1. SERVICE INSPECTION OF INDEPENDENCE, WELLBEING AND CHOICE HERTFORDSHIRE COUNTY COUNCIL Presentation of Report 5 March 2009

2. Focus of the Inspection For all vulnerable adults: Safeguarding From Abuse For adults with learning disabilities only: Delivering Personalised Services

3. The Inspection Team Lead Inspector: Jan Clark Team Inspector: Tim Willis Support Inspector: Rachel Cheney Expert by Experience: Darren Cunningham Support Worker: Tracy Ward

4. Delivery of Adults’ Safeguarding Arrangements We concluded that the council’s overall performance in safeguarding adults was adequate. Key Strengths Responses to alerts were timely and appropriate to protect vulnerable adults There were examples of good practice The Serious Concerns Process was driving improvements in provider services The multi-agency arrangements had been strengthened The Adults Safeguarding Committee was leading developments Preventative services were being developed

5. Delivery of Adults’ Safeguarding Arrangements Key Areas for Improvement Council reporting, scrutiny and governance Managerial decision-making, oversight of practice and outcomes The approach to protection planning Performance management and quality assurance Data collection and analysis of activity and trends Recording practice

6. Delivery of Adults’ Safeguarding Arrangements Key Areas for Improvement (cont) Development of competency-based training Ensuring partners comply with procedures and expected investigative standards Involvement of experts by experience in developing arrangements Development of a Serious Case Review process

7. Delivering Personalised Services We concluded that the delivery of personalised services for adults with learning disabilities was good. Key Strengths Referral and initial responses were sound and person-centred. Eligibility criteria were clear. Accessible information for people with learning disabilities was being developed: DVDs were being increasingly used The implementation of Self-Directed support was progressing positively: the NAQ and the dedicated PCP and SDS teams were playing a key role. Imaginative actions were being taken to promote some people’s independence. The Health Facilitation Service was highly effective in working across health and social care to promote responsiveness to vulnerable people resulting in improved outcomes.

8. Delivering Personalised Services Key Strengths (cont) There was a strong overall approach to independent and self- advocacy, although take-up was inconsistent. Carers’ Contingency Plans were being introduced and were proving helpful when invoked. Day service modernisation was successfully enabling people with learning disabilities to participate increasingly in community life. Community services such as libraries and bus transport were becoming increasingly responsive to people needing extra support. People who used services were becoming increasingly involved in developing the range and quality of services that were available. The Single Assessment Process was well established.

9. Delivering Personalised Services Key Areas for Improvement Capacity issues had resulted in delays in assessment work. Work was in hand to improve the experience of young people in transition from children’s to adult services. There was more to do to improve access to information about services and community opportunities. The approach to medium and longer-term planning for people with lower levels of need could be strengthened. There was more to do to secure good health outcomes for people more consistently. A stronger approach was needed to case reviews, recording practice and the assurance of quality in care management. Support to carers was not yet strong enough.

10. Capacity to Improve We concluded that the council’s capacity to improve was promising. Key Findings There was a strong vision in the council to develop modernised, self- directed community services: this was supported by strong leadership in ACS. Councillors were supportive of the ACS leadership and agenda:they could play a stronger role in governance and quality assurance, particularly for safeguarding. Staff were well engaged and enthusiastic about the direction of ACS: creativity was being encouraged. Business planning processes could be further developed: performance management and quality assurance were developing with some good initiatives but quite a lot more to do. A refreshed learning disability strategy was planned to reflect Valuing People Now. This would sit above the existing suite of commissioning plans.

11. Capacity to Improve Key Findings (cont) Partnerships with all stakeholders were developing well and people using services and their carers felt they had real influence. The learning disability service had been successfully reshaped and was integrated. The Workforce Strategy lacked detail and workforce planning was underdeveloped. There had been a high investment in training and a good range of training and development opportunities were in place. Further work was needed to develop a competency-based approach linked to workforce planning; this was particularly true for safeguarding and had been identified by the SAC as a priority. The SAC had identified and prioritised most key areas needing development to strengthen safeguarding and was driving improvements.

12. Capacity to Improve Key Findings (cont) Joint commissioning was well established. There was more to do to ensure services were developed to reflect the participation and meet the needs of people from minority ethnic communities. More detailed work was underway on identifying the needs of people with learning disabilities. This would inform the new learning disability overarching strategy. The county had been awarded pathfinder status for its work on improving two-tier local government. Increasingly close arrangements between ACS and HPFT were evident. Contracting and performance monitoring of contracted services were being developed. Contracting was becoming more closely engaged with safeguarding work.

13. Next Steps The Business Relationship Manager would normally monitor the delivery of the council’s action plan through established reporting systems. The judgements from the inspection contribute to the Annual Performance Assessment. Monitoring arrangements will be determined by the Care Quality Commission (CQC).