Agenda and minutes

There were no apologies for absence.

Members are asked to declare any interests they may have in the business to be discussed.

Councillor Chaplin declared an Other Disclosable Interest in agenda item 6, “Elderly Persons’ Homes”, in that she had attended a birthday party for three residents at Herrick Lodge on 3 January 2014 in a private capacity.

Councillor Joshi declared an Other Disclosable Interest in the general business of the meeting in that his wife worked for the City Council’s Reablement service.  He also declared an Other Disclosable Interest in the general business of the meeting in that he worked in the voluntary sector with people with mental health problems.

As a standing invitee to Commission meetings Philip Parkinson, Interim Chair of Healthwatch Leicester, declared an Other Disclosable Interest in the general business of the meeting in that his mother-in-law was in receipt of services from the City Council’s Adult Social Care and Safeguarding division.

Although not a member of the Commission, Councillor Rita Patel declared an Other Disclosable Interest in the general business of the meeting in that her sister worked for the City Council’s Adult Social Care and Safeguarding division.  She also declared an Other Disclosable Interest in the general business of the meeting in that in the last few weeks her mother had started to receive a package of services from the City Council’s Adult Social Care and Safeguarding division.

In accordance with the Council’s Code of Conduct, these interests were not considered so significant that they were likely to prejudice the respective people’s judgement of the public interest.  They were not, therefore, required to withdraw from the meeting.

The minutes of the meeting of the Adult Social Care Commission held on 5 December 2013 are attached and the Commission is to confirm them as a correct record.

RESOLVED:

That the minutes of the meeting held on 5 December 2013 be approved as a correct record.

The Monitoring Officer to report on any petitions received.

The Monitoring Officer reported that no petitions had been received.

The Monitoring Officer to report on any questions, representations or statements of case received.   

Questions received after despatch of the agenda are attached.

Five questions were submitted by Mrs Chandarana, as follows:-

“Re: Social Services responsibilities under the Community Care (Delayed Discharges Etc.) Act 2003 (LAC (2003)21 Circular)

1.    Can the Assistant Mayor for Adult Social Care (ASC), the Director of Adult Social Services (DASS) or the Relevant Officer confirm that?

The Council has a responsibility to work with the UHL NHS Trust to identify the causes of delayed transfers of care within the City and assess the appropriate intervention and investment needed to tackle them.

Re: DTOC - Awaiting Residential Home Placement or Availability in Leicester UA (DOH data)

2.    Can the Assistant Mayor for ASC, the DASS or the Relevant Officer confirm that?

Leicester UA has had the biggest increase in the number of bed days lost due to delayed transfers of care attributed to patients Awaiting a Residential Home placement or availability per month from April 2011 to August 2013 compared to every one of its closest fifteen comparator councils - CIPFA’s nearest neighbour comparators (Per 100,000 Population).

3.    Can the Assistant Mayor for ASC, the DASS or the Relevant Officer confirm that?

Leicester UA had the highest number of bed days lost due to delayed transfers of care per month attributed to patients Awaiting a Residential Home placement or availability in both July 2013 and August 2013 compared to every one of its closest fifteen comparator councils (Per 100,000 Population).

4.    Can the Assistant Mayor for ASC, the DASS or the Relevant Officer confirm that?

In August 2013 a total of 249 bed days were lost due to delayed transfers of care attributed to patients Awaiting a Residential Home placement or availability, this reason accounted for 18% (the second largest proportion) of all bed days lost. Hence nearly 1 in 5 of all bed days lost due to delayed transfers of care in Leicester attributed to patients Awaiting a Residential Home placement or availability.

Re: Statutory Guidance – ‘Guidance on the Statutory Chief Officer Post of the Director of Adult Social Services’

5.    Can the Assistant Mayor for ASC, the DASS or the Relevant Officer confirm that?

The Assistant City Mayor for Adult Social Care is accountable and hence, responsible for preventing unnecessary use of healthcare resources.”

It was noted that, as neither Mrs Chandarana or her representative were able to be at the meeting to present the questions, Mrs Chandarana asked that they be withdrawn.  However, the Chair stated that, due to the level of interest in the matters raised through the questions, she would like the response to be given at this meeting.  This would then be sent to Mrs Chandarana in writing and she would be able to ask further questions at a future meeting if she wished.

The Director of Adult Social Care and Safeguarding then gave the following response:-

“I shall respond to questions 1 and 5 first.

I confirm that the Council, through the Director, has a clear responsibility to work with University Hospitals Leicester (  ...  view the full minutes text for item 80.

The Director of Care Services and Commissioning will give an update on progress with:-

a)     The relocation of residents currently in Council Elderly Persons’ Homes to be closed in Phase I (Appendix B1); and

b)     The creation of a new Intermediate Care Facility (Appendix B2).

a)     Relocation of Residents

The Director for Care Services and Commissioning (Adult Social Care) presented an update on progress with the relocation of residents currently in Council elderly persons’ homes that were scheduled for closure.  It was noted that, since the decision to relocate the residents had been taken, one resident had died.  All other residents were now on Stage 3 of the process, which was the stage at which social workers made their assessments of residents.

In reply to questions from Members, the Director for Care Services and Commissioning (Adult Social Care) advised the Commission that at stage 2 residents were invited to identify what was important to them in their new homes.  This could include things such as friendship groups or preferred areas.  After an assessment had been made, discussions were started on what accommodation was available for individual residents based on their stated interests and preferences. 

In preparing moving plans, some residents wanted to represent themselves, but if they had relatives, efforts were made to get the relatives involved as well.  The course of action to be taken when residents had no-one to represent them would depend on whether the individuals had capacity to make a decision about moving, as stated in the Mental Capacity Act. 

People without capacity or anyone to represent them had to be referred to the Independent Mental Capacity Advocacy Service, as required under the legislation.  People without capacity could however be represented by relatives or friends acting in their best interests.  In addition, there were occasions when people who had capacity wanted some extra support.  In these cases, the Council could refer people to mainstream and culturally appropriate advocacy services.

The Head of Care Services (Care Provision Residential) explained that steps had been taken to sensitively prepare and plan.  For example, the process had paused to enable residents to enjoy Christmas.  Overall, people were engaging well, which was reflected in the fact that the residents were now at Stage 3 of the process.

It was noted that some residents previously had indicated a wish to move early.  The Head of Care Services (Care Provision Residential) reported that, now the process was underway, residents no longer appeared to be concerned about doing this.  At present, there was no indication that any residents were reluctant or hesitant about moving, but it was recognised that situations could change and the Council would respond to such changes as they arose.

The Adult Social Care Business Transition Manager confirmed that officers met with service providers fortnightly.  No general negativity about the moving process had been observed during these meetings.  Dedicated teams were based in the homes, so residents and staff knew them, which helped provide reassurance.

In response to further questions, the Adult Social Care Business Transition Manager confirmed that suggestions for suitable accommodation for people to move to were based on needs assessments.  The Council’s over-riding duty of care meant that these needs had to be met, but efforts also were made to meet the preferences  ...  view the full minutes text for item 81.

The Assistant Mayor (Adult Social Care) will provide an update on progress with the current review of the Council’s Mobile Meals Service.

The Director for Care Services and Commissioning (Adult Social Care) reminded the Commission that clarification had been requested on various issues relating to the mobile meals service at the Commission’s last meeting, (minute 71, “Proposal for the Future of Mobile Meals Provision”, 5 December 2013 referred). 

The Director reminded the Commission that a specific question had not been asked in the consultation on reconfiguring the service about whether service users wanted it to continue as at present, as a proposal for changing the service was being sought.  Such a question therefore would not have been appropriate.

The number of users of this service was falling, so it would not be financially viable for it to continue in its current form.  The consultation therefore asked people what type of service they would like in the future.  Responses received had indicated that people still wanted to receive a hot meal and therefore Option 4 has been proposed, which included a framework contract for the provision of a meal delivery service, managed by the Council.

Councillor Rita Patel, Assistant Mayor (Adult Social Care), addressed the Commission at the invitation of the Chair.  She explained that the consultation recognised that people wanted the security they felt with the current system to continue.  She also explained that Option 4 would ensure that people could still have a meal delivery service via a framework contract managed by the Council.  This also would address various concerns that had been raised about the service, such as the nutritional value of meals, the quality of the food and difficulties found in complaining about the service.

There also were elements of the current service that led to unnecessary stages in the delivery process.  For example, the East West Community Project prepared some meals in its kitchen, which were then delivered to the Council and the Council delivered them to the customers.  Another example was that meals bought from a company were reheated in a Council kitchen by Council staff and then delivered by the Council.

Under a framework contract, the Council would still have responsibility for elements such as the nutritional quality of the meals, but would no longer reheat the meals provided by other suppliers.  Alternatively, people could buy their own meals and heat them up themselves.

In summary, Councillor Patel stressed that the Council was committed to ensuring that people could still have access to a mobile meals service via a framework contract.  Service users would be assessed and meals provided where needed.  In particular, it was recognised that, for some users, this was their only social contact, so more suitable befriending services would be put into place to ensure people were not left lonely and isolated. 

Members drew Councillor Patel’s attention to the resolution made at the last meeting of the Commission that the Executive be asked to reconsider the way forward for this service and asked what progress there had been on this.  Councillor Patel assured the Commission that she had looked at this following her  ...  view the full minutes text for item 82.

The Chair submits the draft report of the review of Alternative Care for Elderly People.  The Commission is recommended to adopt the report and the recommendations contained within it.

The Chair submitted the draft report of the review of Alternative Care for Elderly People, thanking officers for their work in preparing the report and Commission members for their input to the review.  Members were reminded that Liz Kendall MP also had attended one of the review meetings and provided useful input.

The Chair reported that she had been contacted by a Councillor from Liverpool, who was very interested in the Shared Lives initiative.  He had asked to meet the Commission and the Assistant Mayor (Adult Social Care) as part of his work to develop a similar initiative.

The following comments were then made in discussion on the report:-

·           The local Asian radio network, (such as Sabras radio), also could be used to promote the Shared Lives scheme, (recommendation 1.2.2 referred), as this could be used to explain the scheme in some people’s first language;

·           A proper communication plan should be prepared; and

·           It would be helpful if people could be asked to provide case studies as soon as possible, (for example, explaining how they had benefited from the scheme).

Councillor Rita Patel, Assistant Mayor (Adult Social Care), thanked the Commission for the very helpful interest it had taken in this scheme.  It was already operating and officers were looking at how it could be expanded.

RESOLVED:

1)     That the Overview Select Committee be asked to endorse the report of the review of alternative care for Elderly People before it is submitted to the Executive for adoption; and

2)     That all involved in the preparation of this report be thanked for their work.

As agreed at its last meeting, the Commission is invited to consider how a review of Dementia Care for Elderly People should be conducted and where this review should be included in the Commission’s work programme.  (See minute 67, “Mental Health Care”, 5 December 2013.)

The Commission was invited to consider how a review of Dementia Care for Elderly People could be conducted and where this review should be included in the Commission’s work programme.  Members were reminded that information relevant to this had been considered at the Commission’s last meeting, (minute 67, “Mental Health Care”, 5 December 2013 referred).

The following comments were made during discussion on this item:-

·           Due to the large amount of information already available on this subject, the Commission needed to be very clear about which issues it wished to address;

·           Some issues, such as accessing existing services, could be complex to review, as the problems experienced by people with dementia could inhibit their ability to access them.  In addition, it was an emotional and stressful time for their families and friends, which could limit their ability to assist;

·           Members welcomed the clear identification in the “Leicester, Leicestershire and Rutland Joint Dementia CommissioningStrategy 2011-2014” of which agency would lead in each area;

·           Research already had been undertaken with people who had not developed dementia, to identify if there were any key factors in why they had not developed it.  The National Institute for Health and Care Excellence had developed standards in relation to these and they were taken in to account in the strategies developed to date;

·           The Commission needed information on whether the recommendations arising from the previous review of the mental health of working age adults by the Health and Wellbeing Scrutiny Commission had been implemented and, if they had not, the reasons why;

·           Consideration could be given to whether members of the Health and Wellbeing Scrutiny Commission should be invited to participate in the review;

·           Support for carers of people with dementia, especially those with early-onset dementia, could be included in the review.  This could include the role and effectiveness of respite care;

·           The scoping document should include reference to the impact on dementia care for the elderly of budget decisions already taken and those to be taken in the future; and

·           Information was needed on whether the recommendation contained in the “Joint Specific Needs Assessment: Dementia in Leicester” that commissioners should find ways of obtaining more effective coding of the attendance of patients with dementia at the emergency department had been implemented.

RESOLVED:

1)     That the Assistant Mayor (Adult Social Care) be asked to arrange for a presentation to be made to the next meeting of the Commission on current dementia care, to include information on the following:-

a)    National Institute for Health and Care Excellence standards relating to mental health;

b)    The extent of the implementation of the recommendations arising from the previous review of the mental health of working age adults by the Health and Wellbeing Scrutiny Commission; and

c)    The extent of the implementation of the recommendation contained in the “Joint Specific Needs Assessment: Dementia in Leicester” that commissioners should find ways of obtaining more effective coding of the attendance of patients with dementia at the emergency department;

2)     That members of  ...  view the full minutes text for item 84.

The meeting adjourned at 7.05 pm and reconvened at 7.13 pm

The Director for Care Services and Commissioning (Adult Social Care) submits a report providing further information to Members as part of the Domiciliary Care Scrutiny Review, and in response to the questions noted in the Scrutiny meeting of 5 December 2013, (minute 69 refers).  The Commission is recommended to receive this information and comment as appropriate.

The Director for Care Services and Commissioning (Adult Social Care) submitted a report providing further information as part of the Domiciliary Care Scrutiny Review.  This also addressed questions raised at the Commission’s meeting held on 5 December 2013, (minute 69 referred).

Members were reminded that the Council’s Communications team would be asked to make an appeal for users of domiciliary care to provide information on their experiences of that care, both positive and negative.  In addition, arrangements were being made to enable the Chair to accompany a care worker for a day, to get a better understanding of their work.  Appropriate arrangements would be made to ensure that confidentiality and privacy were maintained at all times.

In response to a question from the Commission, the Director of Adult Social Care and Safeguarding explained that, under direct payments, people received a personal budget as a cash payment.  The recipient then became responsible for meeting the costs of the services they received.

In reply to further questions from the Commission, the Commissioning Manager (Care Services and Commissioning Division) explained that, during the last week, approximately 22,000 hours of care were provided.  The standard of this care was carefully monitored.  For example, providers’ self-assessments were used and some providers came under the Care Quality Commission.  Officers carefully analysed the data and graded providers on their standard of care.  For example, an assessment is made of whether the minimum level of care was being provided, or whether there was a higher level of provision.

The contracts had been operating for two months.  Their operation had been relatively stable, even during a period of high pressure regarding hospital stays over the Christmas period.  However, starting on 27 January 2014, a consultation would be undertaken with users of Home Care.  This would be done via the telephone. 

It was recognised that people recently had been consulted on various services, (for example, mobile meals and elderly persons’ homes), so it was possible that this could result in some “consultation fatigue”, but there were no proposals to change the method of consultation at this stage.  The consultation would be undertaken through the Contracts and Assurance team.  A stratified sample would be used, but the actual number of people to be consulted was not known at this time.

The Commission welcomed the consultation, but queried whether allowance had been made for the reasoning abilities of some service users.  In addition, as the Council was not the service provider, it needed to be made very clear that information provided would be confidential and that individual users would not be identified in the data compiled.  The Commissioning Manager assured Members that these factors had been taken in to account in preparing for the consultation.  For example, support packages would be checked before anyone was telephoned to make sure they were capable of taking part in the consultation and that, where possible, they could be consulted in their first language.

Members noted that some service users had more than one  ...  view the full minutes text for item 85.

The current work programme for the Commission is attached.  The Commission is asked to consider this and make comments and/or amendments as it considers necessary.

The Commission noted that:-

·           Budget reports would not be considered by  Scrutiny Commissions this year, as the budget had been approved for three years and exceptions were reported as they occurred;

·           A special meeting was likely to be held to receive the presentation on dementia care for elderly people requested under minute 84, “Dementia Care for Elderly People”, above; and

·           Information on the establishment of an Intermediate Care facility currently was being compiled, but was unlikely to be available for the Commission’s next meeting.  However, an update on the development could be provided if wished.

The meeting closed at 7.55 pm