Islington Council: local authority assessment

The local authority understood the risks to people across their care journeys; risks were identified and managed proactively; the effectiveness of these processes in keeping people safe was routinely monitored. Risk was monitored regularly and managers and senior social workers reviewed the presenting risks in incoming referrals, once allocated staff would regularly monitor their caseload and risk through regularly contacting people. Staff told us they had a day each month on which they would contact people waiting to ensure they were waiting well and that their needs had not changed.

Leaders had identified possible risks in relation to the recording of case notes by staff, limiting their ability to ensure actions taken were appropriate under the Care Act, particularly those staff who had access to both health and social care recording systems. This caused inconsistencies with some staff recording on the health system and not the adult social care system and vice versa. Leaders advised action had been taken to reduce this by ensuring all local authority adult social care staff only had access to record on the adult social care system, staff would also have read only access to health records to ensure information was effectively shared, reducing the risk of any information not being shared appropriately. This did not impact on any initial contacts or referrals as they were all received via the Access team.

Policies and processes about safety were aligned with other partners involved in people’s care journeys. Staff told us how multi-disciplinary working in co-located offices supported them to ensure they had shared learning and drove improvement. There were benefits of staff being able to instantly speak with a health colleagues to provide a holistic approach to care, supporting people in the community to prevent, reduce and delay care needs. There were examples of close working with other neighbouring local authorities and having multi-disciplinary teams meant professional relationships were built with health and social care colleagues in other boroughs. Information sharing protocols supported safe, secure and timely sharing of personal information in ways that protected people’s rights and privacy.

Regular audits took place to identify risk, and actions were taken to manage risk. For example, it was identified that staffing was an issue in the First Point of Contact Team, agency staff were being recruited at the time of our assessment to support with the vacancy rate to ensure the team was appropriately staffed to safely and effectively carry out their role. A new duty system was also put in place to screen initial referrals to ensure risk and safeguarding were a priority. The team also had a community support officer who would go out and carry out welfare checks and initial visits to enable the team to deal with more complex, higher risk referrals.

Care and support were planned and organised with people, together with partners and communities in ways that improved their safety across their care journeys and ensured continuity in care. This included referrals, admissions and discharge, and where people were moving between services.

Previous audits had identified a disconnect for people transitioning from Children’s to Adult’s services, with adult social care often becoming involved too late which did not give the young person and their family time to adjust and ensure best outcomes for young people. As a result of this feedback adult social care now became involved with the young person from 14 years old when needed. Leaders told us this had positive outcomes for people using services as this meant adult social care had built a relationship with the person using services and their family and had a good knowledge of their care and support provided in children’s services. Unpaid carers did not always find the transition process smooth and felt Children’s services offered more services and support than Adults services.

Feedback from people using services and their carers identified the charging process for adult social care as a concern and a shock to people transitioning from Children’s to adult services. As a result of this feedback children’s social workers had started to have conversations with the young people and their families about the charging process in adult social care so that cost was fully understood in relation to care and support when receiving adult services.

The transition team had good links with health and worked with partners to ensure safe hospital discharge for people with learning disabilities. Reablement support would be offered if appropriate and feedback from people using services was positive about the take home and settle service and the reablement service.

Specific consideration was given to protecting the safety and well-being of people who were using services which were located away from their local area, and when people moved from one local authority area to another. The local authority has a ‘circle of protection’ worker who worked closely with people placed out of borough to ensure they had the correct support such as advocacy or befriending services to promote choice and social inclusion. The ‘circle of protection’ worker also worked with people during safeguarding concerns to enable their voice to be heard and ensure appropriate action was taken. Staff and partners told us the “circle of protection” worked well.

The local authority had a process in place for people who were in privately funded care placements when their capital had fallen below the threshold for local authority funding.

The local authority undertook contingency planning to ensure preparedness for interruptions in the provision of care and support. The local authority knew how it would respond to different scenarios, such as a cyber-attack, loss of data, power cut or business failure. Plans and information sharing arrangements were set up in advance with partner agencies and neighbouring authorities to minimise the risks to people’s safety and wellbeing.

Funding decisions or disputes with other agencies did not lead to delays in the provision of care and support this meant people continued to receive care and support in a timely manner despite disputes over funding.

Provider failure may be caused by several factors including deregistration by regulators, termination of contracts, loss of premises of closure due to financial pressures. The local authority told us any alternative provision would be dependent on people’s needs, and they aimed to provide a service as similar as possible to the previous one. Providers told us the local authority supported them to reduce risk of provider failure by providing regular advice and support and working with providers tom improve services.