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HEALTHY LIVING AND SOCIAL CARE SCRUTINY COMMITTEE

 

Minutes of a meeting held on 13th June, 2016.

 

Present:  Councillor R.L. Traherne (Chairman); Councillors R.J. Bertin, Ms. R.F. Birch, S.C. Egan, H.C. Hamilton, J.W. Thomas, S.T. Wiliam and Mrs. M.R. Wilkinson.

 

 

78        APOLOGIES FOR ABSENCE – 

 

These were received from Councillors Dr. I.J. Johnson and E. Hacker

 

 

79        MINUTES –

 

RECOMMENDED – T H A T the minutes of the meeting held on 16th May, 2016 be approved as a correct record.

 

 

80        DECLARATIONS OF INTEREST –

 

No declarations were received.

 

 

81        OLDER PEOPLE’S COMMISSIONER FOR WALES – INTRODUCTION (DSS) –

 

The Committee welcomed the Older People’s Commissioner for Wales, Sarah Rochira, who had been invited to provide an update on some of her work as Older People’s Commissioner.

 

The Commissioner was able to relay some of her main thoughts and observations.  She began by outlining how closely her organisation and the Council worked together and how both organisations shared the same ambitions around older people.  She also outlined some of her legal powers.  For example, as Commissioner she had powers to cross-examine individuals under oath and to gain entry into residential care homes.  She went on to explain that these powers were rarely used and much of her time would be spent working with colleagues within the public sector in order to build up knowledge of issues that would be faced over the next 10 to 15 years. 

 

The Commissioner then highlighted that she would be speaking about three aspects in more detail, these being, who exactly older people were, what would make a good public service and how would we know that things were right. 

 

In discussing who older people were, the Commissioner explained that there were two very popular public images.  These would be either a frail elderly person in a wheelchair or a 97 year old skydiving.  Neither of these images/examples was typical or appropriate.  She stated that frailty was not inevitable and that, in Wales, an older person was defined as anyone over the age of 50.  It was also important not to fall into the trap of treating older people as a group apart and there was a need to have an inclusive debate and to reframe who older people were.

 

The Committee heard that there was a large amount of social capital associated with older people which, if tapped, could benefit the Welsh economy by an estimated £1billion each year.  Also, there was a significant amount of unclaimed benefits owed to carers that could amount to £750 million.  It was therefore important to recognise that older people were still a valuable asset and a key question was how this social capital could be reinvested, with one example being in relation to the transferring of skills and knowledge across generations.  She also highlighted that there was a need to change the care model from one of dependency to one in which older people became a greater part of the solution. 

 

With regard to the question of what made a good public service, the Commissioner stated that older people were very good at assessing the quality of services provided.  She made mention that older people were fully aware of the challenges being faced around budgets and they understood that the need for integration was not the end point.  One thing that older people did want to talk about was around ‘structural fault lines’.  This meant that older people question why a crisis point was reached before help was provided.  The Commissioner urged caution when considering changes to the eligibility criteria for receipt of services and also when it was said that the State should only provide a service when that was the only option available. 

 

Another observation raised by older people was around the need to be properly informed and around the importance of advocacy.  Older people had commented that agencies were missing the point around the importance of quality of life.  This was why the Commissioner supported the introduction of the Social Services and Wellbeing Act.  A key question therefore was what made up a good quality of life.  For older people, this included needing to feel safe, being treated with respect and dignity and being made to feel valued.  It was also important to give older people confidence in order for them to do the things and activities that mattered for example, by learning new skills and being able to enjoy physical activity. 

 

The Commissioner went on to state that because unhypothecated services were taking a hit, older people were not able to get out and about.  In reiterating these points, she highlighted examples of older people not being able to go for walks due to lack of public toilets or older people being unwilling to use the bus because the bus stop was without seats.  Members also noted that older people wanted to receive help in the way that most suited them.  This was particularly the case around domiciliary care services.  It was important to remind agencies what older people really valued. 

 

The third aspect that the Commissioner wanted to raise was around the question of how did we know that we were getting things right.  This was a key question for Scrutiny.  The Commissioner added that she had seen much change and for her there were three areas that could be tested.  The first was around ongoing engagement with older people, which was distinct from consultation.  The Commissioner felt that there was too much consultation being carried out and not enough engagement.  The second area was to do with Equality Impact Assessments.  The Commissioner advised that it was crucial for Councils to carry out a proper and robust assessment of the impacts of any proposals in order to help identify any unwanted consequences.  The third area to be tested was around the kind of questions that were being asked.  The Commissioner stated that performance indicators could only provide a certain level of information and that it was important to focus on outcomes.  She advised that Scrutiny could ask questions that older people could not, which in most cases were not easy to answer.  She considered that there was too much focus on systems and processes as opposed to outcomes.  For example, a key question was to ask to what extent were people in care homes able to have a good quality of life.

 

In summary, the Commissioner outlined that older people should be seen as an asset, that they were an important part of the solution, that they had a good knowledge of services and that Scrutiny should ask the right questions with a greater focus on outcomes.

 

The Chairman thanked the Older People’s Commissioner for her input and he raised a query in relation to Operation Jasmine, which highlighted a high number of cases of neglect in care homes and he asked whether the Commissioner was confident whether such levels of abuse could take place again in Wales.  In reply, the Older People’s Commissioner stated that only the Welsh Government and the Care and Social Services Inspectorate Wales could answer this question.  She stated that a lot had changed since the report came out and, from her perspective, she would be surprised if we saw this scale of abuse again.  However, she added that there were cases of abuse every day and we were still too tolerant of things going on in care homes, such as degrading treatment.  She advised that there was a need not to be complacent and that the culture of organisations needed to change in order to support whistle blowing policies.  She stated that it was important to assess the services that were being commissioned and that, if organisations and agencies knew that something was not right, then it was important to put safeguards in place as quickly as possible. 

 

The Committee queried plans around fuel poverty which related to the choice being faced by older people of eating or heating.  In reply to this, the Older People’s Commissioner stated that, for her, the work on poverty was more than just fuel poverty.   She explained that poverty had a huge impact on the wellbeing of older people and she highlighted that there was an issue around the rate at which pensions were set and that she had pushed Welsh Government to do more.  She also mentioned that a lot was going on in relation to people claiming the benefits that they were entitled to but that more could be done, particularly in terms of people receiving back payments for unclaimed benefits.

 

A Committee Member commented that he felt that the Commissioner was ‘spot on’ when it came to people being listened to by care agencies, particularly in relation to patients in hospital.  He added that, when it came to their treatment, patients should have a greater say.  In responding to these comments, the Commissioner advised the Committee that the issues which matter to older people were very broad and a lot of the time older people talked about the little things that could have a big impact.  For example, a lack of dropped curbs in pavements was an important consideration in relation to limiting the use of mobility scooters.

 

The Committee raised concerns around older people being too frightened to make complaints.  In reply to this, the Older People’s Commissioner stated that this was bad for individuals and bad for services.  She added that if we asked for the thoughts of older people more often than this would head off many complaints.  She commented that some people had good cause to be frightened and it was important for organisations and agencies to have open cultures.  It was also important for Senior Officers and Leaders to set an appropriate example, and for them to set the tone of everyday practice that helped support people when raising concerns. 

 

At this point the Director of Social Services was asked to provide some of his thoughts.  He began by highlighting the work of the Scrutiny Committee, which had recently been re-titled, and had been given a specific focus on Wellbeing Outcomes.  He also mentioned the keen interest that Elected Members took in relation to wellbeing and around understanding the impact of services on people’s quality of life and that integration was regularly on the Committee’s agenda.  The Committee was also aware of changes around the Intermediate Care Fund and Safeguarding arrangements, while Members were also regularly apprised of issues around quality assurance. 

 

RECOMMENDED -

(1)       T H A T the role of the Commissioner and her work programme be noted.

 

(2)       T H A T the Scrutiny Committee notes the Vale of Glamorgan Council’s response to views undertaken by the Commissioner.

 

(3)       T H A T the Scrutiny Committee notes the required actions and the Directorate’s response to the report entitled ‘Dementia More Than Just Memory Loss’.

 

Reasons for recommendations

 

(1)       To ensure that Members continue to exercise effective oversight of an important function undertaken by the Social Services Directorate.

 

(2)       To brief Members about the requirements placed upon the Council to meet the action points raised by the Commissioner.

 

(3)       To ensure Scrutiny Members are aware of the report entitled ‘Dementia More Than Just Memory Loss’ and the actions required to ensure implementation.

 

 

82        REVENUE AND CAPITAL MONITORING FOR THE PERIOD 1ST APRIL TO 30TH APRIL 2016 (DSS) –

 

The Operational Manager – Accountancy presented the report, the purpose of which was to present revenue and capital expenditure for the period 1st to 30th April, 2016. 

 

On 2nd March, 2016, Council had approved the Revenue and Capital Budgets for 2016/17.  The report advised that in setting the Social Services Budget for 2016/17, the use of £970,000 from the Social Services Fund had been approved.

 

As it was very early in the financial year, the forecast for Social Services was for a balanced budget.  However, there would be great pressure on the service in the coming year and this position may not be achieved.  A table and graph setting out the variance between profiled budget and actual expenditure to date and the projected position at year end was attached at Appendix 1 to the report.

 

With regard to Children and Young People Services, the major issue concerning this service area for the coming year would be the continued pressure on the children’s placements budgets.  Work would continue to ensure  that children were placed in the most appropriate and cost effective placements.  However, it should be noted that, due to the potential high cost of each placement, the outturn position could fluctuate with a change in the number of Looked After Children.

 

In terms of Adult Services, the major issue concerning the service for the coming year would be continued pressure on Community Care Packages budget.  This budget was extremely volatile and was influenced by legislative changes such as the National Living Wage and the Social Services and Well-being (Wales) Act 2014, which both came into force in April 2016.  It was considered that this budget would overspend by year end but, at this early stage of the year, the level was difficult to predict.  Final negotiations regarding fee levels had yet to be concluded with some service providers, but proposed increases were already above the level of inflation provided for within the budget.  The service also continued to be affected by the pressures of continued demographic growth and the Community Care Packages budget would have to achieve savings this year of £300,000.  The service would strive to manage growing demand and some of these initiatives may be funded via regional grants in the current financial year.  However, the level of grant funding for the year had yet to be fully determined and it was not necessarily guaranteed on an ongoing basis. 

 

The Social Services and Well-being (Wales) Act 2014 came into effect on 6th April 2016 and set a whole range of new challenges and service user entitlements.  With no additional resources from the Welsh Government, apart from £420,000 Delivery Transformation grant for transitional / transformational funding, there would be increased financial pressures on the service.  The implications of the Act would be closely monitored during the year to assess the full financial impact of these changes.

 

The report advised that the Directorate would again this year bid to receive funding for joint initiatives.  Revenue funding of £6.4m and capital funding of £1.2m had been allocated to the University Health Board for the Intermediate Care Fund (ICF).  Funding for individual schemes to be under undertaken by the Vale of Glamorgan Council was currently being finalised.  If successful, the 2016/17 funding would continue to support initiatives in relation to supporting older people to maintain their independence and remain at home, avoiding unnecessary hospital admissions and delayed discharges.  In addition, Welsh Government had extended the scope of the integration agenda this year in order to develop integrated services for people with learning disabilities, an integrated autism service in Wales and an integrated service for children with complex needs.

 

With respect to Leisure Services, as it was early in the financial year, it was projected the service would outturn within budget at year end.

 

In relation to the 2016/17 savings targets, attached at Appendix 2 was a full list of savings to be monitored by the Committee, which now included Leisure Services.

 

The Directorate was currently required to find savings totalling £2.257m by the end of 2019/20.  Current calculations indicated a surplus of £186,000 which was a result of the Foster Carer Recruitment Project, which was being developed in addition to the required savings targets.  This surplus could be used to mitigate any increase in savings to be found in future years.

 

Year

Savings

Required

£000

Savings

Identified

£000

In Year

Surplus /

(Shortfall)

£000

Cumulative

Surplus /

(Shortfall)

£000

Savings   Brought Forward

 

110

110

110

2016/17

1,002

1,078

76

186

2017/18

605

605

0

186

2018/19

320

320

0

186

2019/20

330

330

0

186

TOTAL

2,257

2,443

 

 

 

The report informed that the savings of £270,000, due to be achieved in 2016/17 through changes in the procurement of Domiciliary Care, had been deferred to 2017/18. 

 

For Children’s Services, it was now proposed that the £100,000 Staff Review savings would be saved through a Managed Budget Reduction process and it was proposed that C16 would be moved into C12. 

 

For Adult Services, there was £100,000 of the full year saving generated from the Hafod Homes transfer to offset against the £300,000 saving for Residential Savings shown at A6.  Currently, there were no other formalised plans in place to find the remaining £200,000 of savings.  Further consideration would have to be given to the way in which the saving could be achieved during the year.  With regard to the Care Package Budget Reduction at A3, while there was significant pressure on this budget, schemes had been put in place to deliver savings in this area by transferring domiciliary care clients to direct payments, by putting in place additional reablement capacity and by establishing a review team. 

 

Appendix 3 provided an update on the individual areas of savings within the Social Services Budget Programme.  Included in Appendix 3 was a Reshaping Services logo, shown against specific projects which had a specific alignment with the objectives of the Reshaping Services strategy.  The whole of the Social Services Budget Programme reported into the Reshaping Services governance arrangements. 

 

With regard to capital expenditure, Appendix 4 detailed financial progress on the Capital Programme as at 30th April, 2016.  Members were asked to note that Appendix 4 did not include requests for unspent committed expenditure to be slipped from 2015/16 into 2016/17.  A request for this slippage would be included in the Closing Down report to be presented to a future Cabinet meeting.

 

Delegated Authority had been used to allocate the £200,000 Asset Renewal budget to schemes and they were now fully detailed in Appendix 4. 

 

Concern was raised by the Committee at the end of the last financial year that progress had not been made on several capital schemes.  Appendix 5 provided non-financial information on capital construction schemes.  From this Appendix, it could be seen that most of the previous year’s schemes had now commenced.  Start dates had also been provided for new schemes for this financial year and these would be monitored closely to identify if capital schemes started to slip and to identify if further actions needed to be taken.

 

The Chairman queried the £300,000 savings in relation to residential services as shown under saving target A6.  In reply, the Head of Adult Services advised that this was very challenging and that £100,000 of savings had been generated from the Hafod Homes transfer.  Further work on the structure of residential services was still ongoing and it was planned that this could be progressed through the Reshaping Services Strategy. 

 

In answer to a query on the capital project for St. Paul’s Church, the Operational Manager for Leisure explained that the Project Board was still discussing the strategy for this but a report on options would be presented to Cabinet shortly.

 

With regard to the monitoring of capital projects which had slipped, the Head of Adult Services stated that there were now better arrangements in place with Building Services.  Specifically in relation to Hen Goleg, contract workers were currently on site. 

 

A Committee Member queried the savings target related to residential placements for Looked After Children.  In reply, the Head of Children and Young People Services advised that the target was equivalent to the cost of one residential placement a year.  A report on the Children and Young People Annual Placement Review due for the next Scrutiny Committee in July would provide Members with more detailed information with regard to the challenges and the progress achieved. 

 

In reply to a query regarding the number of savings targets that were currently categorised as red, the Director of Social Services explained that this was due to a recalibration of the savings targets undertaken at the start of each financial year.  Because savings were difficult to achieve in the face of growing demand for services, the Service must be cautious in categorising the risk of not achieving them and it helped to ensure appropriate monitoring. 

 

RECOMMENDED –

 

(1)       T H A T the position with regard to the 2016/17 revenue and capital monitoring be noted.

 

(2)       T H A T the progress made in delivering the Social Services Budget Programme be noted and be referred to Cabinet for consideration.

 

(3)       T H A T the proposed changes to the 2016/17 programme be endorsed and referred to Cabinet for approval.

 

Reasons for recommendations

 

(1)       That Members are aware of the position with regard to the 2016/17 revenue and capital monitoring relevant to this Scrutiny Committee.

 

(2)       That Members are aware of the progress made to date on the Social Services Budget Programme.

 

(3)       That the proposed amendments to the programme are approved.

 

 

83        THE VALE OF GLAMORGAN COUNCIL FOSTERING SERVICE (DSS) –

 

The Operational Manager, Children and Young People Services, presented the report, the purpose of which was to update Members on implementation of the Foster Carer Recruitment Strategy 2015/16 and to provide an overview of the Care and Social Services Inspectorate Wales (CSSIW) Annual Inspection 2015/16 along with the Review of Quality of Care Report for 2015/16 produced by the Council. 

 

As a background summary, the report advised that where children and young people were unable to live within their own families, the Vale of Glamorgan Council aimed to provide high quality alternative family placements which would promote the child’s wellbeing and development.  This was achieved primarily by using approved in-house foster carers.

 

The Vale of Glamorgan Fostering Service was provided by the Placements and Permanency Team.  It was responsible for recruiting, assessing, preparing, training and supporting mainstream and relative (or “kinship”) foster carers.  Mainstream foster carers were those who provided placements for any child subject to the age approval criteria, whereas relative foster carers had been approved specifically for a named child or children. 

 

Under the provisions of the Care Standards Act 2000 and associated Regulations, the CSSIW was required to undertake an annual inspection of Local Authorities which provided a Fostering Service.  The inspection for the Vale of Glamorgan took place during early March 2016 and the Inspection Report was attached at Appendix 1. 

 

There was also a requirement to complete an Annual Review of the Quality of Care provided by the Fostering Service.  The Review Report followed a format prescribed by the CSSIW.  The Report for 2015/16 was attached as Appendix 2.

 

The Children and Young People Services Commissioning Strategy 2013-18 identified that, where children and young people could not be supported to remain with their birth families, they would be placed with foster carers within the Vale of Glamorgan.  Where demand for placements exceeded that available within the Council service, placements were procured from Independent Fostering Agencies (IFAs) at significant additional cost and sometimes at some distance from the area.  A key priority for the Division was to recruit additional in-house carers in order to reduce reliance on IFA placements and to reduce the costs associated with providing services to Looked After Children.

 

A Fostering Service Recruitment Strategy had been updated in March 2015.  The Strategy identified four key recruitment priorities:

 

  • Placements for young people aged 11-16 years who presented challenging and often aggressive behaviour, who may be non-school attendees and who may have difficulties with alcohol and substance misuse
  • Foster carers able to provide placements for sibling groups of two or more children
  • Respite / short breaks placements to support children to remain living at home
  • Foster carers who were willing to make a commitment to provide accommodation for young people for as long as they may require, which was in keeping with the new “When I am Ready” requirements which were likely to be introduced under the Social Services and Well-being Act.

 

To achieve these priorities, the Service aimed to:

 

  • Increase enquiry rates to the service to 100 per year, using local and regional advertising campaigns
  • Increase the enquiries to assessments conversion rate by 15%
  • Increase the number of carers offering placements for sibling groups by a minimum of two per year
  • Increase the number of carers offering teenage placements by a minimum of two per year
  • Increase the number of carers offering respite / short break placements by a minimum of two per year
  • Reduce the demand for IFA placements by 25%.

 

The Committee was updated with the outcomes following the Council’s review of the Foster Carer Recruitment Strategy 2015/16 and also a Review of the Quality of Care 2015/16.  The report outlined that the Fostering Service had been working hard to complete the actions set out in the Recruitment Strategy and in the CSSIW’s Inspection Report from 2014/15.  It had been a challenging year for the Fostering Service with several new staff appointments and a new team manager appointed in September 2015.  There had been a significant increase in the number of kinship assessments that the Service was being asked to complete during care proceedings within the Court arena.  These were required within very tight timescales.  34 kinship assessments were allocated compared with 11 the previous year and 15 new kinship carers approved compared with 4 last year.  This increased demand had affected the Service’s ability to meet targets in regard to mainstream foster carers for the current year.  Although the number of kinship assessments was difficult to predict, it was recognised that this form of care could provide positive outcomes where it enabled children to remain within their wider families.  It was important for the Fostering Service, therefore, to be able to respond to both areas of demand for assessment.  Maintaining the Service’s ability to do this successfully remained a priority for the Children and Young People Services.

 

During the past year, there had been a national decline in the number of initial enquiries experienced by all Fostering Services.  From 1st April 205 to 31st March 2016, the Service received 55 registrations of interest.  This was one less than the previous year.  Initial visits to prospective applicants had also been fewer, reducing from 32 during 2014/15 to 22 for 2015/16.  The drop in initial enquiries would be addressed by developing a new advertising campaign.  For the first time, it would involve television advertising, then using this advert on social media and at local events.

 

The Recruitment Strategy was critical to increasing the number of foster carers in the Vale of Glamorgan.  The Council was also engaged in helping develop a National Fostering Framework, one of the four major workstreams within the programme which had been established by the Strategic Steering Group set up by Welsh Government with the task of improving outcomes for children.  The aims of the National Fostering Framework were to improve permanency planning for children and the quality of placement provision, making consistent use of best practice models for the recruitment and support of carers, and to support an increase in collaboration and co-operation by all stakeholders. 

 

In terms of the CSSIW Annual Inspection of the Fostering Service, the report advised that at the time of the Inspection in March 2016, the Fostering Service was supporting 57 mainstream and 31 relative (kinship) foster carers, providing placements for 114 Looked After Children.  At that time, 195 children and young people were Looked After by the Council.

 

The CSSIW Inspection concluded that the Fostering Service: 

  • Was effectively managed and a new manager was in place
  • Was child centred with motivated staff
  • Had good systems for consultation and quality assurance
  • Provided good support and guidance to foster carers
  • Was responsive to addressing issues raised by inspections and audits.

 

A number of improvements made since the 2015 Inspection were validated.  These included the appointment of a manager, improved monitoring systems, better training and up to date reviews.  The Inspectors identified two areas of compliance, together with a few areas for improvement.  The first related to failing to notify the CSSIW of a change in the manager of the Fostering Service.  This was immediately rectified and written notification given.  The second area related to ensuring that the reasons for placements ending with foster carers were fully recorded and on the “record of placements” template.  This was immediately rectified and the template updated.  Improvement areas around foster carers’ supervision, agreements and delegated agreements had been noted and would be implemented.

 

The Chairman queried the plans around the National Fostering Framework and whether this would impact on the quality of service in the Vale.  In reply, the Director of Social Services stated that, on behalf of Welsh Government and local government, he was leading on this project.  He reassured Members that any proposals would be grounded strongly in the need for local services and local determination, as this was the most effective form when it came to service delivery.  It was therefore important to maintain this, particularly when it came to having proper accountability.  However, he went onto comment that there were some areas that may best be tackled on a national or regional basis .  For example, the one third of Foster Services provided by the Independent Sector appeared to cost the same as the remaining two thirds provided by the Public Sector.

 

In terms of the regional model, the Director explained that the aim was to look at those areas where things could be improved.  This included marketing, a strategy on fees and support to foster carers, such as joint arrangements for training.  In the first instance, any footprint for tacking issues on a regional basis is likely to involve using the Cardiff and Vale UHB footprint but this might include other regional partners.  With regard to the timeframe for this, the Director advised that a 3 year programme was being put before Welsh Government and a Phase 1 update report would be provided to the Committee.

 

A Committee Member stated that he would like to praise the staff for their efforts.  He also queried the reasons for de-registering foster carers.  In reply, the Operational Manager for Children and Young People Services stated that for mainstream foster carers the reasons for de-registrations last year remained similar to previous years.  So for 2015/16, the number of de-registrations included: two due to retirements, one due to a change in circumstances and one following a complaint or allegation.  She also advised that the service had seen an increase in the age of its foster carers and that this was also being reported across Wales.    As a follow on question, the Member queried whether exit interviews would be conducted.  In reply, the Committee was advised that this would depend on the circumstances.

 

The Chairman commented that it appeared that recruitment of new foster carers had become more difficult.  In answer to this, the Operational Manager for Children and Young People Services stated that ‘yes’ it was more difficult and that across Wales the number of initial enquires had decreased.  This was why it was important to have a national marketing programme to attract prospective foster carers.

 

RECOMMENDED -

 

(1)       T H A T the Scrutiny Committee notes the progress made to date in implementing the Foster Carer Recruitment Strategy.

 

(2)       T H A T the Scrutiny Committee notes the content of the quality of care report and the positive findings of the CSSIW Annual Inspection.

 

(3)       T H A T the Scrutiny Committee’s thanks and congratulations be passed on to staff.

 

(4)       T H A T the report be referred to Cabinet to highlight the positive work being undertaken.

 

Reasons for recommendations

 

(1&2)  To enable the Scrutiny Committee to exercise effective oversight of this key activity within the Children and Young Peoples Services and to ensure that the Council’s Statutory functions in relation to providing a regulated fostering service are fully met.

 

(3)       In order to pass on the Committee’s thanks and appreciation.

 

(4)       In order to update Cabinet on the findings following the CSSIW Annual Inspection.

 

 

84        HOSPITAL DISCHARGE AND DELAYED TRANSFERS OF CARE (DSS) –

 

The Head of Adult Services presented the report, the purpose of which was to inform the Scrutiny Committee about how well the hospital discharge arrangements facilitate timely hospital discharge through joint working between the Council and the University Health Board.  The report also advised the Committee about the performance of the Vale of Glamorgan Council and the initiatives in place to reduce delayed transfer of care from hospital.

 

The majority of discharges from hospital occurred without any need for social care involvement.  The overall numbers of delayed transfers of care cases for all reasons in a month were very small in comparison with the total number of hospital admissions.  The Council worked very closely with Cardiff and the Vale University Health Board (UHB) to monitor delays, to resolve issues in individual cases so that delays were kept to a minimum and to introduce new ways for improving discharge arrangements.  This also involved making known to staff in the UHB the pressures and risks which were being managed by the Council in delivering social care and the range of services available in the community that could help people return home quickly and safely.

 

Where social care support was needed or accommodation issues had arisen, these cases were usually resolved: at the Customer Contact Centre (C1V) for straightforward issues such as restarting a care package;  through the Community Resource Service for those people able to participate in a reablement package;  and through the Integrated Discharge Service for more complex cases such as those where people’s needs could be met only in a residential care or nursing care home setting. 

 

The report informed that the Integrated Discharge Service was a multi-disciplinary team based at Llandough Hospital.  Since April 2016, it had taken over organising discharge arrangements for Vale residents who were in the Princess of Wales Hospital in Bridgend as well as continuing to support discharges from Llandough and the Heath Hospitals.  The team was made up of Social Workers, Discharge Liaison Nurses and more recently a Housing Solutions Worker.  With finance from the Intermediate Care Fund, a Housing Solutions Worker had been supporting the team for approximately one year to access the Raven Flats at Redlands in Penarth and the extra-care unit in Barry.  This person also provided help in resolving housing issues such as organising deep cleaning of properties where there was a requirement to facilitate safe discharges.  The team worked closely with Discharge Co-ordinators provided by Age Connects, who help individuals to consider which residential placement was right for them. 

 

The Welsh Government had a system in place that sought to measure the number of Delayed Transfers of Care (DToC).  The system broadly categorised delays into three areas:

 

  • Health Service related reasons, such as waiting for specialist assessments or no bed being available in a specialist health facility.
  • Social Care reasons, again delays due to assessment or inability to provide a package of social care or housing related issues. 
  • Patient related issues, such as disagreements with the hospital, selecting or waiting for a specific residential placement.

 

The process for agreeing which cases fit these categories was called Validation.  The figures were based upon a monthly census, on a specific day, to take a snapshot of the situation in the hospitals.  The validated monthly figures were submitted to Welsh Government and shared by the key organisations locally.  The delays for Social Care reasons were the primary area for which the Council accepted responsibility and the figures were reported to the Scrutiny Committee on a quarterly basis.  Performance for the previous five years was set out in the table as follows:

 

 

2011/12

2012/13

2013/14

2014/15

2015/16

April

0

9

10

4

8

May

8

5

17

5

4

June

6

1

6

3

10

July

6

3

5

6

3

August

4

2

11

3

3

September

12

5

14

4

5

October

6

8

6

0

2

November

12

5

8

2

6

December

6

3

3

3

5

January

7

10

2

8

2

February

8

9

6

9

4

March

10

11

2

4

2

 

 

 

 

 

 

Total

85

71

90

51

54

Population

10753

10765

11020

11219

11480

 

 

 

 

 

 

Performance

7.90

6.60

8.17

4.55

4.70

 

 

 

 

 

 

Welsh Average

5.03

4.57

4.7

4.83

 

 

2013/14 was a difficult year for the Vale of Glamorgan in respect of DToC figures.  This was a result of a combination of factors, including extensive winter pressures and staffing issues at the Integrated Discharge Service.  Performance had improved in 2014/15 through a sustained focus on this area of work.  Progress had been maintained in 2015/16.  The Directorate monitored performance closely and took remedial action, where necessary.  For example, informed by a dip in performance in June 2015, the Service deployed two additional Social Work posts to good effect.  It was helpful to consider the number of Social Care delays in context with other reasons for problematic discharge.  The University Health Board acknowledged that health related reasons were a prime source of delay and also that it needed to take more purposeful action in responding to patient-related issues, especially with these involved prolonged difficulties in agreeing moves to an appropriate residential care or nursing home. 

 

Moving home was a significant decision and so should not be one that was taken without full and proper consideration.  This was particularly the case when an individual’s new home included arrangements for the provision of personal care.  Some care homes were much more popular than others and so long waiting lists could occur alongside vacancies elsewhere.  The choice protocol which was published by Welsh Government in 2011 had been reviewed and it was being redrafted again with significant input from the Council.  The new protocol advised that an individual that was ready for discharge and needed a residential or nursing home placement would have to make an alternative choice of home where the first choice home was not available and not continue occupying a hospital bed unnecessarily.  The individual may be able to move to a care home of their choice later, when a place became available.  The partner organisations had acknowledged that this changed response had significant training implications, particularly for Ward staff.  Also, there may be some immediate impact upon the availability of placements in nursing homes, a sector where capacity issues could occur at periods of peak demand (especially for EMI nursing beds).

 

Given the increased pressures on hospital beds and community facilities, the Service continued to take forward a considerable programme of collaboration with the University Health Board.  Much of this was focussed on efforts to improve arrangements at the hospital/community interface, to ensure that people accessed appropriate support in a timely fashion and discharge delays were kept to a minimum.  This work was undertaken through partnership arrangements at several levels.  The Chair of the University Health Board had been leading a task group, supported by the Cabinet Members from the Vale of Glamorgan and Cardiff Councils.  A DToC Improvement Group also existed, comprising senior officers from across the three organisations.  These arrangements ensued the delivery of an Action Plan to support improved discharge enabling partner organisations to meet the target of reducing the regional Delayed Transfer of Care figure by 25% in 2015, with a commitment to achieving the same goal for 2016.  A new Action Plan called Home First was being developed.  Using the Intermediate Care Fund, the three statutory organisations had jointly appointed to a nurse led senior leadership role.  The new manager would focus specifically on Delayed Transfers of Care and the flow of patients across the whole Health and Social Care system.  This would ensure a clear lead for this area and should result in greater focus upon community solutions which supported swifter discharge. 

 

The Chairman queried the appointment of the nurse led senior leadership role, which would focus specifically on Delayed Transfers of Care and patient flow.  In response, the Head of Adult Services advised that this would be of great benefit to the Health Board as this person would focus on the process associated with delays around health reasons. 

 

In reply to a question relating to the use of new protocols around choice with residential placements, the Committee heard that it was not uncommon for people to be given their second choice.  This was a complex undertaking that involved a number of stages and was not just simply about the number of vacancies within residential homes. 

 

RECOMMENDED - T H A T the contents of the report be noted.

 

Reason for recommendation

 

To ensure that the Scrutiny Committee exercised detailed oversight of this key area.

 

 

85        COMMUNITY CARE CHARGES FOR NON-RESIDENTIAL SERVICES 2016/17 (REF) -

 

Cabinet, on 23rd May, 2016, requested for the Scrutiny Committee to consider proposed changes that would be levied in 2016/17 for non-residential Community Care Services which the Council either provided directly or commissioned. 

 

The charging policy for non-residential Community Care Services had been operational in the Vale since 1993.  It was last reviewed in 2011.  In part, this was done to ensure compliance with the Social Care Charges (Wales) Measure 2010, regulations and guidance which became effective in April 2011.  The Measure gave local authorities in Wales a discretionary power to impose a reasonably charge upon adult recipients of non-residential Community Care Services.  Additionally, the Welsh Government was provided with authority to determine the maximum weekly charge any individual service user could be asked to pay, which was initially set at £50 per week but had risen incrementally to £60 per week.

 

Implementation of the Social Services and Wellbeing Act required the authority to review its existing charging policy for non-residential services to ensure its compliance with the Regulations and Charging Code of Practice issued under the Act 2014.  This work was presently ongoing and work would continue in order to seek clarity from Welsh Government about some aspects of these regulations. 

 

Non-residential Community Care Services were made available through a range of providers, including the Council.  Those clients who received this service from the independent sector were charged in accordance with the rate the provider charged the Council.  A review of the charges levied in 2011 highlighted that the users of Council provided services were receiving their services at a subsidised rate.  In November 2011, Cabinet agreed that the Council should move to recover the full costs of these services.  Cabinet had acknowledged that this would have an adverse impact on service users, the change would be phased in over a three year period. 

 

A further review of charges in 2015 indicated that in many areas, an element of subsidy remained in place.  Unit costs of day services had been recalculated and these were shown in the following table.

 

Client Group

Current charge

per day

Unit cost

per day

Places

available

per week

Older People

£51

£58

125

Learning Disability

£64

£116

155

Physical Disability

£55

£55

125

 

It would therefore be proposed that the full unit costs would be charged from 1st July, 2016.

 

There were also a small number of relatively low cost services for which the service user paid for by means of a flat rate charge.  These included meals received at home or in day centres and Telecare services.  Service users were charged in addition to and separately from any charges which may be levied for other services.  It was therefore proposed that the flat charge for meals provided in a day service setting or via a Meals on Wheels service be increased from £4.10 to £4.60 per meal from 1st July, 2016.  The charge could also be raised to £5.30 in order to cover the current actual costs. 

 

The charge levied for the basis TeleV package was currently £5.10 per week.  This service was available to all individuals in the Vale and it provided a relatively low level of support that enabled people to remain in the community without the need for additional social care support.  It was proposed that the charge for this service should be increased to a weekly rate of £5.15.  Additionally, it was proposed that the charge for the TeleV+ service be increased from £8.50 per week to £8.59 from 1st July, 2016.  Emergency Community Alarm cover for residents in Sheltered Housing (VCAS) would be increased from £4.12 per week to £4.17 and the VCAS owned costs from £60.98 per year to £70.58 per year.

 

Having considered the report, the Committee

 

RECOMMENDED - T H A T the Scrutiny Committee endorses the proposed charges that would be levied in 2016/17 from 1st July, 2016 for non-residential Community Care services which the Council either provides directly or commissions.

 

Reason for recommendation

 

To agree the revised charges for non-residential Community Care Services for the financial year 2016/17 which would take effect from 1st July, 2016.

 

 

86        END OF YEAR PERFORMANCE REPORT 2015-16 AND TARGET SETTING FOR 2016-17 (DSS) -

 

The purpose of the report was to present end of year performance results for the period 1st April, 2015 to 31st March, 2016 for the Social Services Directorate.  The report also provided an update on the developments of the Council’s Performance Management Framework and presented the proposed targets for improvement for 2016-17 for existing performance indicators aligned to Wellbeing Outcome 4, ‘An Active and Healthy Vale’.

 

End of year performance reports for 2015-16 focus on the achievement of key objectives within each directorate which in turn contribute towards the achievement of identified outcomes in the Corporate Plan 2013-17, the Outcome Agreement with Welsh Government 2013-16 and the Improvement Plan Part 1 2015-16. 

 

End of year (quarter 4) performance reports were cumulative and comprised performance information covering the period 1st April 2015 to 31st March 2016, this was attached at appendix 1.

 

Overall Social Services had achieved the majority of its priorities for 2015-16 as outlined in its Service Plan. 84% (27) of Service Plan actions had been completed at end of year. Of the 32 actions contained within the Service Plan, slippage was reported against 5 actions. Action against all slipped actions was being progressed and these had been carried forward into the Directorate's respective Service Plans for 2016-17.

 

  • In terms of the contribution made to achieving corporate      priorities, the Directorate had completed 8 of its 9 actions against the      Corporate Plan, with slippage reported for 1 action. All 6 actions      relating to the Improvement Objectives had been completed.  The Directorate had no Outcome Agreement      actions for which it was responsible.
  • Of the 80 Performance Indicators reported at end of year, 52 (65%)      had met or exceeded target, 11 (14%) were within 10% of target, and 11      (14%) missed the target by more than 10%. For 6 measures a performance      status was not applicable.

 

This report also contained information relating to the proposed targets aligned with the new Corporate Plan Well-being Outcomes.  Appendix 2 outlined the proposed targets for the Healthy Living and Social Care Committee and included all relevant performance indicators that were within the remit of the newly formed Committee. Targets had been set for those performance indicators that were continuing into 2016-17. 

 

In referring to the suite of Performance Indicators to be monitored for the current financial year, the Chairman queried whether the Committee would be able receive the same level of detail and information given that a smaller number of indicators would be available.  In response, the Director of Social Services stated that the Committee would receive better contextual and qualitative information which would be aligned to the Corporate Plan.  He confirmed that some information would be reported differently and that some unsatisfactory indicators had been removed, but there was no reason why the Service could not continue to provide information in any relevant area, as long as this was still being collated.  He also assured Members that part of his statutory role was to provide performance information on how services were being developed and he advised that a Member Working Group would be able to make any changes to the Performance Management Framework where it was necessary.

 

A Committee Member commented that, due to the Social Services and Well-being Act, things would be different for all local authorities.  He felt there was a need for local authorities in Wales to look at and share best practice and it was important to have greater feedback and engagement as outlined previously by the Older People’s Commissioner.  He stated that it was also important to consider what was relevant to Older People and that the Committee had to seek changes in indicators if the new approach was not working well.  He also mentioned that the Council could develop the links created with the 50 plus forum.

 

Following this, the Director of Social Services referred to the need to supply more qualitative information through greater dialogue with service users around outcomes.  He mentioned the work on qualitative measures that was being undertaken by the Social Services Improvement Agency (SSIA), as it had been recognised that the new Performance Management Framework would require a lot more resources.

 

RECOMMENDED -

 

(1)       T H A T the end of year performance results for the period 1st April 2015 to 31st March 2016 for the Social Services Directorate be noted.

 

(2)       T H A T the progress made on developing the Council’s Performance Management Framework be noted.

 

(3)       T H A T it be noted that the Committee had reviewed and endorsed the proposed targets for 2016/17, whilst recognising that there was still significant work to be carried out.

 

(4)       T H A T the Committee was of the view it would still want to receive management information that was being collected as part of the new data set collection.

 

Reasons for recommendations

 

(1)       To ensure that the Committee has reviewed the Directorate’s performance results and the progress made towards achieving key outcomes as outlined in the Corporate Plan 2013-17, the Outcome Agreement with Welsh Government 2013-16 and the Improvement Plan Part 1 2015-16.

 

(2)       To ensure that Members are aware of progress being made on developing the Council’s Performance Management Framework.

 

(3 & 4) To ensure that the Council’s reports a relevant set of performance indicators against which it could demonstrate achievements of its priorities and consistently set challenging yet realistic performance improvement targets for those priorities in line with requirements under the Local Government (Wales) Measure 2009.

 

 

87        JENNER PARK CLUBHOUSE (REF) -

 

Cabinet, on 23rd May, 2016, requested that the Scrutiny Committee consider proposals which sought to renew the temporary license arrangements with Barry Town AFC (the Club) in respect of the use of the lounge area at the Jenner Park Club House.

 

Cabinet approved the construction of a new 3G pitch at Jenner Park Stadium and 3G 5-a-side pitches at the Colcot Sports Centre at its meeting on 11th May, 2015.  Following this, on 19th October, 2015, Cabinet had agreed a short term licence to the Club to use the lounge area of the Jenner Park Club House.  Discussions regarding future management arrangements at Jenner Park remained ongoing as the process for developing a potential trust model was taking longer to explore than first envisaged.  The Council was, however, continuing to manage the day to day use of the site without any significant issues and usage had continued to increase.

 

The Cabinet report proposed to renew the licence for the use of the lounge area at the Club House for a period of 24 months while the long term management of Jenner Park continued to be investigated and considered.

 

The report recommended that the fee for the lounge area of the Club House be increased to £300 per month from the previous £250 per month and that the cost of any specifically metered utilities also be passed on to the Club as licence holders.  Should the licence still be in operation on 1st April, 2017, the fee would be considered as part of the review of fees and charges for Leisure Services.  This would be reflected in the terms and conditions of the licence.

 

In reply to a Member’s query around the increase in the fee from £250 to £300 per month, the Operational Manager for Leisure advised that the increase was fair and was in line with the rent paid for other similar premises.  He also explained that it was important for the Council to recover the full costs of the Club House and that the increase reflected the quality of amenities that the Club would be receiving.  In reply to a follow up question around the affordability of the increase, the Operational Manager for Leisure stated that the Club would now be able to benefit from its charity status and would be able to engage in more commercial activities and so the Club should be able to generate greater income. 

 

A Committee Member questioned whether issues of car parking around Jenner Park had been addressed.  In reply, the Operational Manager for Leisure advised that it had been stressed to the Club that the use of the southern end car park should be encouraged.  He also stated that it had been anticipated this would not add to the issues of parking on Jenner Road.  In addition, the use of the Council Depot was also not recommended as there were issues around security and capacity. 

 

RECOMMENDED - T H A T the Committee endorses the proposal on a temporary licence arrangements with Barry Town AFC in respect of its use of the lounge area at Jenner Park Club House as outlined in the report.

 

Reason for recommendation

 

To enable the proposed temporary licence arrangements with Barry Town AFC in respect of its use of the lounge area at Jenner Park Club House.

 

 

 

 

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