Agenda item

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

Councillor Dempster, Assistant City Mayor, Adult Social Care said that the report showed that performance was good, but it was important not to be complacent and to be aware that circumstances in adult social care could change very quickly.  The Assistant City Mayor commended the staff for their hard work. 

The Strategic Director, Adult Social Care stated that in some areas there was sustained improvement. There continued to be no further clarity from the Government regarding the proposed LHA cap that would fund and enable the development of supported accommodation, and without that clarity, the plans to provide that accommodation could fall two years behind schedule.

Continued pressure and growth in demand for social care arose from the increasing frailty of a growing population, and within adult social care, there was an increasing level of demand from those who already had a care and support package.  The meeting also heard that Leicester had a higher number of working age adults who required adult social care than its comparators.

The Chair questioned whether, when work started on the supported living accommodation, it could be phased and heard that the council had agreed to provide 100 places but it would not be appropriate to build on a phased basis as this would impact on the economies of scale.

In response to a question about preventative work, the Strategic Director commented that most preventative work around those conditions that affected adults of working age, generally was within the remit of the Public Health and local health services i.e. in preventing ill health, supporting people to manage long terms conditions so as to minimise the impact on their general wellbeing and health. Adult Social Care itself was very limited in what it could do to prevent people of working age with long term conditions and major health needs to improve their health and minimise the impact and the need for future social care.

In relation to the ASC Strategic Priorities, the Strategic Director explained that one of the priorities related to supporting young people and their families in transition to adulthood. Work on transition had been delayed, but progress was now being made jointly with Children’s Services and health partners on this priority. It was anticipated that there would be more detail on this in the Quarter 2 / Quarter 3 reports.

A Member referred to section 3.2.5 of the report which stated that 74.2% of enquiries had begun with 24 hours of the threshold decision being made and questioned what had happened to the remaining enquiries. The Director of ASC and Safeguarding explained that there could be a number of reasons for this, including an unwillingness to engage. Some of the enquiries might have been dealt with within 24-36 hours and all enquiries were actioned. The Strategic Director explained that there was no national or legal target for the department and that the 24 hour measure had been set by the department in order to get a feel of its performance. They could equally have set a measure of 48 hours. 

 It was noted that 44.7% of individuals had their safeguarding outcomes only partially met; this might have been because the individual had requested an outcome which would not have been possible to deliver. Karen Chauhan, Chair of Healthwatch requested more details on the outcomes that had only been partially met and the Director of ASC and Safeguarding confirmed that these details were available and were already produced for the Leicester Safeguarding Adults Board (LSAB).

In response to a query relating to the equalities implications, the Strategic Director offered to bring more information on specific protected characteristics should the Commission wish to look into these further.

A Member referred to Section 3.1 of the report which included details of the introduction of a new strategic priority, which made explicit the Council’s commitment to keeping people safe and questioned whether this was a national priority. The Strategic Director responded that the priorities set were local as there were no national strategic priorities.

Members raised a concern relating to problems with the Council’s Human Resources I.T. system and the Strategic Director explained that this was a new system but it was not working fully at the time of the completion of the Quarter 1 report. Some of the data, such as sickness recording was not available or reliable, but officers in HR were working with the supplier to address these problems and the department was assured that this information would be available in the second quarter. 

A Member questioned whether there was a system in place with the Health Service to follow up on an individual who appeared to be making a recovery for example from an acute episode of mental health care,  to track whether that recovery was sustained.  The Strategic Director responded that there were requirements by GP practices to have a register of carers, for example, but there was no national mandate for a ‘tracking system’ for those who had had acute episodes of mental health care and were discharged from clinical support. People did however have access at any time to their GP and that in their role the primary care clinicians offered that ongoing contact for people. At the request of Councillor Chaplin, it was agreed for the Commission to express concern to central government that funding cuts meant that health and care services could not be proactive in monitoring the wellbeing of individuals who did not receive statutory services.

Questions were raised around this issue, such as what would happen if the carer lived in a different local authority, or what might happen if someone experienced a recurrence of mental health problems several years after they appeared to have recovered.  The Member asked whether some sort of tracking process could be put in place.  The Strategic Director responded that with resources being so challenged, the priorities tended to focus on meeting immediate needs and while prevention was important primary care, Community and General Practitioners were themselves very pressured.  Within current resources across health and social care there was no ability to set up an ongoing tracking service, other than people having access through their GP to services as and when they needed support.

A Member referred to Strategic Priority (SP) 4 to improve the offer to older people to support more of them to remain at home (as an alternative to  residential care), and questioned what was being done to ensure their safety.   The Strategic Director responded that Leicester, like other local authorities, received more reports of problems and safeguarding alerts relating to residents in care homes than from people in their own homes; though this was likely to do with the level of contact and monitoring that exists in and around care homes. An injury or incident for example in an individual’s own home might not be identified or reported. Members also heard that there was a requirement for care homes and other regulated providers to report incidents to the local authority and the Care Quality Commission (CQC) and the Council worked to raise awareness of how to report concerns

The Strategic Director explained that more work was being done to raise awareness around the abuse that could occur within individual’s homes, in families and around those who may be isolated. That abuse could occur in a number of different ways, for example though financial abuse; and low level abuse could be easily hidden.  The service also relied on the community to report concerns of abuse and one of the priorities of the LSAB was to work with communities to raise awareness of this issue.

The Chair expressed a concern that the Council might lose funding as a result of changes around the Delayed Transfers of Care (DToC). Although Leicester’s performance with DToC had been significantly better than the national performance, Leicester had been given a stretched target. The Council were very concerned that this target was unachievable but had had to submit a plan compliant to the target, as a non-compliant plan would not have been accepted. The Council would however be financially penalised if they did not achieve the plan as submitted. Members also expressed strong concerns at this and noted that the Council received over £10m funding from the Better Care Fund which represented 10% of the ASC budget. There would be a very significant impact on the budget if the funding had been  withdrawn and would likely impact on staff, may slow down assessment processes and slow down discharges from hospital.  The Assistant City Mayor for Adult Social Care, directed criticism at the Government for forcing spending cuts on Local Government, adding that it was very difficult to plan for the future, where the Council had been under the potential threat of such a significant cut in funding.  

The Chair stated that these concerns had been passed onto the relevant Executive Leads and letters would be sent to the Members of Parliament for Leicester.  The Chair of Healthwatch added that they would also write to NHS England about this issue.

The Chair concluded the discussion, stating that very good work was taking place in the department and asked for this to be recorded in the minutes.

AGREED:

1)    that it be recommended for the Adult Social Care Scrutiny Commission to express concern to central government that funding cuts meant that health and care services could not be proactive in monitoring the wellbeing of individuals who did not receive statutory services;

2)    for the Chair of Adult Social Care Scrutiny Commission to write to the Chair of the Health and Wellbeing Scrutiny Commission to look into the issue.

7.01 – 7.05. There was a brief adjournment; during which Councillor Thalukdar left the meeting.