Agenda and minutes

Apologies for absence were received from Councillor Chaplin and from Karen Chauhan, Chair of Healthwatch.

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

No declarations of interest were made.

The minutes of the meeting of the Adult Social Care Scrutiny Commission held on 24 October 2017 have been circulated and the Commission is asked to confirm them as a correct record.

AGREED:

That the minutes of the meeting of the Adult Social Care Scrutiny Commission be confirmed as a correct record.

Further to minute 37, “Adult Social Care Integrated Performance Report 2017/18 Quarter 1”, the Chair reminded Members of the concerns that had been raised that funding from the Better Care Fund (BCF) could be reduced if the Council failed to achieve a stretched target relating to Delayed Transfers of Care (DTOC).  She invited the Strategic Director for Adult Social Care and Health to update the Commission on this.

The Director reported that, having agreed a NHS England compliant trajectory for DTOCs in the BCF plan, the potential threat of the health transfers monies (around £10m) had been removed and that the Council had been advised that its performance had been good enough for its funding from the Better Care Fund to be maintained in 2018/19. 

On behalf of the Commission, the Chair asked the Director to thank all staff involved for the hard work that had been done to secure this position.

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.

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

Councillor Dempster, Assistant City Mayor – Adult Social Care and Wellbeing, thanked all staff for continuing to deliver care to vulnerable people in the city despite the recent bad weather conditions.  Some of these members of staff had had very early starts to their work, when weather conditions were very poor, but the service had not been interrupted significantly.

This thanks was endorsed by the Chair on behalf of the Commission, as she had not been aware of any complaints or problems arising during this difficult time.

The Strategic Director of Adult Social Care and Health reminded the Commission that some of these members of staff were employed by the Council, but many were contracted by independent care providers, so he would share these comments with those external providers and contractors.

The Independent Chair, Leicester Safeguarding Adults Board (LSAB) submits the LSAB’s Annual Report 2016/17 and Strategic Plan 2017 – 2020. Members are asked to note and comment on the report as they see fit.

Jane Geraghty, the Independent Chair of the Leicester Safeguarding Adults Board (LSAB) submitted the Board’s Annual Report 2016/17 and Strategic Plan 2017 – 2020.

Attention was drawn to the following points:

·           The LSAB had received a peer review since its last annual report;

·           In contrast to the situation two years ago, the LSAB’s sub-groups now were all chaired by members of the Board;

·           It was recognised nationally that this was an area where it was difficult to collect meaningful data.  However, in Leicester a very good data set had been established;

·           The LSAB was generally in compliance with the duties within the Care Act, but was not complacent;

·           In over 75% of instances where risk was identified, that risk either was removed or reduced.  100% would not be achievable, as adults with capacity had the right to decide whether to change a risky situation;

·           Feedback showed that 89% of people achieved the outcomes that they wanted.  In cases where this was not achieved, it could be for a number of reasons, including some over which the LSAB had no control.  For example, people could want someone prosecuted, but the Crown Prosecution Service could decide that this would not be done; and

·           The Performance, Effectiveness and Quality subgroup also had considered this, in the context of a Making Safeguarding Personal multi-agency audit across Leicester, Leicestershire and Rutland.  Recommendations from this included what to do when it was not possible to achieve the outcomes desired by the person.  In recent activity, approximately 70 cases were investigated and the person’s desired outcomes had not been achieved in four of them.  In two of these cases this was because prosecutions had been wanted by the people concerned and in two the people had disengaged from the process.

Ms Geraghty confirmed that there was very good attendance at Board meetings and partner engagement was reviewed every year, with assurances from partners that people would be safeguarded from harm being challenged.  Good work was being done by the partners, with a multi-agency audit on making safeguarding personal having received national recognition.  It was recognised that this was a journey, but all participants were aware of their responsibilities and they were pushed, challenged and praised where needed.

Members enquired what the extent of problems were due to issues identified in the partner statement by Leicestershire Police.  In reply, officers advised that they had not been a significant feature of formal safeguarding enquiries.  Many were emerging issues and their inter-relationship was not always straightforward.  For example, someone could need to be kept safe, but not as a safeguarding issue.  The Care Act was very specific about who safeguarding applied to, so a lot of individuals were not included in the definition.  It was hoped that, through training, staff would understand what incidents needed to be reported and to whom.

Ms Geraghty explained that partner agencies were expected to do their own awareness raising and training.  However, they recently had been asked to tell the Board of perceived  ...  view the full minutes text for item 50.

The Director for Adult Social Care and Safeguarding submits a report which details information about statutory, corporate complaints and commendations received by Adult Social Care during the previous year.  The Commission is asked to note the contents of the report.

The Director for Adult Social Care and Safeguarding submitted a report detailing information about statutory and corporate complaints and commendations received by Adult Social Care (ASC) services during 2016/17.  In introducing the report, the Director reminded Members that the Council was required to publish an annual report on statutory and corporate complaints received. 

It was noted that the number of complaints and commendations received about ASC services during 2016/17 had increased and there was a slight increase in the number of complaints upheld.  The number of complaints referred to the Local Government Ombudsman had fallen slightly.  Overall, complaints were now dealt with more swiftly than previously.

The Director stressed that complaints were not unwelcome, as they provided valuable feedback on services, and the outcomes were shared with management teams and front-line teams.  The number of complaints received varied from year to year, but were a very small proportion of interactions made with ASC services.

The Commission noted that there could be conflict between what the law allowed the Council to do, what the Council felt it should do, and what members of the public felt the Council should do.  When this conflict could not be resolved, people could complain to the Local Government Ombudsman.  Those complaints often resulted from people having too high expectations of what the Council could offer, or wanting the Council to respond to something that had to be defined as a “want”, rather than a “need”.

Some common themes could be identified in complaints made and those for 2016/17 were set out in the report.  These themes were used to learn from.  For example, work was being done with teams to ensure decisions were fully evidenced, to enable full responses to be made to people unhappy with the outcomes of assessments.  As a result of this work, the number of complaints being upheld was reducing overall.

As the Council worked with various partners, complaints sometimes were received that encompassed ASC services and services provided by partner agencies.  As the Council could only investigate its own services, multi-agency complaints were processed through a jointly agreed local protocol. 

It was recognised that it was important to use compliments positively.  They were received by ASC in various ways and were gathered as effectively as possible.  For example, when a formal compliment was received, the Strategic Director for Adult Social Care and Health sent a commendation letter to the member of staff concerned.  It was hoped that Team Leaders passed on verbal compliments.  Reflective supervision also could be an important way of acknowledging things that had gone well, as it was important for staff to be confident in their own skills and to acknowledge them.  A staff survey was planned, which would provide useful information on how supported staff felt.

Members suggested that officers should be more proactive in publicising their successes.  Councillor Dempster, Assistant City Mayor – Adult Social Care and Wellbeing, endorsed this, suggesting that activities such as a 24 hour Twitter feed could be considered.  She reminded  ...  view the full minutes text for item 51.

The meeting adjourned at 7.18 pm and reconvened at 7.24 pm

The Strategic Director, Adult Social Care submits a report that brings together information on various dimensions of adult social care (ASC) performance in the second quarter (first six months) of 2017/18.

The Scrutiny Commission is requested to note the areas of positive achievement and areas for improvement as highlighted in this report.

The Strategic Director for Adult Social Care and Health submitted a report bringing together information on various aspects of Adult Social Care (ASC) performance in the second quarter (first six months) of 2017/18. 

The Strategic Director drew attention to the forecast budget underspend, stressing that this was a one-off situation and did not imply that pressures on the budget had been removed.  On current growth demand, an increase of around £5million per year for care packages was the likely projection for the period to 2019/20.

The Business Improvement Manager (Adult Social Care and Safeguarding) noted that:

·           Overall, ASC performance was improving year on year.  Despite this, some areas of concern remained, which were highlighted in the report;

·           Measures for the six priorities identified in the report had been devised;

·           This was the first time since these performance reports had been introduced that both long and short term sickness levels had fallen;

·           Expenditure on agency and sessional workers was lower than in the corresponding period in 2016/17;

·           The Council’s national rankings in 15 measures had improved.  This was particularly welcome given the challenges faced by ASC services; and

·           ASC was very interested to understand service users’ experiences, both positive and negative.  Various surveys were being used to help with this.

The Commission welcomed the improvement in sickness rates and stressed the importance of maintaining good staff morale in continuing this improvement.

Members queried how staff cuts were balanced against the reduction in agency workers and whether this was sustainable.  Officers agreed that it was preferable to have staff employed in substantive posts, but compromises had to be made between what it was felt was the right way forward and what it was possible to do in particular staffing groups regarding recruitment challenges.  Changes in ways of working also were being undertaken to reduce the workload on remaining staff.  For example, increased use was being made of processes such as telephone reviews, and it was expected that the need to consider such compromises would increase.

It was noted that the number of permanent admissions to residential care for 18 – 64 year olds and those over 65 were higher than in the corresponding period in 2016/17.  The Director for Adult Social Care and Commissioning explained that work was ongoing in ensuring that younger people had earlier contact with ASC services, so they could make informed choices.  In addition, transitions from children’s care services were being improved.  Proposals for Extra Care also were being examined, although two units would not now be brought in to use within previously anticipated timescales.  Work with other organisations also was on-going to identify where support could be given.

Although it could involve difficult decisions, the management of demand (at the ‘front door’ / access) was improving.  This included a significant move towards capping demand, which included pilot work on a strength-based approach, so that responses moved away from ASC automatically providing any support required.

The Commission noted achievements from the period covered in the report.  The Director  ...  view the full minutes text for item 53.

The Strategic Director submits a report that provides the Adult Social Care Scrutiny Commission with an overview of the Transforming Care Programme. The Commission is recommended to note the report and provide feedback and comment.

The Strategic Director for Adult Social Care and Health submitted a report providing an overview of the Transforming Care Programme (TCP). 

The Director for Adult Social Care and Commissioning presented the report, explaining that the TCP was a national programme, monitored by NHS England, which aimed to move people with a learning disability out of specialist hospitals and in to the community.  This only applied to people who had been in specialist hospitals for over two years, so there were small numbers, but they usually had very high and/or complex needs.  The TCP also placed a requirement on health and social care services to prevent people from being re-admitted wherever possible.

If someone wanted to live in the community or with their own family members, an assessment would be completed to determine what support was required.  Due to the complexity of some individual’s needs, bespoke training was made available to providers to enable them to provide the required support.  The Council funded some of this, but health services also could provide some assistance.

The Strategic Director confirmed that it was not known yet why more Leicester residents were admitted to the specialist hospital ward than residents from the rest of the county and Rutland.  The needs of people admitted from Leicester were of the same complexity as those of others admitted.  It was not felt that more preventative work was available for residents from areas outside of the city, as those services were jointly commissioned across the city, county and Rutland.  The amount spent by the City Council on services for people with learning difficulties was average, so this would not account for the different admission rates either.

The Director for Adult Social Care and Commissioning confirmed that a request had been received from NHS England for offers to discuss the provision of specialist properties in to which people being moved under the TCP could be placed and the allocation of these properties.

AGREED:

That the Director for Adult Social Care and Commissioning be asked to write to the government expressing the Commission’s concern that the Council has a responsibility under the Transforming Care Programme to find appropriate accommodation for people with learning disabilities, but is not being provided with the funding to enable it to do this effectively.

Councillor Dr Chowdhury left the meeting at 7.51 pm, during discussion on this item.

The Commission will receive a power point presentation on the development of integrated teams relating to hospital discharge, locality and points of access. The Commission is asked to note the presentation and comment as appropriate.

The Director for Adult Social Care and Safeguarding gave a presentation on the development of integrated models of care.  A copy of this presentation is attached for information at the end of these minutes.

During the presentation, the Director drew particular attention to the following points:

·           In the city the focus was on a joined up experience for people using health and care services, not the organisational structures;

·           Integration was a key area of the Leicester City Better Care Fund Plan and the Leicester, Leicestershire and Rutland Sustainability and Transformation Plan;

·           No additional resources had been allocated for local integration projects, but available resources were combined;

·           Improved processes, including the sharing of best practice, was helping to avoid delays, including formal discharge delays;

·           Access to on-line patient information systems had improved;

·           Adult Social Care services in the city and county were very engaged with, and committed to, this model of care;

·           Anyone from the partner organisations could make assessments;

·           Much of the integrated community response was funded through the Better Care Fund;

·           The improved falls pathway was working well.  Out of over 1,000 people who had fallen last year and been visited by the integrated Crisis Response Service, only 11 had been conveyed to hospital, the majority being supported at home;

·           Integrated locality teams were based around GP populations and each was supported by a named social work team;

·           One challenge being faced was maintaining the consistent engagement of partners, partly due to the capacity of those partners;

·           It was hoped that integrated teams could be co-located, as this would improve ad hoc and less formal liaison between partners; and

·           Although the City Council had stepped back from establishing integrated points of access, it was maintaining dialogue with the County Council and Leicestershire Partnership NHS Trust in order that it could participate if appropriate.

See also minutes 56, “Inquorate Meeting”, and 57, “Presentation on the Development of Integrated Teams – Continued”, below.

Councillor Thalukdar left the meeting at 8.15 pm, making the meeting inquorate.

The remaining Members decided to continue considering the remaining items on the agenda, noting and commenting as considered appropriate.

Consideration of the presentation on integrated models of care resumed.

The Strategic Director for Adult Social Care and Health confirmed that the driver for this integration had been from governments over many years.

The Director for Adult Social Care and Safeguarding confirmed that a report on progress with removing barriers to integrated models of care locally was due to be considered in the new year.  Until all information for this report had been prepared, it was not possible to give an estimated timescale for the further development of integrated models of care.

The Chair drew the discussion to a close, thanking officers for a very informative presentation.

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.

All members of the Commission were invited to pass suggestions for items for inclusion in the work programme to the Chair.

The Chair thanked everyone for attending and wished them a happy Christmas.

The meeting closed at 8.20 pm