london adass sector led improvement annual workshop 17...

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London ADASS Sector Led Improvement

Annual Workshop

17 March 2015

LSCP

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Welcome

Anne Bristow

London ADASS Sector Led Improvement Lead

LSCP

• All boroughs to be reviewed by April 2016

• 18 reviews completed

• Examples of themes: Commissioning,

Safeguarding, Transitions, QA, Market

Management

• Service User engagement

• DASS Self Assessment

• Peer Reviewer training – new course coming

soon

Borough Dates Theme

Lewisham June/July 2015 Integration with Health

City of London 30 Sept, 1 & 2nd Oct Care Act Implementation

Ealing 28 – 30 September Review of Integrated Model of Care

Greenwich October/November

Croydon 4 6 November Health & Social Care Integration

Tower Hamlets 2 – 4 November Implementation of the Practice Framework

in response to the Care Act

Bromley February 2016 Safeguarding

Hackney March 2016 Making Safeguarding Personal

Hounslow 16 – 18 March 2016

Southwark Transitions

Tri Borough

Lambeth

Waltham Forest

All said helpful or very helpful

Particularly helpful to engage wider staff through

self reflection

Found the process of preparing for the review ie

the documentation helpful

Accurate external critique, sometimes

uncomfortable, but helped them to move on

Picking a concerned area was helpful with

constructive feedback from an experienced

team

Training good and skills developed through

reviews

Teams worked well, complementary skills and

experience, co-ordination valued

Time is given to the process because we believe

in it and outcomes are good

Less pre-review paperwork needed

Clearer articulation and understanding of how to

put vision into practice

Provided material for engagement with Members,

other departments and partners

Restructuring and resource allocation, positive

user feedback, improved Pis

Practice shared and good contacts made across

London

More focussed and timely pre-review

documentation

Reviews could be more tightly focussed and

challenging

Involve Service Managers in reviews

More structured feedback and sharing of reviews

outcomes across London

The tables are named

A facilitator assigned to each table

Each session will last

15 minutes

A whistle will be sounded after each 15 minute period

You can move on to other tables or not move

Dressing the Shop Window – Suzanne Barcz

Getting ready for the Review, putting the right things in the

window, choose wisely

Where’s Wally? [Denise Snow]

The Review Team, the process

Don’t mention the War? [Bruce Morris] Constructive challenges and how to address those challenges

during the review

Care & Support is changing for the better

[Simon Pearce] The Feedback

Effective use of the network approach

Examples from:

Care Act Leads Network

Continuing Healthcare Network

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Care Act Leads Network

Rob Blackstone

LSCP

To share issues and concerns as well as good practices

To draw the group’s attention to matters of concern

relating to Care Act Implementations issues and make

recommendations to the DASS Care Act Leads Group.

To consider how the principles and processes in the

Care Act guidance are implemented

To have oversight of all workstreams that are

implementing elements of the Care Act to prevent duplication and ensure clear alignment of work

Regional response to Regs and Guidance (part 1)

◦ Network divided the Regs and Guidance sub-regionally and co-ordinated the regional

response. Facilitated peer learning and support in understanding implication of the Regs and

Guidance locally. Developed sub-regional relationships that assisted in sharing issues and

support

Sharing examples of presentations and briefings

◦ Minimising duplication of effort

◦ Enhances the content of the presentation / briefing following each iteration

Supporting new members

◦ Peer support to new members to ensure they get up to speed in the shortest time possible

Supporting a Task and Finish approach to discrete elements including:

◦ What makes a good assessment

◦ Sharing of draft policies and procedures

Forum for engaging with national stakeholders – updates from

◦ PHE – national communications campaign

◦ NOMS – developing pathway for prisoners

◦ Department of Health – clarification on the Regs and Guidance

Regional response to Regs and Guidance (part 2) ◦ Network members again divided the Regs and Guidance sub-regionally and co-ordinating the regional

response.

◦ Network members scribed the breakout sessions at the morning regional event

◦ Network members facilitated table discussions at the afternoon regional workshop event

Supporting boroughs in preparation for 1st April 2015 – showstoppers ◦ Advocacy – Royal Greenwich presenting their approach at the next network meeting

◦ Assessment and eligibility – Hounslow presenting their approach to the next network meeting

◦ Network meeting now dedicate first 30 minutes to table discussions where boroughs raise issue and provide

mutual support

Effective use of online fora ◦ Several dedicated webpages

◦ Currently 52 officers signed onto the Care Act leads page

◦ Private members page for sharing draft documents

Support through round robin emails ◦ Responses normally received within an hour following request from network members

Developed a task and finish group

◦ Arose following concerns MH Trusts were not fully aware of the impact of

the Care Act on their pathways

Self-assessment form

◦ Completed by all MH Trusts

◦ Identified the key themes on which to develop a regional work plan

◦ Facilitated engagement with all MH Trusts and relevant Care Act leads

Joint meeting – Invited MH Trust Care Act leads to the January meeting

◦ Resulted in two MH Trusts recruiting Care Act programme managers

◦ MH Trust carer leads now members of the carers network

◦ MH Trust IG / IT leads now members of the Information Management

Group (IMG)

◦ MH Trusts now sharing practice related to the Care Act amongst

themselves

Themed workshops every three months

◦ Focused on resolving issues that have arisen over the three

month period

◦ Invite relevant network members

Greater use of online fora

◦ Developing a virtual Care Act leads online forum on the LSCP

website

Sharing across regions

◦ This has already started but aiming to make it more effective –

e.g. running events with other regions

Embedding the Care Act within the LSCP programme

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Continuing Healthcare (CHC) Network

Pratima Solanki (Joint Chair)

LSCP

To improve:

How the principles and processes in the National

Framework for NHS Continuing Health Care guidance

are being operated across London and to bring about

consistency of practice

The quality of service provision under CHC – better

services, better information, awareness and greater

choice and control for those whose support is funded

through it.

To empower network members and CHC leads to use

best practise examples to embed and/or bring about

culture change in their localities.

Survey looking at CHC and LD ◦ Network undertook a survey to explore use of the CHC procedures specifically with LD clients. Twenty five

responses were received and a summary report was developed. This was presented at the London regional

CHC LD training event. Findings were incorporated into the NHS led LD training programme/workshops

Training & Membership of Independent Review Panels ◦ Network members recently attended the training to become a member on the Independent Review Panels

(IRP) – training very well received. All local authorities now have a nominated lead

CPD ◦ Now that members have attended the IRP training - Network will dedicate dedicated time at each meeting to

discussing IRP panel cases and recurrent themes to support increased understanding of CHC processes

Training framework ◦ Network is looking to develop a framework of accredited CHC trainers in collaboration with NHSE and CCG

colleagues to ensure good quality and consistent training

Raising Public Awareness – through the engagement of London Health watch who

attend the network and are approaching and working through local HW organisations

“From the meeting I attended, I was able to pose questions from the network, and also put our Policy Officer, Zoe, who has CHC as part

of her remit, in contact with Karen, which has led to Zoe being able to progress national CHC issues we have picked up from the

network”

Background: During an annual review of a Service User we discovered that

the Live in Carer commissioned by the LA was undertaking health tasks -

support with bowel management, dressings and peg care.

Agreed the following actions following a review of all similar cases:

DNs to discuss with the SUs for their agreement and then contact the LA

Manager of the Service to discuss the case; LA checks with the Service

User to ensure they are in agreement.

DNs state the tasks, hours and start date.

The LA will then notify the Agency employing the Care Worker of the

agreement to train the live in carer.

DNs must complete the training and ensure all documents are signed off by

their relevant person with authority regarding competency and funding. A

copy of this must be sent to LA for scanning in to the system.

DNs agree a start date and hourly rate with the LA.

The LA Manager will raise an invoice to recharge the health provider for

those tasks at the agreed hourly rate. DN provides regular clinical oversight

The CHC Network has:

Renewed / built my confidence in addressing/tackling

CHC issues

Created a peer support network across LA’s (for advice

etc.)

Commenced engagement with CCG/CSU CHC Leads

Engaged with NHS England CHC Lead

Raised profile of particular issues with LD CHC cases

Forum for comparing LA perception of CCG/CSU CHC

practice across the region

Independent Review Panels (IRPs)

◦ Network has facilitated each Local Authority (LA) in London to have an officer on the IRP –

previously only 8 LAs had representation. Benefits to NHS England but also to panel

members. Network will be reviewing cases at each meeting to identify themes and support

decision making

Joint training opportunities (ie LD training).

◦ Network contributed to the LD training sessions that are running nationally

Joint working

◦ CHC works best when Heath and social care work together. Opportunity to combine CCG and

LA networks and have members attending both meetings to share common problems and

work together to resolve these. Share good practice, opportunity for networking. First joint

meeting scheduled for April 2015

Longer term

◦ Would like social care to be involved in CHC assurance framework to broaden the scope to

include responsibilities of LAs in the process and raising the profile of NHS CHC to senior

management. Network will contribute to this work

http://inspiredrecovery.net/wp-content/uploads/2012/02/Red-arrow-breaking-through-wall-19-mo-update.jpg

What DASSs said about Peer Review, risk

assessment and the LGA offer

Graeme Betts

Adult Improvement Adviser

LGA

Sector Led Improvement - peer review

Purpose

• To ask the “so what?” question

• To understand views and perspectives on the Peer Reviews

• To build on this feedback and create a narrative for the SLI activity

• To weave in best practice from other regions


Process

• Spoken to eleven authorities

• Structured discussions to allow space to tell the story

• Initial findings today

• Report setting out narrative of journey, successes and way forward including best practice from other regions


Structure

• Pre-review

• During

• Feedback/outcomes

• Other comments, views and ideas


Findings - Pre-review (1)

• DASSs were all actively engaged

• Main areas for Peer Reviews – safeguarding, commissioning, personalisation

• Generally, Members and CEx had some involvement


Findings - Pre-review (2)

• Most saw self-assessment as important preparation (some treated it as an inspection)

• A lot of focus on staff – communication and involvement

• Clarity with staff about the difference between peer review and inspection


Findings - During

• As anticipated, thoroughgoing, robust

• Not always comfortable

• Two authorities felt process was not challenging

• While for some, nothing new came out during the review for others the line of questioning “opened staff eyes” and helped them get the message


Findings – Feedback/outcomes (1)

• For most – no surprises, as expected and anticipated

• For some – the position was worse than expected or mixed

• For most – confirmed direction of travel and distance yet to go



• Most authorities felt the review did not identify areas of underperformance and certainly only one felt it identified areas of which it was unaware

• Nevertheless, the majority of authorities felt the review reduced the risk of underperformance



• All authorities were able to identify at least one area which they believed improved as a result of the peer review

• From the DASS’s perspective, these were high level, strategic changes which led to improvements eg restructuring of a service area, changes in approach to working with the third sector, improved process for engaging users



• This suggests the reviews were having a broader impact on the organisations with benefits not just in area of scope

• Some authorities felt they were better placed to implement the Care Act as a result

• Most authorities developed action plans based on the feedback



• For some authorities the independence of the review was beneficial internally or in moving forward partners

• Most authorities felt the review was useful in helping to think through the approach going forward, setting direction and priorities


Findings – the Review Process

• Bit short/tight – limited what you can do in the timescale

• Review team to have more say in who is interviewed

• Experts to be included

• Get basic processes right

• Need for consistency both in approach and in publishing /disseminating a report


Findings – other comments (1)

• Vol peer review v’s ADASS performance regime

• Concern that the impact of peer review is being overstated – it is not a way of stopping or reducing the risk of poor performance

• Need to use data better and see peer review as one element of SLI

• No consequences for those authorities that aren’t committed


Findings – other comments (2)

• Need for a national framework

• Need for CEx’s to push it

• Not a lot of what we do is SLI – mainly development and implementation

• Would like to see more come out from reviewing performance

• Need more benchmarking


Considerations (1)

• Sense from some DASSs, some in LGA and some Chief Executives (never mind DH) that Peer Review in London is not sufficiently challenging

• Consistency and rigour – eg letters and reports

• While the process was described as robust, for most, the outcome was what had been expected

• In other Regions there have been disagreements during the Review and about the outcomes

• There has to be a mechanism to ensure that strong words said privately are acted upon


Considerations (2)

• Users by experience “very incisive”

• Member involvement is generally positive

• If Peer Review is key element in SLI it needs to focus on the difficult areas

• There could be a case for focusing all reviews over next year eg on integration with health and pull out the lessons for all to learn from


Considerations (3)

• It is not enough on its own and needs to be part of a thoroughgoing local SLI process

• More learning could be had for Members and officers from doing Reviews

• Additional benefit could be had from sharing outcomes from reviews – individual issues and themes


Summary

• Initial findings

• Further report with learning from other Regions

• Build in other reports eg Taking Stock

• Overall – to answer the “so what?” question it feels like Peer Review in London is leading to improvements for users but there is scope to strengthen the process and increase the benefits

Table Top Discussion

• Thinking beyond 2016

• How do we want to do Sector Led after this

cycle

Keep Peer Reviews?

Other models?

Do we keep Sector Led as a discreet workstream?

Key messages from today’s workshop

Chair’s Summary

Anne Bristow

london adass sector led improvement annual workshop 17...

Documents