The inspection which took place in November/December 2014 focused on the quality of outcomes achieved for older people with complex needs. The inspection also evaluated the quality of assessment, care and support planning arrangements and the range and quality of services available to support the achievement of individual outcomes for older people. Commissioning, partnership working and leadership and governance arrangements were also considered.
Inspectors concluded that Newport City Council faces significant challenges in delivering on its statutory responsibilities for older people with complex needs. Whilst individual staff and managers demonstrated a high level of professional commitment and did their best for the people they were helping, the organisational arrangements including the current structure and operating model did not support effective and efficient practice.
There has been a culture of responding to crisis rather than working in a proactive person centred way. This way of working had contributed to concerns about the Council’s own residential homes and we found people were sometimes placed there inappropriately. This was further exacerbated by the failure to complete timely reviews which resulted in people remaining in situations which were not fulfilling their needs and in some cases putting them and others at risk.
There are some promising signs of improvement and that senior managers are taking action to improve services. However the scale of the changes required in Newport City Council adult services will require the full commitment of Elected Members and the Executive to deliver the required improvements to ensure older people receive the support they require.
- A pathway for older people should be defined and articulated which includes the team structures, supporting systems, tools and processes. This should include defining what each member of staff and team are required to contribute at each step and ensuring that they have the necessary skills to deliver their particular responsibilities including where there are integrated and/or collocated arrangements with partners.
- The point of contact and access arrangements for older people must be clarified and agreed as a priority. Action should be taken to provide assurance that people will be responded to in a timely way and that the staff they are talking to have the appropriate skills and to respond to their needs and concerns. The Council should also consider how other pilots such as the Neighbourhood Care Networks and the “integrated pathway for older people”, would interface with the Gwent Frailty single point of contact, the Council’s customer portal and the duty system currently operated by Adult Social Services team.
- Senior Managers must establish where the care management and review responsibilities lie and which teams have the responsibility/ownership for individual cases.
- An outcome focussed approach to the assessment of older people should be further developed, which supports the consideration of a range of options and opportunities for the individual and their Carers.
- A robust approach to risk assessment and positive risk taking is required, underpinned by a policy, tools and training which is aimed at improving the skills of assessment and care staff.
- The approach to Carers’ assessments should be improved, including the assessment offer and embedded across all teams.
- A workforce strategy to support the development of this pathway should be developed which includes skills development (including risk assessment), capacity and succession planning.
- The arrangements for commissioning of Adult Social Services post April 2015 must be put in place as a priority and progress made on securing the range of services required to meet the future demands, in particular for older people. The links between the Commissioning Plan and the Medium Term Financial Plan should also be strengthened.
- The scrutiny of performance relating to Adult Social Services should be improved through the provision of supporting information and the development of Members’ ability to explore the underlying issues and drive forward the necessary and agreed service improvements.