Sefton Council adult social care preparation for assurance peer challenge report

Sefton Council requested that the Local Government Association undertake an Adult Social Care Preparation for Assurance Peer Challenge at the council and with partners. The work was commissioned by Deborah Butcher, Executive Director of Adult Social Care and Health (DASS), Sefton Council. She was seeking an external view on the readiness of the Adult Social Care Directorate for the arrival of the Care Quality Commission’s Assurance inspections at some point in the near future and also a view on how the council is able to deliver value for money, quality, effectiveness, and the most personal outcome focused offer for local people. 

Sefton Council like many other councils acknowledge that they are under pressure. This context is shared and replicated across the whole health and care system. The pressures of demand, the pressures of caseloads, the pressures of people waiting to receive services is not one that Sefton stands alone on.  The whole system is under a great deal of strain. 

Working with people  

The peer team met a wide range of staff throughout the peer challenge and it is clear that they are the Directorate’s greatest asset. They are positive and appear well motivated to do their work. There is an explicit strategy focusing on prevention and early intervention to help people live healthier lives. This was backed up by a revised front door with a focus on advice, information and sign-posting. There is also a plan to have investment in the Third Sector so there are resources to signpost clients to. The Directorate is creating a Transitions to Adulthood Team as a dedicated and specialist resource for this cohort of service users. 

Sefton Council has a market position statement in place that explores market shaping and the work needed to develop the future market requirements. The Directorate should consider updating the directory to make it accessible online. 

Providing support  

There are good relationships with providers and Strategic Forums are in place to work together.  There are strong partnerships with the NHS. The peer team felt they were mature and had strengthened during Covid. The DASS being appointed as the new Place Director for Sefton in the NHS Cheshire and Merseyside Integrated Care Board is a real opportunity. 

The Place-based approach by Sefton Council working in communities is a real strength and there are plans for it to be rolled out. The peer team heard that staff would welcome greater clarity and direction on the issue of hybrid working. There is also an opportunity with Place Based working and Third sector investment to identify and embed strengths based practice as a practice methodology and organisational change process to meet the Directorates strategic objectives 

Ensuring safety  

There is a robust model for transitions and the peer team heard evidence of a good system for identifying people who are transitioning into adulthood and who have complex needs. There is active take up by young people of direct payments to buy the right support. The peer team would like to see a wider choice for young people especially around pathways into work and supported employment. There would appear to be an opportunity to create a “Promoting Independence” service for young people as they come into adulthood.   

The quality assurance team appear to be struggling with capacity and as a result can only be reactive when they see the opportunity to be, and would like to be, proactive. The communication between commissioning and contracts colleagues could be stronger and bringing commissioning into the Directorate is an opportunity to strengthen those links.   

The engagement between partners at a strategic level in the Safeguarding Adults Board (SAB) is strong, but there were concerns about engagement of key partners in Task and Finish Groups. The SAB may want to consider how to improve this. 

Leadership  

Councillor Paul Cummins the Cabinet Member for Adult Social Care is an asset to the Adult Social Care Directorate, being knowledgeable and experienced, providing political direction and oversight. There is strong and experienced political leadership by the ruling party and consensus in the area of adult social care and health between the different political parties.   

There is a clear separation between the executive and scrutiny and there is a clear narrative from the political leadership over their direction and what is expected of them from the Care Quality Commission. The Directorate may wish to consider how to strengthen and simplify communication to staff who may be struggling to keep up with the range of initiatives and the impact of these on their role.   

Consider increasing the capacity and capability of the performance team so they can support the Adult Social Care Directorate more effectively as a Business Intelligence function from within adult social care and also train Directorate staff on the interpretation and effective use of this data so they can make changes for improvement.   

The Directorate’s approach to a strengths-based social work was disrupted by Covid. The peer team recommend a re-set and a change of language to move beyond “the three conversations model” language, as this is only one small aspect of the overall approach. This will need to be supported with some infrastructure to support learning, improvement and innovation. 

Whilst the senior leaders of the Directorate lead effectively the top layers in the department are very lean.  As the transformation programme is initiated and completed the council should ensure there is adequate capacity for the team to manage the number, variety and complexity of adult social care work and projects.  The span of control should be enough for these senior staff to be able to respond effectively to the in-coming assurance process, have oversight of reforms, budget management and the related transformation tasks. This is a key risk for the department going forward. 

Other comment and recommendations are included in the body of the report. 

1. Sefton Council requested that the Local Government Association undertake an Adult Social Care Preparation for Assurance Peer Challenge at the council and with partners. The work was commissioned by Deborah Butcher, Executive Director of Adult Social Care and Health (DASS), Sefton Council. She was seeking an external view on the readiness of the Adult Social Care Directorate for the arrival of the Care Quality Commission’s Assurance inspections and a view on how the council is able to deliver value for money, quality, effectiveness, and the most personal outcome focused offer for local people. 

2. A peer challenge is designed to help an authority and its partners assess current achievements, areas for development and capacity to change. The peer challenge is not an inspection. Instead it offers a supportive approach, undertaken by friends – albeit ‘critical friends’ with no surprises. All information was collected on a non-attributable basis in order to promote an open and honest dialogue and feedback form the team of peers is given in good faith.  

3. Prior to the onsite peer challenge work Sefton Council Adult Social Care Directorate team completed a self-assessment about the work of the service that included speaking with a variety of stakeholders, those with lived experience and partners. The peer challenge team arrived at their feedback after triangulating what they read, heard and saw whilst onsite with a view as to saying what needed to be said whilst being mindful of the multiple audiences for the work in the partnership.  

4. The members of the peer challenge team were: 

• Cath Roff, Director of Adults and Health, Leeds City Council  
• Councillor Khevyn Limbajee, Cabinet Member for Adult Services (2018 –  2022), Cabinet Member Community Safety London Borough of Waltham Forest  
• Samantha Baron, Director of Quality and Improvement and Principal Social Worker, Lancashire County Council  
• Tracey Harrison, Assistant Director, Adults, Tameside Metropolitan Borough Council  
• Niamh Kearney, Service Manager, Performance and Practice, Wigan Metropolitan Borough Council
• Hazel Summers, Northwest Care and Health Improvement Adviser, Care and Health Improvement Programme, Local Government Association  
• Marcus Coulson, Challenge Manager, Local Government Association  

5. The team engaged virtually between 5th-7th July 2022. The programme included activities designed to enable members of the team to meet and talk to a range of internal and external stakeholders. These activities included: 

• interviews and discussions with councillors, officers and partners  
• meetings with managers, practitioners, frontline staff and those people with a lived experience and carers  
• reading documents provided by the council, including a self-assessment and a range of other material, consideration of different data and completion of a case file audit  

6. The framework the peer team used was that of the Care Quality Commission and their proposed four Domains of Assurance they will be using for the upcoming adult social care inspection regime.  They are:

Care Quality Commission Adult Social Care Assurance four Domains

Working with people

• Assessing needs  
• Supporting people to live healthier lives  

Providing support

• Care provision, integration and continuity  
• Partnerships and communities  
• Workforce equality, diversity and inclusion  

Ensuring safety

• Safe systems, pathways and transitions  
• Safeguarding 

Leadership

• Governance  
• Learning, improvement and innovation
• Capable, compassionate and inclusive leaders  

7. The peer challenge team would like to thank councillors, staff, those people with a lived experience, carers, partners and providers for their open and constructive responses during the challenge process. All information was collected on a non-attributable basis. The team was made very welcome and would in particular like to thank Deborah Butcher, Executive Director for Adult Social Care and Health/Sefton Place Director Designate, Sarah Alldis, Head of  Adult Social Care and Health, Alisa Nile, Senior Lead Transformation and  Assurance, Sefton Adult Social Care, Tara Scott, Service Manager, Client and  
Business Support, Adult Social Care and Stephen Beard, Service Development Officer, Adult Social Care at Sefton Council, for their invaluable assistance for the support to the peer team, both prior to and whilst onsite, in planning and undertaking this peer challenge which was very well planned and delivered.  

8. Prior to being on-site peer team members met seven people with a lived experience, five carers and a day centre manager and considered 15 case files from across the areas of adult social care. The peer team read at least 189 documents including a self-assessment / position statement. Throughout the peer challenge the team had more than thirty-seven meetings with at least sixty four different people from adult social care, health, the Third Sector and other partners. The peer challenge team have spent over 196 hours with Sefton Council and its documentation, the equivalent of 28 working days  

9. Our feedback to the council on the last day of the challenge gave an overview of the key messages. This report builds on the initial findings and gives a detailed account of the peer challenge.  

This relates to assessing needs (including that of unpaid carers), supporting people to live healthier lives, prevention, well-being, and information and advice.   

Strengths  

10. The peer team met a wide range of staff throughout the peer challenge and it is clear that they are the Directorate’s greatest asset. They are positive and appear well motivated to do their work. They reported being well supported by their managers who were described as accessible, caring and knowledgeable.   

11. There is an explicit strategy in the Adult Social Care Directorate focusing on prevention and early intervention to help people live healthier lives. This was backed up by a revised front door with a focus on advice, information and signposting. There is also a plan to have investment in the Third Sector so there are resources to signpost clients to.  There was evidence of a good link up with social prescribers to be part of a network of support.   

12. Public health spending is aligned to tackling health inequalities with wide recognition of universal proportionalism to tackle the health of the poorest fastest and a recognition that there is more to do.   

13. Cheshire and Merseyside is a Marmot region, with Sefton being one of nine places supporting the work of the Marmot team. This is based on the Marmot Review into health inequalities in England (2010). It proposes an evidence based strategy to address the social determinants of health, the conditions in which people are born, grow, live, work and age and which can lead to health inequalities. It draws further attention to the evidence that most people in England aren't living as long as the best off in society and spend longer in ill health. Premature illness and death affects everyone below the top. The report, titled 'Fair Society, Healthy Lives', proposed a new way to reduce health inequalities in England post-2010. It argues that, traditionally, government policies have focused resources only on some segments of society. To improve health for all and to reduce unfair and unjust inequalities in health, action is needed across the social gradient. This is a positive initiative although it wasn’t clear to the peer team if the council had achieved this ambition yet and more information would be required to understand it fully.   

14. There was evidence that the wider council understood the role it could play in supporting both children and adults in need of support. For example in the digital inclusion work taking place in libraries and the training for staff in a trauma-informed approach when working with customers.   

15. The adult social care front door triage function has taken a prevention and early intervention approach. This was evidenced by work that has already taken place to ensure Occupational Therapy (OT) is incorporated at the front door as well as engagement with Sefton Council for Voluntary Service (CVS) in terms of support from the Third Sector. The Technology Enabled Care (TEC) strategy has been developed and is a very positive initiative.  It is being explored how this can be built into the offer at the front door. Assessment activity is completed at the front door when the need necessitates.  

16. The peer team were impressed with the development of the self-service Ask  SARA initiative to enable people to source their own minor equipment. Ask SARA is an impartial advice tool about equipment and services whose aim is to make daily living easier.  It is an online question and answer tool offering tailored information and links to equipment and resources to help improve day to day life and complete everyday tasks in the home. It can be completed by the applicant themselves or someone they know or care for. There are a variety of different sections with useful information including getting around at home, making helpful adjustments and improving health and well-being, such as managing changes to hearing and vision. This gives people more choice and control.  

17. The people the peer team met with a lived experience were very complimentary about the OT service. There is a good approach developed within OT of the single-handed care. Through the timely reviewing of care packages OTs ensured that people only had a double-handed care when absolutely necessary. The appropriate use of equipment and good staff training has enabled a reduction in double-handed care, an approach which supports dignity and choice.   

18. The Adult Social Care service has returned to direct face to face assessments with service users which is welcomed.  

19. The mental health social workers are co-located with health staff, and this works well. The team remain co-located with Mersey Care, although have now withdrawn from the Section 75 Agreement.  There is a good understanding of the cohort and the client group’s presenting needs. Staff talked about clear benefits since taking back statutory functions and the team feel more cohesive with their adult social care colleagues.  All staff are Approved Mental Health Professionals (AMHPs) and the connection with clinicians remains with regular Multi-Disciplinary Teams and huddles.  There is good provision to meet support needs in the south of the borough but less so in the north.  Staff were dual recording but now concentrate on using the Liquid logic Adults' Social Care System (LAS) recording whilst continuing to share where appropriate via secure email.    

20. A ‘recovery’ team approach is in place for those not eligible under the Care Act rules which works well with housing and other departments.  Presenting needs show high levels of self-neglect and hoarding. 

21. The peer team were told about the ‘Section 12 App’ which looked like a very interesting innovation.This is a smart phone application that supports the speedy identification of an appropriately qualified physician to undertake Section 12 Mental Health Act assessments alongside an AMHP. It is secure means of communication, and it can quickly raise support when required.  Whilst it is in its infancy it seems promising.  Strong protocols are in place which includes a SharePoint site to ensure all relevant professionals are aware.   

22. There was clear evidence of established Practice Leadership in place in adult social care. This included work that has been led by the Principal Social Worker (PSW) to develop a quality assurance framework for adult social care that is complemented by the recent implementation of a Quality Improvement Forum and builds on the existing Practice Forum.  The PSW has a direct line to the  
Head of Service and has recently introduced drop-in sessions for all staff. Risk registers are in place at operational, service, and corporate level and oversight of risk has been an increasing focus for the service and further training is planned for all managers. The peer team welcome this.   

23. Evidence from the peer team’s case file audit completed prior to the onsite work illustrated the increasing complexity in the assessment of need and staffs' engagement with a wide range of people in the assessment process was impressive.   

24. The strategically commissioned Sefton Carers Centre Service was highly rated by carers and the assessments undertaken were reported as being person centred, high quality and future focused.  

25. The peer team heard evidence that there were two carers engaged in research with the universities and national groups is a real asset to be harnessed for the benefit of Sefton carers and the ongoing refresh of the Carers Strategy.  

26. The Directorate’s approach to dealing with complaints was person centred, being focused on improvement. The reporting on complaints is provided regularly into Directorate Management Team and to the Cabinet Member. Learning from complaints (including Ombudsman findings) is undertaken across the service and via the Practice Forum which includes the use of practice alerts for all staff and the service recognises that this remains a key area of focus for further development. It was noted however that, at the moment, there is not a whole system approach across health and social care for complaints handling, for example for complex complaints where people’s experience relates to a number of providers across a pathway such as hospital discharge and is a potential area for development.   

For consideration  

27. The peer team heard that staff would welcome greater clarity and direction on the issue of hybrid working. In particular to identify which direct practice tasks should be online and which should be face to face.   

28. The Directorate is considering creating a Transitions to Adulthood Team (16 – 25) and a specialist Learning Disability social work team (for people 26+) to be integrated with the NHS. Social workers reported finding it difficult to sustain in depth knowledge of the choice of provision for people with learning disabilities within a generic area team. Some teams reported that certain social workers were the de-facto learning disability specialist anyway so discrete teams seems the logical next step. Long serving staff remembered a time when there had been a co-located learning disability team with the NHS and that this model had served people well.  The suggested model would support a dedicated and specialist resource for this cohort of service users and a focus on improved transitions to adulthood.  The service users and carers interviewed supported this approach.   

29. The peer team recommend that the Directorate enhance the current recovery plans with a clear methodology to manage service backlogs in social worker assessments, OT assessments, accessing home care, Reablement, Deprivation  of Liberty Safeguards (DoLS) and reviews that would and include SMART Targets.

30. The Directorate may wish to consider options to integrate with community health in such areas as the adult social care front door, the OT and Reablement Services.  The service recognises that there is not a consistent reablement offer across Sefton.  An integrated offer with community health services would help ensure an equitable offer and make the most of both organisations’ strengths.  Implementation of the social care and health integrated front door would focus on early intervention and prevention and provide short term intervention to maximise independence to ensure support, information and guidance is provided at point of contact.  This would also support an urgent or same day response from the appropriate community services be they health or social care to prevent hospital attendance or admission.  
31. Adult social care staff explained how their strengths-based social work practice was based on the Three Conversations model. However, the case file audit completed prior to the onsite phase of the peer challenge did not find strong evidence of a strengths-based approach and some confusion from staff about which one of the three conversations they should be having at what point in the customer journey. The team heard how Covid had impacted on the Directorate’s roll out of strengths-based social work. We therefore recommend that Sefton consider the identification and implementation of a Strengths Based Practice Model and methodology that goes wider than the Three Conversations model and is underpinned by a transformation programme.   

32. Colleagues described how the pathway out of hospital is split between health and social care services. This did not appear to make the most of a multiagency and multi-disciplinary approach. The peer team believes there is the need for a review of discharge pathways to understand the role of social work and how this contributes to an integrated model.   

33. Social workers told us they are keen to promote direct payments but find them onerous to administrate which impacts on their take up. We suggest that the direct payments process is reviewed to see if it can be simplified as well as how Personal Assistants are accessed.  Consideration should be given to how the use of direct payments is an enabler to innovative care and support options.   

34. The Directorate recognise that teams are feeling challenged and the need to take action to support them.  There was evidence of significant and increased complexity of needs within populations and increased service responses to meet complex needs. For example many packages of care had additional requirements for DoLS and safeguarding referrals.  The peer team therefore recommend that Sefton consider a whole system case audit to benchmark current practice in preparation for a strengths focused transformation programme.  The introduction of specialist learning disability teams will help reduce the volume of complex cases held in the neighbourhood teams.   

35. The peer team recommend that Sefton proceed with the Carers Strategy refresh to ensure that is it more outcomes focused with clear timescales to include stronger representation of the Carers Voice and consider increased investment to Carers Support to extend the reach and to bolster the support offer.   

36. As has been mentioned previously the Directorate complaints process works well with good oversight by the Portfolio Holder and Director.  However, there is no join up of complaints officers across health and social care in order to manage cross-agency complaints. The peer team suggest you consider developing a joint protocol for dealing with system complaints, a “no wrong door approach”, that ensures no matter where the complaint is submitted it is dealt with and not passed around services or organisations.

This relates to markets (including commissioning), workforce equality, integration and partnership working.

Strengths  

37. There are good relationships with providers and the Adult Social Care Directorate which had grown much stronger since Covid. Strategic Forums are in place to work together.  

38. There are strong partnerships with the NHS. The peer team felt they were mature and had strengthened during Covid. There is the need to build on that with greater ambition around integration.  The DASS being appointed as the new Place Director for Sefton in the NHS Cheshire and Merseyside Integrated Care Board is a real opportunity.  

39. The Place-based approach by Sefton Council working in communities with multidisciplinary teams located within a defined footprint is a real strength. There is a good initiative that creates early intervention and prevention  “huddles” where staff can bring a case and problem solve together. Whilst this is only happening in one locality there are plans for it to be rolled out.  

40. Sefton has demonstrated that it is a compassionate council offering support to asylum seekers and refugees with services commissioned from the Third Sector.  

41. There is a Trusted Assessor Model in the Reablement and Discharge to Assess Service within New Directions. This saves valuable social worker time and means a swifter service for Sefton residents.  This model has embedded good relationships between the hospital and New Directions services.   

42. It was reported to the peer team that there was good support offered from hospices to care home managers during the pandemic.   

43. There are good outcomes from Reablement Service.   

44. It is a positive move to bring commissioning into adult social care so there can be clearer strategic leadership and a closer relationship between social work and commissioning. This will ensure a proactive approach to outcomes based commissioning.   

45. The lead provider model for day-care is a positive development and the peer team could see providers working collaboratively rather than competitively to develop niche offers.  The question the peer team pose is, “How can this approach be extended to other areas of provision?”.  

46. It is well known that an ageing population presents a strategic challenge to the council with a growing number of single pensioner households often remaining in under-occupied family homes. To address this the Extra care strategy and relationships with strategic housing is a strength as the council endeavours to develop an attractive retirement housing offer for its older citizens.  

47. The financial assessment process is a good one and appears to deliver timely outcomes with most assessments achieved within two weeks but is dependent  on early assessment particularly in discharge process for those who will be accessing care for the first time.   

48. The Directorate is developing models of virtual Enhanced Health in Care Homes and of rapid response, although this is still in its infancy. Where this is set up providers report it is working well and they have regular contact with coordinators and links through to a geriatrician.  

For consideration  

49. Sefton Council has a market position statement in place that explores market shaping and the work needed to develop the future market requirements.  Whilst this is useful and has been well produced it needs to be stronger on linking assessed population needs to what is specifically required from the market.  This should outline specific types of demand and capacity required in future years and particular parts of the borough. 

50. When negotiating with service users staff need knowledge of community resources if alternatives are to be used, they need to be quick and easy to access or they won’t be used.  Consider updating the Directory and other potential models to make it accessible online so it can be publicised and updated more easily.  

51. The peer team were made aware of the challenging picture in terms of a sustainable market that the service is faced with as there are significant waits for home care which cause an over-reliance on care home placements. Senior staff are aware of this historical issue of a north / south divide in the borough on availability of some types of care, (see point 52 and 53 above).  

52. Social workers report that they are experiencing quite a lot of care homes asking for fee tops ups so reducing choice available. Consider options to improve fees and charges through the context of the ‘Fair Cost of Care’ exercise.

53. Strategic commissioning plans and operational reporting needs to reflect equality, diversity and inclusion issues. As Sefton has a small black and minority ethnic population there is the risk that these groups are lost in the approach taken by the council and its partners when considering service delivery plans. Therefore the equality, diversity, and inclusion issues need greater prominence.  

54. The intermediate care strategy needs to support a reduction in bed based care to more community based care. Consider a coherent, properly resourced reablement offer that offers equity of access across the borough. 

55. Consider an integrated workforce strategy to include blended roles approaches in home care. This is a way for home care staff to work closely with district nurses and support the delivery of some low level health tasks as part of an agreed care plan.  

56. Home care providers shared the council’s frustration in recruiting new staff into home care services. They reflected on how commissioning based on time and task does not support good terms and conditions of service or a rewarding role.  Home care providers are keen to work with the council to re-imaging home care and move away from time and task to outcomes focused care packages which are strength focused.  

57. There was evidence of limited options beyond home care services resulting in quick escalation to packages of care. A whole system transformation programme with Third Sector investment could address this.   
 

This area relates to safeguarding, safe systems and continuity of care.   

Strengths  

58. There is a robust model for transitions with a co-ordinator role and social worker from an area team picking up a young person’s case at 16. However there is also strong support from staff to move to the proposed Transition to Adulthood Team for 16-25 year olds and a dedicated Learning Disability Team (to be integrated with NHS) for people 25+. This would allow a clear focus on cohort of people whose support needs often span health and social care.   

59. The peer team heard evidence of a good system for identifying people who are transitioning into adulthood and who have complex needs. There is a Preparation for Adulthood Guide to help young people and their families with regular “Moving On” meetings.   

60. There is active take up by young people of direct payments to buy the right support.

61. The Directorate is aware of the balance between having a specialist  Safeguarding Team with real expertise amongst those practitioners and of the potential downside that the model may de-skill social workers in area teams and risks a degree of duplication.   

62. There is good joined up approach with the contracts team around institutional safeguarding concerns with regular meetings to share intelligence and take agreed action which is monitored. The peer team saw a clear rapport and mutual respect amongst the two teams for the role each other plays. There is a Safeguarding and Adults Commissioning weekly meeting to share intelligence and concerns. A clear chain of command on recommending and then authorising suspension of placements.  The team kept going throughout Covid.   

63. The quality assurance activity on safeguarding concerns is presented to the Cabinet Member which enables him to keep up-to-date on the issues in real time.  

64. Sefton have returned the Safeguarding Adults Board (SAB) function back to Sefton instead of the SAB that served the four Merseyside areas arrangement that preceded it. This is seen as a positive move with a clear focus on Sefton issues.   

65. A training needs analysis has been completed and there is a robust training programme in place for internal staff and work has been undertaken to ensure that the focus on Domestic Abuse is dealt with through the correct governance and there are no gaps.   

66. The case file audit completed by the peer team prior to the onsite work indicates that there is a clear process in place for safeguarding and accurate recording and good quality investigations.   

67. The Adult Social Care Directorate is well supported by legal colleagues who understood and could describe ASC and the challenges faced by the Directorate.  

For consideration  

68. The peer team would like to see a wider choice for young people especially around pathways into work, leisure and supported employment.  This view was also expressed by some of the carers and service users interviewed and there would appear to be an opportunity to create a “Promoting Independence” service for young people as they come into adulthood.  

69. The quality assurance team appear to be struggling with capacity and as a result can only be reactive when they see the opportunity to be, and would like to be, proactive. The communication between commissioning and contracts colleagues could be stronger and bringing commissioning into the Directorate is an opportunity to strengthen those links.   

70. The engagement between partners at a strategic level in the SAB is strong, but there were concerns about engagement of key partners in Task and Finish Groups. The SAB may want to consider how to improve this.   

71. Another recommendation for the SAB would be to consider the introduction of a performance report that looks at the role of safeguarding across all partner agencies and not just adult social care. This would more appropriately represent the partnership approach of the SAB.   

72. Evidence from the peer team’s case file audit for this peer challenge would suggest that there is the need for a greater emphasis to be placed on social worker’s professional judgement within safeguarding case notes.   

73. Consider how to address the increasing number of inappropriate referrals, largely from health professionals as well as the increasing number of provider care referrals, specifically medication through the professional practice of staff.

This relates to capable and compassionate leaders, learning, improvement and innovation.   

Strengths  

74. Whilst completing the peer challenge the team had the opportunity to meet Councillor Paul Cummins the Cabinet Member for Adult Social Care who is very knowledgeable and experienced, providing clear political direction and oversight.  This is an asset to the Adult Social Care Directorate.  

75. There is strong and experienced political leadership by the ruling party and a lot of consensus in the area of adult social care and health between the different political parties. The opposition get to read all the papers and have a good line of communication with the senior officers.   

76. There is a clear separation between the executive and scrutiny.  Unfortunately due to illness we were unable to meet Councillors involved in scrutiny as it would have been good to hear from Scrutiny about how they question and hold the Executive to account.   

77. The peer team spoke with several politicians and conclude that there is a clear narrative from the political leadership over their direction and what is expected of them from the Care Quality Commission. The Lead Members demonstrated a “hands on” approach guided by professional knowledge of the sector.

78. There was evidence to suggest there is clear engagement with the other partners across the newly formed Integrated Care System and it was good to see adult social care represented on the Integrated Care Board.  

79. The Chief Executive of Sefton Council is fully sighted on adult social care and as a council prioritises the work supporting vulnerable people as per the council vision.  

80. Both the present Director of Adult Social Services and the Head of the Adult Social Care are very experienced which they demonstrated throughout this process with the LGA peer challenge team along with their knowledge of their service, how it operates, and the challenges involved.  

81. From talking with frontline staff, the senior and middle managers in adult social care are seen as approachable and responsive.  They described the culture as positive and supportive with clear leadership. There is stability in the management structure retaining organisational knowledge and understanding.  

82. There is the on-going development of a data warehouse which will go some way to supporting the Directorate.   

83. There are new initiatives being established by the PSW to promote and develop professional practice and practice leadership. This included practice Forums and drop-in sessions for practitioners.   

For consideration  

84. Sefton Council like many other councils acknowledge that they are under pressure.  This context is shared and replicated across the whole health and care system.  The pressures of demand, the pressures of caseloads, the pressures of people waiting to receive services is not one that Sefton stands alone on.  The whole system is under a great deal of strain.   

85. Whilst the senior leaders of the Directorate lead effectively the top layers in the department are very lean.  As the transformation programme is initiated and completed the council should ensure there is adequate capacity for the team to manage the number, variety and complexity of adult social care work and projects.  The span of control should be enough for these senior staff to be able to respond effectively to the in-coming assurance process, have oversight of reforms, budget management and the related transformation tasks.  This is a key risk for the department going forward.   

86. The peer team heard from a range of staff in adult social care that they experienced a lot of changes and initiatives coming from senior managers all at once which left them feeling that it was hard to focus on anything in particular and that they had to do it all at once.  The Directorate may wish to consider development of a Directorate plan with scheduled priorities with defined interdependencies identified.  Secondly strengthen and simplify communication to staff who may be struggling to keep up with the range of initiatives and the impact of these on their role.   

87. Consider increasing the capacity and capability of the performance team so they can support the Adult Social Care Directorate more effectively as a Business Intelligence function from within adult social care.  Train Directorate staff on the interpretation and effective use of this data so they can make changes for improvement.   

88. The Directorate’s approach to a strengths-based social work was disrupted by Covid and didn’t really get going. The peer team recommend a re-set and a change of language to move beyond “the three conversations model” language, as this is only one small aspect of an overall strengths focused approach. Staff appear to be using the language with limited understanding leading to a lack of clarity regarding a strengths focused practice model. This will need to be supported with some infrastructure to support learning, improvement and innovation.   

89. We asked a number of times about the needs of Black, Asian and Minority Ethic people both as staff and service users. There was not a wide awareness either of the makeup of the population or staff group. We therefore recommend that the Directorate considers how it demonstrates inclusive leadership to develop greater awareness and planning for Sefton’s diverse communities.   

90. Members of the peer team thought that it would be good to see the emerging neurodiversity agenda given more prominence in the documentation and practice of the Directorate.

We appreciate the senior political and managerial leadership will want to reflect on these findings and suggestions in order to determine how the organisation wishes to take things forward.   

As part of the peer challenge process, there is an offer of further activity to support this. The LGA is well placed to provide additional support, advice and guidance on a number of the areas for development and improvement and we would be happy to discuss this. Helen Murray, LGA Principal Adviser is the main contact between your authority and the Local Government Association. Her contact details are:

Email: [email protected]
Tel: 07884312235.

There is also Hazel Summers, the North West Care and Health Improvement Adviser who can be contacted at:

Email: [email protected]
Tel: 07827 083838   

In the meantime we are keen to continue the relationship we have formed with the council throughout the peer challenge. We will endeavour to provide signposting to examples of practice and further information and guidance about the issues we have raised in this report to help inform ongoing consideration.

For more information about the Adult Social Care Preparation for Assurance Peer Challenge at Sefton Council please contact:

Marcus Coulson
Senior Regional Advisor
Local Government Association
Email: [email protected]
Tel: 07766 252 853

For more information on the peer challenges and the work of the Local Government Association please see our website: Council improvement and peer support.