Preparation for Assurance Peer Challenge Report - Bexley Council

Bexley Council (the council) asked the Local Government Association (LGA) to undertake an Adult Social Care Preparation for Assurance Peer Challenge at the Council, and with partners.

The council commissioned an independent peer review to assess the ability of the adult social care service to deliver good services to people, as well as preparedness of the adult social service for a Care Quality Commission (CQC) assessment. At the request of the council, the primary areas of focus were independence, population health outcomes, and the approach to outsourcing assessments.

The purpose of a peer challenge is to help an authority and its partners assess current achievements, areas for development, and capacity to change. Peer challenges are improvement focused and are not an inspection.

The peer team used their experience and knowledge of local government and adult social care (ASC) to reflect on the information presented to them by people they met, and material that they read.

Prior to being onsite, the LGA Peer Challenge team undertook a case file audit, lived experience interviews, a review of data, and held one - one calls between members of the peer team and their counterparts at Bexley Council. The team were then onsite for three days holding interviews, focus groups, and discussions to fully understand the adult social care department to develop feedback and recommendations through triangulating the evidence presented.

All information collected was non-attributable to promote an open and honest dialogue.

The members of the peer challenge team were:

• Jo Williams, Torbay Council – Director of Adult Social Services and Lead Peer
• Cllr. Sue Woolley, Lincolnshire County Council – Member Peer
• Steve Maddern, Swindon Borough Council– Public Health Peer
• Alyson Wagget, Kent – Operational Peer
• Jane Walker, Portsmouth City Council, Operational Peer
• Lara Fromings, Reading Borough Council - Commissioning Peer
• Alun Davies, Independent Consultant – Lived Experience Peer
• Sarah Farragher, LGA Peer Challenge Manager 

The team were on-site at Bexley for three days from the 14 – 16 May 2024. In arriving at their findings, the peer team: 

• Held around 50 interviews and discussions with 100 different people including Councillors, officers, partners, people with lived experience, and carers.
• Had access to around thirty-seven documents provided by Bexley including a self-assessment.
• Completed seven case file audits with one follow up conversations and spoke to ten other people with lived experience during the onsite review. 

The peer challenge team spent approximately 160 hours with Bexley Council the equivalent of 21 working days. Invariably, this is still a snapshot of Bexley rather than being a comprehensive picture.

Specifically, the peer team’s work focused on the Care Quality Commission (CQC) framework four assurance themes for the up-coming adult social care assurance. 

They are:

The peer challenge team would like to thank councillors, staff, people with a lived experience, carers, partners, and providers for their open and constructive responses during the challenge process. All information was collected on a non-attributable basis. 

Initial feedback was presented to the council on the last day of the peer challenge and gave an overview of the key messages. This report builds on the presentation and gives a more detailed account of the findings of the peer team. 

There are observations and suggestions within the main section of the report linked to each of the CQC themes and quality statements. The following are the peer team’s key messages to the council:

The council’s approach

The council has a great strengths and ambitions. It is integrated with health and voluntary sector partners through its BexleyCare and OneBexley partnerships. This is an exemplary model built on strong foundations, however CQC are likely to be focused on how this approach is supporting the council’s duties under part one of the Care Act and therefore in preparation the council may want to consider the following elements: 

• The Bexley approach as a partnership
• How the approach impacts on people’s lives and delivers outcomes
• How the council embraces self-awareness and a learning environment and avoid the risks of an optimism bias.

The council may want to articulate this in its existing improvement and development plans.

Evidencing the impact of relationships on outcomes

The council’s approach to integrated working was incredibly impressive and likely to be one of the most mature relationships in the country. This was evident in the place-based working arrangements, the Safeguarding Adults Board approach, and the OneBexley approach. 

Although there were some specific exceptions, which are highlighted within the report, relationships, and commitment to the approach across the board were evident at all levels of system. Generally, colleagues recognised and valued respective health, social care, and voluntary sector roles, were happy working in Bexley and valued their managers. This was not universal and there was an undertone that suggested some staff and partners do not feel empowered to speak up and challenge the status quo. The council may wish to understand this more fully in advance of CQC.

The areas that were less evident in the review was how this joint working was translating into improved outcomes for people with care and support needs, particularly those with the most complex needs. There was good evidence that the approach to assessment was supporting management of waiting lists, and that those wating lists were being reviewed, however those who were waiting were people with the most complex needs and people being supported by alternative assessment process were often receiving single focus interventions. The council may wish to review the current practice and quality assurance process through this lens to ensure that the approach is having the having desired impact for residents.

As part of the Peer Challenge, a case file audit was carried out on seven the cases, the peer team were able to speak to one family member of a person involved in the cases to understand their lived experience. This was a small cohort of case files audits but in line with the number that is likely to be undertaken by CQC.

Strengths 

Assessments were proportional, managed within a reasonable timescale and there was evidence of direct payments being used.

Considerations 

The assessments reviewed were very single issue focused. The peer team were concerned that potential risk factors were not identified and that solutions were focused on fixing an individual problem rather than promoting independence.

The council will get to select the cases it presents to CQC, and it may wish to identify cases that present the strengths and demonstrate the outcomes of the integrated model.

The peer team met with ten residents with lived experience and four family or friend carers during the review all of which have lived experience of a learning disability and or neuro diversity. There were no opportunities during the review to talk to people with other lived experiences of care and support. The outcomes from people with lived experience are included within the body of the report, and in particular within the co-production section contained in quality statement three.

Additionally, the information return included a Friends & Family Survey published in February 2024. The survey was completed by 58 people and consisted of six yes or no questions, a final rating question, and a number of free text comments from respondents. The results suggested a high overall level of satisfaction with adult social care:

• Have the staff treated you with dignity and respect (98 per cent answered yes),
• Have you been involved as much as you want to be in decisions about your care and support needs (93 per cent answered yes)
• Were you given the information you needed about support available (91 per cent answered yes),
• Were you given a variety of options on how your care and support needs could be met (86 per cent answered yes),
• Where possible, has the care and support you received enabled you to live as you wish (81 per cent answered yes),
• Has your family and / or carer been offered a carers assessment (76 per cent answered yes) 

The survey also indicated that 87 per cent of respondents were extremely likely or likely to recommend the service. This survey was not referred to during any of the focus groups within the review.

Strengths

There were opportunities for people with lived experience to be engaged in partnership boards and some good, individualised examples of how co-production was being developed and individual stories included within the council’s opening presentation and within some of the focus groups. 

Considerations 

In general, the voice of people with lived experience did not come across strongly in the peer review. The emphasis within the focus groups was primarily on the strength and value of the system relationships and although the examples provided were positive there are opportunities to strengthen this as staff and partners were struggling to articulate how the way that they are working together is improving outcomes for people.

This relates to assessing needs, planning, and reviewing care, arrangements for direct payments and charging, supporting people to live healthier lives, prevention, wellbeing, information, and advice, understanding, and removing inequalities in care and support, and people’s experiences and outcomes from care.

Strengths 

Strategically there is good engagement across the ASC and Public Health space particularly with relation to the Ageing Well Programme, Joint Strategic Needs Assessment (JSNA) and Health and Wellbeing Board arrangements. These could be enhanced further through earlier engagement with Public Health on Adult Social Care strategies and plans, and more opportunities to be involved with OneBexley’s vision.

Capacity for all areas of assessments has been maximised through a range of outsourcing agreements which is supporting a timely approach.

Considerations 

The council needs to consider the balance of risk, particularly for people with the most complex needs, and how to support staff who are managing the most complexity to feel appropriately supported.

Quality Statement One: Assessing needs

Practice Considerations

There is a significant practice and quality assurance input in multiple forums, including social workers embedded in OneBexley and strengths-based forums within the complex care service with a focus on advice and problem solving. However, across the board there was difficulty articulating what good looks like in terms of outcomes for the residents of Bexley. This suggests that despite best endeavours the quality assurance process is not having the desired impact.

The principal social worker and principal occupational therapy roles are both embedded within wider service roles, but the evidence that they were able to bridge the narrative between front line practice and strategic direction was difficult to see. The council may want to review this capacity to ensure a focus on practice.

The peer team heard that whilst there was a reference to strengths-based practice the policies and framework are not in place yet, the council may want to consider accelerating this work to provide clarity on the approach.

Assessment, reviews, and carers assessments

The council has a commitment to undertaking timely assessments and outsources a significant amount of Care Act statutory assessment and review work through partnership agreements. This is likely to be having a positive impact on people waiting for care. The average wait for assessment is 43 days and review performance is 75 per cent. Most carer assessments are completed within four weeks.

However, this approach is not without risk. The case files audits suggested that some outsourced assessments focused on single issue assessment rather than a holistic consideration of needs and teams reported that people who were waiting had complex needs. The council provided details of how this risk was managed. This included an initial risk assessment to set priority level with any urgent needs being immediately met, weekly management led reviews of people waiting, minimum of monthly phone calls to the person to follow up and allocation and oversight of people with the longest wait. Adult social care regularly reports to Scrutiny specifically on demand and capacity issues.

There is clearly a balance for all councils in managing increasing complexity of need and demand with reducing resources. The team heard reports that there is a focus on resources to support throughput. The impact is a significant level of risk and under capacity within complex care support. Additionally, the team heard that occupational therapy was significantly stretched. The council may wish to consider a review of team capacity and the workforce strategy in this area.

There are clearly benefits to assessments being undertaken by people who are linked into local communities however there are risks in this approach. The council does have a range of contracting management tools and frameworks with partners, which includes links to Adult Social Care Outcomes Framework (ASCOF) performance measures on carers and self-directed support and this is overseen by a quality assurance board. The key is how the council quality assures and risk manages the approach in line with the care and support statutory guidance and articulates what good looks like for risk managements in Bexley.

Information from the national 2021/22 Carers survey, reported on the council data hub suggested that 39 per cent of respondents were very or extremely happy with the support that they received, this is higher than the London average and Bexley benchmarks well in the ASCOF survey responses. A carers audit was undertaken in 2022 and an action plan put in place in January 2023. The council has advised this work is continuing however in advance of CQC the council may wish to ensure action plans are updated with this progress.

Financial Assessment 

Financial assessments and debt recovery are undertaken on behalf of the council through a partnership arrangement with Capita. Information is collated using paper-based systems and processed in a timely manner with notifications being made within five days. The council has noticed a trend in complaints regarding invoicing and is aware there is some work to do around these processes.

Quality Statement Two: Supporting people to live healthier lives.

There are reports that an integrated approach to both initial contacts, with a combined triage function, and an assessment process across health and social care is resulting in a more joined up approach for people with care and support needs. However, within the review the peer team could not identify the outcomes for people with care and support needs and carers as part of the work. The council may want to strengthen the focus on the “so what” question to articulate more clearly how this model is benefiting the population.

The proportionality of occupational therapy resource to social work appears to be low and this was highlighted within the review. Social Care Assistants and the disabled living foundation are offered internal training in assessments for equipment to support independence enabling both equipment and non complex adaptations to be recommended by the non qualified staff.

There is evidence of joint working to improve resident’s lives through the joint Heath and Wellbeing Strategy with clear outcomes for adult social care and public health. There are opportunities for adult social care to involve public health at an earlier point when developing plans and strategies. As separate teams, public health and adult social care are both actively partners within the integrated care system but there are opportunities for adult social care and public health to align more closely around Care Act specific duties and preparation for CQC assessment. There are also opportunities identified for closer working, shared training, etc, across the two services.

There was a mixed picture on whether there was sufficient wellbeing and prevention support and community capacity available within the OneBexley model, with some front-line staff reporting a perception that the assessment model has reduced capacity for delivering preventative services. This was tested out with OneBexley and council leaders during the review who did not share this view, however it is a perception on the front line and something that the council may wish to assure themselves of.

The team heard reports that 90 per cent of reablement capacity is allocated to support hospital discharge. There is an opportunity to expand and accelerate this offer further at the front door and as part of reviews to prevent, reduce, and delay the needs for care and support. The council may wish to assure themselves that the providers consistently adopt a reablement approach.

Housing is a huge challenge for Bexley and the peer team recognise that this is wider than adult social care. This impacts on the ability to provide Extra Care as an alternative to residential care and ability to prevent, reduce and delay the needs for care and support.

Quality Statement Three: Equity in Experiences and Outcomes.

The council has recognised that there is a significant shift in the demographics of the Borough it may want to articulate more clearly plans to meet this changing need. Workforce analysis shows that 72 per cent of adult social care staff identify as white. There are opportunities for adult social care to work more closely with Public Health to ensure plans are reflecting population demographics and demand and capacity can be modelled effectively. There have been positive outcomes from public health led delivery of inequality projects using Integrated Care Board (ICB) funding to improve health outcomes in vulnerable groups.

These opportunities could also be explored further in relation to co-production which is at the early stage of co-design. There are several partnership boards in place and over the last few years there has been a shift so that there are more people with lived experience than officers on the board, however whilst officers are present at the partnership board there is not member involvement in these forums. The week of the review the council had just launched an App to support people to engage with services.

Voluntary sector advocacy and support services, such as Mencap talked positively about the joined-up approach with the council and the positive impact of linking people with local community assets through the model of partner supported assessment.

The inclusion of a fully integrated mental health hub at the front door is supporting to reduce inequities in relation to eligibility for secondary mental health services, although staff in the complex care team report that they do struggle to support people with mental health needs that do not meet secondary eligibility criteria and this is one area in which partnership working across social care delivery may benefit from being strengthened.

There is a solid shared lives offer and good links with pathways to adulthood and promotion of equality, diversity and inclusion.

Co-Production

Co-production in Bexley seems relatively underdeveloped, compared to best practice. The exception being the partnership boards which are increasingly developing their membership of residents with lived experience. There are opportunities to build on this, for example expanding the community champions into paid lived expertise advisor roles that could help drive co-production and co-design approaches.

There is a draft co-production framework drafted by the ICB in internal circulation. This has not been subject to co-design. Given this is a draft there is an opportunity to develop this in partnership with residents. The system governance groups have limited representation of residents with lived experience or their representatives.

There are four partnership boards: learning difficulty; carers; autism and mental health. There are no boards for older people or disabled people with a physical or sensory impairment. There are some good bespoke examples of positive working such as the election practice and the community champion roles. People with lived experience reported the council are more receptive to positive news than challenge.

The peer team heard some specific examples that clearly demonstrated a commitment to co-production and outcomes for residents, these were repeated at multiple points throughout the review. The examples were strong, and the council may want to consider expanding this repertoire further to demonstrate the impact the council are having on resident outcomes.

This relates to market shaping, commissioning, workforce capacity and capability, integration, and partnership working.

Strengths 

There is an established commissioning function, quality of care within the borough appears to be good. There are consistent and embedded partnership structures in place and an opportunity to celebrate some undersold strengths within the borough, for example homecare and supported living.

Considerations 

There is a sense that some of the underlying challenges within the system are not surfaced at an early stage and there is a potential for increased risk in the system that could be addressed through an enhanced learning environment. 

Quality Statement Four: Care Provision, Integration, and Continuity 

There is substantial strength in the integrated commissioning model. This is a mature and established partnerships between leaders. There is a potential risk in the underpinning governance when either organisation to face significant challenge, however these are mitigated as far as possible through the section 75 governance agreements. The strength of relationships demonstrated within the review would suggest that this is not unsurmountable, but the council may want to assure themselves that the current section 75 agreement has sufficient substance to support should there be an incident or a near miss. The council may want to assure an equivalent level of robustness within its partnership arrangements for delivery of outsourced Care Act functions.

There is a good supply of domiciliary care, this is a strength for Bexley and should be celebrated. The ambition is to move this provision to an outcome-based model. This is a positive step towards supporting personalisation and improving quality of support, however this is one area in which the peer team heard that providers had concerns. This may be because the model is only partially delivered and there are concerns about sustainability and operational commissioning capacity to make this achievable.

To ensure success there is a need to undertake open and honest dialogue and have some frank and challenging debates to ensure that this initiative delivers the step-change needed to improve outcomes for individuals. The council appears well placed to have these discussions as the commissioning team are established, respected and have mature relationships with partners.

Direct Payments

Bexley’s performance on direct payments is relatively low at 19 per cent compared to a London average of 25 per cent, suggesting that there is an over reliance on traditional models of care. In the case reviews, albeit a small number of cases, direct payments were actively considered and used. The peer team heard positive reports of the development of individual service funds for people with learning disabilities, with fifteen providers now signed up. This was particularly being championed within the transitions services and there were some innovative and personalised approaches described to maximise people’s choice and control over their lives by combining shared lives provision with direct payments. There are also opportunities to build on nationally established and recognised strengths-based models, such as Circles of Support for a wider cohort of people.

These initiatives are positive to note, and the peer team heard from staff working in other parts of the service that they would welcome the opportunity for this work to be extended so it is accessible for other people with care and support needs. Similarly, the peer team felt that supported living could have an improved profile within the discussions.

The council benchmarks well in relation to care home admissions at 12.1 people per 100,000 compared to 12.6 for London and 14.6 for all England. The quality of care homes within Bexley is good with 86 per cent of care homes rated good or outstanding and 100 per cent of mental health residential home rated as good. The figure is slightly lower for care homes registered for people with learning disabilities with 71 per cent of homes rated good and no homes with an outstanding rating. There are challenges in accessing complex dementia nursing care placements and support for people with complex behaviours which consequently results in out of Borough placements. 

Quality Statement Five: Partnerships and community 

The relationship with the care market appears to be strong although providers reported that they would welcome more strategic engagement. The current quality assurance led forums appear to be focused on information sharing whereas previously this has been more of a collaborative approach. There are some underlying controversial factors which may be impacting on relationships such current unresolved provider inflation discussions, and the implementation of the outcomes-based domiciliary care contract. Whilst the council has recently produced a market position statement it would benefit from continued discussion and communication in this area as providers reported that it was not always clear what the council required.

There are some positive examples of joined up collaborative working with partners for example in response to a fire in 2023 and cross border work to develop shared respite provision.

Internally there appears to be a disconnect between operational staff and commissioning staff, which is likely to be a product of the pressures that the complex care teams are dealing with, the lack of a clearly articulated practice model and associated commissioning strategy. The council may want to think about communication and engagement opportunities to increase awareness.

The council also has strong established foundations with the community and voluntary sector. The OneBexley ethos is powerful and came through clearly throughout the work at a strategic level although there were some challenges at an operational level. There was a concern that the focus of the community and voluntary sector on assessment and review was impacting on capacity to provide community support as well as some of the quality of these reviews. The peer team heard in several forums of a focus on the positives rather than understanding and addressing real, or perceived challenges. There is a risk that the established and cohesive relationship creates a group think mentality however formal contracts, contract monitoring, and quality assurance processes are in place to mitigate this risk and to underpin the relationships. 

This area relates to Section 42 safeguarding enquiries, reviews, safe systems, and continuity of care.

Strengths 

• Bexley has a strong and well functioning safeguarding adult board.
• The volume and length of time people are waiting across this system is supported through the Bexley operating model.

Considerations 

• The council delegates or commissions a considerable proportion of its Care Act functions but retains safeguarding. This fosters positive partnerships however these remain council duties and the council may wish to strengthen the narrative on how these elements are being managed safely.
• There are opportunities to improve pathways into adulthood from children services by earlier and more open sharing of information.

Quality Statement Six: Safe systems, Pathways, and Transitions 

Safeguarding Adults Board 

Bexley has a proactive and functioning Safeguarding Adults Board that is cohesive and focused on improving outcomes. There is a strong partnership between social care, health, and the police. The board is using lessons learned from safeguarding adult reviews (SARS), and other intelligence to make strategic changes including ensuring that vulnerable adults who are missing are subject to the same protocols and priorities as missing children. The board appears to have a good balance of internal and external focus in terms of the areas of focus and are working in partnership across several police forces on specific issues. There was a good understanding on some of the areas of development within the system including Making Safeguarding Personal. The board are involving people with lived experience as quality checkers. 

Waiting lists

Whilst Bexley does have waiting lists these are relatively low and managed by the joint operating model with OneBexley. There are however over 280 people waiting for assessment and this includes people with the most complex needs. The council needs to assure itself that it understands the risk and is managing it appropriately. 

Deprivation of Liberty Safeguarding (DOLS) functions are managed both internally and using agency staff. This is helping to manage the numbers with only 12 people unallocated at the time of the review with 79 per cent of people allocated on time.

Operational arrangements.

Bexley has a proactive and strengths-based transitions team which works closely with the shared lives service and leads the way on Individual Service Funds and personalised support planning. There are some frustrations around the relationships between children and adult services particularly around proactive planning for young people with less complex needs and limited access for transitions workers to the children’s case management system. The council has recently had a CQC SEND visit (outcome not yet published) which identified some areas for improvement.

The complex care team appears to be significantly over stretched as a result there are reports from other parts of the internal and external parts of the system that they are holding and managing risks which they are not always confident doing and that the front door teams are unable to pass on complex work. There are some potential risks around information governance arrangements for external partners accessing the adult social care case management system liquid logic. The council may want to ensure providers are clear on their responsibilities when accessing and recording information and that people with care and support are aware of the access of external providers.

It was reported in some of the focus groups that there was an opportunity to improve the information, advice and guidance offer for self-funders.

Hospital discharge

Bexley does not have any acute hospitals within its footprint consequently Bexley residents access acute care in bordering authorities. Bexley currently operates a discharge to assess model and benchmarks well in offering reablement to people leaving hospital with 4.4 per cent of people over the age of 65 being offered reablement compared to a London average of 4.3 per cent and an England average of 2.9 per cent. The peer team heard reports regarding decisions taken at ICB level that potentially put the discharge to assess offer at risk. 

Quality Statement Seven: Safeguarding

As is common in other areas there has been an increase in safeguarding demands within Bexley. Initial safeguarding enquiries are allocated promptly, with teams reporting 98 per cent of initial enquiries being allocated within 48 hours and 100 per cent allocated within five days. The peer team heard that improvement has been delivered by a redirection of resources from other parts of the system. Completion and closure of safeguarding enquires appears to be a more challenged position and teams reported significant capacity challenges. At the time of the review there were 115 open enquires.

The peer team did not get a sense that making safeguarding personal (MSP) was embedded within practice and case audits suggest that recording of MSP outcomes were not discussed with people. This has also been identified by the Safeguarding Adults Board. Similarly, there did not appear to be a robust feedback mechanism for people who has been through a safeguarding process. There are a number of quality assurance functions and resources in place which are clearly impacting on waiting times, but the council may want to consider how the processes are supporting improved outcomes for people.

This relates to strategic planning, learning, improvement, innovation, governance, management, and sustainability.

Strengths 

• Bexley has a strong and coordinated system approach which is evident at all levels of the organisation. The matrix management approach across the Place is well established and the capacity has been strengthened by the introduction of two roles following the retirement of the executive director earlier this year.

Considerations 

• Whilst the partnership working is undoubtably strong the peer team did identify some gaps within the internal council practice model and leadership and the associated supporting policies and procedures.
• The council and its partners have established overarching joined up visions and structures in place but the operational delivery scaffolding for front line practice was less well defined. Consequently, the peer team struggled to see demonstrable evidence of how practice was translating into improved outcomes for the most complex people. The council may want to focus on strengthening this narrative.

Quality Statement Eight: Governance, management, and sustainability

The council has a strong and connected leader who understands system working. Other elected members showed a good awareness of, and interest in adult social care, including being able to give examples of service response and delivery. Front line staff were used to service visits by members and the Mayor and appeared fairly relaxed regarding councillor engagement.

Leadership is both system and internally focused which is a strength with a range of governance and strategies in place at a strategic level. On a tactical and operational level there appeared to be some gaps in operating polices that scaffold and support practice which is likely to impact on ability to describe outcomes in a strengths-based way. There is a need to assure sufficient focus on Care Act duties, particularly the practice model across staff and partners. To support this the council may wish to strengthen its professional leadership capacity in social work and occupational therapy. 

Staff mostly reported that they feel supported by their front-line managers and that they have good working relationships, there were some exceptions to this which were highlighted to leaders within the review.

The council and the ICB are both financially challenged. Bexley is a relatively low funded authority and is also a relatively low spender. This does create risks given the integration with the NHS and the peer team heard reports of decisions taken at ICB level that reversed previously agreed Place arrangements. This is a significant risk for all partners.

A lack of affordable and available housing is recognised as a national problem and something that all local authorities are dealing with. The market position statement makes a reference to a need for increased Extra Care and there was a clear narrative across the board that a lack of appropriate housing was a significant challenge. Whilst this was acknowledged within the review and there is a combined strategy the priority of the council in this area is not as high as would be given that Bexley has both social care and housing functions.

Quality Statement Nine: Learning, improvement, and innovation.

Bexley has significant innovation and learning in relation to the operating model and integration. There is a clear leadership narrative around innovation rather than making savings. The OneBexley model is expanding. The level of trust and cohesiveness across the system is evident from all angles and some of the work, such as the safeguarding adult board agenda is exemplary. 

The voice of front-line staff and people with lived experience in supporting and developing service change did not come through as strongly as would have been expected given this level of integration. There is a risk that the positive working model is seen as the overall achievement rather than the enabler to improving outcomes for individuals with care and support needs.

There is an open offer of training to the entire system for council delivered training and safeguarding adult board training and this offer is clearly articulated within the council’s Professional Standards Framework. 

There was evidence through the review of an increasing amount of resource that has been invested in quality assurance processes, for example; an increase from four to seven quality assurance officers, practice forums, implementation of electronic market management software (PAMS) and utilising lessons learned from safeguarding. Staff working in this area were clearly able to describe the quality assurance governance. This would benefit from linking to a formal practice model to ensure it is an effective use of resources.

• Councils need an authentic narrative for their adult social care service driven by data and personal experience.
• The narrative needs to be shared with those with a lived experience, carers, frontline staff, team leaders, middle managers, senior staff, corporate centre, politicians, and partners in health, the third sector and elsewhere.
• Ideally this story is told consistently, is supported by data, and personal experience - do not hide poor services.
• This will probably take the form of:
• What are staff proud to deliver, and what outcomes can they point to?
• What needs to improve?
• What are the plans to improve services?
• In the preparation phases, consider putting it on all team agendas asking staff what they do well, what is not so good and to comment on the plans to improve. Collate the information from this process and add to the self-assessment. Ensure the self-assessment is a living document that is regularly updated.
• Immediately prior to CQC arriving, ask staff what they are going to tell the regulator. How is their experience rooted in observable data and contributes to the overall departmental narrative? These stories drive the understanding of yourselves and others.
• The regulator is interested in outcomes and impact from activity. The self-assessment needs to reflect this as do other documents.
• The conversation with the regulator is not therapy! For those interviewed it should be a description of what they do and the impact they have had in people’s lives. Case examples written in the authentic voice of those with a lived experience bring this alive.

We appreciate the senior political and managerial leadership will want to reflect on these findings and suggestions to determine how the organisation wishes to take things forward. 

Whilst it is not mandatory for the council to publish its report, we encourage council’s to do so in the interests of transparency and supporting improvement in the wider sector. The LGA would like to publish this Preparation for Assurance Peer Challenge Report on the Association’s website but will only do so once we have been advised that is has been put in the public domain by the council through its own internal governance processes.

As part of the peer challenge process, there is an offer of further activity to support this. The LGA is well placed to provide additional support, advice, and guidance on several the areas for development and improvement and we would be happy to discuss this. 

Kate Herbert is the LGA Principal Adviser for the London Region and main contact between your authority and the Local Government Association. Kate’s contact details are: 

Email: [email protected]

Telephone: 07867 632404

Steve Tingle is the main contact for the LGA Care and Health Improvement Adviser for the London Region. Steve’s contact details are: 

Email: [email protected] 

Telephone: 020 3838 4854 

In the meantime, we are keen to continue the relationship we have formed with the council throughout the peer challenge. We will endeavour to provide signposting to examples of practice and further information and guidance about the issues we have raised in this report to help inform ongoing consideration.

For more information about the Adult Social Care Preparation for Assurance Peer Challenge at Bexley Council please contact:

Sarah Farragher

Peer Challenge Manager

Local Government Association

Email: [email protected]

Tel: 07531541028

For general information about Adult Social Care Preparation for Assurance Peer Challenges please contact:

Marcus Coulson

Senior Advisor – Adults Peer Challenge Programme

Local Government Association

Email: [email protected]

Tel: 07766 252 853

For more information on the programme of adult’s peer challenges and the work of the Local Government Association please see our website: Adult social care peer challenges | Local Government Association