2014/032 Meeting of: Governing Body Subject: Cornwall Council - Adult Social Care Improvement Plan Author:

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1 2014/032 Meeting of: Governing Body Subject: Cornwall Council - Adult Social Care Improvement Plan Author: Maddison, Interim Manager - Adult Social Care Improvement Presenter: Anne Mankee-Williams, Date of meeting: 9 September, 2014 Requirement: Information 1.0 Situation This report has been prepared by Cornwall Council for presentation to their Cabinet on 10 th September. It presents the first version of the Adult Social Care Improvement Plan for Cornwall Council. It provides background to the service issues to be addressed and sets out early priorities for action to be delivered by end March The Cabinet is being asked: 1. That Cabinet approve the approach to, scope of and early priorities for the Adult Social Care improvement plan 2. That Cabinet continues to support the integration of the strategic commissioning and locality-based provision of health and adult social care in Cornwall and notes the work underway to determine the state of readiness for that integration. 3. That members receive regular reports on both the integration activity and adult social care improvement through the Health & Wellbeing Board, PAC and the Health and Social Care Scrutiny Committee in addition to Cabinet. For NHS Kernow Governing Body, this paper is for information purposes only. 2.0 Background Together with NHS Kernow, the Council has ambitious plans for integrating health and social care. Integration is seen as being able to offer a better quality of service to the public and to provide opportunities to work more efficiently and effectively in a challenging financial climate. One strand of the integration work covers the integration of commissioning, being led within NHS Kernow by Trudy Corsellis. The sharing of the information in this paper is part of the joint work under this programme of work. 3.0 Assessment A joint transformation programme with the Council to plan and deliver the necessary changes has been established. An information gathering process is underway as part of the programme to determine the state of readiness of each partner in relation to commissioner and provider functions. The current positions of both adult social care and NHS Kernow will impact on how and when full integration can occur. However, early action within the Council to improve joint strategic commissioning, to prepare for a locality-based approach to provision and

2 to integrate support for safeguarding has been included in the improvement plan. Other work is underway to scope and identify business critical functions that can also been joined up at an early stage. 4.0 Recommendations The Governing Body is asked to note the contents of this report. 5.0 Details of stakeholder engagement, including quality and patient experience impact Stakeholder engagement is being conducted by both NHS Kernow and Cornwall Council as part of the Living Well transformation programme. 6.0 Are there any equality and human rights implications? Equality impact assessments will be conducted at project or initiative level. 7.0 Financial implications The Council Adult Social Care service is substantially over spending. New controls and schemes of delegation are being put in place to deliver the savings and improvement plans. The impact of these changes may affect health spending, and will be detailed when more information about the council plans is available and has been assessed. 8.0 Identify any risks or issues associated with this initiative There are a range of risks related to the current position for Adult Social Care and the impact upon NHS Kernow and Health provision. These will be identified and addressed as part of the Living Well programme, and Integrating Commissioning programme. Risks are managed jointly where applicable via the Joint Strategic Executive.

3 Report to: Cabinet Date: Wednesday 10 th September 2014 Title: Portfolio Area: Adult Social Care Improvement Plan Health and Adult Care Note: if there is more than one Portfolio Area which may have significant involvement in the issue the Leader will decide who will lead. You must contact the Democratic Services Manager to seek this confirmation. Divisions Affected: All Relevant Scrutiny Committee: Health and Social Care Scrutiny Key Decision: N Approval and clearance obtained: Y / N Urgent Decision: N Date next steps can be taken: (e.g. referral on of recommendation or implementation of substantive decision) Appropriate pre-decision notification given where an executive Decision? N/A Author: Maddison Role: Interim Manager Adult Social Care Improvement Contact: /mmaddison@cornwall.gov.uk Recommendations: 1. That Cabinet approve the approach to, scope of and early priorities for the Adult Social Care improvement plan 2. That Cabinet continues to support the integration of the strategic commissioning and locality-based provision of health and adult social care in Cornwall and notes the work underway to determine

4 the state of readiness for that integration. 3. That members receive regular reports on both the integration activity and adult social care improvement through the Health & Wellbeing Board, PAC and the Health and Social Care Scrutiny Committee in addition to Cabinet. 1. Executive summary This report for Cabinet presents the first version of the Adult Social Care Improvement Plan for Cornwall Council. It provides background to the service issues to be addressed and sets out early priorities for action to be delivered by end March All of the changes will need to be considered in the context of the new Care Act Adult Social Care has a number of significant challenges. These are apparent in the overspending in the service and through the results of work to identify the scope and scale of improvement activity needed in relation to both its assessment and care management and strategic commissioning functions. Initial action has already been taken by Cabinet to begin to address these challenges. An internal peer review has been conducted. This highlighted some good practice but also identified a significant number of areas for improvement including leadership and culture. Further work to identify the scope of the improvement activity needed has been carried out since the beginning of June 2014, focussing on strategic commissioning. There is a new Portfolioholder and new management arrangements at Director level. An interim management team has been established from Head of Service level and work is underway to implement change. The Council and its health partners have ambitious plans for integrating health and social care. Integration is seen as being able to offer a better quality of service to the public and to provide opportunities to work more efficiently and effectively in a challenging financial climate. A joint transformation programme with Kernow Clinical Commissioning group (KCCG) to plan and deliver the necessary changes has been established at officer level. NHS provider organisations in Cornwall are starting to look at options for the future and the Council will be involved in discussions. An information gathering process is underway as part of the programme to determine the state of readiness of each partner in relation to commissioner and provider functions. The current position of adult social care will impact on how and when full integration can occur. Early action to improve joint strategic commissioning, to prepare for a locality-based approach to provision and to integrate support for safeguarding has been included in the improvement plan. Other work is underway to scope and

5 identify business critical functions that can also been joined up at an early stage. The functional scope of the plan is extensive and it will take time to develop, implement and embed changes within the service. The plan will be updated regularly as we establish improvement activity that will extend into 2015/16 and beyond. 2. Background Adult Social Care, the Care Act 2014 and integration Adult Social Care is a statutory responsibility for the Council which importantly includes activity to safeguard vulnerable adults. It covers both assessment and care management responsibilities, which focus on individual members of the public, and the commissioning of activity and services to meet needs and to help manage demand for care, at an individual level and by looking at current and future needs in the wider population. The service receives approx. 48,000 contacts from the public each year through our access service. We support approx. 8,000 adults on an ongoing basis and approx. 2,000 carers. The legislation that applies to Adult Social Care has been updated via the Care Act Work to deliver service improvement is being undertaken in that context and in preparation for new duties under the Act which come in to force from April 2015 and further responsibilities scheduled for April The integration of health and social care is an important theme running through the Act. The Act aims to strengthen a personalised approach to adult social care that emphasises choice, control and promotes prevention, inclusion and wellbeing beyond social care. A joint transformation programme with KCCG to plan and deliver the necessary changes has been established. An information gathering process is underway as part of the programme to determine the state of readiness of each partner in relation to commissioner and provider functions. The current position of adult social care will impact on how and when full integration can occur. However, early action to improve joint strategic commissioning, to prepare for a locality-based approach to provision and to integrate support for safeguarding has been included in the improvement plan. Other work is underway to scope and identify business critical functions that can also been joined up at an early stage. Financial position The service is a major part of the Council s annual revenue expenditure at 132.7m net per annum. Adult Social Care is means tested and charges apply. The contribution to meeting care costs through charges is 20.7m

6 per annum. Income from the NHS through budget transfers and pooled budget arrangements contributes 63.1m per annum. Adult Social Care is overspending. The outturn in 2013/14 was 10.9m overspent. At the end of Quarter 1 in 2014/15 the projection is that the service will be overspent by c. 11m at year end. Audit reports identified the lack of controls in the Early Intervention Service as posing particular, significant financial risk. Financial assessments to determine potential service user contributions are not consistently timely, often due to the delays in the flow of work highlighted in assessment and care management section below. Income is lost as a result. Early priorities in the improvement plan seek to continue to exert better financial controls and reduce the scale of the overspend across adult social care. Commissioning is an important part of the use of resources in the service as over 66% of the annual gross budget relates to third party contracts for the delivery of care services. The improvement plan includes action in relation to strategic commissioning in order to help secure better outcomes for the public and improvements in the financial performance of adult social care as a whole. Leadership and culture The internal peer review in early 2014 identified that leadership and governance of the service was largely ineffective. Changes are made without sufficient attention to the potential for unintended consequences. There is a poor line of sight and a lack of management grip on the issues. Responsibility and lines of accountability are blurred, there is separation between service and budget decision-making and too little involvement of assessment and care management staff and intelligence in influencing strategic commissioning. There are gaps in the strategic direction for the service with change activity, programmes and projects not joined-up and often reactive. Culturally an avoidant management response to problems and challenge was highlighted by the review, with insufficient urgency in dealing with business-critical issues. Assessment and care management The assessment and care management function covers a number of statutory responsibilities including undertaking Section 47 assessments of

7 need and then supporting individuals in need and their carer/s by planning care that responds to any unmet eligible needs. The Council currently sets its eligibility threshold at the level of meeting substantial and critical needs. A new national eligibility threshold is being introduced as part of the Care Act from April The service leads on safeguarding vulnerable adults. It also carries specific legal responsibilities in relation to Mental Health (largely delegated to Cornwall Partnership Foundation Trust (CPFT) via Council staff seconded to the organisation) and in relation to the Mental Capacity Act including Deprivations of Liberty. Other important functions include assessment action and care planning in respect of avoiding admissions to and preventing delayed transfers of care from acute and community hospitals. 120 full time equivalent assessment and care management staff are outposted to other organisations in Cornwall. This includes staff seconded to CPFT as highlighted above, staff seconded to Peninsula Community Health (PCH) (including those who provide the assessment and care management service in support of the discharge process from acute hospitals in Cornwall and Devon) and Occupational Therapy staff who are seconded to the integrated therapy team in PCH. Gaps in strategic commissioning in the past have meant that some of these arrangements have lacked clarity of purpose and some of the necessary governance controls are missing. As a result practice standards, policy and policy changes are not implemented consistently. The internal peer review identified that there is some sensitive, good quality practice and some evidence of positive outcomes. There are some examples of good multi-disciplinary working and many committed and hard-working staff. Some service users and carers are satisfied with the services they receive. However, the review also highlighted complex pathways for members of the public, delays in assessments and reviews, inconsistent understanding and variation in application of eligibility criteria. There is a lack of clarity in the rational for some case decisions and quality of practice is variable with no up-to date practice standards. Performance data is unreliable. Some progress on improvements in safeguarding was identified by the review but it also found that safeguarding arrangements are complex with bottlenecks for work created by lack of capacity in specialist teams. There are some delays in assessment and in completing case work in a timely manner. Commissioning

8 The internal peer review highlighted some positive developments in commissioning and contract management, with efforts to strengthen quality assurance and performance management. However there is a gap in terms of a clearly articulated model for the adult social care offer to the public for the next 3-5 years. Because of that gap there are inconsistent approaches to commissioning intentions that should be comprehensive, flow from the model and link via business cases to the Council s Medium Term Financial Strategy too. Market development work is at a very early stage and more work is needed on market position statements, provider development and supplier relationship management. There are governance issues to resolve in commissioning including joint commissioning with NHS Kernow. Section 75 joint funding agreements are unsigned. Previous governance arrangements for dealing with business as usual for joint commissioning with the NHS ceased to function. The Council s in-house direct care delivery The Council still delivers a range of in-house care services including day care, equipment service, reablement, and residential respite care. There is inconsistent direction for these services and they have been managed separately by care group. The gaps in commissioning strategy highlighted above have contributed to the lack of clarity on future direction. 3. Outcomes/outputs Initial action has already been taken by Cabinet to begin to address the challenges summarised above. There is a new Portfolioholder. The managerial leadership of adult social care has been changed through the creation of the Education, Health and Social Care Directorate in April An interim management team has been established and work is underway to develop more detail for the improvement plan and to get on with implementation. Early action has been taken to change line management reporting, grouping adult social care services by function rather than care group to enable a consistent approach assessment and care management, inhouse direct care delivery and strategic commissioning. Action has been taken to change the shape of the Early Intervention Service and to establish greater clarity of purpose, financial and performance controls. The social care overspending in the service is now reducing. Weekly expenditure on packages of social care fell by almost 50% between April and end of July this year.

9 The first version of the Adult Social Care Improvement Plan is attached as Appendix 1. Early priorities to address the issues in section 2 above focus on work to be delivered by the end of March 2015, setting milestones and target completion dates. In summary, by March 2015 or earlier the following will be in place: Safeguarding improvements including a new integrated safeguarding support and standards unit spanning adult and children s social care and health Early action in assessment and care management to improve workflow and workload management Rebuild workflows in MOSAIC to support practice and collect reliable data New model for peer review in teams through case file audit, supported by managers A proposal for a stronger locality-based model for assessment and care management that can be more easily aligned with health New quality assurance and performance management model in place First phase of a new workforce plan to be complete A new Social Work qualification and career pathway to be agreed across children s and adults services A new governance structure with the NHS for our integrated strategic commissioning activity Establish adult social care offer to the public and complete commissioning intentions and four business cases to support change, including two joint business cases with KCCG An updated scheme of delegation and new system of financial controls for adult social care New management arrangement supporting our in-house service delivery to be in place Adult social care performance information in the corporate performance report to be updated and new indicators chosen for monitoring that reflect the challenges and areas for improvement in the service Service risks to be fully represented in service, directorate and corporate risk registers The plan will be updated regularly as more detail is developed and as we establish improvement activity that will extend into 2015/16 and beyond. The functional scope of the plan is extensive and it will take time to develop, implement and embed changes within the service. It is worth noting that action to address challenges in Children s Social Care in Cornwall took three years.

10 4. Options available and consideration of risk Adult social care is a statutory responsibility for the Council. Addressing the challenges in the service will help to drive better outcomes for the public, improve effective use of resources and help to achieve financial control. There are a number of areas of significant risk within the service as it currently operates. These include timeliness of assessments and completion of care planning work, timeliness of work on adult safeguarding, gaps in financial controls, information governance including poor data quality and inconsistent approaches to quality assurance and performance management. In order to focus on managing risk appropriately, the service is developing a new risk register and the main strategic risks are being added to the Directorate and Corporate risk registers. Activity to manage and reduce those risks is built in to the improvement plan. The Comprehensive Impact Assessment undertaken identifies that the Improvement Plan should deliver positive impacts for equality and diversity, safeguarding and information management. There may be short term negative impacts on health, safety and wellbeing of the workforce due to significant change. Action to mitigate this will be taken. The improvement plan is a living document that will be updated regularly. As we develop more detailed actions and produce proposals for decisions we will update the Comprehensive Impact Assessment and produce new ones, engaging with representative groups, unions and staff as necessary. 5. Proposed Way Forward It is proposed that cabinet comment on and approve the approach, scope and priorities for early action in the improvement plan. 6. Implications Implications Relevant to proposals Y/N Details and proposed measures to address

11 Legal/Governance Y There are a number of legal and governance risks for the Council as a consequence of the current position of adult social care. There is a risk of legal action including potential judicial reviews as a result of delays for some members of the public in receiving needs assessments and subsequent action to meet needs. Action to address includes mapping and then making changes to capacity in relation to demand and by simplifying workflow (supported by changes in MOSAIC). Further measures in relation to safeguarding are summarised below. Capacity gaps for responding to Deprivation of Liberty referrals have already started to be addressed by changes in working practice and investment in staff training to increase the number of practitioners who can undertake Best Interest Assessments. There is a risk of unlawful expenditure as a result of unsigned joint financial agreements between the Council and KCCG. This is being addressed through the new Joint Strategic Executive Group that reports to the Health & Wellbeing Board Financial Y This service is substantially overspending. A revised Scheme of Delegation is being established to take effect from 1 st October 2014 with managers clear about the budget headings for which they are accountable and how they will be held to account. New controls are being put in place within the assessment and care management function to oversee decision-making and to promote a better understanding of both best professional practice and the financial implications of practitioners decisions. Risk Y There are a range of risk implications arising from the current position of the adult social care service. The service is developing a new risk register and the key strategic risks are being added to the Directorate and Corporate risk registers. Action to manage and reduce risk is included across the Improvement Plan. Comprehensive Impact Assessment Implications Equality and Diversity Y People with disabilities and their carers will be affected by the improvement plan. Because of the level of disability that can be associated with aging,

12 the service currently supports a higher number of older people than those of working age. The service supports a higher number of women partly because women s average life expectancy is greater than men. The proposals aim to deliver improvements in a positive way. Further Comprehensive Impact Assessments will be completed as the Improvement Plan is further developed. The aim of the Improvement Plan is to bring a consistent approach and response regardless of disability or age taking into account individuals circumstances. Safeguarding Y Vulnerable adults will be affected by this proposal. The Improvement Plan is likely to have a positive impact such as shorter waiting times to be seen and quicker responses to ensure risk is reduced. People should feel safer sooner. Information Management Community Safety, Crime and Disorder Y N Early actions in the Improvement Plan aim to start to reduce some of the risk the service is carrying around Information Management, especially in relation to workflows within the Care Management System which impact on information security, reporting, record keeping and management. Health, Safety and Wellbeing Other Y N For people with disabilities and their carers, the proposals outlined in the Improvement Plan should result in positive impacts in the long term as the Council improves the way people s care needs are met. Our staff will potentially see some negative short term impacts as changes are implemented. However in the longer term, the Improvement Plan aims to deliver a positive impact for staff including more manageable workloads with clear expectations. The negative impacts will be mitigated by a number of measures including continued involvement of unions and staff and by managing change using the Organisation Design Toolkit.

13 implications Supporting Information Appendices: Appendix 1 Adult Social Care Improvement Plan Version 1 September Background Papers: [under provisions of the Local Government Act 1972] None Approval and clearance of report All reports must have Finance Service clearance and, in the case of Cabinet, Council and Portfolio Advisory Committees, Legal Service clearance. Your report will only receive clearance if the implications in Section 6 are considered by the Finance and Legal Services to be complete and accurate. Make sure you contact the Finance Service and the Legal Service early on for advice where there are potentially financial or legal implications. If there are other resource implications you must forward your report to the appropriate Head of Service for clearance. If those clearing the report make amendments they will advise you of that fact and refer you to the relevant changes. As report author you are responsible for finalising the report and its content but you are required to have regard to the comments of the Finance and Legal Services and clear reasons for not following their advice. All reports: Final report sign offs Legal (if significant/required) Finance Required for all reports Equality and Diversity This report has been cleared by OR not significant/not required Date Cabinet/individual decision reports:

14 Final report sign offs Head of Service Corporate Director This report has been cleared by Date Draft reports process checklist for Cabinet/individual decision reports: Complete the checklist below while you are drafting your Cabinet or individual decision report. It will be removed before publication. Process checklist Portfolio Holder briefed Corporate Director briefed Head of Service sign off (draft) Data protection issues considered If exempt information, public (part 1) report also drafted. (Cabinet/Scrutiny) If not on Cabinet Work Programme, Scrutiny offered the opportunity to consider the report Completed Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No

15 Adult Social Care Improvement Plan - Early Priorities 2014/15 Appendix 1. Theme Subject Issue Action to address Who is accountable for delivery? What will we measure? Milestones Target for completion RAG rating for progress Monitoring Direction Comments 1. Safeguarding Improve safeguarding performance Clarify leadership for safeguarding within Council's adult social care service Service failing to meet current key performance indicators including 80% of case conferences held within 30 Backlogs in allocating work following receipt of safeguarding alerts. Current approach to quality assurance and performance monitoring is insufficient to give good assurance about adult safeguarding practice 1.1 Ensure single manager is accountable for service's safeguarding work and performance 1.2 Complete case audits to better understand reasons for current performance 1.3 Analyse performance on key indicators by individual/team and service area 1.4 Check methodology for counting and recording in comparision with the best performing Councils and consult with DH lead for adult safeguarding on current key performance indicators 1.5 Develop suggestions for updated KPI set for 2015/16 to meet requirements of Safeguarding Adults under Care Act working with new Directorate safeguarding standards unit, the Safeguarding Adults Board and its relevant sub-groups 1.6 Understand current practice in triage team and associated output of unallocated cases and blockages in workflows. 1.7 Temporarily increase capacity in triage team by placing 2 additional workers in team for two months to test impact on quality of decisions made, management of workflow through the team and pathways out and the quality of the application of threshold guidance. 1.8 Review current arrangement of separate specialist safeguarding practice team and develop a proposal that supports best workflow possible within current resources, building on premise that safeguarding is everybody's business 1.9 Ensure Council signs up to national initiative 'Making Safeguarding Personal' in line with best practice and national policy direction for adult safeguarding as set out in the Care Act 1.10 Establish a Directorate lead for safeguarding to oversee a single function for Safeguarding Adults and Children Standards Units and the respective Safeguarding Boards' support. This will enable an integrated framework for practice standards, process and quality assurance, allowing for the innate differences in safeguarding adults and children. Ensure KCCG safeguarding lead roles are integrated in the new function Appoint single senior manager, in line with Council's organisational toolkit, to lead on work to integrate the two standards units and support for the two Boards 1.12 Devise and implement a Quality Assurance and Performance Management (QAPM) framework for adult social care assessment and care management operations (including Approved Mental Health Practitioners and the Mental Capacity Act and Deprivations of Liberty teams) and the Safeguarding Adults Board that has the same characteristics as the QAPM framework for children's services 1.13 New policy and processes, aligned with the Local Authority Designated Officer (LADO) role in children's safeguarding, to respond to safeguarding concerns against professionals/organisations that work with adults 1.14 Participate in work with the new integrated safeguarding function and partner organisations to develop a proposal for a Multi-Agency Safeguarding Hub (MASH) Trevor Doughty Wild Wild Wild Mark Howe/Jack Cordery Wild Wild Wild/ Jack Cordery Wild/Jack Cordery Jack Cordery/Sue Smith (KCCG) Jack Cordery Mark Howe/Jack Cordery Jack Cordery/ Maddison/Anna Mankee-Williams Wild Safeguarding Interim management responsibilities clear in job arrangement in place description for new Head of from June 2014 Audit reported to Safeguarding Board Measure compliance of teams to current performance framework Agreed methodology for counting and recording being used New KPI set to meet requirements under Care Act in Place Measure consistency of threshold application and number of cases wiating for allocation Measure consistency of threshold application and number of cases wiating for allocation Council registered with and participating in national programme New unit in place covering adult and children's social care and integrating KCCG safeguarding lead roles Manager in post Agreed new QAPM in place New policy and business processes in place and communicated to staff and partners Sep-14 Nov-14 NB This section to be used for Feb-15 updates after plan agreed by Cabinet Dec-14 Nov-14 Dec-14 Dec-14 Feb-15 Nov-14

16 Adult Social Care Improvement Plan - Early Priorities 2014/15 Appendix 1. Theme Subject Issue Action to address Who is accountable for delivery? What will we measure? Milestones Target for completion RAG rating for progress Monitoring Direction Comments 2. Assessment and care management Mental Capacity Act and Deprivations of Liberty (DoLs) Improve use of existing team capacity to ensure better workflow and strengthen approach to locality working in preparation for future integration of community health and social care Significant backlog of cases waiting for assessment following Supreme Court ruling earlier in 2014 in Cheshire West case which widened thresholds for consideration of DoLs assessments 2.1 Develop, agree and implement a plan for improving assessment capacity to manage risk inherent in waiting list of cases. Backlogs of cases waiting for allocation 2.2 Undertake workforce and activity analysis to fully understand the capacity challenges and impact on staff across the existing localities and teams. 2.3 Clarify roles of case-coordinators, senior practitioners and Social workers in assessment and review functions and the role of Occupational Therapy in relation to this activity Workflows not properly reviewed by 2.4 Scope and implement project to review and re-engineer all workflows service before MOSAIC system upgrade within MOSAIC to strip out unneccessary bureaucracy that is burdening implemented in early Difficulty staff and ensure inclusion of manadatory performance fields for data in extracting good qaulity data from collection in light of Care Act and statutory return requirements from April system as a result 2015 Current locality approach for assessment and care management teams leaves some of our staff with significant travelling times to visit clients and does not consistently support local working with colleagues in primary care and community health Complaints being received about financial assessment process and risk that income is being lost due to workflow problems 2.5 Implement early action to improve workflow 2.6 From analysis, make recommendations on alternative models of operation, including strengthening locality model to align with locality approach to community health services in NHS. 2.7 Check workflows for initiating and completing financial assessments. Analyse learning from complaints. Review staff training and information for the public Maddison/Mark Howe Wild/Brickchand Ramruttun Wild/Brickchand Ramruttun Mark Howe/Gill Goodier Wild/Brickchand Ramruttun Maddison/Mark Howe Maddison/Mark Howe/Mark Read Number of DoLs cases on waiting list Analysis complete and baseline of number of cases on waiting lists Reduction in number of workflows in MOSAIC. Correct workflows built to support statutory data collection. Reduction in staff time to input casework on system Reduction in number of cases on waiting list and improvements in timeliness of assessments Proposal for alternative management structure developed for decision Review complete Agree plan at DLT June Train additional Best Interest Assessors and ensure staff released to undertake Milestones set out in high level project plan for MOSAIC improvements Feb-15 Dec-14 Feb-15 Dec-14 NB This section to be used for updates after plan agreed by Cabinet

17 Adult Social Care Improvement Plan - Early Priorities 2014/15 Appendix 1. Theme Subject Issue Action to address Who is accountable for delivery? What will we measure? Milestones Target for completion RAG rating for progress Monitoring Direction Comments 3. Quality of practice (In addition to safeguarding actions) Consistent approach to management by care group Significant variation in management practice and approaches to performance management by care group 3.1 Change line management arrangements to give one point for reporting for all assessment and care management teams 3.2 Re-establish line management arrangements with CC staff seconded to teams in CPFT (AMHPs) and PCH (EIS and Integrated Therapy Service) and ensure all of improvement action in this plan encompasses this wider group of staff as required 3.3 Update standards expected for supervision and audit implementation of these 3.4 Establish bi-monthly meetings with front-line assessment and care management staff and Interim Manager for assessment and care management to influence and support best practice 3.5 Develop and implement model for peer review within teams through case file audit including checking application of eligibility threshold 3.6 Develop and implement use of QAPM model to support review of wider quality of practice beyond safeguarding and use QAPM conference model to review performance Maddison Maddison/Mark Howe Wild/Brickchand Ramruttun Mark Howe Mark Howe Wild/Brickchand Ramruttun Interim management arrangement in place. Same design principle used in locality management proposal. Interim management meeting structure established. Regular attendance of key seconded staff. New standards being implemented New meetings in place All teams participating, evidence from reviews QAPM agreed Jul-14 Feb-15 NB This section to be used for updates after plan agreed by Cabinet Sep-14 Sep-14 Dec-14 Dec Workforce Workforce plan in place No comprehensive information readily available in one place to provide profile of current workforce Clear Lack of clarity in Social Work qualification & qualification and carer pathways career pathways for Social Workers Learning & Adult Social Care service is not acting Development as a good client for the current function fully learning and development function aligned to support service priorities 4.1 Complete first phase of workforce plan by establishing a full profile of the 'as is' adult social care workforce in the Council to include roles, qualifications, age profile etc. 4.2 Establish coherent pathways that span Social Work for both children and families and adult care services 4.3 Review and update learning and development business plan for 2014/15 to align with adult social care improvement plan Julian Parker/Laura Wheeler/ Maddison Peter Wild/ Rebecca Burden/Marion Russell/Jack Cordery Mark Howe/ Maddison/Kathy Pope Accurate 'as is' profile in place New pathway agreed Updated plan in place Sep-14 Dec In-house care delivery Clear stategic direction for inhouse care delivery Variation in management practice and approaches to performance management by care group 5.1 Change line management arrangements to give one point for reporting for all in-house care delivery services. Lead change in line with model of adult social care and commissioning direction (see commissioning section below) 5.2 Review management structures and set standards to give coherence to practice and performance Maddison Maddison New management arrangement in place Sep-14 Mar Financial controls Improve financial controls and financial management Lack of financial controls in service and variation in approach by management team 6.1 Agree new budget structure and allocate budget owners for three main functions - assessment and care management, commissioning and in-house care delivery. Update scheme of delegation in line with this. 6.2 Establish new monthly financial reports for service in line with these changes 6.3 In assessment and care management, establish comprehensive financial reporting by team with onward reporting to the new operational management meeting structure & managers being held to account for their areas of financial responsibility at management meeting 6.4 Establish a panel for all placement decisions on a weekly basis to help consistent decision-making and to build better modelling of activity and costs (NB a suitable sign-off process outside of meetings will be required to ensure panel does not contribute to further delaying transfers of care from hospitals to placements) 6.5 Check application of Resorce Allocation System (RAS) and audit use of delegated responsibility to approve budgets at higher level than indicated by the RAS 6.6 Plan and deliver refresh financial training for all staff with delegated financial responsibility under new scheme of delegation and more general financial awareness updates for all front-line staff 6.7 Establish and communicate staffing budgets by team manager across the service so that they can better manage staffing and recruitment Maddison/Russell Ashman/Anna Mankee-Williams Maddison/Russell Ashman Mark Howe/Russell Ashman Wild/Brickchand Ramruttun Mark Howe/Russell Ashman Mark Howe/Russell Ashman Wild/Brickchand Ramruttun New budget structure in place. Managers clear about accountability New reports in place Evidence of use of reports to inform decision-making at operational management meeting Panel in place. Evidence of suitable challenge and influence on decisionmaking at panel meetings Initial audit complete & plan for any necessary improvements agreed All managers and senior staff covered by scheme of delegation by December All other staff by financial year end Updated budget structure in place. Managers clear about accountability Nov-14 Nov-14 Dec-14 Jan-15

18 Adult Social Care Improvement Plan - Early Priorities 2014/15 Appendix 1. Theme Subject Issue Action to address Who is accountable for delivery? What will we measure? Milestones Target for completion RAG rating for progress Monitoring Direction Comments 7. Commissioning Need clear No clear model agreed for adult social strategic care offer to the public direction for adult social care commissioning, aligning with KCCG startegy to support Gaps in commissioning strategies, intentions and business cases to deliver the changes necessary to implement agreed service model No agreed governance framework for Improve dealing with existing joint governance for commissioning activity with NHS existing joint commissioning Section 75 agreements for learning disability and mental health pooled budgets are unsigned Improve Commissioning and contracting alignment of infrastructure needs further council's development to ensure fit for purpose resources to and in readiness for next steps in delivery of integration with NHS agreed commissioning plans 7.1 Develop and agree model, aligning with outcome areas in KCCG's integrated plan 7.2 Review existing commissioning plans and intentions and identify gaps that need to be addressed 7.3 Agree priorities for 2 joint business cases with KCCG and progress work 7.4 Agree new approach for dealing with commissioning 'business as usual' with KCCG. 7.5 Progress work to complete and sign Section 75 for learning disability services 7.6 Progress work to review, re-write and sign Section 75 for mental health services 7.7 Develop, agree and implement new performance report for existing joint commissioning activity 7.8 Review and redesign commissioning and contracting functions within Directorate, using Institute of Public Care model for commissioning function Maddison/Anna Mankee- Williams/Trudy Corsellis (KCCG) Maddison/Anna Mankee- Williams/Trudy Corsellis (KCCG) Maddison/Trudy Corsellis (KCCG) Maddison/Anna Mankee- Williams/Trudy Corsellis (KCCG) Anna Mankee Williams/ Trudy Corsellis (KCCG) Anna Mankee- Williams/ Trudy Corsellis (KCCG) Maddison/Anna Mankee- Williams/Trudy Corsellis (KCCG) Anna Mankee- Williams/ Maddison Review complete and reported to Joint Strategic Executive 2 joint business cases to reshape services agreed and ready for Integrated Commissioning Board in place and reporting to Joint Strategic Executive Committee Signed section 75 in place Signed section 75 in place New report in place reporting on finance and activity metrics for all areas of shared business. New structure in place with team objectives aligned to delivering priorities in adult social care service model and MTFS Priorities agreed Sept 2014 Sep-14 Sep-14 Sep-14 Nov-14 NB This section to be used for updates after plan agreed by Cabinet 8. Corporate action Performance reporting Risk Key Performance Indicator (KPI) on adult social care reviews that is currently included in corporate performance report is not best indicator of overall service performance Service risks not fully represented in risk registers 8.1 Agree first phase of improved content for monitoring adult social care performance in monthly and quarterly corporate reports (NB A more fully developed data set will only be available once remedial work on MOSAIC is complete) 8.2 Analyse and capture key service risks for service, directorate and Corporate risk registers along with actions to mitigate Maddison Maddison New KPIs in corporate report including Direct Payments and Safeguarding plus exception reporting on implementation of Risk registers updated to match findings from diagnostics and action to mitigate in line with improvement plan