Leicester City Council Shared Lives Service

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last rated inspection we rated this key question Good. At this inspection the rating has changed to Requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.The provider was in breach of the legal regulation relating to Good governance.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had not established a sufficiently clear and embedded vision to ensure a consistent culture and shared direction across the Shared Lives scheme. Whilst staff and Shared Lives carers were committed to supporting people and demonstrated a caring approach, this was not consistently underpinned by effective leadership, communication and shared understanding of service priorities. Roles, responsibilities and expectations were not always clearly defined, resulting in inconsistencies in practice and a lack of collective ownership of quality and improvement activities.

Leaders were working to promote the values and principles of the Shared Lives model across the scheme; however, these were not yet consistently reflected in all aspects of operational practice. Opportunities for Shared Lives carers and people using the service to contribute to the ongoing development of the scheme were developing but remained limited in some areas. As a result, leaders had less assurance that the experiences, views and expertise of people and carers were consistently informing service improvements and future planning. Further strengthening engagement and co-production arrangements would support a more shared understanding of the scheme's objectives, priorities and desired outcomes.

Not all leaders understood the context in which the provider delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively, or they did not always do so with integrity, openness and honesty.

Leadership arrangements within the Shared Lives scheme were ineffective and did not provide sufficient assurance that the service was being safely and effectively managed.

The registered manager was not consistently supported through effective leadership structures, challenge or assurance processes, and there was a lack of wider organisational oversight to identify emerging risks and drive improvement. Senior leaders had not established effective mechanisms to monitor service performance, scrutinise quality and safety information, or assure themselves that people were receiving safe, person-centred care.

Shared Lives staff and Shared Lives carers told us there had been noticeable improvements since the new registered manager took over the service, which had led to improved communication, increased visibility of leadership and a clearer sense of direction. Shared Lives carers described feeling better informed about developments within the scheme and valued the more regular contact and support they received.

People did not always feel they could speak up and that their voice would be heard.

The provider was continuing to develop an open and transparent culture where Shared Lives carers felt able to raise concerns, share feedback and contribute to the ongoing development of the scheme. Some Shared Lives carers told us they were unsure of the Freedom to Speak up Policy, though they would approach the Shared Lives staff or the registered manager if they had concerns. However, all shared lives carers we spoke with did not know who they could contact outside of the shared lives service, if they were required to report concerns externally.

Shared Lives staff told us they felt confident raising concerns and were clear about the organisation's escalation processes. While there were examples of Shared Lives carers sharing concerns, there remained opportunities to further strengthen the provider's approach to freedom to speak up by increasing opportunities for Shared Lives carers to provide feedback, challenge practice and raise concerns through a range of formal and informal channels.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Shared Lives carers and staff were treated fairly and with respect, and there was a strong commitment to promoting equality, diversity and human rights. Recruitment, assessment and approval processes for Shared Lives carers were designed to ensure opportunities were accessible to people from a range of backgrounds.

Shared Lives carers told us they felt valued, supported and able to be themselves, and staff demonstrated an understanding of the importance of inclusion and person-centred support. The scheme actively promoted diversity within its workforce and carer network and took steps to challenge discrimination and address barriers to participation.

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

Roles, responsibilities and lines of accountability were not clearly defined or consistently understood across the service, resulting in uncertainty regarding ownership of key operational, quality and safety functions. This contributed to significant gaps in oversight, with leaders failing to identify and respond to concerns in a timely manner. Governance systems were not sufficiently robust to ensure compliance with policy, best practice and regulatory requirements, and leaders demonstrated limited understanding of the standards and expectations required to effectively oversee a Shared Lives scheme.

Although some audits had successfully identified areas requiring improvement, action planning was not sufficiently robust. Records did not consistently include clear timescales for completion, designated individuals responsible for delivering actions, or documented sign-off and review dates to confirm improvements had been achieved and sustained.

As a result, leaders were unable to effectively track progress, hold individuals accountable for delivering improvements, or demonstrate that identified risks and shortfalls had been addressed in a timely manner. The provider lacked a systematic approach to monitoring performance, evaluating quality and assuring compliance with regulatory requirements and organisational policies.

Significant concerns identified during the assessment had not been recognised through existing governance processes, indicating oversight systems were not operating effectively. Opportunities to identify trends, learn from emerging issues and drive continuous improvement had been missed. Consequently, leaders could not demonstrate they had effective governance arrangements in place to ensure the service was consistently safe, effective, well-led and sustainable, placing people at risk of receiving support from a scheme where quality assurance processes were unable to reliably identify, monitor and mitigate concerns.

The provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They did not always share information and learning with partners or collaborate for improvement.

The provider had established positive relationships with a range of external health and social care professionals, and we received generally positive feedback from partner agencies regarding the commitment of staff and Shared Lives carers to supporting people. External professionals told us the service was responsive when concerns were raised and demonstrated a willingness to engage with specialist services. However, these positive relationships were not consistently translated into effective joint working across the internal wider system.

There was a disconnect between teams and key stakeholders involved in people's care and support, which at times impacted the timely sharing of information, coordinated decision-making and implementation of support arrangements. Roles, responsibilities and expectations across supporting teams were not always clearly understood, leading to occasions where important actions were delayed, duplicated or not progressed as promptly as they should have been.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research.

The provider had started to introduce initiatives to support learning and improvement across the Shared Lives scheme; however, these were at an early stage of development and had not yet been embedded sufficiently to demonstrate sustained impact on practice or outcomes for people.

There were some positive developments. For example, quarterly newsletters had recently been introduced to provide Shared Lives carers with relevant information, updates on good practice, seasonal ideas and inspiration, and links to local events and opportunities within the community. This helped to increase communication and promote greater awareness of local resources available to people using the service. One shared lives carer told us “The quarterly magazine from head office provides helpful information, and the monthly local magazine offers guidance about things such as finances”

The provider was a member of Shared Lives Plus, the UK membership charity and representative body for the Shared Lives sector. This provided opportunities to access sector-specific guidance, resources, best practice information, networking opportunities and learning to support service development and quality improvement.