Agenda and minutes

Apologies for absence were received from Cllr Modhwadia, Cllr Joannou and Cllr Zaman.

Members will be asked to declare any interests they may have in the business on the agenda.

The Chair asked members of the commission to declare any interests in the proceedings. Cllr Sahu declared that she co-owned a business which delivered training to the NHS. 

The minutes of the meeting of the Adult Social Care Scrutiny Commission held on 5^th October 2023 have been circulated and the Commission is asked to confirm them as a correct record.

The Chair noted that the minutes of Adult Social Care Scrutiny Commission meeting held on 5 October 2023 were included within the agenda pack and asked members to confirm that they could be agreed as an accurate account. 

The Chair highlighted that the recommendation by the Commission to change the minimum CQC inspection of ‘Requires Improvement’ with ‘Good’ in the ‘well led’ section, to overall inspection being ‘Good’ had been accepted and reflected in the contractual arrangements.

It was further noted by the Chair that questions previously asked by Cllr Dave and Cllr Joannou in relation to the workforce be covered in the first main item on the agenda.

AGREED:

·       Members of the Adult Social Care Scrutiny Commission confirmed that the minutes for the meetings on 5 October 2023 were a correct record.

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

The Monitoring Officer noted that none had been received.

The Director for Adult Social Care and Commissioning submits a report providing a summary of the external adult social care and NHS workforce in Leicester.  

The LLR Integrated Care Board further submits a report providing a summary of the NHS workforce in Leicester, Leicestershire and Rutland.  

The Director of Adult Social Care & Commissioning introduced the item noting that two reports had been submitted and that synergies could be seen across both. The adult social care report was based on data from Skills for Care where Leicester has around a 50% return rate.

It was also highlighted that a professional carer of the year award event was being hosted by Inspired to Care in the city at the same time as the meeting to celebrate the workforce.

The item was presented by the Director of Adult Social Care & Commissioning and Chief People Officer for the Integrated Care Board, and it was noted that:

·       The social care workforce nationally is significant, and the Skills for Care data indicates there are around 15k posts in the city, of which around 14k are filled leaving around 1k vacancies. 6% of the workforce are recruited by the local authority, 81% in the independent sector, 8% in receipt of direct payment and around 6% other.

·       There are 268 CQC regulated providers in the city, including 98 residential settings and 170 non-residential, primarily providing home care.

·       Turnover in the workforce compares favourably in the city with the region and national average. Whilst people may leave specific roles, they are likely to be retained in the adult social care sector.

·       Vacancy rates in the city is lower than the region and national rate at 7.5%. National vacancies have decreased due to an international recruitment campaign and benefits are being seen locally.

·       The local workforce is relatively stable with workers on average having eight years’ experience and 68% working in the sector for at least three years.

·       There are various initiatives in place locally to support providers to recruit and retain workers in the sector and deliver training, including working with Inspired to Care and the Integrated Care System.

·       Providers do employ staff on zero-hour contracts, but the authority is working to improve this and request contracted providers provide evidence of where this may be a personal preference of the workforce.

·       Achievable pay rates for providers are incorporated into contracts using the funding formula.

·       There is an ambition to have one workforce across health and social care in Leicester, Leicestershire and Rutland. A People Board has been in operation since 2018 to ensure collaborative working for recruiting, retaining, and upskilling the local workforce prior to the publication of the national NHS long term plan and next steps to put people at the heart of care.

·       Around 70k individuals are employed by the health sector across LLR and the workforce has continuously been growing since 2019 – 7.7% increase. There are around 2855 health vacancies with the largest group in nursing which is a national trend.

·       Primary care has seen the largest growth in the workforce with an increase of 26%. National funding enabled the ‘additional roles and responsibilities’ scheme to ensure multi-disciplinary teams to enable residents to be seen by a skilled professional at the right time.

·       Sickness rates have reduced overall to 6% across  ...  view the full minutes text for item 11.

The Leicester Safeguarding Adults Board submits an annual report providing an overview of the strategic and developmental priorities of the Board.

The Independent Chair of the Leicester Adults Safeguarding Board presented the item, and it was noted that:

·       The Care Act specifies three statutory duties for the safeguarding board, including publishing the LSAB Plan 2022-25 on the website, publishing an annual report and commissioning safeguarding adult reviews to understand if lessons can be learnt.

·       The safeguarding board is made up of partners and subgroups who undertake work. 

·       Almost half of individuals in the city identify as an ethnic minority group which is important for safeguarding tracking to ensure all communities are aware of safeguarding. The local population is not currently reflective in investigatory work, but a high-level dashboard is being explored to monitor progress.

·       Data is collated from the local authority, police, and health for investigations. Local authority concerns referred as safeguarding gather further information to establish safe or action needed. 48% of referrals resulted in inquiries, in line with the national average.

In response to questions and comments from Members, it was noted that:

·       Healthwatch represent the VCSE sector on the Board and support the co-ordination and engagement subgroup, although the suggestion of further VCSE representation will be considered.

·       Safeguarding Adult Reviews are important and helpful for learning. Timescales to complete reviews can be long for a variety of reasons, including engagement with families or involvement of the coroner but work is underway to ensure learning is underway as quickly as possible.

·       The internal workforce is small, but a check will be made regarding whether any Ukrainian social workers have been recruited.

·       Local Authorities collect and report data nationally. The Director of Adult Social Care & Safeguarding chairs the performance subgroup which monitors dashboard indicators to track referrals. The subgroup is looking at issues associated to variations in data and ensuring it is better reflective of the population and care settings.

·       The engagement subgroup undertake work with community groups and leaders across the city to ensure safeguarding and its importance is promoted and understood. The Ukrainian case study within the report is one example of work undertaken following the welcoming of refugees to the city.

The Chair thanked the Independent Chair of the Leicester Adults Safeguarding Board and the assurance the report provides in learning from serious situations to keep people safe.

Thanks to the late Fran Pearson were also expressed and the Chair noted she will be much missed.

AGREED:

·       The Commission noted the report.

·       Additional information requested be circulated.

A joint report is submitted by the Director for Adult Social Care and Commissioning and Leicestershire Partnership NHS Trust (LPT) providing an update of key challenges, waiting times and joint efforts to address mental health in Leicester City.

The Director of Strategy & Business at Leicestershire Partnership Trustpresented the item, and it was noted that:

·       The local authority and health partners continue to work together to support residents with mental health and all strategies that have been developed feed through into the city’s mental health partnership board which is a sub-group of the Health & Wellbeing Board.

·       Services provided under Leicestershire ‘Step-Up to Great’ Mental Health have now been replaced by Better Mental Health for All.

·       Community mental health services are provided to people whilst they are living at home and are delivered by the local authority, VCSE organisations and health providers. Promoting good mental health and wellbeing in the community helps residents to maintain employment, housing and contribute to society and be part of their community.

·       There have been increasing referrals for adult psychiatry services – now between 300-350 referrals a month across LLR. This has been a challenge for the way of working but initiatives have been underway to increase the workforce by identifying new ways of recruiting, being flexible with a multi-disciplinary team to ensure residents are seen by a professional with the appropriate skills at the right time and undertaking casework reviews. 

·       Perinatal services to support new mothers is on track to meet the target of seeing 1259 mothers, using birth rate indicators, by 31 March 2024 and sustaining the service following an increase in investment.

·       ADHD services remain a big challenge with increasing referrals and the 18week target to see patients is not being met. This is a challenge for all areas across England and work is underway to partner with others to identify solutions. LPT remains the central hub for prescribing medication for residents with ADHD, but spokes have been created by working with community pharmacies to ensure patients are able to access medication until supply is restored.

·       Memory clinics are not meeting targets for expectation diagnosis per population rate. The service is increasing the referrals received - around 316 a month – and currently achieving 65.4% diagnosis with a target of 66.7%.

·       Targets of 95% compliance of seeing patients for dynamic psychotherapy services, psychological therapies and therapeutic services for personality disorders are not currently being met but work is underway for improving.

·       Urgent care has been expanded and includes central access point. Around 167 calls a day are received with average call times reducing from 15minutes to 12minutes. National performance indicators currently will be introduced from April 2024 which will enable benchmarking against other authorities.

·       An urgent care hub is available to try and prevent residents having to go to A&E. The unit has around 270 referrals a month.

·       The crisis service has a caseload between 180-210 patients at any given time. The 4hour response for very urgent cases is at around 80% of the 95% target.

·       There has been investment in the mental health liaison service to provide support to all hospitals in the city. A challenge exists around the timeframes of a patient being identified as needing mental health  ...  view the full minutes text for item 13.

The Director of Public Health submits a report providing an update on drug and alcohol services in Leicester.

The Public Health Consultant presented the report, and it was noted that:

·       There are high numbers of individuals who are not in treatment for both drug and alcohol use. Those who are in treatment often have complex needs that require additional support.

·       A large proportion of the local population do not drink but there is a disproportionate impact on people who do. There is a high rate of hospital admissions and deaths.

·       Success of recovery is more likely when supported by individuals with lived experience – peer mentors and support groups are therefore utilised in recovery journeys.

·       Turning Point provide the largest contracted support for treatment and recovery in the city. Other support is provided at No5 which is the only wet centre in the country and often recognised as such. Unity house also provides supported accommodation for abstinent individuals moving back into the community and an inpatient detoxification unit is provided in Nottingham to provide support to individuals usually over ten days to safely reduce or stop their substance use. There are additional services provided by health partners for individuals who also have a mental health condition.

·       Funding for treatment has been significantly reduced nationally over then last ten years but Leicester continues to be an area with greatest need. Government funding (in addition to core public health funding) is secured to support initiatives until 2025 - with no further commitment currently beyond 2025.

·       National policy has altered with a shift to punishing individuals for recreational drug use which can create barriers to accessing treatment.

·       A combined drug and alcohol strategy has been developed which includes governance structures and task and finish groups. Current plans include identifying priorities for utilising funding and providing evidence to plan for possible future scenarios if funding is reduced. 

In response to questions and comments from Members, it was noted that:

·       Treatment is available but individuals may access sporadically, may not want support or may be unaware they need support. The service work with individuals, families and communities to break down barriers to accessing treatment. An article was reported in the national drugs bulletin on reaching out to different communities and agreed to be circulated.

·       Evaluation of the No5 Wet Centre outcomes and achievements will be explored by officers.

·       Indicators around drugs can be difficult to measure against as success is defined as being abstinent which is not accurate for all individuals as some may aim to reach a maintenance level. Leicester performs worse than others on this indicator as individuals are likely to have high complexity of need and Turning Point have high caseloads. The indicator is being changed nationally to monitor progress during treatment rather than just abstinence.

·       The inpatient detoxification unit located in Nottingham is commissioned and funded by the NHS for people across the Midlands area to access. The current government grant funding for drug and alcohol services is only confirmed until 2025 and usually provided on an annual basis limiting forward planning and commitment for additional units in different  ...  view the full minutes text for item 14.

The Director for Adult Social Care and Commissioning submits a report providing an update on the LLR Living Well with Dementia 2024-2028 strategy.

The Director for Adult Social Care & Commissioning noted the Living Well with Dementia Strategy was nearing its end and therefore the service have worked collaboratively across LLR and with partners and carers to develop a refreshed Strategy. A consultation exercise had been carried out and the feedback helped in shaping the new Strategy, due to launch in January 2024.

In response to questions and comments from Members, it was noted that:

·       The strategy will be delivered with action plans produced at a local level to ensure residents can access the appropriate support at the right time.

·       The diagnosis rate in the city is 73.8% of the population – the second highest across the east and west midlands.

·       Various support services, such as advice, emotional support, carer learning, groups and carer free time, are available for individuals both pre and post diagnosis, including the commissioned dementia support service and from other VCSE organisations. The service are working with health partners to provide consistency of admiral nurses.

·       GP referrals have been increasing although it varies. Work continues to target and support primary care settings to refer and/or signpost patients to appropriate services.

·       The refreshed strategy builds on previous work to ensure continuity.

AGREED:

·       The Commission noted the report.

·       The Commission to support and share the aims of the strategy.

The Work Programme for the Joint Commission is attached for information.

The Chair thanked Members for their contributions to joint discussions and noted that she will continue to work with the Chair of the Public Health & Health Integration Scrutiny Commission to ensure items of mutual interest are considered together where appropriate. 

The Chair noted that she had requested briefing notes to be provided to the Adult Social Care Scrutiny Commission in relation to the £400k savings in the enablement service and calls being dropped by the customer service centre.

It was further noted that the next meeting would take place on 25 January and Members were reminded to share items for consideration.

There being no further business, the meeting closed at 20.21.