Agenda item

[Jennifer Rogers, Quality and Improvement Advanced Practitioner, to present report]

The Director of Adult Services in his opening remarks commented that not all local authorities in adult social care services carried out file audits. The Quality and Improvement Advanced Practitioner stated that in 2018-2019 there had been over 120 file audits in City of Wolverhampton Council’s Adult Social Services Department.  In addition to these there had also been two audit the Auditor checks, to check the quality and consistency of the bi-monthly file audits.  Dip sampling audits had been carried out to measure quality or address specific issues as part of the implementation of the 3 Conversations approach.  More than 50 dip samples had been carried out in 2018/19.  There had also been two thematic audits completed during the year.

The Quality and Improvement Advanced Practitioner stated that file audits in adult social care in Wolverhampton took place every other month.  The auditors ranged from front line managers all the way up to Director level.  They measured files in terms of CQC ratings.  There had been some fluctuation in the current year in quarter 2 and quarter 3.  A new way of working had been introduced in July and they thought this may have helped to explain the dip in the results.  However, they now believed it was down to overly optimistic previous ratings.  In November work was undertaken with managers to discuss the findings of an audit the auditor audit carried out in July 2018, which may have led to a more critical approach being taken in November’s audit in response to the feedback that some auditors wererating files as “good” when a lower rating would have been more appropriate.    

The Quality and Improvement Advanced Practitioner commented that there had been some high performance in a number of areas.  These areas included, Making Safeguarding Personal, Demonstrating Dignity and Respect, Timelessness and Responsiveness and Continuity of Support.  Additional areas which had become strengths from quarter one in the current year included, effective multi-agency working, clear and detailed eligibility and involvement of family members/carers.  She was particularly pleased that there had been a significant improvement in care assessments in quarter 4.   

The Quality and Improvement Advanced Practitioner remarked that an area which required further improvement was in reflective and analytical thinking.  Practitioners were not always recording their reflective discussions or thinking on people’s files.  A revised recording policy was disseminated to teams in January 2019 which contained a section on reflectiverecording to support practice and improve worker confidence.  Another action to address the need for better recording of reflective practice included the introduction of a monthly manager support programme from April 2019 which would cover areas identified by audits. The aim was to support frontline managers improve quality and practice in their teams. Reflective recording would be the focus of the session in June 2019. They were keen to ensure the voice of the person was captured within files. 

A Member of the Panel stated that he was aware of a very complicated case approximately two years ago where the legal guardianship had been taken away from a family who were looking after a sibling.  A care bill of over 20,000 pounds had then been built up.  She asked if financial management was one of the areas which the social workers audited when going through the files.  In response, the Director of Adults commented that financial matters should be included as part of the annual review.  The management of finance was not a complaint which came up often in the complaints process.  When they became aware of issues of finance with a particular person, the Council were able to offer the Appointeeship Service. 

A Member of the Panel expressed surprise that some authorities did not complete social care file audits.  She recommended that a report on this subject area in the future should have a glossary of terms due to the specialised language and phrases in social care.  Whist she thought the overall picture was good, she had two areas of concern which were highlighted within the report, these were risk assessment and analysis and reflective recording.  She thought supervision on a six-week basis would help to resolve the two issues she had highlighted.  A second member of the Panel echoed these views, adding that the risk assessment statistics in the last quarter had improved to 65%, but he was concerned this was still short of where the Council needed to be in an area of critical importance.  He asked if there was going to be an ongoing programme of work or if the actions identified in the report to address the issues were one off action events. The Principal Social Worker responded to these comments by stating that there was an overall Workforce Development Plan.  There were certain topics which would be revisited every year with risk, strength-based conversations and carers assessments falling in this category.  In the current year they would be training a large number in the workforce on restorative approaches, which was about ensuring excellent strength-based relationship practice. 

A Member of the Panel asked for how long the Council had been undertaking file audits in the adult social care service and how the latest statistics compared qualitatively to previous years.  The Principal Social Worker responded that the Council had been carrying them out for the last three years.  The report last year had shown more significant dramatic improvements from the year before. The current year had showed more continued gradual improvement across the areas highlighted within the report.  She offered to include a comparison in next year’s report from the previous year. 

A Member of the Panel asked if the Adult Social Care service was being consistently challenged in particular areas across the years.  In response the Principal Social Worker stated that one area they always struggled with was recording reflective practice.  Social workers did not always find the time to record their reflective practice in the way that they would like.  Such reflective practice had often been carried out but not formally recorded.  In the present year they were changing the operating model and consequently had adjusted their recording forms.  She hoped that this change would make a real difference to recording practices.  Training, team meetings and reflective sessions were further ways of reminding staff about the importance of recording reflective practice.  The Director of Adults Services echoed the Principal Social Worker’s points regarding recording reflective practice. Next year he hoped to be able to incorporate some independent case file audit work from the work that was being done as part of the sector led improvement peer reviews in the West Midlands.  Other authorities tended to struggle in the same areas as Wolverhampton. 

A Member of the Panel referred to paragraph 3.2 in the report, which stated that almost 5% of people who received a service from Adult Social Care in Wolverhampton had received some form of qualitative audit in 2018-2019.  He asked for further information as to why it was at 5% and if there was any intention to increase the amount in the future.  The Director of Adult Services responded that 5% was actually quite high compared to the authorities that did carry out file audits in social care.  If more audits were carried out there would not be the time to ensure they were of a high standard and so some of the insights would be lost.  The Principal Social Worker commented that often only a small sample was needed to pick up on patterns and themes quite quickly.  When they went to other authorities to help with file audits, they would pick a maximum of 30 files. 

A Member of the Panel asked who determined which files were chosen to audit.  The Principal Social Worker responded that there was an Insight Performance Team who used a set criteria.  

Resolved: That the report be noted by the Adults and Safer City Scrutiny Panel and the Panel’s comments be taken account of in future reports on Adult Social Care File Audits.