Phil NorreyChief Executive

To: The Chair and Members of the Cabinet

(See below)

County HallTopsham RoadExeterDevon EX2 4QD

Your ref : Date : 31 October 2017 Email: karen.strahan@devon.gov.ukOur ref : Please ask for : Karen Strahan, 01392 382264 :

CABINET

Wednesday, 8th November, 2017

A meeting of the Cabinet is to be held on the above date at 10.30 am in the Committee Suite - County Hall to consider the following matters.

P NORREYChief Executive

A G E N D A

PART I - OPEN COMMITTEE

1 Apologies for Absence

2 Minutes

Minutes of the meeting held on 11 October 2017 (previously circulated).

3 Items Requiring Urgent Attention

Items which in the opinion of the Chair should be considered at the meeting as matters of urgency.

4 Announcements

5 Petitions

6 Question(s) from Members of the Council

FRAMEWORK DECISION

7 Heart of the South West - Joint Committee (Minute 157/ 86 10 December 2015 and 16 February 2016) (Pages 1 - 24)

Report of the Chief Executive (CX/17/26) on approval and proposals for a Heart of the South West Joint Committee, attached.

Electoral Divisions(s): All Divisions

KEY DECISIONS

8 Adult Social Care: Promoting Independence Policies (Pages 25 - 46)

Report of the Head of Adult Commissioning and Health (ACH/17/71) on approval to the Promoting Independence Policies, which include ‘Choice in Care’ and ‘Support and Arrangements for People Funding Part or All of Their Care’, attached.

An Impact Assessment is attached as Appendix 3 to the report.

Electoral Divisions(s): All Divisions

9 Provider Quality Support Policy (Pages 47 - 106)

Report of the Head of Adult Commissioning and Health (ACH/17/72) on the Provider Quality Support Policy, attached.

An Impact Assessment is also attached.Electoral Divisions(s): All Divisions

10 Budget Monitoring: Month 6 (Pages 107 - 110)

Report of the County Treasurer (CT/17/88), on the Budget Monitoring position at month 6, attached.

Electoral Divisions(s): All Divisions

MATTERS REFERRED

11 Notice(s) of Motion from Council - 5 October 2017 (Pages 111 - 118)

Report of the County Solicitor (CSO/17/30) on the Notices of Motion referred to the Cabinet by the County Council on 5 October 2017, incorporating relevant briefing notes to facilitate the Cabinet’s discussion of the matters raised, attached.

The Notices of Motion were on the following matters;

Plastic Free Coastlines; National Funding Formula for Schools; Ethical Care Council; and 20 MPH Speed Limits

STANDING ITEMS

12 Devon Safeguarding Adults Boards Annual Report: (Pages 119 - 122)

Annual Report of the Devon Safeguarding Adults Board charting progress within Devon of national expectations and safeguarding activity.

Ms Sian Walker, Independent Chairman of the Devon Safeguarding Adults Board to attend the meeting.

[NB: The Safeguarding Board Annual Report will also be available, in due course, at: https://new.devon.gov.uk/devonsafeguardingadultsboard/

Electoral Divisions(s): All Divisions13 Question(s) from Members of the Public

14 Minutes (Pages 123 - 124)

Minutes of the bodies shown below are circulated herewith for information or endorsement as indicated therein:

Farms Interviewing Committee – 16 October 2017.

[NB: Minutes of County Council Committees are published on the Council’s Website at: http://democracy.devon.gov.uk/ieDocHome.aspx?bcr=1Minutes of the Devon Strategic Partnership are publicised at : http://www.devonsp.org.uk/meetings.html Minutes of the Local Admissions Forum are published at: http://www.devon.gov.uk/index/learningschools/schools/admissions/admissions_forum.htm . Minutes of the Devon Education (Schools) Forum are published at: http://www.devon.gov.uk/schoolsforum.htm Minutes of the Children Trust Board are published at:http://www.devonchildrenstrust.org.uk/resources/statutoryboard/meetings.htmlMinutes of the South West Waste Partnership are published at: http://www.plymouth.gov.uk/modgov Minutes of the Devon & Cornwall Police & Crime Panel athttp://www.plymouth.gov.uk/dcpcpmeetingsandminutes.html]

15 Delegated Action/Urgent Matters (Pages 125 - 126)

The Registers of Decisions taken by Members under the urgency provisions or delegated powers will be available for inspection at the meeting in line with the Council’s Constitution and Regulation 13 of the Local Authorities (Executive Arrangements) (Meetings and Access to Information) (England) Regulations 2012. A summary of such decisions taken since the last meeting is attached.

16 Forward Plan (Pages 127 - 134)

In accordance with the Council’s Constitution, the Cabinet is requested to review the list of forthcoming business (previously circulated) and to determine which items are to be defined as key and/or framework decisions and included in the Plan from the date of this meeting.

[NB: The Forward Plan is available on the Council's website at: http://democracy.devon.gov.uk/mgListPlans.aspx?RPId=133&RD=0&bcr=1 ]

KEY DECISION

17 Children's Centres Procurement - Outcome of Tender and Approval for Contract Award (Pages 135 - 156)

Report of the Chief Officer Children’s Services (ACH/17/57) on Children’s Centre Services, outcome of the tender and seeking approval for award of contract, attached.

An Impact Assessment is also attached.Electoral Divisions(s): All Divisions

PART II - ITEMS WHICH MAY BE TAKEN IN THE ABSENCE OF THE PRESS AND PUBLIC

18 Exclusion of the Press and Public

Recommendation: that the press and public be excluded from the meeting for the following items of business under Section 100(A)(4) of the Local Government Act 1972 on the grounds that they involve the likely disclosure of exempt information as defined in Paragraph 3 of Schedule 12A of the Act namely, the financial or business affairs of the preferred bidder or tenderers for the provision or supply of council goods or services and in accordance with Section 36 of the Freedom of Information Act 2000, by virtue of the fact that the public interest in maintaining the exemption outweighs the public interest in disclosing the information.

19 Children's Centres Procurement - Outcome of Tender and Approval for Contract Award (Pages 157 - 162)

[An item to be considered by the Cabinet in accordance with the Cabinet Procedure Rules and Regulation 5 of the Local Authorities (Executive Arrangements) (Meetings and Access to Information) (England) Regulations 2012, no representations having been received to such consideration taking place under Regulation 5(5) thereof].

Report of the Chief Officer for Children’s Services (ACH/17/58) on Children’s Centre Services tender and award of contract, attached.

Electoral Divisions(s): All Divisions

Notice of all items listed above have been included in the Council’s Forward Plan for the required period, unless otherwise indicated. The Forward Plan is published on the County Council's website.Notice of the decisions taken by the Cabinet will be sent by email to all Members of the Council within 2 working days of their being made and will, in the case of key decisions, come into force 5 working days after that date unless 'called-in' or referred back in line with the provisions of the Council's Constitution. The Minutes of this meeting will be published on the Council's website, as indicated below, as soon as possible.Members are reminded that Part II Reports contain confidential information and should therefore be treated accordingly. They should not be disclosed or passed on to any other person(s).Members are also reminded of the need to dispose of such reports carefully and are therefore invited to return them to the Democratic Services Officer at the conclusion of the meeting for disposal.

Membership Councillors J Hart (Chair), S Barker, J Clatworthy, R Croad, A Davis, S Hughes, A Leadbetter, J McInnes and B ParsonsCabinet Member RemitsCouncillors Hart (Policy & Corporate), Barker (Economy & Skills), Clatworthy (Resources & Asset Management), Croad (Community, Public Health, Transportation & Environmental Services), Davis (Infrastructure Development & Waste), S Hughes (Highway Management), Leadbetter (Adult Social Care & Health Services), McInnes (Children’s Services & Schools) and Parsons (Organisational Development & Digital Transformation)Declaration of InterestsMembers are reminded that they must declare any interest they may have in any item to be considered at this meeting, prior to any discussion taking place on that item.Access to InformationAny person wishing to inspect the Council’s / Cabinet Forward Plan or any Reports or Background Papers relating to any item on this agenda should contact Karen Strahan, 01392 382264. The Forward Plan and the Agenda and Minutes of the Committee are published on the Council’s Website and can also be accessed via the Modern.Gov app, available from the usual stores.

Webcasting, Recording or Reporting of Meetings and ProceedingsThe proceedings of this meeting may be recorded for broadcasting live on the internet via the ‘Democracy Centre’ on the County Council’s website. The whole of the meeting may be broadcast apart from any confidential items which may need to be considered in the absence of the press and public. For more information go to: http://www.devoncc.public-i.tv/core/

In addition, anyone wishing to film part or all of the proceedings may do so unless the press and public are excluded for that part of the meeting or there is good reason not to do so, as directed by the Chair. Any filming must be done as unobtrusively as possible from a single fixed position without the use of any additional lighting; focusing only on those actively participating in the meeting and having regard also to the wishes of any member of the public present who may not wish to be filmed. As a matter of courtesy, anyone wishing to film proceedings is asked to advise the Chair or the Democratic Services Officer in attendance so that all those present may be made aware that is happening.

Members of the public may also use Facebook and Twitter or other forms of social media to report on proceedings at this meeting. An open, publicly available Wi-Fi network (i.e. DCC) is normally available for meetings held in the Committee Suite at County Hall. For information on Wi-Fi availability at other locations, please contact the Officer identified above.Questions to the Cabinet / Public ParticipationA Member of the Council may ask the Leader of the Council or the appropriate Cabinet Member a question about any subject for which the Leader or Cabinet Member has responsibility. Any member of the public resident in the administrative area of the county of Devon may also ask the Leader a question upon a matter which, in every case, relates to the functions of the Council. Questions must be delivered to the Office of the Chief Executive Directorate by 12 noon on the fourth working day before the date of the meeting. For further information please contact Karen Strahan on 01392 382264 or look at our website at: http://new.devon.gov.uk/democracy/guide/public-participation-at-committee-meetings/Emergencies In the event of the fire alarm sounding leave the building immediately by the nearest available exit, following the fire exit signs. If doors fail to unlock press the Green break glass next to the door. Do not stop to collect personal belongings, do not use the lifts, do not re-enter the building until told to do so. Mobile Phones Please switch off all mobile phones before entering the Committee Room or Council Chamber

If you need a copy of this Agenda and/or a Report in another format (e.g. large print, audio tape, Braille or other languages), please contact the Information Centre on 01392 380101 or email to: centre@devon.gov.uk or write to the Democratic and Scrutiny Secretariat at County Hall, Exeter, EX2 4QD.

Induction loop system available

NOTES FOR VISITORSAll visitors to County Hall, including visitors to the Committee Suite and the Coaver Club conference and meeting rooms are requested to report to Main Reception on arrival. If visitors have any specific requirements or needs they should contact County Hall reception on 01392 382504 beforehand. Further information about how to get here can be found at: https://new.devon.gov.uk/help/visiting-county-hall/. Please note that visitor car parking on campus is limited and space cannot be guaranteed. Where possible, we encourage visitors to travel to County Hall by other means.

SatNav – Postcode EX2 4QD

Walking and Cycling FacilitiesCounty Hall is a pleasant twenty minute walk from Exeter City Centre. Exeter is also one of six National Cycle demonstration towns and has an excellent network of dedicated cycle routes – a map can be found at: https://new.devon.gov.uk/travel/cycle/. Cycle stands are outside County Hall Main Reception and Lucombe House

Access to County Hall and Public Transport LinksBus Services K, J, T and S operate from the High Street to County Hall (Topsham Road). To return to the High Street use Services K, J, T and R. Local Services to and from Dawlish, Teignmouth, Newton Abbot, Exmouth, Plymouth and Torbay all stop in Barrack Road which is a 5 minute walk from County Hall. Park and Ride Services operate from Sowton, Marsh Barton and Honiton Road with bus services direct to the High Street.

The nearest mainline railway stations are Exeter Central (5 minutes from the High Street) and St David’s and St Thomas’s both of which have regular bus services to the High Street. Bus Service H (which runs from St David’s Station to the High Street) continues and stops in Wonford Road (at the top of Matford Lane shown on the map) a 2/3 minute walk from County Hall, en route to the RD&E Hospital (approximately a 10 minutes walk from County Hall, through Gras Lawn on Barrack Road).

Car SharingCarsharing allows people to benefit from the convenience of the car, whilst alleviating the associated problems of congestion and pollution. For more information see: https://liftshare.com/uk/community/devon.

Car Parking and SecurityThere is a pay and display car park, exclusively for the use of visitors, entered via Topsham Road. Current charges are: Up to 30 minutes – free; 1 hour - £1.10; 2 hours - £2.20; 4 hours - £4.40; 8 hours - £7. Please note that County Hall reception staff are not able to provide change for the parking meters.

As indicated above, parking cannot be guaranteed and visitors should allow themselves enough time to find alternative parking if necessary. Public car parking can be found at the Cathedral Quay or Magdalen Road Car Parks (approx. 20 minutes walk). There are two disabled parking bays within the visitor car park. Additional disabled parking bays are available in the staff car park. These can be accessed via the intercom at the entrance barrier to the staff car park.

NB Denotes bus stops

Fire/Emergency InstructionsIn the event of a fire or other emergency please note the following instructions. If you discover a fire, immediately inform the nearest member of staff and/or operate the nearest fire alarm. On hearing a fire alarm leave the building by the nearest available exit. The County Hall Stewardesses will help direct you. Do not stop to collect personal belongings and do not use the lifts. Assemble either on the cobbled car parking area adjacent to the administrative buildings or in the car park behind Bellair, as shown on the site map above. Please remain at the assembly point until you receive further instructions. Do not re-enter the building without being told to do so.

First AidContact Main Reception (extension 2504) for a trained first aider.

A J

CX/17/26

Cabinet8 November 2017

Council 7 December 2017

Heart of the South West Joint Committee

Report of the Chief Executive

Recommendations: That Cabinet recommends the Council to:

a) Approve the recommendation of the HotSW Leaders (meeting as a shadow Joint Committee) to form a Joint Committee for the Heart of the South West;

b) Approve the Arrangements and Inter-Authority Agreement documents set out in appendices A and B for the establishment of the Joint Committee with the commencement date of 22 January 2018;

d) Appoint Leader and Cabinet Member for Economy and Skills as the Council’s named representative and substitute named representative on the Joint Committee;

c) Appoint Somerset County Council as the Administering Authority for the Joint Committee for a 2 year period commencing 22 January 2018;

e) Approve the transfer of the remaining joint devolution budget to meet the support costs of the Joint Committee for the remainder of 2017/18 financial year subject to approval of any expenditure by the Administering Authority;

f) Approve an initial contribution of £10,500 for 2018/19 to fund the administration and the work programme of the Joint Committee, noting that any expenditure will be subject to the approval of the Administering Authority;

g) Agree that the key function of the Joint Committee is to approve the Productivity Strategy (it is intended to bring the Strategy to the Joint Committee for approval by February 2018);

h) Authorise the initial work programme of the Joint Committee aimed at the successful delivery of the Productivity Strategy;

i) Agree the proposed meeting arrangements for the Joint Committee including the timetable of meetings for the Joint Committee as proposed in para 2.14.

1. Introduction

1.1 Since August 2015, Devon and Somerset County Councils, all Somerset and Devon Districts, Torbay Council, Plymouth City Council, Dartmoor and Exmoor National Parks, the Local Enterprise Partnership (LEP) and the three Clinical Commissioning Groups have worked in partnership to progress towards securing a devolution deal for the HotSW area focusing on delivering improved productivity. Since that time the partnership has continued to progress its objectives in spite of policy shifts at a national level.

1.2 On 16 February 2017 (Minute 86 refers) the Council gave ‘in principle’ approval to the establishment of a HotSW Joint Committee, subject to approving the Joint Committee’s

Please note that the following recommendations are subject to consideration and determination by the Cabinet and County Council (and confirmation under the provisions of the Council's Constitution) before taking effect.

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constitutional arrangements and an inter-authority agreement necessary to support the Joint Committee. This report sets out the necessary documents which, if agreed, will enable the Joint Committee to be formally established. 1.3 On the 13th October representatives of HotSW (from the Somerset, Devon, Plymouth and Torbay upper tier authorities) met Jake Berry MP, Minister for devolution to clarify the position of the Government and the HotSW Partnership on the devolution issue. The meeting was very positive and although no agreements were reached, the representatives were given a clear message that the Government would welcome a bid from the partnership to progress ambitions around improving productivity. The Minister stated there would be no requirement to have an elected mayor for Devon and Somerset as a condition of any deal. This statement has removed one significant barrier to taking the next step in the process.

1.4 It is clear that Government is keen to engage with areas across a wider footprint than single county boundaries. In particular they are keen to work with areas that can articulate:

Unity, clarity of purpose and a shared, ambitious vision built on local strengths Strong partnership between business and the public sector with solid governance

arrangements that provide assurance in capacity to deliver Compelling ideas that can help to deliver Government objectives Clarity on the offer to Government in terms of savings, the capacity to take major

strategic decisions and backed by a robust analysis of risk and benefits.

The Joint Committee will provide the ideal governance framework at this stage to take forward this dialogue with Government.

1.5 The key role of the HotSW Joint Committee is to develop, agree and ensure the implementation of the Productivity Strategy. This can only be achieved by working, where appropriate, in collaboration with the individual constituent authorities and the LEP. The Strategy will agree a common vision for increased prosperity through economic growth informed by a local evidence base and engagement with local stakeholders. It will also link to Government policy initiatives, particularly in relation to the Industrial Strategy, and will form the basis for developing our collective ‘ask’ of Government.

2. HotSW Joint Committee Proposal

2.1 The detail of the proposed functions of the Joint Committee and how it will operate are set out in appendix A attached – the Arrangements document. Appendix B attached sets out an Inter-Authority Agreement for consideration which details how the Joint Committee will be supported and sets out the obligations of the Council if it agrees to become a constituent member.

2.2 The documents detail the Administering Authority functions in support of the operation of the Committee including the provision of financial, legal, constitutional and administrative support to the Committee.

2.3 At this stage the Arrangements and Inter-Authority documents have been ‘scaled’ to fit the functions of the Joint Committee and the limited liabilities that each authority faces in signing up to be a constituent authority. In the event that the remit of the Joint Committee expands to take on more decision-making responsibilities and functions of the constituent authorities, the Arrangements and Inter-Authority agreement will be revisited to ensure that they remain fit for purpose and proportionate. Any expansion of the functions and responsibilities would require the approval of the constituent authorities.

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2.4 The Joint Committee has a much more limited role than a Combined Authority. It does not have the statutory or legal status of a Combined Authority and cannot deliver the full range of benefits that a Combined Authority can, but it does have the potential to provide cohesive, coherent leadership and a formal governance structure. Its role will focus on collaboration, negotiation and influencing with full decision-making responsibilities limited to developing and agreeing the Productivity Strategy. The principle of subsidiarity will apply to the relationship between the Joint Committee, the constituent authorities and local sub-regional partnerships with decisions to deliver the Productivity Strategy and decisions necessary as a result of the other functions of the Joint Committee being taken at the most local and appropriate level.

2.5 The aim of the Joint Committee through the delivery of the Productivity Strategy will be to:

Improve the economic prosperity of the wider area by bringing together the public, private and education sectors;

Work together to realise opportunities and mitigate impacts resulting from Brexit; Increase understanding of the local economy and what needs to implemented locally

to improve prosperity for all; Ensure the necessary strategic framework, including infrastructure requirements, is in

place across the HotSW area to enable sub-regional arrangements to fully deliver local aspirations; and improve the efficiency and productivity of the public sector. This work will be supported by a Joint Committee budget based on an agreed work programme.

2.6 The creation of a single strategic public sector partnership covering the HotSW area will: facilitate collaborative working; help to remove barriers to progress; as well as provide a formal structure to engage with Government at a strategic level on major areas of policy. It also has the potential to enable the constituent authorities and partners to have discussions with neighbouring councils / combined authorities / LEP areas on South West peninsula priorities and issues as well as the ability to move swiftly towards a Combined Authority model in the future (by potentially acting as a shadow Combined Authority) if the conditions are deemed acceptable to the constituent authorities.

2.7 Critically, the Joint Committee will also provide a formal mechanism for the constituent authorities to engage effectively with the LEP across common boundaries and agendas. District Council partners, in particular, might view this as an opportunity to engage more effectively with the LEP. The LEP, which will sit alongside the Joint Committee, has recently adopted new governance requirements to ensure greater transparency and accountability and wishes to further improve its democratic accountability in discussion with HotSW partners. The Joint Committee will provide a formal structure to take these discussions forward and for the constituent authorities to have greater influence over the activities of the LEP on our common agendas.

2.8 Although the Joint Committee is a cost-effective formal structure, some provision needs to be made to meet the support costs of what will be a fully constituted local authority joint committee. It is proposed that Somerset County Council (who have provided the lead for the governance workstream of the devolution project over the last two years) takes on the support role (with the option of rotating the role after 2 years of operation), to provide the financial, legal, democratic support to the Joint Committee from 1st January 2018.

2.9 There is currently the remainder of the joint devolution budget raised from an initial contribution from all authorities and the LEP in 2015. It is recommended that the remaining funds from this budget - £42,000 - are transferred to the Administering Authority and the

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budget is used to support the costs of the Joint Committee for the remainder of 2017/18 financial year and for some of 2018/19.

2.10 In addition, the Joint Committee will need a budget to undertake its work programme and oversee the implementation of the Productivity Strategy. The overall budget required to support the Joint Committee and enable it to undertake its work programme will be dependent, to an extent, on the level of ‘in–kind’ officer resources provided to the Committee by the constituent authorities. The Administering Authority will review the in-kind support which has been provided for the devolution project in consultation with the constituent authorities and bring forward revised budget figures as part of a budget and cost sharing agreement as necessary in due course to the Joint Committee for consideration and recommendation to the constituent authorities. The budget figures set out in this report in paragraph 2.11 are therefore provisional at this stage. The initial Joint Committee work programme is set out in section 3 below for approval.

2.11 Through work undertaken by the partners it is estimated that the operating cost of a Joint Committee will be £89,000 in 2018/19 (and to cover the remainder of 2017/18) excluding any in-kind support. This estimate is made up of the following:

£40,000 for the Administering Authority to undertake its duties. This is seen as a minimum cost and assumes that ‘in-kind’ officer resource remains in place at the same level; the Joint Committee meeting venues are providing by partners as ‘in-kind’ contribution

£25,000 (estimate) for work the Joint Committee would wish to commission £24,000 for the Brexit Resilience and Opportunities Group Secretariat.

2.12 The Shadow Joint Committee recommends the budget is met by contributions from the constituent authorities. This would exclude the LEP and the CCGs from contributing as non-voting partners. As stated above it is estimated there will be a funding carry forward of £42,000 from the 2015 devolution budget. This would leave a shortfall of £47,000 to meet the total estimated budget requirement of the Joint Committee in 2018/19. Using the formula of contributions agreed in 2015 to support the devolution project the contribution requested of each constituent authority for 2018/19 is set out below. This assumes that all authorities agree to become members of the Joint Committee and would have to be recalculated should fewer than 19 authorities become Members.

County Councils - £10,500 Unitary Councils - £4,000 District Councils and National Parks £1,400

2.13 Under this formula it is recommended this Council contributes £10,500 for 2018/19 as a constituent authority. Any expenditure against this budget would be subject to the formal approval of the Administering Authority.

2.14 In terms of the proposed meeting arrangements for the Joint Committee, it is recommended:

(a) That the Joint Committee should meet formally immediately after the LEP Board meetings to assist with engagement and co-operation between the bodies and allow co-ordination of the respective work programmes.

(b) That the following dates are reserved for meetings of the Joint Committee in 2018:

Friday 26th January

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Friday 23rd March Friday 25th May Friday 20th July Friday 28th September Friday 30th November

(c) That the Joint Committee meetings should start at 10am with the venues rotated throughout the HotSW area. The assumption will be that the host authority for that meeting will provide appropriate accommodation and facilities ‘in kind’.

3. HotSW Draft Productivity Strategy and the Joint Committee Work Programme

3.1 The Partnership has, since its inception, been focused on working together to tackle low productivity as this is seen as the key to the area’s future economic growth. The academic research undertaken in the HotSW Green Paper on Productivity – www.torbay.gov.uk/council/how-the-council-works/devolution/productivity-plan-green-paper/ highlighted that whilst Devon and Somerset have one of the highest employment rates in the country too many of those jobs are part-time and low paid. This means that our area has one of the lowest productivity rates in the Country and this is a major barrier to future prosperity.

3.2 The Partnership has continued to lobby Government to work more closely with our area in order to make good on its promise to spread economic growth across the Country and we now need to build on the recent meeting of the Minister and the momentum achieved. This work is urgently needed to ensure that areas such as the Heart of the South West do not get left behind as Government look to focus investment in areas where there are strong, cross boundary strategic partnership arrangements such as the six Mayoral Combined Authorities.

3.3 The Productivity Strategy is being developed through an academic evidence base and engagement with stakeholders and the community. The draft plan is currently out to consultation and can be viewed at www.torbay.gov.uk/devolution. The deadline for response is 30th November 2017. Members are encouraged to respond to the draft strategy.

3.4 In summary the Strategy proposes to deliver prosperity and productivity across the entire HotSW and to do so in an inclusive way. It proposes to build on existing strengths around high tech sectors as well as release untapped potential in our more traditional sectors. Once agreed the strategy will set out a vision for the whole of the area that will be used as a tool to lobby for investment both from the private sector and Government.

3.5 The Strategy is built around three key objectives as set out in fig 1 overleaf:

Developing leadership and knowledge within businesses in our area; Strengthening the connectivity and infrastructure our businesses and

people rely on; and Developing the ability of people in our area to work and learn in a rapidly

changing economy

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Fig 1 – Table of objectives within the draft productivity strategy

Leadership and knowledge

Connectivity and infrastructure

Working and learning

Aspiration To substantially improve the productivity of businesses in the area.

Improve our physical and natural assets to support wellbeing and economic opportunities.

Meet the potential of every individual within the area to work and contribute to our shared prosperity.

High-level aim

Help develop innovative, ambitious, growing businesses that can compete internationally.

Create vibrant places that are attractive to skilled people and new investment, with infrastructure to support productivity growth.

Develop, attract and retain a highly skilled and adaptable workforce.

Strategic objective

Programmes

Management excellence

New markets, new opportunities

Remove barriers to expansion

Attract talent and investment

Programmes

Clean energy infrastructure

Connectivity and resilience

Land for business and housing needs

Natural capital to support productivity

Programmes

Skills for a knowledge-led economy

Pathways to success

Access to work and opportunities

Skills for our ‘golden opportunities’

3.6 It is recommended that one of the first tasks of the Joint Committee will be to approve the Productivity Strategy early in the New Year.

3.7 The Partnership has been meeting as a Shadow Joint Committee since 22nd September 2017. Its focus is to ensure the Joint Committee can immediately move into action and take advantage of major funding streams, national policy debates and lobbying around the economy. The Partnership will be working with the LEP to deliver the Productivity Strategy and will be supporting a joint work programme which initially will involve:

Developing and recommending a delivery and investment Framework, to implement the Productivity Strategy and demonstrate capacity to deliver. This will complement the LEP’s Strategic Investment Panel which oversees the LEP’s investments;

investigating ways to complement existing work to draw out opportunities to attract infrastructure investment in line with the Productivity Strategy aims, building the track record for ambitious and compelling propositions;

investigating ways to complement existing work to improve the delivery of skills in line with the Productivity Strategy aims

investigating ways to complement existing work on strengthening leadership & knowledge within the area’s SMEs in line with the Productivity Strategy aims;

3.8 Any Joint Committee expenditure on the joint work programme will be subject to approval by the Administering Authority.

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4. Consultation, communication and engagement

4.1 Members, partners and the public have been kept informed of developments of the HotSW Devolution Partnership and the Productivity Strategy through press releases, newsletters, presentations, workshops and publications. This information flow will be maintained by the Joint Committee. In addition, all of the authorities within the Partnership have taken formal decisions as required during the various stages of consideration of devolution proposals and the proposed creation of the Joint Committee.

4.2 A draft Productivity Strategy was released for public consultation on 12 October 2017 To complement the on-line consultation there will be; Council-based briefings and targeted key stakeholder events through 6 sub-regional roadshows held in Greater Plymouth, Northern Devon, Greater Exeter, Torbay, Taunton/Bridgwater and Yeovil/Shepton Mallet. The consultation will end on 30 November 2017 and feedback will influence the final strategy which is due for approval in early 2018.

5. Equality Considerations

5.1 The Inter-Authority Agreement requires all constituent authorities to support, promote and discharge its duties under the Equality Act through the work of the Joint Committee. The Partnership is developing an Equality Impact Needs Assessment to inform the development of the Productivity Strategy. The Joint Committee will consider this assessment alongside the Productivity Strategy before adoption.

6. Public Health Considerations

6.1 There is a strong correlation between economic prosperity and health of the population. Public Health specialists will be key stakeholders within the consultation process and will be asked to advise on ways in which the Productivity Strategy could be connected to public health strategies to maximise the benefits to our communities.

7. Risk Management Considerations

7.1 The creation of a Joint Committee will place a formal governance structure around the preparation and implementation of the Productivity Strategy. The Strategy will be used as a tool to attract a greater share of Government funding around the Industrial Strategy and mitigate the risk of Devon and Somerset being left behind other areas of the country.

7.2 Without a Productivity Strategy and Joint Committee in place, the Council and its partners will lack credibility and be at a disadvantage in negotiating and lobbying Government on a range or policy initiatives including the growth agenda and are likely to miss out on potential funding streams.

7.3 The individual financial risk to the individual constituent authorities of establishing the Joint Committee is limited to their financial contributions to the running and operational costs of the Joint Committee. The risk is shared between all of the constituent authorities.

8. Legal considerations

8.1 Each of the partners’ legal teams and Monitoring Officers have been involved in the development of the Arrangements and Inter-Authority documents set out as Appendices A and B. The documentation also aligns to the LEP’s Assurance Framework.

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8.2 This simple documentation sets out the functions, membership and operations of the Joint Committee and the requirements upon the Constituent Authorities in supporting it.

9. Financial considerations

9.1 The costs associated with the early work on the Productivity Strategy preparation largely relate to officer time which is being provided ‘in kind’ by the authorities and partners. Specifically the LEP has met some direct costs.

9.2 The establishment of the Joint Committee provides a low-cost option compared to a Combined Authority model of governance. As part of the Inter-Authority Agreement the assumption is that the constituent authorities will continue to provide in-kind support although this will be reviewed by the Administering Authority to ensure that the levels of support are appropriate, sustainable into the future and acceptable to the authorities providing the support. The direct running costs of the Joint Committee will be limited to providing officer support for the meetings, if there is insufficient ‘in-house’ capacity, and the costs of the meetings themselves. At this stage direct support costs will be kept to a minimum and for 2017/18 and some of 2018/19 will be covered by the residual joint devolution budget established in 2015.

9.3 In addition to the direct costs of administering the Joint Committee there is also the issue of a budget to fund its Work Programme. Further details of the provisional budget requirements are set out in section 2 together with the proposed funding mechanism for contributions from individual constituent authorities.

9.4 In coming to their decision about a Joint Committee and whether the potential costs provide good value for money, Members might like to consider the potential cost/impact of not working in this way and the potential loss of influence with the Government and investment to the area. Through recent funding initiatives and policy – including through the recent meeting with the Minister, it is clear that Government is looking for areas to come together and articulate their vision and priorities across footprints wider than their organisational boundary or sub-regional areas.

9.5 The proposal put before Members sets out a low risk, low cost option to work in a more formal way to capitalise on opportunities arising from future Government strategies, funding announcements and in preparation for Brexit.

10. Options/Alternatives

10.1 There are two options and alternatives that Members might consider:

Option 1 – Do nothing and continue with informal arrangements within the Partnership. As set out above the feedback from Government is they prefer to work ‘at scale’ and are looking more favourably at areas that have a unity of vision and purpose.

Option 2 – move to a Combined Authority. Following the indication from the Minister, the Partnership will need, at some point, review the option of establishing a Combined Authority. Establishing a Combined Authority requires a substantial lead in time to allow for the Parliamentary approval process and would inevitably require the creation of a shadow Combined Authority to test and confirm the concept. The potential benefits of moving to a Combined Authority model will have to be judged against the implications of not doing so, including the cost implications. The Joint Committee has the benefit of allowing the Partnership to move relatively quickly to establish a Combined Authority if that is the wish and agreement of the constituent councils.

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Agenda Item 7

11. Reason for Recommendation/Conclusion

11.1 Working together will deliver better results if we are to help our businesses improve their productivity levels and deliver greater prosperity across the Heart of the South West. By collaborating across local geographies we will strengthen the area’s voice to Government and strengthen the actions the area can take to improve productivity.

11.2 The Productivity Strategy will replace the Local Enterprise Partnership’s Strategic Economic Plan. It will be the key strategic document for the partners to engage with Government and each other on a range of investment opportunities and powers emerging from the Industrial Strategy, Brexit and other policy opportunities.

11.3 The HotSW Joint Committee will provide a formal strategic partnership to complement and maximise the ability of individual authorities and sub-regional arrangements to deliver their aspirations. It will provide the formal arrangements for collaboration on productivity.

11.4 Through the Joint Committee the partners can test and improve their ability to work together as a potential precursor to the possible establishment of a Combined Authority at some point in the future. It will also provide a mechanism to further strengthen democratic input and influence with the LEP and align more effectively with the LEP’s new model of governance and accountability.

11.5 Without a Joint Committee in place, the HotSW area will continue to struggle to position itself to be able to take advantage of Government policy initiatives and new funding opportunities compared to those areas that have and are establishing formal strategic partnerships.

Phil Norrey Chief Executive

Electoral Divisions: All

Leader of the County Council: Councillor John Hart

Local Government Act 1972: List of Background Papers

Heart of the South West Statement of Intent Sept 2015

Heart of the South West Devolution Prospectus for Productivity March 2016

Cabinet 9th December 2015 – min 438 refers

Council 10th December 2015 – min 157 refers

Cabinet 13th July 2016 – min 50 refers

Council 28th July 2016 – min 28 refers

Cabinet 10th February 2017 – min 149 refers

Council 16th February 2017 – min 86 refers

Contact for enquiries: Sue Rose

Room No. G60

Tel No: 01392 382371

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APPENDIX A

HEART OF THE SOUTH WEST (HOTSW) JOINT COMMITTEE – DRAFT ARRANGEMENTS

1. Introduction:

1.1 Legal status: The HotSW Joint Committee is a Joint Committee of the local authorities listed in 1.5 below that comprise the HotSW area and established under Sections 101 to 103 of the Local Government Act 1972 and all other enabling legislation to undertake the functions detailed in section 2 of this Agreement.

1.2 Key purpose: The key purpose of the Joint Committee is to be the vehicle through which the HotSW partners will ensure that the desired increase in productivity across the area is achieved.

1.3 Aims and objectives: The aim is to provide a single strategic public sector partnership that covers the entire area and provides cohesive, coherent leadership and governance to ensure delivery of the Productivity Strategy for the HotSW area. The specific objectives of the Joint Committee are to:

(a) Improve the economy and the prospects for the region by bringing together the public, private and education sectors;

(b) Increase our understanding of the economy and what needs to be done to make it stronger;

(c) Improve the efficiency and productivity of the public sector; (d) Identify and remove barriers to progress and maximise the opportunities

/benefits available to the area from current and future government policy.

1.4 Commencement: The Joint Committee will be established in accordance with the resolutions of the Constituent Authorities listed below in paragraph 1.5 with effect from the Commencement Date (22 January 2018) and shall continue in existence unless and until dissolved by resolution of a majority of the Constituent Authorities.

1.5 Membership: Each of the Constituent Authorities listed below shall appoint 1 member and 1 named substitute member to the Joint Committee on an annual basis. Each member shall have 1 vote including substitute members. For the Councils, the member appointed shall be that Council’s Leader except in the case of Torridge District Council where the member appointed by the Council shall have authority to speak and vote on matters on behalf of the Council. Political balance rules do not apply to the Joint Committee membership. The substitute member shall also be a cabinet member where the Council is operating executive arrangements. For the National Park Authorities the member appointed shall have authority to speak and vote on matters on behalf of the Authority:

Dartmoor National Park Authority Devon County Council East Devon District Council Exeter City Council

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Exmoor National Park Authority Mendip District Council Mid Devon District Council North Devon Council Plymouth City Council Sedgemoor District Council Somerset County Council South Hams District Council South Somerset District Council Torbay Council Taunton Deane Borough Council Teignbridge District Council Torridge District Council West Devon Borough Council West Somerset Council.

1.6 In addition to the Constituent Authorities the partner organisations listed below shall each be invited to appoint 1 co-opted representative and 1 named substitute co-opted representative to the Joint Committee. Co-opted members shall not have voting rights:

Heart of the South West Local Enterprise Partnership (the LEP) NHS Northern, Eastern and Weston Devon Clinical Commissioning Group NHS South Devon and Torbay Clinical Commissioning Group NHS Somerset Clinical Commissioning Group

1.7 The Joint Committee may co-opt further non-voting representatives from the private, public and/or voluntary sectors at any time.

1.8 Each appointed member / representative shall remain a member of the Joint Committee until removed or replaced by the appointing authority / organisation. Appointments to fill vacancies arising should be notified to the Joint Committee Secretary as soon as possible after the vacancy occurs.

1.9 Standing Orders / Rules of Procedure: Outside of the contents of this ‘Arrangements’ document, the Standing Orders and Rules of Procedure for the Joint Committee shall be those contained in the Constitution of the Administering Authority to the Joint Committee, subject, in the event of any conflict, to the provisions in the Arrangements document taking precedent.

1.10 Administering Authority: A Council shall be appointed by the Constituent Authorities as the Administering Authority for the Joint Committee and shall provide legal, democratic services, financial and communications support to the Committee. The Joint Committee’s Forward Plan of business and papers for its meetings shall be published on the Administering Authority’s website with links provided to the websites of the other Constituent Authorities and partner organisations.

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2. Joint Committee Functions:

2.1 The only delegated function of the Joint Committee relates to the approval of the HotSW Productivity Strategy. All other matters referred to in 2.3 are ‘referred’ matters where the Joint Committee will make recommendations to the constituent authority or authorities for decision. Additional delegated or referred functions may be proposed for the Joint Committee in the future by the Joint Committee or any of the Constituent Authorities, but shall only be agreed if approved by all of the Constituent Authorities.

2.2 The principle of subsidiarity will apply to the relationship between the Joint Committee, the constituent authorities and local sub-regional partnerships with decisions being made at the most local and appropriate level on all matters to do with the delivery of the Productivity Strategy and in relation to the other functions of the Joint Committee.

2.3 The Joint Committee shall:

(a) Develop and agree the HotSW Productivity Strategy in collaboration with the LEP.

(b) Ensure delivery of the HotSW Productivity Strategy in collaboration with the LEP and the constituent authorities.

(c) Continue discussions /negotiations with the Government on the possibility of achieving devolved responsibilities, funding and related governance amendments to assist with the delivery of the Productivity Strategy. Joint Committee proposals arising from these discussions /negotiations would require the formal approval of the constituent authorities / partner agencies.

(d) Continue discussions / negotiations with the Government / relevant agencies to secure delivery of the Government’s strategic infrastructure commitments, eg, strategic road and rail transport improvements

(e) Work with the LEP to identify and deliver adjustments to the LEP’s democratic accountability and to assist the organisation to comply with the revised (November 2016) LEP Assurance Framework. This includes endorsing the LEP’s assurance framework on behalf of the constituent authorities as and when required. However, this is subject to the Framework being formally approved by the LEP’s Administering Authority.

(f) Ensure that adequate resources (including staff and funding) are allocated by the constituent authorities to enable the objectives in (a) to (e) above to be delivered.

3. Funding

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3.1 The Constituent Authorities shall agree each year and in advance of the start of the financial year (except in the year of the establishment of the Joint Committee) a budget for the Joint Committee in accordance with a Budget and Cost Sharing Agreement to cover the administrative costs of the Joint Committee and costs incurred in carrying out its functions. All funds will be held and administered by the Administering Authority on behalf of the Constituent Authorities and spent in accordance with that Authority’s financial regulations and policies.

3.2 In the Joint Committee’s first year of operation, the budget will be approved by the Constituent Authorities on the recommendation of the Joint Committee as soon as possible after the establishment of the Joint Committee.

3.3 Joint Committee members’ costs and expenses will be funded and administered by the respective Constituent Authority.

4. Review of the Joint Committee Arrangements

5.1 The Joint Committee may at any time propose amendments to the Arrangements document which shall be subject to the approval of all of the Constituent Authorities.

5.2 Any Constituent Authority may propose to the Joint Committee amendments to the Arrangements. Such amendments shall only be implemented if agreed by all of the Constituent Authorities on the recommendation of the Joint Committee.

5. Members’ Conduct

5.1 All members of the Joint Committee shall observe the “Seven Principles of Public Life” (the ‘Nolan’ principles) and will be bound by their own authority’s code of conduct in their work on the Joint Committee.

5.2 Joint Committee members / representatives shall be subject to the code of conduct for elected members adopted by the Constituent Authority that nominated them to be a Joint Committee member or to the conduct requirements of the organisation that appointed them. This includes the requirement to declare relevant interests at formal meetings of the Joint Committee.

6. Requirements of Joint Committee members

6.1 Joint Committee members shall:

(a) Act in the interests of the Joint Committee as a whole except where this would result in a breach of a statutory or other duty to their Constituent Authority or would be in breach of their Constituent Authority’s Code of Conduct.

(b) Be committed to, and act as a champion for, the achievement of the Joint Committee’s aims.

(c) Be an ambassador for the Joint Committee and its work.

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(d) Attend Joint Committee meetings regularly, work with others to achieve consensus on items of business and make a positive contribution to the Committee’s work.

(e) Act as an advocate for the Joint Committee in any dealings with their organisation including seeking any approvals from their Constituent Authority/Partner Organisation to Joint Committee recommendations.

(f) Adhere to the requirements of the ‘Arrangements’ document and maintain high ethical standards.

7. Appointment of Chairman and Vice-Chairman

7.1 The Joint Committee shall elect a Chairman and Vice-Chairman from amongst the voting membership as the first items of business at its inaugural meeting and at each Joint Committee Annual General Meeting thereafter. The appointments shall be confirmed by a simple majority vote of Constituent Authority members. If a deadlock occurs between two or more candidates a secret ballot shall immediately be conducted to confirm the appointment. If there is still deadlock following a secret ballot then a further meeting of the Joint Committee shall be held within 14 days and a further secret ballot shall be held to resolve the appointment.

7.2 A vacancy occurring in the positions of Chairman or Vice-Chairman between Annual General Meetings shall be filled by election at the next meeting of the Joint Committee. The person elected will serve until the next Annual General Meeting.

7.3 The Chairman and Vice-Chairman shall, unless he or she resigns the office or ceases to be a member of the Joint Committee and subject to 7.5 below, continue in office until a successor is appointed.

7.4 In the absence of the Chairman and the Vice-Chairman at a meeting, the voting members of the Committee present shall elect a Chairman for that meeting.

7.5 The Chairman or Vice-Chairman may be removed by a vote of all of the Constituent Authority members present at a meeting of the Joint Committee.

8. Quorum

The quorum for any meeting of the Joint Committee shall be 9 Constituent Authority members. The Chairman will adjourn the meeting if there is not a quorum present. In the absence of a quorum, the meeting shall be adjourned to a date, time and venue to be agreed by the Chairman.

9. Voting

9.1 Wherever possible the elected and co-opted members of the Joint Committee shall reach decisions by consensus and shall seek to achieve unanimity.

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9.2 In exceptional circumstances where a formal vote is required, the proposal will be carried by a simple majority agreement of the voting members present and voting by a show of hands. The Chairman of the Joint Committee shall not have a casting vote in the event of a tied vote.

10 Decision making Arrangements

10.1 Only the Joint Committee shall approve the Productivity Strategy.

10.2 The Joint Committee may at any time appoint working groups consisting of Joint Committee members and/or co-opted representatives / officers to consider specific matters and report back / make recommendations to the Joint Committee.

11 Formal Meeting Arrangements

11.1 The Joint Committee will hold an Inaugural Meeting within 30 days of the agreed commencement date and thereafter shall meet on a regular basis as agreed by the Joint Committee annually at its Annual General Meeting.

11.2 The Chairman or in his/her absence the Vice-Chairman, may call a special meeting of the Joint Committee following consultation with the Chief Executives’ Advisory Group to consider a matter that falls within the Committee’s remit but cannot be deferred to the next scheduled meeting, provided that at least ten clear working days notice in writing is given to the Joint Committee membership. .11.3 Formal meetings of the Joint Committee shall normally be held in public, in accordance with the Access to Information Rules and the Standing Orders / Rules of Procedure of the Administering Authority.

11.4 Meetings of any working groups or task groups established by the Joint Committee shall, unless otherwise agreed, be held in private.

12. Who can put items on the Joint Committee’s agenda? (a) The Joint Committee itself; (b) Any of the members of the Joint Committee appointed by the Constituent Authorities(c) A Constituent Authority by way of a formal resolution(d) The Chief Executives’ Advisory Group(e) The Monitoring Officer and / or the Chief Finance Officer of the Administering Authority.

13. Reporting Arrangements

13.1 In addition to any ad hoc reports to the Constituent Authorities, the Joint Committee shall supply an annual report of its activities to the Constituent Authorities in May of each year.

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13.2 The Joint Committee shall co-operate with the public scrutiny arrangements of the Constituent Authorities. 14 Record of attendance

14.1 All members present during the whole or part of a meeting are asked sign their names on the attendance sheets before the conclusion of every meeting to assist with the record of attendance.

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APPENDIX B

HOTSW JOINT COMMITTEEDRAFT INTER – AUTHORITY AGREEMENT

1. Commencement and Duration:

1.1 This Agreement (and the obligation of the Constituent Authorities [CAs]) shall take effect on the agreed Commencement Date – 22 January 2018 - and shall continue until the Joint Committee (JC) is dissolved. 2. Formation provisions:

2.1 The CAs agree to form the JC from the agreed Commencement Date and to delegate / refer the functions specified to the JC from that date as set out in section 2.3 of the Arrangements document.

2.1 The JC shall operate in accordance with the Arrangements document and the Standing Orders and Rules of Procedure of the Administering Authority.

3. Administering Authority (AA) arrangements

3.1 The AA shall be appointed by resolution of the CAs for a 24 month period (24 months is considered as appropriate to provide sufficient continuity but also to provide the option to rotate the role on a regular basis).

3.2 The AA shall provide: Financial, legal, constitutional and administrative support to the JC and its

meetings An on-line presence for the JC via the AA website with links to the CAs /

partner organisations websites. Ensure it has appropriate insurance arrangements in place to cover the AA

role.

3.3 The AA may resign from the role by giving 6 months’ notice to the CAs.

3.4 The AA may be removed and replaced by a majority vote of the CA members at a formal meeting of the JC.

3.5 The JC shall cease to exist in the event that no CA or organisation can be identified to undertake the AA role.

4. JC Finance

4.1 The JC’s budgetary arrangements shall be detailed in a budget and cost sharing agreement (to be drafted) to be agreed by all of the Constituent Authorities annually on the recommendation of the JC and in advance of the financial year. The

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only exception to this will be in the JC’s first year of operation when the JC shall recommend a budget and cost sharing agreement to the Constituent Authorities for approval at the first opportunity following its establishment.

4.2 The budget and cost sharing agreement shall cover:(a) The responsibilities of the Constituent Authorities for providing funding for the

JC(b) The anticipated level of expenditure for the JC for the year ahead(c) The cost sharing mechanism to be applied to the Constituent Authorities(d) Details of how the budget will be set and agreed each year(e) Who is to be responsible for maintaining financial records on behalf of the JC

(the ‘accountable body’);(f) What financial records are to be maintained;(g) What financial reports are to be made, to whom and when;(h) What arrangements and responsibilities are to be made for:

auditing accounts; insurance including ensuring all partners have sufficient cover;

(i) How any financial assets held by the JC on behalf of the Constituent Authorities will be redistributed to the CAs in the event of the dissolution of the JC or in the event of a CA formally withdrawing from the CA.

5. Roles and responsibilities of the CAs5.1 The CAs shall:(a) Appoint Members and named substitutes to the JC in accordance with the

‘Arrangements’.(b) Undertake to share the costs of the JC in accordance with the budget and

cost sharing agreement and pay their contribution to the JC to the AA in good time.

(c) Make appropriate arrangements for recommendations of the JC to be considered and decisions made by the CA.

(d) Support the work of the JC by offering services, resources or other ‘in kind’ support to assist with JC projects and activities.

(e) Within the terms of the Inter-Authority Agreement, agree to share information to support the work of the JC.

6. Chief Executives’ Advisory Group

6.1 The Group shall:(a) Ensure that the JC fulfils its functions and responsibilities and in accordance

with all legal and constitutional requirements.(b) Plan and co-ordinate the JC’s activities to ensure the achievement of its aims

and objectives(c) Consider the performance and effectiveness of the JC on an on-going basis

and make recommendations for changes for consideration by the JC and CAs as necessary.

(d) Ensure that professional advice is available and provided as necessary to the JC to enable it to carry out its functions.

(e) Rigorously monitor and scrutinise the JC’s budget.

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(f) Consider disputes between the CAs over the application or interpretation of this Agreement together with any potential breaches of this Agreement.

7. Withdrawal from / dissolution of the JC

7.1 A CA wishing to withdraw from the JC shall give a minimum of 6 months' notice in writing to the other CA via the AA. The CAs shall co-operate with any such request. 7.2 If two or more CAs give notice of withdrawal from membership of the JC in the same Financial Year, the JC shall consider and make recommendations to the remaining CA as to the future operation of the JC and, if appropriate, recommend any necessary amendments required to the JC’s functions and operating arrangements.

7.3 Where a majority of the CAs at any time agree (via formal resolutions) that the JC should be dissolved or terminated on a specified date then the JC shall cease to exist from that date.

8. Accounts, Audit and Reporting arrangements

8.1 The AA’s accounts and audit arrangements will apply to JC business. 8.2 The AA will ensure appropriate reporting arrangements are in place for the JC.

9. Review of Inter-Authority Agreement

9.1 At any time one or more of the CAs may seek a review of this agreement and the operation of the JC by giving notice to the CAs via the AA.

9.2 The review shall be undertaken by the Chief Executives Advisory Group for report to the JC. Any recommendations for changes to the agreement from the JC shall only be implemented if agreed by all of the CAs.

10. Insurance, Indemnities, and Conduct of Claims

10.1 The JC as a scrutiny and policy making group rather than a commissioning body undertakes administrative functions and therefore carries relatively little risk.

10.2 Each authority’s insurance cover will automatically extend to provide protection for their members and officers participating in the work of the JC and in their capacity as officers or members of that authority.

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11. Information Sharing, Data Protection, Confidentiality, Publicity and Freedom of Information (FOI) Requests

11.1 The CA shall share information about their organisations where that information is relevant to the aims and objectives of the JC.

11.2 Where such information is confidential or privileged, for example for reasons of commercial, customer or client confidentiality, the CA concerned shall seek to provide the information in such as form as to assist the JC whilst maintaining confidentiality, for example by the use of statistical and other non-identifiable forms of data. If confidential information is provided by a constituent authority to assist the work of the Joint Committee, then each constituent authority will respect that confidentiality and shall not use or disclose such information without the permission of the authority that provided the information.

11.3 In respect of FOI requests, the AA will ensure that the requirements of the FOI Act 2000 are met in respect of the activities of the JC. In particular the AA will consult the officers of the CA as necessary regarding any potentially contentious enquiries and will then respond to them accordingly on behalf of the JC.

11.4 The JC and the CAs shall at all times abide by the requirements of the Data Protection Act.

11.5 A CA shall not make any public statement or issue any press release or publish any other public document relating to, connected with or arising out of the work of the Joint Committee without obtaining the other CAs’ prior approval as to the contents thereof and the manner of its presentation and publication.

12. Promoting Equality, Diversity and Social Inclusion

12.1 All CAs will support and promote the principles of inclusiveness and equality for all through the work of the JC.

13. Extent of obligations and further assurance

13.1 Nothing in this Agreement is to require any of the CA to act in any way that is inconsistent with its obligations or duties as a local authority.

14. Variations of the Agreement

14.1 Subject to the express provisions of this Agreement, no variation of this Agreement will be valid or effective unless agreed by formal resolution of all of the CA.

15. Dispute Resolution / Breach of this Agreement

15.1 In the event of a dispute arising from the interpretation and operation of this Agreement or a breach of this Agreement by any CA or JC member, the matter shall

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first be considered by the Chief Executives’ Advisory Group. The Group shall seek to resolve the matter by discussion and mutual agreement and report to the JC and CA as necessary.

15.2 Where this fails to achieve a resolution, then the JC may give formal consideration to further action. Such action may include:

(a) A request to a CA to replace a JC member;

(b) A request to a CA to withdraw from the JC;

(c) A recommendation to the other CAs for the termination of the participation of a CA.

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ACH/17/71Cabinet

8 November 2017

POLICIES SUPPORTING PROMOTING INDEPENDENCE IN DEVON

Report from the Head of Adult Commissioning and Health

Recommendation: That Cabinet agree the proposed policies on; 1. “Choice in Care” - Appendix A2. “Support and Arrangements for People Funding Part or All of Their Care” -

Appendix B

1. Background/Introduction

Promoting Independence

1.1 On the 14th June 2017 Cabinet agreed the Promoting Independence Policy https://new.devon.gov.uk/adultsocialcareandhealth/policies-and-procedures/

1.2 In order that we can continue to embed ‘Promoting Independence’ into Adult Support and Care two new policies have been written that:

Clarify and describe the approach to service user choice in meeting eligible care needs

Clarify and describe the approach the authority will take for those people who have the financial means to fund their own care.

1.3 The two new polices in this paper describe our duties relating to aspects of adult support and care as defined by the Care Act 2014. As experience, precedent and advice has developed nationally and locally we have recognised a need to confirm and clarify our duties under the Care Act 2014 under these policy headings so that people can refer in one place to the relevant policy statements on these areas of our work.

2. Choice in Care Policy

2.1 The Choice in Care Policy sets out the principles of choice in adult social care and provides clarity to staff and the public on how Devon County Council will provide choice within the parameters of our duty to achieve best value and the need to promote independence. Devon County Council will work with people to ensure that their choices and the support offered will maximise their independence. Consideration will be given to how the support offered may change as their independence increases.

Please note that the following recommendations are subject to consideration and determination by the Cabinet (and confirmation under the provisions of the Council's Constitution) before taking effect.

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Agenda Item 8

3. Support and Arrangements for People Funding Part or All of Their Care

3.1 This policy is in line with both national legislation and Devon County Council’s Promoting Independence Policy. It specifically relates to people who have eligible needs for social care support but also the financial means to pay for that support.

3.2 The policy clarifies that Devon County Council will generally not arrange residential or nursing care on behalf of individuals if they are required to fund it themselves and they (or someone on their behalf) is able to arrange that care. The exception to this is if Devon County Council asses that someone will be eligible for social care funding in the next 12 months. This enables us to ensure that a sustainable solution is in place prior to Devon County Council being responsible for funding and there is minimum disruption to an individual’s care and support.

3.3 Where people need care and support in their own home or the community and are required to fund it themselves we will encourage and advise them on how they can arrange their own care. Where we are asked to arrange care we will do so.

3.4 Whenever we arrange care we will do this in the same way as we would for people who are eligible for support with the cost of social care. We will do this using our usual contracts. We will set-up and manage the contract with the service provider and obtain the payment that is then due to Devon County Council from the person receiving the service.

4. Financial Considerations

4.1 There are no additional cost implications of these policies. The duties in these policies and the duty to promote independence are constant with the need to use public resources efficiently, effectively and fairly in providing the services that we are required to deliver.

5. Sustainability Considerations

5.1 There are no sustainability impact issues arising from this report

6. Carbon Impact Considerations

6.1 There are no carbon impact issues arising from this report

7. Equality Considerations

7.1 An impact assessment has been completed and is attached at Appendix C. No new significant social or equality impacts are anticipated from these policies. In addition an impact assessment on implementation of the Care Act was published in June 2015. https://new.devon.gov.uk/impact/care-act-implementation-impact-assessment-updated-september-2015/ . This is scheduled to be reviewed by June 2018. The will be an opportunity to evaluate the impact of implementation of all aspects of the Care Act.

8. Risk Management Considerations

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Agenda Item 8

8.1 The recommendations and policies in this report are aimed at reducing any risk of not fully complying with our duties under the Care Act and ensuring that these duties are communicated to our staff, partner agencies and the public.

9. Summary/Conclusions/Reasons for Recommendations

9.1 . The policies on Choice in Care, and on Support and Arrangements for People Funding Part or All of Their Care, will confirm and clarify our duties under the Care Act. This will enable the public, our staff and partner agencies to refer in one place to the relevant policy statements on these issues. They also enable us to clarify and reaffirm our duties and commitment to promoting independence in the context of how we provide options for choice in care and how we support people who fund all or part of their care.

Tim GolbyHead of Adult Commissioning and Health

Electoral Divisions: All

Cabinet Member for Adult Social Care and Health Services: Councillor Andrew Leadbetter

Chief Officer for Adult Care and Health: Jennie Stephens LOCAL GOVERNMENT ACT 1972: LIST OF BACKGROUND PAPERS

Contact for Enquiries: Damian Furniss, Senior Manager, Adult Commissioning and HealthTel No: 01392 382300 Room: Annexe, First Floor Office

Background Paper Date File Reference

Nil

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Agenda Item 8

Appendix A

Choice in care policy

Version 2

Strategic Owner Head of Adult Social Care

Business owner Principal Social Worker Operations

Author James Martin, Senior Policy Officer

Date of approval and commencement TBC

Last review date July 2017

Last reviewer James Martin Senior Policy Officer Paul Grimsey Policy Manager

Next review date Quarter 2. 2020/21

Supporting documents

The Care Act 2014 and associated guidance and regulation

Adult Social Care: Choice Framework Personal budgets policy Direct payments policy Fair and affordable care policy Promoting Independence Policy

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Summary of policy

This policy sets out the principles of choice in adult social care.

We will always, in the first instance, look at a person’s strengths and those in the community to promote independence outside of a DCC funded package of care

When receiving DCC funded adult social care, individuals are able to make choices about how their care is arranged, who delivers their care, and the accommodation in which they receive it.

We will consider the person’s preferences and will take into account how decisions are likely to impact on the person’s wellbeing.

We will work with people to ensure that their choices and the support offered will maximise their independence; consideration will be given to how the level of support offered may reduce as their independence increases. This is will apply to all choices of support.

Any DCC funded care must be compatible with the Fair and Affordable Care Policy and DCCs duty to meet needs at best value.

The offer of preferred choice of accommodation or provider is dependent on this being available at best value and the provider agreeing to DCCs usual terms and conditions.

1. Who this policy applies to

1.1 This policy applies to people who are eligible for adult social care funding to meet their eligible needs. This policy supports DCC Adult Social Care staff when an individual expresses choice in how their care and support are to be delivered.

2. Promoting independence

2.1 The Care Act states that we need to consider promoting independence and reducing the needs a person has at every opportunity.

The Act emphasises the importance of “preventing or delaying the development of needs for care and support and the importance of reducing needs that already exist. At every interaction with a person, a local authority should consider whether or how the person’s needs could be reduced or other needs could be delayed from arising.” (Care and Support Statutory Guidance to the Care Act. 1.14.(b).https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/506202/23902777_Care_Act_Book.pdf

2.2 Devon County Councils Promoting Independence Policy will always be applied and the potential for the following support should always be considered as ways of promoting independence:

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Providing information on healthy life choices Providing information on community resources Identifying personal strengths and supportive relationships

2.3 Your care plan will wherever possible aim to reduce needs that already exist and to prevent or delay the developments of additional needs for care and support

3. Care Act guidance

3.1 In addition to promoting independence, the Wellbeing Principle also states that we are required to consider an individual’s views, wishes, feelings and beliefs:

Considering the person’s views and wishes is critical to a person-centred system. Local authorities should not ignore or downplay the importance of a person’s own opinions in relation to their life and their care. Where particular views, feelings or beliefs (including religious beliefs) impact on the choices that a person may wish to make about their care, these should be taken into account. This is especially important where a person has expressed views in the past, but no longer has capacity to make decisions themselves. (Care and Support Statutory Guidance to the Care Act. 1.14.(b).https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/506202/23902777_Care_Act_Book.pdf

The policy

4. Choice within best value

4.1 We will always take people’s preferences into account and aim to maximise people’s independence.

4.2 Choices that individuals are offered about how their eligible care needs are met must only include the ‘best value’ options where DCC funding is being considered.

4.3 When we say best value we mean the most appropriately costed care package to enable a person’s eligible needs to be met.]

4.4 Care packages that achieve the ‘best possible’ outcomes will not necessarily be funded without due regard to cost.

4.5 The funding made available to support a person will be determined by the most cost effective care package, and the prospect of successfully increasing independence, based on the local care market, the availability of providers and cost.

4.6 When catering for a person’s preference, DCC will fund no more than 5% above the best value care package that meets eligible needs unless there are exceptional circumstances. For these exceptional circumstances to apply we would expect there to be clear evidence that the more expensive option is

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likely to have greater impact in reducing dependence on publicly funded care and that there is a clear time table for reviewing the care package and for considering reducing the cost of the care package

5 Choice through direct payments

5.1 If a person is eligible for social care support from DCC they may choose a direct payment so they can directly arrange support to achieve agreed outcomes. This may include choosing a provider that DCC does not usually work with.

5.2 The value of a direct payment will be no greater than the cost to DCC if it was commissioning the package of care to meet the individual’s eligible needs.

5.3 If an individual wants to meet their needs in a way that is more expensive than best value, then the individual will be required to fund the additional amount above best value.

5.4 The Care Act 2014 currently restricts DCC from offering direct payments for long-term care in a residential setting.

5.5 Direct payments may be offered for short term placements or respite. The Care Act defines short term in this context as:

4 consecutive weeks in any 12-month period, or; 2 or more periods separated by less than 4 weeks which added together

total 4 weeks

The DCC Direct Payments Policy is available for more details

6 Choice of accommodation

6.1 Individuals receiving adult social care funding are able to choose their accommodation as long as:

a) It will meet their needs

6.2 If residential or nursing care has been identified as the only appropriate way of meeting a person’s needs then the individual may not choose another type of specified accommodation such as Supported Living or Shared Lives, but they are able to express a preference for a particular care home to live in.

b) It will cost no more than DCC would usually pay

6.3 In the first instance the best value placement within the specified accommodation, available at the time, is identified and offered. If a person’s needs could be met in more than one type of specified accommodation then the cost of the best value type of accommodation will be offered,

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6.4 Should a person choose to commit to a more expensive provision than the identified best value option then a top-up payment will need to be arranged.

c) It is available

6.5 The preferred choice of provision must be available and, where DCC is commissioning the support, the provider agrees to deliver the care under DCCs usual terms and conditions.

7 Choice of home based or community based care provider

7.1 DCC intends that all regulated personal care will be commissioned via a direct payments or through the Living Well at Home (LWAH) contract for regulated home based care.

7.2 A person can express a preferred choice of provider when DCC commissions their care. This will be dependent on the preferred provider being available and willing to provide the care under DCC usual terms and conditions.

7.3 A person can however refuse a direct payment or express a preferred choice of provider outside of LWAH. Receiving a preferred provider will depend on the provider being available and willing to agree to DCCs usual terms and conditions

7.4 In these situations exceptional circumstance will need to be identified for a spot contract to be arranged and the principles of best value will apply.

7.5 For unregulated care the person will be offered the provider or providers who are able to meet their needs in the most cost effective way.

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Appendix B

Policy on support and arrangements for people funding part or all of their care

Version 2

Strategic Owner Head of Adult Social Care

Business owner Principal Social Worker, Operations

Author James Martin, Senior Policy Officer

Date of approval andcommencement July 2017

Last review date July 2017

Last reviewer James Martin, Senior Policy OfficerPaul Grimsey, Policy Manager

Next review date Quarter 2. 2020/21

Supportingdocuments

The Care Act 2014 and associatedguidance and regulation

Adult Social Care: Choice Framework Personal budgets policy Direct payments policy Fair and affordable care policy Promoting Independence Policy

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1. Who this policy applies to

1.1 This policy will apply to you if you are not eligible for adult social care funding either because your financial assets are greater than the upper capital limit or you do not wish to have a financial assessment.

1.2 This policy will apply if we are assessing you for the first time or if your needs and financial situation are being reviewed.

1.3 It also applies when we are putting services in place to meet an urgent need you may have prior to assessment.

1.4 This policy will need to be considered when individuals are moving from Children’s to Adult Social Care.

2. Why we need this policy

2.1 The Care Act 2014 places new powers and duties on us in relation to how we can and must arrange care for you if you have eligible social care needs. This policy is required to ensure a consistent approach is maintained across Devon.

3. What this policy will achieve

3.1 The aims and objectives of this policy are:

a) To ensure that if you are vulnerable and in need of social care we support you in having your eligible needs met;

b) To help you remain as independent as possible;

c) To set out when and how we can and will arrange care and support for you if you are funding your own care;

d) To demonstrate that we are applying national legislation.

4. The Policy

When we will arrange your care and support

4.1 If you have eligible needs but you are not financially eligible for social care funding, we have a duty to arrange care and support for you in the following circumstances:

a) When you require care and support in your home or the community (i.e. not in a residential or nursing care home) and have asked us to arrange it on your behalf

b) When you require care and support in a care home and are not able to arrange this yourself and no deputy or lasting power of attorney for property and financial affairs has been appointed to do so for you

We may also exercise our power to arrange your care in the following circumstances:

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c) If you approach us to arrange your care in a care home and, after a financial assessment, we conclude that it is likely you will be eligible for social care funding within a period of 12 months, then we may exercise our power to arrange your care home placement. The 12 month timeframe is a guiding principle and each individual will be assessed on case-by-case basis with the benefit to both the individual and DCC considered

d) We may exercise our power to arrange the care and support you are paying for if it is interrupted due to the provider no longer being able to provide it

How your care and support can be arranged

4.2 We will undertake a needs assessment to establish your eligible social care needs.

4.3 We will discuss with you the options for how your care and support could be arranged. The options are:

a) You may be able to and want to arrange your own care and support

b) You may want us to find the care and support so that you can arrange it.

c) You may like us to find and arrange your care and support

Promoting independence

4.4 The Care Act states that we need to consider promoting independence and reducing the needs a person has at every opportunity.

4.5 The Act emphasises the importance of “preventing or delaying the development of needs for care and support and the importance of reducing needs that already exist. At every interaction with a person, a local authority should consider whether or how the person’s needs could be reduced or other needs could be delayed from arising.” (Care and Support Statutory Guidance to the Care Act. 1.14.(c).https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/506202/23902777_Care_Act_Book.pdf

4.6 Devon County Councils Promoting Independence Policy will always be applied and the potential for the following support should always be considered as ways of promoting independence:

Providing information on healthy life choices Providing information on community resources Identifying personal strengths and supportive relationships

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4.7 Your care plan will wherever possible aim to reduce needs that already exist and to prevent or delay the developments of additional needs for care and support

What happens when we arrange your care and support?

4.8 If you require ongoing care and support then we will identify an amount of money sufficient to meet your needs, this is called a personal budget. We will plan and arrange your care and support in the same way as we would for people who are eligible for support with the cost of social care using our usual contracts. We will set-up and manage the contract with the provider of your service. You will be required to pay us for the care and support you receive according to the financial assessment completed.

4.9 You may want to have control over the arrangement and management of your contract with the provider, if we feel you are able to do this, we will help you identify your care and support needs, find a suitable provider of services and help you set-up a contract with your provider. You will be required to pay your provider in full for the care and support you receive.

4.10 You are able to make choices about the care and support you receive. If you want care and support beyond the value of your personal budget we will help you to arrange it as long as we feel you can afford and sustain the cost.

4.11 You need to be aware that if at a future point in time you are no longer able to afford your chosen care and support or you become eligible for funded care and support, your care and support may need to change to reflect the value of your personal budget i.e. you may need to change provider or move to a different care home.

Reviewing the care and support you have in place and how it is arranged

4.12 We will review the care and support you are receiving in a care home or your own home on an annual basis or when you tell us that your care needs have changed. This will ensure that the care and support you are receiving is still appropriate and is meeting your needs.

4.13 If we arrange your care in a care home we will regularly review this to ensure it is still appropriate for us to be making the arrangements. Your circumstances may change and you may have the ability to arrange your care in a care home yourself or someone may have been appointed to act on your behalf.

4.14 There may be instances where we are arranging your care solely because you do not have a suitable deputy or lasting power of attorney for property and financial affairs. Where this is the case and where it is felt that this is significantly impacting on your wellbeing or we are not able to recover monies due to it, then we may need to apply to the Court of Protection to become your deputy.

4.15 Where Devon County Council is appointed as deputy for a person, the council may choose to cease the purchase of care services using its own contractual arrangements with providers. In such cases new

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arrangements for the purchase of services would be made privately by the acting deputy on behalf of the person i.e. the contractual arrangement becomes direct between person and provider as opposed to between the council and provider.

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Impact Assessment

Version 2017b. To publish, please send a dated PDF to impactassessment-mailbox@devon.gov.uk

3. Assessment of: Adult Social Care Promoting Independence Policies – o Choice in Care o Support and Arrangements for People Funding Part or All of Their

Care

Service: Adult Social Care

Head of Service; Tim Golby Head of Social Care Commissioning

Date of sign off/version: 27.10.17

Assessment carried out by (incl. job title): Paul Grimsey Policy Manager Adult Social Care

Section 1 – Background

DescriptionTwo new policies have been written that provide statements on,

1. Choice in Care2. Support and Arrangements for People Funding Part or All of Their Care

The two new polices describe our duties relating to the aspects of adult support and care that they cover as defined by the Care Act 2014. Some of these duties are specifically defined requirements while others, such as the duty to promote independence, are more wider ranging but no less important. Creating these policy statements also allows us a further opportunity to re-emphasise our duties to promote independence in the context of these aspects of our work.

The Choice in Care Policy sets out the principles of choice in adult social care and provides clarity to staff and the public on how Devon County Council will provide choice within the parameters of our duty to achieve best value and the need to promote independence. Devon County Council will work with people to ensure that their choices and the support offered will maximise their independence. Consideration will be given to how the support offered may reduce as their independence increases.

The Policy on Support for People Funding Part or All of Their Care is in line with both national legislation and Devon County Council’s Promoting Independence Policy. Devon County Council will in most cases not arrange residential care for an individual if that person is required to fund it themselves and they are, or someone on their behalf is, able to arrange that care.

The only exception to this is if Devon County Council anticipate that someone will become eligible for social care funding in the next 12 months. In this situation we will arrange residential care if asked to. This enables us to ensure that a sustainable solution is in place prior to Devon County Council being responsible for funding and there is minimum disruption to people care and support.

Appendix C

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Where people need care and support in their own home or the community and are required to fund it themselves we will advise them on how they can arrange their own care. However where ask to do so we will arrange their care for them.

Whenever we arrange someone’s care, where they are required to meet the full cost of this care, we will do this in the same way as we would for people who are eligible for support with the cost of social care. We will do this using our usual contracts. We will set-up and manage the contract with the service provider and obtain the payment that is then due to Devon County Council from the person receiving the service.

Reason for change/review

As experience, precedent and advice has developed nationally and locally we have recognised a need to confirm and clarify our duties under the Care Act under these policy headings so that everyone involved can refer in one place to the relevant policy statements on these areas of our work. We also want to take the opportunity to embed the Promoting Independence duties under the Care Act into Adult Support and Care.

Section 2 - Impacts, options and recommendations (see sections 3, 4 and 5 for background analysis)

Options Appraisal and RecommendationMaintaining the status quo and not creating these policy statements was considered. However we had feedback from staff, partners and the public that while there were statements on these duties and powers in a range of places within the Care Act and local and national guidance, there was a need identified to confirm and clarify our duties and powers for these aspects of our work under these policy headings.

Social/equality impacts (summary)No new significant and specific social/ equality impact is anticipated from these policies.

Devon County Council will continue to carry out our duties in ensuring everyone receives the adult social care support they are eligible for in line with the requirements of the Care Act. This includes offering financial assessments so that people with assets below the nationally prescribed threshold do not need to pay for their care. We will continue to provide these services to all people in Devon and to monitor their impact on people with different characteristics of race, gender, identity, age and culture through DCCs Adult Social Care performance framework, service monitoring and engagement processes.

Environmental impacts (summary)No significant and specific environmental impact is anticipated from these policies

Economic impacts (summary)No significant and specific economic or local business impact is anticipated from these policies.

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Other impacts (partner agencies, services, DCC policies, possible ‘unintended consequences’)No other significant and specific impact is anticipated from these policies

How will impacts and actions be monitored?We will monitor the impact on people with different characteristics of race, gender, identity, age and culture through DCCs Adult Social Care performance framework, service monitoring and engagement processes. The review of the impact assessment on implementation of the Care Act is due to be completed by June 2018. This will also be an opportunity to evaluate the impact of implementation of all aspects of the Care Act including these policies.

Background AnalysisThis section describes how relevant questions and issues have been explored during the options appraisal.

Section 3 - Profile and views of stakeholders and people directly affected

People affectedAll adults who are eligible for adult social care services and support. This includes providing advice and information where we may to be providing a funded care service.

Diversity profile and needs assessment of affected peopleThese policies have the potential to apply to any adult in Devon as anyone may develop social care needs or be a carer. The county has over 750,000 residents, with a higher proportion of older people than the national average. It is also one of the most sparsely populated counties, with few large settlements and a dispersed rural population. A breakdown of Devon’s demography is available at:https://new.devon.gov.uk/factsandfigures/the-people/

Other stakeholders (agencies etc.)Adult Social Care StaffStatutory Agencies involved in the Health and Social Care SystemIndependent Health and Social Care Providers

Consultation process and resultsWe have engaged with a range of service users, carers and other stakeholders on the principles and the Promoting Independence Policy that the amendments to the existing policies reflect.

Consultation has also taken place on the new policies through facilitated discussion with a range of service user representatives including the Commissioning Involvement Group.

The Adult Social Care approach to promoting Independence that informs these policies has also been considered and discussed by;

The DCC, Adult Care, Staff Reference GroupThe Provider Engagement NetworkHealth and Social Care partners through STP planning and partnership arrangements

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Research and information usedThese policies are based on advice from our legal department and on the new Promoting Independence Policy that has informed these policies. We have also been informed by the Care Act and its statutory guidance.https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/506202/23902777_Care_Act_Book.pdf

Section 4a - Social Impacts

Giving Due Regard to Equality and Human Rights

The local authority must consider how people will be affected by the service, policy or practice. In so doing we must give due regard to the need to:• Eliminate unlawful discrimination, harassment and victimisation • Advance equality of opportunity and• Foster good relations.

Where relevant, we must take into account the protected characteristics of age, disability, gender, gender reassignment, pregnancy and maternity, marriage and civil partnership, sexual orientation, race, and religion and belief. This means considering how people with different needs get the different services they require and are not disadvantaged, and facilities are available to them on an equal basis in order to meet their needs; advancing equality of opportunity by recognising the disadvantages to which protected groups are subject and considering how they can be overcome. We also need to ensure that human rights are protected. In particular, that people have:

- A reasonable level of choice in where and how they live their life and interact with others (this is an aspect of the human right to ‘private and family life’).

- An appropriate level of care which results in dignity and respect (the protection to a private and family life, protection from torture and the freedom of thought, belief and religion within the Human Rights Act and elimination of discrimination and the promotion of good relations under the Equality Act 2010).

- A right to life (ensuring that nothing we do results in unlawful or unnecessary/avoidable death).

The Equality Act 2010 and other relevant legislation does not prevent the Council from taking difficult decisions which result in service reductions or closures for example, it does however require the Council to ensure that such decisions are:

- Informed and properly considered with a rigorous, conscious approach and open mind, taking due regard of the effects on the protected characteristics and the general duty to eliminate discrimination, advance equality and foster good relations.

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- Proportionate (negative impacts are proportionate to the aims of the policy decision)

- Fair - Necessary - Reasonable, and- Those affected have been adequately consulted.

In what way can you eliminate or reduce the potential for direct or indirect discrimination, harassment or disadvantage? Are there any lawful, reasonable and proportionate, unavoidable negative consequences?

All residents (include generic equality provisions):These two policies consolidate existing duties and powers under the Care Act and will therefore have a neutral impact on equalities issues. The additional emphasis on promoting independence should have a positive impact on all adults requiring social care support.

Age: These policies apply people aged 18 and over and the likelihood of needing adult social care support increases as people get older. These policies apply equally to any adult irrespective of their age.

Disability (incl. sensory, mobility, mental health, learning disability, ill health) and carers of disabled people: People with disabilities are significantly more likely to need social care support.

Culture and ethnicity: nationality/national origin, skin colour, religion and belief:The additional emphasis on promoting independence should have a positive impact on adults from minority ethnic cultural and religious groups requiring social care support. This approach aims to recognise and maximise peoples social networks and relationships while continuing to provide care services where needed.

Sex, gender and gender identity (including men, women, non-binary and transgender people), and pregnancy and maternity (including women’s right to breastfeed):

It is not anticipated that there will be a negative impact on people with other protected characteristics, e.g. sexual orientation, gender etc.

Sexual orientation and marriage/civil partnership:It is not anticipated there will be disproportionate negative impact on people with other protected characteristics, e.g., sexual orientation, gender etc.

Other socio-economic factors such as families, carers, single people/couples, low income, vulnerability, education, reading/writing skills, ‘digital exclusion’ and rural isolation:

It is not anticipated there will be disproportionate negative impact on other socio-economic factors.

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In what way can you advance equality (meet needs, encourage participation, make adjustments for disabled people, ‘close gaps’). In what way can you foster good relations between groups (tackle prejudice and promote understanding), if relevant?

All residents (include generic equality provisions):

Age: The additional emphasis on promoting independence should have a positive impact on older people requiring social care support. This approach aims to recognise and maximise peoples social networks and relationships while continuing to provide care services where needed.

Disability (incl. sensory, mobility, mental health, learning disability, ill health) and carers of disabled people:The additional emphasis on promoting independence should have a positive impact on people with disabilities requiring social care support. This approach aims to recognise and maximise peoples social networks and relationships while continuing to provide care services where needed.

Culture and ethnicity: nationality/national origin, skin colour, religion and belief:

Sex, gender and gender identity (including men, women, non-binary and transgender people), and pregnancy and maternity (including women’s right to breastfeed):

Sexual orientation and marriage/civil partnership:

Other socio-economic factors such as families, carers, single people/couples, low income, vulnerability, education, reading/writing skills, ‘digital exclusion’ and rural isolation:

Human rights considerations:These policies have been developed with Legal advice from DCC’s legal team and no human rights considerations have been identified.

Supporting independence, wellbeing and resilienceGive consideration to the groups listed above and how they may have different needs. These policies are aimed at promoting independence and supporting wellbeing and resilience for people with adult social care and support needs

Section 4b - Environmental impacts

An impact assessment should give due regard to the following activities in order to ensure we meet a range of environmental legal duties.

The policy or practice does not require the identification of environmental impacts using this Impact Assessment process because it is subject to (please select from the list and proceed to the 4c, otherwise delete this paragraph and complete the environmental analysis below):

• Devon County Council’s Environmental Review Process for permitted development highway schemes.

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• Planning Permission under the Town and Country Planning Act (1990).• Strategic Environmental Assessment under European Directive

2001/42/EC “on the assessment of the effects of certain plans and programmes on the environment”.

Describe any actual or potential negative consequences (consider how to mitigate against these). Describe any actual or potential neutral or positive outcomes (consider how to improve as far as possible).

Reduce waste, and send less waste to landfill:

Conserve and enhance biodiversity (the variety of living species):

Safeguard the distinctive characteristics, features and special qualities of Devon’s landscape:

Conserve and enhance the quality and character of our built environment and public spaces:

Conserve and enhance Devon’s cultural and historic heritage:

Minimise greenhouse gas emissions:

Minimise pollution (including air, land, water, light and noise):

Contribute to reducing water consumption:

Ensure resilience to the future effects of climate change (warmer, wetter winters; drier, hotter summers; more intense storms; and rising sea level):

Other (please state below):

No significant and specific environmental impact is anticipated from these policies.

Section 4c - Economic impacts

Describe any actual or potential negative consequences (consider how to mitigate against these). Describe any actual or potential neutral or positive outcomes (consider how to improve as far as possible).

Impact on knowledge and skills:

Impact on employment levels:

Impact on local business:

No significant and specific economic or local business impact is anticipated from these policies.

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Section 4d -Combined Impacts

Linkages or conflicts between social, environmental and economic impacts:

No significant and specific combined impacts are anticipated from these policies. Devon County Council will continue to carry out our duties in ensuring everyone receives the adult social care support they are eligible for in line with the requirements of the Care Act. This includes offering financial assessments so that people with assets below the nationally prescribed threshold do not need to pay for their care. We will continue to provide these services to all people in Devon.

Section 5 - ‘Social Value’ of planned commissioned/procured services:

How will the economic, social and environmental well-being of the relevant area be improved through what is being proposed? And how, in conducting the process of procurement, might that improvement be secured?

The additional emphasis on promoting independence should have a positive impact on people requiring social care support and their carers. This approach aims to recognise and maximise peoples social networks and relationships while continuing to provide care services where needed.

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ACH/17/72Cabinet

8 November 2017

PROVIDER QUALITY SUPPORT POLICY

Report from the Head of Adult Commissioning and Health

Recommendation: that Cabinet adopt the proposed ‘Provider Quality Support Policy’ to replace the current ‘Quality Threshold Policy’

1. Background/Introduction

1.1 The Care Act 2014 places greater emphasis on local authorities to support independent care providers of improve the quality of the care.

1.2 In response to this in 2014 Devon County Council (DCC) established the Quality Assurance and Improvement Team with a brief to:-

develop quality assurance arrangements across adult social care markets, coordinated with NHS colleagues and neighbouring Councils;

work responsively with providers to resolve quality issues; work proactively to improve quality by promoting and sharing best

practice; develop quality risk profiling as an mechanism for earlier involvement with

providers; minimise the need for whole service safeguarding enquiries.

1.3 Significant progress has been made in the ensuing period towards achieving these aims resulting in more proactive and supportive approaches to safeguarding and quality assurance and significant reductions in levels of whole service safeguarding processes. Working arrangements of the quality teams within health and social care in Devon and across other local authorities in the South West peninsula are more integrated and there are plans for further integration in the future.

1.4 The overall result has been a significant improvement in the quality of Care Quality Commission (CQC) regulated care markets in Devon. The current position as at October 2017 (see diagram below) when compared with October 2015 shows: -

5% (22 of a total of 433 CQC inspections) of providers now rated Outstanding by CQC compared to 2% two years ago (+3%);

82% (354) rated Good compared to 63% (+19%); 12% (54) rated Requires Improvement compared to 29% (+17%); 1% (3) rated Inadequate compared to 6% (+5%).

Please note that the following recommendations are subject to consideration and determination by the Cabinet (and confirmation under the provisions of the Council's Constitution) before taking effect.

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1.5 Devon also compares well in comparison with the average of the South West and England, with 87% of services rated Good or Outstanding in Devon compared to 82% in the South West and 80% in England.

1.6 The Provider Quality Support Policy is the culmination of much work over the last two years by the operations, safeguarding and quality teams in adult health and social care working together to support Providers to achieve these notable outcomes.

2. What is the Provider Quality Support Policy (the Policy) for and why do we need it?

2.1 As borne out by the figures in section 1.4 and 1.5 above, the state of care in Devon is in a very good position and compares favourably to other areas. In addition to CQC inspection outcomes the Policy adopts a range of ‘Early Indicators of Concern’ which are monitored regularly to identify where early intervention / support could help to prevent further escalation of concerns. The ‘Early Indicators of Concern’ are constantly evolving, but as a guide some examples of these are: -

safeguarding concerns; complaints; no manager in place at the service, or frequent changes in management; emergency hospital admissions, or hospital admissions for ‘avoidable

conditions’ e.g. urinary tract infection; feedback from service users, relatives, visiting professionals,

Healthwatch etc.

For further details see the tables on pages 25 and 26 of the Policy.

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2.2 Monitoring ‘Early Indicators of Concern’ is achieved through a combination of: -

systematic risk profiling, using available data (as per 2.1 above) to calculate risk scores for providers;

multi-agency group discussion of provider quality concerns.

2.3 As a result procedures have become more proactive enabling timelier support / intervention.

2.4 Having defined ‘Threshold Levels’ is fundamental to enable commissioners to make timely decisions. The ‘Threshold Levels’ are defined by ‘Characteristics’ which enable consistent application of the Policy, ensures that appropriate and proportionate responses are taken and enables ‘Control Measures’ to be established by commissioners should this be necessary e.g. a suspension of new placement to the service, serving a contract default notice etc. There are 6 ‘Threshold Levels’ defined within the Policy as follows: -

LevelQuality Review

Threshold Level Description

4 Service Closure3 Major Concerns2 Moderate Concerns1 Minor Concerns0 Business as Usual-1 Accredited Provider

For further detail refer to pages 11 and 12 of the attached Policy.

2.5 Also of vital importance is the interface between ‘Quality Thresholds’ and whole service safeguarding adult Enquiry thresholds, which must be regularly reviewed to ensure the appropriate policy is followed. This is best illustrated by the process flowchart on page 23 of the attached Policy, which also provides indicative timescales.

2.6 In reality relatively few providers (circa 10% of the Devon market) have identified quality concerns of any significance, defined as ’Minor Concerns’ within the Policy. The majority of these providers resolve those concerns quickly using the support networks available to them across health and social care as necessary, and will return to ‘Business as Usual’. This is important when considering the Policy context and principles, those being: -

a collaborative partnership between providers and commissioners; proactive and supportive approaches: identifying quality concerns as

early as possible and providing the support needed for sustained quality improvement;

where support / intervention is necessary the response is proportionate to the level of risk presented.

2.7 For around 2% of the market concerns will escalate further, either because the improvement required has not been achieved or not sustained, or due to nature or severity of concerns. These are defined as ‘Moderate Concerns’ in the

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Policy and in these instances under the Policy a ‘Provider Quality Review’ is activated.

2.8 The purpose of a ‘Provider Quality Review’ is to: -

act quickly to identify problems and improve care delivery; coordinate plans across all agencies involved; work out a plan of action which is transparent; prevent further escalation of quality concerns and avoid whole service

safeguarding.

In doing so a ‘Provider Quality Review’ will manage communication, avoid duplication of effort across agencies and prevent unnecessary additional ‘footfall’ in the service that could unintentionally hinder quality improvement.

2.9 The most severe level of concern covered by the Policy is defined as ‘Major Concerns’, encompassing less than 1% of the market. At this level it is most likely that the provider has: -

had a CQC inspection with an Inadequate rating; recently been in a whole service safeguarding process and is now

deemed ‘safe’ (i.e. below whole service safeguarding thresholds).

As concerns escalate it becomes increasingly likely that thresholds for whole service safeguarding adult Enquiry will be met, but if they are not and there is a clear need for service improvement then the Policy will be used. Concerns can also escalate to become ‘Major’ because the provider is: -

unwilling to engage with commissioners; not proactive and their quality assurance processes are ineffective; demonstrating conduct which falls below minimum acceptable standards; failing to meet outcomes in the service improvement plan and/or contract

default notice(s).

2.10 ‘Service Closure’ is defined as a ‘Threshold Level’ within the Policy but service closure will always be managed within whole service safeguarding.

3. How is the Policy going to be used?

3.1 The main application of the Policy will be to manage provider quality concerns through ‘Provider Quality Reviews’ as described in detail within the attached Policy. However, for the Policy to have maximum effect it must operate within a ‘whole system’ and it is therefore intrinsic to: -

quality standards defined within tender and contract specifications: -o the Policy will be written into all existing and new contract

specifications to ensure the relevant conditions can be called upon should this prove necessary. Procedures will be transparent for providers to see what control measures will be applied by commissioners should quality concerns escalate, allied to the ‘Quality Thresholds’;

o providers will be required to complete a Self-Assessment Questionnaires (see page 36 of the attached Policy) as part of the tendering process and maintain this annually thereafter. This will

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provide additional information to inform risk profiling and consequently to target support as necessary;

o increasingly commissioning / contracting done jointly by DCC, Torbay Council, NEW Devon CCG and South Devon and Torbay CCG. This Policy has been developed jointly with quality teams across all organisations and if adopted by Cabinet it will be taken forward through their governance arrangements with the aspiration of becoming a single shared Policy across all organisation (see section 4 below).

contract monitoring and quality assurance procedures: -o as above information resulting from contract monitoring and quality

assurance procedures will inform risk profiling to target support as necessary.

health and social care operations: -o the Policy covers the entire spectrum of quality, from provision of

additional freedoms and flexibilities for ‘Accredited Providers’ to providers with ‘Major Concerns’ and the boundary with whole service safeguarding. The Policy will provide local (to the geographic location of the service) operational managers, who will be the nominated ‘Responsible Manager’ with the safeguarding policy.

3.2 This policy will replace the current DCC ‘Quality Threshold Policy’ which is tied to CQC inspection outcomes. Whilst CQC inspection outcomes will continue to be a factor, importantly the new Policy will enable independent actions to be taken where it is desirable for commissioners to do so.

4. Partnershiop Development and Consultation

4.1 The Policy has been developed jointly by DCC, Torbay Council, NEW Devon CCG, South Devon and Torbay CCG and Torbay and South Devon NHS Foundation Trust and if adopted by Cabinet it will be taken forward through their governance arrangements.

4.2 Increasingly commissioning / contracting is being done jointly so having joint / consistent policies and procedures for supporting providers to embed within contract specifications is even more important than before.

4.3 Further consultation on the Policy is planned in the near future with Devon Partnership Trust and Livewell South West with an aspiration of it becoming a shared or aligned Policy across all organisations.

4.4 A number of groups have been consulted as the Policy has been developed: -

Provider representatives have been consulted through the Provider Engagement Network;

Service user / carer representatives have been consulted through the Commissioning Involvement Group;

Healthwatch.

5. Equality Considerations

An equalities impact assessment has been completed with no negative impacts identified. The Quality Policy is a means of ensuring that providers meet all

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their legal and contractual obligations (including equality considerations) and as described above, will enable proactive and timely support / intervention across a wider scope of providers than the Quality Threshold Policy it replaces. Therefore, the Quality Policy should have an overall positive impact on equality.

6. Legal Considerations

There are no specific legal considerations.

7. Risk Management Considerations

No risks have been identified.

8. Summary/Conclusions/Reasons for Recommendations

8.1 The Provider Quality Support Policy is the culmination of work over the last two years with proven results. The Policy will enable commissioners to move away from the current policy which is restricted to CQC inspection outcomes to a more proactive approach that makes timelier decision making possible.

8.2 The Policy will be aligned with changes to joint commissioning and contracting arrangements to maximise benefits and taken forward through governance arrangements in Torbay Council, NEW Devon CCG, South Devon and Torbay CCG and Torbay and South Devon NHS Foundation Trust in order to establish a ‘whole system’ approach.

8.3 It is recommended that Cabinet adopt the proposed ‘Provider Quality Support Policy’ to replace the current ‘Quality Threshold Policy’.

Tim GolbyHead of Adult Commissioning and Health

Electoral Divisions: All

Cabinet Member for Adult Social Care and Health Services: Councillor Andrew Leadbetter

Chief Officer for Adult Care and Health: Jennie Stephens LOCAL GOVERNMENT ACT 1972: LIST OF BACKGROUND PAPERS

Contact for Enquiries:Steve BlandfordQuality Assurance and Improvement ManagerTel No: 01392 383000Room: Annexe First Floor Office

BACKGROUND PAPER DATE FILE REFERENCE

Provider Quality Support Policy 08/11/17 PQSP_Final

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Provider Quality Support Policy

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Document RatificationThis is a controlled document and should not be altered in any way without the express permission of the author or their representative.

Note: this document is only valid from the date approved below, and checks should be made that it is the most up to date version available.

Document title: Provider Quality Support Policy

Purpose of document: To establish a formal policy to manage provider quality that does not meet the threshold for a whole service safeguarding adults enquiry

Date of issue: 31/10/2017 Next review date: To be confirmedVersion: Final Last review date: NewAuthor: Geraldine Benson / Steve BlandfordService Area: Adult Commissioning and HealthDocument Approval: Cabinet

Adult Care and Health Leadership TeamAdult Commissioning and Health Leadership TeamAdult Care Operations and Health Leadership Team

Date approved: To be confirmed

Devon Safeguarding Adults Board Multi-Agency Policy and Guidance (https://new.devon.gov.uk/devonsafeguardingadultsboard/policy)

Torbay Safeguarding Adults Board Multi-Agency Policy and Guidance(http://www.torbayandsouthdevon.nhs.uk/services/safeguarding-adults/safeguarding-adults-board/)

Links or overlaps with other strategies / policies:

Please selectYes No

Does this document have training implications?If yes please state: ☒ ☐

Process training for all operational staff, safeguarding teams and other relevant adult commissioning and health staff. CareFirst training. Current DSAB Responsible Manager Training should be reviewed.Does this document have financial implications?If yes please state: ☐ ☒

Is this document a direct replacement for another? If yes please state which documents are being replaced: ☒ ☐

Quality Threshold Policy

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Document Amendment HistoryDate Version No. Amendment summary Completed by:

22/12/2016 Initial Draft v1 Initial draft v1 distributed to QAIT for comment. Comments received and amendments made.

Steve Blandford

10/01/2017 Draft v2 Draft v2 presented to Safeguarding Adults Team Managers meeting for comment. Comments received and amendments made.

Steve Blandford

13/01/2017 Draft v3 Draft v3 presented to Adult Commissioning and Health Leadership Team for comment. Comments received and amendments made. Organisational logos added. Slight amendment to Appendix 1 (Process Flowchart) and addition of Appendix 6 (Provider Self-Assessment Form).

Steve Blandford

16/01/2017 Draft v4 Draft v4 reissued to QAIT (Devon and Torbay) and presented to Adult Commissioning and Health Leadership Team, Community Services Managers Forum and T&SD/CQC Commissioners Quality Group for comment. Comments received and amendments made, including name change to ‘Provider Quality Support Protocol’ to avoid clash with Practice Quality Review (PQR), re-ordering of sections to improve flow of document, timescales for Quality Reviews and addition of Appendix for Terms of Reference for Quality Review meetings.

Steve Blandford

11/04/2017 Draft v5 Draft v5 presented to Social Care Leadership Group for comment. No comments received.

Steve Blandford

15/05/2017 Final Draft v6 Final Draft v6 re-distributed to all for final comment. Comments received and amendments made, including renaming from ‘Protocol’ to ‘Policy’ and addition of Disability Leads as Responsible Managers where relevant.

Steve Blandford

04/08/2017 Final Draft v7 Final Draft v7 re-distributed to Adult Care Operations and Health Assistant Directors for final comment. Presented to joint Adult Commissioning / Operations. Further clarification added that a Provider Quality Review must not run alongside Whole Service Safeguarding, concerns escalating to Quality Threshold Level 3 are increasingly likely to meet Whole Service Safeguarding thresholds and Service Closure (Quality Threshold Level 4) should always be managed under Whole Service Safeguarding.

Steve Blandford

30/09/2017

08/11/2017

FINAL Approved by joint Adult Commissioning and Health / Adult Care Operations and Health Leadership Team

Presented to Cabinet for approval

Steve Blandford

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Quality Impact Assessment (QIA)

Please select

Patient / Service Users ☒ Visitors / Relatives ☒

General Public ☐Voluntary /

Community Groups ☐

Trade Unions ☐ GPs ☐

NHS Organisations ☒ Police ☐

Councils ☒ Carers ☐

Staff ☒Other Statutory

Agencies ☒

Who may be affected by this document?

Others (please state): Providers

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Please selectYes No

Does this document require a service redesign, or substantial amendments to an existing process?If yes please state:

☐ ☒

The policies and procedures referenced above need to be reviewed alongside this policy, but are not likely to require substantial amendment.Successful implementation of this policy should result in a sustained reduction of whole service safeguarding proceedings, creating the need to review current resource allocations. This is particularly so for business support currently dedicated to safeguarding, which is a pre-requisite for implementation of this policy.If you answer yes to this question, please complete a full Quality Impact Assessment.

Please select

Age ☐ Disability ☐

Gender re-assignment ☐

Marriage and Civil Partnership ☐

Pregnancy and maternity ☐

Race, including nationality and

ethnicity☐

Religion or Belief ☐ Sex ☐

Are there concerns that the document could adversely impact on people under one of the nine strands of diversity?

Sexual orientation ☐

If you tick any of these strands, please complete a full Quality Impact Assessment.If applicable, what action has been taken to mitigate any concerns?

An equalities impact assessment has been completed with no negative impacts identified. The policy is a means of ensuring that providers meet all their legal and contractual obligations (including equality considerations) and will enable proactive and timely support / intervention across a wider scope of providers than the Quality Threshold Policy it replaces. Therefore, the policy should have an overall positive impact on equality.

Please select

Patients / Service Users ☒ Visitors / Relatives ☐

General Public ☐Voluntary / Community

Groups ☒

Trade Unions ☐ GPs ☐

NHS Organisations ☒ Police ☒

Councils ☒ Carers ☐

Staff ☒Other Statutory

Agencies ☒

Who have you consulted with in the creation of this document?

Note: It may not be sufficient to just speak to other health & social care professionals.

Others (please state): Commissioning Involvement GroupDevon Safeguarding Adults BoardCare Quality CommissionHealthwatch

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Contents

Section Description Page

1 Introduction / Purpose 6

2 What is a Provider Quality Support Review (Quality Review)? 6

3 What can trigger a Quality Review Planning Meeting? 7

4 Quality Review Threshold Guidance 9

5 What information might escalate concerns? 12

6 Escalation / De-escalation Procedure 13

7 Who is the decision maker within a Quality Review? 13

8 Who should take part in a Quality Review? 14

9 What should happen in a Quality Review Planning Meeting? 17

10 What should happen in a Quality Review Progress Meeting? 18

11 Concluding a Quality Review 19

12 Governance and Reporting Arrangements 20

13 References 21

Appendix 1 Quality Review – Process Flow Chart 22

Appendix 2 Quality Review – Process Summary 23

Appendix 3 Early Indicators of Concern in Residential and Nursing Homes for Older People (examples from the research)

24

Appendix 4 Early Indicators of Concern – Learning Disability Services (examples from the research)

25

Appendix 5 Quality Review Terms of Reference 26

Appendix 6 Standing agenda for Quality Review meetings 30/32

Appendix 7 Provider Self-Assessment Form 35

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The Provider Quality Support Policy (Quality Policy)

The Provider Quality Support Policy (Quality Policy) has been developed to establish a formal and coordinated response to quality concerns in relation to residential and nursing care homes, domiciliary care services and unregulated care services (e.g. day services, supported living services etc.) for all adults and older people.

The Quality Policy establishes a formal means of responding to provider concerns where thresholds for whole service safeguarding adult Enquiry are not met, but where there is a clear need for service improvement to minimise the risks presented to service users by the quality of care being provided.

The purpose of the Quality Policy is to: -

1. enable remedial actions to take place for the specific areas of concern identified, thus stabilising poor operational performance and subsequently improving and sustaining the standards of care delivered by a provider;

2. coordinate activity across all agencies to enable effective communication, avoid any duplication and minimise involvement to ensure a proportionate response;

3. clearly describe to providers what the quality threshold levels are, the procedures for escalation and de-escalation between quality threshold levels and what this means for providers, making it clear how quality concerns will be followed up;

4. proactively avoid whole service safeguarding and escalation of provider quality concerns;5. contribute towards improving the overall quality of the provider market.

A Provider Quality Support Review (Quality Review) is a process by which concerns are managed with respect to a number of adults considered to be at risk in one establishment / service, or where there are concerns about poor quality of care being delivered but for which the thresholds for whole service safeguarding are not met. A Quality Review is a supportive process aimed at enabling the provider to improve and sustain the quality of their services.

Dealing with concerns about providers is routinely a matter for the local Health and Social Care Community Services Manager (CSM) or Disability Lead who will ordinarily act as the Responsible Manager (RM) for a Quality Review (see section 7). In terms of Quality Review thresholds (see section 4) this is represented by threshold level 1 and should make up the bulk of the work done to support providers. At this level work is mainly preventative, aimed at avoiding concerns from escalating further. It is a discussion with the provider about the concerns raised, preferably held at the location of the service, or if this is not possible then held at the local office of the commissioner, with constructive advice and support offered.

If concerns should escalate to the extent as indicated by threshold level 2 (or above) a Quality Review Planning Meeting (or if appropriate a whole service safeguarding initial enquiry meeting) should be convened to consider the need for a Quality Review. The purpose of a Quality Review is not to shift responsibility, but to provide appropriate and proportionate wraparound (specialist) support to the RM to resolve provider quality concerns at a local level. The diagram

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above illustrates the relationships between the RM and the wrap-around support accessible through a Quality Review.

This policy is intended to supplement the guidance provided in the Devon and Torbay Safeguarding Adults Board Multi-Agency Policy, which should always be considered in the first instance and throughout a Quality Review to ensure the most appropriate and proportionate route is taken. A Quality Review should never run in parallel with a whole service safeguarding Enquiry. However, a Quality Review may supplement, but does not replace individual safeguarding adults Enquiry. There should be an individual safeguarding Enquiry for each separate adult victim if a concern is deemed to meet the threshold. Concerns escalating to Quality Threshold Level 3 are increasingly likely to meet Whole Service Safeguarding thresholds and Service Closure (Quality Threshold Level 4) should always be managed under Whole Service Safeguarding.

There are five main routes that can trigger the Quality Review Planning Meeting.

i. Where it is decided that the risk and concerns do not meet the necessary thresholds to proceed under a whole service safeguarding adult Enquiry.

In the event that the outcome of a whole service safeguarding initial enquiry meeting is that risks and concerns do not meet the necessary thresholds, attendees should decide whether a Quality Review provides an appropriate and proportionate response to the concerns presented.

The RM has delegated authority to make this decision and for this reason it is essential that either they (or their nominated deputy) are a core attendee.

Where the threshold for a whole service safeguarding adult Enquiry is not met and it is decided to hold a Quality Review, consideration must be given to whether the issues of concern warrant the serving of a contract default notice and if there is sufficient evidence to support this.

Note: In the interests of time and efficiency it is desirable for a whole service safeguarding initial enquiry meeting to morph into a Quality Review Planning Meeting where possible.

ii. Following the closure of a Multi-Agency Whole Service Safeguarding Adults process.

Once a Multi-Agency Whole Service Safeguarding Adults process has concluded attendees should consider whether any quality concerns remain and whether a Quality Review might provide an appropriate and proportionate response to those concerns. The RM has delegated authority to make this decision.

Note: The RM should ensure the smooth handover of the Chair to the (S)QAIO, attendees reviewed and those no longer required stood down, and any outstanding action points and all relevant information passed across to the Quality Review.

iii. Use of the Risk and Sufficiency Profiling Tool

Devon County Council has developed a risk and sufficiency profiling tool to enable a structured and proactive approach to monitoring the care delivered by commissioned services and supporting quality improvement. The tool merges information from a variety of sources (e.g. Care Quality Commission (CQC) inspection outcomes, safeguarding concerns, NHS preventable admissions, contract monitoring information etc.) and an algorithm produces a stratified and graded (High/Moderate/Low) risk profile score for each provider.

High and Moderate graded scores are reviewed regularly by both the Quality Assurance and Improvement Team (QAIT) and through joint DCC/NHS/CQC regional meetings, to consider whether a Quality Review provides an appropriate and proportionate response to the concerns presented.

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In both cases the Principal Social Worker for Commissioning and Health (or nominated deputy) can recommend a Quality Review Planning Meeting to the relevant CSM or Disability Lead.

iv. As the result of an Inspection by CQC or Other Regulatory Body

Where CQC or another regulatory body (such as the Environmental Health Officer or Fire Officer) has inspected a provider and raised concerns in relation to the safety of the provision or to the risk of harm to service users, a Quality Review should be considered.

If CQC inspect and rate the provider overall as Inadequate (under the current regulatory framework) this would automatically warrant a Quality Review Planning Meeting, with a contract default notice being served and invoking a placement suspension. When the provider is re-inspected by CQC and their rating has improved, or where a Quality Review concludes that the provider has made satisfactory progress against identified outcomes / action plans, the action(s) taken against the provider can potentially be de-escalated (i.e. the contract default notice reviewed, placement suspension lifted or changed to Advisory Notice) and the Quality Review potentially ended.

If CQC inspect and rate the provider overall as Requires Improvement (under the current regulatory framework) or Requires Improvement in most areas, particularly when coupled with CQC notices, this could on a discretionary basis warrant a Quality Review Planning Meeting.

The Principal Social Worker for Commissioning and Health (or nominated deputy) can recommend a Quality Review Planning Meeting to the relevant CSM or Disability Lead.

v. As a direct response to Commissioning or Procurement Information, Complaint, or Incident Reporting routes.

If the Adult Commissioning and Health Commissioning Team and/or Procurement Team raise concerns about financial viability or any other changes to a provider organisation that have the potential to introduce risk of service disruption with the potential to impact on safe and effective service delivery, a Quality Review Planning Meeting should be considered.

Examples of other information that might escalate concerns are provided in section 5.

The Principal Social Worker for Commissioning and Health (or nominated deputy) can recommend a Quality Review Planning Meeting to the relevant CSM or Disability Lead.

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Selecting the correct Quality Review Threshold Level should be approached from a perspective of which level is most appropriate in order to: -

ensure the continued safety of service users; establish an appropriate and proportionate level of resources to enable remedial actions to take place

for the specific areas of concern identified, thus stabilising poor operational performance and subsequently improving and maintaining the standards of care delivered by the provider;

coordinate activity across all agencies to enable effective communication, avoid any duplication and minimise involvement to ensure a proportionate response;

enable control measures to be established (e.g. placement suspensions, contract default notices etc.) where this should prove necessary;

achieve the desired level of engagement with and/or cooperation of the provider; provide updates to relevant organisations / groups.

Whilst selecting the right threshold level is a balance of all these factors, the continued safety of service users is paramount. Whole service safeguarding thresholds should be considered at all times to ensure the most appropriate approach is taken.

The Threshold Level should initially be set at a Quality Review Planning Meeting and reviewed at subsequent Quality Review Progress Meetings, although it may be necessary / desirable in exceptional circumstances to do so in-between Meetings. The procedure for escalation / de-escalation between threshold levels is described in section 6.

The following diagram is intended as a guide to the characteristics of Quality Review Threshold Levels as a means for ensuring consistent application of the Quality Policy.

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Note: A Quality Review must not run alongside Whole Service Safeguarding. Concerns escalating to Quality Threshold Level 3 are increasingly likely to meet Whole Service Safeguarding thresholds and Service Closure (Quality Threshold Level 4) should always be managed under Whole Service Safeguarding.

Level Quality Review

Threshold Level

Description

Characteristics

Note: A Quality Review Threshold Level does not necessarily have all, but is likely to have a combination of some of these characteristics.

4 Service Closure

Service Closure procedure invoked Serious or persistent contract default notice served

3 Major Concerns

Overall CQC rating “Inadequate” or “Requires Improvement” in all areas CQC Notices of Proposal / Decision to Cancel Registration Invoking the Service Closure procedure is being considered Repeated safeguarding / quality concerns, levels that are outside what you

would expect for a service of its size and nature, but whole service safeguarding thresholds not met

Further contract default notice(s) served in the event of timescales for delivering service improvements not being achieved

Advisory notice or placement suspension has been in place for >3 months Provider remains unwilling to engage and/or appears to be using deflective

tactics and/or lack of cooperation with Commissioners Direct QAIT involvement mandated at the discretion of Commissioners

Qua

lity

Revi

ew2 Moderate

Concerns

CQC rating is “Requires Improvement” in most areas CQC Warning Notices / Compliance Actions Repeated safeguarding / quality concerns, levels that are outside what you

would expect for a service of its size and nature, but whole service safeguarding thresholds not met

Quality concerns are more widespread and/or more serious in nature Timescales for delivering service improvements not achieved Contract default notice served Advisory notice or placement suspension issued Provider unwilling to engage and/or appears to be using deflective tactics

and/or lack of cooperation with Commissioners QAIT support may be offered at the discretion of Commissioners Provider Self-Assessment Form demonstrates a lack of self-awareness

and/or gives rise to additional concernsSa

fegu

ardi

ng

1 Minor Concerns

Overall CQC rating not worse than “Requires Improvement” Levels of safeguarding concerns are broadly what you would expect for a

service of its size and nature Minor and relatively isolated quality concerns Provider is generally delivering service improvement to timescales Provider is willing to engage with Commissioner to improve the quality of

service provision QAIT support considered Provider Self-Assessment Form (if requested) demonstrates self-awareness

and does not give rise to additional concerns

0 Business as Usual

Overall CQC rating is “Good” Levels of safeguarding concerns are as you would expect for a service of its

size and nature Little or no quality concerns Feedback received about the provider is generally positive

-1 Accredited Provider

Characteristics of level 0 (Business as Usual) are met, additionally …o Overall CQC rating “Outstanding” or “Good” in all domainso No quality concernso Feedback received about the provider is largely positiveo Additional criteria for achieving “Accredited Provider” status are met

Man

aged

rout

inel

y by

the

loca

l Com

mun

ity S

ervi

ces

(Tea

m) M

anag

er

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The following is a guide to the Control Measures associated with each Quality Review Threshold Level.

Level Quality Review

Threshold Level

Description

Control Measures

4 Service Closure

Service Closure procedure invoked Automatic serious or persistent contract default notice issued Termination of contracts Reported to strategic Local Authority/NHS/CQC sub-group meetings and NHS England

South (South West) Regional Quality Surveillance Group

3 Major Concerns

Quality Review Planning Meeting / Progress Meeting(s) to discuss concerns and review progress, held at local office

Invoking the Service Closure procedure might be considered Automatic contract default notice served. Further contract default notice(s) issued in the

event of timescales for delivering service improvements not being achieved Automatic advisory notice or placement suspension Direct 1:1 QAIT support mandated at the discretion of Commissioners Communication with service users / relatives considered Updated Provider Self-Assessment Form automatically requested Reported to strategic Local Authority/NHS/CQC sub-group meetings and NHS England

South (South West) Regional Quality Surveillance Group

2 Moderate Concerns

Quality Review Planning Meeting / Progress Meeting(s) to discuss concerns and review progress, held at local office

Contract default notice served in the event of timescales for delivering service improvements not being achieved

Advisory notice or placement suspension issued at the discretion of Commissioners Direct 1:1 QAIT support offered at the discretion of Commissioners Provider Self-Assessment Form automatically requested Reported to relevant area Local Authority/NHS/CQC sub-group meetings

1 Minor Concerns

Provider meeting involving local operational manager(s) and QAIT to discuss concerns, held at the service location or local office

QAIT support consideredo Direct 1:1 Supporto Themed Supporto Information, Advice and Resources Tools

Provider Self-Assessment Form requested at the discretion of Commissioners Reported to relevant local area ‘Quality Huddle’ meeting

0 Business as Usual

No control measures Provider may apply for “Accredited Provider” status

-1 Accredited Provider

No control measures “Accredited Provider” status

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It is essential that any concerns where screening and threshold information indicate that an adult(s) may be at risk of harm or abuse (as per the Multi-Agency Safeguarding Adults Policy) are forwarded to the Safeguarding Hub for triage.

The following are intended as guides to what information might escalate concerns to the point where a Quality Review Planning Meeting might be considered. See also Section 4 (Quality Review Threshold Guidance) and Section 6 (Escalation / De-escalation Procedure).

I. Abuse in Care Project (Marsland et al, 2012)

The project identified environments and cultures which may indicate risk of abuse and / or poor practice within services for adults with learning disabilities and older people. The full toolkit can be found at the following website (http://www2.hull.ac.uk/fass/care/safeguardingadults.aspx) and may be used a guide to cross reference the concerns identified with the early indicators of concern which would justify a Quality Review Planning Meeting. A summary grid can be found at Appendices 3 & 4. The toolkit can either be used by one person or a group of people who wish to record concerns and can evidence to a provider the need to involve them in a Quality Review.

II. Risk Profiling Tool

See section 3(iii) above.

III. Other Triggers

The following list is not exhaustive, but is intended to give an indication of the kind of concerns that might lead to the initiation of a Quality Review: -

A Safeguarding Adults Enquiry where there are concerns about organisational abuse; Multiple safeguarding adult concerns within a three month period (judgement would need to be made

based on the size of the provision and the nature of the concerns, as a high number of concerns may show that staff are good at recognising and responding to abuse);

Injury or unexplained deterioration in condition of service users where poor care practice or neglect is suspected (for example, moving and handling, wound/pressure area care, catheter care);

A concerning CQC inspection outcome of a provider where key standards are not met; CQC Warning Notice / Notice of Proposal / Notice of Decision; Report of a serious crime within the provider resource or involving their staff, which requires police

involvement (for example, sexual assault, theft); Medication errors leading to harm or risk of harm to multiple service users; Poor or lack of recording of serious incidents / injuries, wounds, medication errors; Sustained evidence of lack of or poor management / leadership within the provider organisation; Lack of willingness to engage with, or sustained unresolved poor relationships with, partner /

commissioning agencies; Admission of service users whose needs cannot be met within the remit of the provider organisation; Evidence of inability to learn from previous safeguarding adults Enquiries or Quality Reviews; Quality assurance procedures are ineffective / no proactive approach to service improvement resulting

in repeated / reactive attempts to improve quality; On-going concerns of poor quality of care provision within the provider organisation; A number of complaints, incidents or concerns expressed about a provider or any whistleblowing

activity; The conduct of the provider does not meet expected standards as set out in contracts;

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A provider of personal care who is not CQC registered, or CQC registration has been refused; Repeated failure to achieve outcomes detailed in service improvement plans / contract default notices.

As described in section 4 (Quality Review Threshold Guidance) setting the Quality Threshold Level and subsequent escalation / de-escalation between Threshold Levels is usually done at Quality Review Planning / Progress Meetings.

Timescales for delivery of improvement must also be considered. All Quality Reviews are different and timescales for delivery of improvements required will be set within individual service improvement plans, but as a general guide should be three months in duration. Progress will be reviewed in Quality Review Progress Meetings and if insufficient progress has been made this would give rise to the need for further escalation.

For example: -

For provider concerns at Quality Threshold Level 1 – where insufficient progress has been made within timescales set (generally within three months) this would give rise to the need for escalation to Quality Threshold Level 2. Associated control measures will include requesting the Provider Self-Assessment Form (if not previously requested), convening a Quality Review Planning Meeting and might include QAIT involvement, serving a contract default notice and consideration of an advisory notice or placement suspension;

For provider concerns at Quality Threshold Level 2 – where insufficient progress has been achieved within timescales set in the service improvement plan (generally within three months) this would give rise to the need for escalation to Quality Threshold Level 3. Associated control measures will include requesting an updated Provider Self-Assessment Form, QAIT involvement, serving a contract default notice, issuing an advisory notice or placement suspension and consideration given to communication with service users / relatives.

In exceptional circumstances it may be necessary to make more urgent decisions, but the same general principles, scheme of delegation (e.g. authority to make decisions, communication, action planning etc.) and timescales must be followed.

A Provider Quality Review must not run alongside Whole Service Safeguarding. Concerns escalating to Quality Threshold Level 3 are increasingly likely to meet Whole Service Safeguarding thresholds and Service Closure (Quality Threshold Level 4) should always be managed under Whole Service Safeguarding.

Updates to relevant organisations / groups must be provided, which will vary depending on the level of escalation. See ‘Reporting Arrangements’ in section 12 for further information.

The Responsible Manager (RM) for a Quality Review will ordinarily be the CSM or Disability Lead (or delegated lead) for the geographic locality within which the service provider is based, or their nominated deputy e.g. Team Manager for escalation up to and including to level 2.

Note: If the majority of service users are NHS funded the RM will be the senior manager for that organisation.

It exceptional circumstances (e.g. where the locality is already managing a service closure) it is permissible for the RM (or nominated deputy for escalation up to and including to level 2) to arrange cover from another locality.

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In the event of concerns relating to a provider of services covering multiple localities or a provider of strategic importance to commissioners, further consideration should be given to appointing either the relevant CDP Centre Manager or Assistant Director as RM and involving relevant Senior Manager(s) from Adult Commissioning and Health.

The RM has delegated authority to call a Quality Review Planning Meeting.

The RM or their nominated deputy (for escalation up to and including to level 2) will be supported by a (Senior) Quality Assurance and Improvement Officer [(S)QA&IO] and together they will meet within 2 working days of concerns being identified to agree who else should be involved in the Quality Review Planning Meeting based upon the nature and severity of the concern(s) and what is known at the time about case responsibility of service users. The scale of proceeding and group representation should be proportionate to the assessed level of risk and escalation i.e.

escalation to Quality Threshold Level 2 would ordinarily involve a small group of professionals working with a provider, referring back to the RM for decisions and communicating / reporting to all other interested parties;

escalation to Quality Threshold Level 3 (due to the more serious nature of concerns) would directly involve the RM and all relevant parties. Concerns escalating to Quality Threshold Level 3 are increasingly likely to meet Whole Service Safeguarding thresholds;

escalation to Quality Threshold Level 4 – Service Closure (due to enduring quality issues and/or the severity of concerns) should always be within Whole Service Safeguarding.

The intention is that the same professionals identified to attend the Quality Review Planning Meeting should subsequently attend Quality Review Progress meetings, albeit that this could change during the Quality Review according to the level of escalation.

Decisions affecting someone’s care or placement must be made by the organisation funding that care or the service they have commissioned to plan, manage and oversee the quality and safety of that person’s care. Managers in joint health and social care roles must be clear about who has authority to make care or health decisions on behalf of a person when they decide about a person’s service and placement. If the person is primarily NHS funded, the decision will be taken by NHS Commissioners. If the person is self-funded or Local Authority-funded, the decision will be on behalf of the Local Authority. This must therefore be taken into consideration in terms of the membership at Quality Review meetings.

As the CCGs commission the specialist services if relevant the safeguarding / patient safety leads should attend in their own right, independently of the RM.

Where a significant proportion of service users are the responsibility of another Health and Social Care Community Services Team, consideration should be given to their attending Quality Review. All relevant CSMs, Disability Leads and Team Managers should be kept informed in all circumstances.

In preparation for the Quality Review Planning meeting the RM and (S)QA&IO should consider the need to serve a contract default notice, which may be required for processes at escalation level 2 and will be automatic for processes at escalation level 3.

All Quality Review meetings should be formally recorded and must be overseen by the RM. For processes at escalation level 2 this will take the form of CareFirst recording coupled with any other specific reports e.g. QAIT visit reports.

For Quality Review meetings at escalation level 3 and above the RM will assume responsibility for arranging a minute taker from the centralised Business Support Team, organising relevant local operational involvement and coordination of involvement across all professionals involved.

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As part of a Quality Review additional resources may be required for support, investigation and remedial activity. The RM (or their nominated deputy) should therefore ensure that attendees have the authority to commit resources should this prove necessary.

Service users / their carers or advocates would not normally be invited to Quality Review meetings. However, consideration should be made to section 9 (What should happen in a Quality Review Planning Meeting?) and section 10 (What should happen in a Quality Review Progress Meeting?) of this Quality Policy which refers to communication with residents, family or their nominated representatives.

In all cases the list of appropriate participants and attendees will be agreed and defined within the Terms of Reference of a Quality Review. A Terms of Reference Template is attached at Appendix 5 as a guide, but there is no set itinerary for all Quality Reviews and this should be reviewed at the Quality Review Planning Meeting and any subsequent Quality Review Progress Meetings based on the information available, to ensure that attendance is appropriate, proportionate and includes the right resources and necessary skill sets.

By no means exhaustive the following individuals or groups would be considered for attendance in a Quality Review: -

Internal and other NHS/ Local Authority representation: RM or nominated deputy (see section 7); CSM (or nominated person) or where relevant Disability Lead for any other operational team where

there is a significant proportion of service users who are their responsibility; NHS commissioners (if it is identified that any service users are primarily NHS funded); QAIT manager / officer; Relevant members of partners agencies (e.g. Devon Partnership Trust); Devon County Council Procurement representatives; Devon County Council Legal representatives; Relevant Adult Commissioning and Health Sector Lead; Principal Social Worker for Commissioning and Health; Representative of the Safeguarding Adults Team; Representative from other funding Local Authorities; Health managers responsible for specialist areas of the service relevant to the enquiry e.g.

Medicines Optimisation / Community Pharmacists; Community Nursing services; Primary care; Specialist medical or clinical leads; CCG Safeguarding / Patient safety Lead.

External and other partner Agencies representation: The Provider i.e. the legal owner or a nominated senior representative of the provider’s organisation

(CQC nominated Responsible Individual / Registered Manager); CQC (where concerns are with respect to a CQC regulated service); Health & Safety Executive officers; The Police (if a criminal offence has or may have taken place); Fire Safety Officer; Environmental Health Officer.

Roles and Responsibilities of Core Participants

The following have been identified as the core participants expected (where relevant) to attend.

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Responsible Manager (RM):o Decision maker within the process;o Organising a minute taker for Quality Reviews at level 3 and above;o Organising relevant local operational involvement;o Coordination of involvement across all professionals involved.

QAIT:o Chair the meeting (for escalation up to level 3);o Agree Initial plan and on-going review of the terms of reference for the Quality Review;o Provide support to the provider and to report on progress;o Draft contract default notices for signature by the Head of Category – People and issuing by

the Procurement Team;o Arrange to issue placement suspensions (where appropriate) on behalf of the Head of Adult

Commissioning and Health. NHS (where relevant):

o Responsibility for decisions affecting someone’s care or placement must be made by the organisation funding that care or the service they have commissioned to plan, manage and oversee the quality and safety of that person’s care. If the person is primarily NHS funded, the decision will be taken by NHS Commissioners. If the person is self-funded or Local Authority-funded, the decision will be on behalf of the Local Authority. This must therefore be taken into consideration in terms of the membership at Quality Review meetingsNote: If the majority of service users are NHS funded the RM will be the senior manager for that organisation.

Sector leads (where relevant, for meetings involving providers of strategic importance to commissioners and always where escalation to level 4 is being considered):

o Provide business / commercial advice and support to the provider as necessary. Principal Social Worker for Commissioning and Health (for meetings involving providers of strategic

importance to commissioners and always where escalation to level 4 is being considered):o Provide support to the provider and to report on progress;o Maintain an overview of all whole service safeguarding and Quality Review meetings across

the DCC footprint. The Provider (i.e. legal owner or a nominated senior representative of the provider’s organisation):

o Fully engage with the Quality Review;o Provide sufficient resources to achieve and sustain the improvements requiredo Develop and maintain a service improvement plan in order to coordinate and prioritise required

improvements and provide updates at Progress meetings ‘Out Of Area’ Commissioners (i.e. any Other Local Authority or CCG commissioning placements with

the service)o Responsibility for decisions affecting someone’s care or placement must be made by the

organisation funding that care or the service they have commissioned to plan, manage and oversee the quality and safety of that person’s care

o Coordination of control measures

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If the decision has been made that concerns would best be managed by a Quality Review then a Quality Review Planning Meeting should be held within 5 working days to consider all relevant facts and evidence before undertaking the following: -

confirm appointment of the RM (see section 7); confirm attendees (whilst not exhaustive the list of individuals and groups outlined in section 8 should

be considered); decide whether Quality Review thresholds have been met (see threshold guidance in section 4 and

guide to what information might escalate concerns in section 5); validate that whole service safeguarding thresholds have not been met; agree the resources to be provided by the local authority, NHS and any other relevant partner agency

to support improvement in the service; define the terms of reference for the Quality Review and all roles, responsibilities, actions and

timescales; decide whether to request the Provider Self-Assessment Form; decide whether to serve a contract default notice; recommend* issuing a placement suspension or advisory notice; determine the level of escalation (see section 4), confirm this with the provider along with details of any

control measures and (where relevant) request the Provider Self-Assessment Form for prior to the first Progress Meeting;

provide updates to relevant organisations / groups.

General Note: When the provider is re-inspected by CQC and their rating has improved, or where a Quality Review concludes that the provider has made satisfactory progress against identified outcomes / action plans, the action(s) taken against the provider can be de-escalated (i.e. the contract default notice reviewed, recommendation* for placement suspension lifted or changed to advisory notice) and the Quality Review closed. In all circumstances the decision around whether to lift a placement suspension or withdraw a contract default notice are linked but independent decisions within a Quality Review.

*Note: Assistant Directors must approve the recommendation to issue or lift a placement suspension or advisory notice.

The agenda for Quality Review meetings is attached at Appendix 6.

The Provider Self-Assessment Form is attached at Appendix 7.

A Provider Quality Review must not run alongside Whole Service Safeguarding. Concerns escalating to Quality Threshold Level 3 are increasingly likely to meet Whole Service Safeguarding thresholds and Service Closure (Quality Threshold Level 4) should always be managed under Whole Service Safeguarding.

Where the decision is that a Quality Review is not required the provider may still need information, advice and support to improve quality and an appropriate response should be determined. It may be useful in such circumstances to request the Provider Self-Assessment Form to gain further insight and enable more targeted support. Any such decision should be clearly recorded with details of who will take responsibility to follow up actions and timescales for completion. The chair of the meeting will assume responsibility for ensuring all agreed actions are completed.

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Communication

Attendees at the Quality Review Planning Meeting will agree the communication plan and the list of named contacts and recipients of information throughout the process. This should be reviewed at all subsequent meetings.

The communication plan will cover communications with the provider, service users, their family / advocates where appropriate and any relevant internal and external stakeholders, including any ‘out of area’ commissioners. Whilst not exhaustive the list of individuals and groups outlined in section 8 should be considered for receiving regular communications. Internal communications should also consider who should be consulted or briefed under the scheme of delegation as outlined in sections 3 and 7 and governance arrangements outlined in section 12.

At all times information governance and data protection requirements must be adhered to.

The Provider must be informed of their right to appeal any decision made within a Quality Review**. Providers must submit their appeal in writing within 10 working days of the date of the decision, and will be considered by the RM within 28 days of receipt of the appeal.

**Note: There is no right to appeal against a Contract Default Notice enshrined in the contract.

Work with providers to address quality concerns will be managed by means of an action-planning process, led by the RM who is supported by the QAIT. This will be coordinated through a service improvement plan (SIP), developed by the provider within an agreed timescale after the Quality Review Planning Meeting and maintained by the provider thereafter, who will present updates at future Progress Meetings.

Quality Review Progress Meetings will ordinarily be at 28 day intervals, but timing should also take into consideration other factors such as service improvement plan timescales, known CQC inspection timescales, availability of reports by visiting officers etc.

If the provider has been requested to provide their Provider Self-Assessment Form this should have been received prior to the first Progress Meeting to enable all participants to have reviewed it in advance alongside the SIP.

The QAIT and any other visiting professionals involved will also provide reports on any visits made to the service, highlighting progress made by the provider and any further concerns that might have been identified.

Any further actions required to ensure the continued safety of service users and to address quality concerns should be incorporated within the providers SIP. Priorities and timescales for all actions should be reviewed having due regard for any timescales set by CQC and where relevant reflected in contract default notices. Any clarification required of the improvement actions within the SIP must be conveyed to the provider and the revised SIP must be agreed by all parties.

Once all information has been received and actions agreed the Quality Review Progress Meeting will consider: -

the potential risk to current or potential service users placed with the provider. If any new information has come to light then whole service safeguarding thresholds should be reconsidered to ensure the appropriate approach is taken*;

the level of escalation within the Quality Review by use of the threshold guidance (section 4) and escalation / de-escalation procedure (section 6).

*Note: this must not prevent any actions from happening that have already been identified to ensure continued safety of service users;

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Depending on the level of concerns escalation might include: -

requesting a Provider Self-Assessment Form; serving (or re-serving where previously agreed timescales for service improvements have not been

achieved) contract default notices; recommend issuing a placement suspension or advisory notice on new placements**; serving a persistent default notice (where more than 2 default notices have been served within a 6

month period) or a serious default notice (where concerns are considered severe enough to warrant doing so);

relocation of current residents.

**Note: Assistant Directors must approve the recommendation to issue a placement suspension or advisory notice.

General Note: such decisions will only be made after detailed consideration of the severity of the concerns identified, the immediate risks presented and will only be made when justified and based on sufficiently evidence-based risk. Concerns escalating to Quality Threshold Level 3 are increasingly likely to meet Whole Service Safeguarding thresholds and Service Closure (Quality Threshold Level 4) should always be managed under Whole Service Safeguarding. Serving a persistent default notice or serious default notice may lead to termination of contracts and as such may only happen at escalation level 4.

Communication with service users, their relatives and carers and other professional bodies (such as other local authorities) should be conducted throughout the Quality Review as per the Communication Plan set-up in the Quality Review Planning Meeting.

The terms of reference for a Quality Review should be reviewed and amended appropriately, along with the Communication Plan, group membership (etc.) and future meeting date(s) set.

The Quality Review will only be closed with the agreement of attendees at a Quality Review Progress Meeting. Risk to service users must be reviewed as part of the decision to conclude the Quality Review.

The rationale for closure of the Quality Review should be fully recorded. The Responsible Manager must write to the provider to confirm that the Quality Review has been closed. Debrief opportunities for staff working for the service provider should be considered in partnership with the proprietor or manager of the service (or Responsible Individual / Registered Manager in the case of a service regulated by CQC).

In the event of a Quality Review closing where quality concerns remain (e.g. in the event of service closure, provider insolvency etc.) the Responsible Manager must include within the letter a statement which states that quality concerns remained at the end of the process in order to put this on record for (potential) future reference.

Any on-going monitoring arrangements should be agreed e.g. a one-off visit at a later date to test embeddedness of agreed arrangements, or a requirement for the provider to submit an updated copy of their service improvement plan.

Agreement should be reached as to the circumstances and conditions required to trigger a subsequent “lessons learned” review of the Quality Review. Findings and learning should be shared appropriately with all stakeholders. Any learning or actions agreed as a result of the findings should be allocated to named responsible professionals, and timescales set for their achievement. This should encompass a review of the early indicators of concern and whether (upon retrospective review) there were warning signs but our systems / processes did not spot them and if there is anything we can do to improve upon this in future.

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Governance Arrangements

Devon County Council has pre-determined routes for organisation governance and reporting which help to ensure the right levels of accountability, decision making and coordination is maintained across the organisation as a whole. Those relevant to the Quality Review are as follows: -

Devon Safeguarding Adults Board (for assurance of follow through of SAR recommendations); Adult Care and Health Leadership Team; Adult Commissioning and Health Leadership Team; Adult Care Operations and Health Leadership Team; Adult Care Operations and Health Community Services Managers Forum; Social Care Leadership Group; Joint Local Authority/NHS/CQC Meetings; Quality Assurance and Improvement Team; Devon Safeguarding Adults Team Managers; Adult Commissioning and Health – Commissioning Team.

It is wholly necessary to ensure the relevant internal and external stakeholders are kept informed of progress and any actions being undertaken within a Quality Review. Therefore both the internal and external governance and reporting requirements will be agreed and recorded during a Quality Review Planning Meeting and reviewed at subsequent Quality Review Progress Meeting(s).

General expectations of all professionals operating within a Quality Review are: -

Openness, transparency and clear communication across all agencies and with providers; Clearly documented procedures covering all professional involvement; Robust documentation of all work undertaken.

Overarching governance of the Quality Review will be through the Adult Care and Health Leadership Team, whilst regular monitoring and review will be through joint Local Authority/NHS/CQC Meetings.

Collectively these governance arrangements help to protect the commissioning body from legal challenge as a result of the consequence of its decisions.

Reporting Arrangements

Tight restrictions will be applied to email distribution of any reports on activity associated with the Quality Policy to ensure information governance procedures are adhered to.

Weekly reports for any services where advisory notices, placement suspensions or contract default notices have been issued will be provided to individuals in job roles where immediate access to such information is required e.g. staff in arranging support teams.

Monthly summary position statements of Quality Reviews have been aligned with reporting around whole service safeguarding. Reporting to organisations / groups will follow

Threshold Level 1 – reported to the local area ‘Quality Huddle’ meeting; Threshold Level 2 – reported to the local area Local Authority / NHS / CQC sub-group meeting; Threshold Level 3 & 4 – reported to strategic Local Authority / NHS / CQC meeting and NHS England

South (South West) Regional Quality Surveillance Group.

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Reporting around the overall effectiveness of the Quality Policy and overarching market analysis will be aligned with existing quarterly reports to the Adult Care Operations and Health Leadership Team and the Adult Commissioning and Health Leadership Team.

Reports to Adult Care and Health Scrutiny, Adult Care and Health Leadership Team and Devon Safeguarding Adults Board will be provided upon request.

Adapted from London Borough of Hackney Establishment of Concerns Protocolhttp://www.hackney.gov.uk/Assets/Documents/establishment-concerns-protocol.doc (link reviewed 21st December 2016)

Marsland, D., Oakes, P., White, C. (2012)Early Indicators of Concern in Residential and Nursing Homes for Older People - A GuideEarly Indicators of Concern in Residential Support Services for People with Learning Disabilities - A Guidehttp://www2.hull.ac.uk/fass/care/safeguardingadults.aspx (link reviewed 21st December 2016)

Devon Safeguarding Adults Board Multi-Agency Policy and Guidance(https://new.devon.gov.uk/devonsafeguardingadultsboard/policy) (link reviewed 21st December 2016)

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Quality Review – Process Flowchart

Yes

Appendix 1

Concerns with Provider Quality at Threshold Level 2 (or above)

CSM or Disability Lead (or nominated deputy) discusses concerns with QAIT, agree participants

at Quality Review Planning meeting

Quality Review Planning meeting

Whole Service Safeguarding Process

Receive updates and review ToR, participants, service improvement plan etc. Determine level of escalation. Decide whether to request Provider Self-Assessment Form, Contract Default Notice,

Advisory Notice or Placement SuspensionNo

No

Quality Review Progress meeting

Yes

Yes

End Quality Review

Existing work / plans to continue until such time as a

safeguarding enquiry confirms whole service

threshold has been met. Then all work to date to be documented by all parties involved and passed to the relevant safeguarding hub.

Agree quality and improvement actions

to be undertaken.Debrief process

No

Within two working days of concerns being identified

Within 5 working days of decision to hold Quality Review Planning Meeting

Ordinarily at 28 day intervals, but timing should also take into consideration other factors such as service improvement plan timescales, known CQC inspections / timescales, availability of reports by visiting officers etc.

If insufficient progress has been achieved within timescales set in the service improvement plan (as a general guide within three months) this would give rise to the need for further escalation

Concerns escalating to Quality Threshold Level 3 are increasingly likely to meet Whole Service Safeguarding thresholds and Service Closure (Quality Threshold Level 4) must always be managed under Whole Service Safeguarding

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QUALITY REVIEW – PROCESS SUMMARY(Where there are concerns about a number of adults at risk in one establishment and/or where there are concerns about poor quality of care which do not meet threshold for safeguarding adult whole home / large scale intervention)

ORGANISATIONAL ABUSE SAFEGUARDING ADULTS REFERRAL OR NOTIFICATION OF CONCERNS BY OTHER MEANS

Appendix 2

PROVIDER VISIT(S)

Who? Includes: Commissioning and / or

Quality Teams (Health and Social Care)

Relevant Health and Social Care Teams

Safeguarding Team CQC Continuing Health Care

Team Professional Practice

Teams e.g. SALT, Medicines Management

What? Includes: Investigate care quality

concerns Monitor standards Work with provider where

appropriate to improve standards

QUALITY REVIEW PLANNING AND

PRORGESS MEETINGS

Who? Includes: Commissioning and / or

Quality Teams (Health and Social Care)

Safeguarding Team Relevant Health and Social

Care teams Legal owner from provider

agency (if appropriate)

What? Can include: Embargo on placements CQC regulatory action Commissioning / Quality

Team action e.g. contract default

Communication with other Local Authorities

Refer further safeguarding adult concerns

Transfer of residents Identify concerns Develop and implement

immediate and long-term action plan

Consider and agree partner support (refer to below)

Inform senior managers and cabinet members

SAFEGUARDING ADULT ENQUIRIES

Who? Includes: Responsible Managers Health & Social Care

professionals Adults at risk and their

families Provider agencies CQC Police Commissioning and / or

Quality Teams (Health and Social Care)

What? Includes: Making Safeguarding

enquires Implementing and

monitoring the safeguarding protection plan

evaluation of outcomes and actions

QUALITY REVIEW CLOSURE MEETING

Attendees as above Review of concerns and progress Review of risks to service users Agree any on-going action planning requirements Agree future monitoring arrangements Agree review dates / criteria if appropriate Consider any ”lessons learned” Close process

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Early Indicators of Concern in Residential and Nursing Homes for Older People (examples from the research)

1. Concerns about management and leadership There is a lack of leadership by managers, for example managers do not make decisions or set priorities The service/home is not being managed in a planned way, but reacts to problems or crises Managers appear unaware of serious problems in the service The manager is new and doesn’t appear to understand what the service is set up to do A responsible manager is not apparent or available within the service.

2. Concerns about staff skills, knowledge and practice Staff appear to lack the information, skills and knowledge to support older people/people with dementia Staff appear challenged by some residents’ behaviours and do not know how to support them effectively Members of staff are controlling of residents Members of staff use negative or judgemental language when talking about residents Record keeping by staff is poor

3. Concerns about residents’ behaviours and wellbeing

One or more of the residents: Show signs of injury through lack of care or attention Appear frightened or show signs of fear Behaviours have changed Moods or psychological presentation have changed

4. Concerns about the service resisting the involvement of external people and isolating individuals Managers/staff do not respond to advice or guidance from practitioners and families who visit the service The service is not reporting concerns or serious incidents to families, external practitioners or agencies Staff or managers appear defensive or hostile when questions or problems are raised by external professionals or families

5. Concerns about the way services are planned and delivered There is a lack of clarity about the purpose and nature of the service The service is accepting residents whose needs they appear unable to meet Residents’ needs as identified in assessments, care plans or risk assessments are not being met The layout of the building does not easily allow residents to socialise and be with other people

6. Concerns about the quality of basic care and the environment The service is not providing a safe environment There is a lack of activities or social opportunities for residents Residents do not have as much money as would be expected Equipment is not being used or is not being used correctly The home is dirty

Ref: Marsland, D., Oakes, P., White, C. (2012) Early Indicators of Concern in residential and Nursing Homes for Older People: A Guide, (online), Available: http://www2.hull.ac.uk/fass/care/safeguardingadults.aspx (20 December 2013).

Appendix 3

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Early Indicators of Concern – Learning Disability Services (examples from the research)1. Concerns about management and leadership The Manager can’t or won’t make decisions or take responsibility for the service The Manager doesn’t ensure that staff are doing their job properly The Manager is often not available There is a high turnover of staff or staff shortages The Manager does not inform Social Services that they are unable to meet the needs of specific service users

2. Concerns about staff skills, knowledge and practice Staff appear to lack knowledge / understanding of what it means to have a learning disability Members of staff appear to lack skills in communicating with individuals and interpreting their interactions Members of staff use judgemental language about the people they support Members of staff are controlling and offer few choices Communication across the staff team is poor Abusive behaviours between residents are not acknowledged or addressed

3. Concerns about residents’ behaviours and wellbeing Residents’ behaviours change – perhaps becoming withdrawn or anxious Residents’ communications and interactions change – increasing or stopping for example Residents’ needs appear to change Residents’ skills change – self care or continence management for example Residents behave very differently with different staff or in different environments e.g. day centre

4. Concerns about the service resisting the involvement of external people and isolating individuals There is little input from outsiders/professionals Individuals have little contact with family or other people who are not staff Appointments are repeatedly cancelled Members of staff do not maintain links between individuals and people outside of the service e.g. family, friends, Management and/or staff demonstrate hostile or negative attitudes to visitors, questions and criticisms It is difficult to meet residents privately

5. Concerns about the way services are planned and delivered Residents’ needs are not being met as agreed and identified in care plans Agreed staffing levels are not being provided Staff do not carry out actions recommended by external professionals The service is unsuitable for some residents but no better option is available The resident group appears to be incompatible The diversity of support needs of the group is very great

6. Concerns about the quality of basic care and the environment There is a lack of care of personal possessions Support for residents to maintain personal hygiene is poor Essential records are not kept effectively The environment is dirty/smelly There are few activities or things to do Residents’ dignity is not being promoted and supported

Ref: Marsland, D., Oakes, P., White, C. (2012) Early Indicators of Concern in Residential Support Services for People with Learning Disabilities: A Guide, (online), Available: http://www2.hull.ac.uk/fass/care/safeguardingadults.aspx (20 December 2013)

Appendix 4

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Provider Quality Support Review (Quality Review)

Terms of Reference1. Aim

1.1 To ensure the continued safety of service users.

1.2 To establish a formal and coordinated response to quality concerns in relation to residential and nursing care homes, domiciliary care services and unregulated care services (e.g. day services, supported living services etc.) for all adults and older people.

1.3 To proactively avoid escalation of provider quality concerns and whole service safeguarding.

2. Purpose

2.1 To establish a formal means of responding to provider concerns where thresholds for whole service safeguarding adult Enquiry are not met, but where there is a clear need for service improvement to minimise the risks presented to service users by the quality of care being provided.

2.2 To establish an appropriate and proportionate level of resources to enable remedial actions to take place for the specific areas of concern identified, thus stabilising poor operational performance and subsequently improving and maintaining the standards of care delivered by the provider.

2.3 To coordinate activity across all agencies to enable effective communication, avoid any duplication and minimise involvement to ensure a proportionate response.

2.4 To clearly describe to providers what the quality threshold levels are, the procedures for escalation and de-escalation between quality threshold levels and what this means for providers, making it clear how quality concerns will be followed up.

2.5 Where it should prove necessary: -

to achieve the desired level of engagement with and/or cooperation of the provider to enable control measures to be established e.g. placement suspensions, contract default

notices, cancellation of contracts etc.

3. Membership

3.1 The scale of proceeding and group representation should be proportionate to the assessed level of risk and escalation i.e.

escalation to level 2 would ordinarily involve a small group of professionals working with a provider, referring back to the Responsible Manager (RM) for decisions and communicating / reporting to all other interested parties;

escalation to level 3 (due to the more serious nature of concerns) would directly involve the RM and all relevant parties;

Appendix 5

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escalation to Quality Threshold Level 4 – Service Closure (due to enduring quality issues and/or the severity of concerns) should always be within Whole Service Safeguarding and follow the process as detailed in the “Decisions and Planning in Care Service Closure” paper.

3.2 The intention is that the same people identified to attend the Quality Review Planning Meeting should subsequently attend Quality Review Progress meetings, albeit that this could change during the Quality Review according to the level of escalation.

3.3 As part of a Quality Review additional resources may be required for support, investigation and remedial activity. The RM (or their nominated deputy) should therefore ensure that attendees have the authority to commit resources should this prove necessary.

3.4 Service users / their carers or advocates would not normally be invited to Quality Review meetings. However, consideration should be given to communication with residents, family or their nominated representatives.

3.5 In all cases the list of appropriate participants and attendees will be agreed and defined within the Terms of Reference of a Quality Review to ensure that attendance is appropriate, proportionate and includes the right resources and necessary skill sets. By no means exhaustive the following individuals or groups would be considered for attendance in a Quality Review: -

Internal and other NHS/ Local Authority representation: RM or nominated deputy (see section 7); CSM (or nominated person) or Disability Lead for any other operational team where there is a

significant proportion of service users who are their responsibility; NHS commissioners (if it is identified that any service users are primarily NHS funded); QAIT manager / officer; Relevant members of partners agencies (e.g. Devon Partnership Trust); Devon County Council Procurement representatives; Devon County Council Legal representatives; Relevant Adult Commissioning and Health Sector Lead; Principal Social Worker for Commissioning and Health; Representative of the Safeguarding Adults Team; Representative from other funding Local Authorities; Health managers responsible for specialist areas of the service relevant to the enquiry e.g.

Medicines Optimisation / Community Pharmacists; Community Nursing services; Primary care; Specialist medical or clinical leads; CCG Safeguarding / Patient safety Lead.

External and other partner Agencies representation: The Provider i.e. the legal owner or a nominated senior representative of the provider’s

organisation (CQC nominated Responsible Individual / Registered Manager); CQC (where concerns are with respect to a CQC regulated service); Health & Safety Executive officers; The Police (if a criminal offence has or may have taken place); Fire Safety Officer;

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Environmental Health Officer.

4. Roles and Responsibilities of Core Participants

4.1 The following have been identified as the core participants expected (where relevant) to attend.

Responsible Manager (RM):o Decision maker within the process;o Organising a minute taker for Quality Reviews at level 3 and above;o Organising relevant local operational involvement;o Coordination of involvement across all professionals involved.

QAIT:o Chair the meeting (for escalation up to level 3);o Agree Initial plan and on-going review of the terms of reference for the Quality Review;o Provide support to the provider and to report on progress;o Draft contract default notices for signature by the Head of Category – People and issuing

by the Procurement Team;o Arrange to issue placement suspensions (where appropriate) on behalf of the Head of

Adult Commissioning and Health. NHS (where relevant):

o Responsibility for decisions affecting someone’s care or placement must be made by the organisation funding that care or the service they have commissioned to plan, manage and oversee the quality and safety of that person’s care. If the person is primarily NHS funded, the decision will be taken by NHS Commissioners. If the person is self-funded or Local Authority-funded, the decision will be on behalf of the Local Authority. This must therefore be taken into consideration in terms of the membership at Quality Review meetingsNote: If the majority of service users are NHS funded the RM will be the senior manager for that organisation.

Sector leads (where relevant, for meetings involving providers of strategic importance to commissioners and always where escalation to level 4 is being considered):

o Provide business / commercial advice and support to the provider as necessary. Principal Social Worker for Commissioning and Health (for meetings involving providers of

strategic importance to commissioners and always where escalation to level 4 is being considered):

o Provide support to the provider and to report on progress;o Maintain an overview of all whole service safeguarding and Quality Review meetings

across the DCC footprint. The Provider (i.e. legal owner or a nominated senior representative of the provider’s organisation):

o Fully engage with the Quality Review;o Provide sufficient resources to achieve and sustain the improvements requiredo Develop and maintain a service improvement plan in order to coordinate and prioritise

required improvements and provide updates at Progress meetings

5. Timing and Frequency of Meetings

5.1 From the point at which the potential need for a Quality Review has been established the Quality Review Planning Meeting will be held within 5 working days.

5.2 Subsequent Quality Review Progress Meetings will ordinarily be at 28 day intervals, but timing should also take into consideration other factors such as service improvement plan timescales, known CQC inspections / timescales, availability of reports by visiting officers etc.

6. Agendas, Papers and Minutes

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6.1 The standing agenda for Quality Review Planning Meetings and Quality Review Progress Meetings are attached.

6.2 Wherever possible reports from visiting professionals involved will be circulated to attendees in advance of meetings.

6.3 All Quality Review meetings should be formally recorded and must be overseen by the RM. For processes at escalation level 2 this will take the form of CareFirst recording coupled with any other specific reports e.g. QAIT visit reports.

6.4 For Quality Review meetings at escalation level 3 and above the RM will assume responsibility for arranging a minute taker from the centralised Business Support Team.

7. Review

7.1 The terms of reference will be reviewed annually to evaluate the outcomes of the Provider Quality Support Policy to ensure it is meeting the needs of the organisation.

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Quality Review – Planning MeetingAGENDA

1. Introductions and Apologies

2. Confidentiality Statement

3. Purpose of the Quality Review Planning meeting:

To review information and consider whether what is being presented meets the

threshold for a Quality Review (as defined in section 4 of the Provider Quality Support

Policy)

4. Confirm appointment of the nominated Responsible Manager

5. Summarise the concerns leading to the Quality Review Planning meeting

6. Consider outcomes of any individual safeguarding enquiries which may indicate further

concerns

7. Enquire with attendees as to detail of any additional factual evidence of concerns

8. Summarise any tabled reports evidencing concerns

9. Feedback from any regulator on activity and outcomes

10. Feedback from Quality Assurance and Improvement Team on any involvement to date

11. Feedback from contract monitoring action plans

12. Feedback from other funding authorities

13. Any incident reporting to be considered

14. Threshold decision making: has the threshold for a Quality Review been met as defined

in section 4 of the Provider Quality Support Policy?

15. If consensus that Quality Review thresholds have NOT been met:

Meeting to consider and agree what quality and improvement actions with appropriate

agencies need to be undertaken. Then close the Quality Review

16. If consensus that Quality Review thresholds ARE met: next steps as below are to be taken

17. Agree and summarise identified areas of concern

18. Legal considerations: MCA, MHA, DOLS, Care Act, Police involvement

Appendix 6(a)

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Agree lead agency for further detailed action or investigation

19. Agree how the Quality Review will be carried out, consideration to be given to the terms of

reference for the review

21. Agree initial Service Improvement Plan, ensuring immediate risk is identified and addressed,

timescales, who is responsible for completing actions

22. Determine the level of escalation as defined in section 4 of the Provider Quality Support

Policy (Quality Review Threshold Guidance)

23. Determine if appropriate to request a Provider Self-Assessment Form

24. Decide whether to serve a Contract Default Notice

25. Consideration as to whether an Advisory Notice or Suspension of Placements is required

26. Threshold decision making: has the threshold for whole service safeguarding potentially

been met as defined within Section 4.1 of the Safeguarding Adults Operational Guidance

Whole Service Enquiries (October 2016) guidance document?

27. If consensus that whole service safeguarding thresholds ARE potentially met: next steps as

below are to be taken

28. All existing work / plans to continue until such time as a safeguarding enquiry confirms whole

service thresholds have been met. Then all work to date to be documented by all parties

involved and passed to the relevant safeguarding hub. Close the Quality Review

20. Communication – inter agency, legal owner / director / provider staff, affected adults / family /

representatives / advocates, staff involved in the review, senior management,

commissioners, media, internal

29. Any other business

30. Date of next meeting

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Quality Review – Progress MeetingAGENDA

1. Introductions and Apologies

2. Confidentiality Statement

3. Purpose of the Quality Review Progress Meeting:

to review information and consider whether what is being presented continues to

meet the thresholds for a Quality Review (as defined in section 4 of the Provider

Quality Support Policy)

4. Re-confirm appointment of the Responsible Manager

5. Agree any previous minutes, including amendments

6. Update action points from previous Quality Review meeting

7. Summarise the history and current status of the Quality Review

8. Summarise the terms of reference for the Quality Review

9. Review the Provider Self-Assessment Form (if appropriate)

10. Provider update on progress with Service Improvement Plan

11. Seek information from each agency (including reports received) which may provide information about new concerns identified, or additional information that could substantiate or refute concerns identified previously

12. Legal considerations; MCA, MHA, DOLS, Care Act, Police involvement

Agree lead agency for further detailed action or investigation

13. Consider any new concerns which may have been received during the review

14. Threshold decision making: does the threshold for a Quality Review continue to be met

as defined in section 4 of the Provider Quality Support Policy?

15. If consensus that Quality Review thresholds have NOT been met: next steps as below are

to be taken

16. Meeting to consider and agree what quality and improvement actions with appropriate

Appendix 6(b)

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agencies need to be undertaken.

17. Debrief process – inter agency, legal owner / director / provider staff, affected adults /

family / representatives / advocates, staff involved in the review, senior management,

commissioners, media, internal.

18. Close the Quality Review

19. If the consensus is that Quality Review thresholds ARE continuing to be met: next steps

as below are to be taken

20. Agree and summarise identified areas of concern

21. Discussion with provider as to how they will work to address these areas. Update Service

Improvement Plan, ensuring immediate risks are identified and addressed, timescales,

who is responsible for completing actions

22. Agree actions for other agencies, again ensuring any immediate risks are identified and

addressed, timescales, who is responsible for completing actions

23. Review the level of escalation as defined in section 4 of the Provider Quality Support

Policy (Quality Review Threshold Guidance)

24. Determine if appropriate to request a Provider Self-Assessment Form

25. Decide whether to serve or lift a Contract Default Notice, Persistent Default Notice or

Serious Default Notice

26. Consideration as to whether an Advisory Notice or Suspension of Placements is required,

should be continued or lifted

27. Threshold decision making: has the threshold for whole service safeguarding potentially

been met as defined within Section 4.1 of the Safeguarding Adults Operational Guidance

Whole Service Enquiries (October 2016) guidance document?

28. If consensus that whole service safeguarding thresholds ARE potentially met: next steps

as below are to be taken

29. All existing work / plans to continue until such time as a safeguarding enquiry confirms

whole service thresholds have been met. Then all work to date to be documented by all

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parties involved and passed to the relevant safeguarding hub. Close the Quality Review

30. Communication – inter agency, legal owner / director / provider staff, affected adults /

family / representatives / advocates, staff involved in the review, senior management,

commissioners, media, internal

31. Any other business

32. Date of next meeting

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Care Homes with Nursing/Residential Care

Provider Self-Assessment FormPlease provide a summary of information for the below Quality Areas numbered 1 – 12

This form should be completed by (date for completion) and returned to (name and address / mailbox of where the document should be returned)

Any questions regarding completing this form please contact (name and contact details for any queries).

Guidance Notes

The Quality Areas - The Quality areas listed includes, for your information, detail of the part of the Health and Social Care Act 2008 regulations the Quality areas relate to.

The Criteria - The Criteria is a basic description of the required evidence that should be in place at the service and available for CQC inspectors and Commissioners to view on request.

In Place - Please indicate with a X mark in the box provided to indicate that the criteria is in place at the service, fully completed, dated and reviewed appropriately.

Not in Place - Please indicate with a X mark in the box provided to indicate if the criteria is NOT in place at the service, or has not yet been fully completed, dated and reviewed appropriately.

Date of Expiry/Review - Please complete this box with a date that the criteria may expire and/ or will be reviewed

Comments/Name of Contractor – Please provide any additional information/comments, including details of contractors who have provided evidence of how you have met the criteria. For example: Fire safety may have been provided by an external contractor (please give name of contractor) who has provided testing of equipment or training and has provided certification or receipts of work carried out.

Self- Assessment Service Improvement/Action plan - Please provide a summary plan (template shown for your use) which indicates, the quality area(s) and the actions to be taken to address any area(s) that you have identified as NOT IN PLACE. Please also include who the actions will be allocated to and the date you expect the actions to be completed.

Appendix 7

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Provider Self-Assessment FormCare Homes with Nursing/Residential Care PROVIDER SELF-ASSESSMENT

Name of Care Home : Registered places :

Name of Proprietor : Current email contact(s):

Name of Manager : Current CQC Rating and last inspection date:

Management / OwnershipAny changes within the last 12 months

Care Home Specialisms/Services:

QUALITY AREA CRITERIA In Place Not in

Place

Date of Expiry / Review

COMMENTS/ NAME OF CONTRATOR

Sufficient annual insurance in place 1. Insurances HSCA 2008 Regulations

15 Public Liability Insurance on display

Written Business Continuity Plan to include:

Major incidents / road traffic accidents

Pandemic, Infection control incidents

Fire, Flood and Power Outages Inclement Weather Fuel shortage Security / Intruder alerts Emergency Evacuation Staff Shortage and how this will

be addressed (i.e. less than 50% of planned staff not at work, in times of crises, such as due to epidemic.)

Critical Equipment Breakdown or equipment not fit for use (e.g. passenger lifts where the home has more than one floor.) Contingency plans in place.

Record of Business Continuity Plan reviewEmergency call-out and out-of-hours support arrangements available and accessible to staff

2. Business Continuity

and Emergency

Plans

HSCA 2008 Regulations

12, 15 and 17

PEEPS for Service Users including

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QUALITY AREA CRITERIA In Place Not in

Place

Date of Expiry / Review

COMMENTS/ NAME OF CONTRATOR

summary for emergency services and staff

First Aid Kit (to include regular stock audit of contents)

Medication Audit Record

Infection Control Audit Record

Nominated Infection Control Lead

Environment/ Building/ Grounds Audit RecordKitchen Audit Record

Care Plan Audit Record

Assessment, care plan and review records in place for all service users Call Bell Audit and Service Record

Service Users’ Feedback and Evaluation

Families, Carers and other professionals Feedback and EvaluationStaff Survey Feedback

Staff meetings

Resident meetings

Statement of Purpose / Service User Guide (updated and reviewed)Current CQC Inspection Rating on display

3. Providers Quality

AssuranceHSCA 2008Regulations

12, 15 and 17

HSCA 2008 Regulation

20A

Complaints & Safeguarding contact info available and on display

4. Incidents/ Accidents

HSCA 2008Regulation 12/ CQC

Regulation 18

Are outcomes of Incidents/ Accidents (including any Action Plans) reviewed (at least annually) to identify trends

5. Complaints HSCA 2008

Regulation 16 and 20

Are outcomes of Complaints fed back to complainants and reviews completed (at least annually) to identify trends

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QUALITY AREA CRITERIA In Place Not in

Place

Date of Expiry / Review

COMMENTS/ NAME OF CONTRATOR

Sufficient PPE for all staff

HSE Health and Safety Poster updated and visible to staffCOSHH information available and chemicals stored securely.

6. Health and Safety

ComplianceHSCA 2008Regulations12 and 15 Clinical Waste contract in place

Passenger Lift(s) service Certificate

Stair Lift(s) Service Certificate7. EquipmentHSCA 2008Regulations12 and 15

LOLER Service Certificates

HSCA 2008Regulations12 and 15

Manual handling equipment

Current Legionella Risk Assessment in situ

Water Temperature Checks and flushing Records8.

Environmental Health HSCA

2008Regulations12 and 15

FSA Rating on display and Safer Food Better Business (SFBB) Documentation in situ or alternative appropriate documentation in situ

Fire Risk Assessment Annual Review

Fire Alarm Panel Service Certificate

Fire Equipment Service Certificate

Emergency Lighting Service

Annual Staff Fire Training Records

Fire Log – Record of in-house fire alarm testing

9. Fire SafetyHSCA 2008Regulations12 and 15

E-Cigarettes / Smoking policy

PAT Testing Certificate10. Electrical Safety HSCA 2008

Regulations12 and 15

5 Year Building Wiring Certificate

Gas Safety Certificate Boilers

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QUALITY AREA CRITERIA In Place Not in

Place

Date of Expiry / Review

COMMENTS/ NAME OF CONTRATOR

Gas Safety Certificate Kitchen

Gas Safety Certificate other e.g. laundry11. Gas SafetyHSCA 2008Regulations12 and 15

Check of Engineer’s Registrationhttp://www.gassaferegister.co.uk/

Policies in place (reviewed, dated and signed) to support staff and staff induction:

Mental Capacity/ DoLs Medication including: Controlled Drugs Covert Staff Administering of Medication Choking Nutrition including MUST tool or

similar Safeguarding and Whistleblowing Infection Control End of Life including TEP and

advanced care plans Mobility and Manual Handling Missing Persons Policy Falls Management Policy Incident/ Accident reporting Complaints and Concerns Emergencies and Crisis Confidentiality and Data Protection Information Governance Code of Conduct Gifts and Legacies / Professional

Boundaries Recruitment and Induction

12. Policies HSCA 2008Regulations

12, 15 and 17

Supervision and AppraisalHSCA 2008Regulations12 and 15

Staff Training

HSCA 2008Regulations12 and 15

All Registered Professionals employed hold current effective registration status

I declare that the above provider self-assessment return is a true representation of the home’s current

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Self assessment - Improvement (action) plan

Quality Area

Action(s) Allocation(name of person

allocated to

complete this work )

Due Date

Completed

position.Signed:

Role

Date:

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Impact AssessmentVersion 2017To publish, please send a dated PDF to impactassessment-mailbox@devon.gov.uk

Assessment of: Adult Social Care Provider Quality Support Policy

Service: All adult social care provision

Head of Service: Tim Golby, Head of Adult Commissioning and Health

Date of sign off by Head Of Service/version: 26/10/17

Assessment carried out by (incl. job title): Steve Blandford, Quality Assurance and Improvement Manager

Section 1 - Background

Description: The Provider Quality Support Policy (Quality Policy) is Devon County Council’s way of establishing a formal and coordinated response to quality concerns in relation to residential and nursing care homes, domiciliary care services and unregulated care services (e.g. day services, supported living services etc.) for adults.

The Quality Policy establishes a formal means of responding to provider concerns where thresholds for whole service safeguarding adult Enquiry are not met, but where there is a clear need for service improvement to minimise the risks presented to service users by the quality of care being provided.

The purpose of the Quality Policy is to: -

1. enable remedial actions to take place for the specific areas of concern identified, thus stabilising poor operational performance and subsequently improving and sustaining the standards of care delivered by a provider;

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2. coordinate activity across all agencies to enable effective communication, avoid any duplication and minimise involvement to ensure a proportionate response;

3. clearly describe to providers what the quality threshold levels are, the procedures for escalation and de-escalation between quality threshold levels and what this means for providers, making it clear how quality concerns will be followed up;

4. proactively avoid whole service safeguarding and escalation of provider quality concerns;

5. contribute towards improving the overall quality of the provider market.

A Provider Quality Support Review (Quality Review) is a process by which concerns are managed with respect to a number of adults considered to be at risk in one establishment / service, or where there are concerns about poor quality of care being delivered but for which the thresholds for whole service safeguarding are not met. A Quality Review is a supportive process aimed at enabling the provider to improve and sustain the quality of their services.

The Quality Policy is therefore essentially a means of supporting providers to fulfil their legal and contractual obligations, escalating issues as necessary to ensure this is achieved.

Reason for change/review:

This new Quality Policy replaces DCC’s Quality Threshold policy under which intervention by DCC’s Quality Assurance and Improvement (QAIT) team was limited to circumstances triggered by CQC inspection outcomes. The new Quality Policy enables the Quality Assurance and Improvement Team (QAIT) to proactively use information from other sources as the basis for their support / intervention in services. The wider policy has been developed based on the QAIT’s experience over the last 2 years which demonstrated the value of Quality Reviews in ensuring providers meet national standards and local contractual obligations - and so enable maintenance of market sufficiency and quality.

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Section 2 - Impacts, options and recommendations

See sections 3, 4 and 5 for background analysis

Options Appraisal and Recommendations:

This policy supplements existing guidance provided in the Devon and Torbay Safeguarding Adults Board Multi-Agency policy, and has been developed out of the QAIT’s experience of supporting provider development for the last two years. The options considered were whether to maintain the previous arrangements which were fit for purpose, or to further develop them into a policy which clearly lays out the thresholds for Quality Reviews.

Social/equality impacts (summary):

The overall equality impact of this policy will be positive, as the increased clarity and consistency of the Quality Review process will make it easier to put the required ‘control measures’ in place to match the level of concern about a provider’s performance.

Environmental impacts (summary):

N/A

Economic impacts (summary):

The overall impact will be positive as the policy will enable DCC to more accurately determine the level of support or challenge given to providers based on the Quality Threshold level of concern they meet.

Other impacts (partner agencies, services, DCC policies, possible ‘unintended consequences’):

There will be a positive impact for the partner agencies involved in adult social care provision alongside Devon County Council: Torbay Council, NEW Devon Clinical Commissioning group (CCG) and South Devon and Torbay CCG.

How will impacts and actions be monitored?

The Provider Quality Support Policy is itself a means of monitoring quality, and successful implementation of the policy will be evidenced by the outcomes of Quality Review meetings between providers and DCC in cases of Moderate and Major concerns, and in completed provider self-assessment forms.

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ckground AnalysisThis section describes how relevant questions and issues have been explored during the options appraisal.

Section 3 - Profile and views of stakeholders and people directly affected

People affected: This policy applies to everyone in receipt of adult social care support, whether commissioned or self-funded.

Diversity profile and needs assessment of affected people:

Estimating the number of self-funders in receipt of adult social care support is difficult. In terms of residential and nursing care, estimates from national studies for the South West suggest that approximately 50% of people are self-funders, although local estimates suggest the figure in Devon is closer to 55%.

There are no reliable sources available for community based care and support.

As at 31/03/17 Devon County Council was funding services for c4,300 adults aged 18 to 64 and c6,600 adults aged 65 plus, a total of c10,900. Of those people 93.4% are White British compared to 94.9% of the Devon population as a whole who are White British.

Other stakeholders (agencies etc.):

Social care providers2 CCGs as joint contract holdersTorbay Council as a partnerDevon Safeguarding Adults BoardCare Quality Commission as the regulatorPolice for specific safeguarding concernsHealthwatch as the consumer voiceOther NHS Commissioners and providers with responsibilities for quality of care

Consultation process and results:

The policy was jointly developed with Torbay Council and Devon’s two NHS Clinical Commissioning Groups to ensure it was aligned with individual agency processes and policies.Providers of adult social care services were consulted on the policy via the Provider Engagement Network, to ensure it was a practical and proportionate way of addressing concerns about standards of provision.The Commissioning Involvement group was used as a means of consulting service users, this group contains a

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range of people who use social care services with an understanding of commissioning processes.

Research and information used:

Two national publications informed the development of this policy:– ‘Early Indicators of Concern in Residential and Nursing Homes for Older People - A Guide’ and ‘Early Indicators of Concern in Residential Support Services for People with Learning Disabilities – A Guide: Marsland, D., Oakes, P., White, C. (2012)

The London Borough of Hackney Establishment of Concerns Protocol was also used as a source of good practice:

http://www.hackney.gov.uk/Assets/Documents/establishment-concerns-protocol.doc (link reviewed 21st December 2016)

Section 4a - Social Impacts

Giving Due Regard to Equality and Human Rights

The local authority must consider how people will be affected by the service, policy or practice. In so doing we must give due regard to the need to:

Eliminate unlawful discrimination, harassment and victimisation Advance equality of opportunity and Foster good relations.

Where relevant, we must take into account the protected characteristics of age, disability, gender, gender reassignment, pregnancy and maternity, marriage and civil partnership, sexual orientation, race, and religion and belief.

This means considering how people with different needs get the different services they require and are not disadvantaged, and facilities are available to them on an equal basis in order to meet their needs; advancing equality of opportunity by recognising the disadvantages to which protected groups are subject and considering how they can be overcome.

We also need to ensure that human rights are protected. In particular, that people have:

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A reasonable level of choice in where and how they live their life and interact with others (this is an aspect of the human right to ‘private and family life’).

An appropriate level of care which results in dignity and respect (the protection to a private and family life, protection from torture and the freedom of thought, belief and religion within the Human Rights Act and elimination of discrimination and the promotion of good relations under the Equality Act 2010).

A right to life (ensuring that nothing we do results in unlawful or unnecessary/avoidable death).

The Equality Act 2010 and other relevant legislation does not prevent the Council from taking difficult decisions which result in service reductions or closures for example, it does however require the Council to ensure that such decisions are:

• Informed and properly considered with a rigorous, conscious approach and open mind, taking due regard of the effects on the protected characteristics and the general duty to eliminate discrimination, advance equality and foster good relations.

• Proportionate (negative impacts are proportionate to the aims of the policy decision)

• Fair

• Necessary

• Reasonable, and

• Those affected have been adequately consulted.

Characteristics In what way can you eliminate or reduce the potential for direct or indirect discrimination, harassment or disadvantage?

Are there any lawful, reasonable and proportionate, unavoidable negative consequences?

In what way can you advance equality (meet needs, encourage participation, make adjustments for disabled people, ‘close gaps’).

In what way can you foster good relations between groups (tackle prejudice and promote understanding), if relevant?

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All residents (include generic equality provisions):

The policy applies to all people receiving adult social care in Devon, rather than all residents. It is DCC’s way of ensuring that providers meet fundamental standards of care as set out in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Because our previous policy was inspection outcome based and new policy uses wider intelligence sources, implementation of the new policy should have an overall positive impact in terms of equality.

Age: This policy applies to all adults receiving social care support. The youngest people affected by this policy will be aged 18, having transitioned into adult services. The policy included work with children’s services to develop a whole service safeguarding procedure for providers covering both adults and children’s services so there will be a positive impact in terms of age.

Disability (incl. sensory, mobility, mental health, learning disability, ill health) and carers of disabled people:

People receiving social care support will have the full range of disabilities and the Provider Quality Support policy has a key role to play in maintaining the quality of provision for all social care services. It will therefore have a positive impact.

Culture and ethnicity: nationality/national origin, skin colour, religion and belief:

DCC contracts and CQC provider regualtions require providers to be sensitive to issues arising from culture and ethnicity, and this policy strengthens the way in which DCC is able to work with providers on such issues. It should therefore

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have a positive impact.

Sex, gender and gender identity (including men, women, non-binary and transgender people), and pregnancy and maternity (including women’s right to breastfeed).

Sex, gender and gender identity could be the basis of concerns about provider performance and this improved approach to the Quality Review process should make it easier to work with providers, so resulting in a positive impact in such cases.

Sexual orientation and marriage/civil partnership:

If an issue of provider performance includes discrimination on the basis of sexual orientation then this improved Quality Review process should help resolution and thus have a positive impact.

Other socio-economic factors such as families, carers, single people/couples, low income, vulnerability, education, reading/writing skills, ‘digital exclusion’ and rural isolation.

Having an improved Quality Review process should address all issues of provider performance, including those arising from these other factors.

Human rights considerations:

Supporting independence, wellbeing and resilience?

Give consideration to the groups listed above and how they may have different needs.

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In what way can you support and create opportunities for people and communities (of place and interest) to be independent, empowered and resourceful?

DCC’s engagement with adult social care providers is based on the promotion of independence and the Quality Review process is a way of reinforcing this.

In what way can you help people to be safe, protected from harm, and with good health and wellbeing?

The Quality Review process has been developed in close liaison with the Devon Safeguarding Adults Board and has been designed to ensure safeguarding issues can be appropriately escalated or de-escalated.

In what way can you help people to be connected, and involved in community activities?

Providers are expected to support community involvement whenever relevant as part of the promotion of independence.

Section 4b - Environmental impacts

An impact assessment should give due regard to the following activities in order to ensure we meet a range of environmental legal duties.

The policy or practice does not require the identification of environmental impacts using this Impact Assessment process because it is subject to (please select from the table below and proceed to the 4c, otherwise complete the environmental analysis table):

Devon County Council’s Environmental Review Process for permitted development highway schemes.

Planning Permission under the Town and Country Planning Act (1990).

Strategic Environmental Assessment under European Directive 2001/42/EC “on the assessment of the effects of certain plans and programmes on the environment”.

Describe any actual or potential negative consequences.

Describe any actual or potential neutral or positive outcomes.

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(Consider how to mitigate against these). (Consider how to improve as far as possible).

Reduce waste, and send less waste to landfill:

N/A

Conserve and enhance biodiversity (the variety of living species):

N/A

Safeguard the distinctive characteristics, features and special qualities of Devon’s landscape:

N/A

Conserve and enhance the quality and character of our built environment and public spaces:

N/A

Conserve and enhance Devon’s cultural and historic heritage:

N/A

Minimise greenhouse gas emissions:

N/A

Minimise pollution (including air, land, water, light and noise):

N/A

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Contribute to reducing water consumption:

N/A

Ensure resilience to the future effects of climate change (warmer, wetter winters; drier, hotter summers; more intense storms; and rising sea level):

N/A

Other (please state below):

Section 4c - Economic impacts

Describe any actual or potential negative consequences.

(Consider how to mitigate against these).

Describe any actual or potential neutral or positive outcomes.

(Consider how to improve as far as possible).

Impact on knowledge and skills:

The improvement in the way in which DCC works with providers should have a positive impact on knowledge and skills, as learning from Quality Reviews.

Impact on employment levels: The policy is a way of helping maintain market sufficiency so should have a positive or neutral

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impact on employment levels.

Impact on local business: Improving the way in which providers are engaged includes engagement with many local businesses so should have a positive impact on them.

Section 4d -Combined Impacts

Linkages or conflicts between social, environmental and economic impacts:

Implementation of the Provider Support Quality Policy should have an overall positive impact as the way in which Quality Reviews are carried out becomes clearer and more systematic for all parties.

Section 5 - ‘Social Value’ of planned commissioned/procured services:

How will the economic, social and environmental well-being of the relevant area be improved through what is being proposed? And how, in conducting the process of procurement, might that improvement be secured?

This is a policy which focuses on maintaining the quality and sufficiency of adult social care provision and any improvement resulting from this policy will be of general benefit to the local economy and well-being of the population, so adding social value in its widest sense.

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CT/17/88Cabinet

8th November 2017BUDGET MONITORING 2017/18Report of the County TreasurerPlease note that the following recommendations are subject to consideration and determination by the Cabinet (and confirmation under the provisions of the Council's Constitution) before taking effect.

Recommendation: That the position based on Month 6 is noted.

1. Introduction1.1. This report outlines the financial position and forecast for the Authority at month 6 (to

the end of September) of the financial year.

1.2. The overall underspend is forecast at £2.457 millions. However, as with the month 4 July position, caution should be taken as there is still time for storm events and winter pressures to occur. Further detail on this movement is outlined throughout this report.

2. Revenue Expenditure Adult Care and Health Services2.1. Adult Care and Health services is forecast to underspend by £4.170 millions, which is

an increase of £398,000 from that reported at month 4 mainly due to additional staff vacancy savings within the Commissioning team.

2.2. The Adult Care Operations underspend totals £3.497 millions with the majority of the underspend (£3 millions) relating to better contract negotiation and demand management with both commissioning and operational staff working hard to deliver efficiencies and implement the Promoting Independence policy.

2.3. Other areas of underspend include Older People and Physical Disability £1.393 millions which relates to lower than anticipated care packages (368) and the in-house services which is forecasting an underspend of £439,000 due to lower running costs and staffing vacancies.

2.4. The Learning Disability service (including Autistic Spectrum Conditions) continues to be the area of concern and is forecasting an overspend of £1.335 millions; this is due to an increase in the number of packages which are now 210 above budget.

2.5. Adult Commissioning and Health (including Mental Health) is now showing an underspend of £673,000 due to temporary vacancy savings in the commissioning teams and one off savings on projects.

2.6. There are still risks facing the service, particularly regarding pending HMRC action on National Living Wage compliance for sleep in night shifts and children transitioning to adult services. Winter can also be a challenging and volatile time for the service.

3. Revenue Expenditure Children’s Services 3.1. Children’s Services are showing a forecast overspend of £2.697 millions, a decline on

the month 4 positions of £1.054 millions

3.2. Children’s social care is forecasting an overspend of £1.910 millions (£699,000 in month 4). One of the most significant reasons for the change relates to looked after children particularly in relation to high cost independent residential placements. The total placements budget is over spent by £1.752 millions (£933,000 in month 4).

3.3. Whilst the overall numbers of looked after children are holding steady there is a critical lack of alternative placement availability for those with higher levels of need. This has a direct and significant impact on both costs and the numbers of children entering and remaining in high cost settings.

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3.4. Disabled Children’s Services are also forecast to over spend by £825,000 (£716,000 in month 4). Overall there are 221 more short-break packages of care/services being accessed by children and families than budgeted whilst average costs of packages are also increasing. A project is underway to review the Disabled Children’s Service with the overarching goal to develop an integrated and consistent operating model that is financially sustainable and achieves good outcomes for children with disabilities and their families.

3.5. These overspends within Children’s Social Care have been partially offset by other savings across the remaining budgets including vacancy management, lower legal disbursement and other minor variations of £667,000 (£950,000 at month 4).

3.6. The non DSG element of Education and Learning is forecasting an overspend of £787,000. This relates mainly to personalised transport and the unplanned Special Educational Needs (SEN) contract cost & route increases. Home to College/School transport is expected to show an underspend of £100,000. Overall, there has been an improvement in forecast spending since month 4 of £157,000 nearly all of which relates to personalised transport.

3.7. The Dedicated Schools Grant is currently forecast to overspend by £2.036 millions, all of which can be attributed to High Needs which is currently forecasting to overspend at yearend by £2.145 millions. It has been assumed that this overspend will not impact on the general fund.

4. Revenue Expenditure Highways, Infrastructure Development and Waste4.1. Highways, Infrastructure Development and Waste are showing a small underspend of

£64,000. Risks to this position, such as extreme weather and waste disposal tonnages are monitored throughout the year.

4.2. The term maintenance contract awarded to Skanska commenced operation on 1st April 2017. Savings expected from the new arrangements have been built into the budget and are being achieved.

4.3. Data for the first four months for disposal tonnages show that, due to the ideal growing conditions, green waste tonnages are significantly up. However, overall disposal tonnages are close to budget and therefore this increase can be contained.

5. Revenue Expenditure Communities, Public Health, Environment and Prosperity5.1. Communities, Public Health, Environment and Prosperity (COPHEP) are showing a

forecast overspend of £133,000.

5.2. Due to the lead in times the county wide savings of £333,000 anticipated from the Research and Intelligence review will not be achieved during this financial year. This has been partially offset by an underspend on transport due to reduced journey numbers for the National Travel Scheme.

5.3. Public Health is forecasting a breakeven position within the ring fenced grant. The main area of risk relates to the re-commencement of the NHS Health-check programme due to go live soon. This programme has the potential to exceed the volumes anticipated.

6. Revenue Expenditure Corporate Services6.1. Corporate Services is forecast to break-even at year end.

6.2. As stated in COPHEP (above), due to the lead in times county wide savings of £167,000 anticipated from the Research and Intelligence review are unlikely to be achieved during this financial year.

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6.3. Use of locum solicitors, the need for additional legal support for Fairer Charging, alongside unavoidable costs linked to Coroners and an ambitious income target for the Communications team have resulted in a reported over spend of £200,000

6.4. This has been offset in the main by a combination of higher than expected levels of staff turnover, the subsequent effect of vacancy management and savings in respect of the attrition rate for those in receipt of unfunded pensions.

7. Non Service7.1. Non service items are forecast to underspend by just under £1.2 millions. This is

mainly due to additional investment income of £352,000, additional grant income of £84,000 and savings on Provisions and Pension costs of £722,000.

8. Capital Expenditure 8.1. The approved capital programme for the Council is £161.372 millions. The year-end

forecast is £138.910 millions, producing slippage of £22.462 millions. Significant areas of slippage have been identified in respect of the following schemes:

Marsh Barton station, further talks ongoing with Network Rail and Department for Transport to secure funding;

A361 Gornhay to M5, slipped across financial years due to delay in confirmation of grant award, now confirmed; and

Connecting Devon & Somerset, slight delay due to British Telecom unable to commence part of work until 2018/19.

9. Debt Over 3 Months Old 9.1. Corporate debt stood at £3.5 millions, being 2.0% of the annual value of invoices and

just above the annual target of 1.9%. This is a reduction on previously reported figures following part payment of a significant debt owed by a top FTSE company. We are continuing to pursue the balance of debt owed by way of legal action. It is anticipated that year-end debt will be brought down below the annual target.

10.Conclusion10.1. The ongoing pressures in Children’s Services are very concerning; not only in

relation to the current year but the ongoing impact over the medium term. The forecast overall underspend of just under £2.5 millions is very welcome; however, this must be treated with caution. In recent years we have experienced very mild winters but that will not always be the case and we have yet to see what this winter will bring.

Mary Davis, County Treasurer

Electoral Divisions: All

Cabinet Member: Councillor John Clatworthy

Local Government Act 1972: List of Background Papers

Contact for Enquiries: Mary Davis

Tel No: (01392) 383310 Room: 199

Background Paper Date File Ref: Nil

Date Published: 31st October 2017

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CSO/17/30Cabinet

8 November 2017

NOTICES OF MOTION

Report of the County Solicitor

Recommendation: that consideration be given to any recommendations to be made to the County Council in respect of the Notices of Motion set out hereunder having regard to the relevant factual briefing/background papers and any other representations made to the Cabinet.

~~~~~~~~~~~~~~

The Notices of Motion submitted to the County Council by the Councillors shown below have been referred to the Cabinet in accordance with Standing Order 8(2) - for consideration, reference to another committee or to make a recommendation back to the Council.

A factual ‘Briefing Note/Position Statement’ prepared by the relevant Head of Service is also included where appropriate or available, to facilitate the Cabinet’s discussion of each Notice of Motion.

(a) Plastic Free Coastlines (Councillor Biederman)

This Devon County Council supports Plastic Free Coastlines, committing to plastic free alternatives and supporting plastic free initiatives within Devon.

The Council commits to lead by example to remove single-use plastic items from its premises. Also it must encourage plastic free initiatives, promoting the campaign and supporting its events.

A representative of this council will become a member of the Plastic Free Coastlines Steering group’.

Briefing Note/Position Statement from the Head of Planning, Transportation and Environment

It is estimated that up to 13 million tonnes of plastic leak into the global marine environment every yeari either discarded deliberately or escaped from a waste management process. This has adverse implications for wildlife, the economy and human health.

Entanglement and suffocation are responsible for the death of over 1m sea birds and mammals annuallyii but the unseen effects are equally concerning: The plastics break down and become microplastics which do not biodegrade and are attractive to zooplankton, which in turn are eaten by wildlife higher up the food chain until it arrives on our dinner table. The components used in plastics could harm human health.

The direct economic costs of marine litter to maritime industries, the cost of clean-up and on tourism in the UK are estimated at £103m per yeariii.

The Government has taken action on plastic bags and microbeads (the latter being illegal in most cosmetics from June 2018), but these sources comprise just 2% of the problem. One third of marine plastic litter is attributable to single-use beverage packaging, which offers the greatest opportunity to take actioniv.

It is important to consider that all plastic items, single-use or not, increase the demand for nurdles – these are tiny plastic granules shipped around the world as the raw product. Nurdles are responsible for 9% of marine plastics before the plastic has even been turned into something useful.

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The mantra of Reduce, Reuse, Recycle is key to improving this situation. Society needs to: use alternative materials wherever possible to reduce demand for nurdles and minimise the plastic that could become litter; provide incentives to reuse the plastic items; and improve product design and collection systems so that plastics are easier to recycle.

DCC and our partners have already started taking action on reducing single-use plastic items. Two examples are: desktop-printer cartridges, which, through the switch to multi-function printing devices, have reduced in purchasing volume from over 9000 in 2009 to 500 in 2016 (almost 60% are from recycled sources); and the Devon Norse reusable cup that, through a 10p reduction on drink prices in return for reusing the cup, resulted in 10,000 fewer disposable cups being used for hot drinks in its first 6 months.

We also have the Recycle@Work scheme in most of our work locations, accessible to 90% of staff. The scheme collects various materials including plastic bottles or mixed plastic recycling depending on location. A new Corporate Waste Action plan was adopted by Cabinet in January 2017 to improve performance further.

More broadly, DCC has a role through its environmental partnerships in raising awareness of the issues surrounding marine plastics. Each year the Exe Estuary Partnership organises a spring and autumn Exe Clean-Up. The latest event attracted 111 volunteers who gathered almost 1700 pieces of litter. The North Devon Coastal Creatures Project has been running beach cleans on remote beaches, supporting beach care groups and engaging schools. Active groups that continue to arrange beach cleans have been established at Westward Ho!, Northam Burrows, Woolacombe and Croyde.v

(b) National Funding Formula for Schools (Councillor Greenslade)

County Council expresses its considerable disappointment at the Government’s recently announced proposals which notionally leave Devon Schoolchildren with a funding gap of £268 below the national average. Additionally considerable concern is also registered that Devon has not done well with the high needs block allocation compared to others which will increase pressure on budgets for SEN. These concerns be communicated on an all party basis to the Government and all Devon MP’s.

Briefing Note/Position Statement from the Head of Education and Learning

As Members may be aware, the national funding formula is fast moving. There has been a delay in obtaining clarification from the Department for Education on some of the figures and this is still being resolved.

There is a funding consultation meeting this week and a full note will be provided at the end of the week, so Members have the most up to date information to consider both prior to and at the Cabinet meeting.

(c) Ethical Care Council (Councillor Hodgson)

This Council commits to becoming an Ethical Care Council by commissioning homecare services which adhere to an Ethical Care Charter. This will establish a minimum baseline for the safety, quality and dignity of care by ensuring employment conditions which a) do not routinely short-change clients and b) ensure the recruitment and retension of a more stable worksforce through more sustainable pay (based on a minimum –genuine- living wage), conditions and training levels. On that basis we will adopt and sign UNISON's Ethical Care Charter.

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Briefing Note/Position Statement from the Head of Adult Commissioning and Health

The Unison Care Charter, published in 2013, has three suggested stages of implementation to which, Councils are invited to adhere as they commit to becoming an ‘Ethical Care Council’.Personal Care, delivered in an individual’s own home, is commissioned via the Council’s Living Well at Home (LWAH) contract. Features of this contract vehicle align with many of the aspirations of the Unison Ethical Care Charter.

In the week ending 17/10/2017, DCC commissioned 39,072 hours of personal care; of which 26,426 hours (68%) were commissioned through the LWAH contract. Accordingly, Members are advised it is our assessment that the compliance with the Unison Ethical Care Charter describe below is made against this 68% of the Council’s commissioned Personal Care, rather than the 32% of activity which is commissioned under ‘legacy SPOT contracting arrangements’, where less-stringent contractual obligations are imposed on providers (other than complying with statutory employment practices).

STAGE 1

Charter Requirement Compliance Notes to MembersThe starting point for commissioning of visits will be client need and not minutes or tasks. Workers will have the freedom to provide appropriate care and will be given time to talk to their clients.

Broadly Compliant

- Whilst personal care is currently commissioned against ‘time and task’ it is our assessment that adequate time is commissioned to ensure that individuals receive care in a dignified and respectful manner. - There is a positive intention to move towards outcomes based commissioning over the coming 18 months; which will remove ‘time and task’ features of DCC commissioned homecare.

The time allocated to visits will match the needs of the clients. In general, 15-minute visits will not be used as they undermine the dignity of the clients.

Compliant - Time allocated visits match the needs of the individuals receiving personal care. 15-minute visits are not routinely commissioned by DCC. - Current commissioning data shows that circa 3% of the total personal care commissioning is for 15-minute visits; the need for these visits has been recently reviewed and all are reported to be appropriate in the context of both their duration and purpose.

Homecare workers will be paid for their travel time, their travel costs and other necessary expenses such as mobile phones.

Broadly Compliant

- The LWAH contract requires homecare workers to be paid for their travel time and travel costs.- Incidental expenses incurred during a worker’s employment are usually met by a homecare provider as accepted employment.

Visits will be scheduled so that homecare workers are not forced to rush their time with clients or leave their clients early to get to

Compliant - There is an expectation within the LWAH contract that adequate travel time is scheduled between visits to ensure workers

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the next one on time. are not rushed or forced to leave visits early to arrive at their next appointment on time.- Poor planning of adequate travel time has been intrinsically linked to safeguarding concerns and have been a feature of service failure that has led to whole service safeguarding events involving domiciliary care providers

Those homecare workers who are eligible must be paid statutory sick pay

Compliant There is an expectation within the LWAH contract that workers receive access to the statutory sick pay scheme where they are eligible to receive SSP for periods of absence from work due to ill health.

Assessment of stage 1 compliance: Our commissioning of personal care is broadly compliant with stage 1 of the suggested implementation of the Ethical Care Charter. Changes in commissioning practice, notably a shift towards Outcomes Based Commissioning (OBC) will be required to ensure full compliance with stage 1 implementation requirements.

STAGE 2

Charter Requirement Compliance Notes to MembersClients will be allocated the same homecare worker(s) wherever possible.

Compliant - Accepted practice in the provision of personal care to individuals in their own homes is that personal care is provided by the same worker / team of workers to ensure ‘continuity of care’.- Poor ‘continuity of care’ has been intrinsically linked to safeguarding concerns and have been a feature of service failure that has led to whole service safeguarding events involving domiciliary care providers.

Zero-hour contracts will not be used in place of permanent contracts.

Non-Compliant

- The sector relies heavily on ‘Zero hour’ and ‘minimum hour’ employment contracts due to the constantly changing and dynamic nature of demand for personal care. -A move away from these employment practices by providers would require a change in commissioning practices where the Council agrees to meet the cost for periods of a worker’s employment where they are not delivering personal care to an individual in order to ‘unsaddle’ the provider organisation from the financial risks of incurring employment costs where no

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income is being generated during periods of a worker’s time that they are not delivering personal care.- A shift to outcomes based commissioning is likely to be required to effect such a change in employment practices, forcing a move away from commissioning ‘time and task’ personal care delivery.- Such a shift in commissioning practice may mitigate a risk of escalation of costs to commissioners due to the realisation of efficiencies within a ‘less prescriptive’ offer to individuals in need of personal care.

Providers will have a clear and accountable procedure for following up staff concerns about their clients’ wellbeing.

Compliant - Regulatory Standards, enforceable by the Care Quality Commission, require providers of personal care to implement effective systems which help to maintain the health and well-being of individuals in receipt of their services.

All homecare workers will be regularly trained to the necessary standard to provide a good service (at no cost to themselves and in work time).

Broadly Compliant

- Regulatory Standards, enforceable by the Care Quality Commission, require providers of personal care to ensure workers have the necessary skills and experience to meet the needs of the individuals to whom they deliver personal care. - Poor training has been intrinsically linked to safeguarding concerns and have been a feature of service failure that has led to whole service safeguarding events involving domiciliary care providers.- Further assessment of whether training is provided in work time and without cost to the worker is required to make an assessment of compliance with this charter requirement.

Homecare workers will be given the opportunity to regularly meet co-workers to share best practice and limit their isolation.

Compliant - Regulatory Standards, enforceable by the Care Quality Commission, require providers of personal care to provide supervision and meetings which provide workers with forums to share best practice and limit isolation which is an inherent feature of the ‘lone working environment’ of personal care delivery in an individual’s own home.

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A

Assessment of stage 2 compliance: Our commissioning of personal care is largely compliant with stage 2 of the suggested implementation of the Ethical Care Charter. Changes in commissioning practice, notably a shift towards Outcomes Based Commissioning (OBC) will be required to ensure providers of personal care are less likely to saddled with the financial risk associated with fluctuation in demand for services will be required to ensure full compliance with stage 2 implementation requirements. It is thought that implementation of OBC commissioning models will drive efficiency within the personal care market, consequently there should not be an assumption that a change in commission practice will lead to an escalation in cost to the commissioning authority. Work is underway with our LWAH Primary Providers, linked to the NEW Devon STP Workforce workstream to explore the feasibility of an early shift in employment practices and provider reliance on ‘zero hour’ contracts, in favour of either ‘minimum hour’ or ‘guaranteed hour’ contracts; the commercial contracting arrangements between the Primary Providers and their sub-contracted providers may allow for a ‘commercially focused’ conversation in which guaranteed pay rates for homecare workers could become an accepted contractual requirement.

STAGE 3Charter Requirement Compliance Notes to MembersAll homecare workers will be paid at least the Living Wage (as of November 2015 it is currently £8.25 an hour for the whole of the UK apart from London. For London it is £9.40 an hour. The Living Wage will be calculated again in November 2016 and in each subsequent November). If Council employed homecare workers paid above this rate are outsourced it should be on the basis that the provider is required, and is funded, to maintain these pay levels throughout the contract.

Non-Compliant

- Implementation of the LWAH contract required workers to be paid NMW1 Advice to the council during the procurement of the contract was that to require providers to meet NLW at rates higher than those set by the Low Pay Commission had the potential to be ‘anti-competitive’ within the sphere of ‘public commissioning’ and were accordingly discounted from contractual obligations.- There is discussion within Devon STP workforce workstream which is exploring whether the LWAH Primary Providers could make pay rates contractual requirements within the bounds of their commercial contracting with their sub-provider markets together with a decisive shift away from zero hour to either minimum hour or

1Current National Minimum Wage (NMW) and National Living Wage (NLW) for workers over the age of 25 set by the Low Pay Commission as at April 2017:

Age of worker NMW Under 18 NMW 18-20 NMW 21-24 NLW 25 and over

Apprentice

Hourly Rate £4.05 £5.60 £7.05 £7.50 £3.50

- Poor supervision and support has been intrinsically linked to safeguarding concerns and have been a feature of service failure that has led to whole service safeguarding events involving domiciliary care providers.

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guaranteed hour employment contracts.All homecare workers will be covered by an occupational sick pay scheme to ensure that staff do not feel pressurised to work when they are ill in order to protect the welfare of their vulnerable clients.

Non-Compliant

Occupation sick pay schemes are not a feature of the private care sector; It is suggested that implementation of this charter requirement will require a shift in employment practice across the whole of the care sector rather than just within ‘homecare’. Adoption of such employment practices would undoubtedly escalate costs of purchasing care as care providers would seek to mitigate the costs associated with between 2 – 4.5% absence in their organisations.

Assessment of stage 3 compliance: Our commissioning of personal care is not compliant with stage 3 of the suggested implementation of the Ethical Care Charter. It is unlikely that this stage of the charter could be implemented without increased cost to the commissioning authority.

(c) 20 MPH Speed Limits (Councillor Hodgson)

‘With rising concerns about road safety for pedestrian and cyclists and in response to the growing calls for 20 mph speed limits in villages, this Council will welcome and consider proposals from Town and Parish Councils for 20 mph speed limits in residential areas, town and village centres and associated approach roads’. (NB: The 20 mph zones in London are estimated to already be saving more than £20 million in crash prevention annually. The cost of road signs is remarkably low. For example, Portsmouth converted 1200 streets to 20mph for just over £500,000 – far cheaper than the alternative ideas put forward, which came to £2.2 million. It’s roughly seven times more cost effective, in terms of speed reduction achieved, to introduce a 20 mph limit across a wide area, than to spend the same sum on isolated, physically calmed zones. The police are obliged to enforce all speed limits. The evidence is that drivers drop their speed when a 20 mph limit is enforced).

Briefing Note/Position Statement from the Chief Officer for Highways, Infrastructure Development and Waste

The DfT have commissioned Atkins to carry out a study in to the effectiveness of 20mph speed limits, the recommendations are due to be issued in February 2018. This study will be the most comprehensive and robust study to date and will include detailed and accurate data on casualties and changes in speeds. A commitment has been given to review the County Council’s speed policy when this study is published. In conjunction with the publication of this study the County Council is undertaking an evidence review of the introduction of 20mph limits in Devon and those built up areas which are not within a 20mph limit. This will further feed into the review of speed policy.

Currently speed related concerns identified by communities are considered collectively with the Police, looking objectively at data including measured speeds and collision information. The findings of the investigations inform proposed interventions which range from Community Speedwatch initiatives to engineering solutions. The funds available for interventions are limited and therefore have to be prioritised accordingly and targeted at those locations with most objective need. Officers will be working work with members of the Corporate Infrastructure and Regulatory Scrutiny Committee over the coming months to look at how speed concerns are dealt with going forward.

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This Report has no specific equality, environmental, legal or public health implications that will not be assessed and appropriate safeguards and/or actions taken or included within the detailed policies or practices or requirements in relation to the matters referred to herein.

JAN SHADBOLT[Electoral Divisions: All]

Local Government Act 1972: List of Background PapersContact for Enquiries: K Strahan Tel No: 01392 382264 Room: G31 Background Paper Date File ReferenceNil

i Jambeck, J.R. et al. (2015) Plastic Waste Inputs from Land into the Ocean. Science. 347 (6223) p.768-771ii Surfers Against Sewage (2014) Marine Litter Report. Surfers Against Sewage. Available at: https://www.sas.org.uk/wp-content/uploads/SAS-Marine-Litter-Report-Med.pdf iii Lee, J. (2014) Economic valuation of marine litter and microplastic pollution in the marine environment: An initial assessment of the case of the United Kingdom. Paper presented at the 2015 conference of the UK Network of Environmental Economists. Available at: http://www.eftec.co.uk/keynotes/envecon-2015/lee-paper/download iv Green Alliance (2017) Marine Plastics [online]. URL: http://www.green-alliance.org.uk/marine_plastics.php

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Devon Safeguarding Adults BoardAnnual Report2016–2017

Welcome from the Chair

I am pleased to be able to present my first Annual Report of the Devon Safeguarding Adults Board (DSAB). In this last year we have reviewed how the Board effectively functions and

in particular how membership of the Board is at the right level across all the organisations which have responsibility for safeguarding and protecting people with care and support needs across Devon.

The Board comprises senior leaders from the NHS Clinical Commissioning Groups as well as Hospitals, Community Healthcare and the Ambulance service, the Police, Probation services and the Prison service, the Fire Service, the Local Authority Adult Social Care, Public Health & Community Safety Partnership and Mental Health.

My role is absolutely independent of all these organisations and my duty as Chair is to ensure that the Board is given adequate assurance that

we are all delivering safe services, and that Board Members hold each other to account for this. For me this means that there is the ability to learn from significant events when people haven’t been safe and to make sure that staff across all these organisations are very clear about when people need support and how to intervene to protect those who cannot protect themselves.

When I started my role, I set out that I am personally committed to making the experience of people who are safeguarded, a good personal experience. We have done much to begin to achieve this, through being clear that all staff who work on the front line delivering services have good training and support to help them. We have more to do and especially, if we are to support and promote the ability for people to live as independently as they can; we need to ensure that this goal is well understood by our citizens and all organisations which support and assist people in need. To this effect we will be building in this next year on how we communicate better with the wider public.

I hope that you continue to find this compact version of the Annual Report helpful. For those of you who want more detailed information about the work we have undertaken in this year, may I direct you to our website or feel free to contact the Devon Safeguarding Adult Board Business Manager at: safeguardingadultsboardsecure-mailbox @devon.gcsx.gov.uk

Siân Walker

Devon Safeguarding Adults BoardThis is where senior representatives from member organisations make key decisions relating to Adult Safeguarding. The sub-groups of the Board report, which are listed on the next page, report on progress against their own work plans. At the start of each Board meeting, there is a Personal (anonymised) ‘Safeguarding Story’ shared by a member to ensure that Making Safeguarding Personal is a focus at each Board.

1

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DSAB Sub-groupsOperational Delivery GroupThis was a new Group launched in September 2016 which reports directly to the Board. This is where key pieces of work for the Board are developed and delivered through task and finish groups. In 2016/17 this group launched several work streams including developing a DSAB Multi-Agency Policy and a Multi-Agency Performance Data report to provide assurance to the Board. We also began to work with the Safeguarding Children’s Board to ensure issues picked up in Safeguarding Childrens link to the work with adults and vice versa.

Mental Capacity Act (MCA) GroupThis group ensured that organisations have a good understanding of the MCA and also the Deprivation of Liberty Safeguards as well as reporting on updates to Legislation and the impact it will have on multi-agency practice. This is a joint group with Torbay Safeguarding Adults Board. Joint Chairs were appointed in February 2017 representing both Torbay and Devon. In 2016/17 this group delivered the goals in the MCA section of the DSAB Business Plan, considered learning from reports regarding the Independent Mental Capacity Advocate contract and also began to carry out an audit looking at MCA practice across partner organisations.

Safeguarding Adults Review Core GroupThis group has a key role in organising and delivering the Reviews, ensuring outcomes are passed to the Board for dissemination of key learning and review amongst all partner organisations. In 2016/17 Devon Safeguarding

Adults Board completed 1 Safeguarding Adult Review. We recruited a new Chair to the group who has helped implement an improved process for completing SARs to ensure Making Safeguarding Personal remains at the front of people’s minds.

Learning and Improvement GroupThis group makes sure that all organisations are completing the correct level of training and that this training is being used to improve how we Safeguard people. The group’s work plan for 2017/18 include self-assessment of partners (including training and Safeguarding practice; development of multi-agency case audit to review how we are Safeguarding people; a review of the Training is offered to staff across partner agencies and DSAB Commissioned training.

Themed WorkshopsThese are workshops that were held four times a year to look at key issues within Safeguarding. In 2016/17 these were used to develop the Business Plan for the Board and to review progress of the Mental Capacity Act Group work plan.

Community Reference GroupThis group will be launched in September 2017 and will be co-ordinated with Living Options and Chaired by the Chief Executive of Healthwatch Devon. The main role of this group is to enable the voice of service users to be heard. The Board will be supported and advised by this group to promote strong communication with the public, improved community safety and making safeguarding personal.

Business Plan2017-18 PrioritiesAlthough all the 9 areas within the Business Plan for 2016–19 will be developed throughout the year, priorities 1–3 will be focused on this year and reported to each Board meeting.

For the next three years, some of the main areas of work for the Board will be:

1. Improving people’s experience of safeguarding which includes the delivery of ‘Making Safeguarding Personal’ across all partner organisations.

2. A focus on promoting independence though proactive work to prevent harm and neglect in care and health services.

3. Improving awareness and application of MCA and Best Interests for people.

4. Protecting people from harm by proactively identifying people at risk, whilst promoting independence.

5. Increasing awareness about Self Neglect and development of support routes.

6. Reducing Financial Abuse and Scams.

7. Improving Support for Families at risk by building family dimension into everything we do.

8. Significantly reducing the prevalence of Modern Slavery & Human Trafficking.

9. Prevent (Protecting vulnerable people from being exploited by violent extremism).

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Partner key achievements2016–2017

Devon & Cornwall Police1. County lines. There has been a lot of activity in understanding the exploitation of vulnerable individuals by dangerous drugs networks. All areas of the Force have considered their response to this offence type and reviewed their approach to protecting those being exploited. A number of successful operations have been carried out to disrupt and pursue perpetrators.

2. Modern slavery. The Police participated in the recent Home Office trial in relation to the National Referral Mechanism and we eagerly await the result of the evaluation of the pilot arrangements. There has been significant activity around developing the Force response. The Chief Constable holds the national lead around this portfolio.

3. Safeguarding Adult Review Core Group. Detective Superintendent Keith Perkin has chaired the DSAB sub-group and played a significant role in developing the DSABs approach to Safeguarding Adult Reviews.

Care Quality Commission 1. Preventative measures; three sub group meetings now take place across Devon to talk about services that are at risk and gives a good picture of what is happening in Devon to develop working practices.

2. The first ratings inspection programme was completed during 2016/17.

3. Positive inter-agency working has continued to be developed.

HMP Exeter1. There has been great emphasis on working well with partner agencies.

2. There is zero tolerance to weapons and violence in prison. This is leading to good relationships with the police. The overall impact of this is that the prison feels safer as a whole.

3. There is a Special Care unit in place within the prison which supports prisoners with care and support needs.

Public Health Devon1. During the year, improved links have been made between the DSAB and other strategic groups for example the current Chair of the Safer Devon Partnership, responsible for undertaking Domestic Homicide Reviews, is a member of the DSAB to ensure learning is shared with members.

2. Monthly multi-agency Prevent meetings have been convened to discuss and agree support for a small number of individuals identified at risk of being drawn into violent extremism.

3. Channel Panel: The Prevent Partnership has been developed to support people, communities and professionals mitigate and respond to risks of extremism and threats of terrorism.

NHS South Devon and Torbay Clinical Commissioning Group (SDTCCG)1. The Primary Care safeguarding nurse is now an established role within the CCG, working with and supporting primary care in relation to safeguarding adults and children. This role has a clear work plan to support the CCG and member GPs in meeting their statutory duties.

2. Safeguarding taken wider, e.g. training for dentists. After receiving funding from NHS England in early 2016 SDTCCG commissioned a training company to deliver Level 2 safeguarding adult and safeguarding children to dental practice members to increase their knowledge and understanding of the issue of neglect and self-neglect and its impact upon the health and well-being of adults, vulnerable children and young people.

3. Partnership working to help achieve change has continued to be a key role for the CCG at both a strategic and operational level. This has included leadership of work streams as well as chairing the joint Learning and Improvement Subgroup.

Devon Partnership NHS Trust1. The Trust has established a Safeguarding Team to ensure Safeguarding is a focus for the organisation. The role of this team has a key function in generating awareness and understanding across all areas of practice.

2. We have launched an internal Safeguarding Programme to ensure staff have the correct levels of up-to-date training.

3. From a clinicians point of view a Safeguarding App has been developed to ensure clear and accurate Safeguarding information is readily available to front line staff.

NHS NEW Devon Clinical Commissioning Group1. There is continued emphasis given to the importance of investment in safeguarding within the organisation.

2. There is a MCA/Deprivation of Liberty Safeguards lead in place to ensure this function has prominence across the CCG.

3. There a good relationship with local authority contacts in place when safeguarding issues occur.

3

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Devon County Council Adult Social Care 1. There has been a shift for adult social care over last three years with working proactively with care and support providers and this has continued in 2016/17.

2. Ongoing efforts have been in ensuring that Making Safeguarding Personal remains at the heart of all of our work. Learning has been drawn from Safeguarding processes to establish what has happened to individuals and lessons have been learned which improve how we are developing services.

3. There is evidence of people working well together to manage situations where difficulties have arisen. This has led to people feeling safer to share their concerns.

Northern Devon Healthcare NHS Trust1. Training take-up has increased across the organisation, ensures staff have the correct knowledge and information to carry out their role.

2. The Learning Disability liaison service was developed which is having a positive effect on the application of MCA and Best Interest making.

3. The Safeguarding Adults Lead for the Trust is co-located with children’s team which help ensure ‘Think Family’ principals are embedded across the Trust.

Torbay and South Devon NHS Foundation Trust1. Introducing ‘Freedom to Speak Up Guardians’ – The scheme allows any member of staff to raise concerns in confidence to appointed independent people, confident in the knowledge that they will be listened to, that action will be taken and that they will be thanked and acknowledged for living the values of the NHS.

2. Placing the making safeguarding personal agenda at the heart of safeguarding training. Our training focuses on person centred not process driven responses, empowering people to maintain choice and control throughout safeguarding enquiries.

3. Piloting the use of a mental capacity act rapid assessment tool. The tool allows front line staff in hospital settings to have better access to resources to support assessment and decision making with regards to the Mental Capacity Act 2005.

Devon, Dorset and Cornwall Community Rehabilitation Company 1. Safeguarding was firmly placed on the agenda for the organisation which means its importance is continually stressed while developing policy and practice.

2. There was a new training package for all Working Links organisations launched in 2016/17 which includes safeguarding which has increased awareness of key issues.

National Probation ServiceThis year we produced a guidance document in relation to Safeguarding Adults. This has crystallised our approach to working to the principles Empowerment, Prevention, Proportionality, Protection, Partnership and Accountability all underpin our adult safeguarding work.

Royal Devon and Exeter Hospital NHS Foundation Trust1. There is now an Independent Domestic Abuse Advisor (IDVA) present on RD&E site one day per week – this pilot started February 2017.

2. The Senior Safeguarding Nurse Specialist will improve our team’s capacity to respond to the demands of safeguarding in the community, linking the acute and community aspects of the Trust.

3. Over 90% of all staff trained consistently in Safeguarding Adults. Domestic abuse training statistics are also increasing steadily.

South Western Ambulance Service NHS Foundation Trust (SWASFT)1. SWASFT developed strong links with a large care provider regarding referrals which lead to a greater understanding of roles and responsibilities especially with people who fall but don’t injure themselves.

2. The Named Safeguarding Professional for SWASFT now attends a Care Peer Group Forum to discuss any issues, shared best practices and agree required actions.

3. SWASFT contributed to 19 Safeguarding Adults Reviews to review lessons learned and implement good practice across Devon.

4

Devon Safeguarding Adults BoardWeb: https://new.devon.gov.uk/devonsafeguardingadultsboardEmail: safeguardingadultsboardsecure-mailbox@devon.gcsx.gov.uk

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1FARMS ESTATE COMMITTEE

16/10/17

FARMS ESTATE (INTERVIEWING) COMMITTEE

16 October 2017

Present:-

County Councillors

Councillors C Chugg (Chair), J Brook and T Inch

Co-opted Members

C Latham (Tenants' Representative)

16 Items Requiring Urgent Attention

There was no item raised as a matter of urgency.

17 Exclusion of the Press and Public

RESOLVED that the press and public be excluded from the meeting for the following items of business under Section 100(A)(4) of the Local Government Act 1972 on the grounds that they involve the likely disclosure of exempt information as defined in Paragraphs 1, 2 and 3 of Schedule 12A of the Act, namely information relating to, and which was likely to reveal the identity of, tenants and information relating to the financial or business affairs of tenants and the County Council and, in accordance with Section 36 of the Freedom of Information Act 2000, by virtue of the fact that the public interest in maintaining the exemption outweighed the public interest in disclosing the information.

18 Farm Relettings: Manor Farm, Holcombe and North Ground Farm, Milton Abbot

(An item taken under Section 100A(4) of the Local Government Act 1972 during which the press and public were excluded, no representations having been received to such consideration under Regulation 5(5) of the Local Authorities (Executive Arrangements) (Meetings and Access to Information) (England) Regulations 2012).

The Head of Digital Transformation and Business Support reported on the circumstances of these relettings.

The Committee then considered the rent for these holdings and interviewed prospective tenants. It was MOVED by Councillor Chugg, SECONDED by Councillor Brook and

RESOLVED

(a) That the tenancy of Manor Farm, Holcombe, Dawlish be offered to Mr JE on the terms and conditions proposed; and

(b) That the tenancy of North Ground Farm, Milton Abbot be offered to Mr JD on the terms and conditions proposed.

*DENOTES DELEGATED MATTER WITH POWER TO ACT

The Meeting started at 9.30 am and finished at 3.30 pm

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Agenda Item 14

2FARMS ESTATE COMMITTEE16/10/17

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Cabinet8 November 2017

SCHEDULE OF CABINET MEMBER DECISIONS TAKEN SINCE PREVIOUS MEETINGCabinet Remit/Officer Matter for Decision Effective DateInfrastructure, Development and Waste

Approval to the commencement of the Compulsory Purchase Order process for land associated with the A382 Corridor Improvement scheme, Newton Abbot.

13 October 2017

The Registers of Decisions will be available for inspection at meetings of the Cabinet or, at any other time, in the Democratic Services & Scrutiny Secretariat, during normal office hours. Contact details shown above.

In line with the Openness of Local Government Bodies Regulations 2014, details of Decisions taken by Officers under any express authorisation of the Cabinet or other Committee or under any general authorisation within the

Council’s Scheme of Delegation set out in Part 3 of the Council’s Constitution may be viewed at https://new.devon.gov.uk/democracy/officer-decisions/

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15

1

DEVON COUNTY COUNCIL

COUNCIL/CABINET FORWARD PLAN

In line with the public’s general rights of access to information and the promotion of transparency in the way which decisions are taken by or on behalf of the Council, Devon County Council produces a Forward Plan of any Key Decisions to be taken by the Cabinet and any Framework Decisions to be made by the County Council. The Plan normally

covers a period of a minimum of four months from the date of publication and is updated every month.

The County Council has defined key decisions as those which by reason of their strategic, political or financial significance or which will have a significant effect on communities in more than one division are to be made by the Cabinet or a Committee of the Cabinet. Framework Decisions are those decisions, which, in line with Article 4 of the Council’s

Constitution must be made by the County Council.

The Cabinet will, at every meeting, review its forthcoming business and determine which items are to be defined as key decisions and the date of the meeting at which every such decision is to be made, indicating what documents will be considered and where, in line with legislation, any item may exceptionally be considered in the absence of the press and

public. The revised Plan will be published immediately after each meeting. Where possible the County Council will attempt to keep to the dates shown in the Plan. It is possible that on occasion may need to be rescheduled. Please ensure therefore that you refer to the most up to date Plan.

An up to date version of the Plan will available for inspection at the Democratic Services & Scrutiny Secretariat in the Office of the County Solicitor at County Hall, Topsham

Road, Exeter (Telephone: 01392 382264) between the hours of 9.30am and 4.30am on Mondays to Thursdays and 9.30am and 3.30pm on Fridays, free of charge, or on the County Council’s web site, ‘Information Devon’, (http://www.devon.gov.uk/dcc/committee/) at any time.

Copies of Agenda and Reports of the Cabinet or other Committees of the County Council referred to in this Plan area also on the Council’s Website at

(http://www.devon.gov.uk/dcc/committee/mingifs.html)

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2

FORWARD PLAN All items listed in this Forward Plan will be discussed in public at the relevant meeting, unless otherwise indicated for the reasons shown Any person who wishes to make representations to the Council/Cabinet about (a) any of the matters proposed for consideration in respect of which a decision is to be made or (b) whether or not they are to be discussed in public or private, as outlined below, may do so in writing, before the designated Date for Decision shown, to The Democratic Services & Scrutiny Secretariat, County Hall, Exeter, EX2 4QD or by email to: members.services@devon.gov.uk

PART A - KEY DECISIONS (To Be made by the Cabinet)

Date of Decision

Matter for Decision

Consultees Means of Consultation**

Documents to be considered in making decision County Council Electoral Division(s) affected by matter

Regular / Annual Matters for Consideration

13 December 2017 10 January 2018

Target Budget: Target Budget: Impact of the Provisional Local Government Settlement for forthcoming year on the preparation of that year's budget and affirmation/re-affirmation of service expenditure targets

N/A N/A Report of the County Treasurer outlining all relevant considerations, information and material including any equality and / or impact assessments, as necessary.

All Divisions

9 February 2018

Admission Arrangements and Education Travel Review: Approval to admission arrangements for subsequent academic year

Schools, GBs and Phase Associations

Formal consulation and Devon Education Forum

Report of the Head of Education and Learning outlining all relevant considerations, information and material including any equality and / or impact assessments, as necessary.

All Divisions

11 April 2018

County Road Highway Maintenance Revenue Budget and On Street Parking Account Allocation of highway maintenance funding allocated by the Council in the budget for the current/forthcoming financial year

N/A N/A Report of the Chief Officer for Highways, Infrastructure Development and Waste outlining all relevant considerations, information and material including any equality and / or impact assessments, as necessary.

All Divisions

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16

3

11 April 2018

County Road Highway Maintenance Capital Budget Update on current years programmes and approval of schemes and proposed programmes for forthcoming financial year

N/A N/A Report of the Chief Officer for Highways, Infrastructure Development and Waste outlining all relevant considerations, information and material including any equality and / or impact assessments, as necessary.

All Divisions

Specific Matters for Consideration

8 November 2017

Promoting Independence in Devon - Approval to 'Arranging Care' and 'Choice of Care' Policies

Users and interested parties

Meetings and feedback from users/user groups

Report of the Head of Adult Commissioning and Health, Head of Adult Care Operations and Health outlining all relevant considerations, information and material including any equality and / or impact assessments, as necessary.

All Divisions

8 November 2017

Provider Quality Support Policy

TBC TBC Report of the Head of Adult Commissioning and Health outlining all relevant considerations, information and material including any equality and / or impact assessments, as necessary.

All Divisions

8 November 2017

Budget Monitoring: Approval of Month 6 Report and actions arising

n/a n/a Report of the County Treasurer outlining all relevant considerations, information and material including any equality and / or impact assessments, as necessary.

All Divisions

8 November 2017

Children's Centres Procurement - Award of Contract Award of Contract [NB: This item may contain information about the financial and business affairs of the Council and/or of a third party, purchaser or provider of property, goods or services that may need to be discussed in the absence of the press and public]

TBC TBC Report of the Head of Education and Learning outlining all relevant considerations, information and material including any equality and / or impact assessments, as necessary.

All Divisions

13 December 2017

Schools Revenue Budget 2018/19 - DfE Consultation

Schools and Devon Education Forum

Correspondence, meetings and website

Report of the Head of Education and Learning outlining all relevant considerations, information and material including any equality and / or impact assessments, as necessary.

All Divisions

13 December 2017

Strategic Intent: Doing What Matters Review of existing Strategic Plan

n/a n/a Report of the Chief Executive outlining all relevant considerations, information and material including any equality and / or impact assessments, as necessary.

All Divisions

13 December 2017

Regional Adoption Agency: Approval to Options Appraisal and Business Case for the interim Devon Single LA Hosted RAA (Minute *181/12 April 2017 refers)

Partner Authorities

Meetings and correspondence

Report of the Deputy Chief Officer, Children’s Service and Head of Social Care outlining all relevant considerations, information and material including any equality and / or impact assessments, as necessary.

All Divisions

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4

Between 13 December 2017 and 10 January 2018

Family Based Care Tender for provision of fostering placements Award of Contract [NB: This item may contain information about the financial and business affairs of the Council and/or of a third party, purchaser or provider of property, goods or services that may need to be discussed in the absence of the press and public]

n/a n/a Report of the Head of Childrens Social Care outlining all relevant considerations, information and material including any equality and / or impact assessments, as necessary.

All Divisions

Between 13 December 2017 and 11 January 2018

Roundswell South Business Park

Stakeholders including local residents, businesses, local organisations, statutory and voluntary agencies

North Devon & Torridge Local Plan process (draft plan submitted to Secretary of State and currently at Inquiry)

Report of the Head of Economy, Enterprise and Skills outlining all relevant considerations, information and material including any equality and / or impact assessments, as necessary.

Fremington Rural

Between 10 January 2018 and 14 February 2018

Future Arrangements for 0-19 Public Health Nursing Services

Users and Interested Parties

Feedback from Stakeholders, Users / User Groups

Report of the Chief Officer for Communities, Public Health, Environment and Prosperity outlining all relevant considerations, information and material including any equality and / or impact assessments, as necessary.

All Divisions

Between 10 January 2018 and 14 March 2018

Future Direction of Network Management

n/a n/a Report of the Acting Chief Officer for Highways, Infrastructure Development and Waste outlining all relevant considerations, information and material including any equality and / or impact assessments, as necessary.

All Divisions

10 January 2018

Capital Flood Improvement Scheme: Ivybridge Report to highlight the essential flood improvements required at Ivybridge to significantly reduce the ongoing risk and to request approval for carrying out the capital works funded by DCC, Defra Flood Defence Grant in Aid and Local Levy

n/a n/a Report of the Head of Planning, Transportation and Environment outlining all relevant considerations, information and material including any equality and / or impact assessments, as necessary.

Ivybridge

10 January 2018

Budget Monitoring: Approval to Month 8 Report and actions arising

n/a n/a Report of the County Treasurer outlining all relevant considerations, information and material including any equality and / or impact assessments, as necessary.

All Divisions

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16

5

10 January 2018

High Needs Block

Report of the Head of Education and Learning outlining all relevant considerations, information and material including any equality and / or impact assessments, as necessary.

All Divisions

14 March 2018

Flood Risk Management Action Plan – Update on the current year’s programme and approval of schemes and proposed investment in 2018/19

All other Risk Management Authorities

Liaison through Devon Operational Drainage Group

Report of the Head of Planning, Transportation and Environment outlining all relevant considerations, information and material including any equality and / or impact assessments, as necessary.

All Divisions

14 March 2018

Strategic Review of Special Educational Needs Provision

Report of the Head of Education and Learning outlining all relevant considerations, information and material including any equality and / or impact assessments, as necessary.

All Divisions

11 April 2018

Children and Young People Plan Approval to Children & Young People’s Plan for 2018 onwards

Report of the Chief Officer for Childrens Services outlining all relevant considerations, information and material including any equality and / or impact assessments, as necessary.

All Divisions

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16

6

PART B -FRAMEWORK DECISIONS (Requiring approval of the County Council)

Date of Decision

Matter for Decision

Consultees Means of Consultation**

Documents to be considered in making decision County Council Electoral Division(s) affected by matter

Between 8 November 2017 and 13 December 2017 8 November 2017

Heart of the South West - Joint Committee (Council Minute 86 - 16 February 2017) Approval to inter-authority agreement and terms of reference of Joint Commitee

Government and Bid partners

Meetings & Correspondence

Report of the Chief Executive outlining all relevant considerations, information and material including any equality and / or impact assessments, as necessary.

All Divisions

18 January 2018

Pay Policy Statement Recommendation to County Council in February of each year to approve, in accordance with the provisions of the Localism Act 2011 of the Councils Annual Pay Policy Statement setting out its policy for each financial year relating to remuneration of Chief Officers and other employees and the relationship between the pay of chief officers and other employees

Appointments & Remuneration Committee

Public Meeting Report of the outlining all relevant considerations, information and material including any equality and / or impact assessments, as necessary.

All Divisions

9 February 2018 15 February 2018

Revenue Budget, Medium Term Financial Strategy & Capital Programme for next subsequent financial year and beyond

Public, Stakeholders, Trades Unions, Business and Voluntary Sectors and public

Statutory consultations, meetings, fora and public meetings, correspondence and website

Report of the County Treasurer outlining all relevant considerations, information and material including any equality and / or impact assessments, as necessary.

All Divisions

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16

7

PART C - OTHER MATTERS (i.e. Neither Key Nor Framework Decisions)

Date of Decision

Matter for Decision

Consultees Means of Consultation**

Documents to be considered in making decision County Council Electoral Division(s) affected by matter

Regular / Annual Matters for Consideration

Between 8 November 2017 and 31 December 2019

Standing Items, as necessary (Minutes, References from Committees, Notices of Motion and Registers of Delegated or Urgent Decisions)

As necessary Report of the outlining all relevant considerations, information and material including any equality and / or impact assessments, as necessary.

All Divisions

Between 2 October 2017 and 1 May 2021 Between 8 November 2017 and 1 May 2021

Standing items on the future management, occupation, use and improvement of individual holdings and the estate, monitoring the delivery of the Budget & the Estate Useable Capital Receipts Reserve in line with the approved policy and budget framework [NB: Items relating to the letting or occupancy of individual holdings may contain information about, or which is likely to reveal the identity of, an applicant for a holding and about the financial and business affairs of the Council and any prospective or existing tenant that may need to be discussed in the absence of the press and public]

To be considered at the Farms Estates Committee, including any advice of the Council’s Agents NPS South West Ltd

Report of the County Treasurer, Head of Digital Transformation and Business Support outlining all relevant considerations, information and material including any equality and / or impact assessments, as necessary.

All Divisions

8 November 2017

Devon Safeguarding Adults Boards Annual Report: Endorsement of Annual Report

na/ n/a Report of the Chief Officer for Adult Care and Health outlining all relevant considerations, information and material including any equality and / or impact assessments, as necessary.

All Divisions

13 December 2017

Treasury Management Mid Year Stewardship Report

n/a n/a Report of the County Treasurer outlining all relevant considerations, information and material including any equality and / or impact assessments, as necessary.

All Divisions

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8

9 May 2018

Public Health Annual Report 2016-17 Receipt of statutory annual report on the health of people in Devon by the Director of Public Health.

N/A JSNA Report of the Chief Officer for Communities, Public Health, Environment and Prosperity outlining all relevant considerations, information and material including any equality and / or impact assessments, as necessary.

All Divisions

Between 9 May 2018 and 14 June 2018

Approval to Revenue & Capital Outturn, for the preceding financial year

N/A N/A Report of the County Treasurer outlining all relevant considerations, information and material including any equality and / or impact assessments, as necessary.

All Divisions

11 July 2018

Annual Childcare Sufficiency Report: Endorsement of Annual report outlining how the Council is meeting its statutory duty to secure sufficient early years and childcare places and identifying challenges and actions for the coming year in relation

Interested parties and partners and schools and parents

Report of the Head of Education and Learning outlining all relevant considerations, information and material including any equality and / or impact assessments, as necessary.

All Divisions

11 July 2018

Treasury Management Stewardship Outturn Report

Corporate Services Scrutiny Committee

n/a Report of the County Treasurer outlining all relevant considerations, information and material including any equality and / or impact assessments, as necessary.

All Divisions

14 November 2018

Devon Safeguarding Adults Board Annual Report 2017 To receive the Annual Report of the Devon Safeguarding Adults Board

N/A N/A Report of the Democratic Services and Scrutiny Manager outlining all relevant considerations, information and material including any equality and / or impact assessments, as necessary.

All Divisions

Specific Matters for Consideration

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ACH/17/57Cabinet

8th November 2017

CHILDREN’S CENTRE SERVICES (CP1439-17): OUTCOME OF TENDER AND AWARD OF CONTRACT

Report of the Chief Officer Children’s Services.

Recommendations:

That approval be given to the contract award recommendations set out in Report ACH/17/58.

1. Introduction

1.1 The Children’s Centre Services are the key delivery mechanism for the local authority to meet their statutory duties referenced in the Children Act 1989, the Childcare Act 2006, and Working Together 2015. To improve the well-being of young children and reduce inequalities Children’s Centre Services are key delivery partners within Devon’s Children’s Services Delivery Plan and Targeted Families Support programme (national Troubled Families Programme), they are critical to the delivery of Early Help to children and families from pre-birth through to eight years of age.

1.2 The Joint Health and Wellbeing Strategy, emphasises the need for children to have the best start in life. This is further supported by the work of the Wider Devon Sustainability and Transformation Plan where Best Start in Life is a priority coupled with a focus on preventing adverse childhood experiences.

1.3 Achieving the Best Start in Life for children spans the delivery of a wide range of services. It is vital that the system of services, including Public Health Nursing and Children’s Centres work effectively with a common purpose to ensure outcomes are improved.

1.4 As part of the design process through an options appraisal, joint working between services will be explored to define the co-dependencies and to increase integrated working.

1.5 In Devon the current Children’s Centre Service offers a balance of universal and targeted services for families with children aged four and under. Through the life of the new contract the service will move to providing targeted Early Help support for families increasing the age group to children aged eight and under.

1.6 Following extensive consultation in 2014 the following principles were agreed;

Focus services on the most vulnerable Reduce building costs

Please note that the following recommendations are subject to consideration and determination by the Cabinet (and confirmation under the provisions of the Council's Constitution) before taking effect.

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Focus funding on front line delivery Encourage others to deliver some universal services from Children’s

Centre buildings Reduce numbers of contracts from 43 to 8 aligning to city/council

boundaries in order to reduce management cost

1.7 The new commissioning model was adopted and the Children’s Centres in Northern Devon and the South West areas were completed by April 1st 2015 with 6 contracts let aligned to district council boundaries. The recent procurement process undertaken in Northern Devon and South and West Devon culminated in one provider being successful in all contract areas which has realised further efficiencies in management costs.

1.8 To continue with the efficiencies realised through rationalising the contracts and to allow for the increase in service provision (to families with children aged 8 and under) it was agreed to rationalise the service into one contract covering the authority boundaries of DCC. This has also been the natural results from previous procurements which have resulted in a single provider being successful across the service areas.

1.9 The total estimated value of the Children’s Centre Services contract is approximately £29.5 million over 5 years (the contract will be for a 3 year term with an option to extend for up to a further 2 years).

2. Children’s Centre Services: context and contract design

2.1 The Children’s Centre Services contract will;

• Embed the service into Early Help system • Deliver universal offer for families wanting to return to work or access

training opportunities to enable them to do so • Deliver targeted intervention and support to children 8 years and

under • Deliver a whole family approach to improving outcomes for families • Support families to prevent the need for statutory intervention • Deliver a range of evidenced based parenting interventions• Improve joint working to improve school readiness and increase early

help particularly for children with communication needs. • All of this will be delivered through a progressive contract,

acknowledging the risks associated with the transition from universal to a more targeted approach

The service will meet the needs of targeted families with children aged eight years and under within the boundaries of Devon County Council’s administrative area and will align to the Children and Families Partnership’s four areas of Exeter, Mid and East Devon, South Devon and Northern Devon. All parents and families who are expectant parents or have a child aged eight or under, will have access to a Children’s Centre across the locality area.

2.2 Robust performance measures will be in place to ensure the effective delivery of the service including the transition to targeted services and increase in eligible families. This will be backed up with structured contract monitoring

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Agenda Item 17

arrangements and management information which will be used to further develop and target the service.

3. Financial Considerations

3.1 The financial impact of the contract is set out in the Part 2 report.

4. Sustainability Considerations

4.1 The single contract structure was adopted because it provides the optimum combination of service delivery and efficiency which will allow the Commissioners and the Provider to widen the service to include families with children aged up to eight years and under and mitigate reductions in the budget available. This structure has also been proven effective by the results of previous re-commissioning processes.

5. Equality Considerations

5.1 A detailed impact assessment was undertaken at the pre-procurement stage of this project and the outcomes reflected in the construction of the tender and contract documentation and in the evaluation of the tenders and as such meets our equality duties. EIA attached

6. Risk Management

6.1 Risks identified as part of the process are that the service will not progress from a universal to a targeted service including increasing the eligible age range for families as intended and that there may be gaps between this service and other commissioned services. These have been mitigated by designing into the service specification robust performance monitoring and management processes and ensuring that it is explicit in the specification that the provider must work closely and collaboratively with all partner agencies and providers.

7. Summary/Conclusions/Reasons for Recommendations

7.1 The new Children’s Centre Services contract will realise efficiencies through the single contract / provider model both through reduced costs to the provider which would be passed on to the authority in the form of increased budget allocated to direct service delivery and in management and monitoring of the contract for DCC officers. These efficiencies will allow DCC to ensure the sustainability of the service despite budgetary pressures and allow for the increase of service delivery to fulfil an identified gap in provision that was not previously covered. It is also intended that earlier more targeted interventions will prevent the need for statutory intervention avoiding the related impacts of this.

Electoral Divisions: All

Cabinet Member for Children’s Services: Councillor James McInnes

Head of Children’s Commissioning: Fiona Fleming

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Agenda Item 17

LOCAL GOVERNMENT ACT 1972: LIST OF BACKGROUND PAPERS

Contact for Enquiries: Val Smith (Senior Commissioning Manager Early Years) and Nicola Tribble Head of Category (People) Tel No: 01392 382300 Annexe Floor 1

BACKGROUND PAPER DATE FILE REFERENCE

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Impact AssessmentVersion 2016

Assessment of: Children’s Centre Commissioning

Service: Education

Head of Service: Dawn Stabb

Date of sign off by Head Of Service/version: 13 June 2017

Assessment carried out by (incl. job title): Val Smith Senior Commissioning Manager Early Years

Section 1 - Background

Description: The Early Years’ Service undertook a thorough public consultation in 2014 and the following principles were agreed.

Reduce buildings in order to concentrate funding on front line services Continue to provide a universal entry into Children’s Centre activities Reduce numbers of contracts from 43 to 8 aligning to city/council boundaries in order to reduce

management cost

The new commissioning model was adopted and the children’s centres in Northern Devon and the South West areas were completed by April 1st 2015 with 6 contracts let aligned to district council boundaries. However the planned procurement of Exeter/East and Mid Devon was delayed by one year whilst we explored the possibility

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of jointly commissioning the Public Health Nursing service and children’s centre service as one contract. This has been investigated but due to complex issues within their current contract it was agreed by senior officers and lead members that due to the complexity of the situation the two service areas would remain independently commissioned but develop service specifications that would be co-dependant ensuring a seamless service for families.

Children’s Centres continue to act as a community hub co-ordinating and delivering integrated universal and preventative and targeted services which provide support to children under 5 and their families. Whilst Children’s Centres do provide a small number of universal services their focus is primarily on engagement with vulnerable and disadvantaged families.

They work in partnership with Midwifery and the Health Visiting Service who do offer a universal service to all families with young children.

There has been an appraisal of all designated Children’s Centre buildings in Devon in line with the 2014 consultation and the number of buildings has been significantly reduced in order to reduce management costs and develop the outreach model. .

The recent procurement process undertaken in Northern Devon and South and West has culminated in one provider being successful in all contract areas which has further management costs.

Reason for change/review and options appraisal:

Due to financial pressures a Children’s Centre review has taken place as a further savings target will have to be met in 2018.

Devon’s Early Help strategy has been reviewed and within this the preventive role Children’s Centres play in supporting families with young children. The emphasis continues to offer Early Help to the most vulnerable families with young children preventing escalation where appropriate and reducing the chances of children repeatedly entering into social care statutory services.

However a gap has been identified in the targeted support system for children between the age 5 and 8 years

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therefore discussions have taken place with other Early Help providers to transition targeted family support in to Children’s Centres for families with children between 5 and 8 years where access to evidenced based parenting programmes /approach is identified as part of an Early Help plan.

In recent years the potential market place of providers wishing to deliver Children’s Centres has diminished significantly. This is due in the main to the reduction in funding and also change in direction of some national providers to working with the most vulnerable older children and young people. Devon County Council remains committed to commissioning services rather than direct delivery of services. To mitigate against future budget reductions and by using the learning from the two previous tenders where one organisation has been successful it is proposed that one county contract is procured which will further reduce management costs focusing funding on front line delivery.

However a Market Warming event will be facilitated prior to the launch of the tender by DCC procurement and space will be given to interested providers of all sizes to look at how partnerships/consortium bids may be developed. There will also be a specific question built into the award criteria about how the provider will work in partnership with both DCC and local partners in order to improve outcomes for families with young children.

Section 2 - Key impacts and recommendations

Social/equality impacts: The service will continue to work alongside partners in health and midwifery services to provide a specialist targeted support offer focusing resources on children 0-3 where the evidence base shows that a warm and secure attachment from parents is critical for young children. A warm, consistent and secure attachment with a primary caregiver provides the environment which enables good social and emotional development (1001 critical days). They will continue in line with the agreed principles in the 2014 consultation to direct resources to children living in families in the most deprived communities in Devon that are at more significant risk of having poor life

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chances in health and, education when entering into adulthood.

However the new service specification will provide the opportunity for families with children aged 5 to 8 years to receive a targeted family support offer through their families attending an evidenced based parenting programme and where appropriate direct support in line with their work already undertaken in the targeted family support programme.

Environmental impacts: There is no environmental impact anticipated as number of centres is expected to remain the same

Economic impacts: It is envisaged that by procuring one contract sufficient management savings will be identified to support the additional evidenced based parenting programmes that will be required through the extended age range. The successful service provider will be asked to identify efficiency savings which will then be diverted to support families with children between 5 and 8 years. Extending the age range may provide opportunities to broaden the knowledge and skills and experience of the workforce.

Other impacts (partner agencies, services, DCC policies, possible ‘unintended consequences’):

The development of a co- dependant service specification with the Public Health Nursing service would provide a real opportunity to develop a seamless service for families creating a pathway of support identifying the “right person” at the “right time” to support families with young children.

Links with primary schools would have to be strengthened as in the main they would identify families who may benefit from the extended parenting programmes.

How will impacts and actions be monitored?

Through robust contract monitoring arrangements undertaken by Devon County Council as Responsible Body

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Section 3 - Profile and views of stakeholders and people directly affected

People affected: The current population 0- 5 years in Devon which is 37,984

71627226

7592

7765

8239

Under 1 1 Year 2 Years 3 Years 4 Years690070007100720073007400750076007700780079008000810082008300

Children's Age Breakdown

Therefore in terms of delivery of the service, all children in this age group and their families could be affected.

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Diversity profile and needs assessment of affected people:

Who is the target group for services?The intended overall ‘customer base’ for the Children’s Centre service is the most vulnerable children aged 0-5 and their parents/carers (and including children aged 5-8 in specific circumstances). The Children’s Centre Profile provides specific analysis regarding the 0-5 population based on data regarding children’s health and wellbeing and the demographics of those using or not using the service. In general, the analysis and data provided in the Children’s Centre Profile demonstrates that at a Devon level, and for many geographic areas, the health and wellbeing of Devon’s children aged 0-5 is relatively good compared when compared nationally. However, the overall figures can disguise inequality of outcomes for individual children and specific Lower Super Output Areas (LSOAs) in both urban and rural areas.

Summary data from the Family Support assessments (Outcomes Star) are used to understand the common areas of need that parents and carers in need of Early Help require as part of an intervention. Areas such as Emotional Wellbeing (for both parent and child), Isolation, and Child Boundaries and Behaviour are common areas of need and are some of the most usual reasons for intervention for targeted family support.

Evidence Informed Parenting Programme datasets provide a similar picture. Parents indicate that their highest levels of need at the start of the course are focused on concern around their child’s boundaries and behaviour, and how their children manage their feelings. Our datasets show successful outcomes in these areas are achieved by the end of the course and these are closely linked to parent’s increased understanding of their child’s development and feeling more confident in their parenting by the end of the course.

The following data provides an overview of Children’s Centre performance with regard to registration and reach: 85% of children aged 0-5 are registered with their closest Children’s Centre. 49% of children aged 0-5 attended a centre at least once in the past 12 months. 81% of all children aged 2 years and under were registered with a Children’s Centre 59% of children aged 0-2 years and under attended a centre at least once over the past 12 months.

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85

49

Registration Reach0

20

40

60

80

100

Universal Engagement with Children aged 0-5 (%)

One of the most complete and up to date data sets for children aged 0-5 and their carers is based on data routinely collected across Children’s Centres in Devon by the E-Start database. This enables us to understand not only about population need and service use in Devon, but also our engagement with the most vulnerable groups.

Of those registered, 24% (7914) of children aged under 5 years lived in a family shown by research1 as putting children at a greater risk of poorer outcomes in life. These family types are shown on the following chart. Of these children, over 60% (4780) were seen by the Children’s Centre during Jan – Dec 2015. Reach to these children is higher than reach to the general population.

1 C4EO (2009) Narrowing the Gap in Outcomes for Young Children through Effective Practices in the Early Years, DfE (2013) Family Stressors and Children’s Outcomes.

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61

67

58

58

53

65

66

81

0 10 20 30 40 50 60 70 80 90

Lone Parent

Workless Household

Teenage Parent (19 and under)

Young Parent (21 and under)

Child with BME background

Child living with carer with illness/disability

Child with an illness/disability

Children on the CareFirst database...

Percentage of Children reached living in Households with a Vulnerable Characteristic

2.1 When considering the most deprived geographical areas: 89% of children aged 0-5 who live in the most deprived areas are registered with a Children’s Centre in Devon. 62% of children aged 0-5 who live in the most deprived areas (where the most resources are focused) attended a

centre at least once in the past 12 months.

Other stakeholders: Key stakeholders will include ;Devon Children and Young People Families Alliance, Devon Safeguarding Board, Public Health, New Devon CCG, South Devon CCG, NHS England , Children’s Social Care and Early Help

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Service, current provider and families who use the service. .

Consultation process:

Research and information used:

Children Centre Profile (0-5s): The Children’s Centre Profile draws together demographic information, performance information and population indicators for children aged 0-5. Data relating to patterns of service make good use of the information collected and stored on the E-Start Database.

E-Start Database: The E-Start database is one of the most complete and up to date sources of data regarding children aged 0-5 and their parents/carers. The database is used to understand the diversity and demographics of the population as well as to understand patterns of service use by different groups.

Evidence Informed Parenting Tool: A standardised approach to collecting and collating need and outcome data is in place across all Evidence Informed Parenting Programmes being run by Children’s Centre. The dataset has been used in this document to identify areas of need and outcomes achieved.

Outcomes Star: The Outcomes Star is used routinely across all Children’s Centre to assess need and measure progress towards outcomes for families. The data has been used in this document to outline specific areas of need that any future service redesign needs to consider.

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Background AnalysisThis section describes how relevant questions and issues have been explored during the options appraisal.

Section 4a - Social Impacts

Giving Due Regard to Equality and Human Rights

The local authority must consider how people will be affected by the service, policy or practice. In so doing we must give due regard to the need to:

Eliminate unlawful discrimination, harassment and victimisation Advance equality of opportunity and Foster good relations.

Where relevant, we must take into account the protected characteristics of age, disability, gender, gender reassignment, pregnancy and maternity, marriage and civil partnership, sexual orientation, race, and religion and belief.

This means considering how people with different needs get the different services they require and are not disadvantaged, and facilities are available to them on an equal basis in order to meet their needs; advancing equality of opportunity by recognising the disadvantages to which protected groups are subject and considering how they can be overcome.

We also need to ensure that human rights are protected. In particular, that people have:

A reasonable level of choice in where and how they live their life and interact with others (this is an aspect of the human right to ‘private and family life’).

An appropriate level of care which results in dignity and respect (the protection to a private and family life, protection from torture and the freedom of thought, belief and religion within the Human Rights Act and elimination of discrimination and the promotion of good relations under the Equality Act 2010).

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A right to life (ensuring that nothing we do results in unlawful or unnecessary/avoidable death).

The Equality Act 2010 and other relevant legislation does not prevent the Council from taking difficult decisions which result in service reductions or closures for example, it does however require the Council to ensure that such decisions are:

• Informed and properly considered with a rigorous, conscious approach and open mind, taking due regard of the effects on the protected characteristics and the general duty to eliminate discrimination, advance equality and foster good relations.

• Proportionate (negative impacts are proportionate to the aims of the policy decision)

• Fair

• Necessary

• Reasonable, and

• Those affected have been adequately consulted.

Characteristics In what way are you eliminating or reducing the potential for direct or indirect discrimination, harassment or disadvantage?

Are there any reasonable and proportionate, unavoidable negative consequences?

In what way are you advancing equality (meeting needs, encouraging participation, making adjustments for disabled people, ‘closing gaps’).

In what way are you fostering good relations between groups (tackling prejudice and promoting understanding), if relevant?

All residents (include generic equality provisions):

The aim of the service is to continue to provide advice and support to all families with young children 0-8 years.

However the service specification will require the provider to focus targeted resources on the most vulnerable

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families with children under 8 where an offer of Early Help package of service would avoid escalation into children’s social care.

Age: The service will cover all children and families 0-8 years that are resident in Devon. The service specification will require the provider to plan their specific level of engagement for teenage parents as they are seen a priority group identified by Ofsted

Disability (incl. sensory, mobility, mental health, learning disability, ill health) and carers of disabled people:

Families with children with special educational needs and disabilities are a priority group identified by Ofsted. The service specification will require the provider to fully engage with parents who may be affected by their own disability, mental health, learning disability, ill health or mobility issues and play a key role within a multi-agency approach to supporting vulnerable groups.

Culture and ethnicity: nationality/national origin, skin colour, religion and belief:

The specification requires the provider to apply evidenced based practice to ensure that all families with children under 8 years receive a level of service appropriate to their needs. The provider will be required to demonstrate how they can meet the needs of families from diverse ethnic backgrounds, based on demographic information in their area and local intelligence from partner agencies.

They will be required to implement equal opportunities policies and to actively promote an inclusive culture taking into account religious belief.

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Sex, gender and gender identity (including men, women, non-binary and transgender people), and pregnancy and maternity (including women’s right to breastfeed).

The service specification will require the provider to work with organisations within communities to support all families regardless of their sex, gender and gender identity”

During pregnancy parents are encouraged to engage in children’s centre services at the earliest opportunity through midwives and health visitors.

Sexual orientation and marriage/civil partnership:

The service specification will require the provider to work with organisations within communities to support all families regardless of sexual orientation or marriage/civil partnership status.

Other socio-economic factors such as families, carers, single people/couples, low income, vulnerability, education, reading/writing skills, ‘digital exclusion’ and rural isolation.

The evidence is clear that children living in families in the most deprived communities in Devon are at more significant risk of having poor life chances in health and, education when entering into adulthood.

The service will target their resources to meet the needs of families with young children in the most disadvantaged communities as identified by the National Index of Multiple Deprivation (IMD)

Human rights The service will continue to work in partnership with health and education to ensure that all families with children

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considerations: under 8 years are supported to meet their needs and build capacity of community based resources so that a universal service can continue to be delivered.

Section 4b - Environmental impacts

An impact assessment should give due regard to the following activities in order to ensure we meet a range of environmental legal duties.

The policy or practice does not require the identification of environmental impacts using this Impact Assessment process because it is subject to (please select from the table below and proceed to the 4c, otherwise complete the environmental analysis table):

Devon County Council’s Environmental Review Process for permitted development highway schemes.

Planning Permission under the Town and Country Planning Act (1990).

Strategic Environmental Assessment under European Directive 2001/42/EC “on the assessment of the effects of certain plans and programmes on the environment”.

Describe any actual or potential negative consequences.

(Consider how to mitigate against these).

Describe any actual or potential neutral or positive outcomes.

(Consider how to improve as far as possible).

Reduce waste, and send less waste to landfill:

No impacts identified, the number of centres is expected to stay the same.

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Conserve and enhance biodiversity (the variety of living species):

No impacts identified

Safeguard the distinctive characteristics, features and special qualities of Devon’s landscape:

No impacts identified

Conserve and enhance the quality and character of our built environment and public spaces:

No impacts identified

Conserve and enhance Devon’s cultural and historic heritage:

No impacts identified

Minimise greenhouse gas emissions:

No impacts identified

Minimise pollution (including air, land, water, light and noise):

No impacts identified

Contribute to reducing water consumption:

No impacts identified

Ensure resilience to the future effects of climate change

No impacts identified

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(warmer, wetter winters; drier, hotter summers; more intense storms; and rising sea level):

Other (please state below):

Section 4c - Economic impacts

Describe any actual or potential negative consequences.

(Consider how to mitigate against these).

Describe any actual or potential neutral or positive outcomes.

(Consider how to improve as far as possible).

Impact on knowledge and skills:

Extending the age range covered by the service may provide opportunities to broaden the knowledge, skills and experience of those working with children 0-8 years.

There is no particular impact arising from the move to one contract though this may provide for economies of scale relating to workforce development.

Impact on employment levels: No impacts identified as the number of centres and workforce establishment is expected to remain the same

Impact on local business: One contract may preclude or limit small, local organisations from bidding. However the contractor may ‘sub-contract’ to smaller

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providers.

Section 4d -Combined Impacts

Linkages or conflicts between social, environmental and economic impacts:

None identified

Section 5 - ‘Social Value’ of planned commissioned/procured services:

How will the economic, social and environmental well-being of the relevant area be improved through what is being proposed? And how, in conducting the process of procurement, might that improvement be secured?

The change to one contract will generate the efficiencies which will be used to extend the level of service provided to more children and families (up to 8 years of age), providing better and more targeted support with the expectation of improved social and health outcomes.

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Agenda Item 19By virtue of paragraph(s) 3 of Part 1 of Schedule 12Aof the Local Government Act 1972.