Learning from feedback and performance

Learning from feedback

In 2023, across the council's major directorates, the highest number of compliments from service users were logged in relation to adult social care services. There was an even split between compliments relating to the general level of service provided and individual staff behaviours. Examples can be found in Theme 1 - Working with people. 

The council records and reports on the salient issue contained within a formal complaint.  It is accepted that complaints will often be multi-faceted, but for reporting purposes the substantive theme is recorded as the reason for the complaint being made. 

The majority of complaints received relate to complainants’ expectation that the service provided to them by the council ought to have been better or that the processes followed have not been applied correctly. Complaints about the quality of a service include issues such as the standard of service provided to a customer; the quality and timeliness of communication; and where a member of staff has promised an action and has not followed it up. 

When a formal complaint is responded to and closed, the council’s Customer Relations Team opens a learning stage on the central system and where required, sends an action plan/learning form for the attention of operational managers.  The plan includes any actions set out in the complaint response and any agreed opportunity for individual, local or systemic improvement.  The Customer Relations Team monitors compliance with the 20 working day deadline associated with the learning stage, and the Complaints Manager attends leadership meetings and Quality Assurance Boards to ensure any learning is discussed.  The learning stage is applied following completion of complaints at all stages of the statutory process, it is not only reserved for escalated complaints.

The Serious Incident Review (SIR) process offers us the opportunity to study the background, decisions and actions taken that lead to circumstances in which the person in receipt of social care support, had not received an effective service. A SIR can be requested by anybody, and the most frequent trigger for consideration of a review is the unexpected death of a person who is known to our service. The learning that is derived from a SIR enables us to understand where improvements can be made to how we work and to the processes and guidance that support our operational staff.

A review completed in February 2024 identified that there was learning for the community social work team that was supporting a person who died by suicide. The analysis was:

• The community team’s knowledge of mental health services that were available in the community could have been improved. This was addressed by a team training day which was supported by a senior social work practitioner from the Working Age Mental Health Service and which focussed on: referral/ treatment pathways and on-line training resources (suicide awareness prevention courses, Samaritans, and 'See the Signs and Save a Life' suicide prevention).
• The processes in the team for managing duty cases and high demand were highlighted as areas for learning. These were addressed by team best practice sessions which covered effective triaging and RAG rating and the making and recording of defensible decisions. In addition, the senior social work practitioner’s case numbers were reduced with clear oversight structures and duty process guidance, which covers the whole service, was reviewed and updated.
• The staffing of the duty rota, supported by senior members of staff, required review and greater clarity of roles and responsibilities. This was addressed by a restructuring of the team duty rota to ensure that periods of absence are covered, and by providing capacity for the team’s senior social work practitioner to provide a route of escalation for high-risk cases.

More broadly, learning identified through the SIR process is shared with the whole service via learning bulletins which are sent directly to team managers and shared through presentations at relevant quality assurance and team meetings.

Employee surveys are held across the directorate and allow us to gather important feedback from the workforce. Themes such as communication and staff pay, have been highlighted. As a result of the feedback, we hold sessions throughout the year to update staff on key areas of business. Where targets as part of the People Framework KPI questions are unmet,  work is underway to  address and improve these, as follows. 

*Goal refers to target performance in Our Council Plan 2022-25.

We recently completed a review of our alternatively qualified practitioner roles to reflect current practices and are developing career pathways in adult social care to enable broader career development conversations and opportunities.

The leadership team will continue to engage with staff and improve future methods of engagement, which is an area highlighted in our staff survey feedback.

A corporate survey for staff exiting the authority has been implemented to understand reasons why people choose to leave. We also offer exit interviews with staff leaving the council to gather any learning that can be applied to improve the experience of our workforce.

Quality framework and collaborative audits

Our Quality Assurance Framework sets out how the leadership team ensure a culture of performance and continuous improvement, which identifies what we do well, celebrates success and, where required, takes action to improve. This helps to embed confidence that we are setting and maintaining high standards throughout Adults’ Services.

A robust governance structure is in place to support the delivery of continuous improvement and to ensure a learning culture. This is underpinned by staff performance conversations and team meetings. This enables everyone to play their part in improving the quality of services and supporting the best possible outcomes for those with social care needs.

An audit framework has been in place since October 2021 and is currently under review. Audits are undertaken collaboratively between the supervising practitioner and the person being audited. This provides scope for practice learning and reflection and for practitioners to identify development opportunities. This work is coordinated and scrutinised by the Quality Assurance Management Board and thematic audits will be scheduled where data and feedback highlight the need for more detailed scrutiny.

Key learning identified through audits, SIRs and through other quality assurance processes has included:

• Management of risk
• Self-neglect
• Application of the Mental Capacity Act
• Consideration of the person’s culture

This learning has been included in the review and update of practice guidance, development of new audit processes, including the audits of new system processes, and the dissemination of learning bulletins throughout the service. An example learning bulletin can be found here.

Performance

We are working to improve and further strengthen our performance and financial management frameworks across the directorate. This is part of our Improvement Programme, to ensure we have visibility and assurance at all levels in the service on the delivery of Care Act duties, risks to delivery, quality and sustainability, and people’s care and support experiences and outcomes. 

Adult Social Care has a Performance Management Framework which is a summary of the key internal processes and components through which the service sets, delivers, monitors and reports on its priorities. Regular and detailed scrutiny of performance data is at the heart of keeping track of progress and alerting managers to issues at an early stage before they become serious concerns. Scrutiny of performance data is a core function of team managers, through to senior managers and elected members. A robust performance regime will inform other types of scrutiny, for example through audit, and will contribute to organisational learning. 

The Performance Management Framework includes all key activity undertaken by Adults’ services to ensure our work with adults with care and supports needs is carried out to the highest standards, according to the Care Act (2014). It aims to improve our understanding of whether we are supporting the right people, in the right way, at the right time, and whether we are making a difference to the outcomes they achieve. The framework is designed to help us in our journey of continuous improvement and will inform our service planning.

A plan of collaborative work with our Performance and Insight colleagues has led to the creation of a Microsoft Power BI adult social care dashboard to show the customer journey and outcomes in line with the agreed business processes. This provides managers with information on ‘open’ or ‘work in progress', timeliness and completed work concentrating on contact, assessment, reviews, and safeguarding pathways. The next phase of this work will focus on support planning pathways and caseload management. This will improve data quality, access to 'live' performance management and case data, and ultimately improve confidence in performance data both internally and externally.

In addition, through our Practice and Systems Programme we have amended our financial authorisation process to make this more robust and transparent. This aims to improve our oversight and ability to forecast budget trends.

Set out below is our performance for 2022-23 and the comparison with the Adult Social Care Outcomes Framework (ASCOF) England average.  Figures for 2021-22 are given in brackets.

We use this data to identify positive performance and areas for improvement. Commentary on actions underway is added to those measures where our scores indicate improvement is necessary.

Data quality, intelligence, and insights

Our collaborative work with the Performance and Insight team aims to improve the quality and accessibility of our data to meet the needs of the business (both strategic and operational), as well as ensuring that we are best placed to meet the objectives of the National Data Roadmap and the move towards Client Level Data. Included within the scope of the project is a requirement to provide real-time data through Microsoft Power BI to all aspects of the service and care pathway within Mosaic.

The availability and use of data has improved in recent years, but we want to go further and hone how data can help us understand current and future demand, inequalities and gaps in supply and wider demographic and societal changes, in order  to improve the services and outcomes for our residents. Effective use of data intelligence and analytical insight is an area we will continue to improve so that decisions on future direction are evidence-based. This is a part of the work identified for 2024/25.