To discuss the report and to make any recommendations for action by Cabinet.

Hilary Hall, Director of Adults, Health and Commissioning, introduced the item and explained this was a public interest report regarding an adult social care case that was published by the Ombudsman on September 3. Hilary Hall stated that what had happened in this case had been unacceptable and she offered sincere, unreserved and heartfelt apologies to the family concerned.

Since this case, new methodologies and practices had been introduced to ensure members of the same family were assessed in the same way. These included new methods of monitoring, mandatory guidance to ensure managers had full oversight of performance, and the introduction of a quality assurance panel to provide oversight of packages of care. This panel was chaired by Michael Murphy, Director of Statutory Services and Deputy DASS. Hilary Hall explained the panel required suitable evidence on the recommendations that were proposed by the relevant practitioner or manager before any care package was approved.

Regarding domiciliary care, Hilary Hall told the Panel that an officer had been assigned to ensure the quality of provision and monitor performance. Part of this role entailed contacting families of those in domiciliary care to ensure their expectations were being met. Any complaints would be responded to by this officer.

In respect of the case that was reviewed by the Ombudsman, the Panel was told that there was no one point of contact who had retained overall management of the various strands of the complaint for the couple involved. The complexities of the case had also made it difficult to resolve. Practice had now changed to ensure one senior manager would oversee each complaint, particularly if there were multiple agencies involved.

It was confirmed the report, and the minutes of this Panel, would be considered at October’s Cabinet meeting, where it was expected that the list of recommendations listed in the report would be agreed and actioned. Responding to a question from Cllr Story, Hilary Hall confirmed that one of the five care agencies the Council had a contract with was rated as requires improvement, and this agency had been involved in the case that was reviewed by the Ombudsman. Lynne Lidster, Head of Commissioning – People, told the Panel that at the time the complaints were first raised the agency was under a different ownership and management structure. The manager had not been able to recruit sufficient numbers of permanent members of staff and there had been a reliance on agency staff, which had led to inconsistencies in the levels of support provided and increased complaints. The Panel was told the company was under new management, the number of temporary agency staff used was now zero, and the quality assurance team at Optalis had been working closely with the agency about the level of care provided. The agency had been due an inspection in the spring but it was not possible for this to be undertaken due to Covid19. The CQC had said a re-inspection would not be possible this year. However the quality assurance team was satisfied that the agency’s standards had improved sufficiently, and if the inspection had taken place then the expectation was it would have received a good rating rather than one of requiring improvement. The Care Quality Commission had recently told the agency that as they are not deemed to be “at risk” they would not be prioritised for an inspection. No complaints had been raised in the last two months.

Cllr Story asked if there had been any cases of couples in the care of the Local Authority, as the Ombudsman had recommended that any such cases should be reviewed. The Panel was told there were 27 such cases, which had all been reviewed by the Director of Statutory Services.

Cllr Story asked for an explanation as to how Mrs Y came to be a permanent resident of a care home when 12 days previously arrangements were being discussed over possible living at home arrangements. Hilary Hall said this would be done if it was decided after review that a care home was the most appropriate setting for ensuring a person’s needs were met and were kept under constant review; similarly, a person’s ability to be looked after in their own home would also be kept under review. Michael Murphy said a care user would be considered as being a permanent resident of a care home after they had been there for at least six weeks; until then they would be classed as a temporary resident. Some care users would be put into a care home if it was considered an emergency matter, but generally any moves would only be made following recommendations that were put to the quality assurance panel from a social worker and senior social worker. Guidance in the Care Act around this was very robust and sufficient control levels were in place.

Cllr da Costa said the care agency concerned had been discussed at a previous Panel meeting in September 2019, and at the meeting it was stated that the agency was not to have their contract renewed. It was noted that the Lead Member had stated that they only wanted care providers who had been given a good or outstanding rating. Cllr da Costa said she accepted some of the reasons why this had not happened, but stated her belief that the Council needed to be more transparent in explaining the decision to renew this contract. She said it was essential that the agency have a CQC inspection review, but also congratulated the agency on now having no temporary staff involved in care. Lynne Lidster said the contract renewal had been done with good intentions as an inspection was planned and it had been anticipated that the agency would be given a good rating. He said the ‘requires improvement’ rating was not an accurate reflection of the levels of care the agency was able to provide. He also said the CQC was being pushed for as early an inspection as possible to be undertaken.

Responding to a question from Cllr Tisi, Michael Murphy stated that of the cases involving a couple to have been reviewed, no concerns had been raised about any harm to the relationship of those involved and there had been no reference to any negative consequences to one of the people in a couple having to be placed in an alternative setting due to an emergency. The new panel also meant that cases were being dealt with in a more timely manner. In addition risk assessments were being carried out at an earlier stage.

Cllr Tisi asked how other care providers, which had previously been given a good or outstanding rating, were being assessed to ensure standards were being maintained, particularly when it was not possible to carry out an inspection. Hilary Hall explained this was a focus of the care quality team at Optalis, which kept a detailed database of feedback and complaints, and there was a dedicated officer to oversee everything. The team would also perform regular enhanced visits of care providers to check standards. Lynne Lidster said contract monitoring had been continuing in spite of Covid19 and was still on schedule.

Cllr Carroll and Cllr Johnson both reiterated Hilary Hall’s earlier remarks and offered heartfelt apologies for what had happened in this case, and stated that they did not want something like this to happen again and it was important that lessons were learned. Cllr Carroll said Cabinet was the most appropriate forum for the matter to be discussed further and encouraged all Members to attend if possible. He said an internal review had been undertaken and new protocols and quality assurance measures were now in place. Cllr Carroll said it was important that the Council took a proactive approach to all aspects of its work. He said he would write to the CQC to ask for an inspection of the care agency to take place as soon as possible, and ask for a timescale to be given. He said an inspection would provide maximum assurance to residents that standards of care were high.

Cllr Hunt said she wanted to receive quarterly updates on the actions that were recommended in the Ombudsman report. This was agreed by Members.

RESOLVED UNANIMOUSLY: That Panel recommends that

i.              Cabinet agrees to fulfil the recommendations made in the Ombudsman report

ii.            The outcome of the scrutiny and a further report will be sent to the Ombudsman in three months’ time updating on progress

iii.           Quarterly updates on progress against the actions will be presented to the Adults, Children and Health Overview and Scrutiny Panel.