Agenda item

The Strategic Director Social Care and Education submits a report to provide the Adult Social Care Scrutiny Commission with an overview of the winter planning requirements and the completion of a Self-Assessment Questionnaire regarding service continuity and care market review as required by the Department of Health and Social Care.

The Adult Social Care Scrutiny Commission is recommended to note the Council’s response to the Winter Plan and to provide comment and feedback to the Strategic Director and Executive. The Commission Members are also asked to note the Council’s response to the Service Continuity and Care Market Review self-assessment questionnaire.

The Strategic Director Social Care and Education submitted a report which provided the Adult Social Care Scrutiny Commission with an overview of the winter planning requirements and the completion of a self-assessment questionnaire regarding service continuity ad care market review as required by the Department of Health and Social Care.

Martin Samuels, Strategic Director presented the report and gave the following information:

·         The Commission was aware there had been a lot of demands on adult social care over the past six to seven months, and may well be starting the hardest part where the long expected second-wave of the virus had arrived and there was uncertainty as to how adult social care services would deal with the pressure on entering the winter period which was often a very demanding time for adult social care services anyway.

·         There was the possibility of implications with the country’s new relationship with the EU on 1^st January 2021, and there was potential for an impact on the availability of supplies, on staff etc. for the social care systems.

·         The Department of Health and Social Care wanted to have assurance local authorities across the country were well prepared for the above. In September the Department published a national winter plan which set out a significant number of actions that the Department and other bodies were going to take, and local authorities were expected to take. The Department also released a self-assessment questionnaire relating to service continuity and the care market which the authority completed.

·         Adult social care had worked during the course of October to address the winter plan and questionnaire. Firstly for the winter plan the Statutory Director was required to write to the Minister by the end of October 2020 to state the authority had a plan, but there was no requirement to submit the plan to the department, or indeed, have a single document rather than have the plan captured in a range of inter-related documents. The authority’s plan had been circulated to the Commission Members as a single document. Secondly the service continuity and care market review was submitted on 21 October, also circulated to the Commission. All local authorities had submitted the questionnaire.

·         Self-assessment questionnaires for each local authority within a region were returned and each regional group of ADASS was asked to pull together responses and provide as a report to the Department of Health and Social Care. Because they were treated as advice to Ministers they were not published documents, however, headlines were provided and all of the things Adult Social Care were expected to be concerned about had been identified through the questionnaires, such as, the level of workforce capacity, the high rate of turnover of staff and ongoing vacancies in the sector which was expected to get worse. There were concerns with the availability of home care capacity in some parts of the region (less so in the city), the availability of qualified nurses to support nursing homes which was a worsening situation, the resilience of care homes, and the financial impact on care providers which had been very significant. The various additional funds that had been available to them, for example, the infection control grant and money received from the council, had largely allowed providers to meet the additional costs associated with the virus, but there had been a significant reduction in the number of people that wanted to be in the care system for understandable reasons, that had led to a high number of vacancies in care homes, which meant significantly less income but the same running costs. There were currently 20-25% empty beds in care homes (approximately 4-500 bed vacancies) and had a significant impact on the viability of care homes.

·         In due course rebalancing of the market might see some providers leaving the market, which would lead to some difficult situations for residents of care homes closing, and a number of care homes could go under at the same time. The concerns had been picked up by a number of authorities in the region and had been sent to the Department. There was a national process of assessment being undertaken and a range of actions being considered as to what should be done at national level and at regional level.

·         The authority had a winter plan and awareness of issues locally. The team were taking significant steps to ensure the quality and availability of care required for the winter period was there. During the second wave of the virus it was clear that pressures were growing on the NHS system and those parts of Adult Social Care system which supported the NHS were being preparing to support further.

The Chair noted the authority was prepared for winter months, and the key to the success was better communication with all relevant departments working in union as outlined in 4.1(a) Winter Plan in the report. The Chair asked if the authority was confident enough that all the providers and working partners were working together to face the winter months with the added addition of flu and the Covid-19 virus. The Strategic Director stated that he was struck by the quality and depth of engagement and the grip that the Directors and their teams had on the situation. He added the people of Leicester were lucky they had the Adult Social Care Team that they did.

Tracie Rees, Director for Adult Social Care & Commissioning, informed the Commission that since March, it had started with daily but were now weekly communication with providers who were asked for a range of data. Officers had an information tracker, which included infection rates/ vacancy rates / any issues that could be affecting the home such as staffing numbers, PPE. There were also escalation processes through the Incident Management Team and LRF. There were also systems in place, and various working cells across LLR, for example, for care homes. There were providers representatives sitting on those groups, for example, the care home cell had representatives from EMCare, the East Midlands Care Association, who as well as supporting care homeowners were able to pass on information from the authority to care homes. The sharing information of information and communications was covered with support from providers across the city.

Members of the Commission asked questions, and the following information was provided:

·         With IPC monies, a second tranche payment of monies had just been made to the care homes. As part of monitoring how the money was spent all care providers had to provide a monthly return to state what the money had been spent one, for example, paying staff their full wages if they were having to isolate, the installation of a pod or room to allow visitors, building alterations to help in terms of isolation to ensure there was no opportunity for the virus to move around the home. Money could not be used to cover a lack of income from beds. Care home providers would not get the second tranche of monies if the Authority was not satisfied regarding what the first tranche had been spent on.

·         Safeguarding alerts did drop across the community and nationally, and not just for care homes, but for people living in the community. Officers were beginning to see alert numbers steadily increasing again. A weekly cross-service LLR meeting took place to share issues, concerns, service impacts if, for example, services closed and what that would mean for service users. The meetings were helpful in terms of picking up issues that would normally be picked up by other services, such as, mental health nurses, day service providers. Consideration would be given to see how some work could be continued with care homes, for example, social workers working remotely feeding back issues to the Quality Assurance Team.

·         Public facing messages had been sent out to alert people to the fact the service was still working for people with safeguarding concerns.

·         Referred to in the national Winter Plan was what had become the designated care homes approach, which was essentially that during the first wave of the virus, there was some evidence that people were being discharged into care homes without it being known if they were Covid-19 positive, and given the vulnerability of care home residents and for the potential for the virus to travel very quickly around a care home, the Government had taken the view through the winter plan that no-one should be discharged into a care home if they were Covid-19 positive unless that home was able to take a Covid-19 positive patient. The authority was in a situation where it had a designated care home for elderly people which could take someone who was discharged from hospital and identified as being Covid-19 positive, and involved the care home having a contract with the local authority to do so following a special inspection through the CQC to say they met requirements and would become the sole route for people discharged from hospital into care homes, to ensure there was no risk of Covid-19 from hospital into care homes.

·         There was a challenge to identify a designated care home for people with learning disabilities, as there were no care home organisations in the city who had come forward who were prepared to designate part of their home or have a separate unit where they could support people with complex needs. The authority was in discussion with the County Council who had their own internal homes for people with learning disabilities and could potentially make 2-3 beds available if needed and would hopefully be available in the near future.

·         The hospital bridging service was referred to in the reablement report.

The Deputy City Mayor Councillor Russell referred to the volume of work that had been undertaken and continued to support the sector through unprecedented times. She noted the Adult Social Care department was aware of vulnerabilities that may be faced over coming months and had put in place where possible mitigations and to recognise challenges, and had not been easy for any local authority.

The Chair welcomed the report and echoed the Deputy City Mayor’s sentiments. He praised the work of Adult Social Care services and all the staff and agencies that were working so hard in preparing and implementing the winter care plan, especially through the Corona Virus pandemic. He gave sincere thanks and appreciation for those providing care and support.

The Chair noted the recommendations contained within the report and noted the Council’s response to the Service Continuity and Care Market Review questionnaire which had been thoroughly prepared.

The Chair thanked the Strategic Director and his Team for the report.

AGREED:

That the Adult Social Care Scrutiny Commission:

1.    Note the Council’s response to the Winter Plan and to provide comments and feedback to the Strategic Director and Executive;

2.    Note the Council’s response to the Service Continuity and Care Market Review self-assessment questionnaire.