7.1.1 Commissioning and Provider Services

1. Working with Providers

It is the responsibility of the local authority to work with providers of adult social care to ensure all services provided (be they in-house or external) are safe and meet the needs of service users.

If services do not meet appropriate standards, they may place individuals at risk. The Care Quality Commission (CQC) ensures that providers have planned reviews to measure compliance against the regulations. In addition, the CQC will undertake responsive reviews where there is a sufficient concern.

Important to note, is that any inspection is only a snapshot so there is a responsibility on local authorities to be the ‘eyes and ears’ in terms of quality and standards. Also important to note is the CQC inspect registered services only so that services such as day care, or supported living without domiciliary care, are out of scope of registration.

There is information from a range of sources that will provide information regarding the quality of services:

• Whistleblowing about a named home where names of individuals not known:
  Concerns may be registered about a particular home/service where the names of individuals who may be at risk are not known.
• CQC reports and regulatory letters / information:
  • CQC publish reports on their website for all services inspected. On a monthly basis they circulate notifications to local authorities of all inspection reports that have been published in the previous month (for services in their area);
  • CQC reports outline any statutory requirements or recommendations following inspections. The CQC should liaise closely with local authorities with regard to any registered provider concerns in relation to quality standards.
• Referrals cautions or safeguarding alerts; or
  • Where there are concerns that the care provided is making the adult at risk – a Safeguarding referral should be made (See Worried About an Adult, Hull City Council website) and the health and social care commissioning manager informed.
  • Where is concern about the quality of care being provided – the relevant line manager and health and social care commissioning manager should be informed.
• Referrals to the local authority Safeguarding Adults Team:
  Safeguarding Alerts may lead to Safeguarding Adults investigations and subsequently indicate wider quality concerns about provider organisations.
• Deprivation of Liberty Safeguards (DoLS):
  Requests made and / or authorised under the Mental Capacity Act 2005 in relation to DOLS are monitored and reported on and may highlight service concerns Note that the Supreme Court in March 2014 set out a revised test for determining a deprivation of liberty that is far broader than those set by previous judgments.
• Complaints, MP enquiries and Member enquiries:
  Where complaints or enquiries are made regarding service delivery for Adult Community Care services these are raised with the relevant team manager.
• Financial checks:
  Credit checks measure financial robustness.
• Insurance checks:
  Services are required to have a range of Insurance in place, depending on the nature of the service provided. Services without adequate insurance place service users and the local authority at possible financial risk.
• Performance and quality information:
  A range of information is gathered in relation to a service’s performance and quality which benchmark for safeguarding. Some of this is officially collated whilst some might also be informal. It will be evaluated to ascertain if concerns about the quality of a provider are presenting.
• Policies and procedures:
  Whilst no guarantee about service delivery, policies and procedures give an indication of a provider’s intent and may highlight areas of poor practice that could occur should they not be followed.
• Feedback from individuals and reviews:
  Any individual in contact with a service may raise concerns about its quality. This might be a person receiving a service, their family, carers or friends, a member of staff or a professional visiting the service. Such information will be received through a range of routes depending on the source.
• Commissioning monitoring information:
  Information from commissioners is key and will be used to enable managers and staff to have an overview of the quality of services and ensure that a whole picture of service provision is available.

2. Why Do We Need a Joined Up Approach to Ensuring Quality in Provider Services?

• Local authorities and health agencies have responsibility to the whole of their population, not just those people accessing support via the council, therefore encompassing people purchasing their own care. This means wider responsibility to ensure that the care services available are of sufficient quality. Quality may be defined as:
  • ‘Having choice and control over day-to-day and significant life decisions;
  • Maintaining good relationships with family, partners, friends, staff and others;
  • Spending time purposefully and enjoyably doing things that bring people pleasure and meaning;
  • Having services which enable these outcomes to be achieved and sustained’.
• People who use services and their families are looking for authoritative and reliable information about services so that that they can make informed personal decisions;
• Accurate and timely Information sharing between health and social care agencies is paramount in ensuring that provider concerns raised with one agency are shared to prevent further potential abuse in other areas where the provider operates.

3. How Do We Ensure a Joined up Approach to Ensuring Quality?

Contracts and commissioning

• Local authorities and health agencies work together to ensure learning from good practice and more joined up working.

Listening to people

• Communication links between community health and adult social care are strong. District nurses, dentists, social workers, community psychiatric nurses and carers all play a pivotal role in identifying concerns in people’s own homes and places where they are cared for. It is essential that these concerns are shared with appropriate colleagues to ensure that follow up action is effective and proportionate.

Information sharing

• When deemed necessary, information is shared with neighbouring authorities, Care Quality Commission, NHS Trusts, Children’s Services, Humberside Police, and other commissioners of health and social care services;
• Information is provided regarding providers on local authority websites and updated to ensure that information is accurate and up to date;
• Accessible, easy to understand information is available for people who use services and their families to report concerns and be involved with improvement plans with providers where relevant.

See also Information Sharing and Confidentiality chapter.

Working with providers

• Where quality standards are not met, local authorities work with care providers through the development of improvement plans that are monitored to ensure that improvements are producing positive outcomes for those people using the service;
• Local authorities ensure that contracts and service level agreements are monitored regularly by staff who understand quality and safeguarding issues and that staff are able to identify and share that information when necessary;
• When issues are highlighted involving care providers, local authorities undertake joint investigations with health agencies to ensure that an individual’s health, safety and care needs are being met to a high standard.

Reporting

• Local authorities will identify emerging trends and develop joint strategies for managing improvement.

4. Commissioning Role in Safeguarding Adults

Involving commissioning in safeguarding investigations

When there is a safeguarding alert / investigation about a service that is paid for by the council or the NHS, someone responsible for commissioning that service should be informed. The commissioner will send a representative to attend the strategy meeting.

They will always want to be informed of the outcome of investigations and in some cases they may have specific actions after the case conference to work with provider services to improve practice.