Agenda and minutes

Councillor Palmer (Deputy City Mayor) and Councillor Waddington, (Member for Fosse Ward) had been invited to the meeting for agenda items 6, “Patient Transport Services: Impact on Adult Social Care”, and 7, “Fosse Court Residential Care Home”, respectively.  As both were unable to attend the meeting, they sent their apologies for absence.

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

As a Standing Invitee to the Commission, Mr Philip Parkinson (Healthwatch invited representative) declared an Other Disclosable Interest in the general business of the meeting in that he had a relative in receipt of a social care package from the City Council.

Councillor Chaplin declared an Other Disclosable Interest in agenda item 8, “Review of Housing Related Support Substance Misuse Services”, in that Heathfield House was in Stoneygate Ward, which she represented.

Councillor Dawood declared an Other Disclosable Interest in agenda item 9, “Closure of the Douglas Bader Day Centre – Update”, in that the Centre was in his ward and he had discussed its closure with the Assistant Mayor (Adult Social Care).

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 26 June 2014 are attached the Commission is asked to confirm them as a correct record, subject to the following amendments to minute 11, “Provision of Intermediate Care and Short Term Residential Beds Facilities”, (starting at paragraph 6 of the preamble, changes shown in italics):-

“… and what the LQHA understood was being proposed following fee negotiations with independent residential care homes in the City. This was demonstrated in information tabled by Mr Jackson at the meeting, a copy of which is attached at the end of these minutes for information.

Mr Jackson then made the following comments:-

·         (No changes to first bullet point);

·         The Council stated that a registered manager was needed at the facility, but the cost shown in the Council’s report was a lot lower than the salary paid by LQHAThe information provided as part of the fees review proposal, reflected a lower salary for a Registered Manager than LQHA pays their Registered Manager.  The indicative salary for the Intermediate Care Registered Manager was higher; 

·         In the Council report, Senior Care Assistants were to be paid more than the registered care manager in a care home funded by the Council;

·         (No changes to fourth bullet point); and

·         LQHA was receiving fees that had been set two and a half years previously. Consequently, the Association had a shortfall of approximately £800 per week, which would fund two care assistants, and a total shortfall annually to date of approximately £50,000. This was causing problems financially and operationally for LQHA …”

RESOLVED:

That the minutes of the meeting of the Adult Social Care Commission held on 26 June 2014 be confirmed as a correct record, subject to the following amendments:-

a)    The name of the Chair of Leicestershire Ethnic Elderly Advocacy Project recorded in minute 9, “Review of Voluntary and Community Sector Preventative Services (Adult Social Care)”, being amended to Mr Bhadrashil Trivedi;

b)    The fifth paragraph of minute 9, “Review of Voluntary and Community Sector Preventative Services (Adult Social Care)”, being amended as follows (new wording in italics):-

“The Commission asked whether the services provided by LEEAP could be grant-funded, or whether they would need to be considered under the procurement process.  The Lead Commissioner (Early Intervention and Prevention) reported that …  Some members of the Commission suggested that organisations should not automatically have to go through a procurement process, but instead their funding source should be appropriate to their size.  For example, for a body the size of the LEEAP project it could be more appropriate for it to be grant-funded.

(new paragraph) The Lead Commissioner (Early Intervention and Prevention) reported that …”

c)    Minute 11, “Provision of Intermediate Care and Short Term Residential Beds Facilities”, being amended as follows (starting at paragraph 6 of the preamble, changes shown in italics):-

“… and what the LQHA understood was being proposed following fee negotiations with independent residential care homes in the City. This was demonstrated in information tabled by Mr Jackson at the meeting, a copy of which is attached at the end of these minutes for information.

Mr Jackson then made the following comments:-

·         (No changes to first bullet point);

·         The Council stated that a registered manager was needed at the facility, but the cost shown in the Council’s report was a lot lower than the salary paid by LQHAThe information provided as part of the fees review proposal, reflected a lower salary for a Registered Manager than LQHA pays their Registered Manager.  The indicative salary for the Intermediate Care Registered Manager was higher; 

·         In the Council report, Senior Care Assistants were to be paid more than the registered care manager in a care home funded by the Council;

·         (No changes to fourth bullet point); and

LQHA was receiving fees that had been set two and a half years previously. Consequently, the Association had a shortfall of approximately £800 per week, which would fund two care assistants, and a total shortfall annually to date of approximately £50,000. This was causing problems financially and operationally for LQHA … “

None received to date

The Monitoring Officer reported that no petitions had been received since the last meeting.

None received to date

The Monitoring Officer reported that no questions, representations or statements of case had been received since the last meeting.

The Director of Adult Social Care submits a briefing note on concerns regarding the performance of Arriva Transport Solutions, the contracted provider by the NHS of non-emergency transport to and from Leicester’s hospitals.  (Attached at Appendix B1)

Also attached for information are the following:-

a)     Article entitled “Arriva Transport Solutions fails key 'tests' on hospital transport”, published in the Leicester Mercury, 21 July 2014 (Appendix B2);

b)     Article entitled “Leicester's deputy mayor calls for Arriva Transport Solutions to improve”, published in the Leicester Mercury, 23 July 2014 (Appendix B3);

c)     Letter from East Leicestershire and Rutland Clinical Commissioning Group, “NHS non-emergency patient transport”, received 25 July 2014 (Appendix B4); and

d)     Letter from the Chair and Vice-Chair of the Adult Social Care Scrutiny Commission published in the Leicester Mercury on 26 July 2014 (Appendix B5)

The Commission is recommended to consider the information presented and consider whether any further work is needed on this issue and, if so, whether it should be undertaken by this Commission, the Health and Wellbeing Scrutiny Commission, or jointly by the two Commissions.

The Director of Adult Social Care submitted a briefing note on concerns regarding the performance of Arriva Transport Solutions, the contracted provider by the NHS of non-emergency transport to and from Leicester’s hospitals. 

It was noted that a small number of patients discharged from hospital to receive a social care package were reliant on hospital transport.  However, it was difficult to quantify the impact of poor performance of the transport service on these people, as different elements of the package could be provided by a wide range of providers and thus was not easily captured.  As such, much of the evidence available was anecdotal.  Officers could only capture information about the impact on care packages, although it was recognised that problems with patient transport services could affect people in other ways, such as getting to outpatient appointments.  The impact of problems with patient transport services was only one of a number of issues that affected how well acute care was working.

The Commission welcomed the letter sent by the Deputy City Mayor to the Managing Director of the East Leicestershire and Rutland Clinical Commissioning Group (CCG) confirming that he had proposed that if there had not been clear improvements within three months the contract should be terminated.

Members noted a letter from the Managing Director of the CCG, drawing particular attention to the comments in that letter relating to the impact of clinical assessment requirements for non-ambulatory stretcher vehicles and the need to re-align staff and vehicles.  In view of these comments, the Commission questioned whether the correct type of transport was being used.  It also was noted that the CCG had provided little information on what had gone wrong with the service and no information on what the service’s target were.  This would make it difficult to assess whether problems had been properly rectified and sufficient improvements made.

Mr Philip Parkinson, on behalf of Healthwatch, advised the Commission that:-

·           Healthwatch had had concerns about the apparent lack of control over the contract for approximately 15 months.  Some of the issues were highlighted in a report by the Care Quality Commission, such as staff training still not having been done six months after Arriva Transport Solutions had said it would be done;

·           Healthwatch was aware that Arriva used some taxis to provide passenger transport, but patients reported that the drivers of these could be unhelpful;

·           Even though the Care Quality commission was aware of the problems with passenger transport services, it was not known at present if changes in the operation of the contract would be made; and

·           In view of this, Healthwatch shared the concerns raised by the Commission and the Deputy City Mayor.

The following points were then made in discussion:-

o    Arriva Transport Solutions was a big company, but did not seem to be able to deliver the service required;

o    It would be useful to know if the cases reported by the local press were exceptions, or represented a general experience;

o    There was a lack  ...  view the full minutes text for item 21.

The Director of Adult Social Care and Safeguarding submits a briefing note regarding a serious safeguarding allegation of mistreatment by staff of residents at Fosse Court Residential Care Home.  The Commission is recommended to receive the update and comment as appropriate.

The Councillors representing the Fosse Ward have been invited to the meeting to participate in this item.

The Director of Adult Social Care and Safeguarding submitted a briefing note regarding a serious safeguarding allegation of mistreatment by staff of residents at Fosse Court Residential Care Home.

The Assistant Mayor (Adult Social Care) advised the Commission that the Council had contracts with approximately 103 care homes in the city.  The care provided at these was monitored in a number of ways, so the Council was confident that, as far as could be determined, proper care was being provided at these establishments.  When that care had fallen below the required standard at Fosse Court, swift action had been taken, as it was important to identify failing establishments quickly and take appropriate action.

The Director of Adult Social Care and Safeguarding stressed that the Council was committed to ensuring that any lessons that could be learned from this situation were taken on board.  The Council worked as part of a multi-agency safeguarding partnership, so the local Safeguarding Adults Board had been asked to carry out a full review of the situation.  This would be conducted by someone independent to any agencies involved, so it would not be a Council-led review, but it would provide a thorough and systematic way for development and learning to be captured.

Councillor Cassidy, Member for Fosse Ward, addressed the Commission at the invitation of the Chair.  He thanked officers for providing full information in response to questions raised by the Ward Members about the closure of the home and welcomed this as good practice.  He also stressed that he felt that the Ward Councillors had been kept informed in an appropriate way of the actions being taken in response to the issues identified.

Neither of the Ward Councillors had been aware of any problems in that particular home, leading Councillor Cassidy to ask if there was a way in which Ward Councillors could have more contact with such establishments.  In this way, it was hoped that residents and their relatives could have confidence that the care being provided by the homes was being fully monitored.

Some concern was expressed that the Care Quality Commission (CQC) had missed signs of the problems that were identified at Fosse Court and it was questioned whether the CQC inspections had been undertaken properly, or whether the number of bodies involved in inspecting residential care homes had led to a degree of complacency.

Mr Philip Parkinson, on behalf of Healthwatch, noted that situations such as that at Fosse Court could arise very quickly and required immediate attention.  He paid tribute to the officers who had found alternative settings for all 21 residents very quickly, as well as providing follow-up care the following week, to ensure that their setting was appropriate.  Healthwatch had received very limited feedback on the events at Fosse Court, but that which had been received had been very complimentary.

In response to comments and questions from the Commission, the Director of Adult Social Care and Safeguarding advised that a range of staff had been provided to Fosse  ...  view the full minutes text for item 22.

The Director for Care Services and Commissioning (Adult Social Care) submits a report outlining the findings of a statutoryconsultation exercise on a proposal to remodel Housing Related Support services for substance misuse.  The Commission is recommended to note and comment on the proposals.

The Director for Care Services and Commissioning (Adult Social Care) submitted a report outlining the findings of a statutoryconsultation exercise on a proposal to remodel Housing related support services for substance misuse. 

The Director explained that the review was needed to ensure that the service remained appropriate, as the contract for services at Heathfield House would end on 31 March 2015.  Consultation had been undertaken on different options for the service and this had shown support for a dedicated service that included floating support and accommodation-based support.  It therefore was proposed to procure a mixture of accommodation in a 10-bed unit that offered stays of up to 12 months and floating support.

The Assistant Mayor (Adult Social Care) reminded the Commission that, when the closure of the accommodation-based services for people with alcohol dependency at Evesham House had been agreed, an undertaking had been given that consideration would be given to how Evesham House could be used in the future.  Procurement of the new services now needed to be undertaken quickly, in order for there to be no break in service when the contract for services at Heathfield House ended on 31 March 2015.

The Assistant Mayor (Housing) drew Members’ attention to the weaknesses in the current delivery model that had been highlighted as a result of a review of the service.  In particular, it was noted that the current service had 24 beds, but no floating support, so only a small number of people could be accommodated per year.  Moving to floating support would increase the service capacity.  Procuring a mixture of floating support and accommodation therefore was recommended as the way forward

The Council’s current financial constraints were noted, but the Commission agreed that smaller accommodation units appeared to work better than larger ones.  The extension of the time for which accommodation-based support could be received was welcomed, particularly for people with multiple abuse issues.  In addition, the potential use of Evesham House for the remodelled service was welcomed, as this provided a good base from which to change and/or expand the service in the future.

However, some concern was expressed about replacing 24 hour support with floating support, particularly if urgent action was needed to help someone maintain a tenancy.  In reply, the Head of Commissioning (Care Services and Commissioning) explained that:-

·           It was difficult to say how effective the current contract had been, as it only specified that activity levels should be monitored.  This would be rectified under the new contract, which would require outcomes to be monitored;

·           The current ‘ad hoc’ service described in the report was a service available for all substance misusers, not specifically for those users who had left Evesham House.  This service was ‘Engage’ and was a harm reduction model;

·           Floating support would be used  ...  view the full minutes text for item 23.

The Director for Care Services and Commissioning (Adult Social Care) submits a report providing an indicativetimetablefor theactionsneededto supportexistingservice users attending the Douglas Bader Day Centre to find alternative services before the Centre closes.  The Commission is recommended to note the report and comment as appropriate.

The Director for Care Services and Commissioning (Adult Social Care) submitted a report providing an indicativetimetablefor theactionsneededto supportexistingservice users attending the Douglas Bader Day Centre to find alternative services before the Centre closed.  The report also included a summary of the progress of individual service users moving to alternative provision.

The Director advised the Commission that:-

·           15 people remained using the centre, all of whom had received an assessment;

·           It was intended to close the centre on 22 August 2014.  Anyone not relocated to a different service by then would be moved to the Hastings Road centre;

·           Notice had been given to staff that their contracts would end on 4 September 2014;

·           Some staff had used “bump on” to find new jobs with the Council.  Under this provision, if a member of staff from any service area moved on within the Council, staff from the Douglas Bader centre who did not want to take redundancy could be offered the  post being vacated, subject to a formal recruitment and selection process;

·           No concerns had been received from any of the centre users about moving to the Hastings Road centre; and

·           Those relocated to Hastings Road would continue to receive support until they were in receipt of an alternative service.

Some concern was expressed that the centre would be closing before all of the users had been found alternative services, but it was noted that with staff leaving it would no longer be possible to operate the centre.  It was recognised that relocating users to Hastings Road was not an ideal solution, but the process of relocating users had taken longer than anticipated and users would remain together as a group at Hastings Road.

The Assistant Mayor (Adult Social Care) reiterated that it was unfortunate that some users had to move to Hastings Road, but the facilities there were much better there than at the Douglas Bader centre and users would not receive a lesser service.

The Commission welcomed the choice and control available through personal budgets, but questioned why the assessments had taken so long to complete.  In reply, the Director for Care Services and Commissioning (Adult Social Care) advised that the report had been prepared some time in advance of the meeting, so all of the 15 remaining users of the Douglas Bader centre had now received assessments.  Users who had already moved on were supported in their attendance at alternative day care services, or use of other community services. 

The Commission was reminded that some users of the Douglas Bader centre had been there for approximately 40 years and had quite complex needs and the Council had consistently stated that all users would be supported throughout the process of finding and using alternative  ...  view the full minutes text for item 24.

The Director for Care Services and Commissioning (Adult Social Care) submits the following reports:

a)     A report outlining progress with individual residents’ moves to alternative accommodation, where their current homes are to due be, or have been, closed.  (Appendix E1)

The Commission is recommended to note this update and comment as appropriate; and

b)     A report updating the Commission on the perceptions of residents four weeks after their move from Elizabeth House and Nuffield House.  (Appendix E2)

The Commission is recommended to note the positive findings from resident responses and to note the reasons for any dissatisfaction identified at this stage and the mitigating actions that have been undertaken.

The Director for Care Services and Commissioning (Adult Social Care) also will provide an update at the meeting on progress with the sale of premises.

a)    Progress with Moves to Alternative Accommodation

The Director for Care Services and Commissioning (Adult Social Care) submitted a report outlining progress with individual residents’ moves to alternative accommodation, where their current homes were to due be, or had been, closed. 

It was noted that the procurement process to determine the future of Abbey House and Cooper House was due to be completed within the next few weeks and it was anticipated that an update on the outcome of the procurement process would be made to the Commission in due course.  Once the sale of these premises had been completed, an evaluation of phase 1 would be prepared and submitted to the Commission.  No further update was available on the pending legal proceedings regarding Herrick Lodge.

The Adult Social Care Business Transition Manager advised that 4 permanent and 7 temporary residents currently were in Herrick Lodge, as the home was still available for people to enter on a temporary basis.

In reply to a question, it was noted that resident number 24 had been in hospital, so to date it had not been possible to complete a 4 week review.  This would be done as soon as possible though.

b)    Evaluation of Residents Moving under Phase 1

The Director for Care Services and Commissioning (Adult Social Care) submitted a report updating the Commission on the perceptions of residents four weeks after their move from Elizabeth House and Nuffield House.

The Adult Social Care Business Transition Manager advised the Commission that it was recognised that moving out of elderly persons’ homes would be hard for some residents, so the Council had aimed to use a process under which residents understood what was happening at each stage.  The report submitted drew together comments received before residents moved, at the point of moving and after they had moved.  As could be seen from the report, there had been no placement breakdowns.

The Assistant Mayor (Adult Social Care) commended the officers who had been working on this.  Before the process started, research had been done on how other authorities had approached similar situations, but there were few examples available.  The Assistant Mayor stated that the way in which the moves had been processed in the city was exemplary, with any issues arising being addressed very quickly. 

The Commission welcomed the way that the evidence had been gathered.  However, there was some concern that there appeared to be no family perceptions of what the residents had experienced.  In reply, the Adult Social Care Business Transition Manager advised that part of the moving plan process involved asking residents who they wanted involved in the process and how this should be done.  As a result, some people had said that they wanted to represent themselves, but others nominated people to represent them.

It was noted that two people had died during the moving process.  Both of them had moved to new homes, but had terminal illnesses.

Mr Philip Parkinson, on behalf of Healthwatch, stated that Healthwatch was  ...  view the full minutes text for item 25.

The Director of Adult Social Care and Safeguarding submits a briefing note setting out the timeline for the design development of the intermediate care unit.  The Commission is recommended to note the briefing and agree the key periods for the Commission to receive the plans in development.

The Director of Adult Social Care and Safeguarding submitted a briefing note setting out the timeline for the design development of the intermediate care unit.  She noted that:-

·           Two key points had been identified at which it would be helpful to have input from the Commission.  Although there was a short period for input at these points, they fell at times at which meetings of the Commission were scheduled;

·           If required, additional briefings could be provided for Members; and

·           Architects had been secured through a framework contract to develop an early design.

RESOLVED:

1)    That the Director of Adult Social Care and Safeguarding be asked to hold an informal session at the outline design stage of the intermediate care unit, for Members to view plans for the unit, a report on these discussions to be made to this Commission; and

2)    That the Director of Adult Social Care and Safeguarding be asked to arrange a visit to the proposed site for the intermediate care unit if feasible.

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

The Commission received its current work programme, noting that:-

·           The contact at the Lesbian, Gay, Bisexual and Transgender Centre had been unavailable, so it had not yet been possible to arrange a visit to the Centre;

·           It was planned to undertake some joint working between this Commission and the Health and Wellbeing Scrutiny Commission;

·           Officers from the Adult Social Care service had offered to provide a briefing on issues involved in preparing a scoping document for a review of fees in care settings.  A date for this would be circulated; and

·           The Deputy City Mayor would be giving a briefing on 8 September 2014 on the Better Care Plan, which members of the Commission were welcome to attend.

At the meeting of the Adult Social Care Scrutiny Commission on 25 September 2014, an amendment to this minute was agreed as follows:

“The Deputy City Mayor would be giving a briefing on 8^th September 2014 on the Better Care Together, which members of the Commission were welcome to attend.”

The Commission thanked officers for the introduction to the work of the Commission that had been given at a briefing held on 12 August, which had been very informative.

RESOLVED:

That the Scrutiny Support Officer be asked to update the Commission’s work programme, taking account of the points raised above, and circulate it to all members of the Commission.

The meeting closed at 7.57 pm