Town Hall bosses grilled over inadequate rating for supported living services

Management of the Town Hall’s homecare and supported living services, which have been given six months to improve on a rating of ‘Inadequate’ by the Care Quality Comission (CQC), have been grilled on what went wrong by councillors.

The Town Hall’s Housing with Care service, which provides support to help people, including those with dementia and learning disabilities, to live independently, received damning judgments from the CQC relating to its safety, effectiveness, and leadership.

Staff are now receiving training as part of a systematic plan by council officers to embed “long-term change” in the system.

Anne Canning, Hackney’s group director of children, adults and community health, faced questions from borough reps at a 12 March council meeting on how the service had come to deterioriate from its former rating of ‘Good’ just two years prior.

Canning said: “It’s a challenging recovery plan for the service, but we are taking it very, very seriously, trying to be as transparent and open as possible, and trying to end up in a place where the service users feel they’ve got an authentic, listened-to voice.

“The service was just allowed not to keep modern or up-to-date with practice, and things slipped. I make no excuse for it. It was just not monitored in a regular enough way to keep up-to-date with best practice.

“I wish I could give a reassuring answer as to why it happened. Looking at services and things that needed doing, the in-house home care service was next on my list of things that needed doing.

“The irony of this is the very, very good provider concerns protocol there is when it comes to external providers. We just assumed because it was in-house it didn’t need that level of scrutiny.”

Housing with Care covers 14 schemes, providing care and support to 255 people in supported living.

The CQC inspection multiple failings across the service, including :

• information about people’s end of life wishes not being captured and the providers not following their end of life policy.
• medicines not being managed in a safe way, with records not showing people had been supported to take medicines in a safe way.
• “piecemeal” systems in place to monitor and respond to incidents and allegations of abuse.
• people feeling uninvolved in developing their care plans, with the plans not developed in line with best practice and guidance for meeting specific need.
• insufficient information about people’s healthcare needs, dietary requirements, cultural background and sexual and gender identity.

The inspection found that whilst staff spoke about and treated people they cared for with “kindness and compassion”, that some users of the service found that staff were too rushed to spend time with them.

The Town Hall has now suspended any new placements to Housing with Care until the required level of improvement has been made, marking the first time its so-called ‘Provider Concerns’ protocol has been used with an in-house provider.

Some schemes were also found to have particularly high use of agency staff, with half of some schemes’ shifts being covered by agency workers, which Canning admitted had “crept up over time”, an issue which was picked up on by members of the Health in Hackney scrutiny commission during the meeting.

Amanda Elliot, communications and intelligence manager at Healthwatch Hackney, said: “It felt like the eye went off the ball with this service, and as a result there is quite a high use of agency staff which does pull down quality.

“I don’t know how one can decrease the reliance on agency staff in the current climate, but it would be very welcome if you want to see a step change in people’s feelings about care.”

Cllr Feryal Demirci (Lab, Hoxton East & Shoreditch), deputy mayor and cabinet member for health, social care, transport and parks, said at the meeting’s close that the service will attempt to draw down on agency staff use as part of a wider commitment across all council services.

The deputy mayor will be overseeing the planned improvements to the service over the coming months, which already include the holding of family forums for people using the service and roll-outs of new risk assessments for medicines.

All staff are said to have received refresher training in end of life policies, as well as been provided with updated templates for personalised care plans, as the CQC found that records did not demonstrate whether staff had received the proper training to carry out their roles at the time of their inspection.

Staff are also to receive training around medicines and managing challenging behaviour.

Cllr Yvonne Maxwell (Lab, Hoxton West) said: “The ‘Valuing People’ strategy came out in 2001, which was all about person-centred care. I find it quite worrying that in 2019 we’re looking at training staff in person-centred care planning.

“Have they never had that in the time that it’s been going on? This isn’t something that’s new, it’s something that started nearly 20 years ago now, and it should be embedded.”

Canning responded: “Nobody in the service would disagree that the whole remit of this should be around personalisation. I don’t think that it would be a fair judgment to say that what they found was not personalised care, but one of the drivers was the recording of it.”

Housing with Care is to be reinspected by the CQC within six to 12 months, though management will be reporting back to the Health in Hackney scrutiny commission in six months to update on improvements made.