Inspection of Adult Social Care Oxfordshire County Council Initial Findings and Areas to Explore Owner: CQC Author: Sue Talbot Version: Final Status: For discussion Issue Date: 21 st May 2009 ANNEX 1

Purpose of Meeting Facilitate openness and transparency Provide initial views on pre-fieldwork analysis to date Enable council to make an early response Further shape the fieldwork programme

Team Members Sue Talbot – Lead inspector Alison de Metz- Team inspector Penny Wright- Expert by Experience Alison Rix- Service Inspection Manager

Initial Findings Safeguarding Strong focus on raising standards and improving outcomes in the delivery of adult safeguarding activity. Priority is given to providing front line staff and managers with the skills, tools and support they need. Quality assurance systems and recording practice has been strengthened and practice is well monitored. There is evidence of some thoughtful and effective casework in supporting people with complex needs. Growing levels of involvement by partner agencies in contributing to assessment of risk, protection planning and monitoring, but some issues re. police availability.

Initial Findings Safeguarding Adult safeguarding website valued by staff and partners. Clear focus on ensuring timely reporting of concerns, but area for ongoing vigilance. Attention paid to the management and disclosure of confidential information. The contribution of advocacy to safeguarding activity has been enhanced, but requires stronger promotion in some areas. There is potential to strengthen adult safeguarding arrangements out of office hours. Adult safeguarding arrangements would benefit from a stronger focus on diversity.

Areas to Explore Safeguarding Effectiveness of ‘whole family’ approach to safeguarding activity. Effectiveness of ‘whole community’ approach to safeguarding activity. Effectiveness of arrangements for informing people about risks and strengthening ‘self protection’. Learning from and sharing of lessons to improve safeguarding practice (local and national incidents). Robustness of adult safeguarding arrangements out of hours.

Areas to Explore Safeguarding Work to strengthen capacity across the partnership to support increased levels of activity and longer term interventions. Alignment of adult safeguarding and HR standards across the sector. Engagement of people using services and their carers in shaping AS policy and practice. Support for perpetrators who are also vulnerable. Effectiveness of inter council safeguarding arrangements and response to concerns.

Initial Findings Improved Health and Wellbeing Examples of effective and person centred joint working between health and social care teams. Well developed and effective range of intermediate care/rehabilitation services. Strengthening of arrangements to support early intervention and prevention. Clear identification of local health needs and inequalities, but requires clearer outcome measures. Strong focus on ensuring people living in care homes receive appropriate care and treatment.

Initial Findings Improved Health and Wellbeing Falls prevention some good work, but requires wider promotion. Some gaps in support for people with dementia. Shared care protocols address physical health and personal dignity issues, but need expansion. Mature approach to funding and including people in continuing health care discussions, but some issues re social care staff awareness and review.

Areas to Explore Improved Health and Wellbeing The quality and impact of information, advice and support provided to keep older people and their carers safe and well. Older people and their carers’ experience of hospital discharge arrangements. The outcomes for older people and their carers using intermediate care/rehabilitation services. Impact of work to expand early intervention services. Effectiveness of arrangements in tackling inequalities in health and access to services.

Areas to Explore Improved Health and Wellbeing Local Area Agreement targets- reach and sustainability issues. Achievements in supporting people with long term physical and mental health conditions. Targeted work with older people and their carers who are dependent on drugs or alcohol. Targeted work with older people who experience sensory loss. Effectiveness of local Dignity in Care initiatives. Arrangements for End of Life Care.

Initial Findings Increased Choice and Control Examples of person centred and innovative care management practice. Efforts made to enable people to remain at home with support sensitively adapted to changing needs. Positive growth in Direct Payments and promotion of opportunities to enable greater levels of personal control and independence. Attention paid to informing local people about help available. Attention paid to seeking feedback to ensure support provided is of a good standard and continues to meet individual need.

Initial Findings Increased Choice and Control Good and creative use of volunteers. Targeted work with some groups and individuals to improve access and develop specific services where required. Positive new developments to deliver high quality and flexible day and respite services. Growth in direct access grant funded services. Some examples where the delivery of equipment/home security and safety measures could be more efficient and person centred.

Areas to Explore Improved Choice and Control Experience of people using SDS. Role development and impact of new posts such as broker. Is there ‘equality of choice’ for older people irrespective of their needs or where they live? Learning to date from Banbury SDS developments. Work undertaken to achieve ‘best’ fit of positive risk taking and safeguarding requirements. Progress in expanding range of supported housing, equipment and assistive technology options.

Areas to Explore Improved Choice and Control Quality and outcomes of support planning and review activity. Waiting lists/delays in access to help. Availability of back up/emergency support for people using self directed support. Transition issues. Support available to assist communication and engagement of people with diverse needs. Extent to which universal services are promoting a wider range of opportunities and choice for older people.

Initial Findings Leadership Clear vision and strong ambition underpins the delivery of strategic priorities. Positive and constructive partnership working between the council and most of its partners. Strong elected member involvement and support. Strong, whole systems focus on customer needs and their experience of using services. Clear and robust approach to performance management and to delivering service improvements. Priority given to staff development and accountabilities.

Initial Findings Leadership Significant adult safeguarding improvement agenda mapped, with marked progress in some areas, but work required to embed some developments. Positive challenge to strengthen focus and pace of change in addressing inequalities, but equality impact assessment work under developed. Robust management of risk. Work required to expand partner agency involvement in performance management of adult safeguarding activity.

Areas to Explore Leadership How effectively are partner agencies engaged in and contributing to the transformation agenda? Achievements linked to the Ageing Successfully and Better Deal for Older People. Progress in developing new roles and workforce competences to support the delivery of improved outcomes. Progress in enhancing workforce capacity to address growing level of need and demands.

Areas to Explore Leadership Performance management of SDS developments and benchmarking activity. Progress made in tackling areas for improvement highlighted in Director of Public Health annual report. Impact of Everybody’s Business report.

Initial Findings Commissioning and Use of Resources Clear focus on expanding support options and on enabling people to have increased control and independence in addressing their needs. Comprehensive work programme underpinning the delivery of self directed support. Value for money and sustainability embedded in organisational culture and systems. Effective work in building safeguarding culture and raising the quality and standards of service providers. Clear plans to develop alternatives to residential care.

Initial Findings Commissioning and Use of Resources Thoughtful and effective use of resources. Clear commitment to enabling and learning from the experience of people who use services. Potential for community and voluntary sector to add further value to joint commissioning arrangements.

Areas to Explore Commissioning and Use of Resources Impact of council as ‘enabler’ in supporting the transformation of provider services and the delivery of improved outcomes. Effectiveness of work undertaken to strengthen joint commissioning and to tackle gaps or unmet needs. How does the Resource Allocation System work/implications for medium term financial planning. Achievements in strengthening focus on equality and diversity in commissioning and the delivery of outcomes. How are self-funders benefiting from wider commissioning developments.

Areas to Explore Commissioning and Use of Resources Work undertaken to refine and strengthen the JSNA. Learning from implementation of pooled budgets. Progress made in securing joint investment in adult safeguarding work. Progress on issues highlighted in world class commissioning assessment. How are the new SDS developments enabling service users and their carers to have a stronger voice and control in quality and performance improvement work?

What Older People and their Carers using Services have told us so far (30 respondents) 86% reported it was always/usually easy to get in touch with people who can help. There is always someone to put one’s mind at ease. They are always polite and very helpful, but it is not the same as speaking to someone you have met. 93% said they were always/usually involved in decisions about their care needs. Always consulted about visit times and the type of help required. I am involved in meetings and reviews. I am asked what I want. OT, physio and support broker attend regularly to discuss needs and concerns.

What Older People and their Carers using Services have told us so far (30 respondents) 78% said they were always/usually offered choices about ways to meet their social care needs I am able to access a variety of support to help me cope. The care home staff take me out each week and usually I visit my home town and my local pub to keep in touch with my friends. I am now independent once again- help rapidly mobilised following my fall and hospital admission. I have been greatly helped by all the aids provided. Direct Payments ensure my mother in law has access to opportunities that offer her positive stimulation and support.

What Older People and their Carers using Services have told us so far (30 respondents) 68% said they were always/usually given enough information in a timely way There is a daily journal through which we can communicate. Generally information provided is clear. We don’t understand the regulations and what help is available in this area.

Next Steps Lead inspector to receive any additional information required/be kept informed of new developments. Confirm the fieldwork timetable. Progress planning for the public forum. Conduct telephone interviews where required. Continue to keep in contact with liaison person in managing risk and developing contingencies.