Neath Port Talbot County Council Inspection of Learning Disability Services

Transcription

1 Neath Port Talbot County Council Inspection of Learning Disability Services July 2011

2 ISBN Crown Copyright June 2011 WG 12679

3 Neath Port Talbot County Council Inspection of Learning Disability Services CSSIW 1. Context In December 2009 CSSIW received an anonymous complaint from a member of staff working in learning disability day services. Following discussion with the head of adult services it was agreed that as part of its ongoing programme of work CSSIW would therefore undertake an inspection focussing on the learning disability service, including day service provision. It was also agreed to focus on person centred planning (PCP) as the Council have been developing this area of work and requested CSSIW s view of progress. The inspection did not systematically address the issues raised in the complaint but used this as a platform for a broader inspection of learning disability services. The inspection was undertaken on 7 th 10 th February 2011 by Sue Roberts, Local Authority inspector and David Hulmes, Regulatory inspector. 2. Methodology Inspectors visited one of the three day services, Bronleigh and one of three special needs day service, Brynamlwg. We met the day service managers and a group of day service staff as well as looking at a random selection of case files and staff files in both day services. Inspectors met with a group of care managers and the team manager from the community learning disability team (CLTD) and read twelve case files. Inspectors also met a range of staff that were responsible for the services and strategic development. During the inspection inspectors decided it was necessary to interview the adult protection co-ordinator to clarify some process issues which had been identified during file reading. Prior to the inspection a staff survey was sent to 152 staff across both day services and care management. A 49 % return (76 staff) was received. 3. Conclusions and recommendations 3.1 Overall the council was found to be delivering an integrated model of assessment and care management for people with a learning disability. It was evidenced that work needs to be done to improve the quality and consistency of the assessment and care management process. Guidance has been provided to support care managers to deal with the decision making process regarding eligibility. Work is being done to improve the process of transition for children through into adult services. Managing this interface was reported to be a difficult area for care mangers. At the time of the inspection, transition workers in the adult teams were also struggling to meet the demand. Although person centred planning is being developed within day 1

4 services, there was no significant evidence that this is integrated with care management. Recommendation The council will want to address the issues regarding the quality and consistency of practice of care management to include ensuring adequate capacity to support transition. The council may also wish to address issues of eligibility to demonstrate how it will, with partners, meet the needs of vulnerable adults who do not meet the higher level criteria. 3.2 Day services are currently delivered through a traditional day service model and work is ongoing to develop a more person-centred approach. The future provision of day opportunities is going to be considered as part of the programme to transform adult services. Issues of communication with both operational and senior managers were raised by staff. The council now faces the challenge of delivering a major programme to review adult services and will need to ensure service delivery remains consistent during this time of change. Recommendation The council will want to assure itself that issues raised by day centre staff regarding capacity to deliver service plans are addressed. The council may also want to consider how it can seek the views of carers to feed into any quality assurance mechanisms which are developed. 3.3 Significant work has been done to improve and standardise practice across the services, although the plans to develop outcome based measurements are yet to be implemented. There was evidence that day centres are aiming to co-ordinate a range of activities but these were reported to be difficult to deliver on occasions, due to staff capacity. Carers said they were grateful for the services provided, although some issues about staffing and the lack of an individualised service were seen as being problematic by some carers. Work is being done to adopt a person centred approach and examples were seen of this work producing personal outcome focussed plans. The Coastal 1 initiative also provides the potential for the development of further options for service users. Recommendation The council will want to assure itself that issues raised by day centre staff regarding capacity to deliver service plans are addressed The council may also want to consider how it can seek the views of carers to feed into any quality assurance mechanisms which are developed. 1 The COASTAL Initiative is a Regional Strategic Project covering the local authority areas of Bridgend, Neath Port Talbot, Swansea, Carmarthenshire, Pembrokeshire and Ceredigion. The project is aimed at the promotion of vocational guidance, employment, skills training and lifelong learning opportunities for individuals who are currently economically inactive as a result of illness, disability, (Mental Illness, Learning Disability, Physical Disability, Sensory Impairment) substance misuse problems and/or the serious social disadvantage associated with the transition from long-term care into adulthood 2

5 3.4 There was evidence of improvement in aspects of the delivery of adult protection processes since the national inspection of adult protection undertaken by CSSIW in 2009 Inspectors found evidence of processes for assessing and managing risk. Staff were clear about the referral route and the co-ordination role of the adult protection team. The practice in case files was seen to be safeguarding individuals. However, there were issues about the lack of POVA documentation on the files which were provided for inspection. Recommendation The council will want to be able to demonstrate that the necessary guidance on the administrative practice to support the POVA process is in place and is being adhered to by all staff. 3.5 The development of PCP across adult services and other work funded by the Coastal Initiative has the potential to drive the promotion of independence and social inclusion. Work is commencing to integrate the process and raise awareness across professional groups, including care managers and educational staff. This will be important in order to target young people coming through transition. Recommendation Having made a strong commitment to developing PCP, the council will want to further develop this in order to demonstrate improved outcomes for service users from this approach. 3.6 The council reports additional funding will be made available to meet the predicted demands for services during the next financial year. Work is also ongoing with partners to develop a regional response for specialist service provision. Although work to update and revise date the commissioning strategy for this service has not been taken forward, the delivery of a major project to Transform Adult Social Care (TASC), although at an early stage, has the potential to drive development and service improvement. Recommendation The council will want to ensure capacity to deliver this large scale programme, whilst ensuring that the ongoing work to develop and improve service and practice quality is maintained. 3.7 Aspects of workforce arrangements were working well. Training programmes, team meetings, supervision and business planning was found to be in place, although the process of annual appraisal needs to be established. Issues about capacity in day centres were a significant issue for day centre staff who considered this was having a negative impact on service users. Temporary contracts of employment, some having been in place for several years, were reported to be very unsettling for staff in day services. Managers reported this is now being addressed. Although staff were aware that the corporate workforce strategy had been accepted by 70% of staff in a recent trade union ballot, some staff expressed uncertainties over future terms and conditions Performance management arrangements were found to be variable Recommendation 3

6 The council will want to assure itself that it has a risk management process to manage the impact of current staffing ratios and the effect of sickness absence and annual leave on service users and current day service provision. 3.8 There have been significant changes in the senior management structure and currently the role of head of adult service is being covered on an interim basis. There has been a restructuring at third tier level.there is evidence that these changes appear to be having detrimental effect on communication and engagement with staff and carers. Historically staff and carers reported they have benefitted from a more visible management presence, particularly at a senior level. Recommendation Senior managers will want to address the reported impact which communication is having on both operational and strategic practice. 4 Getting help Access to care management services is through referral to a multi-disciplinary team which covers the whole of the county and is based in The Laurels in Neath. All referrals for assessment are received directly by the team and discussed in a weekly joint allocation meeting. The team considered that joint working with health colleagues was well established. Case files seen by inspectors and discussion with both social services and health staff confirmed this. Case file reading found that: Service users and their carers were seen to be involved in the process although the degree of involvement was variable; Eligibility was recorded on the majority of files; Four case files demonstrated a very thorough approach to risk assessment; Three case files provided good outcome focussed care plans which had been reviewed in detail; The care plans seen both in day services and in the 12 case files read in detail by inspectors, were found to be up to date but there were some exceptions; Timeliness for completing assessments was good but some inconsistencies were identified; There were frequent examples of integrated working with other professionals within the team; Reviews were being carried out although not all met standards for timeliness and did not consistently demonstrate consultation with all stakeholders; Three files did not contain a copy of an assessment; Carer s assessments or evidence that an assessment had been offered where appropriate, was not found on the majority of files; 4

7 The practice of completing an overview assessment was not embedded and the majority of case files had only a contact assessment, even when service users had complex needs; The majority of care plans were not outcome focussed and did not consistently set out the needs of the service user e.g. one examples of a lack of planning for a service user who was now a carer for older parents and a lack of detailed outcomes required from attending the day service in another. Inspectors noted that exceptions and inconsistencies were related to individual practice and the council will want to consider how individual areas for improvement can be identified and development supported. The use of peer support or mentors may help in this. All staff groups agreed that confirming eligibility for some people who had lower levels of need, such as those with Aspergers Syndrome or others who are vulnerable adults, was an issue. This group of potential service users services do not meet health criteria but may still meet social care criteria. Managers confirmed that there had been work undertaken and internal review of eligibility criteria had revised eligibility for people with a learning disability.. No change has been made for the existing cohort of clients but was applied to new people entering the service. If there is difficulty deciding which is the most appropriate team to work with an individual, then this decision can now be escalated to principal officer level for a decision. Work is on-going with health colleagues to address how the needs of the wider group of people with lower level needs can be jointly met. Some families considered that there was a more limited range of services available for adults compared to those available for children. Evidence from case files and from discussion with staff provided a more complex picture. Availability of services was reported to be compounded when children were late moving through transition and required services which may not have vacant places, particularly those who had complex needs or who required respite care. Case files demonstrated some creative packages of care using direct payments. However staff reported that financial restrictions can now mean that new service users may have more limited packages of care than some existing service users. Some of the carers interviewed expressed dissatisfaction with the transition process and described late involvement in the process, slow progress and a lack of individualised approach to service provision. In order to support young adults during the transition from children s services to the Children s Disability Team (CDT) there are 1.5 dedicated transition workers who are based within the CDLT. A transition policy sets out the age of transition as being 17 or earlier, but staff reported that this is not always possible due to capacity issues in both the children and adult teams. Staff highlighted the pressure on both the children and adults teams to meet timescales for transition. The need for a clear understanding of eligibility criteria so that parents could be full aware of what their entitlement to adult services would be. 5

8 PCP is being developed in the care management service and care managers are becoming involved in developing person centred plans, for example, with service users in day care settings. This work was reported to be at an early stage of development for children. A post of transitional co-ordinator is currently being recruited. The post holder, who will be located within the education directorate, will have a multi departmental and cross organisational accountability. Work is being done to try and engage education staff in the PCP process and following workshops to look at how to engage staff, a model is about to be piloted in a school. Strengths Evidence of integrated, multidisciplinary working Evidence of some good care management practice Work being undertaken to improve the process of transition Areas for development Need to develop consistency of care management practice Embedding the use of outcome focussed care planning Further work to resolve issues regarding eligibility Demonstrate improved outcomes for young adults going through the transition process Integration of care management and the PCP process 7. The Services Provided Inspectors focussed on the day service provision and visited two day centres, speaking to staff, managers and reading both service user and staff files. In view of the limited observation of only two centres it is not possible to reach a conclusion about the overall standard of day service provision. However, the two centres visited demonstrated good professional standards of care in particular in dealing with some individuals with very complex needs. Day Service provision Brongleigh is a day service in Neath which has changed its focus from older people to those with a learning disability as part of the plan to have patch based services. As a consequence the centre has been successfully developing a broader range of service options for people than was previously the case. The centre has developed a café which is run by service users. Three staff files showed that job descriptions, personal information and Criminal Record Bureau checks (CRB) were on each file. No photo identifications were seen. Supervision notes and training plans were kept on separate files. There was evidence of risk assessments having been undertaken. 6

9 Brynamlwg is one of the three special needs day services in the county and is based in the same building as Rhodes House residential respite unit in Port Talbot. The day service provides care for people who have complex needs, some of whom are funded through continuing care arrangements. There are an increasing number of service users who have a high level of dependency and need for intensive support levels. Their care plans require additional risk assessments, such as for speech and language therapy (SALT) to deal with swallowing issues or occupational therapy assessments for manual handling needs. They also require frequent updates to respond to changing needs. The four staff files seen had job descriptions, personal information and there was a CRB on each file. Photo identification was also on files and there was evidence of an induction process for new staff. Supervision notes and training plans were kept on separate files. Staff were found to have a broad range of training opportunities. Evidence from reading a random sample of 12 service user case files across both services showed that each service user had an up to date service plan in place. Inspectors noted a variety of activities were available for each service user. However, many of these activities are carried out as a group activity and the opportunity for individual or small group activities was found to be limited. Staff centre managers and care staff reported that without cover for sickness, holidays and training, it was sometimes impossible to provide the individual programmes for service users. This issue had been raised in the complaint which was received by CSSIW. Comments from both care managers and care staff raised concerns about the lack of activity in day centres. The increasingly complex needs of service users who required high levels of support compounded this challenge for the special needs day services. One page person centred plans were seen on all of the files and there were examples of person centred reviews. Care management reviews were on files and were generally up to date. Day services staff were not always involved in the care plan reviews which were seen. Care management assessments were not generally on the files. The views of carers Carers who were interviewed as part of the inspection were all very grateful for the services received, which they considered provided crucial support in allowing them to carry out their caring role. They expressed different views about quality depending on which day service they knew. Some were more satisfied than others. Comments included: Pretty good Not many faults. Very happy with service -if he s down for activities he gets to do them. Fine no problem As a centre you can ask questions and they ll tell you. As a whole very good. Very up and down service. Some comments were also received about the dynamics of the staff team in one particular day centre which they considered had a negative effect on communication. 7

10 Issues about the centres having staffing difficulties were raised, specifically problems of lack of cover for staff sickness and holidays and the perception that there were staff tensions in one of the centres Overall the service was viewed as being a one size fits all rather than a personalised approach. They were waiting to see whether PCP would have any impact on this. Inspectors were not able to draw any firm conclusions as only two day centres were visited as part of this inspection. Although not looked at in detail by inspectors, a shortage of respite care was highlighted by carers and care managers confirmed this. There was evidence of significant work having been done to introduce standardised processes and procedures across the day services. Staff generally welcomed the more structured approach. There are plans to implement further quality assurance processes across in-house services. One of the issues which became evident to inspectors was the differing perceptions between care managers and day centre staff. In-house services have historically been involved in what the service provides and how it is provided. The need to adjust to becoming a purchased service which meets the requirements of commissioners remains an area for development. At the same time there needs to be a greater appreciation by care managers of the pressure on services to deliver what is required within the financial and staffing limitations. As part of the TASC programme the council may wish to consider how it can both challenge current perceptions and ensure engagement in the commissioning agenda. Senior managers are aware that there is currently a distinction between in-house and externally commissioned services. Currently there are no in-house service level agreements in place. It was acknowledged that work is required to ensure that the expectations and standards for both are the same. During the past year managers reported that work has been done to update policies and procedures. Senior managers are assured that each service has standards and that these are now uniform across the service. Outcome measurement was reported not to be in place across the board and the focus is now on developing outcomes that are measureable. Strengths Good standard of care in the day centres visited Service plans generally detailed with evidence of risk analysis Work to improve and develop standards and quality assurance across day services Areas for development / improvement An analysis of the possible pressure points in day service provision in order to address capacity needs The joint working between care management and day service staff Consideration of carers views on day service provision Capacity of the service to 8

11 deliver complex packages of care without undue compromise to other individual activity programmes Development of a shared understanding of the commissioning agenda between in-house services and care management 8. The effect on People s lives Adult protection arrangements are co-ordinated by two dedicated adult protection co-ordinators with administrative support. These posts primarily undertake referrals for residential settings and some complex cases. Other referrals are the responsibility of the team managers and during this inspection the focus was on the response of the learning disability team. Inspectors read eight case files where there had been a POVA investigation. In six of the cases there was no POVA documentation although case file recording and/or the summary provided by the care manager referred to a POVA referral having being received. Upon request POVA documentation for these cases was provided for inspectors by the POVA team who kept master files for all POVA cases. Inspectors discussed this with care managers, the team manager and the POVA coordinator. It was confirmed that there is now a separate section in each case file where POVA documentation should be stored. It would be expected that either care managers or administrative support would place POVA documentation on the files. Any information relevant to the POVA process should be recorded by care managers within case notes. Some care managers reported that ORACLE IT system did contain some notes which may not have been made available and this may account for some of the lack of information on the case files seen by inspectors. The team manager concluded that the information was likely to be in the administrative system awaiting filing. Care managers were not unanimous about the procedure for recording and storing POVA information. There was evidence that work has been completed to further improve adult protection arrangements following the national inspection of adult protection undertaken by CSSIW in December Practice in the case files which were inspected was satisfactory and there were good examples of work to safeguard people. There was evidence of risk analysis and staff confirmed that a risk assessment tool had been recently implemented. The team manager and POVA coordinator explained that, following a pilot, the tool had recently been introduced and was proving useful. There was evidence within the strategy discussions and meetings of established arrangements for multi-agency work. Two case file audits have been undertaken in the last year by the POVA team and the results of these 2 A report of this inspection can be viewed on the CSSIW website 9

12 have been fed back to designated lead managers. The team manager also reported undertaking an audit. 100% of staff in the survey considered that they had received the appropriate level of training. Inspectors discussed adult protection with staff in the day services and there was general agreement that the process was much clearer now and recent training had been positively received by staff. However, the number of referrals made in the day centres inspectors visited was very low, with none having been recorded in one centre and two in the other. This is an area which the council may wish to monitor in view of the vulnerability of this service user group. Day services staff their view of the POVA process A year ago there was a lot of disparity now everything goes to the POVA coordinator. I feel confident where to go, what to do if staff come to me, I know. POVA is more clear cut. Everything is posted around our day centre telling us how to manage the process and to make a referral. Inspectors looked at how the council is working to enable people with a learning disability to receive support in their own communities and to achieve their potential. As identified earlier, inspectors also looked at how person centred planning is being developed by the council. Person Centred Planning (PCP) PCP is being developed through a team which was formed in Posts having been match funded with European funding and line managed through the Coastal project. The PCP team have developed an overarching operational plan and have developed a person centred planning framework. There has been work to introduce and support the development of this approach through both training and direct work with teams. The outcomes of this work are beginning to be seen in a change of approach to assessment and care planning for people with a learning disability. Examples of significant improvements in opportunities for people with a learning disability were given. Individuals had been able to develop life skills to enable them to gain employment or to achieve a goal they had set in their person centred plan. Staff leading the work to develop PCP were aware that the next step is to integrate the contribution of all professionals as well as the person s wider social network into this process. Current arrangements are resulting in parallel processes of care management service and person centred planning reviews. This practice is not time efficient for staff or necessarily providing the best outcomes for service users. The Coastal project is being used to help develop employment opportunities across adult services. Within learning disability services the Coastal team have been focussing on developing the existing Vocational Skills Service and working to develop PCP and the use of a one page personal profile which can be used to determine whether supporting someone to go into employment is 10

13 an option. The first year has been one of consolidation and the manager of the project considers that the next year will be used to work more with teams and involve them in this approach. Case files demonstrated that outside of the more traditional day service options there are currently limited day opportunities open to service users. Service users who we met welcomed these opportunities. Although no case files demonstrated examples of the use of direct payments, care managers reported this was an option and 52 people currently access a direct payment across learning disability services. Several care plans showed that the Independent Living Fund (ILF) is being accessed by care managers. Good links had been developed with further education and other community based options which will provide a sound platform for the further development required if PCP is to become a reality for people with a learning disability. Strengths Robust documentation system in POVA team Evidence of risk assessment and in more recent files, the use of risk analysis tool throughout the process Evidence of partnership working on POVA cases Increased training and improved understanding of POVA process by day centre staff Evidence that the council is working towards the promotion of independence A process for developing PCP has been developed Areas for development Developing consistent practice for the recording and storing of POVA documentation by care management team Monitoring of referral levels within day centres to ensure any issues are appropriately raised through POVA Continuing to maximise the development of PCP and community based options in order to improve outcomes for service users. 9. Shaping Services The Director of Social Services and Housing reported that there would be additional 800,000 going into the learning disabilities budget next year. Although the council is facing significant financial restraints this is necessary, in part to meet the needs of children identified who will be coming through transition from children s services. Work has been done to review the service level agreements with providers and the ongoing need to achieve efficiency targets within the service was reported. As part of the Making the Connections 3 agenda the council is working with partners to develop more regional solutions in order to meet specific needs or 3 The Making the Connections report was published by the Welsh assembly Government in October It is based on the vision that excellent public services are essential and that joint working is vital to deliver top quality services. 11

14 specialist services. In addition, as referenced earlier, the council is about to embark upon a significant project TASC. This work is at a very early stage of development and neither staff on the ground or carers were aware of any details. The council will be looking at how it will deliver services for adults of a working age. It will be taken forward through a project management model which has been tested out in older people s services. Work done in this project will form the basis for future commissioning and an analysis of need has been started. The council is trying to find a more effective process for engaging service users and other stakeholders in the planning and commissioning process. The model which is developed for TASC will be integral to this change. An initial vision for learning disability services has been developed and there are plans to take this out for further development and consultation. Views about involvement and consultation were variable. Carers who met inspectors commented that there had been more consultation in the past and that, although a disability forum exists, they now felt disillusioned by the process. However, 62% of carers reported in the survey that they felt involved in the consultation process. Fifty three percent of staff considered that change is not well planned or effectively delivered. The council will want to assure itself that they are able to deliver the planned changes in a way which can demonstrate that staff, service users and carers have been consulted and engaged in the process. Strengths Areas for development / improvement Despite a difficult financial Developing involvement and position, some future finding is consultation with all secured in order to meet stakeholders in relation to the predicted service demands TASC programme The council is working with partners on a regional basis in order to delver efficiencies in specialist service provision Early stages of the development of TASC which has the potential to drive future commissioning 10. Delivering Social Services In the staff survey sixty seven per cent of staff considered that staff recruitment and retention problems have had an impact in their area of work. From discussion with staff this position is different in care management and day services. The care management team reported no on-going staff vacancies and considered that the team had developed more stability and cohesiveness over the last two years. We are a stable team no-one leaves. 12

15 Although workloads were demanding it was reported that an analysis had been carried out which had resulted in a better system for managing caseloads. As mentioned in Section 7 of this report, day centre staff reported some capacity issues. In addition staff expressed uncertainties following the recent workforce negotiations with the council and some staff were concerned that there may be job cuts in the future. Senior officers reported that the council has been working to develop an acceptable corporate solution to address considerable budget challenges. The workforce strategy was supported by over 70% of the workforce following a trade union ballot. The strategy resulted in staff accepting a pay cut for one year and this process had inevitably caused an issue for some staff. Staff acknowledged this and agreed that some of the issues and actions taken which were affecting staff terms and conditions were part of the corporate process for dealing with efficiency savings. The practice of temporary contracts was also causing some staff in day services to feel very uncertain. Examples were given of people who had worked on a temporary contract for several years having had their posts terminated. Inspectors were informed by managers that this issue has taken a time to resolve but that human resources is due to take a report through the political process which will recommend that people who have been temporary for two years or more are made permanent. Eighty three percent of staff reported in the survey that their training needs are identified and that a range of training courses were available. Day services staff considered that the quality of training could be improved through variation in training providers. Operational managers said they were looking to develop a method to assess the outcomes of training. Seventy seven percent of staff who responded to the survey reported that they receive regular supervision; 86% said they had regular teams meetings and business planning was reported to be established across both services. Day services staff commented these processes had generally improved over the past year. Care managers reported that they did not have annual appraisals and managers confirmed this was not embedded across all staff groups. The management of quality and performance was found to be inconsistent. Seventy eight percent of staff considered that there are clear standards for their work. Staff and managers referred to some individual quality assurance and performance management processes being in place. Case file audits are not regularly undertaken. Reference was made to an audit tool which has been developed and piloted in the older person s team, with plans to use in the CLTD. Carers who met with inspectors considered that quality assurance was not uniformly established across day services and reported differences between services. The Council will want to consider how it can develop a more consistent approach to performance management in this service. 13

16 The inspection did not look in detail at the collation of management information. However, inspectors were concerned at the potential difficulty in accurately collecting information from the unified assessment tool for the national performance indicators on carers. The council will want to assure itself that its system for collating this data is fit for purpose. Strengths Areas for development / improvement Staff are generally positive about the training they receive Recently developed service standards and procedures across learning disability direct services Staff supervision is established across the service Analysing the impact of staffing levels in day services and dealing with any identified issues Completing the work being done to improve the position for people on a temporary contract Implementing the planned work to develop outcomes for training Improve performance in delivering annual appraisals Improving quality assurance and performance management arrangements 11. Providing Direction Progress in taking forward developments in the service have been influenced by senior management changes which have affected both capacity and approach during the last two years. At senior management level, the Head of Adult services has been on maternity leave since August The duties of this post have been split with the operational duties being covered Head of Housing Services and the strategic developments by the corporate Head of Change Management and Innovation. There has also been a reconfiguration to create a new operational structure at the next tier. Direct services across both mental health and learning disabilities are now managed by one principal officer and commissioning and care management services by a second principal officer who has also taken on the safeguarding remit. From evidence seen by inspectors these changes were having an impact on front line staff. Communication was an issue. Staff said that senior managers were less visible than in the past, particularly the Head of Adult Services. Staff across both day services and care management considered that there had been deterioration in the contact they had with senior managers. Only 29% of staff in the survey considered that they are consulted about decisions that affect their service and them. Interviews with staff also confirmed this view. 14

17 Carers stated that they had appreciated contact with previous senior managers and the changes during the past two years had reduced communication and consultation. In the survey staff said: Our day centre constantly works towards independence for the service user this includes interaction within the local community, travel training, work experience and life skills. However in the present climate there are constraints e.g. financial which can affect certain activities. I think front line staff would benefit greatly with their ideas and suggestions being heard and communicated up management hierarchy. Upper management need to take on board the challenging times that face frontline staff and improved communication would help. In general I feel on the whole NPT CBC do a good job. Managers agreed that they had not appreciated the positive impact of previous good practice such as a regular newsletter and visits to services by senior managers. Recent changes in process were reported by care managers, particularly regarding requests for funding. Care managers understood the need for scrutiny but considered that it now takes longer for decisions to be made and that these are often not communicated to the care manager. The council will want to assure itself that current systems are timely, transparent and robust. The council is approaching the TASC programme as an opportunity to rigorously review its service and performance. The delivery and management of the projects which are being developed to support the TASC programme are acknowledged as being demanding. The Director has identified corporate project management support for this process. The council will want to assure itself that it has the necessary capacity to both undertake this work and to maintain and improve the quality of frontline services during this review. Strengths Areas for development / improvement Potential opportunities Developing and implementing provided by the TASC the communication strategy programme identified in the service business plan Managing the impact of the changes in senior management capacity and structures to ensure there is not a negative impact on frontline service delivery Managing capacity to deliver the TASC programme 15