09.
The training budget for 2007/08 was £18,000 while in 2008/09 it was £19,500 (up 8% from 2007/ 08)
The training budget for 2009 /10 has yet to be agreed but once finalised, the Training and Learning Work Stream will be working with OD and BILD to deliver the programme and further promote and publicise this training both internal and external to the local authority.
The focus and targeting of the 2009 /10 training programme will be agreed at the next meeting of this Work Stream following analysis and learning from the 2008/09 training programme.
The LSAB will continue to work with multi-agency partners to increase capacity across partner organisations and agencies by continuing as appropriate with joint investigations and targeting those staff that will be involved in and carrying out those investigations to ensure that they have received the required level of training and support in order to fulfil these responsibilities.
Targets / Goals
To review and evaluate the 2008 /09 Training Programme To incorporate the feedback from stakeholders and partners into this review To use this feedback to develop the 2009 /10 Training Programme To identify and re-train / refresh Harrow Staff who have not had appropriate Safeguarding training in the last 3 years To increase the % of trained Harrow Council Staff (SAS figures) to 90% To increase the training provided to private / independent / third sector staff by a minimum of 10%
Publicity and Communication Work Stream
The LSAB recognises the need to promote and safeguard the wellbeing of service users and to raise awareness around the issues of abuse Page | 22 68 9.) Aim
To Raise Awareness amongst staff, carers, service users and the wider general public to identify, report and respond to allegations or suspicions of adult abuse
Action / Outcome / Achievements
Together with the actions detailed above and the series of awareness raising events that took place in support of World Elder Abuse Awareness Day (WEAAD) the Publicity and Communications Work Stream has developed the Council’s Webpage to further raise awareness and promote the issue of Safeguarding Adults.
There have been articles in the Staff newsletter and the Local Press have been approached to raise awareness around the issues surrounding elder abuse.
Further dissemination of user wallet cards for Direct Payment and Self Directed Care Service Users has taken place and there have been presentations at various forums including the Domiciliary Care provider’s forum.
Work has also taken place to distribute Harrow’s posters, leaflets, fliers and training programme to all providers across Harrow with whom we have commissioned any service for vulnerable adults.
The LSAB will also have a 2-page spread in the March 09 edition of “Harrow People” (a free magazine that goes to every household and business in Harrow) This is an excellent awareness raising opportunity and the LSAB will take full advantage of the opportunity to raise the profile and awareness of Safeguarding issues within Harrow’s wider community.
Targets / Goals
To work with partners on a joint response to WEAAD 2009 To further develop the Council’s Safeguarding Website To continue to work with partners, both internal and external to the Council, to explore and further develop awareness raising opportunities To replenish existing stocks of posters, fliers etc. To produce this information in more accessible formats i.e. community languages To disseminate, promote and publicise this information as widely as possible
Improving Practice Work Stream
The LSAB recognises that developing knowledge bases, sharing experiences and learning and promoting good practice is central to developing effective and consistent approaches to Safeguarding Adults.
10.) Aim
This work stream offers workers from all agencies, an opportunity to share and discuss individual or complex issues / cases and to benefit from a multi-agency discussion around those issues.
Action / Outcome / Achievements Page | 23 69 Together with the actions detailed above the Improving Practice Work Stream has been instrumental in discussing and agreeing the future direction of Safeguarding Adults in Harrow.
It has identified £120,000 to be used to build and strengthen existing approaches. This money has initially been used to recruit two new full time members of staff with a more dedicated Safeguarding focus and role.
The Improving Practice Work Stream will continue to develop the role and function of these new posts and will lead on shaping an evolving role profile.
Together with further developing and contributing to the Council’s website, this work stream will also be responsible for taking the learning from the 2008 Serious Case Review forward once ratified by the LSAB at its February 09 meeting.
The Improving Practice Work Stream has also identified Safeguarding Champions within each of the Care Management Teams to take forward the work of Quality Assurance.
The Improving Practice Work Stream has also identified a BOEM (Black and Other Ethnic Minority) Safeguarding Champion to represent BOEM Communities in Harrow. A draft role profile has been developed and this role will be further developed in 2009.
Targets / Goals
To further contribute to shaping Harrow’s Safeguarding Adults Team Under the direction of the LSAB to deliver the SCR Action Plan To further develop the mechanisms to involve stakeholders and partners in this process To further develop the mechanisms to share the feedback and lessons learned from this process with staff, stakeholders and partners
Quality Assurance Work Stream
The Quality Assurance Work Stream was established in 2008 to develop and implement a quality assurance process and establish a system of auditing safeguarding adult’s case practice.
The aim of the Quality Assurance Work Stream is to ensure the consistent implementation of Harrow’s Multi-Agency Safeguarding Adults Policy and Procedure when abuse is alleged or suspected.
The Quality Assurance Work Stream also aims to support the continuous professional development of all those with a role to play in the Safeguarding Adults process with particular focus on developing Care Management and Multi-Agency skills and approaches.
This Work Stream has developed its terms of reference, an audit process and an audit tool which was used to undertake its 1st internal audit in August 2008.
The purpose of the audit and audit tool is to explore current practice, identify good practice and areas for development and to use this learning to further develop and improve responses to vulnerable adults.
Page | 24 70 This process and tool will be further developed in 2009 and used as a basis to carry out a number of sample case audits on a 2 monthly basis.
An external (independent) audit process has also been developed and the LSAB is currently commissioning an independent external auditor to carry out this audit. This work is planned for Feb / March 2009.
The audit process is being used as a learning and development tool and as such it is used to highlight, not only good practice examples, but also to highlight potential corrective, remedial or additional actions.
Safeguarding Champions / Managers address any training or development issues arising from the audit process for their staff and take these forward, they are also responsible for providing the feedback / learning to their various teams as a wider learning outcome.
In 2009 the LSAB’s Quality Assurance processes will aim to link with the Council’s wider Quality Assurance Framework and will investigate any potential for learning and development.
The Council has also commissioned MORI to undertake a wide ranging survey of adult social care service users to obtain their feedback as to how Harrow is performing against the 7 outcomes set out in the Department of Health’s, “Your health, your care, your say” paper.
Targets / Goals
To further develop the Quality Assurance Work Stream, its processes and protocols in line with the above to ensure the consistent implementation of Harrow’s Policy and Procedures
User and Carer Involvement Work Stream
This Work Stream has not physically met in 2008 but nevertheless Harrow has made a number of key advances in this area.
A Service User Engagement Officer has been appointed by the Council and the LSAB will develop closer working links with this post in 2009.
The post holder has an excellent working knowledge of Safeguarding issues and has considered safeguarding as a significant part of the role.
Working closely with HLDT (Harrow Learning Disability Team) and the Action Plan Project Lead, a leaflet explaining what abuse is and how to seek help and report it has been developed in accessible format for service users.
This leaflet will be adapted in 2009 and used to share this information with all service user groups and made available on the Council’s website.
Plans are also in place in 2009 to translate the LSAB’s other safeguarding information, posters and fliers into accessible formats including that of community languages.
Page | 25 71 Safeguarding will also be the focus of an upcoming Project Board meeting at which users and carer’s will be represented. Feedback and learning from this meeting will be used to further inform the LSAB’s and this work streams development.
Targets / Goals
To further develop the User and Carer Work Stream in line with the above To further develop the mechanisms to involve stakeholders and partners in this process To further develop the mechanisms to share the feedback and lessons learned from this process with staff, stakeholders and partners
11.) Aim
Ensuring Planning and Development based on Local Knowledge
Action / Outcome / Achievements
See sections on Data Collection, Statistics and the Safeguarding Adults Team
12.) Aim
To Improve Access to Safeguarding Services
Action / Outcome / Achievements
Together with the actions detailed above, the LSAB will continue to develop its Safeguarding Website, the good practice element of that website and further explore links to other organisations in the public, private and voluntary sectors where people can find additional help, advice and support.
Targets / Goals
To further develop the Council’s Safeguarding Website To continue to work with partners, both internal and external to the Council, to explore and further develop awareness raising opportunities
The Actions, Targets and Goals identified in this report will be included in an updated 2009 /10 Action Plan and taken forward by the LSAB.
Page | 26 72 External Links and Working with Partners
NHS Harrow (formerly Harrow PCT)
Strengths and Achievements
The last year has seen Safeguarding Adults issues as being very high on the agenda for NHS Harrow and as such the organisation has welcomed an increasingly prominent, robust and embedded LSAB within Harrow.
NHS Harrow started the year leading a major investigation into the use of inappropriate restraint on one of its elderly care wards (now managed by North West London Hospital Trust). The PCT concluded and published the investigation in September 2008, and resulted in the PCT apologising to patients and relatives affected. Whilst the case and investigation was upsetting for all involved, it identified a number of actions that the PCT and its partners have implemented that will help improve the care for all vulnerable patients.
The level of awareness of safeguarding adults issues has increased within the PCT significantly, and much of this has been to a greater recognition of its importance at a strategic level including the importance of the PCT providing a strategic lead for the local NHS at the LSAB. The PCT commissions NHS services within Harrow and as such recognises it’s responsibilities for ensuring high quality services including safeguarding.
During 2008/9 the PCT made it mandatory for all staff with patient contact to attend Safeguarding Adults Training. By the end of the year 75% of all staff had attended the training and the remaining staff will attend in the first quarter of 2009/10.
Challenges
Services for people with learning disabilities have also been a major focus for NHS Harrow. Following two local reviews and a national review it is clear that much has to be done to improve both specialist services for people with learning disabilities and how mainstream health services ensure that this part of the population have their needs met. NHS Harrow has made learning disabilities one of its priorities during the next three years.
Harrow Mental Health Services (HMHS)
Strengths and Achievements
During the last year safeguarding has become further embedded as a core mainstream activity in the practice of Harrow Mental Health Services.
HMHS has seen the numbers of referrals, strategy meetings, case conferences and protection plans steadily increase - this has been largely due to a targeted programme of awareness raising training amongst all professional disciplines within the service.
Though these (and other) training courses, the service has raised the skill levels of social workers, occupational therapists and nurses - particularly community psychiatric nurses in safeguarding investigations. Health professionals are now clearer about their role in safeguarding and as a result are fully engaged in the process. The skill level of administrative staff in minuting safeguarding meetings has also significantly improved Page | 27 73 following training.
HMHS has also successfully concluded a number of complex investigations, some spanning several boroughs and involving groups of vulnerable people and more complex and targeted protection plans are now being implemented and reviewed.
The amendments to the Trust’s (CNWL’s) risk assessment and risk management policies have also proved to be a useful tool in supporting safeguarding activities.
Careful thought has also been given to the Trust's safeguarding policy to ensure it links appropriately to borough policies; the success of this process has been embedded in clear local guidance and clarity on local procedures which are set out in a separate flow chart for the service.
The trust has facilitated a positive process of engagement with these local procedures through the trust-wide Safeguarding Vulnerable Groups Group. This group has developed a much stronger role in the last year, has initiated training for managers and lead staff and has placed clear expectations on local leads. The ethos within the trust fosters an awareness of safeguarding issues and emphasizes safeguarding as a priority.
Challenges
The numbers of referrals from the inpatient wards remain lower than expected but to address this, a programme of training and awareness raising for ward based staff started in January 2009.
Attendance by doctors at safeguarding meeting is good and significant progress on issues relating to confidentially has been made, however alerts and referrals from doctors remain low.
Domestic violence involving mental health service users remains a challenge - The safeguarding aspects of domestic violence involving service users needs to continue to be considered within these situations. Targeted training will be considered in the next year to address this area.
The collection of safeguarding statistics within the Trust also needs further consideration and development within mainstream performance management and monitoring processes and this issue will be further addressed in 2009.
The increased clarity of roles in local procedures and the lead given by CNWL’s Safeguarding Vulnerable Groups group has given Harrow Mental Health Services a sound framework to meet future challenges and move the service forward in 2009
In conclusion both CNWL and Harrow Mental Health Services have made significant strides during 2008 and as a result Harrow’s mental health service users are better protected than in the past.
Page | 28 74 Central and North West London NHS Foundation Trust (CNWL)
Strengths and Achievements
The CNWL Safeguarding Vulnerable Groups Group is the main forum within the Trust were issues involving vulnerable adults are discussed. The main remit of the group is to provide a forum for Local Authority Leads and CNWL staff involved in safeguarding vulnerable groups to meet on a regular basis in order to maintain continuous dialogue and collaboration.
The group is also tasked to develop and monitor Trust wide standards in relation to safeguarding vulnerable adults and ensure staff are made aware of them. The group is chaired by a Consultant Psychiatrist who is the Lead Clinician for Safeguarding Adults in the Trust.
The group reports directly to the Clinical Governance Committee which is a sub-group of the Board of Directors. All the boroughs covered by CNWL are represented in this group which meets on a quarterly basis.
In the last year the group led an ambitious and but very successful awareness raising training programme in collaboration with our local authority partners. The aim of this programme was to delivers awareness training for clinicians and staff working in CNWL in order to raise the profile of the safeguarding agenda and increase reporting figures.
The Safeguarding Vulnerable Groups Group continues to work with all our local authority partners to ensure that CNWL staff are compliant with the local policies and that senior management including the Board are kept adequately briefed on any pertinent issues.
Challenges
To further develop the Trust’s Safeguarding agenda and take this work forward in 2009.
North West London Hospitals NHS Trust (NWLHT)
Strengths and Achievements
Training for Safeguarding Vulnerable Adults is included in the NWLHT’s mandatory training programme and is included in the junior doctors' induction programme which is completed prior to commencement.
Sue Mackie, Deputy Director of Nursing, has also provided training to various staff groups and has developed a Safeguarding Adults e-learning package. NWLH has also been represented on, and fully cooperated with a Serious Case Review.
Charles Caley, Associate Medical Director, and Sue Mackie are the Trust Safeguarding Vulnerable Adult leads and Safeguarding Vulnerable Adults is reported to the Patient Safety Committee.
These developments, together with the on-going work of NWLHT has led to an increased awareness across the Trust of the issues relating to Safeguarding Vulnerable Adults.
Page | 29 75 Challenges
To further develop the Trust’s Safeguarding agenda and take this work forward in 2009.
Royal National Orthopaedic Hospital (RNOH)
Strengths and Achievements
During RNOH’s first year as representatives to the LSAB it has been both enlightening and constructive in raising this important aspect of patient / client safety.
RNOH welcomes this from all levels and has formally signed up to Harrow Safeguarding Agenda amongst other multi agency partners.
This process has inspired RNOH to increase awareness amongst all clinical staff by addressing awareness sessions and discussing as an agenda item at our Nursing Advisory Committee.
RNOH welcomes a forum for discussion amongst multi agency partners and the willingness to share objectives through board meetings has been useful. This is further strengthened by the Training and Learning Programmes on offer from Harrow Council.
Challenges
RNOH’s upcoming challenges will be to ensure that all employees have an awareness of “safeguarding vulnerable adults” both at induction and at annual updates.
We recognise the need to champion and embrace this fundamental aspect of patient safety within an acute NHS setting.
Future developments / initiatives in this area will be to create permanent specific leadership to take forward this agenda internally and at a high level.
The aims of the leadership will be to strengthen and develop relationships with other multi agency partners both internally and externally to RNOH.
Harrow Metropolitan Police
Strengths and Achievements
Harrow Police continue to work in partnership with both the Council and other multi-agency partners at both a strategic and tactical / operational level.
Police representatives attend regular LSAB meetings and contribute towards ensuring that the challenges for all our agencies are addressed and forthcoming demands anticipated.
Police have publicised the Single Point of Contact to Care Home Providers in the last 12 months to give them a channel for support and advice.
A benefit taken from this is, Care Home Managers involved in investigations within the residential homes are supported by Police through a Single Point of Contact, this enabling them to focus on points of interest that may support a Police investigation. Page | 30 76 Early advice in respect of Criminal Allegations allow matters to be resolved more quickly giving a better outcome for the service users and service providers alike.
Police are keen to further build on working partnerships with Service providers, thus increasing public confidence.
Challenges
Of the many challenges; Competing demands for the same officer’s time and the abstraction of officers at strategy meetings and case conferences which impacts on other areas of Police business.
Police are currently designing a Standard Operating Procedure to address all of the issues MPS wide, including the training of staff to undertake these investigations.
Age Concern
Strengths and Achievements
Age Concern continues to support Harrow’s Safeguarding Adults agenda and has been a regular member of Harrow’s LSAB.
In 2008 Age Concern’s Advocacy Officer and a Volunteer Advocate have attended free training provided by Social Services, courses attended included ‘Abuse in Black and Minority Ethnic Communities’ which was appropriate as many of the cases that Age Concern have dealt with have been from BME groups.
Age Concern have been involved in and contributed towards a number of complex Safeguarding Adults cases involving elder abuse and have successfully worked with multi- agency partners including Social Services, Housing and the Police.
Age Concern also put in a bid for an Elder Abuse Officer to raise awareness but were unfortunately unsuccessful on this occasion.
Never-the-less Age Concern can demonstrate some positive outcome for individuals based on safeguarding adults cases we have been involved in.
Challenges
The challenge for us (Age Concern and others) in Harrow is that, due to acknowledged under-reporting, many incidents of elder abuse go undetected - this highlights the importance of awareness raising, both with older people and the community at large.
Elder abuse is still not something people want to talk about nor does it make front page news or get people's sympathy compared to child abuse.
Challenges remain but Age Concern is committed to working with partner agencies to better protect Harrow’s older residents.
Page | 31 77 Harrow Association of Disabled People (HAD)
Strengths and Achievements
The majority of HAD’s safeguarding contribution has come through raising issues for individuals whom we have seen to be vulnerable whilst working with our services.
These are often clients from the Welfare Benefits or Advocacy services, - sometimes their issues have been able to be dealt with through advice and support, or involvement of a third party, occasionally they have had to go through formal Adult Protection mechanisms.
It could be argued that many advocacy issues deal with Adult Protection where people are vulnerable because they are not getting their needs met, or have been taken advantage of.
One of the main areas where HAD have made a contribution is through identifying issues which may affect Direct Payment service users and their potential vulnerability to abuse.
HAD also specialises in providing help, advice and support to service users who choose to employ personal assistants as part of their support package and the associated opportunities and challenges.
The strengths of the approaches taken in Harrow are that: x Advocacy is available for people who need help, often provided by SLAs from Harrow Council. x The same safeguarding training, which seems to be highly thought of, is available across all sectors so there can be consistency of approach. x The complaints team take complaints seriously and understand the social care issues involved.
The strengths of HAD’s approach is that: x Services are interlinked and all take an advocacy approach x Services will also refer to other services which are in a better position to help the person and as well as internal services; staff have a good knowledge of what else is available locally to help. x Staff have training and are generally good at picking up clues which need following up or that may have a safeguarding issue involved. x The Direct Payment (DP) team is available to all DP clients at any time for further support and advice x The DP team has developed a good balance between understanding the very real benefits for people in receiving support in the form of a DP while also recognising the challenges which may arise and have been proactive in finding appropriate solutions.
Challenges x acceptable or manageable risks have to be balanced with empowerment and safeguarding issues x employment issues and rights have to be balanced with safeguarding issues x Emerging issues e.g. protecting PAs from abuse, and service users from litigation, require a considered approach to the complexities involved
Page | 32 78 x Together with the Council, supporting and encouraging service users who have capacity to carry out the recommended checks (CRB’s and references etc.) on their staff x Supporting service users who refuse to accept help, or when they have previously been managing well and their ability has deteriorated and identifying these users through both mainstream and ancillary services
Harrow MENCAP
Strengths and Achievements
The work of Harrow MENCAP and Harrow's LSAB has ensured that the safety and protection of vulnerable adults remains a high priority on the agenda of all agencies'.
The commitment shown by the LSAB which involves the Statutory and Voluntary sectors will endeavour to raise the profile and awareness of Harrow’s community to the needs of vulnerable adults and strengthen the systems and processes involved in their protection.
Challenges
Harrow MENCAP see the 2 key challenges as continuing to improve the information systems and in empowering vulnerable adults through active involvement within the Safeguarding Adults agenda.
Supporta Care
Strengths and Achievements
Supporta Care were invited to be a member of the LSAB from November 2008 and will continue to have representation on this board and contribute to further safeguarding adults developments and initiatives.
Managers within Supporta Care have attended safeguarding adults training provided by the Council in 2008 and throughout the last 12 months Supporta Care has continued to provide safeguarding adults training to all new staff and have provided refresher training to all existing staff to ensure that they are aware of adult abuse, what forms it can take, how to report suspicions and what support is available to them.
Supporta Care have also raised a number of safeguarding adult alerts during the last 12 months and have been part of the subsequent investigations with the Council, PCT, Police and CSCI.
Both the Council and Supporta Care have a clear and detailed policy on safeguarding adults and from the involvement that we have had in individual situations, there is generally a good knowledge of the policy amongst staff.
The approach, as required through “No Secrets”, is very transparent and communication between the necessary organisations has been good.
Page | 33 79 Challenges
Supporta Care believe that the main challenge is often the time taken to get a strategy meeting organised which can be a difficult when staff are on suspension awaiting the outcome of an investigation.
Fremantle Trust
Strengths and Achievements
Fremantle places a high priority on all staff completing and regularly updating our in-house Safeguarding Adults training.
Fremantle requires each service to have at least one in-house senior staff member trained to deliver the 1 day Awareness training, which includes how to recognise abuse, the duty to report, how to report, etc. The same module is delivered centrally to all staff at induction.
Challenges
To ensure that Harrow Procedures are clear in their practical guidance and are specific about reporting arrangements locally.
To ensure that Safeguarding reports can easily be made to the appropriate Care Management team.
To address (our and other) Asian day centre users on the subject of Safeguarding.
Information (including posters and leaflets) from Harrow should be translated into Gujarati (and other community languages) for maximum accessibility.
Page | 34 80 Statistics
Safeguarding Adults Referrals 1st January - 31st December 2008
Summary Statistics 2007 Variance + / - % No of Refs: - 276 % 48% Female 164 59% 52% Male 111 40% 41% Not Stated / Recorded 1 0%
From different Ethnic Backgrounds (non 97 35% 49% white): - Female 60 62% 82% Male 36 37% 13% (ethnicity) Not Stated / Recorded 1 1%
W/UK BME From different Ethnic Backgrounds (white): 179 97 47% - From different Ethnic Backgrounds (non 65% 35% 0% white): -
Where Abuse took Place: - Care Home (Residential and Nursing) 100 36% 39% Family Home / Own Home 107 39% 49% Adult Placement / Supported / Sheltered 10 4% -33% Accommodation Perpetrator's / Someone Else’s Home 14 5% 40% Community / Other 12 4% 50% Day Care 9 3% 80% Hospital / Acute 6 2% 20% Not Stated / Recorded 18 7%
Client Group: - Older People 138 50% 16% Learning Disability 84 30% 71% Physical disability 50 18% 257% Mental Health 2 1% -60% Not Stated / Recorded 2 1%
Type of Abuse: - Physical 129 47% 45% Many cases Financial 52 19% 41% involved multiple abuses, Neglect 43 16% 54% highlighted are Psychological 22 8% 16% the primary Sexual 18 7% 29% reasons for Not Stated / Recorded 12 4% referral
Alleged Perpetrator:- Paid Care Worker 76 28% -3% Family Mem/Carer 81 29% 25% Friend / Acquaintance 17 6% -6% Service User 49 18% 308% Other Prof 5 2% -38% Stranger 7 3% 17% Not Stated / Recorded 41 15%
Page | 35 81 Page | 36 82 Page | 37 83 Page | 38 84 Harrow’s Local Safeguarding Adults Board (LSAB)
Terms of Reference and The Strategic Management of Safeguarding Adults in Harrow
Department of Health / Home Office Guidance “NO SECRETS” 2000
The Department of Health and the Home Office published NO SECRETS in March 2000. It was issued as Guidance under Section 7 of the Local Authority Social Services Act 1970.
NO SECRETS makes it a requirement for local authority Social Services Departments to take a lead in working in partnership with health care providers, the police and the voluntary and private sector to: “ create a framework for action within which all responsible agencies work together to ensure a coherent policy for the protection of adults at risk of abuse”
Local authorities are required to:
• Collaborate with public, voluntary, private sector agencies and with users and carers and involve them in developing an inter-agency response to Safeguarding Adults. • Adopt a lead /co-ordinating role in the development of local Safeguarding Adults Policies and Procedures • Carry out a policy and service audit, develop a Safeguarding Adults Strategy and present an Annual Report to elected Members. • Collect and collate monitoring information. • Ensure that Safeguarding Adults is included in commissioning and contract monitoring. • Develop a Training Plan and ensure that training is provided. • Disseminate information.
Partner agencies have a responsibility to:
• Work in collaboration with the local authority and other agencies. • Investigate and take action when a vulnerable adult is believed to be suffering abuse. • Produce internal guidelines. • Appoint a lead officer. • Provide training for staff and volunteers • Draw up guidance on confidentiality • Disseminate information to staff and service users.
LSAB Terms of Reference
1). Harrow’s Local Safeguarding Adults Board (LSAB) is a multi-agency forum comprising of partners from the statutory sector (Council, PCT / NHS Acute and Mental Health Trusts, Police and CSCI.) together with partners from the private and voluntary sectors.
2). Working with service users and carers at the heart of the process, the LSAB aims to:
Page | 39 85 x ensure effective partnership arrangements x devise strategies to detect and prevent abuse from happening x agree operational definitions and thresholds for intervention x co-ordinate multi-agency safeguarding adults policies and procedures x develop systems and structures to safeguard vulnerable adults in Harrrow
3). The Roles and Responsibilities of the LSAB
Member agencies are responsible for their full and effective contributions to the work of the LSAB.
This will include:
x To oversee the continued working of the Safeguarding Adults Policies and Procedures, including publication, distribution and administration of the procedures document. x To manage and audit multi-agency relationships relating to the implementation of the procedures document. x To review the policy and procedures on a two-yearly basis to reflect current experience and government guidance together with expectations and lessons learned from the monitoring process. x To make links with other areas of national and local policy development x To develop good practice guidance relating to i.e. Contracting and Commissioning, Care Management and developing those links across Child Protection, Domestic Violence, Direct Payments, the Community Safety Plan, etc. x To maintain a strategic overview of Safeguarding Adults training and oversee the implementation of a multi-agency training programme x To secure funding from statutory agencies to support the work and infrastructure of Safeguarding Adults in Harrow x To promote the awareness of Safeguarding Adults issues amongst staff / professionals in the statutory, private and voluntary sectors together with service users and carers and the wider community. x To produce public information, organise events, and use available resources to publicise the work of the LSAB. x To promote a wider professional and public understanding of Safeguarding Adults through a variety of events or information campaigns. x To identify and secure adequate resources and funding to ensure there are sufficient skilled staff across agencies to undertake investigations as appropriate x To develop a robust audit and monitoring system and cascade / implement the learning from those audits to improve performance and practice. x To use information from audit and monitoring to develop more robust protective measures and services. x To oversee the production of an Annual Report and Action Plan to identify and deliver on the LSAB’s aims and objectives. x To present an Annual Safeguarding Adults report to Senior Officers, Members and to Executive Management Boards in line with good Governance arrangements. x To ensure Safeguarding Adults and Protection issues are effectively addressed / included in areas of strategic planning and within the Harrow Strategic Partnership. Page | 40 86 x To commission Serious Case Reviews on cases where a vulnerable adult/s has been seriously injured or died as a result of adult abuse. x To liaise with other strategic groups, i.e. the Local Safeguarding Children’s Board (LSCB) and the Domestic Violence Steering Group on areas of mutual interest including training and awareness raising. x To oversee the work of the various Work Streams to deliver on identified aims and objectives and strategic priorities. x To support the Safeguarding Adults Co-ordinator in their role. x That a quorum is a third of the membership that is also representative of the sectors and client groups.
4). Membership, Accountability and Decision Making Authority
Representatives from partner organisations / agencies will be of sufficient seniority and authority within their agency to be able to take decisions and commit time / resources as appropriate to the work of the LSAB and associated work streams.
The LSAB will have a standing membership from:
x Adult and Housing Services x Contracts and Brokerage x The Metropolitan Police x Harrow Primary Care Trust x North West London Hospital Trust (NWLHT) x Central and North West London Mental Health NHS Foundation Trust (CNWL) x Commission for Social Care Inspection (CSCI) x Independent Sector Providers x The voluntary sector including Age Concern, HAD, Mencap, MIND, etc x User and Carer Groups x Advocacy Services x Harrow Commission for Race Equality (CRE)
5). Representatives from these organisations are accountable to the organisation / agency they represent and are responsible for reporting back, both at an operational and strategic level and for embedding Safeguarding Adults within their agency and its Governance arrangements.
6). All representatives and agencies are jointly responsible for the actions of the LSAB
7). Other organisations / agencies or groups may be part of the LSAB or associated work streams for either a time limited period or permanently as appropriate and as decided by the LSAB
8). The LSAB will meet 4 times per year with the work streams meeting in between the board meetings and reporting back to the LSAB at each board meeting.
Page | 41 87 Page | 42 88 2009 / 2010
and Partners Local Safeguarding Adults Board (L.S.A.B.)
Joint Project Plan for the Delivery of Actions from the 2008 Annual Report
(also included are the outstanding actions from the Total Transformation Programme and the CSCI 2008 Inspection
Seamus Doherty, Safeguarding Adults Co-ordinator, April 2009 i 89 Harrow Local Safeguarding Adults Board (L.S.A.B.)
Joint Project Plan for the Delivery of Actions from the 2008 Annual Report
(also included are the outstanding actions from the Total Transformation Programme and the CSCI 2008 Inspection
Others to Lead Time Aim / Focus Action Expected Outcome be Person Scale Involved
1 Further develop x To review and clearly define the Clear governance routes across all agencies in Harrow Paul Najsarek Sue Update the LSAB’s LSAB’s governance routes for HSP, LAA Spurlock report Governance (across all agencies) with the Signup, commitment and ownership of agreed responses at and CAA and for June arrangements and view to developing effective links all levels within the Council and partners organisations arrangements Seamus 09 and ownership both and mechanisms to these Doherty Dec 09 internally and routes. All agencies are clear on their roles and responsibilities across partner towards Safeguarding Adults and their role and function LSAB Reps agencies. x Clear reporting lines within within the LSAB to agencies and an overall link to investigate the Harrow Strategic Partnership Ownership and Commitment to achieving excellence in Governance Board service provision routes for 90 their own x Sign-up, Commitment and Multi- Org. Agency approach to Safeguarding Adults work is promoted within the above frameworks
x Develop a Mission Statement to ensure clarify around the Roles, Responsibilities and Purpose of the LSAB Others to Lead Time Aim / Focus Action Expected Outcome be Person Scale Involved
2 To improve the x SLA’s / Contracts to include That all services either directly provided or commissioned by Seamus LSAB Reps Update care of Vulnerable Safeguarding Adults issues Harrow on behalf of vulnerable people have clearly defined Doherty and as report Adults receiving protocols and local procedures in place that acknowledge the Contracts negotiated for June Community Care x To work with Contracts and and reference Harrow’s overarching policy and procedures and 09 and Services and to Brokerage to further develop and Brokerage Dec 09 minimise the risk embed Safeguarding within That these local procedures set out the organisations Team of abuse contracts and contract commitment to work in line with Harrow’s expectations and monitoring arrangements affirm their commitment to delivering safe and quality services to Harrow service users SDS Team Self Update x CRB’s offered as part of Direct That service users accessing Direct Payments and Self and Directed report Payments and Self Directed Directed Support are advised and supported to access safe Organisation Support for June Support recruitment practices when employing staff to deliver their dealing with Lead – 09 and care package DP’s David Dec 09 Fabbro x On-going work with CSCI to That the LSAB continues to work with regulators and local Seamus
91 ensure providers have local and providers to contribute to the delivery of safe services Doherty and overarching Safeguarding CSCI Policies and Procedures
x Further develop the Complaints To ensure clear demarcation between the complaints and Seamus LSAB Reps Update and Safeguarding Adults safeguarding processes and to ensure that each is treated Doherty and as report Interface and actioned according to agreed legislation and guidance Stuart Dalton negotiated for June 09 and To use the learning from complaints to inform the LSAB’s Dec 09 Quality Assurance processes and to work with partners to ensure that this learning is shared within the Council and with Partners. Others to Lead Time Aim / Focus Action Expected Outcome be Person Scale Involved
3 Training and x Further develop Harrow’s To further improve the responses to Harrow’s vulnerable Learning Work Learning and Training adults when abuse is alleged or suspected Stream - To Programme and associated work empower and stream To incorporate feedback and lessons learned from enable staff, experience, good practice and updates in legislation and carers and service x To Raise Awareness and further guidance users with an develop the skills and improved ability to experience of staff across all To learn from the feedback received from both the providers identify, report, agencies to improve responses and participants of Safeguarding Adults Training and to use and respond to to Vulnerable Adults and to build this information to further develop the training and learning Combination allegations or on existing capacity opportunities both internally and externally to the Council of the suspicions that Training and Update abuse is or has x 2008 / 2009 Training To empower and support staff with the skills, knowledge and Learning, LSAB Reps report taken place Programme will be evaluated experience required to deliver safe services to vulnerable Improving as for June and a plan put in place for adults commensurate with their role in the process Practice and negotiated 09 and further cross-agency training and Publicity and Dec 09 learning in 09/10 To increase capacity across partner organisations and Communicati 92 agencies by continuing as appropriate with joint on Work investigations and targeting those staff that will be involved Streams in and carrying out those investigations to ensure that they have received the required level of training and support in order to fulfil these responsibilities
x To continue a programme of To empower and enable staff, carers and service users with Multi-Agency Training and to an improved ability to identify, report, and respond to explore mechanisms for allegations or suspicions that abuse is or has taken place incorporating user and carer feedback into this training programme
Specific Actions
Review 2008 /09 Training Programme and to develop the 2009 /10 Training Programme Risk Identification, Assessment and Management - Information and Training Mental Capacity Act - Capacity and Training Deprivation of Liberty Safeguards (DOLS) and Training Further increase and support Training for Voluntary Sector Providers - (10% increase in training) Further increase and support Training for Independent Sector Providers - (10% increase in training) Further increase and support Training for Hospital / Acute Staff - (10% increase in training) Further increase and support Training for PCT Staff - (10% increase in training) Others to Lead Time Aim / Focus Action Expected Outcome be Person Scale Involved
4 Publicity and x To further develop the Communications mechanisms and processes Work Stream - To used to get the Safeguarding Raise Awareness Adults message and agenda amongst staff, promoted as widely as possible carers, service in Harrow. users and the wider general x To facilitate better recognition of public to identify, the issues relating to report and safeguarding adults respond to allegations or x To further improve the pathways suspicions of to access Safeguarding Adults adult abuse services through posters, fliers Publicity and credit card information used To Raise Awareness amongst staff, carers, service users and across the borough and the wider general public to identify, report and respond Communica Update
93 to allegations or suspicions of adult abuse tion Work LSAB Reps report for x Further develop opportunities Stream as June 09 with Local Press and To empower and enable staff, carers, service users and the (with negotiated and Dec Communication to wider wider general public with an improved ability to identify, possible 09 Community report, and respond to allegations or suspicions that abuse is input from or has taken place other Work x To continue with presentations Streams) at Partnership Boards and User and Carer Groups and Forums
x Further develop mechanisms with partner organisations and agencies to arrange for the dissemination of our awareness raising materials
x To investigate further opportunities with partner agencies, across all sectors, to identify more ways in which this information can be publicised to service users, carers, providers and the general public Specific Actions
WEAAD 2009 Information / Outreach programme Website development Community language posters, fliers, information etc. Develop the HLDT Abuse Leaflet for other Service User Groups Target the under reporting from Hospital / Acute sectors Target the under reporting from CNWL and HMHS Inpatient Wards Target the under reporting from BME Communities 94 Others to Lead Time Aim / Focus Action Expected Outcome be Person Scale Involved
5 Improving x To continue to share information, To empower and support staff with the skills, knowledge and Practice Work look at innovative ideas and experience required to deliver safe services to vulnerable Stream - This approaches and to look at the adults commensurate with their role in the process work stream aims positive and less positive to use the experiences of those involved in To use the learning, feedback and discussion from this learning from the various elements of both the group to shape and inform future direction and practice and experience and Safeguarding Adults work and to use this to contribute towards continuous local practice to raise processes improvement standards through the sharing of x To explore mechanisms for user To further improve the responses to Harrow’s vulnerable information and and carer involvement, to gain adults when abuse is alleged or suspected Improving good practice. their feedback and experiences Practice of Safeguarding Adults Services To incorporate the feedback and lessons learned from Work LSAB Reps Update and to use these experiences to experience, good practice and updates in guidance and Stream as report for learn, develop and inform legislation (with negotiated June 09 current and future policy and possible and Dec
95 practice To learn from the feedback received from partners and input from 09 workers involved in the Safeguarding Adults process and to other Work x To request a further Multi- use this information to further develop the training, learning Streams) Agency contribution from partner and development opportunities both internally and externally statutory agencies to support the to the Council work and infrastructure of Safeguarding Adults in Harrow
x To further develop Harrow’s To build on existing processes / practices and further Safeguarding Adults Team improve Harrow’s responses when abuse is alleged or suspected
x To offer workers from all To equip, empower and support workers from all agencies agencies, an opportunity to with an opportunity to share and discuss individual or share and discuss individual or complex issues / cases and to benefit from a multi-agency complex issues / cases and to discussion around those issues benefit from a multi-agency discussion around those issues Specific Actions
Analysis of referrals about Self funders Analysis of referrals about Paid carers Safeguarding and Personalisation interfaces Representation on MAPPA Representation on MARAC Representation on DV Steering Group Representation on DV Health and Social Care Group Representation on Race Hate Crime Representation on SDS steering group Representation on LAPN Representation on Child and Vulnerable Adult Trafficking Group Representation on CNWL 6 Borough Vulnerable Groups Meeting Representation on NW London Safeguarding Adults Network Representation on Complaints and Contracts Interface – Quality Assurance and Monitoring Forum Annual Report 2009 and associated Action Plan Serious Case Review and associated Action Plan Cornwall Report and associated Action Plan User briefings with all client groups Carer briefings
96 Member briefings SDS Team briefings Care Management Team briefings Customer Support Officers / Team Support Officers briefings Feedback from Partner Organisations, Agencies and Stakeholders Safeguarding Adults Champion and role profile BME Champion and role profile Develop interfaces with LINks Support and contribute to the development of Pan-London Policies and Procedures Share the Council’s approach and identified good practice in relation to risk with the PCT and other partners Liaise and work with HLDT to address Safeguarding issues as they relate to Transitions - children to adult services Further develop Statistical Data in light of the new National Data Set Request a further multi-agency contribution from partners for 2009 /10 Review and further develop Harrow’s Safeguarding Adults Team Further develop the Good Practice element of the website Others to Lead Time Aim / Focus Action Expected Outcome be Person Scale Involved
6 Quality Assurance x Minimum Annual External Quality Work Stream – Audit of Safeguarding case Aims to ensure the records and practice to include consistent front-line staff and managers in implementation of their feedback from the audit. Harrow’s Multi- Agency x Minimum quarterly internal Safeguarding sample of case records by QA Adults Policy and Group in line with terms of Procedure when reference abuse is alleged or suspected. x Publish “lessons learnt” and best practice examples on the The Quality Safeguarding Adults intranet site Maintaining Personal Dignity and Respect Assurance Work Stream also aims x Feedback findings, good practice Freedom from Harassment and Discrimination Combination
97 to support the and lessons learned to teams of continuous and individuals Improved ownership of Safeguarding Issues through Audit Quality Quality Update professional Process Assurance Assurance, report for development of all x Update training content on basis Work Improving June 09 those with a role to of results of audit / best practice Improved access for professionals and others to the learning Stream Practice and and Dec 09 play in the from Safeguarding Adults cases Training and Safeguarding x Amend policy and practitioner Learning Adults process with guidance where necessary Lessons learned incorporated into Training and Practice Work particular focus on Streams developing Care x Quarterly monitoring reports to Management and LSAB Multi-Agency skills and approaches. x LSAB to agree multi agency approach and to ensure all agencies respond to findings of audit.
x To review findings of audit and best practice research and update training package 6 monthly.
x To develop mechanisms of involving partner agencies within these audits
Specific Actions
Internal and External Audit Processes Links Harrow’s Quality Assurance Framework MORI Poll - Feeling and Staying Safe Benchmark, Review and Improve Timescales in line with procedures Safeguarding and Contracts & Brokerage interfaces - Monitoring, Reviewing and Action Planning Safeguarding and Complaints interfaces - Monitoring, Reviewing and Action Planning Further develop Governance arrangements Further develop links to other strategic plans and boards
98 Maintain and develop the LSAB’s membership and attendance Benchmark the LSAB against the ADSS 2005 Safeguarding Adults Document Others to Lead Aim / Focus Action Expected Outcome be Time Scale Person Involved
7 User and Carer x To further develop this Work Work Stream – Stream to include the views, Aims to explore experiences, responses and and implement the recommendations of Users and opportunities in Carers and / or their relation to User and representative groups Carer Involvement 99 across multi- x Encourage Users and Carers agency partners. and / or their representative groups to work together and It will seek to share their experiences and maximise the further communicate these to Maintaining Personal Dignity and Respect opportunities to raise standards and improve proactively involve practice Freedom from Harassment and Discrimination Combination Users and Carers of and / or their x Develop mechanisms to equip, Improved ownership of Safeguarding Issues through Quality representative empower and support the views stakeholder involvement Assurance, groups, to learn of Users and Carers and / or their User and Improving Update from their representative groups to Improved access for Users and Carers to the Safeguarding Carer Work Practice and report for experiences, with a meaningfully contribute towards processes Stream Training and June 09 and view to improving the Safeguarding Adults agenda Learning Dec 09 service delivery in Harrow Incorporate feedback and lessons learned into Training and Work and standards of Practice Streams practice. x Use the learning from the feedback received from Users To empower and support Service Users and Carers and / or and Carers and / or their their representative groups to become more engaged in the representative groups to further development of appropriate responses that meet identified develop good practice both needs. internally and externally to the Council x Support multi-agency partners to identify their organisations methods of involving Users and Carers and / or their representative groups to contribute towards a co-ordinated approach
x Make recommendations on appropriate policy and good practice guidance based on feedback and lessons learned
Specific Actions
Explore the opportunities and mechanisms to facilitate the views and experiences of users and carers Develop links with Harrow’s new Service User Engagement Officer Undertake User briefings with all client groups Undertake Carer briefings with all client groups MORI Poll - Feeling and Staying Safe Include this feedback and learning in the development of local good practice Share this feedback and learning both internally and externally to the Council to promote wider local good practice 100 Others to Lead Time Aim / Focus Action Expected Outcome be Person Scale Involved 101 8 Multi-Agency x To maintain and further develop To maintain and further develop links, representation and Seamus LSAB Reps Update Working and links and representation at both networking opportunities at both a strategic and operational Doherty as report for Information strategic and operational levels level on Statutory (and other) groups to promote and negotiated June 09 Sharing. on the following groups in order represent the work of Safeguarding Adults in Harrow and Dec to represent the work of 09 Safeguarding Adults in Harrow, To further develop and improve practice and responses in these include:- line with an ambition of quality services and striving for excellence MAPPP – Multi Agency Public Protection Panel Enhance information sharing and partnership working to both share and learn from the experiences of stakeholders and MARAC – Multi Agency Risk partners Assessment Conference (Domestic Violence Risk To use the above learning to further develop strategic and Assessment and Review Panel) operational responses when abuse is alleged or suspected.
Harrow’s Domestic Violence Forum and its Health and Social Care Sub Group
Harrow’s Race Hate Crime 102 Forum
LAPN – London Adult Protection Network
North West London Safeguarding Adults Network
Child and Vulnerable Adult Trafficking Group
CNWL Safeguarding Vulnerable Groups Group
NWLHT Safeguarding Adults Group
Complaints and Contracts Interface – Quality Assurance and Monitoring Forum Others to Lead Time Aim / Focus Action Expected Outcome be Person Scale Involved
9 Statistics and x To further develop Harrow's IT To enable Harrow to build a picture of local prevalence and to Seamus Update Analysis - Ensuring Systems in light of the new shape its prevention and protection strategies accordingly Doherty and report for Planning and National Data Set to give more David June and Development robust statistics around data To improve the ability to Safeguard and Plan for the future of Harrington Dec 08 based on Local collection, analysis and Service Provision Knowledge monitoring.
x To use this information to analyse To shape future services and strategies based on the trends, patterns and prevalence monitoring and analysis of local statistical information and to build a local picture, which will ultimately be used to shape and inform direction and practice
Lead Others to be Time Aim / Focus Action Expected Outcome Person Involved Scale 103 10 Further develop x Balance the tensions between Outcome from Total Transformation Programme - Ref: Area David Sue Update the work and the council’s duty of care and the 3 on Self Directed Care Fabbro, Spurlock / report for interfaces with the freer arrangements that self- Self David June and SDS Team in directed support brings. To ensure that work on developing Self Directed Care takes Directed Fabbro - Dec 08 relation to the account of the requirements for Safeguarding in the Care Lead / Self Personalisation x Work with the SDS Team to planning, consultation and process development stages. Seamus Directed agenda ensure risk and risk Doherty Support management are fully To ensure that market development, contract compliance Lead / considered within the SDS and quality assurance measures are in place to support the Seamus processes. Safeguarding agenda. Doherty
x To ensure that where abuse is Maintaining Personal Dignity and Respect. Possible alleged or suspected within the Areas of SDS framework that Harrow’s Freedom from Harassment and Discrimination. work to be Multi-Agency Policies and identified Procedures are implemented as within Work appropriate Streams Lead Others to be Time Aim / Focus Action Expected Outcome Person Involved Scale
11 Further address x Develop an Information / Maintaining Personal Dignity and Respect Seamus Combinatio Update the under- Outreach Programme targeted Doherty n of report for reporting from towards Harrow’s BME Freedom from Harassment and Discrimination Quality June and Harrow’s BME Community and Representative Assurance, Dec 08 Communities Groups To improve performance in areas of under-reporting by Improving targeting Harrow’s BME Community and Representative Practice x Further develop the BME Groups BME and Champions Role and Profile Safeguardin Training To improve performance and practice through research, g Champion and x Further develop Statistical Data training and learning. Learning to measure performance in this Work area against Harrow’s BME Streams demography together with x Further develop Training and Safeguardin Awareness Raising opportunities g for BME Communities and their Champions 104 Representative Groups 105 This page is intentionally left blank
106 Agenda Item 11 Pages 107 to 196
Meeting: Overview and Scrutiny Committee
Date: 11 June
Subject: Joint Review Report - commissioning services and support for people with learning disabilities and complex needs Responsible Officer: Paul Najsarek, Corporate Director of Adults and Housing Services Committee Chairman: Cllr Sheinwald
Exempt: No
Enclosures: Appendix 1 - Joint Review Report Appendix 2 Joint Review Action Plan
Section 1 – Summary and Recommendations
This report sets out the findings of the Joint Review into the commissioning of services and support for people with learning disabilities and complex needs and the action plan developed by the Council in response to those findings.
Recommendations: Overview and Scrutiny Committee are requested to: 1. Note the findings of the Joint Review; and 2. Note the actions contained within the Action Plan to address the recommendations set out in the Joint Review Report
Reason: (For recommendation) To inform Councillors of the outcome of the Joint Review.
107 Section 2 – Report
Background
1. Harrow was one of 10 areas selected for a pilot Joint Review of commissioning services and support for people with learning disabilities and complex needs. The aim of the review was to assess how well the council and PCT commission services and support for people with learning disabilities and complex needs. A related purpose of the review was to test out the new methodology to be used during the review to inform learning for future joint reviews.
2. The review was undertaken over a period of 5 days from 7 October 2008 to 15 October 2008. The review was undertaken by a joint team from the Commission for Social Care Inspection (CSCI), the Mental Health Act Commission (MHAC) and the Healthcare Commission (HC). These separate inspectorates merged to become the Care Quality Commission with effect from 1 April 2009.
3. It should be noted that the joint review followed on very quickly from a service inspection of independence, well-being and choice which focused on the Council’s Learning Disability Team. Although the fieldwork was undertaken by CSCI in January 2008, the report and action plan were only agreed in May 2008. The review therefore took place during a period when we were implementing actions arising from the previous inspection.
4. The Joint Review focused on how council and PCT commissioning practices were delivering and improving outcomes for people with learning disabilities and complex needs. The experience of people who use services and carers was a primary source of evidence for the review although all review and service inspection activity relating to case file samples are acknowledged to be a way of learning about people’s experiences as service users and carers and triangulating evidence. It is consistently acknowledged throughout the methodologies of the commissions, that samples are small and cannot constitute a representative or academically and statistically valid sample.
5. The Action Plan at Appendix 2 was submitted to the Joint Review team on 6 March 2009.
Key Findings
6. The detailed findings are contained with the report attached as Appendix 1.
7. It should be noted that the joint review followed on very quickly from a service inspection of independence, well-being and choice which focused on the Council’s Learning Disability Team. Although the fieldwork was undertaken by CSCI in January 2008, the report and action plan were only agreed in May 2008. The review therefore took
108 place during a period when we were implementing actions arising from the previous inspection.
8. The report recognises that ‘the council, with the support of the PCT, had made a sound start in implementing the action plan, which had resulted from the January 2008 CSCI service inspection of Harrow Council. A range of new initiatives from both agencies were increasingly effective in improving services.’
Financial Implications
9. The action plan attached at Appendix 2 identifies whether actions are contained within existing resources or will require additional investment from either the PCT or Adult and Housing Services revenue budgets.
Section 3 - Statutory Officer Clearance
Not Applicable
Section 4 - Contact Details and Background Papers
Contact: Mark Gillett, Divisional Director of Commissioning & Partnerships [email protected] 020 8424 1911 or (ext 2911)
Background Papers:
Joint Review Report - commissioning services and support for people with learning disabilities and complex needs
109 This page is intentionally left blank
110 Harrow Council and Harrow PCT - Joint Action Plan Joint Review – commissioning services and support for people with learning disabilities and complex needs
Standard: Putting People at the Centre of Commissioning Outcome: People with learning disabilities, their families and their carers are routinely involved in the planning, design, development and evaluation of services, resulting in a far more personalised approach to service delivery.
RECOMMENDATION The council and the PCT should strengthen consultation arrangements by ensuring that there is an audit trail of improvements and modifications. The impact of carers’ views on service developments should be improved.
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE To produce a joint annual report setting out progress on the The Council and the PCT will be able to demonstrate ongoing October 09 Paul Najsarek Existing implementation of Valuing People Now improvement in services to people with learning disabilities Corp Director resources Then annually Harrow Council
Sarah Crowther Chief Executive Harrow PCT To commission MORI to undertake surveys of service users with Baseline established of views of service users with learning May 09 Paul Najsarek Additional 111 LD and their carers disability, and their carers, on the services they experience Corp Director investment Harrow Council agreed To ensure that user and carer experience are central to Harrow’s • 3 service users with LD and 3 carers recruited and June 09 Sue Conn Existing Quality Assurance Framework supported to be members of the quarterly Adult and Senior resources Housing Services Quality Assurance Board. Professional • Service users and their carers will recognise the Service improvements and modifications that result from their input Development Team Harrow Council
Una Taylor Service user Engagement Officer Harrow Council
Page 1 6/3/2009 Harrow Council and Harrow PCT - Joint Action Plan Joint Review – commissioning services and support for people with learning disabilities and complex needs
Standard: Putting People at the Centre of Commissioning Outcome: People with learning disabilities, their families and their carers are routinely involved in the planning, design, development and evaluation of services, (Cont) resulting in a far more personalised approach to service delivery.
RECOMMENDATION The council and the PCT should strengthen consultation arrangements by ensuring that there is an audit trail of improvements and modifications. The impact of (Cont) carers’ views on service developments should be improved.
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE To promote service user and carer involvement in recruitment • 6 service users with learning disabilities trained in March 09 Una Taylor Existing panels recruitment practices Service user resources • 3 carers of service users with learning disabilities trained in June 09 Engagement recruitment practices Officer • User and Carer representatives on recruitment panels Harrow Council contribute to appointment decisions Jasvinder 112 Perihar Senior Professional well-being and carers strategy Harrow Council
Page 2 6/3/2009 Harrow Council and Harrow PCT - Joint Action Plan Joint Review – commissioning services and support for people with learning disabilities and complex needs
Standard: Putting People at the Centre of Commissioning Outcome: People with learning disabilities, their families and their carers are routinely involved in the planning, design, development and evaluation of services, (contd) resulting in a far more personalised approach to service delivery.
RECOMMENDATION The council and the PCT should strengthen consultation arrangements by ensuring that there is an audit trail of improvements and modifications. The impact of (contd) carers’ views on service developments should be improved.
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE To ensure that LD issues are considered by the Carers Carers will recognise the improvements and modifications that June 09 Mary Cleary Existing Partnership Board. result from their input. Head of resource Integrated To use the mechanisms of the Quality Assurance framework to Feedback from Carers will inform the Partnership board and Commissioning analyse the information obtained and feed into the Partnership influence planning, provision and service improvement. Harrow PCT board. Jasvinder Perihar 113 Jasvinder Perihar Senior Professional well-being and carers strategy Harrow Council
Page 3 6/3/2009 Harrow Council and Harrow PCT - Joint Action Plan Joint Review – commissioning services and support for people with learning disabilities and complex needs
Standard: Putting People at the Centre of Commissioning Outcome: People with learning disabilities, their families and their carers are routinely involved in the planning, design, development and evaluation of services, resulting in a far more personalised approach to service delivery.
RECOMMENDATION The council and the PCT should strengthen consultation arrangements by ensuring that there is an audit trail of improvements and modifications. The impact of (contd) carers’ views on service developments should be improved.
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE To provide opportunities for users and carers to contribute to the • Service users and their carers will recognise the July 09 Una Taylor Existing design and development of services improvements and modifications that result from their input Service user resource • There will be an audit trail of the evidence of the impact of Engagement user and carer impact on the design and development of Officer services Harrow Council • Minutes of all service user meetings reflect service March 09 contributions, carer’s views and to be incorporated in Keith Holmes developments plans. NRC Project 114 • Minutes are produced and circulated in accessible format to Manager enable service users to recognise their contributions to Harrow Council improvements and modifications.
Page 4 6/3/2009 Harrow Council and Harrow PCT - Joint Action Plan Joint Review – commissioning services and support for people with learning disabilities and complex needs
Standard: Putting People at the Centre of Commissioning Outcome: People with learning disabilities, their families and their carers are routinely involved in the planning, design, development and evaluation of services, (contd) resulting in a far more personalised approach to service delivery.
RECOMMENDATION The council and the PCT should strengthen consultation arrangements by ensuring that there is an audit trail of improvements and modifications. The impact of (contd) carers’ views on service developments should be improved.
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE To maintain service user groups to provide opportunities for • 10 service users with learning disability will participate in a March 09 Una Taylor Existing users to share their views and experiences of the services regular futures forum Service user resources available to them • Service users will recognise the improvements and Engagement modifications that result from their input Officer • There will be an audit trail of the evidence of the impact of Harrow Council user views on service improvement
115 • A large proportion of service users will participate in some of the one-off forums on specific topics July 09 • All service users will participate in service user meetings at the NRCs July 09
Page 5 6/3/2009 Harrow Council and Harrow PCT - Joint Action Plan Joint Review – commissioning services and support for people with learning disabilities and complex needs
Standard: Putting People at the Centre of Commissioning Outcome: People with learning disabilities, their families and their carers are routinely involved in the planning, design, development and evaluation of services, (contd) resulting in a far more personalised approach to service delivery.
RECOMMENDATION The council and the PCT should make the Learning Disability Partnership Board a more effective driver for change and strengthen its monitoring role.
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE To conclude consultation on partnership governance • An improved structure in place which has been clearly April 09 Paul Najsarek Existing arrangements for adult health and social care in Harrow informed by the views of service users and their carers Corp Director resources Harrow Council • Annual Work Plan agreed and compatible with ‘Valuing People Now’ targets. Sarah Crowther Chief Executive Harrow PCT
116 To request support from the Valuing People Support Team to • Members of the Partnership Board are effective in enabling September 09 Paul Najsarek Additional support the continued development of the Learning Disability it to be a driver for change and strengthened monitoring role Corp Director investment Partnership Board • Members of the board will be able articulate the Harrow Council improvements and developments that result from the actions of the partnership board Sarah Crowthe • The Learning Disability Partnership Board is able to hold to r account the Council and the PCT for the implementation of Chief Executive Valuing People Now Harrow PCT
Page 6 6/3/2009 Harrow Council and Harrow PCT - Joint Action Plan Joint Review – commissioning services and support for people with learning disabilities and complex needs
Standard: Putting People at the Centre of Commissioning Outcome: People with learning disabilities, their families and their carers are routinely involved in the planning, design, development and evaluation of services, (contd) resulting in a far more personalised approach to service delivery.
RECOMMENDATION The council and PCT should ensure more inclusive, individualised and culturally sensitive assessment of needs and care plans are undertaken and that more bespoke, ambitious and outcome focused care planning is provided.
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE To continue to provide training in Person Centred Planning 100% of staff trained in PCP to enable person centred thinking February 09 Doris Sheridan Existing (PCP) for care management staff Service resources Manager HLDT Harrow Council To ensure that all assessments and reviews and care plans are • 100% of service users to have been offered opportunity for September 09 Doris Sheridan, Existing PCP outcome focused. Care Managers will promote PCPs and a PCP, service users will have a plan based on their Service resources
117 the decision panels will monitor that PCPs have been fully individual needs Manager HLDT explored. Harrow council • Forms will be available electronically and in paper format, to Paper version PCP process to be embedded in assessment and review be taken to every assessment and review. March 09. processes. To include IT system, forms, training and practice. Electronic July • PCP Formats, designed by service users are being used March 09 To develop a Person Centred self assessment format which during assessments and reviews. incorporates the recent feedback from service users (SUs have identified their favourite headings). • Decision Panels will audit and record that PCPs have been March 09 Day centre officers to facilitate service users to complete PCPs promoted and care plans reflect a bespoke, outcome and all service users accessing NRCs will have had a PCP in focused approach. place. • Care plan format is individualised to reflect the service July 09 Current care plan on Framework I needs to be redesigned to be users PCP details. more PCP focused (individualised with outcome focus). IT to be commissioned to undertake this adaptation as an alternative to drop down statements. Forms are produced in accessible format and translated or March 09 Una Taylor Develop information regarding PCPs in accessible formats and interpreted on request. languages on request.
Page 7 6/3/2009 Harrow Council and Harrow PCT - Joint Action Plan Joint Review – commissioning services and support for people with learning disabilities and complex needs To increase the number of LD users with an individual budget, 25 Service users with learning disability will have a personal March 09 Barbara Huggan Existing and improve support to them budget Service resources Manager- Self-directed care team Harrow Council
118
Page 8 6/3/2009 Harrow Council and Harrow PCT - Joint Action Plan Joint Review – commissioning services and support for people with learning disabilities and complex needs
Standard: Putting People at the Centre of Commissioning Outcome: People with learning disabilities, their families and their carers are routinely involved in the planning, design, development and evaluation of services, (contd) resulting in a far more personalised approach to service delivery.
RECOMMENDATION The council and the PCT should ensure that care management support is available to people who need ongoing support
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE To ensure annual scheduled reviews take place for all service • 80% (target as per performance data quality) of all March 09 Doris Sheridan, Existing users known to HLDT clients who receive a service will be reviewed during Service resources the year Manager HLDT • There will be a NIL backlog of cases by end of financial Harrow Council year To provide further training to the Customer Service Officers to • Service users will access CSOs who are familiar with March 09 Doris Sheridan, Existing ensure the new Customer service standards are complied with. the new Customer Service standands, as first point of Service resources contact Manager HLDT
119 To transfer supervision of CSOs to transfer to Senior Practitoner • CSOs will be supervised daily by the Senior Harrow Council to enhance care management process. Practitoner, and benefit for her care management experience. • Service user’s enquires will be responded to efficiently and timely as the CSO team will be part of the care management process and are available 9-5pm. EDT thereafter. To ensure emergency social worker slots are available on a Service users are able to get support in an emergency via the March 09 Doris Sheridan, Existing weekly basis emergency HLDT social worker on duty or via the out of hours Service resources Emergency Duty Team Manager HLDT Harrow Council To offer a flexible appointment system • Users and carers are able to attend appointments outside March 09 Doris Sheridan, Existing normal office hours Service resources • Reduction in assessment waiting times Manager HLDT • Improved customer satisfaction Harrow Council
To increase investment in HLDT and intensive support services £200,000 will be invested in 2009/10 and 2010 by Harrow PCT March 10 Mary Cleary Additional in 2009/10 and 2010/11 Head of investment Integrated Commissioning Harrow PCT
Page 9 6/3/2009 Harrow Council and Harrow PCT - Joint Action Plan Joint Review – commissioning services and support for people with learning disabilities and complex needs
Standard: Putting People at the Centre of Commissioning Outcome: People with learning disabilities, their families and their carers are routinely involved in the planning, design, development and evaluation of services, (contd) resulting in a far more personalised approach to service delivery.
RECOMMENDATION The council and the PCT should commission more structured, focused and specialist advocacy services to ensure that the most vulnerable and isolated receive appropriate support.
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE To commission jointly Harrow Association of Disabled People to • £35k new funding will be made available to Harrow February 09 David South Additional provide advocacy support to people with a learning disability Association of Disabled People to provide additional Service investment advocacy services Manager • At least 110 people will benefit from additional services, and Commissioning of these 55 will have a learning disability Harrow Council
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Page 10 6/3/2009 Harrow Council and Harrow PCT - Joint Action Plan Joint Review – commissioning services and support for people with learning disabilities and complex needs
Standard: Understanding the needs of populations and individuals Outcome: Local authorities and PCTs have an improved understanding of the current and emerging health and social care needs of their learning disability population, particularly those with complex needs, and their family carers, and have secured the resources and investment to meet their requirements.
RECOMMENDATION The council and the PCT should understand more fully of the range of needs of people with learning disabilities and complex needs. They should utilise better understanding of the current and future needs of young people with learning disabilities approaching adulthood to strengthen the transitions process and the range and choice of local services and support..
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE To carry out a detailed assessment of the needs of people with • Full needs assessment will be available for learning June 09 Anandhi Nagraj Additional learning disabilities and complex needs, including the needs of disability to inform Harrow JSNA refreshes Public health investment young people with learning disabilities approaching adulthood • Service and commissioning priorities will be informed by the consultant needs assessment Harrow PCT • Service model will reflect and meet needs of local service users
121
Page 11 6/3/2009 Harrow Council and Harrow PCT - Joint Action Plan Joint Review – commissioning services and support for people with learning disabilities and complex needs
Standard: Understanding the needs of populations and individuals Outcome: Local authorities and PCTs have an improved understanding of the current and emerging health and social care needs of their learning disability (contd) population, particularly those with complex needs, and their family carers, and have secured the resources and investment to meet their requirements.
RECOMMENDATION The council and the PCT should understand more fully of the range of needs of people with learning disabilities and complex needs. They should utilise better (Contd) understanding of the current and future needs of young people with learning disabilities approaching adulthood to strengthen the transitions process and the range and choice of local services and support..
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE To establish a transition working group with representation from Feedback from users and families will show that their experience Feb 09 Doris Sheridan Existing key agencies. is improving. Service resources Manager HLDT Harrow council
To hold transition meetings on a regular basis at HLDT with Service users and Carers will be fully supported and able to April 09 Doris Sheridan Existing representation from Transition champion, project manager access Connexions from April 09, and further education Service resources 122 (CSCI/HLDT, Transition worker HLDT, Transition worker - opportunities from Sept 09 Manager HLDT Mencap, Connexions worker Harrow) Harrow council
To identify transition cases in advance and plan transition • All young people and their carers are supported through April 09 Doris Sheridan Existing process for each individual. Explore and coordinate a focused transition and participate in transition planning and Service resources approach regarding all transition cases and arising issues identifying their needs and wishes. Manager HLDT • Feedback from families will show that their experience is Harrow council improving • Carers and service users will be fully supported whilst going through transition To ensure all transition cases have an overview assessment • All young people and their carers are supported through April 09 Doris Sheridan Existing carried out by HLDT transition and participate in transition planning and Service resources identifying their needs and wishes. Manager HLDT • Feedback from families will show that their experience is Harrow council improving
Page 12 6/3/2009 Harrow Council and Harrow PCT - Joint Action Plan Joint Review – commissioning services and support for people with learning disabilities and complex needs
Standard: Understanding the needs of populations and individuals Outcome: Local authorities and PCTs have an improved understanding of the current and emerging health and social care needs of their learning disability (Cont) population, particularly those with complex needs, and their family carers, and have secured the resources and investment to meet their requirements.
RECOMMENDATION The council and the PCT should understand more fully of the range of needs of people with learning disabilities and complex needs. They should utilise better (Contd) understanding of the current and future needs of young people with learning disabilities approaching adulthood to strengthen the transitions process and the range and choice of local services and support.
To ensure all carers of persons going through transition (having • Carers will be fully supported through the transition of the April 09 Doris Sheridan Existing reached the age of 18 and found to be FACS eligible) are offered service user Service resources a carers assessment Manager HLDT Harrow Council
123 To develop a protocol to provide adult continuing care needs • 95% of all LD continuing care assessments carried out Mar 09 Angie Woods Existing assessments in a consistent and timely way within timescales prescribed by the protocol Women & resources children & CAMHS commissioner Harrow PCT Doris Sheridan Service Manager HLDT Harrow Council
Page 13 6/3/2009 Harrow Council and Harrow PCT - Joint Action Plan Joint Review – commissioning services and support for people with learning disabilities and complex needs
Standard: Understanding the needs of populations and individuals Outcome: Local authorities and PCTs have an improved understanding of the current and emerging health and social care needs of their learning disability (contd) population, particularly those with complex needs, and their family carers, and have secured the resources and investment to meet their requirements.
RECOMMENDATION The council and the PCT should gather improved information about the needs of people with learning disabilities from ethnic minority communities and use this to develop increasingly specialist, accessible and differentiated services and support
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE To ensure needs of people with LD from BME groups are Needs assessment will inform commissioning of culturally June 09 Anandhi Nagraj identified through the needs assessment appropriate, specialist, accessible and differentiated services Public Health and support Consultant Harrow PCT To distil the information provided by user/carer views, as being Views of BME service users and carers will be embedded in September 09 Sue Conn Existing outlined in the quality assurance framework, to provide service development and commissioning Senior resources understanding of BME needs Professional Service 124 Development Team Harrow Council
Page 14 6/3/2009 Harrow Council and Harrow PCT - Joint Action Plan Joint Review – commissioning services and support for people with learning disabilities and complex needs
Standard: Understanding the needs of populations and individuals Outcome: Local authorities and PCTs have an improved understanding of the current and emerging health and social care needs of their learning disability (contd) population, particularly those with complex needs, and their family carers, and have secured the resources and investment to meet their requirements.
RECOMMENDATION The council should make better use of intelligence from frontline staff about the deficits in service provision.
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE Ensure engagement of front line staff in Provider Forums Increased awareness of customer experience, the needs of July 09 Nick Davies Existing service users, and gaps in services, will inform market Service resources management, and service improvement and development Manager Supporting people, Contracts& Brokerage Harrow Council
125 David South Service Manager Commissioning Harrow Council
To develop mechanisms within the Quality Assurance • Establishment of learning forums where staff can improve July 09 Sue Conn Existing Framework to record, monitor and act upon staff feedback, e.g. their understanding of needs Senior resources supervision and cross-agency learning forums • Use of IPADs to ensure that managers are aware of and Professional can act upon staff feedback about deficits in service Service provision Development Team Harrow Council
Page 15 6/3/2009 Harrow Council and Harrow PCT - Joint Action Plan Joint Review – commissioning services and support for people with learning disabilities and complex needs
Standard: Sharing and using information more effectively Outcome: Local authorities and their partners apply the principles of Putting People First so that information about people with learning disabilities and complex needs is shared across agencies and used to deliver improved, personalised services and supports, tailored to people’s expressed needs and wants.
RECOMMENDATION The council and the PCT should continue to develop Direct Payments opportunities and support arrangements
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE To continue to promote Direct Payments within the deployment • Increasing number of users will receive direct payments and Mar 09 Barbara Huggan Existing of Personal Budgets personal budgets, giving opportunity for more choice and Service resource control Manager- • Target of 97 service users with learning disability on DP will March 09 Self-directed be met care team • Target of 25 service users with a learning disability on DP is March 09 Harrow Council likely to be met • 2010 LAA target of 20% of all community care clients to receive IB will include LD March 10 126 To Increase the support available to service users through 3rd Additional support for service users wishing to take up Direct Mar 09 David Fabbro Additional sector organisations and independent brokers, to enable them to Payments and Personal budgets, through 6 independent Project Officer investment access DP and PB brokers, HAD, MAB, and Age Concern Self-directed Support Harrow Council To bid to be part of pilot scheme which will inform future • Place bid Mar 09 Mary Cleary Existing development of personal health budgets, which may include LD, • Be informed about outcome of bid May 09 Head of resources but the learning from which will be applicable to people with LD Integrated Commissioning Harrow PCT
Page 16 6/3/2009 Harrow Council and Harrow PCT - Joint Action Plan Joint Review – commissioning services and support for people with learning disabilities and complex needs
Standard: Sharing and using information more effectively Outcome: Local authorities and their partners apply the principles of Putting People First so that information about people with learning disabilities and complex (contd) needs is shared across agencies and used to deliver improved, personalised services and supports, tailored to people’s expressed needs and wants.
RECOMMENDATION The council and the PCT should improve the range and choice of individualised day activities, adult education and supported employment opportunities.
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE To modernise day services provided through the new • New timetables based on one page profile outcomes July 09 Keith Holmes Additional Neighbourhood Resource Centres developed with service users NRC Project investment • Three month review to be carried out after opening of NRCs October 09 Manager to measure activities against outcomes identified in profiles Harrow Council and previous activities prior to NRCs • Increase in the range and choice of opportunities available August 09 and to service users ongoing
127 • Increase in number of users accessing community based August 09 and activities ongoing To work with Reach 3 Project which will support the To scope the work with Reach 3 with the aim of transforming day April 09 David South Additional transformation of day care services by providing expertise in care services in line with modernisation agenda, through Service investment of finance and outcome-based commissioning financial and service modelling Manager £10,000 made in Commissioning 2008. No further Harrow Council additional investment Keith Holmes planned NRC project Manager Harrow Council
Page 17 6/3/2009 Harrow Council and Harrow PCT - Joint Action Plan Joint Review – commissioning services and support for people with learning disabilities and complex needs
Standard: Sharing and using information more effectively Outcome: Local authorities and their partners apply the principles of Putting People First so that information about people with learning disabilities and complex (contd) needs is shared across agencies and used to deliver improved, personalised services and supports, tailored to people’s expressed needs and wants.
RECOMMENDATION The council and the PCT should improve the range and choice of individualised day activities, adult education and supported employment opportunities. (conttd)
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE To develop a vocational strategy for adults with a learning LAA baseline target will be identified in July once data is July 09 Claire Codling Existing disability available, with a significant increase in the percentage of LD Senior resources adults in paid employment Professional Development and enterprise Harrow Council To appoint a Mencap Pathway job broker to Harrow HRD Team 10 people with learning disabilities to be recruited to posts within March 2010 Carol Yarde Additional 128 the Council Head of Adults investment & Housing Transformation Project Plan Harrow Council To develop individualised plans for all users using NRCs, to offer Users will have a greater choice of activities Aug 2009 Keith Holmes Existing a range of adult education, employment and day activities NRC Project resources Manager Harrow Council
Page 18 6/3/2009 Harrow Council and Harrow PCT - Joint Action Plan Joint Review – commissioning services and support for people with learning disabilities and complex needs
Standard: Sharing and using information more effectively Outcome: Local authorities and their partners apply the principles of Putting People First so that information about people with learning disabilities and complex (contd) needs is shared across agencies and used to deliver improved, personalised services and supports, tailored to people’s expressed needs and wants.
RECOMMENDATION The council and the PCT should strengthen the skills of staff at public access points to ensure that appropriate advice and guidance on how to secure services and support is available
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE To ensure that the PCT’s ongoing development programme for Staff will be more skilled at communicating with LD service users Sept 09 Mary Cleary Additional frontline staff, to include GPs and practice managers, will be Head of investment reviewed to include specific communication needs of people with Integrated LD Commissioning Harrow PCT To explore extending PCT training in communication needs of • Identification of number of staff that require training, and Sept 09 Mary Cleary Additional
129 people with LD to Access Harrow staff investment required from the Council Head of investment • Access Harrow staff will enhance skills and acquire tools for Integrated providing service to LD service users Commissioning Harrow PCT
Jonathan Milburne Manager Access Harrow Harrow Council
Page 19 6/3/2009 Harrow Council and Harrow PCT - Joint Action Plan Joint Review – commissioning services and support for people with learning disabilities and complex needs
Standard: Sharing and using information more effectively Outcome: Local authorities and their partners apply the principles of Putting People First so that information about people with learning disabilities and complex (contd) needs is shared across agencies and used to deliver improved, personalised services and supports, tailored to people’s expressed needs and wants.
RECOMMENDATION The council and the PCT should urgently strengthen the processes for undertaking risk assessments and protection planning. Compliance with expectations should be monitored and reported to senior managers
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE To continue to provide a range of Safeguarding Training to • 85% of staff to be trained April 09 and LSAB/Seamus Existing Council and PCT staff • Staff will feel more equipped to assess and manage risk ongoing Docherty resources • Further improve Harrow’s response to allegations and Safeguarding suspected abuse in line with timescales in policy September 09 Adults Manager To monitor the training and report to LSAB, LSAB to maintain a LSAB will lead on developments and improvements and maintain March 09 and LSAB/Seamus Existing strategic view governance of training related issues ongoing Docherty resources Safeguarding Adults Manager 130 To review Safeguarding Training Programme to learn and Service users and carers will say that improving safeguarding LSAB/Seamus Existing develop from stakeholder feedback processes help them to feel safe, in a satisfaction survey in Survey Sept 09 Docherty resources To develop more specific training around risk identification, September 09 Safeguarding assessment and management Adults Manager To incorporate risk identification, assessment and management • 100% of staff to be trained in risk assessment and April 2010 David Fabbro Existing into Self Directed Care agenda management. SDS will take full account of risk issues at Feb 09 and Project Officer resources each stage of |SDS process. ongoing Self-directed The SDS team will introduce the risk assessment format, Support developed in HLDT, following the joint review • 100% service users will have risks identified and managed March 09 Harrow Council using the risk assessment format as a tool resulting in SDS team will further develop a quality assurance questionnaire strengthened protection plans for service users. specifically related to their service users and carers. • Quality assurance questionnaire will be analysed and Written guidance will be given to users and providers of self- comments and feedback will be used to develop service March 09 directed support in accessible format. provision.
• Service users and carers will receive information regarding Sept 09 self-directed support so that they are well informed.
Page 20 6/3/2009 Harrow Council and Harrow PCT - Joint Action Plan Joint Review – commissioning services and support for people with learning disabilities and complex needs To share the council’s approach with PCT Staff will feel more equipped to assess and manage risk March 09 and LSAB/Seamus Existing ongoing Docherty resources Safeguarding Adults Manager
131
Page 21 6/3/2009 Harrow Council and Harrow PCT - Joint Action Plan Joint Review – commissioning services and support for people with learning disabilities and complex needs
Standard: Sharing and using information more effectively Outcome: Local authorities and their partners apply the principles of Putting People First so that information about people with learning disabilities and complex (contd) needs is shared across agencies and used to deliver improved, personalised services and supports, tailored to people’s expressed needs and wants.
RECOMMENDATION The council and the PCT should ensure that assessor led reviews take place and lead to amended care where needed
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE • To ensure that reviews are scheduled for 6 weeks after • 100% of users and carers will receive updated care plans to Feb 09 and Doris Sheridan Existing needs are identified and met, and yearly thereafter confirm eligible needs, and reflect any changes, ongoing Service resources • To ensure care plans are updated to reflect amended care • Ensure suitability of care provision and make any necessary Manager HLDT as appropriate adjustments Harrow council • To ensure reviews are carried throughout the year and • Respond to changing circumstances capacity within the team is maintained to respond to • All users and carers who work during the day will have demand. opportunity to have their review at a more convenient time • To ensure reviews are offered outside normal working 132 hours to meet the needs of users and carers who are not available during the day • To ensure that carers reviews are scheduled for carers in receipt of services
• To ensure that each team manager audits 6 case files per • Ongoing monitoring of casework to ensure quality of month to monitor quality of casework using the Auditing assessments, care plans and reviews Audit tool is used in March 2009 tool. supervision to maintain Pis and quality standards. • To ensure that Service managers audit 2 case files per • Service manager addresses any performance management month. issues within team.
• To ensure that Divisional Director and Corporate Director • Divisional director and Corporate director will have audited April 2009 then undertake audit of case files. 12 files by April 09 and feedback findings to Service quarterly Manager. thereafter.
• To ensure the Care management manual is updated and • 100% staffs are trained and working is accordance with the February 2009 effectively used by staff. Care management manual. To ensure the PCT review all continuing care clients within 3 100% of clients receive reviews in the indicated timescale, so March 10 Angela Newitt Existing months of being first approved for CC and annually thereafter that and services can be tailored to meet needs Lead Nurse for resources Continuing Care Harrow PCT
Page 22 6/3/2009 Harrow Council and Harrow PCT - Joint Action Plan Joint Review – commissioning services and support for people with learning disabilities and complex needs
Standard: Sharing and using information more effectively Outcome: Local authorities and their partners apply the principles of Putting People First so that information about people with learning disabilities and complex (contd) needs is shared across agencies and used to deliver improved, personalised services and supports, tailored to people’s expressed needs and wants.
RECOMMENDATION The Council and the PCT should work with partners both within the council and other agencies to ensure a range of universal services is increasingly offered to people with learning disabilities and complex needs
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE To ensure NRCs start operation in agreed timeframe • Greater choice of activities in line with ethos of NRCs July 09 Keith Holmes Additional • Increase in number of users accessing mainstream NRC Project investment community activities. Manager Harrow Council To jointly promote the range of services available across the • Greater choice of activities and health and well-being July 09 Carol Yarde Council and PCT • A healthy walks co-ordinator, who will be linked to NRCs, to Head of Adults Additional be operational in July 09. & Housing investment • Transformation 133 Green gyms will open in March 09. • A project worker will be recruited to promote free adult Project Plan swimming for LD users Harrow Council Additional investment To produce an integrated commissioning strategy with PCT, to • Greater range of services available to users with LD and April 09 Mark Gillett Temporary include commissioning of preventative services and services to complex needs Div. Director additional self-funders • Further development of information and advice services Commissioning investment • Development of catalogue of services for users and self- and funders Partnerships Harrow Council
Mary Cleary Head of Integrated Commissioning Harrow PCT To develop a joint strategy for health and well-being for Harrow • Publication of strategy September 09 Andrew Howe Existing • An overarching view of vision and targets contained in the Director of resources LAA, Transformation Plan, and PCT commissioning plans, Public Health to inform service development • Improved health and well-being of people with LD
Page 23 6/3/2009 Harrow Council and Harrow PCT - Joint Action Plan Joint Review – commissioning services and support for people with learning disabilities and complex needs
Standard: Assuring high quality providers for all services Outcome: People with learning disabilities and complex needs have services and support in place that are personalised according to their needs and reflective/sensitive to changes in their requirements.
RECOMMENDATION The council and the PCT should use strengthened joint commissioning arrangements to secure an increased range of supported living services
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE To jointly re-commission residential services for people with LD • Reduce by 3 (from 8 to 5) the number of registered care April 10 Mark Gillett Reinvestment of currently provided through by Support for Living homes within the re-provided service leading to increase Div. Director existing range of living arrangements for people with LD Commissioning resources • Number of people with LD supported to live independently March 10 and will continue to increase (107 directly provided in 08 to 252 Partnerships directly provided in 09) Harrow Council • 2010 LAA target of 2785 service users supported to live March 10 independently will include LD • 134 To complete the transfer of responsibility and funding for the Health care flexibilities will be used to maximise the alignment of April 09 Mark Gillett Transfer of social care of people with learning disabilities from the NHS to health and social care budgets to provide enhanced streamlined Div. Director existing the Council support to users Commissioning resources and Partnerships Harrow Council
Mary Cleary Head of Integrated Commissioning Harrow PCT
Page 24 6/3/2009 Harrow Council and Harrow PCT - Joint Action Plan Joint Review – commissioning services and support for people with learning disabilities and complex needs
Standard: Assuring high quality providers for all services Outcome: People with learning disabilities and complex needs have services and support in place that are personalised according to their needs and (contd) reflective/sensitive to changes in their requirements.
RECOMMENDATION The council and the PCT should use strengthened joint commissioning arrangements to secure an increased range of supported living services (contd)
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE To develop an accommodation strategy as part of transformation • Needs assessment February 09 Nick Davies Additional project, to include LD • Launch of strategy June 09 Service investment • Define the Council’s need for accommodation solutions for Manager the next five years, including accommodation for people Supporting with LD people, Contracts& Brokerage Harrow Council 135
Page 25 6/3/2009 Harrow Council and Harrow PCT - Joint Action Plan Joint Review – commissioning services and support for people with learning disabilities and complex needs
Standard: Assuring high quality providers for all services Outcome: People with learning disabilities and complex needs have services and support in place that are personalised according to their needs and (contd) reflective/sensitive to changes in their requirements.
RECOMMENDATION The PCT should strengthen the commissioning of health care specialist services including assessment and treatment, forensic services and the accessibility and responsiveness of primary health care services.
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE To review current specialist health provision as part of Redesigned care pathways and better commissioned health March 10 Mary Cleary Additional development of separate provider organisation, with a view to services Head of investment tendering out the community health and mental health provision Integrated Commissioning Harrow PCT
To fully implement LD DES All LD users on the Council register are identified on the GP LD March 10 Mary Cleary Additional register, and 80% of those on the GP LD register receive an Head of investment 136 annual health check Integrated Commissioning Harrow PCT
Use DES to develop Health Action Plan for 50% of people with 50% of people with LD on council register will have a Health March 10 Mary Cleary Additional LD on council register by March 2010 Action Plan Head of investment Integrated Commissioning Harrow PCT
Page 26 6/3/2009 Harrow Council and Harrow PCT - Joint Action Plan Joint Review – commissioning services and support for people with learning disabilities and complex needs Standard: Assuring high quality providers for all services Outcome: People with learning disabilities and complex needs have services and support in place that are personalised according to their needs and (contd) reflective/sensitive to changes in their requirements.
RECOMMENDATION The council should ensure that the vision and aspirations of the Transformation Plan are cascaded effectively to frontline teams
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE To develop a joint communication strategy with PCT that will • To recruit a project manager Feb 09 Carol Yarde Existing include effective cascade of information to frontline staff Head of Adults resources • Communication following monthly TPP programme board April 09 & Housing meetings Transformation Project Plan • Two-monthly newsletter for frontline staff April 09 Harrow Council
• Frontline staff will have a greater understanding of TPP, which will enable them to communicate to users information April 09 about new services, measured through annual staff surveys 137
• Users and carers will have better understanding of services May 09 and ability to access them, measured through annual user surveys
Page 27 6/3/2009 Harrow Council and Harrow PCT - Joint Action Plan Joint Review – commissioning services and support for people with learning disabilities and complex needs
Standard: Assuring high quality providers for all services Outcome: People with learning disabilities and complex needs have services and support in place that are personalised according to their needs and (contd) reflective/sensitive to changes in their requirements.
RECOMMENDATION The council and the PCT should produce a detailed and funded joint commissioning plan for people with learning disabilities, including those with complex needs, and their carers
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE To jointly develop an Integrated Commissioning Strategy • Publication of strategy April 09 Mark Gillett Temporary • Commissioning reflects the identified needs of people with Div. Director additional LD and identifies the funding to meet those needs Commissioning investment • Commissioned services promote independence, well-being and and choice Partnerships • Market management secures increased range of services Harrow Council and greater choice for individual service users Mary Cleary
138 Head of Integrated Commissioning Harrow PCT
Page 28 6/3/2009 Harrow Council and Harrow PCT - Joint Action Plan Joint Review – commissioning services and support for people with learning disabilities and complex needs
Standard: Assuring high quality providers for all services Outcome: People with learning disabilities and complex needs have services and support in place that are personalised according to their needs and (contd) reflective/sensitive to changes in their requirements.
RECOMMENDATION The council and the PCT should ensure that robust clauses within provider contracts in relation to adult safeguarding issues are monitored and performance reported in a structured way
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE To include Safeguarding clauses in new residential spot • All new residential spot contracts have a safeguarding March 09 Nick Davies Existing contracts clause Service resources • Users and carers feedback that they feel safe in a September 09 Manager satisfaction survey Supporting people,
139 Contracts& Brokerage Harrow Council
To monitor the safeguarding clause through the volume of • Impact of safeguarding clause is monitored April 09 Nick Davies Existing service failure rates, CRIll safeguarding information, and Service resources safeguarding strategy meetings • Users and carers feedback that they feel safe in a September 09 Manager satisfaction survey Supporting people, Contracts& Brokerage Harrow Council
Page 29 6/3/2009 Harrow Council and Harrow PCT - Joint Action Plan Joint Review – commissioning services and support for people with learning disabilities and complex needs
Standard: Assuring high quality providers for all services Outcome: People with learning disabilities and complex needs have services and support in place that are personalised according to their needs and (contd) reflective/sensitive to changes in their requirements.
RECOMMENDATION The council and the PCT should ensure that robust clauses within provider contracts in relation to adult safeguarding issues are monitored and performance (contd) reported in a structured way
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE To benchmark across providers and issue default notices if • Importance if safeguarding is reinforced to providers June 09 Nick Davies Existing appropriate • Users and carers feedback that they feel safe in a Service resources satisfaction survey September 09 Manager Supporting people, Contracts& Brokerage Harrow Council
140
Page 30 6/3/2009 Harrow Council and Harrow PCT - Joint Action Plan Joint Review – commissioning services and support for people with learning disabilities and complex needs
Standard: Assuring high quality providers for all services Outcome: People with learning disabilities and complex needs have services and support in place that are personalised according to their needs and (contd) reflective/sensitive to changes in their requirements.
RECOMMENDATION The council and the PCT should develop a more service user orientated approach by strengthening quality assurance processes to ensure that managers know about the actuality of service users and carers experiences
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE To develop the Quality Assurance Framework which sets out • Managers will be informed by MORI survey of LD users and April 09 Sue Conn Existing mechanisms to capture fully the views of people with LD and carers, by complaints data, and by feedback from the Senior resources carers regular user forums established in provider services Professional • Evidence of the impact of service user and carer views on Service service development, through user surveys Development Team
141 Harrow Council
Establishment of a quarterly quality assurance board • Views of service users and carers, and feedback from staff April 09 Sue Conn Existing will be available to managers, to inform service planning Senior resources • Evidence of the impact of service user and carer views on Professional service development Service Development Team Harrow Council
To commission MORI to undertake surveys of service users with • Baseline established of views of service users and carers April 09 Paul Najsarek Additional LD and their carers with learning disability on the services they experience Corp Director investment • Development of an action plan to improve service delivery April 09 Harrow Council and quality Carol Yarde Head of Adults & Housing Transformation Project Plan Harrow Council
Page 31 6/3/2009 Harrow Council and Harrow PCT - Joint Action Plan Joint Review – commissioning services and support for people with learning disabilities and complex needs Standard: Assuring high quality providers for all services Outcome: People with learning disabilities and complex needs have services and support in place that are personalised according to their needs and (contd) reflective/sensitive to changes in their requirements.
RECOMMENDATION The council and the PCT should develop a more service user orientated approach by strengthening quality assurance processes to ensure that managers know (contd) about the actuality of service users and carers experiences
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE Develop a carers’ evaluation questionnaire to be used annually Ensure carers have positive outcomes from their assessments in April 09 Jasvinder Existing following a carers assessment line with the 7 health and social care outcomes Perihar resources Jasvinder Perihar Ongoing monitoring of casework to ensure Carers have been • 100% Carers will be identified and supported and offered a Senior identified and offered a separate carer’s assessment if they wish. separate carer’s assessment if they wish. Professional Quality of carer’s assessments to be monitored via Audit tool. • Carers will feel supported and valued. well-being and Team managers to include in the 6 case files per month, 2 that • 100%Carers will be aware of qualify assurance carers strategy 142 include carer’s assessments. questionnaires and have an opportunity to influence service Harrow Council provision and commissioning.
Page 32 6/3/2009 Harrow Council and Harrow PCT - Joint Action Plan Joint Review – commissioning services and support for people with learning disabilities and complex needs
Standard: Recognising the importance of good health services; recognising the interdependence between work, health and well-being; recognising human rights Outcome: People with learning disabilities and complex needs have the right to live a fulfilling life with good, accessible health care, social care and employment opportunities close to home
RECOMMENDATION The PCT should ensure that Health Action Plans are in place and of sufficient quality and detail to deliver structured and co-coordinated generic and specialist health care checks and services
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE To implement Standardised Health Action Plans in conjunction 50% of people on Council LD register will have a Health Action September 09 Mary Cleary Additional with implementation of the LD DES Plan by Sept 09 Head of investment Integrated Commissioning Harrow PCT
143
RECOMMENDATION The PCT should ensure that secondary health care professionals have the skills and protocols in place to ensure an accessible and appropriate service for people with learning disabilities complex needs and their carers
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE To develop Action Plan to deliver Valuing People Now, and More responsive and accessible health services for people with June 09 Mary Cleary Existing respond to Death by Indifference, and Health Care for All, to be LD, to be measured against the baseline established by IPSOS Head of resources monitored by LDPB and PCT Mori poll Integrated Commissioning Harrow PCT
Page 33 6/3/2009 Harrow Council and Harrow PCT - Joint Action Plan Joint Review – commissioning services and support for people with learning disabilities and complex needs
Standard: Recognising the importance of good health services; recognising the interdependence between work, health and well-being; recognising human rights Outcome: People with learning disabilities and complex needs have the right to live a fulfilling life with good, accessible health care, social care and employment (contd) opportunities close to home
RECOMMENDATION The council and the PCT should ensure that a high quality and flexible carer support service, including respite care, is available
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE To develop plans for carer breaks jointly with PCT • Increase the numbers of breaks provided to carers April 10 Jasvinder Additional • Deliver outcomes of the National Carers Strategy: respect, Perihar investment by a life outside of caring, financial support, mental / physical Jasvinder PCT well-being, support for young carers Perihar Senior Professional well-being and 144 carers strategy Harrow Council
Revise all SLAs to be outcome-focused Clearer monitoring of activities and their outcomes provided by April 09 Jasvinder Existing SLAs Perihar resources Jasvinder Perihar Senior Professional well-being and carers strategy Harrow Council
Page 34 6/3/2009 Harrow Council and Harrow PCT - Joint Action Plan Joint Review – commissioning services and support for people with learning disabilities and complex needs
Standard: Recognising the importance of good health services; recognising the interdependence between work, health and well-being; recognising human rights Outcome: People with learning disabilities and complex needs have the right to live a fulfilling life with good, accessible health care, social care and employment (contd) opportunities close to home
RECOMMENDATION The council and the PCT should ensure that a high quality and flexible carer support service, including respite care, is available (contd)
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE Undertake joint pathway mapping for all care groups to inform Better targeting of training and breaks for carers, and Sept 09 Jasvinder Existing the development of carers’ services development of services Perihar resources Jasvinder Perihar 145 Senior Professional well-being and carers strategy Harrow Council
Page 35 6/3/2009 Harrow Council and Harrow PCT - Joint Action Plan Joint Review – commissioning services and support for people with learning disabilities and complex needs
Standard: Recognising the importance of good health services; recognising the interdependence between work, health and well-being; recognising human rights Outcome: People with learning disabilities and complex needs have the right to live a fulfilling life with good, accessible health care, social care and employment opportunities close to home
RECOMMENDATION The council should ensure that better quality assurance processes are in place to ensure that day opportunities are increasingly person centered and routinely offer community based activities
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE To ensure user and carer experience are central to the quality Evidence that user/ carer views are incorporated into service Apr 09 Sue Conn Existing assurance framework development Senior resources Professional Service Development Team Harrow Council 146 Development of 3 NRCs to offer community based services • New timetables based on one page profile outcomes July 09 Keith Holmes Additional developed with service users NRC Project investment • Three month review to be carried out after opening of NRCs October 09 Manager to measure activities against outcomes identified in profiles Harrow Council and previous activities prior to NRCs • Increase in the range and choice of opportunities available August 09 and to service users ongoing • Increase in number of users accessing community based activities August 09 and ongoing To train all management staff in person-centred thinking • All current day service users will have a one-page profile April 09 Keith Holmes Existing based on person-centred thinking. NRC Project resources • New service users will have a plan developed as part of April 09 and Manager their induction ongoing Harrow Council
Page 36 6/3/2009 Harrow Council and Harrow PCT - Joint Action Plan Joint Review – commissioning services and support for people with learning disabilities and complex needs Standard: Recognising the importance of good health services; recognising the interdependence between work, health and well-being; recognising human rights Outcome: People with learning disabilities and complex needs have the right to live a fulfilling life with good, accessible health care, social care and employment (contd) opportunities close to home
RECOMMENDATION The council should ensure that better quality assurance processes are in place to ensure that day opportunities are increasingly person centered and routinely offer (contd.) community based activities
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE To develop monitoring systems based on QAF and training Regular reporting on outcomes to senior management, to May 09 Nick Davies Existing support planning and improvements in the availability of day Service resources resources Manager Supporting people, Contracts&
147 Brokerage Harrow Council
Page 37 6/3/2009 Harrow Council and Harrow PCT - Joint Action Plan Joint Review – commissioning services and support for people with learning disabilities and complex needs
Standard: Recognising the importance of good health services; recognising the interdependence between work, health and well-being; recognising human rights Outcome: People with learning disabilities and complex needs have the right to live a fulfilling life with good, accessible health care, social care and employment (contd) opportunities close to home
RECOMMENDATION The council and the PCT should ensure that the criteria used by the resource allocation panel, and the reasons for individual decisions, are communicated effectively to people who use services and their carers
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE PCT will develop easy read communications for each stage in People with LD and their carers will have good quality Dec 09 Mary Cleary Existing the Continuing Care Assessment process information about how decisions are made Head of resources Integrated Commissioning
148 Harrow PCT
HLDT will develop an easy read communication letters to inform People with LD and their carers will understand the outcome of May 09 Doris Sheridan Existing service users about panel decisions. the HLDT panel decisions. Service resources Manager HLDT Harrow council
Page 38 6/3/2009 Harrow Council and Harrow PCT - Joint Action Plan Joint Review – commissioning services and support for people with learning disabilities and complex needs
Standard: Developing incentives for commissioning for health and well-being Outcome: There is effective partnership working that results in the development of a health and social care market that puts people first, and delivers the kinds of services that are important to them.
RECOMMENDATION The council and the PCT should agree with providers the range of new support services required to deliver increasingly personalised support plans
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE To monitor the impact of the brokerage pilots with 3 voluntary The pilot will inform service mapping and identify gaps in December 09 David Fabbro Existing sector organisations and the work of the Independent Brokers services Project Officer resources Self-directed Support Harrow Council To hold meetings with providers, and with voluntary sector, to Market management to provide a greater range of services December 09 Nick Davies Existing discuss brokerage Service resources Manager Supporting 149 people, Contracts& Brokerage Harrow Council
To develop the Integrated commissioning strategy, to include LD • A framework to support the provision of flexible, responsive April 09 David South Temporary and equitable services to meet national and local key Service additional targets Manager investment • Plans for securing, specifying and monitoring services Commissioning provided by NHS, Council, other public agencies, and Harrow Council private and voluntary sector • Clarification of commissioning and decommissioning intentions of PCT and Council for 2009-2014
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Standard: Developing incentives for commissioning for health and well-being Outcome: There is effective partnership working that results in the development of a health and social care market that puts people first, and delivers the kinds of (contd) services that are important to them.
RECOMMENDATION The council and the PCT should agree with providers the range of new support services required to deliver increasingly personalised support plans (contd)
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE To agree an approach to the development of joint and integrated Publication of plan and timetable with clear milestones July 09 Mark Gillett Existing commissioning structures established Div. Director resources Commissioning and
150 Partnerships Harrow Council
Mary Cleary Head of Integrated Commissioning Harrow PCT
Page 40 6/3/2009 Harrow Council and Harrow PCT - Joint Action Plan Joint Review – commissioning services and support for people with learning disabilities and complex needs
Standard: Developing incentives for commissioning for health and well-being Outcome: There is effective partnership working that results in the development of a health and social care market that puts people first, and delivers the kinds of (contd) services that are important to them.
RECOMMENDATION The council and the PCT should raise the profile of the new commissioning team with providers and establish formal and regular communication systems
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE To Establish provider fora for Improved communication between providers and Apr 09 Nick Davies Existing • Home care commissioners/contract managers, to increase providers’ Service resources • Residential Services awareness of commissioning priorities, key service Manager • 3rd Sector developments, and commissioning opportunities, leading to more Supporting effective market management people, Contracts& Brokerage
151 Harrow Council
Publication of Provider Update Improved communication between providers and May 09 Nick Davies Existing commissioners/contract managers, to increase providers’ Service resources awareness of commissioning priorities, key service Manager developments, and commissioning opportunities, leading to more Supporting effective market management people, Contracts& Brokerage Harrow Council
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Standard: Developing incentives for commissioning for health and well-being Outcome: There is effective partnership working that results in the development of a health and social care market that puts people first, and delivers the kinds of (contd) services that are important to them.
RECOMMENDATION The council and the PCT should agree with providers a range of initiatives and incentives to develop a wide range of services
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE To continue to improve services with the 2 homecare providers Better outcomes and value for money March 09 Nick Davies Existing on partnership boards, Service resources Manager Supporting people, Contracts& Brokerage Harrow Council
152 To start a pattern of regular meetings with residential and Better quality assurance e.g. CRILL and performance ratings March 09 Nick Davies Existing nursing care providers Service resources Manager Supporting people, Contracts& Brokerage Harrow Council
To reduce unit costs Measure against benchmarking with other Las as part of West April 2010 Nick Davies Existing London Procurement Group Service resources Manager Supporting people, Contracts& Brokerage Harrow Council
Page 42 6/3/2009 Harrow Council and Harrow PCT - Joint Action Plan Joint Review – commissioning services and support for people with learning disabilities and complex needs Standard: Developing incentives for commissioning for health and well-being Outcome: There is effective partnership working that results in the development of a health and social care market that puts people first, and delivers the kinds of (contd) services that are important to them.
RECOMMENDATION The council and the PCT should agree with providers a range of initiatives and incentives to develop a wide range of services (contd)
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE To link incentives with quality, (using CRILL data) and y to • Contracts will include quality incentive payments March 10 Nick Davies Existing reconfigure services in line with demand • Provision will respond to and meet demand Service resources Manager Supporting people, Contracts& Brokerage Harrow Council 153
To develop new services in line with gaps identified in the To meet the objectives stated in the accommodation strategy Feb 09 Nick Davies Existing integrated commissioning strategy, accommodation strategy and and integrated commissioning strategy Service resources evaluation of SDS brokerage services Manager Supporting people, Contracts& Brokerage Harrow Council
To use to 0.5% CQUIN payment to incentivise quality outcomes Contracts will routinely include quality incentive payments March 10 Mary Cleary Existing with providers of LD services Head of resources Integrated Commissioning Harrow PCT
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Standard: Developing incentives for commissioning for health and well-being Outcome: There is effective partnership working that results in the development of a health and social care market that puts people first, and delivers the kinds of (contd) services that are important to them.
RECOMMENDATION The council and the PCT should streamline and make more timely the tendering process for purchasing health and social care.
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE To continue discussion to set up an integrated commissioning Integrated timetables and joint improved planning March 11 Mary Cleary Existing team Head of resources Integrated Commissioning Harrow PCT
Mark Gillett Div. Director 154 Commissioning and Partnerships Harrow Council
To review procurement processes, particularly for the voluntary Better quality services and value for money, with outcome April 2010 Nick Davies Additional sector focused SLAs Service investment Manager Supporting people, Contracts& Brokerage Harrow Council
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Standard: Making it happen: local accountability, capability and leadership Outcome: People with learning disabilities and complex needs, their families and carers are aware of what services and support they can expect and have a right to receive from councils and the NHS. Outcome: Commitment at a corporate, strategic and operational level means that local authorities and PCTs know what services need to be delivered and how to deliver them to improve the quality of life for people with learning disabilities and complex needs and their families.
RECOMMENDATION The council and the PCT should ensure that the vision of the service is articulated in a set of monitorable and specific team and unit targets
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE To update the service targets contained in the Learning disability Staff at all levels will be clear about requirements Mar 09 David Existing Action Plan and translate to team level Harrington resources Service Manager- performance
155 LBH To translate the LD and MH targets in PCT CSP plan to team Staff at all levels will be clear about requirements June 09 Mary Cleary Existing level Head of resources Integrated Commissioning Harrow PCT
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Standard: Making it happen: local accountability, capability and leadership Outcome: People with learning disabilities and complex needs, their families and carers are aware of what services and support they can expect and have a right (contd) to receive from councils and the NHS. Outcome: Commitment at a corporate, strategic and operational level means that local authorities and PCTs know what services need to be delivered and how to (contd) deliver them to improve the quality of life for people with learning disabilities and complex needs and their families.
RECOMMENDATION The council and the PCT should improve the numbers of specific and personalised care plans for people who use services
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE To ensure a project board meeting dedicated to PCP with PCP project board meetings held every 2 months. June 09 Doris Sheridan Existing attendance from all key personnel from day services takes place Service resources regularly Manager HLDT Harrow Council
156 To ensure that all staff receive PCP (person centred thinking 100 % of staff to have undertaken PCP training. February 09. & Doris Sheridan Existing skills) training. Ongoing Service resources Manager HLDT Harrow Council To increase the number of users with a PCP in place • PCP to be put in place for all service users who are March 09 and Doris Sheridan Existing reviewed or assessed ongoing Service resources Manager HLDT Harrow Council
• All users accessing NCRs will have a PCP in place July 09 Keith Holmes NRC Project Manager Harrow Council To ensure that Framework-i is updated to accommodate a one- Format of one page PCP profile is available on HOST to August 2009 Doris Sheridan Existing page profile to be completed at every review for individuals download in preparation for reviews. Service resources Manager HLDT Harrow Council
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Standard: Making it happen: local accountability, capability and leadership Outcome: People with learning disabilities and complex needs, their families and carers are aware of what services and support they can expect and have a right (contd) to receive from councils and the NHS. Outcome: Commitment at a corporate, strategic and operational level means that local authorities and PCTs know what services need to be delivered and how to (contd) deliver them to improve the quality of life for people with learning disabilities and complex needs and their families.
RECOMMENDATION The council and the PCT should extend training opportunities to a wide range of staff to increase specialist skills in meeting the needs of people with learning disabilities and complex needs
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE To undertake a training needs analysis • Identification of specialist training needs of staff Mar 09 Mark Gillett DOH Training • Publication of specialist training programme within Learning Apr 09 Div. Director grant and Development Plans of Council and PCT Commissioning • Increased numbers of staff with specialist skills in meeting Mar 10 and the needs of people with LD & complex needs Partnerships 157 • Evidence of the impact of skilled staff on services for people Mar 10 Harrow Council with LD & complex needs
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Standard: Making it happen: local accountability, capability and leadership Outcome: People with learning disabilities and complex needs, their families and carers are aware of what services and support they can expect and have a right (contd) to receive from councils and the NHS. Outcome: Commitment at a corporate, strategic and operational level means that local authorities and PCTs know what services need to be delivered and how to (contd) deliver them to improve the quality of life for people with learning disabilities and complex needs and their families.
RECOMMENDATION The council and the PCT should continue to develop and utilise emerging quality assurance processes and stronger business processes to secure better outcomes for people who use services and their carers.
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE To develop integrated commissioning strategy with focus on • Publication of integrated commissioning strategy Apr 09 Mark Gillett Temporary commissioning for outcomes • Evidence of improved outcomes for service users Mary Cleary additional Head of investment
158 Integrated Commissioning Harrow PCT
To develop quality assurance framework • Publication of quality assurance framework, and board April 09 Sue Conn Existing To establish a senior management monitoring board • Use and act upon the information to improve services Senior resources Professional Service Development Team Harrow Council
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Standard: Making it happen: local accountability, capability and leadership Outcome: People with learning disabilities and complex needs, their families and carers are aware of what services and support they can expect and have a right (contd) to receive from councils and the NHS. Outcome: Commitment at a corporate, strategic and operational level means that local authorities and PCTs know what services need to be delivered and how to (contd) deliver them to improve the quality of life for people with learning disabilities and complex needs and their families.
RECOMMENDATION The council and the PCT should speed up the process of strengthening the staffing and skills at middle management level to deliver the required improvements
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE Increase capacity at middle manager level within Adult • Recruitment of 1 Head of Service, 1 Policy Development Jun 09 Bernie Flaherty Growth revenue Community Care services Officer, and 3 Personalisation officers Divisional • Enhanced ability to improve quality of life for people with LD director • Enhanced ability to lead the workforce through the Community care modernisation agenda Harrow Council Increase capacity within the Adult Commissioning team To increase the team by one new commissioner to a total of 3 June 09 Mark Gillett Additional 159 ensure services are commissioned and delivered in a timely way Div. Director investment Commissioning and Partnerships Harrow Council
To undertake a training needs analysis • Identification of specialist training needs of managers April 09 Mark Gillett Existing • Publication of specialist training programme within Learning Div. Director resources and Development Plans of Council and PCT Commissioning and Partnerships Harrow Council
To provide facilitated action learning sets for middle managers Managers will have tools for the successful implementation of December 09 Carol Yarde Additional projects within time and budget Head of Adults investment & Housing (funded by Joint Transformation Improvement Project Plan Partnership) Harrow Council
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Standard: Making it happen: local accountability, capability and leadership Outcome: People with learning disabilities and complex needs, their families and carers are aware of what services and support they can expect and have a right (contd) to receive from councils and the NHS. Outcome: Commitment at a corporate, strategic and operational level means that local authorities and PCTs know what services need to be delivered and how to (contd) deliver them to improve the quality of life for people with learning disabilities and complex needs and their families.
RECOMMENDATION The council and the PCT should speed up the process of strengthening the staffing and skills at middle management level to deliver the required improvements (contd)
ACTION MEASURE / OUTCOME WHEN LEAD RESOURCE To continue to organise workshops for all programme managers Programme managers and leads will have tools for the Ongoing Carol Yarde Existing or programme leads in the TPP, so that training and successful implementation of projects within time and budget Head of Adults resources development requirements can be identified and addressed. & Housing
160 Transformation Project Plan Harrow Council
Head of Integrated Commissioning Harrow PCT PCT to appoint 1 new team manager for health element of HLDT Strengthened leadership in the health element of HLDT June 09 Mary Cleary Existing Head of resources Integrated Commissioning Harrow PCT PCT will enhance commissioning capacity for LD More senior management and director level input to reflect the March 09 Mary Cleary Existing degree of priority given to commissioning in PCT plans Head of resources Integrated Commissioning Harrow PCT
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Commissioning services and support for people with learning disabilities and complex needs
Name of council London Borough of Harrow
Name of primary care Harrow Primary Care Trust trust Area Harrow Month and year of visit October 2008
161 Commission for Social Care Inspection The Commission for Social Care Inspection (CSCI) works to provide a clear, independent assessment of the state of adult social care services in England. CSCI combines inspection, review, performance and regulatory functions across the range of adult social care services in the public and independent sectors.
Healthcare Commission The Healthcare Commission is England’s watchdog for healthcare. It is our job to help to improve the quality of people’s health and the healthcare that they receive. This includes checking on the services provided by the NHS, private healthcare organisations and charities.
Mental Health Act Commission The Mental Health Act Commission provides a safeguard for people who are detained in hospital under the powers of the Mental Health Act.
Background
We wanted to place people with learning disabilities and complex needs and family carers at the heart of this joint commissioning review.
A reference group was established that included people with learning disabilities, family carers and commissioners to ensure our methodology focused on the concerns of people with learning disabilities and complex needs.
The methodology was developed for the commissioning process for people with learning disabilities and complex needs. We wanted to understand the impact of commissioning processes from their perspective. To do this we:
x Spent time with people with learning disabilities and complex needs, which we called ‘A Day in the Life of...’ to understand the outcomes for people.
x Carried out mystery shopping exercises to see how far local services met individuals’ needs.
x Held sessions open to the public so that we heard a wide range of views from the community.
x Held individual interviews and focus groups.
x Looked for examples of good practice that we could report, enabling others to learn and improve their commissioning practices.
The review team combined people with learning disabilities and family carers and ‘peer review’ commissioners as team members enabling us to focus directly on what matters to people with learning disabilities and complex needs.
(For further information on the methodology please refer to the Appendix).
162 The commissioning of services and support for people with learning disabilities and complex needs
London Borough of Harrow and Harrow PCT
October 2008
Review Team Timothy Willis Team Lead Reviewer Commission for Social Care Inspection Andy Law Expert by Experience Reviewer
Paman Steer Supporter for Expert by Experience Reviewer Inderpreet Johar Family Carer Reviewer
Sheila Taylor Service Commissioner Reviewer
Lorraine Yearsley Mental Health Act Commission Reviewer
Richard Ngatai Healthcare Commission Reviewer
Reena Sharma Business Coordinator Commission for Social Care Inspection
A copy of this report can be made available in other formats on request. You can obtain a summary in a different format or language from:
CSCI details are: website: www.csci.org.uk
Or e-mail: [email protected]
Healthcare Commission details are: website: www.healthcarecommission.org.uk
Or contact the helpline: 0845 601 3012
Or e-mail: [email protected]
Mental Health Act Commission details are: website at: www.mhac.org.uk
Or e-mail: [email protected]
163 Acknowledgements We would like to thank all the people with learning disabilities and complex needs, staff, family carers and everyone else who participated in the review.
Copyright © 2008 Commission for Social Care Inspection, Commission for Healthcare Audit and Inspection, Mental Health Act Commission. This publication may be reproduced in whole or part, free of charge, in any format or medium provided that it was not used for commercial gain. This consent was subject to the material being reproduced accurately and on the proviso that it was not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI, Healthcare Audit and Inspection, Mental Health Act Commission copyright, with the title and date of publication of the document specified.
164 The joint review of commissioning services and support for people with learning disabilities and complex needs
Report
Contents Page
Introduction 1
Local context 1
Summary 2
Recommendations 6
Key findings
Putting people at the centre of commissioning 9
Understanding the needs of populations and individuals 11
Sharing and using information more effectively 13
Assuring high quality providers for all services 16
Recognising the importance of good health services; recognising 18 the interdependence between work, health and well-being; recognising human rights Developing incentives for commissioning for health and well- 20 being Making it happen – Local accountability, capability and 21 leadership
Glossary 25
Appendix
Review background and methodology 29
165 Introduction
A review team visited London Borough of Harrow, October 2008 to find out how well the council and PCT were commissioning services and support for people with learning disabilities and complex needs.
This report sets out, for the commissioning organisations, the findings from the review, with a summary and recommendations for action. It is also intended to be of interest to the general public, and in particular, for people who use services in Harrow. It will support the council and PCT and their partner organisations in Harrow in working together to improve the lives of people with learning disabilities and complex needs.
Local context
London Borough of Harrow has a population of 214,625 (Source: ONS 2007 Mid Year Population Estimates (MYPEs). Based on national prevalence rates approximately 2.36% of the population (7,000 people) have learning disabilities and the proportion of people with learning disabilities is projected to rise by 9% by 2021 (Source: Harrow Joint Strategic Needs Assessment 2008). Harrow has the fifth most diverse ethnic minority population in the country with the total ethnic population estimated at 52.9% (Source: ONS 2006 Population Estimates by Ethnic Group).
The council works closely with the coterminous PCT and with the voluntary sector, in the commissioning of services. Provision of social services for the adult population sits within the Council’s Adults and Housing Directorate. The Directorate incorporates responsibility for social care services for all adults and housing services and is led by the Corporate Director of Adults and Housing Services.
Harrow PCT commissions and provides services for people with learning disabilities. Harrow PCT commissions a wide range of primary, community, secondary and specialist health services for the Harrow GP registered population, which at 233,654 is larger than the resident population.
In October 2008, the Healthcare Commission published the annual health check assessment. Harrow PCT has been rated as 'Fair' for Use of Resources and 'Fair' for Quality of Services. Across all the indicators, the PCT improved its performance in 2007-2008 compared to the previous year.
In the December 2007 Comprehensive Performance Assessment update, the council was judged by the Audit Commission to be a two star council, with a Direction of Travel judgment of “improving adequately” and a score of two out of four for adult social care services. Harrow has been a council in need of improvement for over two years.
In December 2008 social care services were judged by CSCI to be one star, with adult services being assessed as adequate with promising capacity for improvement. In January 2008, a Service Inspection of Independence, Wellbeing and Choice had focused upon personalistion for people with learning disabilities services and safeguarding for all adults. The Service Inspection found that the personalisation of services for people with learning disabilities was poor.
1 166 Executive summary of findings Sound progress had been made in setting in place processes to put people with learning disabilities and complex needs at the centre of commissioning new services. A range of forums and opportunities were in place for consulting on new and redesigned services and the engagement of service users had been particularly successful with regard to specific investment in more community-based initiatives. However, carers were less well engaged and there were examples of the voice of the service user and carers having had little impact on the plans for the services. Learning Disabilities Partnership Board (LDPB) was weak and ineffective.
Important projects had been developed to increase the personalisation of support provided but these were at an early stage and had not yet had an impact on mainstream care planning. Multidisciplinary assessment and care planning had improved from what had been a very poor baseline in early 2008 but was yet to be adequate. Despite some episodic examples of good work, overall plans were insufficiently specific to the individual needs of people with learning disabilities, were not always available in an appropriate format and lacked bespoke and individual objectives. Access to health therapies was poor.
Cultural needs were not routinely addressed and the benefits of an extensive advocacy service had yet to be capitalised upon because of an unfocussed and unstructured approach to using this support. The improvement of the council’s and the PCT’s complaints services had been prioritised and the service was an increasingly important part of an embryonic quality assurance process.
A Joint Strategic Needs Analysis [JSNA] had been completed but managers acknowledged that an understanding of needs of people with learning disabilities and complex needs remained inadequate. This had inhibited the development of strategic commissioning plans and had slowed the progress of commissioning modern services such as improved supported employment opportunities. Understanding the needs of people from ethnic minority communities had been a low priority.
Where priority had been accorded to areas of service development, sound plans had been made and were based on good evidence. Progress had been achieved in relation to the development of three Neighbourhood Resource Centres (NRCs), and increased supported housing opportunities. However, robust processes for recording and understanding service deficits were underdeveloped and inconsistently applied.
Particularly poor information had been available in relation to the transitions for young people from children’s to adult services and this had led to serious and enduring deficits in the quality of service provision. Managers had taken effective action to strengthen the service in 2008. However, operational guidance remained inadequate, monitoring arrangements were weak and, in some cases, the care available was determined largely by providers, at short notice and sometimes was provided outside the borough.
Progress had been made in sharing information at an operational and strategic level and opportunities for more personalised support, over which service users and carers could influence more control, were improving from a low baseline. Direct Payments had been an area of poor performance but had been prioritised, had become a Local
2 167 Area Agreement (LAA) target and had improved dramatically in 2008. A range of additional housing options had become available and more were on schedule to be available from 2009. However, overall, the range and choice of services and support remained weak. Supported accommodation and day opportunities were unavailable to most service users and recreational opportunities were limited – especially for people from ethnic minority communities.
The accessibility of services was poor and the availability of information was unacceptably variable. Sharing information amongst operational staff had been encouraged in a number of ways. These included health and social care staff using one shared database of people receiving services and both the council and primary health care settings keeping registers of people with learning disabilities. However, these tools had not been used effectively to improve service users experience of services.
Processes for managing risk were underdeveloped and insufficiently structured and auditable. The improvements underway in developing less intrusive and more independent care packages, such as supported living placements for people who had been in residential care, had not been matched by similar processes for managing risk to ensure that packages of care continued to be safe and secure. This review identified deficits in effective management of the risks associated with some increasingly ambitious and personalised casework, which included insufficiently structured protection plans, lack of identification and recording of risk factors and confusion between therapeutic and risk management initiatives. The level of management awareness of the importance of strengthening risk management processes was poor.
Partnership arrangements had improved – both between health and social care agencies and within the council. Other council departments had an improving understanding of the corporate responsibility for meeting the needs of this group and the LAA had been used effectively to identify shared priorities. However, deficits remained in relation to addressing some harassment issues and engaging effectively with adult education services.
The council and partners had adopted an overall transformation plan, which clearly set out the vision for modernising services, and the PCT had an effective operating plan, which included clear targets for improving learning disability services for people with complex needs and learning disabilities. Significant external funding had been secured for the development of supported housing and Neighbourhood Resource Centres (NRCs). There were plans for developing a commissioning team in the council, strengthening the commissioning function for specialist health care support within the PCT and a good vision for the council to lead a joint learning disability service from 2009 onwards.
However, there was no commissioning or joint health and social care commissioning plan for people with learning disabilities and staff and partners were unclear about the vision and the focus of the service. The transformation plan lacked sufficient specific targets and engagement with independent providers as important partners in developing new services was underdeveloped. There was no independent sector standing forum for discussing issues and the relationship with voluntary organisations was mixed and was under review. Contract monitoring was broadly satisfactory but
3 168 supervision of health care providers and the monitoring of key adult safeguarding clauses was poor.
Both agencies had increased funding for the service and shown determination and maturity in resolving a number of longstanding funding disputes between them. However, key health care services remained unavailable and funding for this service user group remained relatively low. There were some new programmes to increase opportunities for people to receive support in the community. A personalisation project was underway and well-scoped plans for developing self directed care and utilising a brokerage system were underway. However, progress had been limited.
Specialist health care assessments and services were fragmented, inadequate and often inaccessible. Health Action Plans (HAPs) were either not in place or ineffective. There was no health care facilitator or special protocols in place to ensure people with learning disabilities had swift, appropriate and accessible care from primary and secondary health care services. There were acknowledged gaps in services for some specialisms.
Support for family carers had improved markedly in 2008 but remained inadequate. Health and social care services had failed to engage purposefully with carers and continued to be viewed with some suspicion. Some decision-making and resource allocation processes were perceived as opaque and dismissive. There had been no initiatives to help carers remain in employment and many carers were unaware of important new services that were available.
Processes for maintaining minimum quality standards were poor and limited use had been made of established systems for checking progress such as routine reviews. The review process was increasingly implemented, but there was little quality control and the impact of reviews of the care provided was limited. Quality assurance of services provided was poor. Day care units had no targets for engaging people who used the service in out of centre activities and arrangements for ensuring that individualised activities were routinely made available, were invariably poor. Respite care was of variable quality and carers’ views had not been gathered regarding features that could be improved.
Both the resource allocation panels worked well in allocating resources effectively but there was less transparency and rigour in relation to the council’s panel than for the continuing health care panel. Care plan deficits had led to confusion amongst staff about the management of sensitive information and this had been to the detriment of people who used services on some occasions.
The vision for the service was clear at a strategic level but was yet to cascade effectively into routine commissioning and contracting processes. More progress had been made in developing supported housing options and there was a strong relationship between the Supporting People strategy and the vision for supporting people with learning disabilities.
However, there were few examples of commissioning utilising incentives or special contract arrangements to promote the development of the required services. Contracting was adequate but was not used effectively to increasingly shape differentiated and skilled services and the tendering process was not streamlined.
4 169 There was little dialogue with the independent sector about the required service developments. The relationship with the voluntary sector, though strong in parts, was variable.
The new senior managers in both organisations and elected members showed sound leadership and set a clear strategic direction. A range of strategic plans were having an increased effect. In the council, the transformation plan was a potentially effective vehicle for cascading the aspirations of the service and, in the PCT, the operating plan was backed up by a formal performance management process and a structured system for collecting frontline intelligence to inform service development.
However, mechanisms for sharing performance information with stakeholders and the public were underdeveloped and/or in a state of flux. The profile of the national Valuing People strategy had been low in both organisations and the vision for the service had yet to cascade to all staff and stakeholders. Communications systems were poor and there were limited basic management systems in place to drive up the quality of practice by setting local quality targets for improvement.
Significant improvement in the performance and morale of the care management team had been achieved alongside steady improvements regarding the availability of more modern services such as self-directed care. Nevertheless, the learning disability service had been failing for some years and recent performance for both organisations remained poor in relation to personalisation in care management, service quality and systems for promoting improvement. Business processes and training opportunities for staff had been strengthened but the span of control of some managers remained very large and basic risk assessment processes were not implemented consistently. Training opportunities for partners were limited and strengthened budget management processes remained vulnerable due to mounting spending pressures and unreliable forecasting processes.
The council, with the support of the PCT, had made a sound start in implementing the action plan, which had resulted from the January 2008 CSCI service inspection of Harrow council. A range of new initiatives from both agencies were increasingly effective in improving services.
5 170 Recommendations Putting people at the x The council and the PCT should strengthen centre of consultation arrangements by ensuring that there is an commissioning audit trail of improvements and modifications. The impact of carer’s views on service developments should be improved. x The council and the PCT should make the Learning Disability Partnership Board a more effective driver for change and strengthen its monitoring role. x The council and PCT should ensure more inclusive, individualised and culturally sensitive assessment of needs and care plans are undertaken and that more bespoke, ambitious and outcome focused care planning is provided. x The council and the PCT should ensure that care management support is available to people who need ongoing support. x The council and the PCT should commission more structured, focused and specialist advocacy services to ensure that the most vulnerable and isolated receive appropriate support. Understanding the x The council and the PCT should understand more fully needs of populations the range of needs of people with learning disabilities and individuals and complex needs. They should utilise better understanding of the current and future needs of young people with learning disabilities approaching adulthood to strengthen the transitions process and the range and choice of local services and support. x The council and the PCT should gather improved information about the needs of people with learning disabilities from ethnic minority communities and use this to develop increasingly specialist, accessible and differentiated services and support. x The council should make better use of intelligence from frontline staff about the deficits in service provision. Sharing and using x The council and the PCT should continue to develop information more Direct Payments opportunities and support effectively arrangements. x The council and the PCT should improve the range and choice of individualised day activities, adult education and supported employment opportunities. x The council and the PCT should strengthen the skills of staff at public access points to ensure that appropriate advice and guidance on how to secure services and support is available. x The council and the PCT should urgently strengthen
6 171 the processes for undertaking risk assessments and protection planning. Compliance with expectations should be monitored and reported to senior managers. x The council and the PCT should ensure that care management led reviews take place and lead to amended care where needed. x The council and the PCT should work with partners both within the council and other agencies to ensure that a range of universal services is increasingly accessible to people with learning disabilities and complex needs. Assuring high quality x The council and the PCT should use strengthened providers for all joint commissioning arrangements to secure an services increased range of supported living services. x The PCT should strengthen the commissioning of health care specialist services including assessment and treatment, forensic services and the accessibility and responsiveness of primary health care services. x The council should ensure that the vision and aspirations of the Transformation Plan are cascaded effectively to frontline teams. x The council and the PCT should produce a detailed and funded joint commissioning plan for people with learning disabilities, including those with complex needs, and their carers. x The council and the PCT should ensure that robust clauses within provider contracts in relation to adult safeguarding issues are monitored and performance reported in a structured way. x The council and the PCT should develop a more service user orientated approach by strengthening quality assurance processes to ensure that managers know about the actuality of service users and carers experiences. Recognising the x The PCT should ensure that Health Action Plans are importance of good in place and of sufficient quality and detail to deliver health services; structured and co-ordinated generic and specialist recognising the health care checks and services. interdependence x The PCT should ensure that secondary health care between work, health professionals have the skills and protocols in place to and well-being; ensure an accessible and appropriate service for recognising human people with learning disabilities complex needs and rights their carers. x The council and the PCT should ensure that a high quality and flexible carer support service, including respite care, is available. x The council should ensure that better quality assurance processes are in place to ensure that day
7 172 opportunities are increasingly person centred and routinely offer community based activities. x The council and the PCT should ensure that the criteria used by the resource allocation panel, and the reasons for individual decisions, are communicated effectively to people who use services and their carers. Developing incentives x The council and the PCT should communicate more for commissioning for effectively with providers and agree the range of new health and well-being support services required to deliver increasingly personalised support plans. x The council and the PCT should raise the profile of the new commissioning team with providers and establish formal and regular communication systems. x The council and the PCT should use a range of incentives in commissioning to develop a wider range of services. x The council and the PCT should streamline and make more timely the tendering process for purchasing health and social care provision. Making it happen: local x The council and the PCT should ensure that the vision accountability, of the service is articulated in a set of monitorable and capability and specific team and unit targets. leadership x The council and the PCT should improve the numbers of specific and personalised care plans for people who use services. x The council and the PCT should extend training opportunities to a wide range of staff to increase specialist skills in meeting the needs of people with learning disabilities and complex needs. x The council and the PCT should continue to develop and utilise emerging quality assurance processes and stronger business processes to secure better outcomes for people who use services and their carers. x The council and the PCT should speed up the process of strengthening the staffing and skills at middle management level to deliver the required improvements.
8 173 Key review findings
Putting people at the centre of commissioning Outcome: People with learning disabilities, their families and their carers are routinely involved in the planning, design, development and evaluation of services, resulting in a far more personalised approach to service delivery. Summary Some sound processes were in place for engaging with service users and carers. These included good representation on the LDPB, regular meetings and the involvement of service users and carers in the development of new policies such as the carers’ strategy. Service users and carers were closely involved in the initial stages of developing the well resourced plans to create three multi-agency NRCs which will provide flexible community based care from 2009. Employment of people with disabilities within the council and PCT had improved and structured programmes for developing employment opportunities were in place.
Evidence of the impact of service users and carers' views on service development was less consistent. In addition to the NRCs, there had been involvement in the development of self-directed care, the personalisation team and the wording used in the Transformation Plan. However, the impact of their views on mainstream provided services was less apparent and some senior managers were unaware of any modifications that had been made to policies because of the views of service users.
The LDPB was weak. The meetings were not used consistently to prioritise carer’s views, the board did not set the strategic direction for commissioning, officers dominated some discussions and some board members found the process of meetings tokenistic. Some key organisations felt omitted from consultation processes and some frontline staff in organisations were not as well engaged as their senior managers.
Overall, engagement with service users was markedly better than with carers. Carers felt uninformed and that there was a culture of lack of transparency in decision making at both an individual casework and service development level. During the protracted period of the council and PCT negotiating with funding bodies for the development of the NRCs, carers were not consulted or kept informed of developments. Carers’ confidence in the agencies prioritising the carer contribution to the modernisation process had been eroded.
Consultation arrangements were insufficiently strategically driven. Processes focused on groups with whom the agencies had established and longstanding relationships. The selection of groups for consultation and development of stronger partnership arrangements was driven more by custom and personal contacts than by a systematic analysis of the key groups with which a relationship should be developed.
Good, initial, progress had been made, through the incremental implementation of the action/improvement plan following the January CSCI 2008 Service Inspection, by the Harrow Learning Disabilities team (HLDT), and some interventions were increasingly service user centred. The practice of health and social care workers had become more closely aligned and better co-operation around sharing funding costs freely on a needs driven, rather than agency budgets dominated, basis had been more evident. Delays in processing social care assessments had been eliminated by
9 174 more creative and co-operative working.
There were recent and episodic examples of sound user focused work. A small personalisation project and yet smaller intensive support team were beginning to have an impact. Under resourcing of health care professionals within the HLDT had been addressed and vacant posts had been filled with agency staff pending resolution of recruitment difficulties.
Despite these improvements within the HLDT, multidisciplinary assessments remained generally poor and unstructured. Only social workers could undertake overview assessments and staff from both agencies were unable to routinely deploy the resources of the other agency. Health managers acknowledged that health staff often completed forms with limited attention or detail in a bid to ensure a speedy service was delivered to service users.
There were significant delays in the provision of health therapies. Where they were available, they were often expert and valued, but there were insufficient occupational therapists and there was no structured approach to managing the waiting list to reassess the fluctuating priority of needs of those awaiting a service. GPs were unaware of the services that were available.
Some care plans were missing, many were inadequate and most were not set out in a form that was accessible to service users. Objectives were routinely generic and insufficiently ambitious. There was no settled model of personal care plans and some people who used services were not effectively involved in developing their care plans. Few carers assessments were available on files and carers were not informed of the range of services that might be available to them.
Cultural needs were not prioritised in care plans and securing the services of a paid specialist carer who was of a similar cultural background was an unstructured and unplanned process. Some staff found that it was a matter of chance whether the requested carer from a similar cultural background would be available and some staff assumed, with no hard evidence that, as the care staff in certain units were of a diverse mix, they would automatically be able to meet a wide variety of cultural needs.
The commissioning of care plans and the extent and accessibility of ongoing care management support was inadequate. Individual care plans had broken down on occasions because there was little ongoing assistance to supervise and manage the inevitable stresses and strains of initiatives such as supported work placements. Service users and carers felt that getting in touch with a social worker was difficult, that social workers changed repeatedly without warning or notification and that when the assessment and procurement of a care package was complete, the care management service was seemingly arbitrarily withdrawn. This had led to some incidents of service users suffering harassment and bullying while engaged in community activities, which were not addressed by care managers. This eroded the confidence of service users and carers in some of the more ambitious care packages.
Older carers told us about a lack of planning for the future care of their relatives, when they were no longer able to provide family care. Care management decisions
10 175 had seemed to be short term and had lacked the required consideration of how needs would be met in the long term.
Advocacy services were not well commissioned, focused, specialist or consistently deployed to support those who were most vulnerable or most isolated. Advocacy were available and well deployed in some individual situations and there were good arrangements in place for Independent Mental Capacity Act (IMCA) advocacy in association with other Local Authorities. However, a clear remit for the service and a range of specialist advocacy functions and skills had not been secured. Staff were unaware of the criteria for deploying the service and the provision of advocacy often reflected individual workers preferences rather than the policies of the agencies.
The complaints service had improved. Complaints were increasingly resolved at an earlier stage and advocates had been used on occasions to enable and encourage people to pursue concerns. Analysis of complaints had led to more general learning and improvements in policies and procedures. However, arrangements for informing service users and carers about how to complain were under developed, information about how to complain was not available in an accessible format, there was little knowledge of the Patient Advice and Liaison Service (PAL) service and access to IMCA assessments for people undergoing transitions was subject to significant delays.
Recommendations x The council and the PCT should strengthen consultation arrangements by ensuring that there is an audit trail of improvements and modifications. The impact of carers views on service developments should be improved. x The council and the PCT should make the Learning Disability Partnership Board a more effective driver for change and strengthen its monitoring role. x The council and PCT should ensure more inclusive, individualised and culturally sensitive assessment of needs and care plans are undertaken and that more bespoke, ambitious and outcome focused care planning is provided. x The council and the PCT should ensure that care management support is available to people who need ongoing support. x The council and the PCT should commission more structured, focused and specialist advocacy services to ensure that the most vulnerable and isolated receive appropriate support.
Understanding the needs of populations and individuals Outcome: Local authorities and PCTs have an improved understanding of the current and emerging health and social care needs of their learning disability population, particularly those with complex needs, and their family carers, and have secured the resources and investment to meet their requirements. Summary The Joint Strategic Needs Assessment had been completed but this had not been used to underpin and inform either a social care or a joint agency commissioning plan. Both organisations had identified a serious deficit in relation to their understanding of the needs of people with learning disabilities. Plans were in place to collect further information about the broad range of needs of people with learning
11 176 disabilities, complex needs and challenging behaviour and the needs of carers.
The transitions process for people moving from children’s services to adult services had been weak for many years and this had led to ad hoc placements and unplanned and inappropriate services. Due to a lack of planning and commissioning of appropriate forms of care, many of these services had been commissioned from outside the borough. The development of a steering group, transitions board and information-sharing protocol had strengthened the transitions service in 2008.
However, these improvements in the transitions process were yet to have an impact at the frontline. Operational guidance was inadequate and the policy read like a good practice guide rather than a specialist and auditable set of interagency procedures to drive consistently good practice. There were no monitoring arrangements to ensure that practice complied with the standards set out and reviewers identified recent unplanned transitions placements into out of borough settings. Providers found the transitions process ‘un-managed’ and managers acknowledged, and were addressing, a culture of transitions planning often being led in practice by special schools and placements made according to local contacts. Inter team protocols and management arrangements for transitions from adult services to older people’s services had received little attention. Nevertheless, progress had been made in 2008 and adult services had begun managing some cases on an ongoing basis where the primary need was that of learning disabilities.
Local managers had identified three major service deficits. These included; in borough and specialist day and residential care, support regarding challenging behaviour within supported housing units and some continued use of historic residential care block contracts as weaknesses in the service provided. An action plan had been implemented and this included initiatives in relation to developing increased health care support. The importance of developing supported employment opportunities for people with learning disabilities had been acknowledged and the improvement process included a LAA target and a corporate initiative led by another department in the council.
There had been a lack of attention to equality and diversity issues. Specialist services to support people from ethnic minority communities was under developed and individual needs assessments did not effectively highlight service deficits. Little proactive work had been undertaken to scope the specialist services required for people from minority communities and for gender specific services. One particular gap identified by some Asian carers was the dearth of provision of single sex services such as day and respite care.
At a strategic level, overall analysis of particular elements of the needs of the service was stronger. Sound needs analysis had underpinned the development of initiatives in relation to the three NRCs, the strategic agreement to use the council as the lead commissioner for learning disability services in the future and the plans to use the north west London framework project to increase independent living units. However, the overall processes for cataloguing and understanding gaps in services were ad hoc and ineffective. Expertise and intelligence gathered from frontline staff was not collated and used to inform the commissioning of new and improved services in a structured way.
12 177 Recommendations x The council and the PCT should understand more fully of the range of needs of people with learning disabilities and complex needs. They should utilise better understanding of the current and future needs of young people with learning disabilities approaching adulthood to strengthen the transitions process and the range and choice of local services and support. x The council and the PCT should gather improved information about the needs of people with learning disabilities from ethnic minority communities and use this to develop increasingly specialist, accessible and differentiated services and support. x The council should make better use of intelligence from frontline staff about the deficits in service provision.
Sharing and using information more effectively Outcome: Local authorities and their partners apply the principles of Putting People First so that information about people with learning disabilities and complex needs is shared across agencies and used to deliver improved, personalised services and supports, tailored to people’s expressed needs and wants. Summary The provision of, increased control over, and individualisation of packages of care had been underdeveloped in both agencies for some years. However, Direct Payments and individual budgets had been prioritised in 2007/08, take up had increased, there had been increased investment in the support agency and an increase in the hourly rate paid. A specialist team ha d been developed and there was an LAA target. 40 service users with learning disabilities were accessing the service and this was anticipated to rise to 30 by the end of 2008.
Nevertheless, we were told that Direct Payments progress continued to be hindered by practical difficulties including the support agency consistently being overwhelmed with demand, the hourly rate remained too low to be practicable to secure care and there was a continued lack of suitably skilled Personal Assistants.
Housing options had improved and the use of residential care, though still rising slightly, remained at the lower end of the London average. The Supporting People strategy was strong and included specific targets and impressive efforts had been made to publicise information regarding Supporting People services including visits to community groups. The service was involved in the North West London housing plan and the benefits of an integrated housing and adult social care department were being realised.
However, the overall range and quality of social care and health services remained weak. Day opportunities, education and supported employment opportunities were few. Some service users remained supported employment preparation training for up to five years and some had attended five days per week buildings based day care for over 10 years. HAPs and annual health checks were either not undertaken, poor or of an unacceptable quality.
Information about services and accessibility of support remained a significant
13 178 weakness and a substantial barrier to the most vulnerable receiving the appropriate care. Some access points had staff who lacked skills in engaging with and responding warmly to service users and carers with mobility problems, complex needs or communication difficulties. Signposting to voluntary organisations was poor. One council service indicated that if visitors lacked communication skills, then they would simply not get a service. The Patient Advice and Liaison Service (PALS) providing information for the public was widely variable.
Partnership work had been promoted at the frontline through the aligned health and social care team all using the Framework client database processes. There were good links between GP and local authority held registers of people with learning disabilities, but this had failed to deliver tangible improvements for people who used services and their carers. There was limited use of the learning disability register in social care or in health as a tool for developing new services.
Some senior managers and elected members were aware of the need to strengthen risk management and contingency plans for supporting vulnerable people in the community, risk assessments were undertaken and incidents of suspected adult abuse were investigated. The Self Directed Support (SDS) initiative included a structured approach to the management of the new and extended risks associated with care packages that promoted increased independence, engagement with universal services and community based activity.
However, the identification of the breadth of potential risk factors, risk management consideration and the effectiveness of protection plans in practice was unacceptably weak. There was no clear audit trail of management decisions about whether to utilise safeguarding adults procedures or not. No arrangements were in place to performance manage and monitor accountable staff for agreed actions within protection/contingency plans. There was confusion between therapeutic interventions and protection arrangements and some senior managers mistook enthusiastic casework for effective risk management.
Overall leadership for adult safeguarding issues was unclear and plans to create a specialist adult safeguarding unit which could set out standards and monitor compliance of practice within both formal safeguarding interventions and ongoing care management protection arrangements, had yet to be achieved. Monitoring of standards in health services was variable.
The effectiveness of the use of the Learning Disabilities Development Fund grant had been variable but was improving. The PCT had not deployed the resource in 2007- 2008 but good use had been made by both agencies to develop alternative services for 2008-2009.
The impact of frontline intelligence about the needs of service users and carers on the commissioning process had improved from a low baseline. There were better links between the resource allocation panel and the commissioning and contracting staff. However, although reviews were taking place increasingly frequently, the quality remained poor. Reviews routinely failed to deliver amended or improved care plans. Where they occurred, assessor led reviews were held at inappropriately short notice while some only took place when instigated by family carers. Some reviews lacked involvement of other agencies, some did not involve family members and
14 179 outcomes were simply vague aspirations. One review had a recommendation that:
"She should be encouraged to become involved in the local community at weekends”
However, there were no implementation proposals to achieve this aim. Another review had determined that the person using the service should maintain contact with their family but no action had been taken with the result that contact had lapsed. Health needs – such as visual impairments – went unaddressed and some vulnerability issues were inadequately handled. One record identified risks and noted,
“staff should be kept informed” but no action had been taken.
The council had increasingly embraced a corporate approach to developing services. Progress was mixed but improvements had been realised in relation to a sound directory of all council services being available, cohesion between the LAA targets and other council policies such as the sustainable communities strategy and the involvement of service users and carers in the development of wider council strategies such as the housing plan. Nevertheless, key areas of huge practical importance for the quality of life of service users and carers remained to be tackled, including effectively addressing hate crime and working purposefully in partnership with education organisations to develop accessible training courses and opportunities.
There was a lack of services for the significant proportion of people in Harrow who were from ethnic minority communities. The LDPB had identified a lack of recreational opportunities for people from minority groups as an area of need but neither the council nor the PCT had prioritised this issue until recently. The lack of knowledge of, and interest in, the particular requirements of this group had led to a dominant culture of expecting local communities to provide their own care in their own way. Some senior figures acknowledged that both agencies had failed to prioritise services for people from ethnic minority communities.
Recommendations x The council and the PCT should continue to develop Direct Payments opportunities and support arrangements. x The council and the PCT should improve the range and choice of individualised day activities, adult education and supported employment opportunities. x The council and the PCT should strengthen the skills of staff at public access points to ensure that appropriate advice and guidance on how to secure services and support is available. x The council and the PCT should urgently strengthen the processes for undertaking risk assessments and protection planning. Compliance with expectations should be monitored and reported to senior managers. x The council and the PCT should ensure that assessor led reviews take place and lead to amended care where needed. x The council and the PCT should work with partners both within the council and
15 180 other agencies to ensure that a range of universal services is increasingly available.
Assuring high quality providers for all services Outcome: People with learning disabilities and complex needs have services and support in place that are personalised according to their needs and reflective/sensitive to changes in their requirements. Summary Improvement proposals within the council had been set out in 2008 in a Transformation Plan that sought to prioritise flexible spot purchasing to extend the range and choice of services available. The council and PCT had started to withdraw from a historic large block contract for residential care and was utilising the resources realised to develop additional supported accommodation options. A range of new services had been developed, including additional independent living units and floating support, including provision for people with learning disabilities and complex needs. A limited number of tenancies were in operation but more were planned for 2009. Significant external funding from the Department of Health and the Housing Corporation had been secured to progress the development of NRCs and to enable the re-design of warden-controlled accommodation into extra care units.
Immediate initiatives included plans to develop a discreet commissioning team within adult social care services and to strengthen commissioning specialist health services within the PCT in relation to specialist health services. There was a joint agreement between the PCT and the council for the council to take lead responsibility for the commissioning of the majority of learning disability services and the PCT had agreed to commission specialist health services. Plans included clear lead responsibility for learning disabilities services being located with the adult social care department and the joint development of self directed care, telecare and reablement services. The plans had been carefully developed and external consultants had been utilised to craft the new joint commissioning arrangements.
In social care, small-scale efficiencies had been delivered in relation to cost savings and quality improvements in some early service redesign initiatives. Specific improvements set out in the PCT operating plan included acknowledged areas of deficit in relation to health services such as assessment and treatment services, specialist forensic services and links with generic primary and secondary care services.
The Transformation Plan was sound but was yet to become fully effective in setting a clear vision for the service. The plan was well structured, included some clear percentage improvement targets, had been developed in partnership with people who used services and set out seven clear work programmes. However, the document was very new and this had led to confusion amongst staff and partners about the status of the plan and many targets were insufficiently specific to be utilised by operational managers as effective drivers for change. The plan had not been shared effectively with key partners, the underlying understanding of the needs of people with learning disabilities was weak and monitoring arrangements were poorly set out.
16 181 Plans for commissioning specific social care services were less well developed than plans for the structure and processes for joint commissioning in the future. There was no learning disabilities commissioning plan or joint commissioning plan in place and capacity for commissioning with both organisations was weak. Nevertheless, additional resources from both agencies had been used to resolve longstanding financial disagreements and a dysfunctional joint commissioning unit had been disbanded. Supporting People services had been developed and were part of the west London joint development initiative for independent living options. The PCT had also engaged with the London wide procurement programme.
Both agencies had increased investment in Learning Disability services – including a 5% uplift in the PCTs continuing care budget and a £1.2m increase in the council’s adult social care budget for this service user group in 07/08. A joint Director of Public Health was being planned and a range of fragmented partnership and joint funding arrangements had been rationalised. However, the overall investment in learning disabilities services remained relatively low in the council. The provision of general health services was variable but the range of health services available through traditional services was limited; there were no healthcare therapies available at day care centres.
The relationship with the voluntary sector was variable. Some organisations were better engaged than others. Overall, working arrangements with voluntary sector providers had been strengthened through more robust service level agreements and proportionate, but effective, contract monitoring arrangements. Nevertheless, all organisations felt insecure about long term funding.
The relationship with independent providers was under developed and unproductive and tendering processes were perceived as slow and unresponsive. Despite the significant changes in the services that were being commissioned by both organisations, there was no routine ‘forum’ for discussing service development. Providers were not clear about the vision for the service and had not been engaged in joint planning service developments.
Contract monitoring arrangements were satisfactory. Adult safeguarding clauses within contracts were strong, monitoring had been strengthened in the PCT and some joint contract monitoring had been undertaken in 2008. However neither contract specification nor monitoring had yet been used to promote a good range of specialist and differentiated services. Adult Safeguarding clauses in contracts were sound but there were no performance management processes to monitor compliance with the expectations. Performance data regarding compliance with key clauses such as the requirement to report all incidents within 24 hours was unavailable. Health staff had not undertaken contract monitoring in the past. Providers found contracts largely ‘standard’ and treated as a ‘requirement’ rather than a driver for excellence.
Quality assurance processes were mixed. Some processes that utilised customer feedback through questionnaires had been developed, some performance indicators were improving and carers assessments were now above the average for London. However, the review process was not used by either organisation to deliver intelligence about the appropriateness or quality of the provided services. Reviews were often led by providers and focused only on reviewing the provided service. Providers told us that assessors were often reluctant to prioritise assessor led
17 182 ‘reassessments’ and consequently providers felt obliged to undertake reviews as best they were able to try and keep pace with the changing needs of people who used their services.
Recommendations x The council and the PCT should use strengthened joint commissioning arrangements to secure an increased range of supported living services. x The PCT should strengthen the commissioning of health care specialist services including assessment and treatment, forensic services and the accessibility and responsiveness of primary health care services. x The council should ensure that the vision and aspirations of the Transformation Plan are cascaded effectively to frontline teams. x The council and the PCT should produce a detailed and funded joint commissioning plan for people with learning disabilities, including those with complex needs, and their carers. x The council and the PCT should ensure that robust clauses within provider contracts in relation to adult safeguarding issues are monitored and performance reported in a structured way. x The council and the PCT should develop a more service user orientated approach by strengthening quality assurance processes to ensure that managers know about the actuality of service users and carers experiences.
Recognising the importance of good health services; recognising the interdependence between work, health and well-being; recognising human rights Outcome: People with learning disabilities and complex needs have the right to live a fulfilling life with good, accessible health care, social care and employment opportunities close to home. Summary Both agencies had prioritised the development of an improved range of support services. Helping people to live at home and the development of supported employment opportunities had been agreed as LAA targets and three voluntary organisations had been commissioned to provide additional support. However, performance regarding both issues remained poor. People who used services had few opportunities to engage in purposeful activity, were often bored with activities that were provided and had little access to social or health care support outside office hours.
Use of residential care was improving slowly. There were few people who were placed in NHS campus accommodation and there was an active programme for returning people in out of borough placements to more local settings and placements. A number of successful re-settlements from residential care to an independent living placement in the community had been achieved in 2008 and this had resulted in major quality benefits for those involved.
Self directed support was increasingly offered and, in some situations, a ‘taster’ of different types of services had been offered so that service users could choose the
18 183 way in which care was to be provided based on their experience of the range of care available. A deaf blind register had been developed, some specialist day care was available and there was an independent living scheme. A ‘training house’, with associated floating support had been provided to develop the independent living skills of some people considering a move to supported accommodation. Plans were in place to provide more appropriate support for people with learning disabilities and mental health needs from 2010 onwards.
Specialist health care services were not widely available and the absence of Health Action Plans meant that where they were provided it was in a chaotic way. Managers acknowledged widespread gaps in accessible and responsive healthcare services, especially in relation to children with learning disabilities, services for people from ethnic minority communities and services for older people with learning disabilities. We were told of a lack of access to speech and language therapies, physiotherapy and support for people with challenging behaviours. Service users had not been referred for sensory impairment assessment/rehabilitation and some occupational therapy reports were very out of date. There was limited specialist support for people with asperger’s or the autism spectrum disorder.
There had been no specialist training or protocols for managing people with learning disabilities who required secondary health care treatment. Reviewers were told of consequent poor and inappropriate management of people with learning disabilities that led to them failing to receive appropriate medical attention for their physical illnesses. There was no health facilitator and where community support workers were engaged to provide individualised care in the community this was neither differentiated nor especially skilled. The deficit of health care support had been discussed at the LDPB and referred to the health services sub group but progress on securing improved outcomes for people who used services remained slow.
Support for family carers had improved significantly from a low baseline, the national performance indicator had improved but experience remained mixed. A range of carers services had been strengthened, some carers had had positive individual experiences and a carers ‘emergency card’ provided access to respite care at short notice. There was a carers register, priority had been given to support for older carers, a scheme for carers breaks was in place and a new carers strategy was under discussion. However, deficits remained. Respite care was limited, inflexible and on some occasions of indifferent quality. Services were perceived as limited and rationed by carers. Carers support was often inaccessible, not widely publicised and it was hard to access support when there were emergency situations. Many carers were unaware of the newly introduced carers emergency card. There were no initiatives to maintain/return carers to work and reviewers met a number of carers who had felt that they had been forced to give up work to care for their relatives.
The quality of Day Care services was variable and systems for quality assuring activities and programmes were poor. There were no targets for engaging in out of centre activity and limited daytime transport led to a high proportion of activities taking place within the building. Staffing and sickness problems reduced the potential for taking people out of the centre to undertake the activities they wanted to do in the community. Staff skills and their capacity to undertake these activities were not well managed.
19 184 The continuing care panel was streamlined and effective in processing applications and managing the budget. The panel had made efforts to involve service users and carers, had addressed the boundary between social and health care with increasing flexibility and had used a special joint panel in 2008 to resolve some longstanding funding disputes. However, despite improvements in the administration of continuing care, the threshold between social care and continuing care remained problematic for some service users. Some practice was led by a need to meet the criteria rather than prioritising the care that was most appropriate.
Funding decisions by the resource allocation panel were not as quick, well communicated or as well understood as for the continuing care process. Information to service users and carers did not include a clear explanation of the criteria to be met or give a coherent explanation of the rationale for the decision. There was no systematic process to promote the dignity and autonomy of those involved by ensuring transparency in the decision making process.
The inadequacy of care plans compromised both the quality of the support provided and the arrangements that were in place to promote the dignity and human rights of the person using the service. Some care plans lacked essential details as required under the Mental health Act. Information regarding capacity and consent for individual service users was not disseminated to staff who required that information to make day to day decisions about managing care. This left service users vulnerable to improper management of their rights to make decisions and staff vulnerable to allegations that they had denied the human rights of some service users. Some staff were confused about conflicting priorities and understood that by not sharing such personal information they were protecting the confidentiality of the person using the service.
Recommendations x The PCT should ensure that Health Action Plans are in place and of sufficient quality and detail to deliver structured and co-ordinated generic and specialist health care checks and services. x The PCT should ensure that secondary health care professionals have the skills and protocols in place to ensure an accessible and appropriate service for people with learning disabilities complex needs and their carers. x The council and the PCT should ensure that a high quality and flexible carer support service, including respite care, is available. x The council should ensure that better quality assurance processes are in place to ensure that day opportunities are increasingly person centred and routinely offer community based activities. x The council and the PCT should ensure that the criteria used by the resource allocation panel, and the reasons for individual decisions, are communicated effectively to people who use services and their carers.
Developing incentives for commissioning for health and well-being Outcome: There is effective partnership working that results in the development of a health and social care market that puts people first, and delivers the kinds of services that are important to them.
20 185 Summary There was a clear vision to move away from large ‘one size fits all’ contracts and towards individual purchasing of specific packages of care. Self directed support arrangements were in place, growing in influence and there were plans to develop provider’s capacity to meet growing demand. A system of brokerage to secure packages of care devised through person centred planning was to be introduced. A number of provider events had been undertaken and providers were aware of the priority of bringing service users in out of borough placements nearer to their home address. There was close and effective working with the Supporting People team. Quality standards and value for money factors were beginning to be used to develop, with providers, a wider array of choices for service users.
However, the relationship with the Independent sector had been neglected in favour of utilising block contracts and in house services for some years and the residual effect of this low priority remained evident. There were no regular forums for discussing market management/development and providers remained unclear about the vision for the service or the part they and emerging provided services might play in an improved service. Staff involved in commissioning in both the health and social care services had not had a high profile with independent sector providers and providers had not been engaged in the review of commissioning arrangements.
Commissioning decisions were not routinely used to influence the type and quality of service provided. A tiny minority of providers had received a premium for specialist care or particular quality standards. Increased casework consideration of individual needs was not matched by strong commissioning mechanisms to deliver improved health and social care services. The PCT was at a very early stage in developing their commitment to world class commissioning.
There were flexible arrangements for contracting with parts of the voluntary sector in both health and social care. The relationship with the voluntary sector was strong in parts, there was a Compact in place and the council’s overview and scrutiny committee was reviewing the role and function of the voluntary sector.
Contracts or service level agreements were in place for all providers and there was some differentiation in the type of service provided and variation in the prices paid for home care services. Contract monitoring of basic expectations took place within the council commissioned services. However, business processes underpinning commissioning were slow and awkward and tendering was a longwinded and tiresome process – especially for smaller providers.
Recommendations x The council and the PCT should agree with providers the range of new support services required to deliver increasingly personalised support plans. x The council and the PCT should raise the profile of the new commissioning team with providers and establish formal and regular communication systems. x The council and the PCT should agree with providers a range of initiatives and incentives to develop a wide range of services.
The council and the PCT should streamline and make more timely the tendering process for purchasing health and social care.
21 186 Making it happen: local accountability, capability and leadership Outcome: People with learning disabilities and complex needs, their families and carers are aware of what services and support they can expect and have a right to receive from councils and the NHS. Outcome: Commitment at a corporate, strategic and operational level means that local authorities and PCTs know what services need to be delivered and how to deliver them to improve the quality of life for people with learning disabilities and complex needs and their families. Summary In 2008, elected members and PCT board members gave sound leadership to developing a range of individual and personalised support systems for people with learning disabilities and complex needs. Resolute decision-making had been evident in withdrawing from block contracts and promoting more individualised care plans. Senior managers from both agencies gave clear and consistent leadership in relation to developing a wider range and quality of individualised support.
Within the council, a range of strategic plans including the transformation programme, the budget integration plan for health and local government and the joint commissioning plan had been well publicised and overall performance was monitored through monthly reports.
However, there had been few initiatives to report information in a transparent and effective way to the public. The PCT communication plan was being revised, the council website was being redeveloped and the publication of information about the work of the LDPB was poor. Nevertheless, although the profile of Valuing People within the PCT operating plan was poor, it was a generally strong document that was freely available and had some clear and quantified targets. Overall, strategic monitoring of the progress of improvement was well established in the PCT. The performance scorecard was a structured and clear way of monitoring performance and regular meetings were held with the main providers. The PCT had established an effective system for collating frontline intelligence to inform commissioning decisions.
The council and the PCT had agreed important joint targets for planned improvements regarding supported employment, supported accommodation and more regular health checks. These priorities had been set out in a clear and transparent way within, and were monitored through, the LAA process. However, notwithstanding the vision for the service being clearly understood by senior managers, it had yet to cascade to frontline managers and staff in provided and commissioned services as sets of tangible objectives and team priorities and targets. Communication systems were under developed and where they existed, targets were focused on process issues such as completing tasks on time, rather than quality issues which were of central importance to people who used services and their carers.
The details of the way in which services were to be reshaped or re-commissioned was not clear to staff. The lack of a commissioning or joint commissioning plan contributed to uncertainty and although a strategic commissioning group was in place, staff in the new commissioning team were yet to be appointed. This deficiency in capacity within the commissioning function contributed to ongoing service deficits
22 187 such as a lack of specialist support for people with learning disabilities and mental health problems.
The action plan from the CSCI January 2008 service inspection had been used as an effective vehicle for rescuing a failing service. The plan was well monitored, compliance with new requirements was increasingly managed through spot audits and basic systems such as complaints were better managed. 75% of targets had been achieved within 4 months of the plan being agreed. Increased management and practitioner capacity had been made available to the Harrow Learning Disabilities team (HLDT), customer service initiatives had been pursued and vacant posts had been filled. More stable management, more effective leadership, clearer systems and new services to promote independence had contributed to improved team morale. Management issues regarding capacity and competency were being addressed and team building initiatives had been pursued. Annual appraisals were completed and a structured system of supervision – absent at the time of the January 2008 Service Inspection had been implemented.
Nevertheless, quality assurance processes were underdeveloped and this had led to continued inadequacies in the care provided for the majority of people who used services and their carers. Deficits remained in relation to the adequacy of care planning and service provision and the systems and levers for exerting improvement and promoting a health/social care quality cycle, continued to be fragmented. Supervision, though happening was of uncertain quality and was yet to prove sufficiently challenging to deliver consistently ambitious and person centred care planning. Where progress had been achieved, it reflected personal commitment rather than systematic processes of setting out required behaviour and monitoring compliance to assure minimum standards of practice.
The services provided remained weak and the experiences of service users and carers were, at best, of variable quality and at times of an unacceptable standard. Respite care, home care, day care and access to health care services remained problematic issues. The processes for identifying deficits were underdeveloped and managers did not always take action to rectify problems. Social care processes were less well developed than those for the PCT. Overall the cultural change towards focusing on quality of service users experiences was evident amongst senior managers but had yet to percolate through the organisation to all practitioners/frontline staff.
The services had prioritised training opportunities for directly managed assessment and care management staff. Opportunities were freely available, valued by staff and included training for managers. A good practice forum had been established. However, specialist training opportunities for provider staff, both in house and in the independent sector, were more limited and specific training initiatives to develop specialist skills for working with people with complex needs, were underdeveloped.
Business processes had been strengthened with the appointment of additional finance and commissioning staff within both organisations. Project managers had been used effectively to pursue priority improvement projects. Overall budget management had been improved and a balanced budget had been achieved for the first time. Spend was beginning to shift from traditional, provided services to bespoke, individualised care plans through the development of individual budgets.
23 188 Both organisations recognised the challenge of building on achievements in budget management by developing higher quality services that delivered increased value for money.
However, budget pressures remained a significant inhibitor of progress. Financial forecasting has been strengthened through the creation of weekly meetings and the provision of enhanced financial support for budget holders. However, financial forecasts were not completely accurate and there was uncertainty about the extent of anticipated new financial pressures, such as transitions. Budgets were devolved to local managers, but the extent and effectiveness of financial support for these staff was variable.
Nevertheless, some business processes remained under developed. Sound strategic performance management and information processes were not matched by frontline quality assurance processes. A range of improvement projects and the service inspection action plan remained ‘work in progress’ and a number of important improvements had focused on building systems and processes for the future management of the service which had not yet had an impact on the experiences of people who used services and their carers.
Some managers had a significant span of control and the lack of capacity at a middle management level had yet to be satisfactorily addressed on a long-term basis. Plans to enhance management capacity below head of service to focus on developing learning disability services were being implemented.
Recommendations x The council and the PCT should ensure that the vision of the service is articulated in a set of monitor able and specific team and unit targets. x The council and the PCT should improve the numbers of specific and personalised care plans for people who use services. x The council and the PCT should extend training opportunities to a wide range of staff to increase specialist skills in meeting the needs of people with learning disabilities and complex needs. x The council and the PCT should continue to develop and utilise emerging quality assurance processes and stronger business processes to secure better outcomes for people who use services and their carers. x The council and the PCT should speed up the process of strengthening the staffing and skills at middle management level to deliver the required improvements.
24 189 Joint Learning Disability Commissioning Review
Glossary
Campus Provides long-term care Provision 1. Are through the NHS, in conjunction with NHS ownership/management of housing (residents do not have an independent landlord and housing rights).
2. Is commissioned by the NHS.
3. Includes people who have been in assessment and treatment beds more than 18 months who are not compulsorily detained or undergoing a recognised and validated treatment programme.
4. People living in such accommodation are technically and legally NHS patients.
Care A process where by an individuals needs are assessed and evaluated, Management eligibility for service is determined, care plans are drafted and implemented and needs are monitored and re-assessed.
Care Manager A practitioner who, as part of their role undertakes care management.
Care Pathways A method of organising all of the care a person receives from different professionals and organisations, to make sure it is coordinated.
Care planning A plan outlining support and care needs for the person. This plan must include the whole person including health needs, emotional well being, employment and leisure.
A care plan must be regularly reviewed with the individual and multidisciplinary team if appropriate.
Contingency Plans which are developed for the purpose of ‘back up’ where the planning planning factors (e.g. scope, forces, destination, risks, area of responsibility etc.) have been identified or can be assumed. These plans are produced in as much detail as possible, including what is needed and how to do it, as a basis for future planning.
Continuing Fully funded care for people who do not require care in an NHS acute Care Funding hospital, but who nevertheless require a high degree of ongoing health care. Anybody can qualify for NHS continuing care funding if their needs satisfy eligibility criteria.
Care A plan of care for people receiving mental health services or support Programme from more than one professional. Approach
25 190 Commissioning Commissioners understand people’s needs now and how to plan for the future. They are able to shape services that are fair, of good quality and change in accordance with people’s needs and wishes. Commissioners use the resources they have in the most effective ways to ensure that localities have the capacity to meet people’s needs and wishes.
Commissioning includes a range of activities, such as:
Knowing what services people need to live a good life
Using this knowledge to plan changes for the whole local area
Taking action to change services where they are not good enough
Paying for services to meet individual needs
Checking that outcomes from services are of a good quality and changing services and plans if needed
Direct Local council payments for people who have been assessed as eligible Payments for help from social services and who would like to arrange and pay for their own care and support services instead of getting them from the council.
Forensic Services offered to people who are likely to become a danger to Services themselves or others and as a result have been or likely to be in contact with the law.
Gap analysis The difference between what is needed and what is available. The difference between where you are and where you want to be.
Health Action A Health Action Plan (HAP) details the actions needed to maintain and Plans improve the health of an individual and any help needed to accomplish these. It is a mechanism to link the individual and the range of services and supports they need, if they are to have better health. Health Action Plans need to be supported by wider changes that assist and sustain this individual approach. The Plan is primarily for the person with learning disabilities and is usually co-produced with them.
Health Someone to help support and navigate people through the NHS to facilitator access the best and most appropriate healthcare.
Health Facilitation involves both casework to help people access mainstream services and also development work within mainstream services to help all parts of the NHS to develop the necessary skills.
Independent Services which support a person with learning disabilities either as an Advocacy individual or as a group to raise issues with councils or Primary Care services Trusts when making decisions about situations which directly affect their life.
26 191 Independent Any private, voluntary, or not for profit provider that physically delivers provider health or social care services.
Joint Strategic A process that identifies current and future health and wellbeing needs Needs in light of existing services, and informs future service planning taking Assessment into account evidence of effectiveness. Joint Strategic Needs Assessment identifies 'the big picture' in terms of the health and wellbeing needs and inequalities of a local population.
Learning Money from the government to pay for some of the new ways of working Disability in the Valuing People strategy. Learning Disability Partnership Boards Development influence locally the way in which this money is spent. Fund Learning The Board brings together council departments, health services and Disability other sectors that give people with learning disabilities support. This Partnership means that everyone can share information about what is happening in Board the local area. Partnership Boards are to take responsibility for local delivery of the Valuing People strategy, led by the local Council and with the active participation of all key stakeholders.
Local Area Three-year funding arrangement between central Government and a Agreement local area, as represented by a Local Strategic Partnership (LSP) The LSP will set out a plan of priorities for its area, in return for greater flexibility of funding streams.
Out of Area Adult social services and or Primary Care Trusts commission Placement placements of individuals from the council area in provision outside of the council geographical area.
Patient Advice A service to help patients, their families and carers, to find answers to Liaison Service questions or concerns regarding the care or treatment they receive from all NHS services.
People with For this review the definition of people with learning disabilities and Learning complex needs are : 16 years old and over, and experience difficulties disability and because of: complex needs x The extent of their intellectual impairment;
x Having physical disabilities which severely affect their ability to be independent ;
x Having sensory disabilities, which severely affect their ability to be independent;
x Having a combination of physical and/or sensory disabilities ;
x Any behaviour that can severely challenge services;
x Having a form of autistic spectrum disorder;
27 192 x Having complex health needs;
x Having enduring mental health needs; and
x Having a forensic history.
And their needs require health or social care organisations to provide ongoing support and assistance, no matter how this is funded.
Person centred Person centred approaches look at the whole of the person and the approaches whole of their lives, support networks, family, friends, health, leisure, education and employment needs.
Person centred approaches are based on the ownership of the planning process by the individual with learning disabilities.
Person centred Person Centred Planning means putting the person at the centre of planning planning for their lives and at the centre of the services they receive. Person centred planning is about:
x Listening to and learning about what people want from their lives;
x Helping people to think about what they want now and in the future; and
x Family, friends, professionals and services working together with the person to make this happen.
Safeguarding The systems, processes and practices in place to safeguard people people from abuse. Councils lead and coordinate local arrangements with arrangements partner organisations.
Self directed People who are eligible for social care knowing what they are entitled to support and controlling the way they use their money to get the support they need in they way they want it. Strategic Strategic planning is an organisation's process of defining its strategy, or planning direction, and making decisions on allocating its resources to pursue this strategy, including its capital and people.
Supervision A structure by which management oversees the performance or operation of a person or group.
Transition When someone moves from one time in their life into another. For instance, when children are moving into adulthood, adults move in to older adult services. It can also mean when people have major changes in their life, for instance when some one moves home.
Appendix
28 193 Review background and methodology
This joint review has been commissioned by the three commissions due in part to the findings of the national audit for specialist inpatient services 2007 by the Healthcare Commission (HC) and Commission for Social Care Inspection (CSCI) joint investigation into Cornwall Partnership Trust and Sutton and Merton. It also sits in the context of high level reports that have recently been published highlighting poor health and social care services and commissioning practice: Death by Indifference, Mencap, Mansell 2 and the Disability Rights Commission Equal treatment, closing the gap, and most recently the Joint Committee on Human Rights A Life Like Any Other? and the Sir Jonathan Michael Inquiry.
There is also a revised edition of Valuing People due to be published later this year which has had considerable consultation and is expected to address specifically issues facing people who have more complex needs.
The methodology for the joint reviews was devised with an expert reference group which included people with learning disabilities, family carers, commissioners in local authorities and the NHS, academics, Valuing People Support Team and the Department of Health.
An assessment framework was used to assess how well the local council and PCT[s] were commissioning services and support for people with learning disabilities and complex needs. The assessment framework has eight high level statements with a set of outcomes and underpinning descriptors. The review team based the assessment framework on the Commissioning Framework for Health and Wellbeing (Department of Health 2007).
The joint review process was designed to reduce demands on the council and PCT[s]. Before visiting London Borough of Harrow the review team collated and analysed nationally available data held by CSCI, Mental Health Act Commission (MHAC), HC, the Office of National Statistics, key information graphical system and the information centre. The team also gathered information from the council and PCT[s] in the form of a self-assessment document, which provided evidence unavailable from elsewhere. The strategic health authority, Valuing People Support Team and the Audit Commission were also asked about the commissioning practice within the area.
The purpose of the site visit was to:
x Further explore findings from the data analysis; and
x Focus on the experiences and outcomes for people with learning disabilities and complex needs and their family carers.
29 194 During the site visit the review team met with people who use services, their families and carers, staff and managers from the council and PCT(s) and representatives of other organisations. The following activities were included as part of the review visit:
x “A day in the life of…” which involved spending time with people with learning disabilities and complex needs
x Mystery shopping
x Interviews
x Meetings
x Focus groups
x Good practice visits
x An Open to the public session
30 195 This page is intentionally left blank
196 Agenda Item 12 Pages 197 to 214
Meeting: Overview and Scrutiny Committee
Date: 11th June 2009
Subject: Sustainability review scope and interim report
Responsible Officer: Alex Dewsnap, Divisional Director - Partnership Development & Performance Exempt: No
Enclosures: Appendix 1: Revised scope of the Sustainability Review Appendix 2: Interim report on the Change Challenge Panel
Section 1 – Summary and Recommendations
This report introduces the revised scope for the Sustainability review as well as the findings and recommendations of the Climate Change Challenge Panel which forms part of the Sustainability Review.
Recommendations: Councillors are asked to: i. endorse and adopt the revisions of the scope. ii. endorse and agree the Review Group’s findings and recommendations as contained within the response attached in Appendix 2.
Reason: (For recommendation) To enable the work of the Sustainability Review Group to continue.
197 Section 2 – Report
Background
A review into sustainability, which was commissioned as part of the 2008- 2009 work programme commenced in March 2009. The first meeting of the review group was held on the 26th March 2009 where the initial scope for the review was decided upon by the members of the group. Following the second meeting of the group which was held 15th April 2009, the first draft of the scope was revised and agreed by the review group scope as well as the decision to hold a challenge panel on the council’s draft climate change strategy. This was then submitted to Overview and Scrutiny for adoption on 21st April 2009.
A further third meeting of the group was briefly convened after the challenge panel on the council’s draft climate change strategy drew to a close on the 6th May 2009. Following on from the discussions of the third review group meeting, additions and revisions were made to the scope. The review group also discussed their findings and recommendations of the challenge panel and agreed that it should be submitted at the next meeting of the committee. The Review Group’s response to the draft climate change strategy contains observations, findings and a number of recommendations. The Overview and Scrutiny Committee is asked to endorse these recommendations and to agree the revised scope.
Current situation Not appropriate to this report.
Why a change is needed Not appropriate to this report.
Main options Not appropriate to this report.
Other options considered Not appropriate to this report.
Recommendation: Considerations Resources, costs and risks Any costs associated with the delivery of the work programme will be met from within the existing resources/budget.
Staffing/workforce There are no staffing/workforce considerations specific to this report.
Equalities impact There are no equalities considerations specific to this report.
Community safety (s17 Crime & Disorder Act 1998) There are no community safety considerations specific to this report.
Legal Implications
198 There are no legal implications arising directly from this report.
Financial Implications There are no financial implications arising directly from this report.
Performance Issues There are no performance issues arising directly form this report.
Section 3 - Statutory Officer Clearance This is no longer required for reports to scrutiny.
Section 4 - Contact Details and Background Papers Ofordi Nabokei, Scrutiny Officer. Email: [email protected] Tel: 020 8420 9205
If appropriate, does the report include the following considerations?
1. Consultation YES / NO 2. Corporate Priorities YES / NO
199 APPENDIX 1
HARROW COUNCIL
OVERVIEW AND SCRUTINY COMMITTEE
DATE 8th May 2009
REVIEW OF SUSTAINABILITY- SCOPE
1 SUBJECT Review of Sustainability 2 COMMITTEE Overview & Scrutiny
3 REVIEW GROUP Cllr Seymour (Co-Chair) Cllr Miles (Co-Chair) Cllr Solanki Cllr O’Dell Cllr Idaikkadar Cllr Kinnear Cllr Teli 4 AIMS/ To investigate how far the council has progressed with OBJECTIVES/ incorporating sustainability into its objectives and priorities and OUTCOMES whether, where possible, there is jointed up cross-cutting work regarding this. 5 MEASURES OF A number of recommendations to support the operation and SUCCESS OF implementation and embedding of sustainability and for the use REVIEW of the executive’s arrangements. 6 SCOPE To examine: • The Climate Change Strategy; • Economic Sustainability; • Community Sustainability; and To make recommendations, where appropriate, for a more robust system to be put in place.
7 SERVICE Building Stronger Communities (09/10) PRIORITIES (Corporate/Dept) 8 REVIEW SPONSOR 9 ACCOUNTABLE Lynne Margetts, Service Manager Scrutiny MANAGER
10 SUPPORT OFFICER Ofordi Nabokei, Scrutiny Officer 11 ADMINISTRATIVE None SUPPORT 12 EXTERNAL INPUT • Environmental Climate Change Professionals • Community Leaders • Residents • Neighbouring Local Authorities (where appropriate) • Police (where appropriate) • Partner organisations 13 METHODOLOGY In-Depth Review looking at the following areas:
1) Climate Change Strategy
200 Critical analysis by the review group of the draft Climate Change Strategy followed by a Challenge Panel with the report authors and input from external professionals. The group will make a number of recommendations in light of this and produce an interim report.
(If possible and if time permits, critically assess the response to the consultation of the strategy).
2) Economic Sustainability
Impact of Recession on Economic Sustainability: Investigation of successful economic sustainability policies and initiatives (or lack of) in Harrow through desktop review, evidence gathering and discussions with council officers and partners. Assessment of these against either similar boroughs & / or governmental guidance. The review will make a number of recommendations to back up its findings.
Budget / Financial Strategy Review: Analysis through desktop review of good / best practice, discussions and a question and answer session with officers about the Council budget including procurement and financial strategy and how sustainability is incorporated into this. The review will make a number of recommendations to back up its findings.
3) Community Sustainability
Community Cohesion and what Harrow has done to increase integration: Evidence-gathering obtained through information provided by officers, partnership officers, policies and initiatives in Harrow, through canvassing the views of residents and the police (where appropriate). In addition, this information will be discussed with these groups. The information is to be reviewed and assessed in light of the fact that Harrow has missed the LAA target measuring the 'number of people who think people from different backgrounds get on well together’. Following on from that, the review group will put forward a number of recommendations from its findings.
4) Roundtable Discussion
Following on from looking at Environmental, Economic and Community sustainability the review group will hold a round table with the PCT, the Police and possibly TLF to see how the council’s partners are tackling sustainability and how well their policies and strategies join up with the council’s.
14 EQUALITY Equality considerations will be of paramount importance to this IMPLICATIONS review. The review will consider during the course of its work, how equality implications have been taken into account in current policy and practice, for example in promoting cohesion, equalities and opportunities, and consider the possible implications of any changes it recommends. 201 In carrying out this review, the review group will also need to consider its own practices and how it can facilitate all relevant stakeholders in the borough to have their voices heard. Equalities should also be developed further in the outcomes of the review. 15 ASSUMPTIONS/ Involvement of officers and partnership officers in the relevant CONSTRAINTS services will be dependent upon resources (staff time in particular). The scope takes account of this constraint and evidence gathering will be designed to minimise undue workload on officers and partnership officers. 16 SECTION 17 None IMPLICATIONS 17 TIMESCALE Review to commence from March 2009
Report to be submitted to 24 September O&S 18 RESOURCE Ofordi Nabokei, Scrutiny Officer COMMITMENTS 19 REPORT AUTHOR Scrutiny Officer directed by the Review Group
20 REPORTING Outline of formal reporting process: ARRANGEMENTS To Service Director [ ] TBC………..N/A………………. To Portfolio Holder [ ] TBC………..N/A………………. To CMT [ ] When………N/A………………. To Cabinet [ ] When………N/A………………..
21 FOLLOW UP To go to Performance and Finance for 6 monthly updates. ARRANGEMENTS (proposals)
202 APPENDIX 2 –Sustainability Review Group Challenge Panel of the Draft Climate Change Strategy.
CHAIRMAN’S INTRODUCTION & ACKNOWLEDGEMENTS
The Overview and Scrutiny committee commissioned a review of Sustainability in their 2008-2009 Work Programme. The review was picked up in late March 2009. The review group are delighted to have been able to conduct this Challenge Panel as one part of the wider sustainability review which will look at economic and community sustainability.
Harrow Council signed up to the Nottingham Declaration on climate change in 2007. The Declaration requires local authorities who sign up to it to systematically address the causes of climate change and to prepare their community for its impacts. In light of this, the review group felt that as the council had sent out a draft Climate Change Strategy for consultation, a scrutiny input would add some value to the strategy by viewing it from a wider perspective that takes more into account than solely environmental issues as well as looking at how this strategy would tie in with other sustainability strategies. th The Challenge Panel met on 6 May 2009 and we are grateful to those who have assisted the panel in providing the information upon which we based our challenge and for their frank and open responses:
• Gemma Moore, Senior Climate Change and Environmental Officer
• John Edwards, Divisional Director of Environmental Services.
• Peter Barron, Planner, Economic Develop & Enterprise & Research
• Sally Crew, Group Manager Transport and Policy Programme, London Borough of Southwark
• LGiU and their event on Sustainability and Climate Change
• Ollie Swan, Energy Manager, London Borough of Bexley
We have looked at evidence ranging from documents and presentations to other local authorities draft and adopted Climate Change Strategies as well as meetings with officers.
The aim of this Challenge Panel has been (i) to provide a critical assessment and impartial view on Harrow’s draft climate change strategy; and (ii) to make recommendations, where appropriate, for more robust processes and additions to the strategy which we think would be beneficial to the council if adopted.
With this in mind we intend to make a number of recommendations to the Overview and Scrutiny Committee. These are included in the report below.
Cllr Anthony Seymour Chair Climate Change Challenge Panel.
203
BACKGROUND
A review into sustainability was commissioned as part of the 2008-2009 work programme and commenced in March 2009. The first meeting of the review group was held on the 26th March 2009 where the initial scope for the review was decided upon by the members of the group. Following the second meeting of the group which was held 15th April 2009 the initial scope for the review was submitted to Overview and Scrutiny for adoption. The sustainability review was divided into thee separate streams of work which looked at environmental, economic and community sustainability. The scope set out the format for the each strand and with regards to the environmental sustainability strand it was decided that this would be a short piece of work in the format of a challenge panel for the council’s draft climate change strategy so that the review could look at both economic and community sustainability in more depth.
On the 21st April 2009 the Overview and Scrutiny committee agreed the scope and the format of the challenge panel. Following on from the meeting with the divisional director of Environmental Services, further clarification and information was sought provided. The notes of the meeting and background meetings are held within the Scrutiny Unit.
To ensure that the review groups response to the strategy was included in the consultation on this strategy and interim response was provided to environmental services by the consultation closing date of the 15th May 2009. The response was given with the proviso that this was an interim response subject to amendment and adoption of the Overview and Scrutiny Committee. Moreover, once there was an adopted version of the report, this would be provided to Environmental Services.
The panel comprised of: • Cllr Anthony Seymour (Chair) • Cllr Jerry Miles • Cllr Dinesh Solanki • Cllr Eileen Kinnear • Cllr Yogesh Teli • Cllr O’Dell
A detailed breakdown of the recommendations is contained within the Recommendation Matrix which is attached as Appendix A
The panel’s findings and recommendations are included in the pages that follow.
204
OBSERVATIONS AND FINDINGS
The review group’s observations and findings are summarised in the paragraphs below:
COMMUNICATION OF THE STRATEGY
• From reading the Draft Climate Change Strategy, the review group found that the language contained within it was not accessible: it did not clearly explain all of the concepts and issues contained within it. The group felt that at times some of the language was overly technical and could have been expressed better.
• Following on from the above, the strategy is divided into areas or ‘themes’ but the group found it hard to clearly identify what the overall and theme-specific goals are that the strategy is striving to achieve. This should have been set out and explained more clearly in the draft strategy. By doing so, it would go some way to allowing people to understand not only what the issues are but how they affect them and what the council is trying to achieve. The online consultation goes some way to making the issues relevant and clear to residents however this was not included in the strategy itself and should have been.
• From discussions prior to and at the challenge panel, the review group found that it was not clear whom the Council sent the draft document to for consultation.
• The group are of the view that it would have been useful for anyone reading the document to see how the council is currently tackling the issue. This would show the council is leading by example and takes the matter very seriously not only in words but also in action. It may also have the effect of focussing the council response to climate change. The review group found that the strategy only talks about the issues in broad terms. The strategy does not clearly communicate what the council has already done to mitigate and adapt to climate change, this may give the reader the impression that nothing has been implemented or is currently being done which is far from the case.
• Following on from the point above, the review group looked at a number of strategies from other local authorities (London Borough of Bexley’s draft and finalised versions and Worthing Borough Council's strategy) and found that Harrow’s draft strategy in comparison lacks a draft plan which would have shown or given a more detailed indication as to how Harrow proposes to tackle climate change rather than speaking about it in broad terms. It would have also given consultees the opportunity to provide further feedback, for example, on specific items they think the council should or should not be looking at in the final strategy and action plan as well as items that should be looked at in more depth. The review group is of the opinion that an action plan would enable Harrow to focus its approach further and should be included in the strategy.
205
EDUCATON AND PROMOTION:
• From reading the strategy and a discussion with the Divisional Director of Environmental Services, the review group felt that whilst the strategy speaks of promoting and educating residents about climate change it does not go into any specific details about how this will be done. The review group is aware that there already is promotion and education regarding this issue but is of the view that the amount that is currently being done by the council needs to be stepped up considerably irrespective of national campaigns about climate change. Worcestershire County Council is a beacon local authority for climate change who have sought to educate and promote climate change not only as an issue in itself but also by appealing to peoples’ drivers/ motivations and using those motivators to tackle climate change. This may be another useful tool by which Harrow can further educate its residents.
• The review group noted that whilst there are a plethora of initiatives, they are not contained in one accessible easy to read guide for residents. Therefore, in conjunction with a clearer explanation of how climate change will affect local residents a comprehensive book or leaflet which draws together all the basic things that can be done to tackle climate change, how they should be done, where they can be done as well as any potential funding that can be obtained should be published and sent to each household.
• Following the discussions had during the challenge panel, the review group observed that there is no joined up council-wide response on how the council’s actions have an effect on climate change. In addition, officer education is not as high as it should be. If Harrow’s residents do not see their own council officers championing this issue what motivation or trust will residents have in their council to effectively stem climate change? The council and its officers should not only be providing education and advice on climate change but equally as important, they should be leading the way as an example to the residents of Harrow. This may require the council to take a stricter stance not only on issues such as procurement but also in terms of the levels of permits and parking spaces that are afforded to council officers.
206
THE STRATEGY NOT IN ISOLATION:
• From reading the strategy and from the discussion during the challenge panel, the review group found that the draft strategy made mention of other documents and strategies, such as the Sustainable Communities Plan, the Local Development Framework and the Sustainable Design Supplementary Planning document. Having said that, the review group gained a sense that whilst references were made to the other documents that was as far as it went: each strategy dealt with its own sphere and did not seem to be joined up or integrated fully with the other documents or show what it could bring to the other strategies or how it could add to them.
207
RECOMMENDATIONS
These findings have led the Sustainability Review Group to recommend the following:
1. Whilst taking into account that there is a need for a certain level of technical language, the language used in the strategy should be clear, concise and accessible to all ranges of reader. Therefore the strategy should be re-written to achieve this.
2. A summary should be attached to the strategy which shows exactly what the strategy’s goals are.
3. The strategy should contain and clearly communicate what the council has already done to mitigate and adapt to climate change.
4. An action plan, subject to amendment as and when required, should be included into the strategy which not only specifies how it will tackle climate change in terms of the proposed actions but also has targets it has set for itself, states how it will progress, how it will measure its progress, a timescale to achieve these actions, the expected impact of undertaking said actions as well as a named lead responsible officer for each action. As items and actions are completed the action plan should be reviewed and amended.
5. The council should take a more proactive lead in educating and promoting climate change to residents and its own officers. It should not rely on the momentum which is being built up or on national campaigns.
6. A comprehensive book/ leaflet which draws together all the basic things that can be done, how they should be done, where they can be done as well as any potential funding that can be obtained to help residents stem climate change should be published and sent to each household.
7. The council and its officers should not only be educating and promoting issues related to climate change but should take a tougher line internally about their own actions and policies so as to lead the way / be exemplars to Harrow residents.
8. The Climate Change Strategy should be more joined up and integrated with other plans and strategies to be more effective in reducing climate change. It should fully state what it can bring to the other strategies and how it can, where applicable, ameliorate them.
208
CONCLUSION
The comments of the panel in this report are designed to assist and help support the ongoing development of the Climate Change Strategy and generate a more inclusive, clear and specific approach to tacking the issue of Climate Change and educating the residents of Harrow about it. In this challenge panel, scrutiny intention has been to act as a ‘critical friend’ to help the strategy to develop and suggest ways in which this could be achieved.
The methodology of a Challenge Panel is that in terms of time and resources it is a short piece of work which aimed, in this instance, to critically assess the draft climate change strategy and provide a scrutiny input to the consultation. Moreover, this report is part of a wider review on sustainability which aims to focus more on economic and community sustainability. The conclusion of the Challenge Panel on the draft Climate Change strategy brings to a close the review group’s look at environmental sustainability. In light of the above, the Challenge Panel cannot go into as much depth as other forms of review.
Where we have made suggestions for more robust processes or additions to the strategy to be adopted, we hope they are helpful
Climate Change Challenge Panel May 2009
209 APPENDIX A RECOMMENDATION ACTION SHEET Key: CD = Corporate Director(s) PH = Portfolio Holder Prioritisation Requiring action immediately: ST. Requiring action in medium term: MT Requiring action in long term: LT Incorporated information – Evidence received from officers O Evidence received from External Professionals EP Evidence received from External Sources ES
Recommendation Prior Identified Incorp P’ship? Action taken (for Measure of success 210 officer/memb info (Y/N) completion at six er/group to month period action 1. Whilst taking into ST - Officer(s) who EP, ES N A clearly written well An accessible, easy to read account that there is a ongoing drafted the thought out strategy. need for a certain level of strategy document that is technical language, the accessible and language used in the comprehensible to strategy should be clear, all who read it. concise and accessible to all ranges of reader. Therefore the strategy should be re-written to achieve this ST - Officer(s) who O, EP, N Visible statements or Text in the strategy which 2. A summary should be attached to the strategy Ongoing drafted the ES bullet points of what highlights the main issues and which shows exactly what strategy the strategy aims to topics the strategy is concerned the strategy’s goals are achieve. with as ell as what the strategies goals are 3. The strategy should ST - Officer(s) who O, EP N A table or section of A reader who looks at the strategy contain and clearly Ongoing drafted the text which shows knows what the council has communicate what the strategy what the council has already achieved and has a council has already done already done - clear baseline from which to measure to mitigate and adapt to statements of what subsequent success or failure climate change. has already been achieved 4. An action plan, subject ST, MT - Officer(s) who ES, Each proposed area A document which shows, subject to amendment as and Ongoing drafted the that will be tackled to amendments, exactly what the
211 when required, should be strategy and has, subject to council will be doing and how it will included into the strategy are in charge amendment and do it in a more specific and defined which not only specifies of ensuring it revision the terms rather than a broad how it will tackle climate is adhered to proposed actions, its suggestion that does not show a change in terms of the targets how it focussed approach. proposed actions but also intends to progress, has targets it has set for how it will measure itself, states how it will its progress, progress, how it will timescales, and measure its progress, a named lead timescale to achieve responsible officer these actions, the for each action expected impact of undertaking said actions as well as a named lead responsible officer for each action. As items and actions are completed the action plan should be reviewed and amended. 5. The council should MT, LT Environmental EP, ES Y More visible Residents and officers alike have a take a more proactive Services campaigns, clear understanding of what lead in educating and Officers and communication and climate change is, how It will affect promoting climate change Climate education harrow and how their actions / to residents and its own Change / programmes being behaviour has an impact on this. officers. It should not rely environmental devised or set up on the momentum which organisations about this. is being built up or on in conjunction national campaigns. with the 212 council 6. A comprehensive ST, MT Environmental Y Gathering all the Residents have at their fingertips book/ leaflet which draws Services relevant information all the information they require together all the basic Officers and and contact details regarding climate change, what things that can be done, Climate and placing them in they can do, any grants to help how they should be done, Change / an easily accessible them carry it out and all other where they can be done environmental booklet for residents relevant information they need on as well as any potential organisations the subject in one easy accessible funding that can be in conjunction source. obtained to help residents with the stem climate change council should be published and sent to each household. 7. The council and its MT, LT Harrow EP Y The responsibility placed on officers should not only Council as a residents by the council is also be educating and whole. equally placed on council officers promoting issues related and their actions. to climate change but should take a tougher line internally about their own actions and policies so as to lead the way / be exemplars to Harrow residents. 8. The Climate Change MT, LT - All council O, ES, Y Ensuring that where More integrated joined up policy Strategy should be more Ongoing departments EP applicable the and implementation context. joined up and integrated and services council’s other with other plans and in conjunction policies and
213 strategies to be more with partner strategies are not effective in reducing organisations only mentioned but climate change. It should such as the the strategy also fully state what it can PCT. shows how they will bring to the other add value / or pick strategies and how it can, up where it has left where applicable, off. ameliorate them.
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214 Agenda Item 13 Pages 215 to 226
Meeting: Overview and Scrutiny Committee
Date: 11th June 2009
Subject: Use of Resources Challenge Panel
Responsible Officer: Alex Dewsnap, Divisional Director Partnership Development and Performance Portfolio Holder: Cllr Paul Osborn, Performance, Communication and Corporate Services Portfolio Holder
Exempt: No
Enclosures: Appendix One: Report of the Use of Resources Challenge Panel
Section 1 – Summary and Recommendations
This report accompanies the report from the Use of Resources Challenge Panel
Recommendations: Councillors are asked to: I. Note the findings and observations of the Use of Resources Challenge Panel II. Agree the recommendations therein III. Refer the report to cabinet for consideration
215 Section 2 – Report Background (if needed) This year the Comprehensive Performance Assessment (CPA), the means by which an individual council’s performance is measured has been replaced by Comprehensive Area Assessment (CAA). The CAA differs from the CPA in that for the first time, whilst councils and other public service providers in a local area will continue to be individually assessed, a collective assessment of the performance of all of these organisations and how they are measuring, responding to and meeting local people’s needs will also be made. The two components of CAA are thus: • Organisational Assessment and • Area Assessment
The assessment of a council’s own performance, the organisational assessment, has two components: • how well it delivers value for money in the use of resources and • how well it manages its performance.
Further details regarding the Use of Resources process is included in the attached report.
In preparing for this new assessment, the council decided to prepare a self assessment of its performance against the key lines of enquiry. It is important that this self assessment: • provides the council with an accurate baseline assessment of our performance and references appropriate evidence of this assessment • identifies the key areas for improvement • represents a clear understanding of what needs to happen in order to deliver this improvement
• The Overview and Scrutiny committee was asked to provide challenge to the robustness. The panel took place on 22nd April as a round-table discussions between scrutiny councillors and council officers.
The findings and recommendations from the panel are attached at Appendix One.
Financial Implications There are none associated with this report
Performance Issues There are none associated with this report
Risk Implications There are none associated with this report
Section 3 - Statutory Officer Clearance No required for this report
216 Section 4 - Contact Details and Background Papers
Contact: Lynne Margetts, Service Manager Scrutiny 020 8420 9387
Background Papers: None
If appropriate, does the report include the following considerations?
1. Consultation NO 2. Corporate Priorities YES
217 APPENDIX ONE
May 2009
Overview and Scrutiny Committee
Draft Report of the Scrutiny Challenge Panel
Use of Resources Self Assessment
Members of the Challenge Panel
Cllr Brian Gate (Chairman) Cllr Cllr Jerry Miles Cllr Vina Mithani Cllr Dinesh Solanki Cllr Yogesh Teli
218
TABLE OF CONTENTS
CHAIRMAN’S INTRODUCTION & ACKNOWLEDGEMENTS...... 6 BACKGROUND...... 7 KEY OBSERVATIONS ...... 9 RECOMMENDATIONS ...... 11 CONCLUSION...... 12
219 CHAIRMAN’S INTRODUCTION & ACKNOWLEDGEMENTS
The Overview and Scrutiny committee was pleased to have been invited to participate in the preparation of the council’s Use of Resources self assessment and I am delighted to have been able to chair this important investigation. The Use of Resources self assessment is an important part of the council’s improvement journey and the panel is happy to have been able to offer our views on the structure and content of this important document.
The challenge panel met on 22nd April and we are grateful to those who provided us with the information upon which we based our challenge: • Myfanwy Barret, Corporate Director Corporate Finance • Tom Whiting, Assistant Chief Executive • Alex Dewsnap, Divisional Director, Partnership Development and Performance • John Edwards, Divisional Director, Environmental Services • Mala Kripalani, Service Manager, Improvement Programme Team
The changes to the council’s assessment regime are significant and we recognise the importance of ensuring the council has an accurate baseline from which to drive our future improvement. The significance of the changes have been made clear to the panel and we hope that our observations are useful in determining the content of the self assessment. The panel would welcome the opportunity to continue to engage in the development of the self assessment and in monitoring the improvement plan that derives from it. To this end we intend to make a number of recommendations to the Overview and Scrutiny committee regarding the monitoring processes. These are included in our findings and recommendations below.
Cllr Brian Gate , Chairman Use of Resources Self Assessment Challenge Panel
220 BACKGROUND This year the Comprehensive Performance Assessment (CPA), the means by which an individual council’s performance is measured has been replaced by Comprehensive Area Assessment (CAA). The CAA differs from the CPA in that for the first time, whilst councils and other public service providers in a local area will continue to be individually assessed, a collective assessment of the performance of all of these organisations and how they are measuring, responding to and meeting local people’s needs will also be made. The two components of CAA are thus: • Organisational Assessment and • Area Assessment
The assessment of a council’s own performance, the organisational assessment, has two components: • how well it delivers value for money in the use of resources and • how well it manages its performance.
The Use of Resources (UoR) assessment considers how well the council manages and uses resources to deliver value for money and better and sustainable outcomes for local people. The assessment is structured into three themes • Managing finances - focusing on sound and strategic financial management; • Governing the business - focusing on strategic commissioning of services and good governance; • Managing resources - focusing on the effective management of natural resources, assets and people.
It is important that this self assessment: • provides the council with an accurate baseline assessment of our performance and references appropriate evidence of this assessment • identifies the key areas for improvement • represents a clear understanding of what needs to happen in order to deliver this improvement
The Overview and Scrutiny committee was asked to provide challenge to the robustness of the self assessment and chose to do so by considering the following points: • Why the council has chosen to produce a self assessment if there is no requirement to do so – what value will it offer to the organisation and whether in its current format this value will be realised • What difference the self assessment is expected to make to the council • How the officers feel that the self assessment will help the council to improve • How effectively they feel it has addressed the strengths and weaknesses of the organisation • What criteria have been used to include either strong or weak performance • Whether the self assessed ratings are fair and whether the statements regarding the strengths of the council’s performance are accurate and merit the proposed grading • Whether all/appropriate areas for improvement have been included • How they propose to manage/oversee improvement in the areas identified
221
The panel took place on 22nd April as a round-table discussions between scrutiny councillors and council officers. At the meeting the panel received detailed information on the content of the self assessment and was able to question and make recommendations on specific elements of the content and also to raise a number of strategic questions in relation to the development of the assessment.
The panel comprised: • Cllr Brian Gate (Chairman) • Cllr Cllr Jerry Miles • Cllr Vina Mithani • Cllr Dinesh Solanki • Cllr Yogesh Teli
The panel’s findings and recommendations are included in the pages that follow.
222 KEY OBSERVATIONS The observations of the panel are grouped around three interconnected themes: • The usefulness and purpose of the self assessment • The improvement process • The validity of the data included
The usefulness and purpose of the self assessment Officers explained the purpose of the self assessment. Although the borough isn’t required to produce an assessment, because the regime has changed so significantly officers feel that it is important that the council assesses its performance against the new regime and establishes a baseline in terms of our performance as an organisation, we need to understand our strengths, our weaknesses and how we can improve. The document has formed the basis for constructive discussions with the auditors and has thus facilitated a healthy working relationship with them from which the council will benefit in terms of helpful performance feedback They also explained that the change in requirements reflects a desire to ensure that the burden of inspection on councils is reducing.
The panel agrees that the self assessment is an important process and endorsed the decision to produce it. Reassurance are sought however, that the process has been one which will make a useful contribution to the ongoing improvement process, the purpose of the exercise is not the self assessment itself but the organisation’s commitment to the objective analysis and improvement proposals incorporated in the document.
The improvement process It is the council’s stated intention that the self assessment forms the basis of our improvement journey for the foreseeable future and that all improvement priorities will be integrated into the Council Improvement Programme (CIP). However, for this meeting, the detail of the plan was not available and as such the panel could not comment on any specific areas of improvement. We would urge that the final document, incorporating improvement priorities is presented to the panel prior to final submission to the auditor.
In the absence of specific information, the panel considered some of the more strategic issues in relation to the council’s improvement priorities.
Officers advised the group that there is no clear guidance on what performance constitutes ‘good’ or ‘excellent’. This clearly presents difficulties for the council in terms of developing appropriate improvement processes in order to deliver a high performance assessment. The officers also advised the group that they felt that it was important in proposing improvement priorities to ensure that these priorities are practical and deliverable. As there is no clear guidance on what constitutes excellent performance then, it is beyond the capacity of the organisation to simply devise an improvement process that will tick the appropriate performance boxes.
The panel in general considers this an opportunity in that the improvement plan which the council will deliver will be more than a technical exercise and will be realistic in terms of resourcing. However we recognise that, in the absence of the performance descriptors, the council must be clear as to how it will determine its improvement priorities. We generally agree that this
223 presents a significant opportunity for the council to determine the agenda in a way that previous assessment regimes, with their more prescriptive approach had not. We recommended that officer therefore must place the needs and aspirations of local people at the forefront of our improvement planning process. Only in this way can the council achieve the lasting and truly embedded improvements that will make a real difference in the quality of life of local people and thus result in appropriately improved performance ratings. In recognising that targets must be realistic and achievable, the panel also feels that our ambition must not be constrained and that in setting our improvement targets and processes, the council should have an eye to the approach being adopted by other council’s in order to ensure that best practice is reflected in our own improvement processes.
In this context, the panel considered the approach of Hillingdon Council which had been observed during research undertaken as part of the standing review of the budget. Hillingdon councillors had decided that, whilst they are subject to the star rating assessment processes of the Audit Commission, they refused to allow the star rating to be the determinant of their improvement priorities, preferring instead to focus on the expressed needs and aspirations of their residents. In Hillingdon’s view, to deliver what residents want is the key and if the high performance ratings follow then so be it. Of course, whilst this is a laudable approach, the impact of high performance ratings on staff morale and thus on performance and reputation is likely to be positive, the relationship is therefore a complex one, the impact of the star rating on staff morale and organisational reputation cannot be underestimated.
The validity of the data included The council has generally assessed itself at level 3 under the regime. Only under the key line of enquiry (KLOE) ‘Is the organisation making effective use of natural resources?’ has the organisation rated itself as less than ‘3’, ‘2’. The self assessment presents the council with something of a dilemma – we need to present a realistic assessment of our performance but must not do ourselves down or oversell our performance. The panel concedes the logic in showing ourselves in a good light but cautions against the negative impact of an over generous assessment and would urge that we don’t oversell our performance. The group also highlighted the danger of omitting areas of significant under performance if this is subsequently identified by the CAA process. The panel’s general conclusion is that the self assessment should promise less and deliver more.
As a general comment, we feel that the document placed significant emphasis on a number of new processes that the council has introduced to improve corporate procedures – e.g. service planning, budget monitoring. However, it is not convincing in terms of the evidence included as to how these processes have delivered real improvement and outcomes for local people. Whilst it might be the case that the council is on the cusp of real improvement at this point, it is important that we capture the evidence of this and ensure that this evidence is incorporated in the self assessment.
224
RECOMMENDATIONS The Use of Resources self assessment challenge panel recommends that: • The organisation ensures that the self assessment provides a focus for the council’s improvement process and does not become an end in itself • The final self assessment, incorporating the improvement priorities should made available to the panel for comment • The council ensures that the improvement priorities eventually incorporated in the self assessment are grounded in a clear understanding of residents’ priorities • Whilst improvement priorities must be realistic and achievable, they must also be aspirational, the panel also recommends that the council appraises itself of the improvement processes being adopted in other, similar boroughs • The self assessment ‘under sells’ but ‘over delivers’ in terms of its content • The content incorporates evidence of the impact of the processes that have been included in it
225
CONCLUSION
All in all the challenge panel endorses the approach taken by the council in producing the self assessment. We recognise that the production of the document is a difficult exercise, which must balance the need to highlight our achievements at the same time as identifying our key improvements. However, we would caution against an over optimistic appraisal, overselling our performance could well have a detrimental impact on our reputation – if we cannot demonstrate self awareness how can we demonstrate the capacity to improve.
Finally, we would counsel that the organisation must not become preoccupied with the production of the self assessment, it must be a helpful document that enables the council to secure improvement, it is not an end in itself.
Use of Resources Self Assessment Challenge Panel 22nd April 2009
226 Agenda Item 14 Pages 227 to 256
Meeting: Overview and Scrutiny Committee
Date: 11th June 2009
Subject: Scrutiny Annual Report
Responsible Officer: Alex Dewsnap, Divisional Director, Partnership Development and Performance Portfolio Holder: Cllr Paul Osborn, Performance, Communication and Corporate Services Portfolio Holder
Exempt: No
Enclosures: Appendix One: Scrutiny Annual Report
Section 1 – Summary and Recommendations
This report introduces the Scrutiny Annual Report for 2008/09. It outlines the activities of the scrutiny committees and the scrutiny lead members during the year.
Recommendations: Councillors are recommended to: I. Endorse the annual report II. Refer the report to Full Council on 9th July for formal adoption
227 Section 2 – Report Background (if needed) This report outlines the activities of the Overview and Scrutiny committee, the Performance and Finance and Call-In sub committees and the Scrutiny Lead Councillors. It outlines outcomes of the individual projects that have been undertaken and includes proposed activities for the remainder of the administration. The scrutiny annual report is prepared in accordance with article 6.03 (d) of the Council’s constitution.
Financial Implications There are no financial implications associated with this report.
Performance Issues There are no specific performance issues associated with this report
Risk Implications There are no risk implications associated with this report.
Section 3 - Statutory Officer Clearance Not required
228 Section 4 - Contact Details and Background Papers
Contact: Lynne Margetts, Service Manager Scrutiny 020 8420 9387
Background Papers: None
229 APPENDIX ONE
230
SCRUTINY ANNUAL REPORT
2008/09
231
CONTENTS
Chairman’s Foreword...... 1 Report from the Overview and Scrutiny Committee ...... 3 Health meetings ...... 3 Education meetings...... 3 General meetings ...... 4 Scrutiny Reviews...... 5 Delivering a Strengthened Voluntary and Community Sector...... 5 Standing Review of the Budget...... 5 Right To Manage ...... 5 Council Improvement Programme ...... 6 Extended schools...... 6 Sustainability...... 6 Use of Resources ...... 6 Standing Review of NHS Finances...... 7 Place Survey...... 7 Priorities for the coming year...... 7 Performance and Finance Sub-Committee:...... 9 Report from lead members for Adult Health and Social Care ...... 11 Report from the Lead Members for Children and Young People ...... 13 Report from the Lead Members for Corporate Effectiveness...... 15 Report from the Lead Members for Safer and Stronger Communities...... 17 Report from the Lead Members for Sustainable Development and Enterprise ...... 18 Scrutiny Member Development programme 2008/09...... 20 Call- In Sub Committee...... 22 Conclusion ...... 24
232 Chairman’s Foreword Welcome to the scrutiny annual report for 2008/09. As usual, this has been another productive year as we have seen our reconfigured structure and processes bed in and we have continued to hold service providers to account and secure improvements in services for local people.
In last year’s report, we outlined the proposals for the changes to our structures. This would see the abolition of the service based sub committees and their replacement with a single Overview and Scrutiny committee and a Performance and Finance sub committee. This was a real innovation for us and in particular, the introduction of the Performance and Finance sub committee has ensured that the council’s and our partners’ performance is closely monitored. This was something that we had not achieved with quite as much focus and rigour in the past and it has made a significant improvement to our strategic approach. In order to assess the robustness of our new structures, we enlisted the help of the Improvement and Development Agency. In September, an independent facilitator worked with us to identify the strengths and weaknesses of the structures.
Several strengths were identified, in particular a more focussed work programme, committed co-opted Members and Lead Members for performance and policy. Some advantages to dissolving the sub-committees were also identified. It was suggested that cross-cutting work has been made easier and that the new structure allows for more effective use of Member time.
The workshop also suggested some difficulties with the new structure: the lead member structure did not appear to be fully understood, awareness of the function amongst the public at large appears limited, the commitment of all backbench councillors needs to be secured, there appear to be limited resources available. There was great concern about the capacity to consider health issues. We agreed to work cross party to ensure an effective overview and scrutiny function for the benefit of the people of Harrow.
Also this year, we have participated in ‘Evidence for Accountability’ project. Other participants in the project were the Audit Commission, OfSted, the National Audit Office, The Welsh Assembly, Public Accounts Select Committee and the Healthcare Commission. In order to reach conclusions on the effectiveness of our processes and how well we gather, analyse and utilise the evidence in our review processes, the project monitored our review ‘Delivering a Strengthened Voluntary and Community Sector’ from the early scoping phase, through the evidence gathering process to the development of the review’s recommendations. In April we received their comments:
In March we hosted the launch of the Centre for Public Scrutiny (CfPS) guidance on Councillor Calls for Action. Nearly 100 representatives of scrutiny committees in the London/South East area attended the launch and participated in the associated work shops, designed to help all of us ensure the most effective implementation of this challenging piece of legislation. Harrow scrutiny councillors participate in the discussions
Harrow Scrutiny Annual Report 2008/09 1 233
As we go to press we await the result of the national CfPS ‘Good Scrutiny’ awards. We have been shortlisted for an award for our review, ‘Delivering a Strengthened Voluntary and Community Sector’ alongside colleagues from Westminster and Staffordshire. More details of this ambitious project are included in the section on the work of the Overview and Scrutiny committee, but this was an extremely challenging project which enabled us to work with our colleagues from the voluntary and community sector to ensure that we have a 21st century relationship with key service providers. We are extremely grateful for the commitment given to the project by 3rd sector colleagues.
In this context, this year saw the establishment of the scrutiny pool of advisors. In all of the work that we do, we try to ensure that we engage with community experts, to ensure we can fully understand the issues being investigated, from an alternative perspective to the council’s. We felt that we would like to offer these volunteers a more structured relationship with scrutiny so in future we plan to meet with them twice a year to ensure we are taking their views into account and engaging with them as effectively as possible. We would like to take this opportunity to thank those residents and community representatives who have given up their time to work with us, you have certainly made a significant and important contribution to our work and we look forward to continuing to work with you in the future.
In the light of the local elections in 2010 and in order to make sure that scrutiny remains outside of the political maelstrom, we intend to ensure that all of our review work is completed early in the New Year. The Overview and Scrutiny section of the annual report outline the projects that will occupy us for the next 9 months but we look forward to the remaining challenges of this administration and to ensuring that the service that are delivered to local people are of the highest quality.
Councillor Stanley Sheinwald Councillor Mitzi Green Chairman Overview and Scrutiny committee Vice Chairman Overview and Scrutiny committee
Harrow Scrutiny Annual Report 2008/09 2 234 Report from the Overview and Scrutiny Committee Further to the reconfiguration of the scrutiny structures, the Overview and Scrutiny committee now meets every month. In order to ensure that there is adequate time to consider some of the more high profile issues, a number of the meetings are now themed: there are 4 health meetings per year and 2 education meetings. Whilst we try to ensure that the agendas are reserved exclusively for the specific purpose, we are able to respond flexibly to urgent matters. We are extremely grateful for the officers, partners and portfolio holders who have attended our meetings and provided us with such useful information during the year.
Health meetings This year has seen a significant amount of agenda time being given over to the consideration of health matters. We are grateful to the support given to the committee by Sarah Crowther, Chief Executive of the PCT, Andrew Bland, Director of Commissioning at the PCT and Fiona Wise, Chief Executive of the NW London Hospitals NHS Trust. We are also grateful to representatives from the Central and NW London Mental Health Foundation Trust, the Royal National Orthopaedic Hospital for meeting with the committee to discuss their annual health checks.
As the Healthcare for London proposals are The borough’s first polyclinic at Alexandra Avenue released and as our local healthcare providers have begun to consider how to implement the principles behind Lord Darzi’s recommendations, Harrow PCT have brought a number of local implementation issues to councillors for their consideration. In particular we are grateful for the opportunity we have been given to discuss with the PCT the future development of the Mollison Way surgery and proposals regarding Kemore Clinic and Alexandra Avenue.
The number of health issues being considered at the Overview and Scrutiny committee also reflects the fact that our health partners have faced some difficult issues this year, including , sadly, the recurrence of maternal deaths at Northwick Park hospital. An innovation this year has been to take the Overview and Scrutiny committee out of the Civic Centre, and in acknowledgement of a number local health concerns, the 23rd September meeting was hosted by Northwick Park hospital. Because of the strategic proximity of the hospital to both Harrow and Brent councils, Brent councillors were invited to attend. This was a useful experience and we look forward to holding more of our meetings in the wider Harrow community in future.
Education meetings There have been two meetings specifically designated to consider education/children’s issues. The first in November 2008, considered the educational achievement of the borough’s children, Special Educational Needs provision and the council’s response to the Children and Young Person’s Bill 2007.
Harrow Scrutiny Annual Report 2008/09 3 235 The second meeting in April this year, considered the whole range of children’s policy issues: development of a children’s trust in the borough, adoptions, the ‘Children’s Pledge’ the safeguarding children plan and the overall children’s plan. The committee was very grateful to Cllr Christine Bednell, the Children’s Services Portfolio Holder and Cllr Anjana Patel, Schools and Children's Development Portfolio Holder and the Corporate Director for Children’s Services for their attendance at the meeting and the advice, comment and information which they provided to us.
General meetings We held two question and answer sessions with the Leader. The first in June 2008, with the Chief Executive, considered the Council's Corporate Assessment Score, the IDeA Peer Review, resident satisfaction and the Council budget.
The second session was held in December and members of the Overview and Scrutiny committee discussed the development of the budget with the Leader and the Corporate Director of Finance. Councillors were able to investigate, amongst other things the impact of the credit crunch on the council’s finances and on the borough in general.
The committee has also considered a range of other strategic issues: • In February, we were delighted to meet with the borough Commander, Richard Walton and Cllr Susan Hall, Environment and Community Safety Portfolio Holder, to discuss the strategic priorities for crime and disorder reduction. • In October we considered the council’s communications and were grateful for the advice and comment provided by Cllr Paul Osborn, Communication and Corporate Services Portfolio Holder • Cllr Osborn also attended the committee in July to discuss the results of the staff survey with us. • In July and November, Cllr Macleod-Cullinane attended the committee to discuss a range of housing and social care issues.
We also received reports on a number of other issues including: • Councillor Calls for Action • Local Area Agreement • Local Involvement Network • Adult and children’s complaints • Joint Strategic Needs Assessment
Councillor calls for action could mean quite a change for Overview and Scrutiny
We are very grateful to all of the officers who have provided us with the information upon which to base our investigations.
Harrow Scrutiny Annual Report 2008/09 4 236 Scrutiny Reviews The committee has commissioned a wide-ranging work programme this year and a number of excellent projects have been undertaken.
Delivering a Strengthened Voluntary and Community Sector. This challenging piece of work was undertaken in full partnership with the voluntary sector – we would like to thank Jula Smith, Harrow Association of Voluntary Service, Mike Coker, Community Link Up Julie Brown, Kids Can Achieve, John Woolf, Woodcraft Folk, Julie Bellchambers, Harrow Voluntary Youth Workers forum, Mohamed Ali, Iwanaaji Somali Disabled Association and Ramji Cauhan, an education co-optee on the Overview and Scrutiny committee for joining scrutiny on this project. The project has resulted in a number of far reaching proposals which will help to make a significant difference to the relationship between the council and the 3rd sector and ensure that the resources of both the council and the sector Consultation with the sector was a key part of are used to the best advantage of our local the project residents.
17 of the 22 recommendations of the review have been agreed by cabinet and three of the remaining four will be implemented as part of the development of the 3rd sector strategy. Only one of the 22 recommendations was rejected.
The review has also been shortlisted for a ‘Good Scrutiny Award’ by the Centre for Public Scrutiny. This is a great achievement and is the first time we have received such a nomination It is a great honour for us and reflects well on the cross working party scrutiny in the borough
Standing Review of the Budget This project is a long standing piece of work which will enable scrutiny councillors to make an ongoing contribution to the development of the council’s budget. The interim report of the group was received and endorsed by Cabinet in December 2008. In the second phase of the project, we are considering a number of issues which we hope will help the authority to emerge from the recession in a healthy financial state – development of the capital budget, options for the development of shared services and revenue income maximisation options. We are extremely grateful to the help of the co-optees from the Open Budget Group who have joined the review: Elizabeth Hugo, Cliff Lichfield and Philp Morrish.
Right To Manage In response to a number of concerns raised regarding the Right to Manage process being introduced in the borough, we held a challenge panel to investigate the issues identified. The findings of the panel were passed to the portfolio holder for Adults and Housing services to assist him to support the development of more constructive relationships between the housing tenants and the tenant management organisation. We are grateful for the support of Linda Robinson, from Local Agenda 21, who joined us on this project.
Harrow Scrutiny Annual Report 2008/09 5 237
Council Improvement Programme The Council Improvement Programme was developed to support the council to improve the services it delivers to local people in a more targeted, strategic manner and to help the organisation improve its reputation. The panel hoped to offer a challenge to the content of the programme in order to ensure that it was targeting the most important improvement priorities. The panel was able to identify a number of issues such as the need for robust monitoring processes to ensure that the council is able to learn from both its successes and its failures, the need for effective management procedures to ensure the delivery of improvements across the council and the need to ensure that the programme is able to evolve. The findings of the panel were endorsed by Cabinet.
Extended schools This piece of work will be considered at the Overview and Scrutiny committee in June. The project has identified how effectively the council’s extended schools are working and areas for further development and improvement which would include more effective engagement of schools in the regime and an assessment of how well the extended schools are managed in order to improve performance across the board. The report will be presented to cabinet after it has been considered at the Overview and Scrutiny committee in June. We were very grateful for the support of Julie Brown, Kids Can Achieve and Despo Speel and Ramji Chauhan, education co-optees on the Overview and Scrutiny committee for their support on this project
Sustainability We began work on this in-depth project to consider the council’s approach to sustainability early in 2009. The project comprises three specific parts: • Consideration of the council’s climate change strategy • The impact of the recession on the council’s business base • The impact of the recession on community cohesion.
The report from the first of these three projects, consideration of the climate change strategy, will be presented to the Overview and Scrutiny committee in June. The remaining components of the project will be carried over into the next year’s work programme.
Use of Resources The regime under which the council’s performance is rated nationally has changed. Comprehensive Performance Assessment has been replaced by the Comprehensive Area Assessment which comprises both an assessment of how well the council uses the resources available to it and how well the council and our partners understand the needs of local people and how well we meet these needs. In order to support the council through the process, we have been involved in a number of sessions to discuss the council’s performance. The new use of resources model
In particular we met with officers to discuss the self assessment that the council wishes to submit in terms of our use of resources. This challenge panel was able to make a number of recommendations about the content of the document and its overall thrust.
Harrow Scrutiny Annual Report 2008/09 6 238
Standing Review of NHS Finances This long standing investigation of the issues that led to the significant financial crisis in local health providers in 2005 -06 has now been completed. By meeting with representatives of the PCT, the NW London Hospital Trust and council social care providers, the review has been able to work with colleagues to safeguard the interests of residents by highlighting their experiences of the strategies adopted by the organisations to resolve their budget crises. The review highlighted in particular the concerns of carers as local budgets were reduced to meet the financial targets. The group has decided to ask the Performance and Finance sub committee to maintain a watching brief over the performance of health partners. We are particularly grateful to Janet Smith, Harrow Mind, Ruth Coman, Avani Modasia, Age concern Harrow and Julian Maw, Harrow LINk for joining the group and offering their local insight to support the group’s investigation.
Place Survey To support colleagues constructing the place survey we held a challenge panel to identify the additional questions that we felt would offer the most value to the council. Our proposals were incorporated into the final draft of the survey.
Priorities for the coming year We are now entering the final year of the current administration and the final year therefore for scrutiny before the next election. In order to safeguard the political neutrality of scrutiny and to ensure that our deliberations don’t get bogged down in election activity, we have agreed that all of our projects will be completed by January 2010. Our work programme for the next year will comprise a number of projects, prioritised from the list below: • Continuation of the standing review of the budget • Further work on proposals as they emerge from Healthcare for London • Completion of the sustainability review, - economic development and support for the council’s business base and community cohesion. • Young people and crime • Communications and fear of crime • Transition from children to adults services • Adults and Housing Transformation Programme Plan • Performance of the Housing Revenue Account • Housing repair contract – Kier • Community lettings • NW London Acute Health Services Review • Voluntary sector grants criteria
The final priority given to each of these projects will be determined by the Overview and Scrutiny committee in June and the methodology for undertaking each will be considered in more detail over the summer.
We look forward to reporting the successful completion of these projects and others in our final report in May 2010
Harrow Scrutiny Annual Report 2008/09 7 239
Councillor Stanley Sheinwald Councillor Mitzi Green Chairman Overview and Scrutiny committee Vice Chairman Overview and Scrutiny committee
OVERVIEW AND SCRUTINY COMMITTEE 2008/09
Committee meetings 12 ordinary 4 special
Attendance by Leader of the Council 2 meetings
Attendance by Portfolio Holders Councillor David Ashton (2) Councillor Christine Bednell (1) Councillor Susan Hall (2) Councillor Barry Macleod-Cullinane (2) Councillor Chris Mote (1) Councillor Paul Osborn (2) Councillor Anjana Patel (1)
Attendance by Chief Executive 1 meeting
Harrow Scrutiny Annual Report 2008/09 8 240 Performance and Finance Sub-Committee: The Performance and Finance sub-committee has firmly established itself and settled well into its role in 2008/09.
The remit of Performance and Finance, the engine for the scrutiny process which analyses performance information, identifies key issues through the performance framework and escalates matters of long-term importance has, this year, been expanded to look at partner organisations such as the Primary Care Trust and their impact on the delivery of services to residents.
During this year, the Performance and Finance sub-committee has considered and followed up on a number of health related issues. We have scrutinised the issue of maternal deaths at Northwick Park Hospital. The Trust was asked to report on the number of maternal deaths compared with the number of births against the national average for maternity deaths over the last three years (2005-2008). This report was requested by the Performance and Finance Committee due to concerns about the occurrence of the three deaths over a 10 month period at Northwick Park Hospital and whether or not there were underlying trends linking the three maternal deaths in 2007/08. The Performance and Finance sub-committee spoke to and received a report from the Chief Executive of the North West London Hospitals NHS Trust who informed the committee that a further review, chaired by a Non-Executive Director of the Primary Care Trust (PCT), with three expert independent clinicians on the Panel, had been set up to establish whether there were any underlying trends linking the deaths. A review report was also submitted to the Healthcare Commission to ensure that the review report had fulfilled its terms of reference, that the investigation was conducted in a proper manner and to provide an external opinion on the findings of the review report.
In addition to this, we received updates on Healthy Schools. The National Healthy Schools Programme has four aspects to it. They are personal, social, health education; emotional, health and well being; physical activity and healthy eating. These themes relate to both the school curriculum and the emotional and physical learning environment in school. Each theme includes a number of criteria that schools need to fulfil in order to achieve National Healthy School Status. All Harrow schools are registered to participate in the National Healthy Schools programme with a target that 90% of Harrow schools will achieve healthy schools status by late 2009.
We received a six monthly update on the Accord MP review which Performance and Finance sub-committee had conducted in the autumn of 2007 regarding the operation of the Accord MP partnership, looking at how public realm work (involving highway maintenance and other infrastructure services) was carried out before the partnership, how it was currently being done and what lessons could be learnt.
The Director of Public Health provided us with a six monthly update on the Obesity review which was undertaken between May and November 2007. The review looked at how to best tackle the issue of obesity within the borough. The review focused on 2 areas children’s opportunities for access to physical activity and adulthood obesity and diabetes. At the six monthly update the Performance and Finance sub-committee received an update on the progress being made with regards to implementing the recommendations made by the review group. These updates continue to come to Performance and Finance on a six-monthly basis.
Harrow Scrutiny Annual Report 2008/09 9 241 Performance and Finance also received updates on other reviews ranging from health to housing, and enterprise resource planning to workforce development. As part of our role we monitor the progress that has been made with regards to the implementation of recommendations made in reviews and how this has affected the performance of those service areas.
We have returned again to housing speaking to the Portfolio Holder, Corporate and Divisional directors of housing regarding progress made on the delivery of the Decent Homes Standard- in particular the levels of satisfaction by residents and standard of work being delivered by Kier. Furthermore we also looked into the suspension of non-urgent repairs until the next financial year and the financial overview of the Housing Revenue Account. We have proposed that a review group will commence a challenge panel on the Housing Revenue Account later in the year to identify a number of steps that can be taken to stem the eventual the depletion of funds from the account as well as how this eventual depletion will affect the housing service.
We are pleased that the Performance and Finance sub-committee has been able to extend its remit to look at partner organisations’ performance and to further drive and support service improvements that ensure Harrow residents receive effective and efficient services. This is at the heart of the committee’s work and we look forward to continuing to make further contributions in this field.
Councillor Mark Versallion Cllr Brian Gate Chairman Performance and Finance sub Vice Chairman Performance and Finance sub committee committee
PERFORMANCE AND FINANCE SCRUTINY SUB-COMMITTEE 2008/09
Committee meetings 4
Attendance by Leader of the Council None
Attendance by Portfolio Holders Councillor Barry Macleod-Cullinane (1) Councillor Paul Osborn (1)
Attendance by Chief Executive None
Harrow Scrutiny Annual Report 2008/09 10 242
Report from lead members for Adult Health and Social Care Consideration of local health and social care issues As discussed in the work of the Overview and Scrutiny Committee, this year a number of committee meetings have focused on local health issues, reflecting the importance and priority given to health concerns in a Harrow context.
In addition to the issues considered in a committee setting, we have continued to facilitate the relationship with our local NHS trusts by informally meeting with their directors and visiting their facilities. Prior to Harrow PCT’s consultation on changes at Mollison Way Medical Centre, we received an informal briefing from the Chief Executive of the PCT to discuss local concerns and the proposed way forward. We value these interactions outside of formal committee time.
We continue to meet quarterly with the Council’s Corporate Director of Adult and Housing Services to discuss issues around social care. We have pursued a particular interest in safeguarding adults and protecting the most vulnerable people in our communities, and also the personalisation agenda. Harrow has made great progress in this area - one in five individual budgets in London is for Harrow residents. The targets for next year are equally challenging and we look forward to charting Harrow’s progress in offering its residents personal budgets and self-directed support.
Healthcare for London – consultation on new major trauma and stroke services for London In Healthcare for London: A Framework for Action, Professor Lord Ara Darzi set out a vision for the transformation of health and healthcare in London. The public consultation on the principles for change and models of healthcare in London Consulting the Capital ran from November 2007 to March 2008. A second consultation proposed some of the first steps to make the vision reality, by focusing on particular clinical areas that had been identified as needing immediate attention – adult services for acute stroke care and adult services for acute major trauma care.
As the proposals were considered ‘substantial variation or development’ to local healthcare services, a public consultation statutorily required the affected Overview and Scrutiny Committees to form a pan-London Joint Overview and Scrutiny Committee (JOSC) to consider the implications and the consultation process from a scrutiny perspective. Each Overview and Scrutiny Committee participating in the pan-London JOSC was represented by one elected member of their authority – Harrow’s representative was Councillor Vina Mithani.
In Harrow we also reconvened our scrutiny working group for Healthcare for London, which facilitated Harrow’s contribution to the JOSC, as well as being responsible for putting together Harrow scrutiny’s individual response to the Healthcare for London consultation. In order to put this together we held an extremely valuable challenge session with key stakeholders to identify local concerns and views on the proposals. Through this we gathered evidence from
Harrow Scrutiny Annual Report 2008/09 11 243 North West London Hospitals Trust, NHS Harrow, Harrow Association of Voluntary Services, Harrow Local Involvement Network, Harrow Council Adult Services, Harrow Council’s Executive Member for Adults and Housing, Imperial College Healthcare Trust and the London Ambulance Service. We submitted our local response to the Healthcare for London by the time public consultation closed on 8 May 2009.
Providing scrutiny commentaries to NHS trusts’ self assessments Each year, every NHS trust is required to self-assess their organisation against a set of 24 core standards – known as their ‘annual health check’ declaration. Overview and Scrutiny Committees can offer comments on these self-assessments which are submitted to the Healthcare Commission. The Healthcare Commission uses the information given by third parties to form their performance ratings of NHS trusts which are issued every autumn. We discussed the self-assessments with the trusts at our Overview and Scrutiny Committee meeting in March 2009 and provided commentaries for each of the self-assessments produced by the four NHS trusts that serve our borough.
Visit to mental health facilities at Northwick Park Hospital On Monday 9 March 2009, we visited the mental facilities run by Central and North West London Foundation Trust at Northwick Park Hospital. This visit was arranged primarily as part of scrutiny’s evidence gathering for NHS Trusts’ annual health check process and gave us an opportunity to speak with mental health practitioners about how they meet the needs of mental health patients and their families and carers and also the plans for the future.
Looking forward We anticipate that health and social care issues will continue to feature prominently on the policy horizon in the year to come. Locally in particular, we would expect to keep an eye on the progress of polyclinics in Harrow and the implementation of the new stroke services for North West London, as proposed by Healthcare for London. On the social care front, we will keep track of the continued progress of the Council’s Adult and Housing transformation programme and its various workstreams. In both health and social care, it will be important to work with our local involvement network (LINk) to ensure that both the LINk and scrutiny are tackling issues of local importance in a complementary manner to add value to local service improvement and policy development.
Policy Lead Performance Lead Councillor Vina Mithani Councillor Rekha Shah
Harrow Scrutiny Annual Report 2008/09 12 244 Report from the Lead Members for Children and Young People
Over the past year a number of significant children and young people issues have arisen, many of which we have considered at the regular meetings we hold with the Corporate Director for Children’s Services. These meetings have been extremely valuable for following up on key issues outside of the committee setting. The topics we have covered over the year culminated in a special children and young people Overview and Scrutiny meeting that was held at the end of the year. Detailed and challenging discussions took place at the meeting where the Children’s Services Portfolio Holder and the Schools and Children's Development Portfolio Holder were also in attendance.
Safeguarding A number of high profile and negative cases relating to safeguarding children and young people have come up this year, and most notably the unfortunate death of Baby P. As lead members we held key discussions with the Corporate Director for Children’s Services to ensure that the right processes and procedures are in place with regards to safeguarding children and young people in Harrow. All councillors are Corporate Parents but as the scrutiny leads we will continue to avidly scrutinise our safeguarding procedures and the work of the Local Safeguarding Children’s Board. CRB checks have been carried out on all Councillors and further training will be provided on being a corporate parent in 2009/10. The interaction of children looked after with councillors will also be monitored by us through the Young Voices programme. Furthermore, we will keep a watching brief on the implementation of the recommendations arising from the Laming review, The Protection of Children in England.
School Reorganisation A major change in the configuration of Harrow schools was agreed this year, as leads the reorganisation of schools in Harrow was policy change which we took a particular interest in. We held a number of discussions with the Director for Children’s Services to ensure that the age of transfer to 11 years and the alignment of first and middle schools to fit in line with National Curriculum Key Stages was on course to be delivered as efficiently as possible. We were keen to ensure the impact of the change in the age of transfer is minimal.
Children’s Trusts We have been avidly monitoring the development of Children’s Trust arrangements in Harrow, especially in view of the numerous government guidance documents that have been published over the last two years. Our work in this area culminated in an update report to Overview and Scrutiny. We were pleased to learn that adequate progress is being made towards developing an effective Harrow Children’s Trust, ensuring agencies work together for the benefit of children and families in Harrow. The lead members will continue to monitor Trust arrangements in 2009/10.
Adoption Inspection During the year we also looked into the council’s adoption procedures following the presentation of an inspection report at Adoption Panel. We were particularly concerned with the follow up and after care procedures. Detailed constructive discussions took place at the April Overview and Scrutiny meeting where other members of Overview and Scrutiny also scrutinised the policies and procedures we have in place for adoption and fostering. A number of our concerns were allayed but we will continue to ensure that the adoption and fostering services we provide remain up to standard.
Harrow Scrutiny Annual Report 2008/09 13 245 Transition from Children and Young People’s Services to Adults Services The issue of transition from children’s care to adults is another area in which we focussed our attention on this year. Of particular concern was the need for the council to develop better links for children moving into adult care with a particular emphasis on those with disabilities and learning difficulties. The disjoint between the funded management of the child and the independent individual management of adults and the difference in the whole package of care provided is something that we are keen to address. Also relevant to this is the progress of the personalisation agenda. We look forward to reviewing the draft strategy that should be available this summer and following this with a more focussed piece of work in 2009/10.
Light touch review of Extended Schools as community resources In addition to the issues we covered throughout the year, Councillor Margaret Davine also chaired a light touch review of Extended Schools as community resources. The review took place between September 2008 and March 2009. As part of the review, the review group went on a number of school visits, witnessing extended school activities and consulting with parents, children, extended schools cluster co-ordinators and head teachers. The final report of the review will be presented at the Overview and Scrutiny meeting in June 2009. Extended schools in Harrow
Looking forward
We expect that over the coming year issues relating to children and young people will remain paramount. We will continue to monitor the progress of a number of new developments such as the progress of schools reorganisation, the development of Children’s Trust arrangements and our progress in maintaining our safeguarding procedures. We expect to play a significant role in the upcoming challenge panel/ light touch review of young people and crime.
Policy Lead Performance Lead Councillor Magaret Davine Councillor Janet Mote
Harrow Scrutiny Annual Report 2008/09 14 246 Report from the Lead Members for Corporate Effectiveness We have continued to meet during 2008/09 to discuss matters relating to the corporate effectiveness of the council and we are very grateful to those officers who have attended our briefings to provide us with information.
Local Area Agreement We have received a number of reports this year on the performance of our Local Area Agreement. Whilst we were happy to hear that we are likely to hit target, at least to the minimum 60%, for the majority of the agreement, we were disappointed to hear that we are unlikely to receive any reward grant for two: • Improving the schools attendance at the 25% worst performing primary and secondary schools • Percentage of people who feel that their local area is a place where people from different backgrounds get on well together.
We were advised that in the case of ‘school attendances’, because the performance of Harrow’s schools is amongst some of the highest in the country, this target was set exceptionally high which will make its achievement difficult, and we are reassured on this.
However, with regard to ‘people from different backgrounds in the area getting on with each other’, we are rather more concerned. Indeed we were particularly concerned to hear that performance has in fact, deteriorated. In the light of the recession and the real hope that Harrow, one of the most multi-cultural boroughs in the country, maintains its real spirit of community and diversity, we intend to continue to monitor this. We also welcome the work being undertaken by the scrutiny Sustainability review.
We were also advised that the council has now signed a new Local Area Agreement, which whilst not attracting the same level of reward grant and now pump priming funding, will help to focus the activities of the Harrow Strategic Partnership
Human Resources We raised a number of issues with officers from Human Resources as we have been particularly concerned about the capacity of the organisation in the light of the need to deliver cultural change and improvements to residents. Whilst the Chief Executive has made it very clear that he expects to see significant change in terms of the culture of the organisation, we have been concerned at the length of time it is taking to achieve this change and to implement the processes needed to support the change. In particular we have received information regarding the council’s work force planning processes, the rate and recording of sickness absences across the council and staff morale. Whilst we have been reassured regarding some of the fundamental processes which are now in place across the council, we will continue to monitor the speed with which the council is delivering real cultural change across the organisation.
Place Survey We received information regarding levels of satisfaction being expressed by local people regarding the quality of council and other public services in the borough. We were glad to hear that in general satisfaction levels are encouraging. However, we were concerned to hear that: • It is perceived that local public services do not promote the needs of local people • Expectations regarding local services are rising faster than the capacity of providers • Residents generally seem badly informed
Harrow Scrutiny Annual Report 2008/09 15 247 This is an extremely useful survey and we are glad to hear that it will be helping the council to focus on the issues of most importance to local people.
Councillor Calls for Action These changes offer an interesting opportunity for ward councillors to champion issues raised by their local constituents by offering them an opportunity to seek resolution of ward concerns via the Overview and Scrutiny committee. We have received a number of briefings on the proposals which were implemented with effect from 1st April this year and we are happy that, despite initial delays in the publication of guidance on the implementation of the proposals, the council is prepared for the implementation and has worked out how the new regime fits with the council’s existing complaints process and how Overview and Scrutiny and councillor calls for action will add value to how the council addresses local resident’s’ concerns.
Looking forward We anticipate that a key area of our work will continue to be the capacity of the organisation to deliver real change. As such we expect to continue to monitor improvements in human resources functions and to monitor the extent of cultural change. The council has an ambitious and challenging improvement agenda, and we feel that ensuring that the corporate capacity of the organisation to deliver this agenda should be a priority for us. We will also continue to monitor customer satisfaction and the impact that the recession may be having on this.
Councillor Stanley Sheinwald Councillor Mark Versallion Policy Lead Performance Lead
Harrow Scrutiny Annual Report 2008/09 16 248 Report from the Lead Members for Safer and Stronger Communities During this year we have spent some time looking at how the various community safety and policing bodies in the borough including the (HPCCG, CDRP, Race Hate Forum, Safer Neighbourhood Panel etc) link together.
We have also met with the Community Safety Manager on a number of occasions to discuss emerging issues and developments. Of particular importance to our work are the implications and duties that have recently come into force under the Crime and Disorder Overview and Scrutiny Regulations 2009, requiring us to scrutinise decisions made, or other action taken, in connection with the discharge by the responsible authorities of their crime and disorder functions.
At the February Overview and Scrutiny meeting we considered the Harrow Strategic Assessment which provided a six-monthly profile of crime and safety in the borough. At this meeting we had the opportunity to put questions to the Borough Commander, Chief Superintendent Richards Walton and the Deputy Portfolio Holder for Environment Services and Community Safety, Councillor Susan Hall who were in attendance.
Looking Forward In the future we will be considering further the safer communities element of our roles and addressing the implications of Councillor Call for Action (CCfA) on the council and keeping a watching brief on how it will operate on the ground, In line with this we will be addressing how the council ensures we are implementing the ‘Duty to Involve’ that has recently come into force. The ‘Duty to Involve’ seeks to ensure that local people have their say and a culture of engagement and empowerment is embedded.
In 2009/10 we will also be ensuring that we are closely involved in the development of the council’s Gypsy and Traveller Strategy.
The Overview and Scrutiny work programme for 2009/2010 also features a number of key issues that fit within our remit including Communications and Fear of Crime and Young People and Crime. We hope to be closely involved in this work.
Councillor Anthony Seymour Councillor Nana Asante Policy Lead Performance Lead
Harrow Scrutiny Annual Report 2008/09 17 249 Report from the Lead Members for Sustainable Development and Enterprise In 2008/09 we have looked at issues which are central to the quality of life of our tenants and residents. Our work has dealt with key strategic issues for the borough’s future alongside issues at an operational level which impact on our residents’ daily lives. These issues are further detailed below:
Scrutiny review of the Right to Manage Between November 2008 and January 2009 a scrutiny review group (jointly chaired by Councillor Dinesh Solanki and Councillor Jerry Miles) investigated a number of concerns which had been raised by residents and brought forward by the Portfolio Holder regarding the Right to Manage process and the Independent Tenant Advisor being implemented in the borough. These concerns centred on how the Right to Manage process has been conducted within Harrow and that many residents did not feel the process had been clearly or properly explained to them.
This investigation was conducted in the form of a two day challenge panel during which the review group questioned witnesses ranging from officers to residents, the members of Harrow’s various residents’ groups including the Harrow Federation of Tenants and Residents Association to the Independent Tenant Advisor. The findings from the investigation led the review group to make a number of recommendations. These recommendations highlight the importance of clear and effective communication between officers, partners, residents and the importance of building and fostering good relationships with residents.
The recommendations form a base for improving relations between the parties concerned as well as a basis for clear and effective communication. The report has been well received by colleagues within the council. Scrutiny will of course monitor the progress of the Right to Manage process and the implementation of the challenge panel’s recommendations.
Other work Due to the current economic situation our planned work on the town centre redevelopment has been put on hold.
The Local Development Framework Core Strategy was looked at briefly in September 2008 and is currently in the process of being prepared. The Core Strategy is expected to be adopted in 2010. As the Local Development Framework process continues, we will continue to monitor this issue and see what issues emerge from it.
More generally we have also carried out background work regarding the publication of notices and information for controlled parking zones. We have also looked informally at a number of issues ranging from residential development in back gardens to the improvements made by London Overground and their impact on Harrow; as well as the impact the recession has had on Harrow’s small to medium enterprises and what is being done both nationally and locally (by the council and its partners) to address this issue and support this business base.
Harrow Scrutiny Annual Report 2008/09 18 250 Looking forward One area that at present is a national and local priority is sustainability. We are currently undertaking a review of this wide ranging cross-cutting issue. Early issues that have been identified for possible consideration during the review include: • How effectively the council uses its own resources • How we are helping our business base through the current economic difficulties • How we are engaging with our communities and safeguarding its cohesiveness.
The specific coverage of the review will be looked at in more detail in the course of the review’s scoping stage. We will also need to look at how well Harrow has developed its policies and implementation of sustainability as well as how to improve and further extend the scope the council has for incorporating sustainability into its service areas and service delivery.
Councillor Jerry Miles Councillor Dinesh Solanki Policy Lead Performance Lead
Harrow Scrutiny Annual Report 2008/09 19 251 Scrutiny Member Development programme 2008/09 Building upon our previous years’ Scrutiny Member Development Programme, this year we have continued to consolidate our skills and knowledge development. Following a training needs analysis of scrutiny councillors, the following aims and objectives were identified for the Scrutiny Member Development Programme for 2008/09: • TEAM: To develop a team spirit for scrutiny • EXPERTISE: To develop sufficient expertise and technical knowledge to deliver effective challenge • ROLES: To consolidate the scrutiny structure and clarify the understanding of the roles within it e.g. scrutiny leads and scrutiny chairmen/ vice-chairmen • LEADERSHIP: To develop leadership and facilitation skills • RESEARCH: To enhance research and analytical skills • INFLUENCE: To assert scrutiny’s influencing role by targeting recommendations • RELATIONSHIPS: To build relationships externally with partner organisations and internally with officers and the Executive
In addition to the events run through Harrow’s corporate member development programme, a number of scrutiny-specific activities run throughout the year sought to address the areas identified above, as outlined below.
Briefings As they proved so valuable to our work last year, we have continued with quarterly briefing sessions for scrutiny lead members with the relevant Corporate Directors, in addition to written and verbal briefings from our Scrutiny Team. More widely, briefing sessions were held before a number of committee meetings giving members and co-optees the opportunity to discuss questioning strategies for issues on the committee agendas. Building on the role of scrutiny lead members, these sessions enabled the scrutiny lead members to then lead on the issues in their areas of expertise in the committee meetings.
Furthermore, following the success of previous subject-specific briefings, this year a performance and finance refresher training session was held on 6 October 2008, aimed at members of the Performance and Finance Sub-Committee.
Peer learning Sharing experiences with and learning from colleagues carrying out similar duties to us is important. To this end, we have visited other boroughs to see their scrutiny committees in action – a number of us observed committee meetings at Hillingdon and Brent. These were valuable peer-led learning and development opportunities with especially with regard to chairing techniques, questioning styles and learning from general good practice. Likewise, we have had scrutiny colleagues from other boroughs come to our meetings to watch us in action – we have welcomed councillors from Brent and Ealing Councils to our Overview and Scrutiny Committee and Performance and Finance Sub-Committee.
Scrutiny in the community Venturing out of the Civic Centre, we held one of our committee meetings in a ‘community setting’. On 23 September 2008, the Overview and Scrutiny Committee was held at Northwick Park Hospital and focused solely on issues relating to the hospital. This follows other boroughs’ experiences that such meetings engage the public more easily whilst also encouraging a forging of a team spirit and strategic style of questioning, which can also be transferred to committee meetings at the Civic Centre. We thank North West London Hospitals for opening out their facilities to us and accommodating our meeting.
Harrow Scrutiny Annual Report 2008/09 20 252
Utilising external expertise We asked the IDeA to facilitate a group session on 22 September 2008 to review the impact of the reconfiguration of scrutiny structures in Harrow. This session afforded us with the opportunity for informal discussions between members with a view to develop an effective scrutiny function. It also served as a team building session for members involved in scrutiny.
We have continued to also take advantage of training sessions held by external providers, for example one of our scrutiny lead members went to Birmingham last summer to attend a session on chairing scrutiny run by Inlogov. Past experience has highlighted how valuable these one-off training courses can be.
Looking forward Not to rest on our laurels, in Harrow we have always sought to receive feedback on our processes and our work. To this effect, researchers from the Evidence for Accountability project (from a variety of academic institutions) which used one of our reviews (‘Delivering a Strengthened Community and Voluntary Sector for Harrow’) as a case study, presented their observations of our evidence-gathering and review processes in a session in February 2009. More detail on the findings of this project is detailed elsewhere. We will use the comments from the researchers to continue to improve both our own scrutiny skills and our wider processes.
We will use the learning and successes from this year’s Scrutiny Member Development Programme to inform how we approach next year’s programme.
Harrow Scrutiny Annual Report 2008/09 21 253 Call- In Sub Committee The call-in process enables decisions that have been taken but not yet implemented by the cabinet, portfolio holders or officers to be examined by members of the call-in sub committee. A decision can be called in by:
• Any six members of the council, and additionally, in relation to Executive decisions on education matters only, any six Members of the Council and the voting co-opted members of the Overview and Scrutiny Committee; • Any member of the Overview and Scrutiny Committee; • 150 members of the public, (defined as anyone registered on the electoral roll of the borough).
Whoever is calling in the decision must notify the Chief Executive and specify the grounds upon which the call in is being made. These are:
1. Inadequate consultation has been undertaken with stakeholders prior to the decision 2. The absence of adequate evidence on which to base a decision 3. The decision is contrary to the policy framework, or contrary to, or not wholly in accordance with, the budget framework 4. The action is not proportionate to the desired outcome 5. A potential human rights challenge 6. Insufficient consideration of legal and financial advice.
The call-in sub committee can reach one of the following conclusions: • The challenge to the decision should be taken no further and the decision should be implemented • The decision is contrary to the policy framework or contrary to or not wholly in accordance with the budget framework and should therefore be referred to the council • The matter should be referred back to the decision taker for reconsideration.
During 2008/09 one non-education decision was called in. The decision to make tennis courts in West Harrow Recreation Ground available to lease was called in on the grounds that there had been inadequate consultation with stakeholders prior to the decision and there was inadequate evidence upon which to base a decision. The sub committee upheld the call-in and the decision was referred back to the Portfolio Holder for Major Contracts and Property.
During 2008/09, no education decisions were called in.
Statistics – call-in 2008/09 2007/08 Committee meetings: 1 3 Decisions called-in: 1 3 Call-ins triggered by residents 0 1 Call-ins rejected: 0 3 Call-ins upheld: 1 0 Decisions altered following call-in: 0 N/A
Harrow Scrutiny Annual Report 2008/09 22 254
Date of decision Date of Issue Reason Outcome call-in for call- of call-in in Cabinet 7th April Decision to make available for lease 1, 2 Upheld 23rd March 2009 2009 tennis courts in West Harrow Recreation Ground
Councillor Anthony Seymour Councillor Mitzi Green Chairman Vice Chairman
Harrow Scrutiny Annual Report 2008/09 23 255 Conclusion
This has been a good year for scrutiny, we have tested our new structures and have delivered some excellent projects. This is the final year of this administration and possibly our final year as scrutiny councillors so we look forward to continuing our work and supporting the delivery of excellent services to our local residents.
Harrow Scrutiny Councillors June 2009
Harrow Scrutiny Annual Report 2008/09 24 256 Agenda Item 16 Pages 257 to 316
Meeting: Overview and Scrutiny Committee
Date: 11 June 2009
Subject: Scrutiny review – Extended Schools as Community Resources
Responsible Officer: Alex Dewsnap, Divisional Director of Partnership Development and Performance
Portfolio Holder: Councillor Christine Bednell, Children’s Services Portfolio Holder
Councillor Anjana Patel, Schools and Children’s Services Development Portfolio Holder
Exempt: No
Enclosures: Final report of the review group
Section 1 – Summary and Recommendations
This report sets out the details, findings and recommendations of the scrutiny review of extended schools as community resources.
Recommendations:
1. Endorse the report and its recommendations; and 2. For Overview and Scrutiny Committee to monitor the continuing progress of the recommendations in six months and receive the first progress update in six months. 3. To forward the report on to the Portfolio Holder for consideration
Section 2 – Report
Background
The extended schools review was carried out as part of the Overview and Scrutiny 2008/09 work programme to address the progress to date and any gaps in the current level of extended schools services. The review was also 257 carried out to assess how far extended schools are succeeding in meeting the core offer and the objective for them to be a key community resource. Their long term sustainability was another area the review group considered as part of the review. The review was carried out between September 2008 and March 2009.
The investigation was carried out by reviewing a wide range of desktop research, evidence submitted from key officers, consultation with relevant stakeholders and actually going out to witness extended schools services and activities in practice.
The final report details the main recommendations arising from the review and the Overview and Scrutiny Committee is asked to endorse these recommendations.
Resources, costs and risks Any costs associated with these recommendations will have to be met from within existing resources.
Staffing/workforce There are no direct staffing or workforce considerations specific to this report.
Equalities impact The review group ensured the consideration of equalities implications formed part of this investigation as equalities is integral to the principles and the role of extended schools.
Legal Implications None
Financial Implications Any costs arising from the recommendations will have to be contained from existing budgets.
Performance Issues There are no performance considerations specific to this report.
Section 3 - Statutory Officer Clearance This is not required for this report
Section 4 - Contact Details and Background Papers
Contact: Fola Beckley, Scrutiny Officer, [email protected]
Background Papers:
Detailed in the full report
If appropriate, does the report include the following considerations?
1. Consultation YES 2. Corporate Priorities YES
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OVERVIEW AND SCRUTINY COMMITTEE
REVIEW OF EXTENDED SCHOOLS AS COMMUNITY RESOURCES
April 2009
REVIEW GROUP MEMBERSHIP: Councillor Margaret Davine Councillor Mitzi Green Councillor Manji Kara Councillor Dinesh Solanki Councillor Yogesh Teli Julie Browne – Director, Kids Can Achieve Ramji Chauhan – Parent Governor Representative Despo Speel - Parent Governor Representative
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CONTENTS
Page
CHAIRMAN’S INTRODUCTION 2
EXECUTIVE SUMMARY 4
RECOMMENDATIONS 5
INTRODUCTION 10
LOCAL CONTEXT - EXTENDED SCHOOLS IN HARROW 12
REVIEW METHODOLOGIES 17
KEY FINDINGS AND CONCLUSIONS OF THE REVIEW 23
APPENDICES
Appendix A: Agreed scope for the review 24
Appendix B: Notes of cluster group visits 30
Appendix C: List of review members, participants and witnesses 54
Appendix D: Background papers and further information 57
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CHAIRMAN’S INTRODUCTION
I am delighted to introduce the report of the Extended Schools as Community Resources Review. This review was originally planned and scoped as a case study in a larger in-depth review on Building Schools for the Future which the Overview and Scrutiny Committee decided not to proceed with when Harrow’s bid to the fund was accelerated. It was however agreed by the Committee that a light touch review focussed specifically on Extended Schools should be included in the 2008/9 work programme.
Extended Schools have the potential to improve both the attainment and well being of children, young people and their families, as well as support the promotion of an increased sense of community. The review was carried out in order to gauge the impact and assess the development of the service to date. The report shows that Harrow is making good progress with regards to the provision of its extended schools services. We also addressed the issue of whether all of Harrow’s extended school clusters are meeting the core offer of services for extended schools, which all schools are required deliver by July 2010, to ensure consistency throughout the borough. We also hoped that through the review we would be able to identify and share good practice, which is an objective I believe we have achieved.
Whether extended schools offer added value for money and are therefore a good investment was another area we considered as part of the review. The issue of long- term sustainability is crucial to the future of the programme when government funding ceases. You will see from reading the report that this is an area that requires further thought and strategic planning by some schools and cluster groups.
As this was a light touch review, the group had a limited timescale and so focused its attention on a range of specific clusters to ensure a balanced overview of the borough’s provision. We believe therefore that our recommendations form a sound pragmatic basis to support the further development of good practice in extended schools in Harrow.
The review group further concluded that extended schools require a robust support structure and a strategic approach where schools work effectively together in their cluster groups, with the local authority, children’s centres, voluntary and community sector organisations, other key partners and the communities which they serve, if they are to realise their full potential for the longer term.
I believe that the report of the review, although limited by its scope, provides a good foundation for further investigations and I am looking forward to reading the report on the community use of schools, that is being produced later this summer.
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261 I look forward to receiving the responses to the findings and recommendations that we have put forward.
Finally I would like to thank everyone who has been involved in and contributed to the review for the support, time and expertise they have so willingly provided. A special thank you goes to the Scrutiny Officer for her patience and support during the writing of the report.
Councillor Margaret Davine
Chair of the Review Group
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262 EXECUTIVE SUMMARY
This report sets out the details, findings, conclusions and recommendations of the light touch review of Extended Schools as Community Resources. The review group came to look at extended schools as community resources having initially planned on addressing the preparations towards the implementation of Building Schools for the Future. Harrow was initially in the last tranche for implementation amongst neighbouring boroughs but this was brought forward and the reviews scope and objectives became irrelevant.
The Scrutiny Review Group carried out their investigation between September 2008 and March 2009. A variety of methods were employed to carry out the review amongst which included desktop research, detailed officer presentations and discussions, consultation with Cluster Co-ordinators, parents, children and head teachers. Aware of the limited timescale for the review, the review group chose to focus the visits to extended school services and activities to three cluster groups in the borough.
The review revealed that it is essential to have a clear strategic approach to extended schools cluster group working. The importance of effective collaborative working between head teachers, schools and cluster co-ordinator was also highlighted. The investigation also uncovered the need to have Cluster Co-ordinators with the appropriate level of skills, knowledge and experience. The enthusiasm and approach to the Extended Schools programme of Cluster Co-oridnators also has implications on the effectiveness of the extended schools programme as was made evident by the review.
The recommendations’ put together draw on the key findings of the review group including the need to have effective systems of support and challenge for Cluster Co- ordinators, the need to develop effective forms of communicating the extended schools programme and the need to mainstream the positive practice e of employing Parent Ambassadors.
The following section of this report details the review group’s recommendations in full.
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263 RECOMMENDATIONS
Finding: As a result of the visits carried out as part of the review, it was evident that there is a real variance in the knowledge, skills and experience of the Cluster Co- ordinators and this in turn has an impact on the approach and outcomes of individual cluster groups and how they work.
Recommendation 1
Officers should ensure robust systems of support; advice and challenge are
in place for all clusters which will help develop the knowledge and expertise of each Cluster Co-ordinator and their lead head teacher.
Finding: The effectiveness and good work of Parent Ambassadors located at some schools was commended by members of the panel. The Parent Ambassador scheme was most developed in the Canons cluster. An example of the work of the Canons Cluster Parent Ambassador is detailed below:
The Parent Ambassador was able to support a student who spoke very little English, was very shy and was struggling to integrate in the school. The Parent Ambassador initially assessed the student and found that he was not only unable to speak and communicate English but was also weak in communicating in his mother tongue and had special educational needs. From this a formal meeting took place between the mother of the student and herself. It was found that the student actually attended a special educational needs school in Poland, prior to arrival in the UK. From this the Parent Ambassador then started working with the family to support the student and did so for a year, the student is now beginning to settle and has the range of support that he requires.
Recommendation 2
Clusters Co-ordinators and head teachers are encouraged to consider the introduction of the appointment of Parent Ambassadors for hard to reach communities in their local area/ cluster to look at whether such a scheme would be beneficial to the community.
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264 Finding: Having consulted with Parent Governors and local parents, it became evident that some of the activities provided by some schools/ cluster groups are not communicated as widely and effectively as they could be. An overall booklet detailing various activities in cluster groups with dates, schools etc for the borough was considered but it was decided that this may be impractical due to the variety of activities provided and the fact that activities change and are held in a variety of venues. The review group felt that it is important for people within communities and clusters besides parents and carers know about the extended schools programme and what is happening in local schools.
Recommendation 3
That cluster groups develop a termly pro-forma for publicising activities and ensure a copy goes home with each child in the cluster. The information should also be widely available through community venues such as libraries, children’s centres, health centres and relevant websites.
Recommendation 4
Other ways of communicating with the community at large should be investigated so that members of the community not directly involved with schools are aware of the services and activities available.
Recommendation 5 Elected members who are also school governors should work to raise the profile of extended schools within the schools they govern, in their individual wards and in the community at large.
Finding: The review group found that the working relationship between some Children’s Centres, extended school clusters and other partners such as the voluntary sector needs further development. However, examples of good working relationships and infrastructure were found, an example of this is at Whitefriars First and Middle School and Children’s Centre. The review group witnessed at first hand parents from schools across the cluster taking ESOL classes whilst their children were looked after in Whitefriars Children’s Centre.
In addition progress is being made towards developing better relations with the voluntary and community sector due to the recently appointed Children’s Services Liaison Officer, appointed to help build the link between the voluntary and community sector and cluster.
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Another positive step towards developing the cohesive relationship with Extended Schools and Children’s Centres is the Parenting Co-odinator that has been recently appointed to work across the Children’s Centres and Extended Schools agenda strategically co-ordinating and developing parenting provision across the borough. The parenting co-ordinator developing a Parenting Strategy, which will provide information and support for parents with children from birth till 19.
Recommendation 6
Steps should be taken to ensure that strategic working is ongoing to bring together expertise from the clusters and local authority officers together in the integration of Extended Schools and Children’s Centres. As further Children’s Centres are established and opened full advantage should be taken of working together.
Finding: Extended schools are funded through the standards fund and area based grants. From the onset of the review, the review group expressed concerns that the formal government funding will cease from March 2011 and schools are required to mainstream extended schools into their budget. It was found that some clusters do not appear to have robust plans for the future. Cluster groups need to develop ways in which activities can be sustained and have plans in place for post 2011 development.
In relation to sustainability, consideration will also need to be given to not only financial resources but the human resource element as well. The Extended Schools programme will impact on the working patterns of teachers in the long term. E.g. will there be flexibility for teachers that stay late in after school clubs to come in later the next day? It has been highlighted nationally and by some clusters in the borough that the dependence on the goodwill of some teacher on the extended schools programme could affect sustainability in the long run.
REVENUE 2008 - 09 2009 - 10 2010 - 11 Area based ES Start up grant £ 431,559.00 £ 680,160.00 £ 279,711.00 Standards ES Sustainability fund £ 269,345.00 £ 496,447.00 £ 699,455.00 Standards fund £ 700,904.00 £ 1,176,607.00 £ 979,166.00 The table above details the various funding streams from the government for the Extended Schools Programme till 2010/11
Recommendation 7
All agencies that are involved in Extended Schools need to develop an overall vision of how all schools and cluster groups7 develop plans for mainstreaming and in turn sustaining extended schools activities across clusters post 2011.
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Finding: The limited timescale meant that the review group were not able to fully analyse, consult and consider the development of the extended schools programme. However, a great deal of information was accumulated via desktop scrutiny of the action plans, cluster activity sheets, cluster profiles etc which provided an incite into the work plans and outcomes across the different clusters. There was even less time to explore the community resources element of Extended Schools.
Finding: Concerns relating to community access to schools was touched on by the review group in one of the early meetings. The issue for schools in relation to security and opening hours e.g. the requirement for caretakers to open up the schools was expressed as a concern for schools. It was also felt that it is often the case that primary schools are not really ideally placed to support community activities due to their infrastructure while secondary schools are in a better position to be accessible to communities. Community resources and community lettings are key issues for the borough and were also highlighted in the Overview and Scrutiny review ‘Delivering a Strengthened Voluntary Sector for Harrow’ November 2008.
Recommendation 8
A challenge panel/ further review should be held in 6 months time to address the progress of the recommendations that have been put forward from the review group and to also explore the community lettings and community resources element of Extended Schools.
Recommendation 9 In line with the recommendation above schools should be examining services they can provide to the community including making their premises available at a reasonable cost.
Other Issues Considered
The issue of SEN children and young people was also not fully explored by the review group. The disadvantaged subsidy which will be targeted for SEN pupils will be introduced later this year and will be specifically targeted for particular groups.
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267 It was considered that the issue in terms of cluster working with specialist schools is other schools not having the required infrastructure, facilities and equipment to meet the needs of some pupils. This could be a challenge for cross organisational working. Transportation issues and moving pupils between schools is another issue to be considered for SEN pupils. Nevertheless the review group also witnessed at first hand good practise in Harrow in the CH Unite cluster where the students who could have potentially had problems on the playground and end up excluded were catered for with the provision of music classes at lunch time.
The MORI survey Extended Schools Survey of Schools Pupils and Parents, December 2008 also highlighted the need for further support of staff in special schools, the development of targeted activities and the need to address transport and cost which can be barriers for parents of pupils in special schools. Development in this area would also be of benefit as one third of parents felt that that provision of extended services provided some respite from caring and an opportunity for them to get involved in other activities themselves.
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268 INTRODUCTION
The National Context
The term extended school encompasses the Governments overall ambition to provide ‘a range of activities and services that go beyond the school day, to help meet the needs of its pupils, their families and the wider community’. (DfES Prospectus, 2005). The extended schools programme was officially introduced in June 2005 though many schools in Harrow, other parts of London and further a field already had informal extended school services and activities in place.
Extended schools services are services that go beyond the school day, often outside normal school hours and they aim to put schools at the heart of the community in order to have a positive impact on the quality of life and the life chances of children, young people and families. Extended schools have been identified as key to supporting the delivery of the Every Child Matters (ECM) initiative, with a particular focus on raising attainment for children and young people and ensuring they: Are healthy Stay safe Enjoy and achieve Make a positive contribution Achieve economic well-being
The Government set out the requirement that by 2010 all children and young people should have access to a core set of extended services in and around their school from 8 am till 6pm, 48 weeks in a year. In the delivery of services, schools are expected to work with local authorities, other schools, the voluntary and community sector and other local service providers to support children and young people and their families. The Government indicated that the universal approach to services and in particular schools working in partnership with specialist services would also help to support vulnerable children to be identified and in turn assisted through the extended schools programme.
Extended Schools: Building on Experience (June 2007) further re-iterated that schools, through the extended schools programme should work to reach out to disadvantaged families whilst also ensuring provision for all families.
The Government invested £680 million in the first 2 years of running extended schools and a further £1.3 billion was committed for the period between 2007- 2010. However, no further funding beyond 2011 has been clearly dedicated, this being an issue that was of particular concern to the review group and was considered as part of the review.
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The Core Offer
The Core offer for extended schools services requires that all children, young people and families should have access to a certain level of integrated services and this should be met by 2010.
The core offer is detailed below:
CORE OFFER DESCRIPTION
A varied menu of activities (including Primary schools - provision for a varied menu of activities study support, play and childcare) along with childcare from 8am-6pm, five days a week, 48 weeks a year.
Secondary Schools – access to a varied menu of activities which also offer young people a safe place to be from 8am-6pm during term time and more flexibly in the holidays. Parenting Support Information sessions for parents/ careers of pupils at the beginning of primary and secondary phases
Information on national and local sources of information, advice and support
Access to parenting groups using structured, evidence- based parenting programmes as well as more informal opportunities for parents to engage with the school and each other.
Family learning sessions to allow children to learn with their parents/careers Swift and easy access to targeted and Integrated working between schools, specialist services specialist services such as health and social care and the voluntary and community sector to ensure that children and young with additional needs are identified early in order to ensure they receive appropriate support quickly. Community Access Wider community access to suitable school facilities such as playing fields, ICT and sports and arts facilities including adult learning which is a response to an assessment of local demand
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270 LOCAL CONTEXT – EXTENDED SCHOOLS IN HARROW
Children’s Services Directorate took responsibility for the strategic delivery of extended schools services in September 2007. The Integrated Early Years and Community Services Division (IEYCS) in the Children’s Services Directorate have direct responsibility for extended schools, and the Head of Service also has responsibility for children’s centres. The extended schools programme is directly relevant to two of the three corporate priorities for 2009/2010 which includes: Improve support for vulnerable people Build stronger communities
Harrow is making good progress with regards to provision of the core offer of extended schools. By October 2008, Harrow had met both the primary and secondary policy pledges (half of primary schools and a third of secondary schools delivering the full core offer). 77% of schools in Harrow were meeting the full core offer which was 11% above the average for London boroughs and 8% above the national average; this is based on the TDA Self Assessment Toolkit. The services at Glebe First and Middle School were also highlighted as good practice in the ‘Extended Schools: Building on Experience’ report published by the Department for Children, Schools and Families (June 2007).
The Table above charts Harrow’s progress against boroughs that are statistically comparable.
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271 The Clusters Groups
The Borough has adopted a cluster based approach to extended schools services and there are seven clusters operating in the borough, which includes: CH Unite Children First HA2Cando Canons Cluster Pinner Cluster Stanmore-Kenton Cluster West Cluster
Each of the seven extended school clusters employs a Cluster Co-ordinator who is based in the lead school. The Cluster Co-ordinator role is part-time at spinal point H11 in three clusters including Canons, CH Unite and Stanmore-Kenton. The Children First, Pinner Cluster, HA2Cando and West Cluster all employ full-time Cluster Co-ordinators. The grade of the Cluster Co-ordinators is at H11 to allow the Cluster Co-ordinator to work at a level where they can provide strategic advice and guidance to cluster heads. The Cluster Co-ordinators are responsible for supporting the IEYCS Management Team by implementing their strategic vision through day-to-day management of the cluster projects and activities. Each Cluster Co-ordinator works with head teachers and other cluster staff to develop a three year cluster action plan. The review found that the action plans of some clusters are more robust than others and there is a varied level of service provided.
All Cluster Co-ordinators’ employment also sits with lead schools in the cluster they manage; this supports the alignment of performance management with the employment responsibilities. The fact that Cluster Co-ordinators also have different job descriptions and are managed individually by different schools is also reflective of the difference in the service provided. There is a termly group meeting of cluster heads to share good practice, aid working together and provide advice. An impact meeting with Cluster Co- ordinators is also held once a term to showcase good practice in all areas of the cluster groups. Cluster Co-ordinators also meet with Children’s Centre managers once a term.
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272 Extended Schools and Children’s Centres
Children’s Centres and extended services are ideally placed together in IEYCS as both agendas aim to improve the outcomes for children and their families and the attainment and well being of the child. This allows for IEYCS to impart a strong vision and strategic partnership approach to the delivery of services for children, young people and their families. Children’s Centres also form part of cluster groups to meet needs locally integrating relevant partners including the voluntary and community sector. A Liaison Officer was appointed at the end of October 2008. The officer is located in the Harrow Association of Voluntary Sector Organisations. Their main role is to support lasting partnerships between voluntary sector organisations and clusters and build the capacity of the voluntary sector to develop their work in clusters.
Harrow will have 16 Children’s Centres by 2011, providing in partnership with others, a range of early intervention and prevention services to children and their families. Strong partnerships with Harrow Primary Care Trust, North West London Hospitals Trust and the voluntary and community sector are also required to ensure robust service delivery plans are in place for each Children’s Centre.
The aspiration for Children’s Centres is to be the starting point for communities accessing wider services. In line with the ‘swift and easy access’ element of extended schools, there is a swift and easy access group that meets regularly with a plan of activity in place. The group has representatives from across services, agencies and partners. Information about accessing services that schools use frequently is currently being collated. The group is linked to the Common Assessment Framework Steering Group that reports to the Children and Young Peoples Strategic Partnership.
Challenges for Harrow’s Extended Schools
An internal service review of extended schools was carried out under the direction of the Head of Services for IEYCS in autumn 2007. The review included consultation with Cluster Co-ordinators and cluster heads, an externally facilitated away day, meetings with the Training and Development Agency (TDA) and a visit to Portsmouth County Council who are considered by the Department for Children Schools and Families (DCSF) as a high performing authority in relation to extended schools.
The following areas of development for cluster working were identified:
Embedding the Extended Schools agenda in every school and transferring to delivering and sustaining the services provided.
Ensuring value for money and minimising duplication of services through smart commissioning, which is cross cluster where appropriate.
Ensuring services are targeted and reach those who need them the most and ensuring the links are made to every schools self evaluation and school improvement plan.
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Ensuring effective monitoring and evaluation of outcomes are in place linked to a cluster self evaluation framework.
Further developing Cluster Co-ordinators’ knowledge, skill and confidence.
Developing performance management skills of Cluster Co-ordinators’ with clear, consistent performance measures put in place.
Cross cluster working, sharing best practice and improved commissioning.
Improving the development of partnership working within the clusters.
A year on from the IEYCS review of the services, the review group have found that a number of these points have been improved and implemented by IEYCS but there are also a number that have yet to be fully imbedded.
Changing Demography
One of the main challenges for many extended schools clusters is that although Harrow is a relatively affluent borough, the borough is also changing demographically. There are pockets of deprivation which include a number of hard-to-reach communities and the index of deprivation shows Harrow is falling nationally in its ranking for child poverty.
The issue of affordability was highlighted by many cluster co-ordinators as an increasing challenge especially as it’s a particular issue that the extended schools programme is meant to address. The reality is that in order for many Extended Schools to be sustained, charging either has been or may need to be introduced. Even charging for as little as £1 a day may be too expensive for some families. This concern has not just been highlighted at a local level but also in a recent article in The Guardian which wrote about the extended school programme:
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274 ‘Because it relies on schools combining some government funding with other sources of income – from charities, local authority grants and parental contribution – many schools are charging parents nominal fees for childcare and classes. The fees – perhaps just a pound a day for breakfast club or an after school dance lesson – may not mean much to financially –secure families, but they make the initiative unaffordable for the struggling parents for who it was conceived.’ The Guardian, 4 February 2009
Progress towards achieving the 2010 target
In October 2008, the IEYCS also used the Training and Development Agency’s self assessment toolkit to assist in further developing the Extended Schools Programme. The self assessment tool was used to support consistent and transparent discussions with the TDA, address achievements and challenges and to better identify where local authorities might need support and to facilitate national planning by providing intelligence about likely future risks to programme delivery. The self assessment toolkit provided good evidence that the borough is in a strong position to meet and in fact exceed the full core offer by September 2009 which equates to a minimum of 86% of schools meeting the full core offer. The IEYCS have also reported that they are confident that the full core offer will be met.
Good Practice in Harrow
The IEYCS has developed a self-evaluation tool for local authorities, which attempts to answer the question ‘what is a good Children's Centre?’. The tool details 29 areas of service delivery that children's centre leaders and managers can measure their own performances against. These include multi-agency work, developing a learning community, and partnerships with parents and carers. The publication will give examples of what constitutes satisfactory, good and excellent practice. It is envisaged that the toolkit will be rolled out nationally. The toolkit will officially be launched on 11 May 2009, and there are plans to pilot a one-day course on using the guidance for authorities interested in taking part.
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275 REVIEW METHODOLOGY
The review was carried out in order to assess the progress of extended schools as community resources to date and to consider any potential areas for improvement in the current service provided. The scope of the review was agreed on 4 September 2008 by the Overview and Scrutiny Committee and review group meetings took place on 3 July, 17 September, 10 December 2008, 8 January 2009 and 12 March 2009.
The review group hoped that through the review they could contribute to the wider strategic operation of the extended school programme for the overall benefit of children, young people, families and the wider community. In particular, the review aimed to: Assess the impact and connectivity of cluster activities - whether all clusters of extended schools are helping the authority deliver and promote the Every Child Matters outcomes. To gauge whether all of Harrow’s extended schools and clusters are meeting the core offer of services properly and to identify any gaps in provision. To consider whether extended schools services are a good investment and sustainable – including value for money considerations around finance, performance, attendance rates, exclusions and uptake of services. To identify and share good practice within extended schools clusters. To maximise links between children’s centres and extended schools to ensure joined up services. To consider the strategic development of extended schools services and the links to the different priorities of partner agencies. To evaluate the value added to the community through the provision of extended services in schools, including engagement with stakeholders. To highlight any issues that warrant further study by scrutiny
The review group employed the methods listed below to support their investigation: Initial briefing on national policy and research Detailed officer presentations, supplemented by oral evidence and relevant documentation Discussions with the Head of Service Early Years Childcare and Parenting, Integrated Early Years & Community Services Team Manager and the Childcare & Parenting Service Manager desktop research The methods detailed above assisted members in carrying out a stock take and get further understanding of progress to date, the services provided across the borough, the cluster group structure, the challenges and any gaps in provision and also areas of good practise. The information gathered assisted the review group to set out and plan the consultation element of the review.
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Consultation via meetings, visits to schools, visits to activities and informal discussions were carried out with the following groups/ individuals: cluster head teachers group children, young people and parents Parent Ambassador school Learning Development Assistant parent governors
Cluster Case Studies
The review group decided early on when planning the review that it was important to carry out fact finding visits with cluster groups in the borough to get an idea of the various activities and services provided at first hand. Due to the limited timescale, the review group decided to look at three out of the seven cluster groups as case studies to help inform the review. The different cluster groups were chosen on the basis of their level of service and performance the remaining four clusters were consulted afterwards. The visits took place between 4 February and 14 February 2009.
Members of the panel visited activities in the following cluster groups: Canons HA2Cando CHUnite Discussions also took place with the 3 Cluster Co-ordinators. The Chairman of the review and the Scrutiny Officer also met with the head teachers in the Canons cluster. Detailed below is a summary of the visits and further details are included in the appendix of this report along with the responses from the consultation with the remaining four other Cluster Co-ordinators.
Canons Cluster Head Teachers Meeting, Little Stanmore School – 4 February 2009
The chairman of the review group met with Canons Cluster Co-ordinator and the Canons Head teachers. The Canons cluster develops their work programme from the basis of the needs of the cluster along with consultation with children, families and the community. The cluster group is also making some steps and progress to develop a closer relationship with the community. There is also a Parent Ambassador scheme operated in each of the schools in the cluster which has proven to be very effective in improving communication and the performance of some pupils.
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Canons Cluster Visit, Canons High School – 10 February 2009
The chairman of the review group met with the Canons Cluster Co-ordinator, the Head Teacher of Canons High School, the Learning Assistant, Parent Ambassador and pupils at the school involved in the Cultural Heritage Programme. The chairman of the review was briefed by A-Level pupils involved in the cultural heritage programme who were each looking at different topics to address culture, heritage and ethnicity including fashion, fostering and dance.
A-level Students
The Learning Assistant and Parent Ambassador explained the role of the Parent Ambassador which is to provide a link between schools, parents and communities to improve the attainment and well being of pupils. The Parent Ambassador works closely with pupils and families who need assistance with assimilation, integration and attainment. Often all that is required is translation, awareness of cultural practices in the UK and general support and guidance to bridge the cultural gap and aid attainment.
CH Unite Cluster Visit, Elmgrove School, ESOL Class – 12 February 2009
Prior to the visit of the ESOL class the chairman of the review met with the Head teacher of Elmgrove School and the CH Unite Cluster Co-ordinator. The Cluster Co-
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278 ordinator explained that activities are decided on in the cluster group by initially carrying out a trial and depending on the level of interest generated and take up of the activity would be continued/ dis-continued. It was explained that often consultation did not really capture the voice of hard-to-reach groups and the most vulnerable. The cluster group also has a Parent Ambassador who supports children and families of Arabic and Somali background.
The Cluster Co-ordinator explained that many of the services are taken up by the many hard-to-reach communities in the cluster group. The activities including StayNPlay and ESOL classes are particularly popular. Link workers also work closely with families with more intensive issues. With regards to sustainability the Cluster Co-ordinator and the Head teacher expressed concerns over sustainability and future funding. The Cluster Co-ordinator also explained that charges were also introduced for some activities which lead to many people dropping out of activities.
The chairman of the review group was also able to witness an ESOL class at first hand. Whilst parents were in the class, their children were looked after in the crèche in the children’s centre.
ESOL Class at Whitefriars Children’s Centre
HA2 Cando Cluster Visit, Grange First – 13 February 2009
The review group members attended HA2 Cando Cluster Group and witnessed at first hand an after school club. Some members of the review group also took the opportunity to speak to pupils first hand about their experience in the after school club. The Cluster Co-ordinator reported that children come to the clubs in order to get homework done and often the children come from homes where they can often get their homework done at school in a more productive environment.
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Children at home work club
The review group also put a number of questions to the Cluster Co-ordinator. The review group heard that cluster activities are decided by schools putting forward bids for particular activities. It was reported that a large number of the community activities are mainly geared towards parents such as parenting support and ESOL classes. The Cluster Co-ordinator also reported that some of the challenges for the cluster group includes the changing population, sustainability and some of the complexities involved with charging for services and activities.
Summary of consultation with all 7 Cluster Groups
Overall the findings from the visits to the three cluster case studies and the four other cluster groups consulted are as follows:
Parent Ambassadors are extremely valuable and act as good link between parents, pupils and schools to help improve well being and attainment.
All clusters have some element of good practise though it is more consistent in some more so than others
There is a clear variance in the skills level, knowledge and confidence of Cluster Co-ordinators and in line with this there are different approaches to supporting extended schools in the borough. There is a very strategic approach looking at the needs of the cluster group as a whole and the overall policy objectives as well as a more individual school needs based approach which is less productive for cluster group working.
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Sustainability in view of future funding and long term planning is a real concern for some schools, Cluster Co-ordinators and cluster groups.
Charging for services is also a concern considering a number of activities are aimed at low income families and even when charges are set fairly low, this can sometimes reduce take up. This is a real concern in view of the fact that extended schools are aimed at meeting the needs of the most vulnerable.
The wider community is not immediately considered in terms of planning and provision of services as they are immediately taken up by pupils and parents in schools.
Extended schools services are in high demand, ESOL classes and access to IT equipment are particularly in demand.
The links between some cluster groups and children’s centres needs developing.
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KEY FINDINGS AND CONCLUSIONS
Some evidence has shown that extended schools are having a positive impact on pupil attainment, life chances, pupil and family engagement and to some extent the review group witnessed this at first hand through their visits. Harrow is also doing notably well with regards to delivering and possibly exceeding the target to meet the full core offer by 2010.
There are some clear examples of excellent practice within Harrow’s extended school cluster groups but much of this is based on individual Cluster Co-ordinators who can most achieve value for money and head teachers buy in and support for the extended schools programme. The robustness of the approach taken by some of the Cluster Co- ordinators to cluster working also makes a difference and this can be seen due to the fact that some part-time Co-ordinators are able to really galvanise and support their individual clusters whilst at the same time some full-time Cluster Co-ordinators are not able to.
Nevertheless, the review group also witnessed at first hand that there are some potentially worrying trends in the provision of services for the most disadvantaged pupils and parents. The very pupils and parents that the extended schools programme is particularly meant to cater for are not always able to access the services. Should parents be increasingly required to pay for services? There may be real equalities and accessibility implications arising from this should payment of services increase.
There is real value in the extended schools programme but the quality of the service needs to be improved in some clusters and the programme needs to be sustainable in its own right. The review group also felt that although extended schools are clearly valuable to children and parents/ carers whether they are really community resources for the wider community can be challenged as access to services tends to be limited to children, young people and parents/carers associated with a particular school or cluster group alone.
Had the review group had more time, good practice in other boroughs would also have been considered as well as further consultation with parent and local residents to capture user perceptions and experiences.
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282 APPPENDIX A
SCOPE FOR REVIEW OF EXTENDED SCHOOLS AS COMMUNITY RESOURCES
December 2008
1 SUBJECT Extended Schools as Community Resources
2 COMMITTEE Overview and Scrutiny Committee
3 REVIEW GROUP Councillor Margaret Davine MEMBERSHIP Councillor Mitzi Green Councillor Manji Kara Councillor Dinesh Solanki Councillor Yogesh Teli Ramji Chauhan (education co-optee – parent governor) Despo Speel (education co-optee – parent governor)
4 Impact of ES to date AIMS/ OBJECTIVES/ OUTCOMES • To assess the impact and connectivity of cluster activities - whether all clusters of extended schools are helping the authority deliver and promote the Every Child Matters outcomes.
• To gauge whether all of Harrow’s extended schools and clusters are meeting the core offer of services well and identify any gaps in provision.
Strategy and vision for ES
• To add value to the corporate priority on ‘Extending the community use of schools while making education even better’ and help develop the corporate vision around the extended schools agenda and the overall connection with the ‘wider family’ of provision through the children’s centres.
Sustainability & Adding Value as a Community Resource
• To consider whether extended schools services are a good investment and sustainable – including value for money considerations around finance, performance, attendance rates, exclusions and uptake of services • To evaluate the value added to the community through the provision of extended services in schools, including
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283 engagement with stakeholders.
Service development and partnerships
• To identify and share good practice within extended schools clusters. • To maximise links between children’s centres and extended schools to ensure joined up services. • To consider the strategic development of extended schools services and the links to the different priorities of partner agencies.
Further Development
• To highlight any issues that warrant further study by scrutiny.
5 MEASURES OF • Expansion in the capacity of schools to meet the wider SUCCESS OF partnership agenda, for example in relation to extended REVIEW schools, children’s centres. • Enhanced culture of learning in Harrow, e.g. enhanced participation in school life for Harrow’s children and young people (including extra-curricular activities). • Contribution to the authority’s progress on sustained school improvement. • A tangible input into the process of external evaluation of Harrow’s services for children and young people.
6 SCOPE The scope of the review will only consider issues where there is the potential for the local authority to make an impact – what the Council can add to the wider strategic operation of schools and the schools’ clusters, the Council as promoting the cohesiveness of schools in Harrow.
7 SERVICE PRIORITIES Corporate priority 2008/09 – ‘Extending the community use of schools while making education even better’ (Corporate/Dept)
8 REVIEW SPONSOR Paul Clark, Corporate Director Children’s Services
9 ACCOUNTABLE Lynne Margetts, Service Manager Scrutiny MANAGER
10 SUPPORT OFFICER Fola Beckley, Scrutiny Officer
11 ADMINISTRATIVE Scrutiny Team SUPPORT
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284 12 EXTERNAL INPUT Possible input from the following may be considered during the course of the review:
Stakeholders:
• Children and young people • Parents and carers • Harrow Association of Governing Bodies • Head teachers • Teaching staff and support staff in schools • School councils and the Youth Parliament • Other local authorities • Staff within children’s settings e.g. schools, children’s centres, extended schools services • Relevant corporate director(s) • Relevant portfolio holder(s) • Integrated Early Years and Community Services Partnership • Service providers within extended school clusters • The ‘wider community’ e.g. residents within cluster areas
Partner agencies:
• Harrow Primary Care Trust • Harrow Police • Harrow Colleges • North West London Hospitals Trust
Experts/advisers:
• Advisor from SACRE • Representative interest groups • Centre for Public Scrutiny • Academic experts • Public policy think-tanks
13 METHODOLOGY During this light-touch review, the Review Group may draw upon the following methodologies:
• Desktop performance research sessions – small working groups to analyse population data and policy directions, to ascertain Harrow’s current position, identify the challenges/opportunities faced, and the relevant timescales for implementation of government direction: 1. Relevant documents will include demographic data, performance information (results, trends) for Harrow schools, reviews by external bodies (Ofsted
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285 evaluation of Harrow LA, Joint Area Review), audit and survey findings and any relevant previous scrutiny reviews 2. Stock take of extended services within schools 3. Benchmarking against other local authorities with specific reference to value for money considerations in delivering extended school activities
• Focus groups - of parents, children and young people, head teachers, governors, cluster co-ordinators (different focus groups for service users and service providers)
• Fact finding visits – to extended schools in Harrow’s clusters and to other local authorities where best practice has been identified
• Challenge session(s) – evidence gathering from key witnesses from within the local authority and more widely from partner organisations
• Survey of users (e.g. parents and children) in one or more clusters – to gather feedback on users’ access to a full menu of activities under the extended schools initiative
Methodologies open to the Review Group include: Written evidence, oral evidence, research, questionnaires, surveys, focus groups, presentations, questioning senior managers and members, inspections, site visits, expert witnesses, public meetings etc.
14 EQUALITY Equality considerations will be of paramount importance to IMPLICATIONS this review. The review will consider during the course of its work, how equality implications have been taken into account in current policy and practice and consider the possible implications of any changes it recommends.
In carrying out this review, the Review Group will also need to consider its own practices and how it can facilitate all relevant stakeholders in the borough to have their voices heard.
15 ASSUMPTIONS/ The review will require a long-term commitment from members and officers. CONSTRAINTS Success will depend upon the ability and willingness of officers, partners and stakeholders (as relevant) to participate and contribute fully in this review.
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286 16 SECTION 17 The review will have regard to the possible community safety IMPLICATIONS implications of any recommended changes to policy/practice.
17 TIMESCALE A light-touch review to be carried out over Autumn/ Winter 08/09 so as to allow enough time for the transfer of responsibility for extended schools services from the Community Learning Directorate to Children’s Services to be embedded.
The Review Group will ensure that it flags up any potential budgetary implications of its findings in a timely fashion. The final report of the review will be presented to Cabinet in Spring 2009 so as to allow recommendations to be implemented in time for the 2009/2010 academic year (September 2009).
18 RESOURCE To be met from the existing scrutiny budget. No significant COMMITMENTS additional expenditure is anticipated.
19 REPORT AUTHOR Fola Beckley as advised by the review group
20 SCRUTINY A feasibility study was undertaken and presented to the PRINCIPLES Overview and Scrutiny Committee in November 2007, assuring compliance with the scrutiny principles.
21 REPORTING Outline of formal reporting process: ARRANGEMENTS To Service Director [a ] throughout the course of the review and when developing recommendations
To Portfolio Holder [a] as a witness in the review and when developing recommendations
To Corporate Strategic
Board [a] To be confirmed
To Cabinet [a] Spring 2009
22 FOLLOW UP Initial monitoring by Overview and Scrutiny Committee (after ARRANGEMENTS 6 months) then monitoring by the Performance and Finance (proposals) Scrutiny Sub-Committee on a ‘by-exception’ basis.
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287 APPENDIX B
NOTES OF CLUSTER GROUP VISITS
Cannons Cluster Group Head Teachers meeting - Wednesday 4 February 2009
Attendees: Cllr Margaret Davine, Jackie Vaz – Canons Cluster Co-ordinator, Fola Beckley – Scrutiny Officer
Canons Cluster Head Teachers. Aylward First and Middle School – Moira Arnold Canons High School – Lynn Rowlands, Glebe (full service extended) First and Middle School – Donna Barrett, Krishna - Avanti Primary School – Naina Parma, Little Stanmore First and Middle School – Suzanne Kushner, Stag Lane First School – Nina Will, Stag Lane Middle School – Elena Evans, St. Bernadette’s Catholic Primary School – David O’Farrell, Woodlands School – John Feltham.
1. Welcome & Introduction
Councillor Davine opened the meeting and set out the scope for the Extended Schools Review, explaining that the emphasis was to explore the various elements of cluster working, value for money and sustainability. The review group also wanted to explore whether the core offer is being met across the borough, how the funding is being spent and allocated and the general progress of extended schools to date.
2. Discussion and Questions
The Canons Cluster Group
The Cluster Co-ordinator explained that the Canons extended schools cluster is well established and the schools have been working collaboratively prior to the formal establishment of extended schools. The Canons Cluster Co-ordianator is also fortunate to have knowledge and experience with adult education and has also worked as a head teacher and so this knowledge supports the work of co-ordinating extended schools. The Canons cluster makes an effort to never loose site of the focus to improve the life chances of children.
The Canons Cluster approach to working
The cluster group management team comprises of 3 head teachers who meet regularly. The cluster development plan is very detailed and consultation is carried out to develop the implementation action plan.
The Canons cluster group takes a strategic approach to managing the Extended Schools Programme, starting from the needs in the cluster (in this instance there is a high level of deprivation). Consultation with children, families and the community is then carried out. The common themes and issues are then addressed across the cluster (e.g. IT for low income families), a development plan is produced and then activities and action for specific schools are decided on.
Schools complete bidding pro-formas providing information on how the funding will be spent, what the expected outcome of the activities may be, monitoring etc. With regards to the
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288 monitoring of activities, these are collected by schools at the end of the municipal year in terms of outcomes relating to school work, attitude, improved IT skills etc.
Working with the wider community
The work the cluster is carrying out in respect of community cohesion was also discussed and there is a Community Connect event that the cluster is getting involved in on 16 May.
Canons cluster works closely with other partners and providers and play a distinctive preventative role by avoiding referral through their support of the most vulnerable and/ or deprived children via the Extended Schools programme.
Parent Ambassador
Each school has a Parent Ambassador. All the Parent Ambassadors are able to speak one of the common languages of pupils in the schools of which English is not their first language. For example, St Bernadette’s has an appointed Romanian, Polish and English Parent Ambassador.
Parent Ambassadors have not been prescribed to Extended Schools; however they have proven to be very beneficial to the Extended School Programme in Canons.
Woodlands have a slightly different approach in terms of the Parent Ambassador and work closely with Mencap and the Parent Voice Forum in Harrow. An example of a programme currently in place is a Psychologist working on sibling development. An example of the positive effects of the Parent Ambassador scheme is at Stag Lane School where the Parent Ambassador has assisted in developing the relationship with children who were previously not doing well at school who have now improved their performance.
It was stressed that training is key to the success of Parent Ambassadors. The accredited Parent Ambassadors Course involves some of what it’s taught in the Support Workers in schools course.
Sustainability
Q: What is the cluster group doing with regards to sustainability in view of the fact that the funding for Extended Schools will run out by 2010.
The cluster group has been successful in terms of accessing funding from other sources for example £1 million was accessed that was put into Kenton Learning Centre through staff at Glebe School and Stanmore College.
Children’s Centres
The Chair of the review group mentioned that she has concerns with the level of activity at Chandos Children’s Centre and that thought needs to be put into how to make best use of ESOL classes. In response it was explained that part of the problem is that parents prefer to stay locally in their own community rather than travelling out.
It was suggested that a way forward would be to look at what is being done at present at the centre and link it with the existing objective’s in the cluster group. It was expressed that what is
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289 required is someone with overall direction to support the children’s centres. Further thought needs to be given as to how communities can be made aware that the children’s centre is there.
Further Action: It was suggested that Jackie should take forward the concerns with Wendy Beeton and look at how things could possibly be improved.
The Head teachers suggested that further strategic thinking around Children’s Centres needs to take place and suggested an outreach scheme to support preventative programmes could be useful along with preventative work with Drs and health centres.
Q: The Chair of the review group enquired over how other residents get involved in the activities delivered through extended schools.
A: It was explained that activities tend to get full from parents and children and young people that attend the individual schools first as there is a great deal of demand for services and therefore making it less likely for services to be offered up to the wider community. It was also highlighted that there is wider community involvement at Kenton Learning Centre. The Head of Glebe School explained that they produce a regular community newsletter and they have internal and external notice boards.
Further Action: It was decided that a further meeting will be organised with the Cluster Co- ordinator to look at the evidence file, strategy and further information relation to the Canons cluster.
Cannons High School Visit - Tuesday 10 February 2009
Attendees: Cllr Margaret Davine, Jackie Vaz – Canons Cluster Co-ordinator, Lynn Rowland, Head Teacher of Canons High, Barbara Beckley – Learning Assistant, Grazyna Krason - Parent Ambassador,Fola Beckley – Scrutiny Officer
1. Welcome & Introduction
Jackie Vaz opened the meeting and explained that Community Cohesion is at the heart of the Extended Schools programme. She explained that each school in the cluster is addressing a different aspect of cultural heritage. At Glebe School they are running a programme called ‘Who do we think we are?’ addressing cultural heritage and background. At Canons High a number of young people are producing a film as part of this programme.
2. Canons High Students - Cultural Heritage Programme
Student A – Was inspired by the success of Italian Vogue featuring mainly BME models and was inspired by the success of Barak Obama’s presidential election. The Student explained that she would also be touching on the issue of using larger sized models in the fashion industry. As part of her work Student A will be holding interview’s with a number of people including models and other people in the industry. The project and film is aimed at challenging stereotypes.
Student B – Choose to address the issue of fostering. The student explained that she was inspired by a relative who is a foster career and has embarked on her project by carrying out research on the different types of foster care. To support the work, the student is using a case study (a student who is foster child) and also attends the school. The case study addresses
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290 where the student is coming from as an un-accompanied refugee child, their background and the foster family they are currently living with.
Q: How was the student identified to be used as a case study?
A: The student is currently also studying for their GCSE exams at Canons High and was identified at the time when both students were attending revision class. The student is on course to do well in his GCSE’s and so is an example of a successful refugee foster child doing well.
Student C – Choose to address the issue of cultural heritage by looking at how different cultures contribute to various types of dancing. The film will explore how some people step out of their box and embrace different types of dancing. The study explores people that are not afraid of being individual. The student also explained that he formerly studied dance but stopped due to the fact that it was not culturally acceptable. The film project will explore how dance breaks down barriers. The student aims for the film to show different ethnicities in the history of dance, exploring how dance has moved on and merged from culture to culture.
Q: The lead member commented that the work being carried out is very positive and enquired how the films were being produced?
A: The students explained that the films are being produced formally through the development of storyboards; scripts etc and they have received sufficient training on how to use the cameras and produce films.
Follow Up: The lead member of the review group expressed that she was interested in viewing the results of films currently in development.
3. Discussion with Barbara Beckley, Learning Assistant and Grazyna Krason, Parent Ambassador
A discussion took place with the Learning Assistant Barbara Beckley and a Parent Ambassador, Grazyna Krason
The Cluster Co-coordinator explained that the role of Parent Ambassadors is to provide the extra link between schools, parents and communities. Grazyna explained how she came to be a Parent Ambassador through a friend who had a son attending Canons High that was aware of the post being advertised. Grazyna was keen to help Polish communities and felt that the role would also be challenging. It was heard that the rest of the Canons Cluster also has access to Grazyna.
Grazyna gave the example of a student who spoke very little English, was very shy and also had special educational needs, struggling with social skills that she was able to help. As the Parent Ambassador, Grazyna was able to initially analyse the student and managed to find out that he was also weak in communicating in his mother tongue. From this a formal meeting took place between the mother of the student and herself. It was found that the student actually attended a special educational needs school in Poland, prior to arrival in the UK. From this Greysha then started working with the family and did so for a year, the student is now beginning to settle.
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291 Grazyna explained that many students often just require translation services as support for their work and she is currently working with around 8 students with English language skills at varying levels. Some of the students will also be taking an additional GCSE in Polish. There is also a Polish school held on Saturday’s where small group work sessions take place to support students.
Grazyna expressed that sometimes the difficulties with pupils assimilating at schools was simply down to differences in what is acceptable/ unacceptable, for example in Poland it is perfectly fine to take children out of schools at anytime of the year for holiday’s where as in the UK this is not acceptable apart from during official school holidays.
The Cluster co-coordinator expressed that the funding of Parent Ambassadors is a real challenge as they are valuable resources but there are concerns with sustainability.
Q: The lead member enquired about the training for the position of Parent Ambassador?
A: It was explained by the Cluster Co-coordinator that the training for the position almost equates to an NVQ
Q: Does the Parent Ambassador work a set number of hours or is it flexible role?
A: The Parent Ambassador works 4 days a week
Q: How do parents get in contact with the Parent Ambassador?
A: The Parent Ambassador is approached via the schools
Q: Was the position advertised formally?
A: Barbara Beckley explained that the Cluster Co-coordinator gave advice as to how the position can be advertised; a basic Job description was produced and consulted on by members of the community. The position was then advertised in local papers, school newsletters and also through word of mouth.
Q: Who goes on the training course, is it apparent for people thinking of becoming Parent Ambassadors?
A: It was explained that the training would not generally be apparent to people thinking of becoming a Parent Ambassador.
The Head Teacher also expressed that she is currently looking into how she can support other communities.
Activities to support the wider community
It was explained the benefits of the Parent Ambassador scheme has gone wider than Harrow. The Personal Community Development Learning Group (PCDL) is working on developing learning activities for the wider community
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292 It was explained that the Parents into Employment PIE programme supports beginners of ESOL class. The Language Café at Glebe is also available for those that have moved on from the ESOL classes.
Q: How does the Community Language café work?
A: The language café is run with the help of volunteers.
Q: What work is done with voluntary organisations?
A: The cluster group works with HASVO and PIE. The Cluster Co-ordinator is currently looking at how to work with volunteers and how to train them
The lead member expressed that she is very concerned with what is happening with adult education. The Cluster Co-coordinator agreed and expressed that children’s centers are the ideal place for adult education as the venue includes a crèche for families.
The Cluster Co-coordinator explained the approach to cluster working in Canons which involves her setting out the basic aims and objectives for the cluster group and then schools provide information on what they can deliver in respect of the targets. The Cluster Co-coordinator tries to ensure that the activities link in and fit with objectives of ‘narrowing the gap’. Canons Cluster Development Plan, new action plan coming out for next year along with a Strategy for Adult Learning.
The Lead member of the review expressed that the Parent Ambassador scheme makes a real difference and every effort should be made to preserve them.
Information request: The job description for the Parent Ambassador was requested.
CH Unite Cluster Visit - Thursday 12 February 2009
Attendees: Cllr Margaret Davine, Hashmita Gami – CH Unite Cluster Co-ordinator, Joy Lawrence, Head Teacher - Elmgrove School, Fola Beckley – Scrutiny Officer
The CH Unite approach to cluster working
The Head Teacher explained about the healthy eating programme which involves working with the most vulnerable children and the activity is held twice a week for 5 weeks. The programmme is funded through the ‘Let’s get cooking and Extended Schools Grant’.
The Cluster Coordinator explained that the approach to extended schools in the cluster is to have money set aside to carry out individual school projects. Funding has been used to employ 5 Education Link workers. Two of the link workers have been trained to deliver parent nurturing groups and delivery will start in March 2009. The cluster groups funding has essentially been used to support other people to acquire other resources to get various programmes up and running.
The issue of how activities are decided on was discussed and the Cluster Co-coordinator explained that activities were decided on by carrying out a trial for an activity/ service for a limited period and then measuring the amount of interest generated. If the interest is high and
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293 feedback is positive then the programme is continued it was found that. consultation did not capture the voice of those hard to reach and most vulnerable.
Q: The chair of the review enquired over whether parents get involved in the healthy schools programme.
A: The Cluster Co-coordinator explained that during the summer term, there is more involvement from parents. The head teacher went on further to explain that the ‘stay and play’ programme is aimed at supporting parents as well.
Parent Ambassadors
Elmgrove Middle School has used its school based project grant to fund a Parent Ambassador who works one day a week. The budget allocated to the Parent Ambassador is £43k. The Parent Ambassador supports Somali and Arabic speaking children and families was initially a teaching assistant. The position is a 15 hour a week role and is currently a temporary position, due to become permanent in September 2009.
Q: What did the recruitment process for the Parent Ambassador involve?
A: It was explained that the individual hired received training prior to taking up the post and was already working with Somali children.
Q: It was enquired over how Elmgrove Middle School links with the rest of the community and in particular the hard-to-reach communities?
A: The hard-to-reach communities in the school are the Afghan, Somali, Polish and Chechnyan. Usually the link with the community is carried out in the playground, Library etc. There are 34 different languages spoken in Elmgrove Middle School. The Parent Ambassador also works with other schools and learning assistants.
Q: Do you plan to employ anymore Parent Ambassadors?
A: They would like more Parent Ambassadors, resource permitting. CH Unite is hoping to put forward a cross-cluster bid with HOPE (Harrow Offering Parents Encouragement) to enable this initiative to be offered to other schools.
Q: How will the Parent Ambassador be sustained post 2010 when the funding will run out?
A: The Head Teacher expressed that a lot of funding will also be reduced because year 7’s pupils will be lost with the re-organisation of schools in the borough.
The Cluster Co-ordinator explained the parent StayNPlays which is currently run across 3 schools, 5 times a weeks. StayNPlay sessions reach parents in a non-threatening and informal manner.
The aim of the project is:
To bridge the gap between school and home with positive, independent, non judgemental link workers
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To fulfil the Extended Schools Agenda by leading Positive Parenting groups through the StayNPlays
To be able to sign post families onto the relevant services/agencies/activities ie. Children’s Centres, Harrow colleges, Holiday schemes etc
To enhance and build on relationships between parents/carers and schools.
To empower the parents/carers to share ideas in positive parenting the Stay N Plays
The link workers have supported parents on more intensive issues such as helping a family with gambling problems.
Q: How many ESOL courses are available?
A: 3 courses run with around 17 people from across the cluster schools on each course that is actually meant for 12 people, with a waiting list of approximately 35 parents. All the ESOL classes are held at Whitefriars Children’s Centre and Whitefriars First and Middle School in partnership with the children’s centre and the EMAS team.
The cluster co-coordinator was approached by the Somali Support School to provide ESOL classes, ICT classes and sewing classes. These services were provided by tapping into the Learning and Skills Council funding.
Monitoring
Q: What is the monitoring system that in place to assess the cluster activities provided?
A: The cluster coordinator explained that children and young people were given the opportunity to present their views on a graffiti wall. Older children are given evaluation forms to fill in. Tutors are also given evaluation forms to fill in. Link workers also write up case studies, look at registers and write up evaluation reports at the end of each term. Qualitative data and information is also compiled by the cluster co-coordinator which can be very helpful especially when bidding for funding.
Harrow High school data system is able to track children with link workers attached to them to see how they are progressing.
Working with the wider community
The Cluster Coordinator explained that in terms of the wider community accessing their services, most services are taken up by students and parents and occasionally other relatives. High schools and higher education organisations tend to hire out their premises more to the wider community.
Sustainability
Q: Have you ever considered charging for services?
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295 A: It was explained that when a charging policy was introduced, the number of people accessing activities dropped significantly though the charges were reasonable.
The lead member expressed that most of the activities were particularly aimed at low income families, charging for services may add to alienate those in the greatest need of the services. The cluster co-coordinator explained that she would be looking at alternative sources of funding.
ACTION: The lead member requested that information on the charges should be supplied
Future work of the Cluster group
Q: The lead member enquired over what the future plans for the cluster group were?
A: The Cluster Co-ordinator explained that some of the link workers will be focused on the transition work involved with children going directly into high schools. The link workers will be working with pupils who may find moving to high schools challenging and will be taking them to schools before their arrival at high school for visits in July to encourage open discussions about their fears. This is aimed at making the transition less daunting. The link workers will be carrying this out for Hatch End, Harrow High and Park High.
There will also be a film making workshop that will be held over the summer term for children who may find the transition difficult. To create sustainability the cluster group has grown their own skills by training two link workers in delivering an evidence based family link Parenting Nurturing programme. The programme has been scheduled for delivery in March 09 it provides simple, effective tools to help parents understand and manage their child’s feelings and behaviour and encourage parents and carers to enjoy bringing up children and to get the best out of family life..
The Cluster Coordinator explained that evidence has shown that the ESOL and numerical classes have assisted parents to gain better understating and in turn parents then take more of an interest in their children’s work.
Narrowing the GAP which relates to raising pupil achievement in terms of Math’s and English has been a focus but the cluster head teacher representative felt that the work being done in schools should go beyond the actual school for example in terms of the lack of reading material in some homes, support should also be provided here. Some work should be done to support parent and children in terms of encouraging the balance between nurture, education and the empowerment of parents as well.
ESOL Meeting
The chairman of the review group and Scrutiny Officer had the opportunity to attend a beginners ESOL class involving Somali and Afghanistan women. Whist the women are taught their children are in the children’s centre crèche.
The students showed a keen interest in what they were taught, encouraged one another and worked hard to understand and develop their skills. The students requested homework and explained that the classes also assisted them in understanding the homework and lessons their children were being taught.
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296
HA2 Cando Cluster Visit - Friday 13 February 2009
Attendees: Councillor Margaret Davine, Councillor Yogesh Teli, Julie Browne – Kids Can Achieve, Maggie Coates – Cluster Co-coordinator, Sue Carlton – Head teacher at Grange First, Fola Beckley, Scrutiny Officer
1. Welcome & Introduction
The review group members were met by the Cluster Co-ordinator and the Head teacher of Grange First. The review group members then moved on to view the Homework club. Members were briefed that pparents are also able to attend the homework clubs to develop a better understanding of what the needs of their children are. The club is overseen by a teaching assistant who works with the pupils who are of varying ages. A register is taken and the class goes on till 4.15. The club is free and funded through the cluster group. Homework is always set on Friday so it can be done at the club; the class is always full with 25 - 30 children attending. There is also a homework club held on Thursdays.
It was explained that there is quite a number of Somali children that attend the homework club as the environment is sometimes more conducive than their home environment for homework, they are able to settle and work better. A particular example of a child that had problems at home was able to do their homework in the homework club and in turn the learning assistant then passed the homework on directly to their teacher.
The after school club
Q: It was enquired over what encourages the children to come?
A: The children like to get their homework done and it is convenient for parents.
Q: Are parents pushing for the service?
A: Yes, great deal of demand
Value for money of cluster groups
Q: How do schools access the funding for their various activities in the cluster group?
A: There is a bidding process, schools map out the activity and programmes they can run along with the intended outcomes
Q: How are the benefits of each service analysed?
A: The Cluster Co-ordinator analyses at information with regards to attendance, general views on the services provided and case studies
Activities to support the wider community
Q: Are there any programmes geared towards parents?
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297 A: More focussed on how parents can support children, there are parent groups but they tend to change a lot
Q: What services are provided for the wider community?
A: Large number of ESOL classes held during the day and evening and these are always full. Some parents also use IT. All schools within the cluster have an ESOL class except for Alexandra School.
Q: Is there evidence that the ESOL classes have a good effect on children?
A: Unable to say as it is a long term issue that can be easily quantified
The cluster
Q: How are issues addressed across the entire cluster?
A: They hold regular meetings with cluster heads
Q: Are the clubs and activities in the cluster targeted?
A: Some clubs are particularly targeted for more vulnerable, low income families
Q; How is good practice spread across the cluster groups?
A: They meet and share good practice and develop services across the cluster by schools bidding for funding to provide particular services.
Issues for the cluster
Q: Are there any key issues for this particular cluster?
A: There is a changing population with greater demand on the service as well as support required for a number of Somali and Tamil children who are under-achieving
Q: What is the cluster group doing to address these key issues?
A: Working and getting down to an individual level with children through personal encouragement and support. The cluster has acquired extra support from EMAS. After school clubs help to get pupils achievement up not just in terms academics all the time but also well being
Q: Are there any particular issues in subject terms?
A: Often math’s but a lot of the time it is behaviour problems
Q: Do all schools in the cluster have after school clubs?
A: yes, in terms of breakfast clubs, if these are held at a school that a child doesn’t attend they are dropped off at their school afterwards
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298 Sustainability and charging
Q: In view of funding running out by 2010, what are your plans for the future?
A: They will be accessing New Opportunities funding, breakfast club is currently financed via the schools budget. Some after school clubs charge though they have yet to have had any services that were initially free that they have now had to start charging for. There is a reasonable charge for some activities/ services. There is a rolling programme of activities per term.
Q: How has the increase in prices affected low income families?
A: Sometimes there is individual support available for families with particular difficulties.
Q: How do you find out, assess what services to provide?
A: Consultations are carried out with schools, through parents evening and newsletters that go out to all parents
Q: How are the services provided publicised?
A: Through notice boards, newsletters, parents evenings
Q: What are the general costs of some of the activities provided?
A: Breakfast club £1 for drop in, after school club £6.00/ £6.50 per day
Q: What is the provision during holiday period?
A: Half term holiday club there isn’t good take up, probably due to the inconvenient timings as the club runs from 9am – 4pm and making the club affordable is also an issue
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299 CONSULTATION WITH CLUSTER GROUPS NOT VISISTED
West Cluster Consultation
March 2009
Written submission from Evania Inward, Cluster Co-ordinator
What activities do you provide within your cluster?
West Cluster provides a range of activities and projects for both children and families of the schools in all core offer areas. These include: Clubs and classes for children and young people to support enjoyment, new activities they haven’t experienced before, study support for ICT, homework or other targeted areas of need, family learning opportunities Activities & opportunities for parents and carers to socialise and become more involved in school activities, especially where they may be isolated Direct access for children & young people to school counselling, play therapy, Educational Psychologist support and a range of other specialist services Community Education Projects – a small grant will be available again this year to empower and enable children, young people, families or local not-for-profit community groups to have a say about what they think they want and then lead on developing their own activities (with support) School staff, parents and local community members are being trained to run parenting groups (Family Links Nurture Program) and to become Learning Mentors to support children 1-2-1 and groups – both new roles in schools.
Please see the attached action plan 2009-10, a recent newsletter and the scrutiny evaluation report which gives a good idea of the range and scope of activities and whole school development.
How are the activities decided on? a) The Community Development Leader (Cluster Co-ordinator) meets 1-2-1 with individual school Head Teachers, SENCos and or extended serviced lead staff in individual schools to discuss: the current provision and evaluation of last years projects and activities in the school feedback and results of any surveys and consultations with children, young people, parents, carers and the wider community (undertaken over the previous year by the cluster and by individual schools) target groups, needs and gaps in provision (including children and young people who are ‘at risk’, vulnerable and disadvantaged, underachieving and hard-to reach families) the school’s aims and objectives to develop their extended services provision in the following year Schools will also have a SIP and SEF that will inform planning
Head Teachers and the co-ordinator will keep up-to-date with local strategic priorities such as the Children and Young People’s Plan and input relevant target groups and issues into the cluster to inform planning.
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300 b) When all schools have had in depth meetings with the co-ordinator, the whole cluster heads steering group meets to decide on common strategic priorities and target groups across the cluster. All schools and Children’s Centres in the cluster are encouraged to be active participants in this process. Generally participation from all schools in the cluster is excellent. c)The co-ordinator, with support from the Management Team (consisting of 2 appointed head teacher representatives who line manage the co-ordinator, including the lead head who has overall financial accountability) will complete a West Cluster action plan based on the cluster’s decisions & common needs. d) The Co-ordinator meets regularly throughout the year with heads, senior management, staff, parents and other project leaders delivering extended services in all the schools, to enable and support implementation and evaluation of the plan where appropriate.
What is the cluster groups approach to working?
Cluster heads and senior school staff with lead responsibilities for Extended Schools meet every half term as a whole cluster steering group. This group works very well as an active and participatory partnership, making collective decisions and as a supportive learning forum where schools share good practice in a range of areas that they are developing and hear about topical issues and opportunities. We rotate whole cluster meetings around the different cluster schools with the hosting head teacher chairing the meeting. Depending on expertise, interest and facilities, different head teachers or lead staff will also take active lead roles in leading on new projects or to support the co-ordinator with particular project areas, recruitment, grant panel or hosting cluster events in their school on behalf of the cluster.
We also encourage and enable staff and parents across the different cluster schools to meet together at least once or twice per term for peer support and learning, especially where they have new and developing roles or deliver Extended Schools, for example: Nurture network for parent group leaders (33 trained so far) – twice termly meet up to enable training (e.g. talks from local professionals), peer support and clinical supervision with the school counsellor dealing with any issues arising from delivering parenting courses Cluster SENCos Forum – (newly forming) – aim to meet twice termly, supported by Educational Psychologists for sharing best practice, resources and specialist training Learning Mentors Link Up group – (newly forming) sharing ideas about how to implement the new role
Are the activities decided according to the needs of the cluster? individual schools?
Both, the process of strategic cluster prioritising and planning decision-making is described above in 2), but the schools may implement the cluster priorities through different activities and projects, different clubs or classes that will target the specific and localised needs of the children, families and communities that they serve.
Is a bidding process employed?
The cluster fulfils local authority criteria in order to receive the overall cluster extended schools funding on an annual basis (action plan and related budget, evaluation reports, and recently we have agreed the detail of the cluster’s Service Level Agreement with IYECS department)
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301 For individual cluster schools to procure a £2,500 clubs and classes allocation, they are required to complete a SMART action plan proforma that outlines how, what, when, where and expected outcome measures. Our Community Education Grant has a full tried and tested application process, for which applicants must provide full details of the projects aims, outcomes and a SMART action plan of how the activities will be delivered. All cluster/schools’ spending works to the FIS Financial Regulations for schools. Ledger reports are regularly scrutinised by the management team and the cluster heads steering group that meet every half term.
Do you have any notable programmes/ elements of good practise?
The Community Education Project brought 27 new projects in the first 2 years of the cluster and is unique in the borough. It aims to celebrate and use individuals’ strengths and skills, to empower and enable children, families and local people to lead on their own projects and find their own solutions to their needs. The grant has shown good value for money, and brought a range of new partners and better involved parents in the schools.
The West Cluster now has 33 trained staff, parents and more recently bi-lingual community members to deliver the Family Links Nurture Program for parents in-house across all the cluster/schools. We hope to bring this program to more non-English speaking families and are looking at teenager-appropriate activities for the High School.
What process/ procedures do you use to monitor the impact of the cluster activities?
A range of quantitative and qualitative measures are employed that are appropriate and relevant to the project, activity in question The person leading the activity will be responsible for monitoring impact and outcomes, and the co-ordinator endeavours to collate all this from both the Head Teachers and the various lead persons (for example, parent group leaders, homework club leader, School Counsellor, Educational Psychologist, Play Therapist). Please see latest action plan for more details. For clubs and classes, individual schools are required to complete a proforma that shows the benefits and outcomes from the activities they ran with their allocation of £2,500 per school Project leaders running community education projects are required in their application to state how they will measure progress and success of their projects. This has shown to be an area of learning and need however as there is a lot of training and capacity building to be done to ensure people understand the reasoning and methods of measuring impact The co-ordinator maintains ongoing verbal and written consultation and feedback wherever possible. All meetings and key issues raised by children, parents or staff about any extended services activities will be recorded in an appropriate way to inform project evaluation and changes to future planning.
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302 Do you have Parent Ambassadors?
Not currently but the West Cluster would like to employ Parent Ambassadors that have bi- lingual skills and knowledge/experience of the different ethnic, cultural and faith communities that we serve.
A couple of schools have or are interested in class parent link schemes, and the West Cluster this year has a new priority of finding new and creative ways of engaging and involving ‘hard-to- reach’ parents and carers.
Funding such roles is the main barrier – we are looking at £5k p.a. to sustain one part-time Parent Ambassador. We are working with other clusters to explore funding and partnership opportunities with the voluntary sector.
If you do have Parent Ambassadors, how did you got about employing them? what are their terms of employment? Are the focussed on assisting a particular community in the school? Do you have a job description for the role?
Currently exploring all these issues - would be grateful for any advice on this.
Do you work with the other cluster co-ordinators in the borough?
Cluster Co-ordinators try to meet half termly depending on time, to learn from each other, attend training or events, share good practice and solve challenges together. We have recently been assessing where are our common target communities, common areas of concern in delivering extended services across the Harrow clusters, and where can we link up to provide strategic or cross-cluster support. We meet regularly (at least termly) with the local authority team manager for strategic input and learn about the latest initiatives and opportunities.
How do you work with the Head teachers in your cluster?
Please see 2) above. The co-ordinator works as much as possible in partnership with all head teachers to inform the strategic cluster direction and to drive and support activities and projects to happen in an appropriate and effective way in the schools.
Sustainability - What are your plans for the future in view of the fact that funding of Extended Schools runs out in 2010?
Many of the West Cluster’s activities focus on developing staff skills and capacity, or affordable charging for some activities, and build in sustainability wherever possible. However, we are aware that some extra activities & staff costs are dependant on the Extended Schools funding and therefore would be at risk with this loss of funding – for example the school counsellor. We are also aware that some activities would not be accessed by some children or parents if there were a charge.
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303 It is the West Cluster’s intention to explore any possible ways to enable successful, long term project to become financially sustainable, whether through charging, fundraising or other creative partnership approaches.
What activities/ what works (if any) do you do that supports community engagement/ the wider community
The Community Education Project invites local not-for-profit voluntary and community groups and supplementary schools to apply and lead activities in or with schools. E.g. Multi-cultural Heritage project, Tamil Saturday Supplementary school We have trained 4 bi-lingual community members to be Parent Group Leaders and hope to employ them to deliver mother-tongue parent groups for the Cluster schools We invite local community and faith representatives into schools – e.g. World Café event with parents and local community representatives, World in Our School Week, and TransAge places older people to works with a few schools in the Cluster We will be exploring opportunities for parents and children to meet people from different backgrounds and cultures to enable better cultural and religious awareness The Cluster Co-ordinator works where possible with groups and individuals in the wider community to work with schools to provide support to children and families, for example through providing activities, volunteering or using school facilities.
Are there any key issues for this particular cluster?
The West Cluster has a very diverse community base with a range of needs and barriers to access, some of which are endemic and is rooted in long term experiences and cultural expectations/aspirations. We endeavour to ‘chip away’ in raising aspirations, encouraging, empowering and involving people from different backgrounds and situations, and providing positive, practical solutions where we can. However, a long term and sustained approach is necessary to support community development, community-based grass roots and voluntary sector work outside and beyond the reach (and remit) of schools.
Schools’ staffs are at capacity with undertaking new roles they are fulfilling in addition to their core work of teaching and learning, and we find that some can reach saturation point. Extra funding is often needed to provide cover or pay to deliver extended services beyond contracted hours. While many staff and parents volunteer their time and skills free, this is neither preferable nor sustainable in the long term.
Strategic cross-borough staff support: clusters would like to work with Workforce Development to explore borough support for school staff and parents delivering extended schools activities. In particular, parent group leaders, learning mentors and school counselling/therapeutic staff, commonly working in many Harrow schools.
Swift & Easy Access can be easier said than done! Many public and voluntary sector services in health, social care and family outreach services have limited capacity, funding cuts and a range of competing different targets and agendas, and whilst we always work in a spirit of creative and positive partnership and look for opportunities and links, sometimes it is a challenge. Long term strategic and practical working to plan for cross-cluster, cross-borough work in schools for children 0-19 years is welcomed. CAF also not up and running in Harrow – schools have various questions and issues about this.
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304 Stanmore Kenton Cluster Consultatation
March 2009
Consultation with Susan Scott, Extended Cluster Co-ordinator for Stanmore Kenton
What activities do you provide within your cluster?
Family Learning, ESOL, Numeracy and Literacy Improve your Moths Improve your English Family activities with children e.g. Forensic Science, Crafty Creations, Taste a different Sport, Design Technology Adventure Based Learning indoor and outdoor with HOAC Hillingdon Outdoor Activity Centre Parenting programme at each school Story reading in First Schools Study and revision support Counselling service in each school Breakfast Club at Bentley Wood ICT club for community at Bentley Wood Mental Health and well being project at 4 schools
How are the activities decided on?
Currently most of the programmes are historical. They have been very successfully run and evaluated well. Head teachers believe they are making a difference. Activities are designed to meet the core offer. A new approach to consultation with schools, children and families is commencing within the cluster. One programme is running as a grant was made available to commence a project on Mental Health and Well Being.
What is the cluster groups approach to working? Are the activities decided according to the needs of the cluster or individual schools?
Cluster Head Teachers meet 6 times per year to decide priorities and agree finance for projects. Decisions are based on identifying needs from each school. This can be by consultation or local Discussion with families by schools.
Is a bidding process employed?
Some projects employ an internal bidding process. The Cluster approach is to make funds available for projects e.g. counselling grant, community cohesion grant and ask schools to submit plans for how they will use the money and how they will evaluate success.
Do you have any notable programmes/ elements of good practice?
The HOAC indoor and outdoor adventure based learning is recognized as being a successful project. We are hoping that the Mental Health Project which is in partnership with other agencies will be recognized as an important piece of work when it reaches completion in the
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305 summer
What process/ procedures do you use to monitor the impact of the cluster activities?
Benchmarking the standard or behaviour of children prior to the project and then measuring success in terms of raising achievement at project completion. Teaching staff are of paramount importance in providing this data. Some projects we collect formal written evaluation. Some projects have an intuitive success rating from the start i.e. Bentley Wood breakfast club. Teachers are reporting marked improvements in punctuality.
Do you have Parent Ambassadors?
Not currently but we are looking at ways of developing parenting skills from within our staff working at the cluster schools.
If you do have Parent Ambassadors, how did you go about employing them? What are their terms of employment? Are the focused on assisting a particular community in the school? Do you have a job description for the role?
N/A
Do you work with the other cluster co-coordinators in the borough?
Yes. I am currently planning a joint project with Canons Cluster aimed at including fathers. I am developing a project with West Cluster which will be working with School Nurses.
How do you work with the Head teachers in your cluster?
Through the regular 6 weekly meetings then by individual visit to schools. Many issues are brought up and dealt with electronically. I am aware that Head Teachers time is very precious.
Sustainability - What are your plans for the future in view of the fact that funding of Extended Schools runs out in 2010?
A clear charging policy Income from lettings Identifying sources of funding, government, charities, trusts Partnership working and exchanging resources
What activities/ what work (if any) do you do that supports community engagement/ the wider community
We have 3 supplementary schools running in the Cluster. Individual schools plan visits such as the Jewish Life exhibition. We have made £500 available to each school to use on a community cohesion project that meets their local needs.
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306 Are there any key issues for this particular cluster?
Bentley Wood girls are drawn from across and outside the Borough so links with the local school and community are more difficult. We have very mixed school populations with a high level of deprivation in the Kenmore Park area and much lower levels in the Stanburn and Whitchurch catchments areas.
Pinner Cluster Consultation
March 2009 Consultation with Sukhi Cooper, Extended Schools Co-oridinator for the Pinner Cluster
What activities do you provide within your cluster?
Attached is the Scrutiny Report 07/08 which lists all activities that the Pinner Cluster has supported.
Attached is a list of activities for Jan 09/Feb 09.
How are the activities decided on?
Activities are decided through careful consultation with the schools, community, parents, children, young people and staff. This process is ongoing and built alongside parent consultation evenings in the schools throughout the year.
Consultations have also been held with specific community groups that have been identified as underachieving to determine how best the cluster can support them.
Profile data on the Pinner Cluster also provides vital information on the characteristics of the cluster community which may impact ES programmes.
What is the cluster groups approach to working?
The Extended Schools Coordinator for the Pinner Cluster meets the Pinner Cluster Executive Committee every half term to discuss and seek approval of all activities/projects in the Pinner Cluster. The Executive Committee is representative of all school phases in the cluster.
Extended Schools is an agenda item on the cluster head’s meeting which is planned just after the executive meeting to inform schools of the progress of all ES activities.
The Extended Schools Coordinator is available to speak to governors to present successes and achievements in the cluster as well as supporting schools to deliver/extend the ES core offer.
The Cluster seeks to establish good partnerships and cohesive models with schools, parents, families, the local community, local agencies, the third sector and stakeholders to ensure that all ES activities are of a good quality and help improve the quality of C & YP lives in order to thrive and achieve.
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307 Are the activities decided according to the needs of the cluster? individual schools?
The ES Coordinator meets with the Head Teacher of each school in the Pinner Cluster twice a year to: conduct/update an audit of all activities in the Cluster in relation to the core offer is carried out once a year To discuss the SEF and areas that ES can support schools to raise pupil achievement and support Community Cohesion Any areas for development through ES support
Is a bidding process employed?
No bidding processes are adopted in this cluster. Projects/activities are designed around the needs as identified through consultation and meeting head teacher’s. Schools will provide target groups in accordance to agreed base line criteria set with desirable outcomes.
Do you have any notable programmes/ elements of good practice?
The Pinner Cluster Youth Forum was set up in September 2008 with representation from most schools in the Cluster. The forum meets every month with an aim to encourage ideas from young people to be carried forward. The group has successfully secured funding for a number of bids to deliver projects in the cluster. Details are available on request.
StayNPlay sessions at Pinner Wood Children Centre where rated as Level 1. Parents with ESOL needs are targeted to learn how to use effective language through play. Crèche support is provided for younger children and older children attend a study support session which is delivered by teaching assistants from Pinner Wood. Wider Family Learning funding was secured for this model.
What process/ procedures do you use to monitor the impact of the cluster? activities?
A project plan is produced for all activities. A Health and Safety Policy booklet is sent to all facilitators. Baseline criteria are agreed with all partners with desirable outcomes. The Extended Schools Coordinator visits all programmes on a regular basis to monitor delivery and progress of programmes. Evaluation is built in during or at the end of programme for all participants and facilitators. Details of participants are kept on the Pinner Cluster database which can track participation on all ES programmes A termly report is produced which tracks all ES activities by school, adult/child ethnicity, gender which is shared with all schools.
Do you have Parent Ambassadors?
No
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308 If you do have Parent Ambassadors, how did you go about employing them? What are their terms of employment? Are the focussed on assisting a particular community in the school? Do you have a job description for the role? N/A
Do you work with the other cluster co-coordinators in the borough?
As Cluster Coordinators, we meet every term with the Extended Services Manager to discuss cross-clusters issues, training needs and any new advances in relation to ES.
Good practice models are shared between all clusters and if required clusters will work together.
How do you work with the Head teachers in your cluster? As described above.
Sustainability - What are your plans for the future in view of the fact that funding for Extended Schools runs out in 2010?
The action plan for the Pinner Cluster 09/10 has addressed how they intend to sustain projects/activities.
seeking funding to sustain projects creating, maintaining partnerships with other external/local agencies embedding sustainable models in schools Charging policies
What activities/ what work (if any) do you do that supports community engagement/ the wider community.
The Extended Schools Coordinator has completed a community engagement, extended services audit for all cluster schools - this is attached.
Are there any key issues for this particular cluster?
Sustainability once funding runs out in 2010.
Children First Cluster Consultation
March 2009 Written submission from Patsy Headlam, Cluster Co-ordinator
What activities do you provide within your cluster?
ESOL classes, Holiday Play schemes, breakfast and after school clubs, Learning Mentors, Counsellors, Art Therapists, various community learning activities, annual Community Performing Arts Day, Legal Advice Clinics, parenting classes, one off events ie. ‘Help Your Child to Learn’ evening.
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309 How are the activities decided on?
Consultations are carried out with parents and children which help us to pinpoint what activities are needed. The cluster schools may also identify a need.
What is the cluster groups approach to working? Are the activities decided according to the needs of the cluster or individual schools?
Some activities are specific to the needs of a particular school i.e. ESOL classes and the work Harrow Mencap do in the clusters’ special schools. But some activities are available to all cluster schools such as the Community Learning programmes, performing arts day and holiday play schemes.
Is a bidding process employed?
Yes – each cluster school was able to bid for up to £2k last year for extended schools related projects.
Do you have any notable programmes/ elements of good practice?
In the past, we have secured £20,000 from the e-Learning Foundation to contribute to laptops for four schools. Kingsley High School is a school for children who have profound learning difficulties and as a result they were able to purchase inclusive technology to enable their pupils to use IT.
The cluster schools have signed up to a Minibus Sharing Protocol which enables minibuses to be shared across cluster schools. We also organise training for school staff so that they are able to drive the minibuses. This scheme has saved transport costs in some of our schools at no cost to develop.
This year we will be taking our annual Community Arts Day which involves 200 children from cluster schools, to Under One Sky as part of our outreach work. The cluster is happy to pioneer a range of activities and projects and then share them with other co-ordinators so that all Harrow families benefit.
What process/ procedures do you use to monitor the impact of the cluster activities?
Tutor and participant evaluation forms are completed after activities. The evaluations are shared with Heads at cluster meetings.
Do you have Parent Ambassadors?
No
If you do have Parent Ambassadors, how did you go about employing them? What are their terms of employment? Are they focussed on assisting a particular community in the school? Do you have a job description for the role? N/A
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310 Do you work with the other cluster co-ordinators in the borough?
Yes, we have regular meetings where we can share good practice and discuss issues
How do you work with the Head teachers in your cluster?
We have excellent relationships with the Head teachers and the whole cluster meet 6 times a year to discuss projects, issues and to plan activities. There is a lead Head teacher (Paul Williams, Shaftesbury) and a team of three other Head teachers who form a management team to steer the cluster and CPD.
Sustainability - What are your plans for the future in view of the fact that funding of Extended Schools runs out in 2010?
New projects are planned with this in mind. For existing projects that are cluster funded, for example counselling provision, the Heads are already talking about the possibility of budgeting to pay for this out of school funds. For subsidised activities such as the holiday play scheme, I negotiated a reduced day rate with the provider which I was then subsiding even further. In order for the play scheme to be viable, I have planned incremental rises so that by March 2011 parents will be paying the full negotiated rate.
The Cluster Co-ordinators are working on a possible funding bid with HOPE and the Parenting Co-ordinator to develop the role of Parent Mentors in schools. We are exploring ways of working with the voluntary and community sector to capacity build them to develop services through schools. We are fortunate that as a result of the recent successful £4.2m lottery fund the new youth complex development will be located within the cluster, bringing a range of opportunities for partnership working when cluster funding runs out.
What activities/ what work (if any) do you do that supports community engagement/ the wider community
We have links with the Afghan Association who now hold a Saturday school at Hatch End High School and who in return for use of classrooms give the school a Pashto speaking TA for two days a week. A local firm of solicitors provide their services free of charge which enables us to run the Legal Advice Clinics. We work closely with TransAge, HOPE, HAVS and a range of organisations that provide support to parents and children in the cluster. This year the cluster is involved in the development and management of the Youth Music Stage at Under One Sky. Cluster children will be performing two pieces and will run workshops for other parents and children on the day. As Hatch End High has Arts status, the cluster is able to access a range of quality art interventions that are provided as part of their outreach work.
Are there any key issues for this particular cluster?
The cluster is unique in many ways. It is one of the largest clusters in Harrow; it is spread over the widest geographic area, it is the only one to have five High Schools and it is the only one to have two special schools. Within the cluster we have one of the areas of highest deprivation (parts of Harrow Weald) and one of the areas of most economic advantage (Hatch End). All these factors mean that whilst some activities can be offered widely to all families, many of our programmes are bespoke for individual schools in order that they meet the needs of the school communities.
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311
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312 APPENDIX C - LIST OF REVIEW MEMBERS, PARTICIPANTS AND WITNESSES
Scrutiny Review of Extended Schools as Community Resources
Evidence Review Childcare, Parent Parent Childcare, & Parenting Childcare & Years Early Serv Community Team Mngr-Integrated Mngr-Integrated Team - Yrs, Head Serv-Early of Mngr Service Q & A with IEYCS colleagues colleagues Q IEYCS & A with Canons with 4 – Meeting Cluster Head Teachers Group Cluster Canons to Visit 5 – School High at Canons HA2Cando to Visit 7 – First Grange at Cluster School 8 – FINAL REVIEW GROUP MEETING REVIEW GROUP MEETING MEETING GROUP REVIEW Scoping 1 – Plan/ 2 Project – Draft Research Desktop IEYCS from Presentation 3 – Colleagues, including: 6 – Visit to CH Unite Cluster Cluster Unite CH to Visit 6 – Elmgrove School 313 MEMBERS
Councillor Margaret Davine 9 9 9 9 9 9 9 9 (Chairman)
Councillor Green 9 9
Councillor Manji Kara
Councillor Dinesh Solanki 9 9
Councillor Yogesh Teli 9 9 9
CO-OPTEES
Ramji Chauhan, Parent Governor 9 9 9 9
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Evidence Review Review Evidence Childcare, Parent Childcare & Parenting & Years Early Community Serv Head of Serv-Early Yrs, Service Mngr - Mngr-Integrated Team REVIEW GROUP MEETING MEETING GROUP REVIEW Scoping 1 – 2Draft – Project Plan/ Desktop Research IEYCS from 3 – Presentation Colleagues, including: colleagues IEYCS with & A Q Canons with 4 – Meeting Teachers Head Cluster Group Cluster Canons 5 to – Visit School High at Canons HA2Cando to Visit 7 – First Grange at Cluster School GROUP REVIEW 8 – FINAL MEETING 6 – Visit to CH UniteCluster School Elmgrove Julie Browne, Kids Can Achieve 9 9 9
Despo Speel, Parent Governor 9 9
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WITNESSES
Wendy Beeton, Head of Service-Early 9 9 9 Years, Childcare and Parenting
Jenna Matkovich, Team Manager - 9 Integrated Early Years &
Hilary Obryn, Service Manager - 9 Childcare & Parenting
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56 APPENDIX D
BACKGROUND PAPERS AND FURTHER INFORMATION
Background Papers
Harrow Extended Services data overview, Training and Development Agency, October 2008
Extended Schools Survey of Schools, Pupils and Parents (A quantitative study of perceptions and usage of extended schools services in schools), December 2008
Extended Schools: Building on Experience, Department for Children, Schools and Families, June 2007
Making a Difference to Children, Families and the Community (Extended Schools and Cluster working in Harrow – the next three years), January 2008
Cluster group profiles and action plans from Harrow’s 7 Extended Schools
Further Information
For more information on the work of this Scrutiny Review Group, please contact:
Fola Beckley, Scrutiny Officer
Address: Scrutiny Team, Harrow Council, PO Box 57, Civic Centre (3rd Floor West Wing), Harrow HA1 2XF
Tel: 020 8420 5389 Email: [email protected] Website: www.harrow.gov.uk/scrutiny
57 316 Agenda Item 17 Pages 317 to 330
Meeting: Overview and Scrutiny Committee
Date: 11 June 2009
Subject: Improving surgical services for children and young people in hospitals Responsible Officer: Alex Dewsnapp, Divisional Director of Partnership Development and Performance
Portfolio Holder: Councillor Christine Bednell, Children’s Services Portfolio Holder
Exempt: No
Enclosures: North West London Collaborative Programme Paediatric Initiative - Briefing Note for the 8 NWL Inner OSCs and Officers
Section 1 – Summary and Recommendations
This report details the way forward for the delivery of North West London (NWL) Collaborative Programme Paediatric Initiative ‘Improving surgical services for Children and Young People in Hospital’. Chelsea and Westminster NHS Foundation Trust in collaboration with Great Ormond Street and Guy’s and St. Thomas’ Hospital Foundation Trust has been selected as the preferred provider of these services.
The 8 NWL Health Scrutiny Chairmen/ Children and Young People Scrutiny Chairmen and officers have met on a number of occasions to discuss whether formal or informal consultation is required in relation to implementing the programme. It was decided that informal consultatation was sufficient for the programme.
Recommendations:
1. That the Overview and Scrutiny Committee endorses the decisions made by the 8 NWL Health Scrutiny Chairmen/ Children and Young People Scrutiny Chairmen and officers that formal consultation is not necessary.
317 2. That the Overview and Scrutiny Committee endorses that there should be a process of on-going consultation with the public and stakeholders.
Section 2 – Report
Background
At a meeting of the NWL Joint Committee of PCT's ,Chelsea and Westminster Hospital NHS Foundation Trust in collaboration with Great Ormond Street and Guy’s and St. Thomas’ Hospital Foundation Trust has been selected as the preferred provider of complex, in-patient neonatal and paediatric surgery for children and young people (0-18 years) residing in NWL. The Trust has also has been designated as the lead centre for the NWL children's surgical provider network.
'Improving Surgical Services for Children and Young People' is a key component of the NWL Collaborative Commissioning programme. Currently, services are fragmented with paediatric intensive care beds on two sites. Chelsea and Westminster, which undertakes the majority of complex surgery does not have a Paediatric Intensive Care Unit. A new project has been embarked on to resolve the current fragmentation of neonatal and specialist paediatric surgical care from critical care in NWL which will be implemented by April 2010
Lead members and officers that cover Overview and Scrutiny of children and young people's health in NWL held a meeting on 11 May to discuss whether formal (a joint committee of the 8 NW London boroughs) or informal consultation was required to support the implementation of the NWL Collaborative Programme Paediatric Initiative. Dr Sarah Crowther, Chief Executive Officer, Harrow PCT (Senior Responsible Officer for the Initiative) and Patricia Wright (North West London Collaborative Programme Officer) give a presentation and responded to a number of questions from lead members.
It was decided that as the changes are not deemed a substantial variation in service but an improvement to a service that effects a small number of children (less than 200) across the NWL borough’s, formal consultation is not required.
At a further meeting of the NWL borough’s on Friday 22 May, it was confirmed that subject to the approval of individual Overview and Scrutiny committee’s, formal consultation is not necessary as long as there is a process of on-going consultation with the public and stakeholders. Overview and Scrutiny committees must also be kept informed.
In view of this, it is required that our Overview and Scrutiny Committee addresses whether or not we choose to endorse this approach or not.
Resources, costs and risks
There are no resource, costs and risk implications specific to this report. 318
Staffing/workforce There are no direct staffing or workforce considerations specific to this report.
Equalities impact
The North West London Collaborative Commissioning programme incorporated equalities concerns as part of the work in identifying Chelsea and Westminster NHS Foundation Trust in collaboration with Great Ormond Street and Guy’s and St. Thomas’ Hospital Foundation Trust as the designated lead centre. In turn, the NW London boroughs also considered this when making their decisions over the option of either formal or informal consultatation.
Legal Implications None
Financial Implications
There are no direct financial implications for the council specific to this report.
Performance Issues
There are no performance considerations specific to this report.
Section 3 - Statutory Officer Clearance
This is not required for this report
Section 4 - Contact Details and Background Papers
Contact: Fola Beckley, Scrutiny Officer, [email protected]
Background Papers:
Briefing Note – NWL Collaborative Programme Paediatric Initiative ‘Improving Surgical Services for Children and Young People in Hospital’
Detailed in If appropriate, does the report include the following considerations?
1. Consultation NO 2. Corporate Priorities NO
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Briefing Note for the 8 NWL Inner OSCs and Officers 12th May 2009
NWL Collaborative Programme Paediatric Initiative ‘Improving Surgical Services for Children and Young People in Hospital’
Executive Summary (extract from the Pre-Consultation Business Case document)
The Improving surgical services for children and young people in hospital project is a key component of the North West London Collaborative Commissioning Programme, covering a population of around 1.85 million, developed by the NWL PCTs (NHS Brent, Harrow, Ealing, Hammersmith & Fulham, Hillingdon, Hounslow, Kensington & Chelsea, Westminster) for the period 2009 to 2014.
Improving health and social care services for children, young people and maternity services to the levels expected within the National Service Framework (NSF) for children, young people and maternity services (2004), Every Child Matters and Healthcare for London has been identified as a key initiative within the plan. However, it is also recognised that this is a large piece of work, some of which is being done at a local level and some of which requires collaboration. In response to clinical concerns about the fragmentation of complex neonatal and paediatric surgery and critical care, the NWL PCTs agreed to focus on improving surgical services for children and young people in hospital as the first phase of the collaborative work. The aim of this project is to ensure the ongoing safety and sustainability of surgical services for children and young people (0-18 years) and to transform the quality of care, wherever it is provided, to a level equivalent to the best in the world.
Case for Change
Clinical Drivers for change The literature on specialist paediatric surgery and critical care (Appendix 2) makes a strong clinical and organisational case for the development of a Lead Centre for specialist, in-patient Paediatrics, which would be the ‘hub’ for a paediatric network, within a given geographical area.
Such an approach is known to reduce mortality and morbidity due to the concentration and co-location of facilities, skills and expertise. Changes in medical education and the effect of the European Working Time Directive (EWTD) will also dilute expertise in District General Hospitals (DGHs) making it even more critical that specialist paediatric care is concentrated in a ‘hub’ with more routine care being provided in the ‘spokes’ with support being provided from the ‘hub’ as required.
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No formal review of paediatric services within NWL had been undertaken in the last 10 years and as a result:
• Specialist paediatric services (surgery and medicine) are fragmented • There is no clearly designated Lead Centre for Paediatrics • Paediatric Intensive Care (PIC) beds are on 2 sites and the site undertaking the majority of complex surgery does not have a Paediatric Intensive Care Unit (PICU) • PIC and Neonatal Intensive Care (NIC) services are arranged in networks but are still fragmented • There are clear standards for the provision of PIC, NIC and Paediatric surgery. At present there is little evidence to demonstrate that these are being complied with • Information to demonstrate the effectiveness and quality of care is poor
The NWL Clinical Reference Group (CRG), which provides clinical leadership to the NWL Collaborative Programme, identified the provision of neonatal and specialist paediatric surgery on three sites as a significant clinical governance issue and in need of urgent attention in the summer of 2007 (Appendix 1).
As part of the, then, CRG paediatric work stream, initially led by Dr John Fell, Consultant Paediatrician at Chelsea and Westminster Hospital, it was identified, after significant dialogue with the key clinical stakeholders the neonatal and specialist paediatric surgery, paediatrics, neonatology, anaesthetics and critical care in North West London that there was a clinical consensus that the services should be centralised on one site.
The NWL Clinical Reference Group (CRG) recommended in Oct 2007, the co-location of paediatric and neonatal surgery (the majority of which is currently provided at Chelsea and Westminster Hospital) and paediatric intensive care (currently available at St Mary’s Hospital) is essential to ensure a high quality, risk minimised service.
Clinical case for change The original CRG recommendations are supported by a wealth of literature demonstrating the deficiencies in general and specialist paediatric care, and outlining the standards to which services should aspire. By 2014 providers of paediatric services will be expected to comply with the standards described in the NSF for children, young people and maternity services (2004). NWL PCTs, as the commissioners of care, are required to ensure that the NSF is achieved by this date.
Three key publications set the context for the review of specialist paediatric surgical services in NWL.
1. The National Service Framework for children, young people and maternity services (2004)
2. Healthcare for London: Children’s Pathway Report (March 2008) 3. Commissioning Safe and Sustainable Specialised Paediatric Services: A Framework of Critical Inter-Dependencies (August 2008)
These publications support the development of a formal network of care for paediatric services if services are to remain safe and sustainable. The focus of the work should be on improving access to services for all children according to their needs, particularly by co-locating services and developing managed Local Children’s Clinical Networks for children who are ill or injured.
Following agreement on the case for change, the NWL Strategy Reference Group made a decision in February 2008 to establish a Paediatric Project Group to scope and specify the service required and make recommendations on action to be taken to improve the quality and safety of services. At this meeting it was also agreed to tender for a provider for the specialist element of paediatric surgery currently undertaken within the NWL sector.
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Project Structure
Project approach In view of the concerns expressed by the NWL Clinical Reference Group about the need to co-locate paediatric and neonatal surgery with paediatric (and neonatal) intensive care, the Paediatric Project group decided to approach the work in several phases outlined below.
Phase 1: To resolve the current fragmentation of specialist, in-patient neonatal and paediatric surgery by optimising the number of centres that provides a service and aligning paediatric and neonatal critical care with that centre. Phase 2: To create a children’s surgical provider network, co-ordinated by a lead centre, that ensures that surgical care for children within NWL is children-centred, high quality, provided as close to home as possible, meets national standards and is sustainable within the context of the Children’s NSF. Phase 3: To rationalise general paediatric care (medical and surgical) in line with the outputs from the Darzi review of healthcare in London. Phase 4: To develop a Managed Clinical Network for Babies, Children and Young People.
The project group made recommendations to the NWL JCPCT in October 2008 that Phases 1 & 2 (Appendix 3) should be combined and that this work should proceed urgently because of ongoing concerns about fragmentation of care. However, the process of developing a surgical network and any recommendations from it should be evolutionary and should dovetail with the emerging work from HfL.
Objectives of the proposed scheme The project aims:
1. To resolve the current fragmentation of in-patient, neonatal and specialist paediatric surgical care from critical care in NWL by April 2010; 2. To designate a hospital as the lead centre for an evolving children’s surgical provider network across NWL; and 3. To develop a Managed Clinical Network for Children, Young People and Maternity Services commencing in April 2009, with full implementation in April 2010.
Objectives 1. and 2. are the focus of this business case.
Governance The programme is governed in accordance with the North West London Collaborative Programme - Governance Arrangements (November 2008) (Appendix 12).
A Paediatric Project group was established to oversee the work and to make recommendations on proposed changes for decision by the NWL JCPCT. The work of the Project group was supported by advice from external clinical experts, PricewaterhouseCoopers, Capsticks Solicitors LLP and Participate Ltd.
Independent review of the process was undertaken by the Health Gateway team, National Clinical Advisory Team (NCAT) and The Consultation Institute.
Tendering the Services To obtain approval from the NWL JCPCT to tender for a provider that could address the issues identified in the sections above regarding the current provision of complex neonatal and paediatric surgical services, first it was necessary to define the ‘case mix’ of surgical cases for the children and young people of NWL for which such concerns were held. This was to be quantified both in terms of volumes and cost.
The eight NWL PCTs have 28 providers that undertake complex in-patient neonatal and paediatric surgery for children and young people aged between 0 – 18 in NWL. The estimated annual volume of cases by
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PCT that met the requirement of the ‘case mix’ that was to be tendered within Phase 1 (based on the methodology defined in this document) is included in the table below.
Responsible PCT List A - Complex List B – Non-complex Total List A –Complex 0-14 0-1 year 1-14 years 0-1 years years 15-18 years Brent 21 42 24 87 21 Ealing 12 53 22 87 16 Hammersmith & Fulham 20 18 18 56 14 Harrow 13 12 8 33 18 Hillingdon 12 14 20 46 18 Hounslow 19 41 18 78 26 Kensington & Chelsea 8 18 13 39 13 Westminster 12 16 15 43 8 Total 469 134
The estimated cost of these cases is circa £2.3m.
Based on data from the eight NWL PCTs the network will manage a surgical patient population of circa. 13,000 cases aged 0 – 18.
Stakeholder Engagement
An extensive programme of stakeholder engagement was developed for the project. Engagement support was commissioned from an organisation called Participate Ltd who are experts in public involvement and communications. Participate is also an Approved Partner of the Consultation Institute. Participate developed a comprehensive engagement plan (Appendix 7) for the programme and co-ordinated the development of an identity and a series of workshops, focus groups and a comprehensive public dialogue process.
The insights from the stakeholder engagement in general supported the case for change and the development of a children’s surgical provider network.
All of the insight and information generated from the engagement process was used to refine the Service Specification and the High Level Evaluation Criteria.
Information gleaned from the original CRG recommendations, and the Bidder dialogue process and Clinician event in early February 2009, was used to review the Service specification to ensure that it appropriately reflected the need for safe, high quality, co-ordinated care. In particular, the Service Specification was refined to give greater emphasis to:
Governance Leadership Efficient use of resources Addressing the HfL principle of “localise where possible, centralise where that improves the quality of care” Use of technology Understanding the differing needs of different age groups/stages of development Clearly defining the scope of the Provider Network
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Key issues arising from the Patient/Carer and Parent/Public events included the importance of:
Staff and resources - right staff will deliver everything else Facilities – reflecting the holistic aspects of care Quality of care Communication – in its broadest sense
All of these issues were covered in the final ITT and will be addressed in more detail through the transition and mobilisation phases of the procurement process; directly through the contract with the lead provider and indirectly through the work of the children’s surgical provider network.
In addition, the Evaluation Panel was cognisant of stakeholder feedback when evaluating the Bids. For example, “Teenagers have a voice: give them an adolescent ward; space and privacy; don’t patronise them; let them have a say in what happens.”
C&WFT received a higher score on involvement of children and young people (in particular adolescents) because they already have an adolescent unit and demonstrated that they had involved young people in the production of a DVD about children’s services at the Trust
Option Appraisal
Two final Bids were received from:
• Chelsea and Westminster Hospital NHS Foundation Trust • Imperial College Healthcare NHS Trust
Both Trusts submitted compliant Bids with models of care for the complex surgery which met the requirements of the Invitation to Tender (ITT). The bids were evaluated against an agreed set of evaluation criteria and the overall scores for each organisation are shown in the table below.
Table 1: Overall Scores
Workstream Criteria Chelsea & Imperial Westminster % % 1. Service A - Provision of Care 11.13 8.51 Specification B - Strategic Fit 12.06 9.14 C - Governance 5.35 4.76 D - Quality of care 9.45 7.20 E - Focus on Child and Family 8.70 5.71 F - Workforce for the provision of Surgical 4.37 3.45 Services G - Facilities 3.38 2.66 H - Physical Access 1.17 0.88 J - Networks 10.91 8.84 TOTAL (out of 90%) 66.52 51.16 2.Commercial A - Financing Proposals 2.13 1.57 and Legal B - Pricing and Performance Monitoring 2.21 1.94 C - Transitional Arrangements 2.87 1.80 D - Legal N/A N/A TOTAL (out of 10%) 7.20 5.27 GRAND TOTAL (out of 100%) 73.72 56.46
Chelsea and Westminster NHS Foundation Trust scored higher than Imperial College Healthcare Trust across all criteria. The relatively smaller differences between the Trusts in relation to governance, proposed
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facilities, physical access and sections A and B of the Commercial and Legal criteria was to be expected given the known capability of the organisations, their relative locations and the fact that the payment mechanisms lie within the PbR regimen.
The service options proposed are summarised below.
Chelsea and Westminster Hospital NHS Foundation Trust
The text below is extracted from the executive summary provided by the Trust.
“The Chelsea and Westminster Hospital NHS Foundation and its antecedent The Westminster Children’s Hospital have recently celebrated 100 years of providing specialist paediatric care. We now submit our proposal to continue to be the acute hub for children and young people with complex surgical needs. The Trust is already the provider of 63% of this complex surgery on-site and our surgeons deliver 77% of the total work either at our site, at The Royal Brompton Hospital or at St. Mary’s Hospital. For complex surgery undertaken on our site, critical care support is provided in the Trust’s excellent Level 3 Neonatal Intensive Care Unit, which is the hub for neonatal surgery in North West London, and the Trust’s Paediatric High Dependency Unit. The Trust intends to double the capacity of its Paediatric High Dependency Unit and to extend the scope of its work to cover short term post-operative ventilation, enabling us to provide on-site critical support for over 98% of the children and young people with complex surgical needs covered by this tender.
Chelsea and Westminster is submitting this proposal in partnership with Great Ormond Street Hospital for Children NHS Trust and the Evelina at Guy’s and St. Thomas’ NHS Foundation Trust. Great Ormond Street will be supporting the Trust in the design, development and ongoing operation of our extended Paediatric High Dependency Unit. In those few cases, estimated to be no more than ten per year, in which children require the support of a full Paediatric Intensive Care Unit with associated on-site specialty support, Chelsea and Westminster will coordinate transport directly to one of our tertiary partners via the Children’s Acute Transport Service (CATS).
Chelsea and Westminster is also submitting a proposal to be the lead centre of the North West London paediatric surgical network. We will bring together a federation of London’s premier specialist children’s providers, to create London’s first formal clinical network for paediatric surgery. The federation will be anchored by four centres of excellence in the delivery of paediatric care – Great Ormond Street, Guys and St. Thomas’s, The Royal Brompton & Harefield and Chelsea and Westminster Hospital.
We will together ensure that the North West London surgical network is underpinned by the combined expertise and experience of the four centres to enable delivery of the highest standards of care throughout the network. Coordinated by Chelsea and Westminster, working together we will deliver safe and streamlined pathways of care for every child requiring specialist surgery.
Combining our expertise in research, education, innovation and the strength of our workforce we will also support other providers within the network to ensure that they can provide safe, high quality paediatric surgical care close to home wherever possible.
As the lead centre/hub we would anticipate playing a crucial role in supporting the development of the Managed Clinical Network for Children, Young People and Maternity Services in North West London.”
Imperial College Healthcare NHS Trust
The text below is extracted from the executive summary provided by the Trust.
“The proposal is for a partnership which brings together the excellence in clinical services of GOSH with ICHT. Furthermore, as constituent elements of Imperial College Academic Health Science Centre (AHSC) and University College Partners AHSC, our two lead organisations can bring to bear the expertise of two of the world’s leading universities, both committed to integrating research and education with clinical services
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to develop and implement innovative techniques and approaches that improve patient outcomes. The location of specialist paediatric services within these centres of excellence, in partnership with the North West London Paediatric Surgical and Critical Care Network, offers exciting possibilities for the improvement of the health and well-being of children and young people in North West London.
Provision of surgical services - the model of care GOSH and ICHT are already significant providers of specialist neonatal and paediatric surgical and medical care in North West London. Our network model follows that proposed by the Children’s Surgical Forum for Paediatric Managed Surgical Networks (Royal College of Surgeons 2007). Roles within the network are as follows: local hospitals will undertake mainly day case surgery; ICHT as the regional hub centre will undertake secondary and tertiary level surgery with full critical care support; and GOSH as the supra- regional hub centre will undertake tertiary and quaternary level surgery, again with full critical care support. ICHT and GOSH will work closely together to lead the network, in particular for training, education, setting standards, audit and research. Our network model is consistent with the standards laid out by the NSF for Children and Young People, Health Care for London and NWL and Specialist commissioner intentions. We are convinced that this model has the potential to improve significantly standards of surgical care for local children.
ICHT as the regional network hub ICHT already provides specialist neonatal and paediatric surgery with intensive care on one site within the North West London sector, St Mary’s Hospital, co-located with other essential paediatric surgical and medical services, including: 24-hour A&E; a 24-hour consultant-led paediatric anaesthetic service; a paediatric intensive care and high dependency unit; a neonatal intensive care and high dependency unit; a full radiology (including paediatric radiology) and pathology service; a nationally rated foetal and antenatal service; ENT surgery for airway support; orthopaedics; ophthalmology; infectious diseases; haematology & bone marrow transplantation; respiratory medicine; neurology; nephrology: allergy and immunology. Additional paediatric medical support for gastroenterology will also be sought as part of our bid. Within the network we will identify appropriate clinical pathways for cases to ensure that, as far as possible, children are transferred to the appropriate hub centre from the outset.
GOSH the supra-regional network hub As an internationally renowned children’s hospital, GOSH provides a comprehensive range of highly specialised services for children, in particular for surgery including: general paediatric surgery, urology, cardiothoracic surgery, neurosurgery and maxillofacial surgery. ICHT will link very closely with GOSH for referral of children requiring these tertiary and quaternary services. The Children’s Acute Transport Service, (CATS) is based at GOSH, and teams from both the ICHT and GOSH PICUs already support this excellent service”.
Pros and Cons of the options
C&WFT currently provides the majority of in-patient complex surgical care and requires minimal investment in workforce or facilities to meet the requirements of the tender.
The Trust has proposed a model of critical care support for the service that is endorsed by both GSTT and GOSH and meets the majority of the requirements of the 'Commissioning safe and sustainable specialised paediatric services: a Framework of Critical Inter- Dependencies (Aug 2008) provided robust pathways are in place to ensure that the care of children who require the support of a full PICU service can access it rapidly and that ongoing care is co-ordinated through strong partnership arrangements. The Evaluation Panel was reassured at the Bidder Presentation Day that the Trust had considered the staffing required to deliver this model of care and this would be developed further in conjunction with GOSH.
ICHT described a model of care that also meets the majority of the requirements of the 'Commissioning safe and sustainable specialised paediatric services: a Framework of Critical Inter- Dependencies (Aug 2008), in particular in relation to co-location with surgery and support services.
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However, the Project group had considerable concerns about the assumptions made by the Trust in relation to their experience of providing in-patient neonatal and paediatric surgical services for the cohort of patients and their plans for staffing the service by April 2010. In particular, the assumption was made that all staff working in the current service at C&WFT would TUPE across to ICHT. There was little acknowledgement of how difficult this process could be, or that an alternative staffing plan (or the likelihood of its being required) should be in place.
Risk
Overall, the information provided by C&WFT gave the Evaluation Panel greater confidence that the model of care proposed, particularly as the Trust was already providing a significant part of the service being tendered, would achieve the aim and objectives of the project with minimal risk. The Panel felt that any residual risk could be mitigated through the mobilisation phase of the project.
The Panel had considerable concerns about ICHT’s workforce model, in particular, their assumptions around TUPE and the lack of any contingency plan should staff not transfer under TUPE. There were also concerns about the Trust’s ability to deliver the project within the agreed timescale.
Conclusions
The organisation of in-patient surgical care for children and young people (0-18 years) in NWL is fragmented. Clinicians in NWL raised concerns about fragmented care and the risks to the ongoing safety and sustainability and quality of care in 2007.
The NWL PCTs responded to these concerns by tendering for a lead centre to resolve the current fragmentation of in-patient, neonatal and specialist paediatric surgical care from critical care in NWL by April 2010 and to be the designated lead centre for an evolving children’s surgical provider network across NWL.
Two final Bids were received from:
• Chelsea and Westminster Hospital NHS Foundation Trust • Imperial College Healthcare NHS Trust
Both Trusts submitted compliant Bids with models of care for the complex surgery which met the requirements of the tender documentation. Chelsea and Westminster NHS Foundation Trust scored higher that Imperial College Healthcare Trust across all evaluation criteria.
Overall, the information provided by C&WFT gave the Evaluation Panel greater confidence that the model of care proposed, particularly as the Trust was already providing a significant part of the service being tendered, would achieve the aim and objectives of the project with minimal risk. The Panel felt that any residual risk could be mitigated through the mobilisation phase of the project.
The Panel had considerable concerns about ICHT’s workforce model, in particular, their assumptions around TUPE and the lack of any contingency plan should staff not transfer under TUPE. There were also concerns about the Trust’s ability to deliver the project within the agreed timescale.
Recommendations
The recommendation from the Project group is that Chelsea and Westminster Hospital NHS Foundation Trust be selected as the Preferred Provider of complex, in-patient neonatal and paediatric surgery for children and young people (0-18 years) residing in North West London and that the Trust should be designated as the Lead centre for the NWL children’s surgical provider network.
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NWL JCPCT meeting in Public
At their meeting in Public held on 12th May 2009 the NWL JCPCT accepted the recommendation from the Project Group that:
Chelsea and Westminster Hospital NHS Foundation Trust be selected as the Preferred Provider of complex, in-patient neonatal and paediatric surgery for children and young people (0-18 years) residing in North West London and that the Trust should be designated as the Lead centre for the NWL children’s surgical provider network.
The recommendation was approved subject to:
• Pre-consultation Business Case considered by NHSL at their NHSL Executive Meeting on the 18th May 2009 • OSCs to consider whether the change is substantial and requires formal consultation
Next Steps
• Consultation, if required • Appointment of Preferred Provider – changes to commence 1 April 2010 • Mobilisation phase – Agree contract – Ongoing stakeholder engagement* – Mobilisation plan o Facilities o Staffing etc. – Establish Children’s surgical provider network • Contract commences 1 April 2010
* Ongoing Stakeholder Engagement – Throughout the transition and mobilisation phase to establish the complex in-patient surgical service as defined in the Service Specification. o Input to design of facilities o Input to review of policies and procedures o Development of a Lead centre patient/carer forum – In the development of the Children’s surgical provider network o Establishment of a stakeholder forum o Stakeholder involvement in the development of the structure and governance arrangements for the network – In the development of a Managed Clinical Network for Children, Young People and Maternity Services o Stakeholder involvement in the project group o Establishment of stakeholder groups to support the work streams arising from the deliberations at the Project group – Regular briefings to key local stakeholders throughout the mobilisation period and early stages of the development of the network to provide reassurance that the objectives of the project are being met and the benefits realised within the agreed timetable.
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