SCRUTINY COMMITTEE (SOCIAL CARE AND HEALTH)
Minutes of a meeting held on 17th June, 2013.
Present: Councillor R.L. Traherne (Chairman); Councillor Mrs. M.E.J. Birch (Vice-Chairman); Councillors R.J. Bertin, Ms. R. Birch, Dr. I.J. Johnson, Ms. R.F. Probert, J.W. Thomas and S.T. Wiliam.
Also present: Councillor S.C. Egan.
APOLOGIES FOR ABSENCE –
These were received from Councillors Ms. K. Edmunds and E. Hacker.
RECOMMENDED - T H A T the minutes of the meeting held on 20th May, 2013 be approved as a correct record.
DECLARATIONS OF INTEREST –
No declarations were received.
SOCIAL SERVICES CHANGE PLAN 2011-2014: PROGRESS REPORT (DSS) –
Committee was advised of the progress made in delivering the actions set out in the Social Services Change Plan 2011-2014.
The Council’s second three-year Social Services Change Plan was now in its final year, and a copy was attached at Appendix 1 to the report.
This Change Plan:
· replaced the three-year Plan successfully completed in 2010, and
· set out formally (as a Council strategy) the long term strategic plan for Social Services with key actions, responsible officers for delivering those actions and timescales for completion.
There were seven priority areas in the Plan:
· Integrating Health and Social Care Services
· Integrating social care for Children and Young People Services
· Human Resources
· Information: use of different channels and media to improve access to information and services
· Resource management
· Co-production and equality impact.
The Change Plan came into effect in April 2011 and dealt primarily with those issues where a corporate approach across Council Directorates was required to deliver appropriate action. The Corporate Management Team sponsored the Change Plan as a key programme of work and there was a formal implementation group comprising officer representatives from across the Council. Six monthly progress reports were submitted to the Corporate Management Team.
The sixth progress report, submitted to Corporate Management Team on 5th June 2013 was attached at Appendix 2 to the report. It contained a summary report card in respect of the overall programme and project updates for each of the seven priority areas. It identified any delays in delivery and included details of the work being done to complete these actions.
The Corporate Implementation and Monitoring Group had discussed how best to achieve and monitor progress against the relatively small number of incomplete actions in the Plan. It was proposed that these should be transferred to the Directorate’s Service Plan from 1st April 2013. This would assist in streamlining the Directorate’s planning and monitoring framework, which also included the Budget Programme and the Director’s Annual Report.
The Change Plan had played a significant role in providing a coherent direction for social services in the Vale of Glamorgan and an overarching framework for sustained improvement and service redesign. It had helped the Directorate to respond effectively to the considerable challenges involved in putting social services on a more sustainable footing in the face of increases in demand for social care and the need to make efficiency savings. However, the new corporate planning framework had been designed to provide a similar opportunity for longer-term strategic planning and it was not useful to have two major documents which addressed the same need. Moreover, many of the key actions set out in the Change Plan had been achieved, which provided a good foundation for further progress. The remainder could be incorporated in the Service Plan which was subject to the same level of corporate and political scrutiny.
Members, having noted the good process, observed that there were still a number of issues identified in Appendix 1 to the report.
Regarding the timing of change, Members were advised that when the Service Plan was next brought before the Committee, the outstanding Change Plan items would be incorporated within it.
Regarding Action IHSC3, Members were advised that officers were hopeful that there would be funding from the Regional Collaboration Fund which would help this work stream move forward.
Regarding reference IHSC8, Committee were advised that the strategic process was managed with Cardiff Council and officers were waiting to see how Cardiff Council progressed matters.
Part of the Action Plan for reference no. RM11 was that the Council would refresh all of the financial information held in respect of residential care homes for older people. This information would be used for fee-setting.
In response to a question, Members were advised that the revisions to the Directorate Service Plan should be available in the Autumn.
(1) T H A T the progress made in delivering the actions in the Social Services Change Plan be noted.
(2) T H A T the areas of concern where implementation of particular actions had been delayed and the work being done to expedite delivery be noted.
(3) T H A T the progress report be referred to Cabinet with a recommendation that:
(i) changes to the Plan be endorsed;
(ii) remaining actions in the Plan be transferred to the Directorate’s Service Plan, as agreed by Scrutiny Committee on 11th March and by Cabinet on 8th April 2013.
Reasons for recommendations
(1&2) To provide an update on implementation of the Social Service Change Plan, in accordance with agreed monitoring mechanisms.
(3) (i) To complete the current cycle of monitoring, which ensures robust oversight of a key strategic plan for the Council.
(ii) To reduce the number of strategic plans for Social Services now that there are a limited number of major actions outstanding in the Change Plan and the Directorate’s Service Plan had become the primary document against which performance was measured.
REVENUE AND CAPITAL MONITORING FOR THE PERIOD 1ST APRIL 2013 TO 30TH APRIL 2013 (DSS) –
Committee received a report which:
· brought to the attention of Committee the position in respect of revenue and capital expenditure for the period 1st April 2013 to 30th April 2013 regarding those revenue and capital budgets which formed this Committee’s remit
· updated Committee on the progress made in delivering the Social Services Budget Programme.
The current forecast for Social Services was for a balanced budget.
In addition to increased demand for services, there was pressure on the Directorate to achieve its savings targets for 2013/14 onwards.
Children and Young People’s Services – the major issue concerning this service was the continued pressure on the children’s placements budget. Any increase in the number of children becoming looked after by the Council over the year could significantly impact on the service.
Adult Services – the major issue concerning this service was the continued pressure on the Community Care Package budget. This budget was extremely volatile and could be adversely affected by outside influences.
The Social Services Directorate was committed to achieving a balanced budget in 2013/14 whilst delivering the approved savings.
Appendix 2 to the report detailed financial progress on the Capital Programme as at 30th April 2013.
With regard to the Social Services Budget Programme Update, the Directorate was currently required to find savings totalling £6.0m. by the end of 2016/17. Savings totalling £6.189m. had currently been identified. The surplus would be used to mitigate any additional savings to be found in future years.
The Social Services Directorate was committed to achieving a balanced budget. The corporate programme board and project teams overseeing the Plan would continue to develop it further and ensure delivery and progress. Progress updates would be reported on a monthly basis as part of the overall financial monitoring report for the Directorate.
The Chairman referred to a report that had been presented to Cabinet that afternoon entitled 'Joint Funding of Residential Placements for Children Looked After by the Council' which had proposed that a joint budget be established for meeting the education and social care costs of placements in residential homes in respect of children with highly complex needs who were looked after by the Council and asked if this expenditure could be shown as a separate line in future reports.
Members enquired as to the Care Packages Budget Reduction (p. 4 of Appendix 3) and were advised that the Care Package Reduction was being undertaken as part of a rolling programme which should result in the achievement of the required level of savings.
The Director referred to 'the Regional Collaboration Fund' and advised that this was a sizeable topic which justified a report on its own. Committee were advised that a report would be presented to a Joint Cabinet meeting comprising Members of Cardiff Council and the Vale of Glamorgan Council in July. Members felt that they should be given an opportunity to speak on this matter in the Autumn.
A Member asked if budgets could be delegated to individual social workers in an attempt to save money in accordance with findings of the Audit Commission.
In response, Members were advised that it is necessary to limit the potential for individual social workers to over-provide for their own clients, to the detriment of others. Nevertheless, social workers had been given clear guidelines as to the costs of the provision of services and were now aware of the actual costs of services. Furthermore, decision-making is delegated as far as possible, primarily to front-line managers. The Directorate operated a dynamic system of assessment, care management and review.
(1) T H A T the position with regard to the 2013/14 revenue and capital monitoring be noted.
(2) T H A T the progress made on the Social Services Budget Programme be noted and referred to Cabinet for information.
(3) T H A T future reports of this nature include information, as a separate line, on expenditure of the joint budget established for meeting the educational and social care costs of placements in residential homes in respect of children with highly complex needs who are looked after by the Council.
Reasons for recommendations
(1) That Members are aware of the position with regard to the 2013/14 revenue and capital monitoring relevant to this Scrutiny Committee.
(2) That Scrutiny and Cabinet Members are aware of the progress made to date on the Social Services Budget Programme.
(3) To inform Committee of expenditure on the joint budget.
UPDATE ON THE DEVELOPMENT OF FAMILIES FIRST SERVICES (DSS) –
Committee received an update on the way in which the Welsh Government Families First Grant had been used to delivery multi-agency, early intervention services in the Vale of Glamorgan.
In April 2012, the Welsh Government replaced the Cymorth Grant with the Families First fund. In keeping with this change, the funding criteria were revised, away from the provision of open access and universal services towards more targeted services.
The Vale of Glamorgan Council acts as the recipient body on behalf of the Children and Young People Partnership (CYPP). In response to the funding changes and the revised criteria, the CYPP established a multi-agency Project Management Board to draft the service model for Families First and to plan implementation of the service from April 2012.
Welsh Government had increased the Cymorth Grant annually, until by 2010-11 it had grown to £1,592,303. During 2011-12 £1,269,797 was allocated for the transitional year from Cymorth to Families First. An additional £250k. was transferred into the Revenue Support Grant for supporting partnership working and participation by children and young people.
On the basis of evidence from programmes like Flying Start, there had emerged a consensus that the best way to support families (particularly those in poverty) was through whole-family services which were provided in an integrated way by a range of agencies and professional disciplines and which were tailored to the needs of individual families. This 'Team Around the Family' approach had been used extensively across the UK. In the Vale of Glamorgan, Families First funding was used to provide:
· the FACT Team (Families Achieving Change Together) which used this approach
· a range of bespoke projects that supported the long term aims
· co-ordination and support for the programme.
The provision of integrated services at tiers 2 and 3 was aimed at reducing the numbers of families requiring higher level, more intensive and very often more costly services from all statutory agencies. The aim was to provide holistic support to children, young people and families who did not meet the threshold for statutory services at the point of referral but who were likely to meet that threshold if early support was not provided.
The programme currently provided funding for the following projects which were detailed at Appendix 2 to the report:
· Raising awareness of welfare rights
· Family support programme
· Disability Focus
· Partnership for Young Parents (expanded to be Vale wide)
· Putting Families First
· Young people support programme
· Young carers.
Two new projects had been funded from April 2013:
· The C-Card scheme – to be incorporated as part of an existing project and managed by Learning and Skills
· Family mentoring and volunteering – to be incorporated as part of an existing project and internally and externally provided.
Members expressed the view that the development of the service to provide inclusive preventative and early prevention support to children, young people and families was to be commended and Members enquired as to whether feedback was positive.
Members were then advised that the feedback being received was extremely favourable.
Members were advised that the reality of the situation was that some families faced different problems as they went through life. It was sometimes the case that some families were admitted to the programme recurrently. Without support, people could not always sustain improvements to their lives.
Members enquired as to the criteria which had to be met to be admitted to the Families First service and Committee were advised that this information would be supplied.
In response to a question concerning an exit strategy for the initiative, Committee were advised that, after a period of time, the grant was devolved to the Local Authority.
(1) T H A T the use made of the Families First grant be noted.
(2) T H A T the proposals for continued development of the Families First Service, including the implications for the Council, be supported.
(3) T H A T annual updates on progress with the Families First Service be provided to Committee annually.
(4) T H A T Committee receive a further report within six months, particularly focusing on case studies, assessment and outcomes.
(5) T H A T the Members of the Committee be informed as to how the grant money is allocated within the Families First Service and also informed about the referral criteria for the Families First Service by e-mail.
Reasons for recommendations
(1) To ensure that Members are kept informed about developments.
(2) To ensure that Members support the way in which the Welsh Government grant to the Children and Young People’s Partnership is being used to deliver Families First in the Vale of Glamorgan.
(3) To ensure that the Committee is able to exercise appropriate oversight of this important stand in the overall strategy for delivering effective children and families services, including the financial and legal responsibilities undertaken by the Council as grant recipient body on behalf of the Children and Young People’s Partnership.
(4) For the information of Committee.
(5) For the information of the Members.
SOUTH WALES PROGRAMME CONSULTATION (MD) –
The views of the Committee were sought on the South Wales Programme public consultation which outlined options for the future provision of a small number of hospital services – consultant-led maternity and neonatal care, inpatients children’s services and emergency medicine (A&E) for the people of South Wales and South Powys.
The five health boards providing care for people in South Wales and South Powys had launched a formal eight week public consultation about the future of four hospital services. The public consultation outlined options for the future provision of consultant-led maternity and neonatal care, inpatients children’s services and emergency medicine (A&E) for the people of South Wales and South Powys.
Four options were being consulted upon for the future provision of these services. Frontline doctors, nurses, midwives, therapists and paramedics had worked together over the past 18 months to look at the challenges facing these services and proposals to concentrate them on four or five hospitals across the South Wales area. The aim was to create a network of healthcare services which provided as much care locally as possible when safe to do so.
The reasons for change were that patients were not getting access to the best care and services did not meet clinical standards. Senior doctors were not available at nights and weekends. There were not enough doctors to provide these services in all hospitals and although this was a UK problem, it was worse in Wales. Some services were at risk of collapsing because of the shortage of doctors.
Feedback from an extensive 12 week engagement exercise with public, staff and stakeholders undertaken in the Autumn of 2012 had informed the options that were now being consulted upon. The results of the engagement showed that there was an understanding of why services needed to change and a majority supported the ideas for change. People would like services to be provided in as many hospitals as they safely could. There was also concern about the impact on the Welsh Ambulance Service on people living in deprived areas, on access and travel times and on public transport.
As part of the engagement, it was explained that three hospitals were considered to be fixed points because of the range of services they provided and the size of the population they covered. University Hospital Wales, Cardiff, Morriston Hospital, Swansea and a new hospital to be build near Cwmbran which would be a Specialist and Critical Care Centre.
Feedback from the public and clinicians during the engagement was used to develop six benefit criteria against which all options were assessed: safety, quality, sustainability, access, equity and strategic fit.
At the time of the engagement exercise, there were six possible scenarios for the location of these services. After consideration of issues such as access and equity and the impact on the Welsh Ambulance Service and other hospitals in South Wales, two had been ruled out.
The four options being consulted on for the future of these services were:
· Option 1: UHW, Morriston, Specialist and Critical Care Centre (SCCC), a new hospital which was planned to be built near Cwmbran, plus Prince Charles Hospital.
· Option 2: UHW, Morriston, SCCC plus Royal Glamorgan Hospital.
· Option 3: UHW, Morriston, SCCC plus Prince Charles and Princess of Wales.
· Option 4: UHW, Morriston, SCCC plus Prince Charles and Royal Glamorgan.
The options had been assessed against a wide range of factors, including their impact on travel times, especially for people living in the most deprived communities, the number of doctors needed, the impact on the Welsh Ambulance Service and a high level assessment of how much they would cost. The option which had emerged from the process as having the least impact on all the factors the South Wales Programme had considered and was therefore the best fit, was Option 3 – concentrating these services on five hospitals: UHW, Morriston, SCCC, Prince Charles and Princess of Wales hospitals.
Concentrating these services in a smaller number of hospitals means there will need to be a corresponding move of other services. It was acknowledged within the documentation that in the future some patients may have to travel 'a bit' further to access a 'small percentage' of services but that the benefits of the changes would be better standards of care and a stronger guarantee of clinical skills and expertise when people need them most.
As part of the consultation, discussions would take place with interested groups and fora about the proposals, as well as a range of formal public meetings held to ensure a wide range of views would be heard.
It was anticipated that the analysis of the consultation response would be completed by September when it would be shared with Community Health Councils (CHCs) within the South Wales Programme area. Each CHC would then formally respond to its respective health board, indicating whether it agreed to the proposals or if it was not satisfied, they would be in the interests of health services within its area. Health Boards would meet in October to make a decision.
The issues contained within the document were discussed and, whilst no consensus was reached, concerns were expressed about some of the impacts and the need for change.
Some Members proposed that consultant led services should be retained at Royal Glamorgan Hospital, Morriston Hospital, Princess of Wales Hospital, University Hospital of Wales, Prince Charles Hospital and the Specialist and Critical Care Centre, Cwmbran. In addition, more should be done to attract consultants through incentives and by recruiting further afield e.g. within the EU. This view was not supported by the majority of the Committee, with some recognising that changes were inevitable and others feeling that at this stage they did not have sufficient information to formulate a view on the options.
Particular issues raised by individual Members of the Committee during discussion of the programme were:
· Concern about safety levels for midwifery if complications arose during labour and a patient needed to be transferred. It was felt that this may not lead to the best quality of care.
· Changes in neo-natal services would impact on people living in deprived areas.
· Concern about the capacity of the Ambulance Service to travel the required distances as performance levels were already below target.
· Reassurance was required that no hospitals were to close.
· It was considered acceptable for patients to travel further to access more specialist services if this led to better outcomes for patients.
· The consultation document assumed a great deal of knowledge about the issues, and it was felt that more details were required.
· Assurances were sought that, if there were less sites, then there would be proper staffing of services.
· More effort was required to attract and recruit consultants, e.g. through incentives or looking to the EU.
RECOMMENDED – T H A T the individual Councillors’ responses to the consultation be taken into account when drafting the Council’s response to the consultation.
Reason for recommendation
That Members’ views form part of the Council’s response.
EXTRA CARE HOUSING (DSS) –
Committee were updated on progress made in the development of Extra Care Housing in the Vale of Glamorgan.
There had been some delay in the scheme due to some initial problems when the contractor went on site and the weather conditions at the start of the calendar year. As a result, the completion date for the building works was now May 2014.
The building had progressed markedly in the last two months and should be waterproof soon. This would enable the contractor to progress, regardless of the weather conditions.
Regular meetings were now taking place with Hendre, the development arm of Hafod, concerning issues within the project such as:
· the use of colour within the design to support people with sight impairment
· not fitting two of the kitchens to enable specially adapted kitchens to be fitted if required to meet particular needs of a small number of tenants.
An officer working group was now meeting monthly to plan this new service. The work streams being monitored were:
· Housing related support – Supporting People
· Social care requirements
· Nomination rights for the accommodation
· Housing benefits.
By the time the scheme was completed, two tenders would have been let, namely:
· a Supporting People tender to ensure that tenant related support and advice was available to support tenants prior to their move and once they were in the property
· a domiciliary care contract to provide the social care support and care to the new tenants.
A risk log for the development had been developed and was attached at Appendix A to the report for information. The key risks at the current time were insufficient officer time to complete the work and the development of a robust void management procedure to ensure the Council did not incur any additional costs due to voids in the scheme.
Within the planning consent, a sum of £75,000 had been earmarked for the provision of public art. Hendre had appointed a consultant to work with them in this element of the scheme. An artist had been appointed to deliver the glass work within the building and she made a presentation in May to the Housing sub group of the 50+ Forum, which was attended by the Cabinet. Further work was to be done on community art and contact would be made with the appropriate stakeholders to complete this element of the scheme.
RECOMMENDED – T H A T the current position with regard to Extra Care Housing in the Vale of Glamorgan be noted.
Reason for recommendation
To ensure effective scrutiny of a key function undertaken by the Council.
MATTER WHICH THE CHAIRMAN HAD DECIDED WAS URGENT –
RECOMMENDED – T H A T the following matter which the Chairman had decided was urgent for the reason given beneath the minute heading be considered.
BRYNEITHIN UPDATE –
(Urgent by reason of the need to ensure timely information is provided regarding the development of the Bryneithin site)
As a result of the closure of the Bryneithin Residential Care Home, Cabinet on 8th April 2013 had established a corporate project group to consider future use options for the site to assist the Council in meeting the social care needs of older people. The options appraisal exercise was to be conducted in the context of there being no funds available from the Council’s Capital Programme. Cabinet were also informed that the project group would seek to engage with relevant stakeholders, including the Cardiff and Vale University Health Board.
Cabinet established a working group to oversee, and be involved, in all future options for the Bryneithin site and any consultation with the relevant stakeholders.
The Cabinet Working Group comprised the Leader, Deputy Leader and Cabinet Member for Adult Services and senior Council officers, including the Head of Adult Services supported by a Major Projects Manager from the Project Management Unit co-ordinating a multi disciplined team of officers.
The Cabinet Working Group had met and considered the site and identified a number of potential options (listed in no particular order below) for the future use of the Bryneithin site, all of which would satisfy the requirement of meeting older people’s needs for care and support:
· private residential development for older people
· registered Social Landlord residential development for older people
· private extra care facility
· registered Social Landlord extra care facility.
As part of the appraisal exercise, it was intended to consult key stakeholders and the local community on the above options and, as part of this consultation, invite any other ideas for development options for the site that would assist in meeting older people’s need for care and support. Following the exercise, a final list of options would be reported for the consideration of a future Cabinet. Initial discussions had already been held with the Cardiff and Vale University Health Board and further discussions would be held as may be required.
Along with consulting key stakeholders, a key issue would also be the suitability of the site for these options. Of the site’s 2.75 acres of land, 1.3 acres to the north of the existing home was situated outside the Residential Settlement Boundary of which 0.9 acres was dense sloping woodland. Planning policy would presume against development outside the Residential Settlement Boundary and any proposal to develop this 1.3 acre part of the site would need to demonstrate why an exception should be made to the policy position. The remaining 1.45 acres of the site within the Residential Settlement Boundary included a narrow tree lined access lane measuring 0.45 acres where it runs from the public highway to the edge of the front lawns of the existing home.
In accordance with Cabinet minute C1293 (5) authority had been granted for the Director of Social Services to make arrangements for securing the Bryneithin site, including the demolition of the buildings if necessary, in consultation with the Leader, the Cabinet Member for Adult Services and the Managing Director.
It was also intended to commission specialist contractors / consultants to undertake ground / site investigations and topographic surveys of the site. This survey information would be required to assist with securing an end use for the site.
Whilst the priority was to secure a use option for the site that met older people’s needs for care and support, the Cabinet Working Group had tentatively considered the potential fall back option of marketing and disposing the site for residential development. This would be a last resort but could raise a capital receipt for Social Services that may be invested in the Vale to again meet older people’s needs for care and support.
Having considered the contents of the report, it was
(1) T H A T the contents of the report be noted.
(2) T H A T all Members of the Committee, along with Ward Members, be invited to attend a site visit at the former Bryneithin Residential Care Home site in order that they might view the ground conditions.
Reasons for recommendations
(1) Having regard to the content of the report.
(2) To view the site.