Agenda item

Councillor Jane Palmer, the Cabinet Member for Health and Social Care, thanked the Committee for inviting her and Ms Sandra Taylor, the Council’s Director of Adult Social Care and Health, to the meeting.  Ms Taylor noted that this provided them with a good opportunity to talk to Members about the recent CQC inspection of Adult Social Care.  New regulations had been introduced which had seen Hillingdon as one of the first twelve local authorities to have an inspection of its adult social care services.  It was noted that all of the local authorities in North West London had been inspected, although some reports had not yet been published. 

Hillingdon had been advised in 2023 that it would be inspected by the CQC in 2024.  The Council received the templates and started to develop an action plan for improvements and develop a self assessment document.  The CQC contacted the Council on 19 February 2024 to request that a range of information be provided within the following two weeks.  As progress had already been made, the self assessment had to be rewritten, identifying the service’s strengths and weaknesses and included evidence to support the detail that had been included therein.  199 pieces of evidence were submitted to the CQC at the beginning of March 2024.  Ms Taylor praised the diligent and focussed team that had pulled the information together to be submitted to the CQC within a very short time period. 

On 14 June 2024, a three and a half hour leadership meeting was held with the inspectors to tell them what the Council thought was important.  This meeting had been attended by Mr Dan Kennedy, Mr Keith Spencer, Ms Taylor and others to demonstrate leadership across the piste.  An onsite inspection was also held. 

The Council had had to provide the CQC with the names of individuals that they wanted to interview including residents, representatives from the Select Committee, Cabinet Member, Chief Executive, partners such as Healthwatch Hillingdon and the third sector.  The Council team had briefed each of these individuals face-to-face before their interviews.  In July 2024, eight CQC inspectors came to Hillingdon and worked closely with staff who highlighted what Hillingdon did well for residents and the areas that were being worked on.  In all, 133 meetings and conversations took place.  The inspectors were also encouraged to go out and meet staff working in the community. 

Ms Taylor advised that the Council had received the first draft of the CQC report in September 2024.  Whilst the content of the report was good, the style had needed some work and factual inaccuracies had needed to be corrected.  The CQC took on the Council’s feedback and the updated report was sent to the Council in November 2024.  The changes were then accepted by the Council and the final version of the report was published on 13 December 2024. 

Ms Taylor was proud of the work that had been undertaken and the Council’s achievements.  Although she was disappointed with the score of 2 for Equity in experience and outcomes, it had been recognised that improvements were needed in equality and equity for residents.  The CQC had also suggested that more information should be brought to the Health and Social Care Select Committee and that further work was needed in relation to Expert by Experience (the Council had previously been very good at this but it had fallen off so needed to be improved to give residents a voice).  Members agreed that equity was important and suggested that consideration was needed to ensure that there were no digital barriers experienced by residents, especially those in deprived and diverse communities. 

Thought would also be needed to ensure that measures were in place to include the issue of an ageing workforce in the improvement plans.  Ms Taylor advised that a Workforce Strategy Action Plan had been developed which was good as long as it was kept up to date.  It was predominantly the carers that were ageing but it would be important to retain skills so apprenticeships had been introduced.  A copy of the Workforce Strategy and the initial Self Assessment document would be sent to the Democratic, Civic and Ceremonial Manager for circulation to the Committee. 

Ms Taylor advised that there had been a number of people who had struggled with digital barriers so meetings had been held with the Council’s Chief Operating Officer to look at how the Council could reach out and support them.  The local authority had also been working with voluntary sector partners on initiatives such as the provision of help for those that were eligible to apply for Pension Credits.  It was noted that care providers produced care plans online but that there was also provision for these to be available in paper format.  Tech-enabled care needed to be better used and communication around this needed to be improved. 

Councillor Palmer advised that she attended the Older People’s Forum and Disability Forum and had heard about the digital challenges being faced by residents.  Ms Tayor and her team had been taking this feedback on board to ensure that the voices were not lost.  It was important to ensure that support was available to those who were not digitally able.

Concern had previously been expressed that some residents had been struggling with the move towards digital access to information.  However, no certainty had yet been provided about when measures would be in place to help these residents.  Members requested that further information and evidence be provided at a future meeting in relation to improvements to digital access.

The Cabinet Member thanked the Committee for their valuable scrutiny of Adult Social Care and hoped that they would continue to work closely to help shape policy going forward.  It was noted that the Health and Social Care Select Committee did feel valued and aimed to support Adult Social Care by acting as a critical friend.  It was agreed that arrangements would be made for the Chair, Labour Lead, Cabinet Member and Ms Taylor to meet to discuss what information should be brought to the Committee in future to enable it to be as effective as possible.  Ms Taylor suggested that the Action Plan could be brought to the Committee in a few months to demonstrate improvements that had been achieved. 

Members congratulated and thanked Councillor Palmer, Ms Taylor and her team for their efforts in getting the information to the CQC.  They also thanked the CQC for coming in and undertaking the inspection which had been useful for the Committee.  The process had been quite intense but reflected the service well.  It appeared that most residents were able to access services easily and were happy with the care that they received.  The carers were being well supported, staff were valued and partners appreciated the good joint working relationships that had been built. 

Ms Taylor advised that a lot of work had been undertaken.  Government grant funding had been secured to get Health Inequalities Officers embedded in the team for a fixed term.  It was anticipated that, if health inequalities was embedded in all of its work, Social Care would not be needed as much or could be introduced at a later stage.  This would be a key driver for the forthcoming year.  It was suggested that Ms Kelly O’Neill, the Council’s Director of Public Health be invited to attend a future meeting to talk about health inequalities. 

Councillor Palmer noted that there should not be a north/south divide when talking about addressing health and social care issues.  Harefield experienced poor air quality, high levels of suicide and large numbers of heart attacks and was second only to Botwell in terms of health inequalities in the Borough.  It was important to look at the whole of the Borough to identify solutions. 

Concern was expressed that staff had noted in the CQC inspection report that there had been instances where delays in safeguarding investigations being completed had been caused by delays of four weeks in providing a suitable advocate.  Ms Taylor advised that the inspectors had raised this with her in July 2024 and action had been taken immediately.  The issue had been included in the action plan and contractual arrangements had been changed to ensure an appropriate response. 

Ms Taylor noted that improvements were being made to the Council website with regard to language accessibility.  Currently, the team had access to ‘Big Word’ translators but were also blessed with diversity which meant that many of the staff were able to step in to provide translation support when needed.  There were plans to further improve this accessibility. 

The CQC report had noted that the Council recognised the need to do further work to understand the diverse needs of the community, particularly to ensure services for the LGBTQIA+ community were accessible and appropriate to meet their needs in a person-centred way.  Ms Taylor advised that the barriers faced by this community were not in relation social care but in general.  There needed to be an equity of experience.  Consideration needed to be given to how the individual was made to feel so that improvements could be made.  Work was already underway with a Brunel University professor to look at whether the commissioning was right and what could be done differently. 

Ms Taylor advised that Hillingdon had excellent supported living facilities but insufficient places in residential care for individuals with learning disabilities and mental ill health.  A need had been identified for those with complex requirements who struggled in supported living so needed residential care.  Plans had therefore been drawn up for accommodation and support to be provided locally and were currently with the Planning Department (many of these individuals wanted to stay in Hillingdon but were currently having to be placed out of Borough). 

Direct payments was where the local authority paid money to people regularly (or someone acting on their behalf) so they could arrange their own support, instead of receiving social care services arranged by the local authority.  Although Hillingdon had a lower uptake of direct payments than the England average of 26.22%, Ms Taylor advised that this was not something that needed to be increased as many residents did not want to use direct payments.  As these were Council funds, the local authority did need to monitor the use of direct payments, some of which uses could be quite innovative - she advised that she would share information in the summer about the innovative use of direct payments.  However, there were some providers that would only offer care paid for by direct payments.  In the future, the Council would be looking to use direct payments as the first option unless the resident needed something else. 

RESOLVED:  That:

1.    Ms Sandra Taylor send a copy of the Workforce Strategy and the initial Self Assessment document to the Democratic, Civic and Ceremonial Manager for circulation to the Committee;

2.    Ms Sandra Taylor provide further information and evidence at a future meeting in relation to improvements to digital access;

3.    a meeting be set up for the Chair, Labour Lead, Cabinet Member and Ms Sandra Taylor to discuss what information should be brought to the Committee in future to enable it to be as effective as possible;

4.    Ms Sandra Taylor bring the Action Plan to a future meeting to demonstrate improvements that had been achieved;

5.    Ms Sandra Taylor share information in the summer about the innovative use of direct payments; and

6.    the discussion be noted.