(All quotations are from the CSCI report headed ‘Independence, Wellbeing and Choice, Surrey County Council 2008′ which was published on the 21st of October, and can be found here. ) 

It was clear from the CSCI (Commission for Social Care Inspection) report that Surrey County Council had tried to apply the lessons coming out of the appalling Joint Area Review of Childrens’ Services to services for vulnerable adults.

Although the JAR report wasn’t published until July, concerns had been coming through since last spring.  As Surrey’s poor procedures were shown up, especially with regard to safeguarding children, putting into question its own self-assessment,  there was time for any equivalent shortcomings in services within Adults and Community Care to begin to be addressed before the paper evidence went to the Inspectors, including ‘crucially the council’s own assessment of their overall performance’. 

So Surrey wasn’t shown to be groundlessly self-satisfied in this report, having carried out a review of cases in advance.

The areas of work the Inspectors looked at were Safeguarding Adults, Delivering Personalised Services, Access to Preventative Services, and the Council’s Capacity to Improve.

The judgements were: adequate, adequate, adequate, and uncertain.

But if you can only reach ‘adequate‘ after ‘the chief exectuive and elected members acted quickly and decisively [following the JAR] … [on] the implications for adult’s services generally and arrangements for safeguarding vulnerable adults specifically’ then the situation must have been fairly dire to start with.

Safeguarding Adults

Vulnerable adults were safeguarded and generally the right things were done. However the Council’s own (11th-hour) audit, confirmed by the Inspectors, ‘indentified inconsistencies in safeguarding practise.  …  Key safeguarding actions did not always take place in line with the multi-agency procedures. Protection plans or actons from meetings were not effectively monitored or followed up to ensure that they were having the required impact. There was no evidence that people who were the subject of an investigation or those who had made the referral were kept informed of the progress and outcome of the investigation.’

Particularly relevant to Boroughs like Woking with a significant ethnic mix ‘there was no representation from black and minority ethnic communities [on the adult safeguarding board] … The annual safeguarding report did not include a sufficiently detailend analysis … For example the annual report did not report on outcomes or provide a breakdown of referrals by ethnic background.’  …

‘Some representatives of people from black and minority ethnic communities had reported delays in early signs of abuse being recognised because of a lack of familiarity with some aspects of cultural diversity.’

(It was interesting that later the report noted ‘The use of direct payments was increasing among people from diverse communities as it ensured the provision of more sensitive and individually tailored support’.)

There are differing support services all over the County for vulnerable people, and information was not good enough … ‘Staff in support organisations, the contact centre and other agencies were confused by the differences in provision and this needed to be addressed if people using the services were to be truly empowered and safeguarded.’  

nb The safeguarding team was highly regarded and had significantly raised the profile of safeguarding vulnerable adults. Criticisms stem from poor management arrangements. 

Overall judgement: adequate

Delivering Personalised Services

Essentially what’s there is OK, but flawed by inconsistency and lack of coherent management.

‘ …numbers of carers and people funding their own care in particular had not been adequately supported or provided with information when they most needed it.’

Views of the Contact Centre were mixed, though the Inspectors ‘observed professional, effective and responsive practise … ‘.

Care planning ‘was improved, but not up to the standard of other comparable Councils, but ‘numbers of carers and people funding their own care in particular had not been adequately supported or provided with information when they most needed it.’ …

‘Carers’ assessments were not consistently undertaken. We heard from people for whom a carers’ assessment had only taken place in response to a request for support from a carer who had reached crisis point.’ 

Voucher systems for to give carers respite breaks were good, but didn’t work properly throughout the County through lack of provision.

Joint health and social care provision was valued, but was not organised properly; information had to be repeated too many times; staff turnover meant ‘having to repeat information which suggested that professionals did not read or did not have access to clear and up-to-date case records.’

Again there was poor information for carers and people using the services about what could be available for them - even the County Councils website gave wrong information when the Inspectors looked at it.

The Inspectors pointed out that it was particularly significant for Surrey, where 75% of older people would not qualify for community care funding and so are self-funding, and expressed surprise that most people paying for their own care said they had ‘limited support from professionals’ even though ‘the council offers assessment and care management regardless of on individual’s financial situation’.

Overall judgement: adequate

Access to Preventative Services

Some well-used and appreciated services, but ‘there were variations across different areas of the county that were a source of confusion for professional staff and people using the service.’ …

‘The experience for people from black and minority ethnic communnities was that referral to preventative support sometimes came too late to avert a crisis. Awareness among diverse communities of how to access support was limited.’

After an initial assessment, ‘the practise among professionals in referring people on to non care managed services and sources of information was inconsistent. Knowledge among staff and people using services about the range of support available was varied which had a direct impact on access to services. ‘

This seems to tie in with what I’ve been told: the social worker comes along and at the end of it hands you a couple of leaflets about organisations that might perhaps help.

Judgement: adequate

Capacity to Improve

In nearly four pages of Key Findings, for me one paragraph stood out:

‘The Council’s Business Delivery Review in 2006 had released additional resources for investment to develop adult social care. However, a consequence for key stakeholders was the reduction in managerial and front line capacity. Staff and partners thought the quality of their safeguarding and care management work was affected by heavy workloads but the area teams did not have a consistent and systematic approach to workload management.’

The BDR  led decreased front line capacity despite all Tory reassurances to the contrary.

Now, to maintain services even at the present level for the growing number of older people and vulnerable people, Surrey County Council is relying on the ‘transformation project’, which allows people in need to pay for the services they use directly, with the idea that this demand will generate better-suited and more efficient services. But ‘The council was in the early stages of realising the potential for partnership working to secure bests value from existing arrangements. Commissioning and specifically joint commissioning were under developed. The Council had invested significant additional resources and capacity in its ambitious transformation project. It was too early to confirm the council’s expectations that the recent actions to increase the leadership, senior management and commissioning capacity in adult social care would address these areas for development.’

The judgement on capacity to improve is uncertain.

In the circumstances I would say ‘uncertain’ gives the benefit of a substantial doubt, especially since the same judgement was made in 2006-7.

Heads have already rolled, metaphorically speaking, and there has been a re-organisation at the very top. Thankfully there has been some account taken of the damage that could be done by another root and branch re-organisation, and we’ve been told that teams on the ground should not be affected.