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SCRUTINY COMMITTEE (SOCIAL CARE AND HEALTH)

 

Minutes of a meeting held on 7th November, 2013.

 

Present:  Councillor R.L. Traherne (Chairman); Councillor Mrs. M.E.J. Birch (Vice-Chairman); Councillors Ms. R. Birch, Ms. K. Edmunds, Dr. I.J. Johnson, J.W. Thomas and S.T. Wiliam.

 

Also present: Councillor C.P.J. Elmore.

 

 

566     APOLOGIES –

 

These were received from Councillors R.J. Bertin and Ms. R.F. Probert.

 

 

567     MINUTES – 

 

RECOMMENDED – T H A T the minutes of the meeting held on 7th October, 2013 be approved as a correct record.

 

 

568     DECLARATIONS OF INTEREST – 

 

No declarations were received.

 

 

569     DISABLED FACILITIES GRANT PERFORMANCE 2013–14 QUARTER 1 (REF) –

 

Cabinet, on 21st November 2013, was advised of the Council's performance delivering Disabled Facilities Grant (DFG) in quarter 1 of 2013–14.

 

Cabinet agreed on 15th July, 2013 (Minute No. C1415 refers) an action plan for service improvement during 2013-14 and that a detailed report on Disabled Facilities Grants be brought to Cabinet on a quarterly basis. Appendix 1, as attached to the report, provided detailed information on the performance of the delivery of disabled facilities grants during quarter 1 of 2013–14.

 

The report outlined that overall the DFG performance was within target.  However, as seen in the second table in Appendix 1, the time taken between a client's 1st point of contact with the Council and the Occupational Therapist recommendation was behind target.  However, when comparing the performance on a quarterly basis there had been an improvement in this stage from the last quarter.  This deficit was being addressed through additional staffing.  The Occupational Therapist employed by Public Protection would start in November 2013 and in the meantime an agency Occupational Therapist had been employed. Appendix 2, as attached to the report, provided an update on the implementation of the agreed action plan which will deliver further service improvement.

 

The adaptations detailed within this report were for private sector residents who either owned their properties or were renting from private landlords. Adaptations required by Council tenants were delivered by Housing Services, while adaptations for housing association tenants were delivered by their housing association supported by Property Adaptation Grants funded directly by Welsh Government.

 

Cabinet had resolved –

 

(1)       That the report on performance for delivering Disabled Facilities Grant in Quarter 1 of 2013-14 be noted.

 

(2)       That the report be referred to the Scrutiny Committees (Housing and Public Protection, Health and Social Care and Corporate Resources) for information.

 

Members of the Committee were advised that the Public Protection Occupational Therapist had started work this week and was a permanent member of staff.  The Agency Occupational Therapist would be employed until Christmas.

 

Members of the Committee welcomed the progress that had been made.

 

RECOMMENDED – T H A T the decisions of Cabinet be noted.

 

Reason for recommendation

 

Having regard to the decisions of the Cabinet.

 

 

570    THE FINANCIAL POSITION IN ADULT SERVICES (DSS) –

 

Committee received a report which:

 

-               brought to the attention of the Committee the current position in Adult Services regarding revenue expenditure

-               provided an analysis of pressures on budget for Adult Services

-               provided an update on the actions being taken to mitigate anticipated overspends, in part through delivery of the Social Services Budget Programme. 

 

Committee were advised that resource management in Adult Social Care was inherently problematic for the following reasons:

 

·                Potential demand for most social care services would often exceed supply and so the Council was always involved with establishing eligibility

·                Like all local authorities in Wales, the Council was heavily dependent on funding from the Welsh Government.  The formula used to allocate this funding was especially problematic for the Vale of Glamorgan in that Social Services here received substantially less money for spending on social services than local authorities similar in size.  The outcome was that the Council’s average spend per head of population was relatively low

·                Decisions which affected the type and cost of services being provided were often outside the Council’s control and may be unpredictable

·                Some individual services were very expensive.  Even with the appropriate monitoring and efficiency measures and controls operating well, packages of care for adults with especially complex needs could exceed £100,000 per year

·                Financial decisions had to follow the changing needs of individual users

·                Market pressures meant that Councils could face escalating costs when purchasing services from independent providers

·                Whilst some services were low volume and high cost, others such as the provision of home care and some residential care services were notable for their high turnover and volatility, brought about by changes in circumstances such as admission to hospital

·                Expenditure incurred during one year may lock the Council into financial commitments on behalf of individual service users for many years to come.  For example, a package of care commissioned for someone who had just turned 18 may still be required into old age

·                To balance the competing priorities of managing service demand, improving quality, meeting higher expectations and reducing expenditure was especially difficult in situations where safeguarding people from significant harm had to be a key factor in decision making.

 

Given this challenging context, it was essential that the Council had in place a coherent strategy for securing financial stability within the resources available.  On 30th July 2012, Cabinet had endorsed the Social Services Budget Programme.  Since that time, the Social Care and Health Scrutiny Committee had received monthly progress updates on the way in which the programme had been implemented.

 

In respect of the overall budget programme, the Social Services Directorate was currently required to find savings totalling £6.0m. by the end of 2016/17.  Savings totalling £6.189m. had been identified.  The surplus would be used to mitigate any additional savings to be found in future years.

 

The current forecast for Social Services was an overspend at year end 2013/14 of £876k.  This was after deducting savings of £2.04m. which had been identified for the year. 

 

In Adult Services, the major issue was the continuing pressure on Community Care Packages.  This was the Division’s most volatile budget and the one most dependent on levels of service demand which were not within the Council’s direct control.  At present, the projected year end position for this budget was an overspend of £1.635m., following the reduction in budget to accommodate the savings target for the year of £685k.  There were potential underspends elsewhere in Adult Services of around £466k. which could be used to offset this position.  The overall projected overspend for the Division at year end was £1,169k.

 

The level of additional funding identified by the Welsh Government for the First Steps Initiative (which resulted in the introduction of the £50 cap for non-residential services) had been announced at £646k. for the current year.  This would reduce the overall overspend.

 

The allocation of additional funding for the next and subsequent years had not yet been determined but Committee were advised that they would receive a further report when a definitive decision on this matter had been made by the Welsh Government. 

 

Committee were advised that a report on the budget proposals would be brought before Cabinet later in November which would refer to the ongoing pressures on the Social Services Budget.  In turn, the report would be brought before this Committee. 

 

Members enquired if any reductions in the Directorate’s budget would affect the Council’s statutory duties. 

 

It was

 

RECOMMENDED –

 

(1)          T H A T the current position with regard to the 2013/14 revenue budget be noted.

 

(2)          T H A T the progress made in managing increased demand and delivering measures to control expenditure be noted.

 

(3)          T H A T the report be referred to Cabinet for information.

 

(4)          T H A T Cabinet be requested to make absolutely sure that future budgets take into account the fact that, due to ever increasing demand, there should be no further reductions to the Social Services Budget in view of the fact that any further significant reductions in resources were likely to mean that statutory requirements may not be met.

 

(5)          T H A T the grant of £646,000 from the Welsh Government in 2013/14 be welcomed albeit that this did not cover the full costs to the Council incurred through implementing the First Steps Improvement Initiative.  Cabinet were requested to make further representations to the Welsh Government Ministers for full compensation of the Scheme’s cost.

 

(6)          T H A T the creation of the Intermediate Care Fund in the 2014/15 draft Welsh Government Budget to promote collaboration between Local Health Boards and local authorities be welcomed and that the Council’s own application development process commences as soon as practicable in order to make best use of this funding opportunity.

 

Reasons for recommendations

 

(1)          That Members are aware of the current position with regard to the 2013/14 revenue budget and the actions being taken to bring expenditure within the budget set for the Adult Services Division.

 

(2&3)  That Members are able to exercise effective oversight of the way in which the budget was being managed.

 

(4)       To advise Cabinet of the view of this Committee.

 

(5)       To seek full compensation for the costs of the First Steps Initiative.

 

(6)          To make best use of this funding opportunity.

 

 

571     CHILDREN AND YOUNG PEOPLE SERVICES – COMMISSIONING STRATEGY AND ACTION PLAN 2013-2018 (DSS) –

 

Committee were updated on progress made in implementing the Children and Young People Services Commissioning Strategy and Action Plan 2013-18. 

 

In February 2013, Committee considered the draft Children and Young People Services Commissioning Strategy and Action Plan.  Committee recommended that Cabinet endorse the objectives and principles it contained, and asked for regular progress updates.

 

Following implementation of the Strategy, efforts had focused on the following key areas:

 

·               Preventing children and young people becoming looked after where this was not necessary to safeguard their welfare

·               Enabling those that do come into care to be rehabilitated back to their family network where it was safe to do so

·               Providing the best possible outcomes for those who remained accommodated.

 

An updated Action Plan detailing progress to date was attached to the report at Appendix 2. 

 

Successful implementation of the Strategy would require a continuing and co-ordinated effort that built on the achievements above. 

 

At this stage, no additional actions had been included in the Plan but the Directorate would continue to deliver on those in place, focusing on:

 

·                increasing the number of foster carers who could provide respite, with a view to supporting families to stay together

·                further developing a range of accommodation options for young people aged 16 plus and care leavers

·                through Permanency Panel, ensuring that plans for permanency consider the range of available options and that children do not remain looked after for longer than necessary and that those who need to remain looked after are appropriately matched in their placements

·                undertaking a further review of all looked after children to ensure their legal status remains appropriate and, where possible and safe to do so, secure a return to the child’s immediate or extended family

·                developing the multi-disciplinary 'team around the child' approach to providing placement support to increase stability and reduce disruption.

 

This work would continue against the backdrop of ongoing robust arrangements in Placement Panel and Complex Needs Panel that sought to ensure all admissions to care were appropriate in the first instance and that, where possible, children were supported to remain within their families.

 

The Children and Young People Services Divisional Management Team would continue to be responsible for overseeing the delivery of the Action Plan, monitoring the impact on children and their families and driving forward the focus on reducing admissions to care and increasing reunification to family and friends as a key priority for the Directorate.

 

RECOMMENDED –

 

(1)          T H A T the progress made in delivering the Children and Young People Services Commissioning Strategy and Action Plan be noted.

 

(2)          T H A T the report be referred to Cabinet.

 

(3)          T H A T the report be referred to Scrutiny Committee (Lifelong Learning) for information.

 

(4)          T H A T Committee continues to receive six monthly progress updates.

 

Reason for recommendations

 

(1-4)    To provide Members with opportunities to exercise oversight of a key strategic document for the Council.

 

 

572     SOCIAL SERVICES REPRESENTATIONS AND COMPLAINTS – ANNUAL REPORT 2012/13 (DSS) –

 

Committee received a report which advised of:

 

·               the Social Services Representations and Complaints Procedure

·               activity, performance and achievements within this important area of work during 2012/13

·               improvements planned for 2013/14.

 

The Annual Social Services Representations and Complaints Annual Report 2012/2013 was attached at Appendix 1 to the report. 

 

The Annual Report detailed that the Directorate had received 56 concerns or complaints in 2012/13.  This figures was broken down across the service as shown below:

 

 

Enquiries*

Complaints

Adult Services

13

19

Children and Young People Services

14

30

Business Management and Innovation

2

7

Total

29

56

 

*   An enquiry is an issue of concern to the service user, dealt with by the team, without escalation to a complaint.  None of the 29 enquiries became a Stage 1 complaint.

 

There had been a decrease in the number of enquiries recorded, from 38 in 2011/12 to 29 in 2012/13.  In the same period, there was a decrease in the number of complaints from 106 to 56.

 

Increased staff awareness regarding their responsibilities under the Complaints Procedure and their commitment to resolving concerns at the earliest opportunity was considered to be a factor in reducing the volume of complaints.  The Complaints Officer had taken on more of a mediation role during the past year.  Some people who contacted Social Services were not sure if they wanted to make a complaint.  In these circumstances, the Complaints Officer would arrange to meet with them to listen to their concerns and to explore how they could be resolved.  This intervention involves using a range of approaches, including discussion, supplying information and listening to the concerns of the individual and ensuring that the relevant service area was notified.

 

The Social Services Procedure included timescales within which complainants should have received a response to their complaint.  During 2012/13, there was a small dip in performance, with 79.63% of Stage 1 complaints being responded to within the 10 day timescale.  This was a slight reduction from the 80.70% reported in 2011/12.  Stage 2 and Stage 3 complaints were all completed within the agreed timescales.

 

The most common complaints received were as follows: 

 

 

2012/2013 – Most Common Complaints Recieved

Adult

Services

Children and Young People  Services

Business Management and Innovation

Charges for care services

 

0

0

2

Disagreement with assessment policy

 

1

0

1

Lack of information/ consultation

 

5

4

0

Lack of response from team

 

0

2

0

Placement provision

 

1

0

0

Quality/level of service

 

4

8

3

Complaint about staff

 

5

15

0

Unhappy with care provision

 

3

1

1

Total

19

30

7

 

Complaints against staff were the most common.  This was a typical pattern within local authority social services, partly because of the sensitive and sometimes contested nature of the work which staff undertake but also because the statutory basis for Social Services was very complex.  A number of complaints arise in circumstances where staff have acted appropriately in delivering the Council’s policies and priorities but this was not acceptable to families.  The improved performance in achieving early resolution of complaints demonstrated the extent to which good investigation could provide opportunities for reconciling different perceptions.  It was often possible to demonstrate that the staff had acted fairly or made reasonable decisions, based on all relevant considerations.

 

Compliments were also regarded as important information, and used to identify good practice.  The Directorate received 99 compliments during 2012/13, compared to 58 in 2011/12.

 

The Directorate continued to improve the way in which complaints were dealt with and, in the past year:

 

·               complaints information reports were issued to managers on a monthly basis

·               the Complaints Officer worked effectively with the Independent Complaints Secretariat to ensure Stage 3 panels were arranged in a timely manner

·               managers could now access on the StaffNet information on complaints processes and templates of letters to be used at each stage of the process

·               the Complaints Officer had contributed to the development of the following policies – complaints made by and against foster carers and Appeals against eligibility decisions and appeals against charging decisions

·               information leaflets had been reviewed.

 

The priorities for developing the complaints and compliments service during 2013/14 included:

 

·               implementing any changes necessary following Welsh Government consultation on proposals to amend the statutory complaints procedure

·               ongoing training programme to include complaints awareness sessions with managers and their teams

·               improving compliance with set timescales for dealing with complaints

·               further increasing the numbers of Independent Investigators and Independent Persons on the database

·               reviewing the complaint information leaflets for use by children and young people

·               work with the Corporate Complaints Team on the process for collating feedback from complaints

·               further developing the monitoring and evaluation process to improve the ability of the Directorate to learn from complaints and to use the outcomes and recommendations arising from complaints to improve services

·               contribute to the biannual Corporate Complaints report.

 

Members expressed complimentary views on the contents of the report, although it was noted that 20% of the Stage 1 complaints failed to be resolved within the required timescale (10 days). 

 

By way of explanation, it was explained that the timescale was quite tight, and some complaints were of a multi-faceted nature.  Complainants were informed if their concerns would take longer to resolve than the period set out in the procedures.  Furthermore, the previous year’s reconfiguration of Rondell House had resulted in a spike in the number of complaints received that year.

 

RECOMMENDED –

 

(1)          T H A T the contents of the report be noted.

 

(2)          T H A T Committee continues to receive an annual report in relation to complaints and compliments received by the Social Services Directorate.

 

Reason for recommendations

 

(1&2)  To ensure effective scrutiny of performance in Social Services and the direct impact upon individual services and their carers.

 

 

573     SUSTAINABLE SOCIAL SERVICES FOR WALES: A FRAMEWORK FOR ACTION AND THE SOCIAL SERVICES AND WELLBEING (WALES) BILL (DSS) –

 

Committee was provided with an update in respect of the Local Government Implementation Plan for Sustainable Social Services and received an outline of the current position regarding the Social Services and Wellbeing (Wales) Bill.

 

The Social Services and Wellbeing (Wales) Bill (the Bill) was introduced to the Welsh Assembly in January 2013.  It sought to consolidate and rationalise existing legislation affecting social services and provided a single, unified legislative framework for delivery of the Sustainable Social Services agenda. 

 

Social care was located within a wider framework of 'wellbeing', placing a new duty on local government to provide care and support for 'people in need' and emphasising the important role of prevention.  The Bill therefore contained significant implications not just for all Social Services but also for other local government services and the wider public sector. 

 

The Bill had just passed through the first stage of scrutiny in the Assembly.  The report contained over 60 recommendations which AMs wished to see accepted by the Deputy Minister and be reflected in the Bill through amendments introduced during the Stage 2 scrutiny. 

 

Whilst the broad aims of the Bill had attracted considerable support, there was still much disquiet about how such a comprehensive programme of change could be managed and delivered, especially given the state of public sector finances for the foreseeable future.  The Welsh Government maintained that, in the longer term, implementing the Bill would be cost neutral, based on a conviction that a focus on wellbeing, prevention and the provision of information and advice would divert and reduce demand for current and more expensive forms of care and support. 

 

In its Stage 1 Report, however, the Health and Social Care Committee concluded that 'We are not satisfied with the information that has been made available on the total cost of the Bill and have not received any evidence to convince us that the Bill will be cost neutral in the long term.  We are mindful that the size and complexity of the Bill make it extremely difficult to cost.  We also recognise the concerns of witnesses with regard to the current challenges facing public sector funding which will shape the context within which this Bill is delivered'.

 

The WLGA commissioned an independent report from the Institute of Public Care called 'Transitional and longer-term implications of the Social Services and Wellbeing (Wales) Bill, September 2013'.  The report represented the best effort to date at providing a realistic appraisal of the current context for social services, the Bill’s likely impact, the costs of transformation and the significant challenges that must be overcome.  It argued that, without the implementation of the wellbeing agenda at the heart of the Bill, local partners would struggle to meet the demands placed on them through changing demographics and welfare reform whilst implementation of other elements such as new assessment and Direct Payments arrangements could prove to be costly.

 

The report explored the key implementation issues that the Welsh Government, local authorities and the NHS may need to consider as they look to work together to make the aspirations of the Bill a reality in the current climate.  For local authorities, the key tasks were:

 

·                Undertake rigorous self-assessment and agree a plan for service development with local area partners

·                Agree the forms of local integration most needed to deliver the changes in pathways and services to secure better outcomes for citizens

·                Explore with citizens and with local third sector partners how to create a culture of engagement and greater co-production in services

·                Undertake a local cost-benefit analysis of their development plans and review budgets accordingly

·                Place wellbeing at the heart of service provision

·                Develop a commissioning strategy to realign services to focus on early intervention and prevention, and improve outcomes

·                Seek to develop and commission services which offered cost-effective and integrated solutions to care

·                Develop local arrangements which fit the proposed assessment and eligibility framework and support staff through guidance and training

·                Review existing information systems and information sharing protocols and identify improvements needed

·                Develop and strengthen their partnership working across a range of agencies

·                Respond to the demands of developing a “whole†Council approach to service delivery

·                Work with the third sector to deliver cost-effective public services.

 

Social Services were facing unprecedented pressures in terms of demand for services (actual and projected), increased public expectations, demographic change, significant new duties being introduced through the forthcoming legislation and, in common with other parts of the public sector, severely constrained financial resources.  This presented formidable challenges in an environment in which some Councils were already recording overspends in their Social Services budgets.  The impact of welfare reforms was increasing even more the need for help from Social Services and its partners.

 

From the start, Local Government had been clear about the essential building blocks for social services reform.  For the Bill to deliver on its promises, it must simplify the law, make clear the core functions of Social Services, streamline bureaucracy, balance national constituency and local autonomy, require key partners such as health and social services to work together far more closely in meeting people’s needs within their own homes and communities and define how wellbeing and preventative responsibilities would be shared equitably across the public and third sectors in Wales. 

 

Clearly, implementation would be complicated, requiring a whole system change and new models of care in local areas.  Efforts to modernise services face many obstacles, including:

 

·                Budgetary pressures and the need for savings

·                Potential opposition from service users and carers who value existing provision highly and depend upon it for an improved quality of life

·                Encouraging current service providers from all sectors to change their approach

·                The scale of the agenda, with a need to focus on innovation and continuous improvement in all areas of service design, delivery and evaluation

·                Difficulties in finding the resources required to bring about transformational change

·                The clear risks that the new legislation will impose increased costs

·                The risks of cost shunting from the NHS and other partners, including central government.

 

It was considered that the programmes of work undertaken in the Vale and in its collaborative enterprises placed this Council in a good position for responding positively to increased emphasis on implementing new service models.

 

However, Welsh Government strategy was predicated on an assessment that there was a choice between retrenchment and renewal.  In the absence of a more sustainable solution to the question about how the costs of social care were to be met in the longer term, it seemed likely that both options would have to form part of any realistic approach, requiring as many people as possible to take increased responsibility for meeting their own needs so that the most vulnerable could be safeguarded from harm. 

 

Having considered the contents of the report, it was

 

RECOMMENDED –

 

(1)          T H A T the contents of the report be noted.

 

(2)          T H A T Committee continues to receive regular updates about the progress made in achieving the actions set out in the Local Government Implementation Plan for Sustainable Social Services and the Social Services and Wellbeing (Wales) Bill.

  

Reason for recommendations

 

(1&2)  To ensure that Elected Members are kept informed about fundamental changes in the policy and legislative framework which underpins the work of Social Services.

 

 

574     MATTERS WHICH THE CHAIRMAN HAD DECIDED WERE URGENT –

 

RESOLVED – T H A T the following matters which the Chairman had decided were urgent for the reason given beneath the minute headings be considered.

 

 

575     BRYNEITHIN UPDATE –

(Urgent by reason of the need to ensure timely information was provided regarding the development of the Bryneithin Site)

 

Committee were advised that:

 

·               A Bat Licence had been received in respect of the welfare and conservation of bats.  The appropriate actions had been taken and demolition subsequently started.  As of 5th November 2013, the demolition had been completed.

·               Following the consultation exercise, the Cabinet Working Group considered a list of options which would need to be developed further and reported for consideration by Cabinet on 18th November to ensure proper consideration was given to the emerging themes and future marketing of the site.  The options for consideration provided varying levels of accommodation with care.  These were extra care and / or housing for older people.

·               Cabinet would consider a proposal to gift the unusable woodland at the rear of the property to the local school. 

·               It was intended that future marketing of the site would commence, following the consideration by Cabinet, at the beginning of 2014 as interest in development projects improves at the beginning of a calendar year so it was hoped that this would maximise the marketing potential of the site.

 

Note: Timescales were indicative and may be subject to change.

 

Having considered the contents of the report, it was

 

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

 

Reason for recommendation

 

Having regard to the contents of the report.

 

 

576     INDEPENDENT LIVING FUND (DSS) –

(Urgent by virtue of the recent developments with regard to the proposed transfer of the Independent Living Fund)

 

Committee received a report which advised:

 

·               that, on 6th November 2013, the Court of Appeal upheld a legal challenge by five disabled people against the UK Government’s decision to close the Independent Living Fund in March 2015

·               the Independent Living Fund had contacted local authorities to advise that they would be cancelling all activity related to the transfer of the Fund

·               Welsh Government officials had advised that they were no longer intending to carry out consultation into the possible options for transferring the Fund

·               it remained to be seen whether the UK Government would seek to revisit the idea of closing the Fund.

 

Having considered the contents of the report, it was

 

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

 

Reason for recommendation

 

Having regard to the contents of the report.

 

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