Agenda item

The Service Lead, Commissioning and Transformation introduced the report and provided a presentation regarding the Adult Social Care Transformation Programme 2015-20 and the Adult Social Care Improvement Programme 2020-21.

 

The Adult Social Care Programme had been initiated in 2015 with the purpose of delivering a personalised, preventative and asset-based approach towards providing Adult Social Care.  It was envisaged that implementing a planned programme of transformation would improve the wellbeing of individuals requiring care and support, and deliver significant financial savings. 

 

To date savings in excess of £8 million had been delivered, primarily through the implementation of the following initiatives: asset-based approach to social work, direct payments, Multi-Disciplinary Review Team, continuing health care, and Integrated Care Decision Making (this comprised of four projects: Home First, Anticipatory Care Planning, Community Multi-Disciplinary Teams, and Local Access Points).

 

The Adult Social Care Transformation Programme had introduced a more personalised approach, focused on individual wellbeing, resulting in a broader ‘person centred’ and asset based range of services being offered to meet the needs of people.

 

The main impacts of implementing the Adult Social Care Transformation Programme had been:

 

·  Supporting people to stay at home for longer

·  People being more in control of their care needs

·  Minimising unnecessary delays to hospital discharge when people were medically fit to leave

·  Preventing unnecessary hospital admissions

·  Managing the Council’s expenditure effectively

 

Members were advised that Adult Social Care was facing a number of challenges, stemming from the following factors:

 

·  Increasing levels and complexity of need, especially for people already known to social care.

·  Provider inflationary uplifts and price rate increases

·  National Minimum Living Wage obligations

·  Labour market competition and uncertainty relating to the impact of Brexit

 

The Adult Social Care Improvement Programme would continue to deliver the necessary reduction in spending during 2020/21 by continuing with the current initiatives. 

 

Progress on the following suite of projects would continue to improve practice and assist to address the funding shortfall:

 

·  Digital and Assistive Technology

·  Creation of a Peripatetic Team

·  Disabled Facilities Grant

·  Improve Access Contact and Adult Social Care Pathway

·  Remodelling provider services

·  Improving brokerage function

·  Consolidation of teams

 

Following the conclusion of the presentation, the Chair invited comments and questions from Members.

 

During the course of a wide-ranging discussion, the following points were raised:

 

·  A Member asked how many people in Slough had a disability.  In response, it was explained that the number of people with a disability would be larger than the number of people receiving Adult Social Care. This was because the support a person received was based on an assessment of need.

·  A Member requested the following information:

-  The number of people currently in receipt of direct payments.

-  The number of people working in the Review Team.

-  In relation to Anticipatory Care Planning – the number of additional people identified as a result of the new process.

-  The size of caseload for individual staff members working in the Community Multi-Disciplinary Teams.

-  It was noted that ‘Make Every Contact Count’ training had been delivered in 2018/29 to over 200 staff – it was asked if there were plans to roll this out further, and if so, which staff members would be invited to attend.

-  In relation to commissioning of Adult Social Care services – it was asked what types of services, above the standard range, had been commissioned.

 

The Director of Adults and Communities agreed to circulate a written response to the Committee, addressing the points detailed above.

 

·  It was asked if means testing Adult Social Care provision discouraged people from saving money to pay for their own care.  It was explained that the boundary between health and social care was difficult for some people to differentiate.  Unlike NHS health care, social care was not a free service and often people were surprised when asked to fund their own care.  It was anticipated that the new Government would be reviewing the sustainability of Adult Social Care in the near future.  A consultation would be undertaken and Members were encouraged to submit their views.

·  In relation to Direct Payments, it was asked what measures were in place to ensure that payments were spent appropriately.  It was explained that the Council was able to scrutinise the use of payments and there were limitations to the types of purchases for which the payments could be used.  In the majority of cases, people took the responsibility of using public money very seriously and had occasionally returned surplus funding back to the Council.  Only in a minority of cases did people misuse their payments.  Members were assured that mechanisms were in place to detect misuse and take action to stop payments if this occurred.

·  A Member asked if the Information Technology systems used by various partner agencies were integrated with each other.  It was explained that it was not possible to share information across the NHS and social care systems.  However, the implementation of ‘connected care’ enabled social workers and other partner agencies to access a summary of key information relating to a client in receipt of a range of support. 

·  It was queried how the Council monitored digital support provided in people’s homes.  It was explained that as part of a commissioning exercise the Council would be identifying suitable products to support people to remain independent.  To maximise economies of scale the Council would be looking to work with East Berkshire Clinical Commissioners Groups.  The current Care Line system was reaching its end of life span and work would be undertaken to identify a better offer.

·  A Member asked what measures were in place to ensure the suitability of care procured through a direct payment.  It was explained that the Council provided advice to people regarding employment legislation, including how to undertake a Disclosure and Barring Service check. 

 

(Councillor Sarfraz left the meeting)

 

·  It was queried how the Council managed direct payments to individuals who lacked the mental capacity to make their own care arrangements.  It was explained that there were a range of options available in these circumstances.  A family member could manage the payments or the Council could take over the direct payment and manage a person’s bank account.  In addition, it was explained that if there were any concerns that family members were using payments inappropriately this would be a safeguarding matter and the Council would take necessary action.

·  A Member asked how the Council ensured that every contact counted and that vulnerable people ‘remained on the radar’.  It was explained that the ‘Make Every Contact Count’ (MECC) approach was embedded across the Council.  It was suggested that a MECC training session could be arranged for Members to attend.

 

The Chair then invited Councillor Smith to address the Committee under Rule 30.

 

Councillor Smith raised concern that the form used to claim direct payments, stated there was a £7 weekly cap on expenditure for non-specialist support, such as cleaning and gardening.  He said this rate was not in-line with the National Minimum Wage and was insufficient to cover the cost of one hour cleaning.  In addition, he asked what arrangements were in place to care for the pets of people who were moved into temporary accommodation. 

 

The Director of Adults and Communities explained that there was no cap on direct payments and the funding a person received was based on their level of need.  Resources were determined by a national formula that equated the level of an individual’s need into a funding amount.  Councillor Smith agreed to provide a copy of the form to the Director of Adults and Communities.  It was explained that as part of a person’s care package, suitable provision would be made for a person’s pet.  Councillor Smith was invited to provide further details regarding any particular cases to the Director of Adults and Communities.

 

The Chair then invited Councillor Strutton to address the Committee under Rule 30.

 

Councillor Strutton congratulated the Service Lead, Commissioning and Transformation on the innovative solutions that had been implemented.  He asked how the new initiatives would be monitored to ensure that better outcomes were achieved for residents.  With regard to Anticipatory Care Planning, he asked what the timeframe was for a GP referral to Occupational Therapy resulting in a home visit being carried out.  In addition, he asked, on average how long it took for home adaptation works to be undertaken.  In relation to digital and assistive technology, he highlighted that investment in technological solutions had the potential to deliver huge financial savings for the Council.  In concluding, he raised concern regarding the Council’s management of it disability adapted housing stock.  He said that often the Council refurbished a property and removed the adaptations previously installed.  He said it was not effective management and further work needed to be undertaken to improve the turnover of Council housing stock.

 

In response to the points raised, the Director of Adults and Communities advised that as part of the Council’s ‘Our Future Programme’ opportunities would be sought to improve the digital offer.  However, it was important to ‘scope out’ the digital requirements and ensure that the right investments were made.  With regard to hospital discharges, it was explained that a weekly meeting was held with managers to review cases involving patients who had not been discharged from hospital on time.  Responding to concern regarding the time taken to install adaptations into people’s homes, it was advised that under a certain financial limit adaptions could be undertaken immediately.  It was accepted that in some circumstances there had been delays and this needed to be improved.  In relation to Occupational Therapy referrals, it was explained that the timeframe for an assessment, depended on the level of urgency. 

 

On behalf of the Committee, the Chair thanked the Service Lead, Commissioning and Transformation and the Director of Adults and Communities for the report and presentation.

 

Resolved –

 

(a)  That the update report and presentation be noted.

 

(b)  That the Director of Adults and Communities be requested to circulate a response to the queries raised, by no later than 13th February 2020.

 

(c)  That a ‘Make Every Contact Count’ training session be arranged for all Members.