ADEQUATE

Oh dear, another disappointing report on public services in Cornwall. The Care Quality Commission (CQC) has published its findings on the adult social services of 148 councils in England for the year ending March 2009. For the third year running Cornwall’s overall assessment is “adequate” for delivering outcomes. Adequate means, the CQC says, “only delivering the minimum requirements for people”. Note that there are two aspects of the work where the assessment for Cornwall is “performing well”.

Continued performance at this overall level — adequate, only delivering minimum requirements — for three years is not acceptable. The council should show the transparency and openness the Conservatives promised (see Minutes of Cornwall Council AGM for June 2009, item CC/10) and explain why only adequate and what is being done and will be done to make sure there is marked and continuing improvement. External help will be forthcoming. If necessary improvements come at a price, the council should be candid about that; I think most people in Cornwall would be willing to pay such a price.

Put alongside the recent report on the safety of children in care in Cornwall which has led to government intervention, it raises difficult questions about some aspects of social services in Cornwall. The new unitary council faces serious challenges. If it cannot deliver, others will have to.

The adult social care report, published December 2009, is here.

GOVERNMENT INTERVENES IN CORNWALL

The government is responding vigorously to Ofsted’s report on Cornwall children’s services by setting up an improvement board to oversee and help the services. The primary aim of the intervention is to ensure that the services to safeguard children in Cornwall are improved. Details are in the media statement Ministers intervene to improve Cornwall’s children’s services which is here.

The government is acting with effect and everyone should be pleased about its response. That it has come to this is shameful.

Relief at the government’s decisive intervention and a wish to see improvement made should not push away the need for a thorough and public explanation of why the council has failed to such a degree.

See here news of Cornwall council’s setting up a panel to improve children’s services, rather overtaken by the action of the Department for children, schools, and families.

ICEBERGS IN CORNWALL

A dismal recital of three issues in Cornwall: health, children, budget.

Health

The Care Quality Commission (CQC) has published its assessments of the health services in Cornwall for 2008/09. This is the commission that earlier this year took over the regulation and assessment of health services from the former healthcare commission (and social care and mental health commissions).

Once again the Royal Cornwall Hospitals NHS Trust (RCHT), which runs three hospitals in Cornwall, at Truro, Penzance, and Hayle, gets a mixed report. The CQC Commission has assessed it as “fair” for financial management but has judged it “weak” on quality of services, as it did for the years from 2005/06. Two questions arise: Why is the RCHT performance on the quality of services weak in assessments for four years running and how can it be turned around? No one seems able or willing to say.

It is not surprising that some staff talk of low morale and pressure.

It is unacceptable for a hospital group to get these repeated “weak” assessments. Next spring all hospitals must register with the CQC, registration will require compliance with new standards, and the CQC will get powers to intervene robustly when trusts do not meet those standards. It should ensure the RCHT, if still judged weak then, improves massively and speedily. Whatever it takes should be done.

There are grounds for hope. RCHT has just produced a five-year plan for 2010-2014: it reads excellently, acknowledging “unacceptable poor performance, particularly over the past four years” and promising “better, safer, good value care.” People in Cornwall are invited to comment on the plan.

(Note that the Cornwall Partnership NHS Trust and the Cornwall and Isles of Scilly Primary Care Trust have both received acceptable reports from the CQC for 2008/09.)

Children

More very disappointing news about another public service in Cornwall. Read here the Ofsted report of September 2009, Inspection of safeguarding and looked after children services: Cornwall Council.

The council, and government which through Dawn Primarolo said that the report “highlights fundamental weaknesses in Cornwall’s children’s services,” are no doubt working to put things right and there will be a further assessment in a while that should either reassure us or see the service taken over. However, improvements take money and the children’s services are already overspending their revenue budget; that takes me to the third iceberg.

See also Cornwall’s children’s services ‘inadequate’ in the Local government chronicle for 23 October 2009.

Budget

The new Tory leader of Cornwall Council asked for a report on the status of the unitary council’s finances for 2009/10 and thereafter. The report, Cornwall Council financial health check report August 2009, is here.

Achieved unitary savings will probably be less than forecasted; currently there is likely to be significant overspending on the revenue budget, especially on the adult social care and children’s services budgets; and the overspend for the current financial year can be met from the £18.2 million unearmarked reserves accumulated by the previous Liberal Democrat council.

There is no immediate financial crisis but the council has to tackle the issue of overspending: reserves deplete fast. That means more efficiency and productivity, cutting unnecessary spending, and reducing costs. If the intended unitary nett savings can be realised, they will lessen but not remove the difficulties. Cutting costs often turns out to be cutting services and jobs, a sorry thought.

Accompanying the publication of the report there is a media report dated October 2009 from the unitary council here. I do not know why a report made in August is published only in October though I suppose August is a month for holidays not politics.

________________________________________________________________________________

ASSESSING CORNWALL

Another report on Cornwall county council, this from the Audit Commission. This is the comprehensive performance assessment (CPA) for 2007 and the council scores three stars and is “improving adequately.” Read it here.

Thirty seven percent of councils have more stars and seventeen percent fewer; seventy nine percent are improving better than Cornwall and none worse.
Here are two recent assessments of Cornwall county council.

Cornwall county council: the parrot is pale

One star Cornwall

None of these is excellent overall. None gets into the Vorsprung Cornwall thread. Note that these are not about Cornwall suffering from external and distant agency; these are assessments of internal works. I’m whistling to keep my spirits up.

ONE-STAR CORNWALL

The annual assessment by the Commission for Social Care Inspection (CSCI) of the performance of Cornwall county council’s adult social services has just given the council one star (out of a possible maximum of three) for 2007 and described its delivery of outcomes as “adequate.” Of the 150 England authorities assessed by CSCI for 2007 I count forty eight getting three stars, seventy four getting two stars, and twenty eight, including Cornwall, getting one star. Cornwall is in the bottom, ie worst, fifth group. For adult services in 2004 it got three stars, in 2005 two stars, and in 2006 one, a downhill katabasis.

The full CSCI report is here but it does not fully explain the reasons for the council’s decline in the performance ratings. The county council’s response, which strikes me as overly upbeat, is here. The prospects for improvement by the council are assessed by CSCI as “promising”. I really hope that’s a judgement that proves to be right.

Additamentum 29 January 2009

The original web address for the county council’s response has changed since I wrote the post. I have now amended it to the new web address in the post above. It is textually: ‘Cornwall County Council welcomes findings of report into its adult social care services’ 29 November 2007.