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 SCRUTINY COMMITTEE (SOCIAL CARE AND HEALTH)

 

Minutes of a meeting held on 10th February, 2014

 

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

 

Also present: Councillors S.C. Egan and C.P.J. Elmore.

 

 

812     APOLOGIES FOR ABSENCE –

 

These were received from Councillors R.J. Bertin, Ms. R. Birch and Ms. K. Edmunds.

 

 

813     MINUTES –

 

RECOMMENDED – T H A T the minutes of the meeting held on 13th January, 2014 be approved as a correct record.

 

 

814     DECLARATIONS OF INTEREST –

 

No declarations were received.

 

 

815     REVENUE AND CAPITAL MONITORING FOR THE PERIOD 1ST APRIL 2013 TO 31ST DECEMBER 2013 (DSS) –

 

Committee received a report which advised of the position in respect of revenue and capital monitoring for the period 1st April to 31st December 2013 regarding those revenue and capital budgets which formed this Committee’s remit.  The Committee also received an update on the progress made in delivering the Social Services Budget Programme.

 

It was currently projected that the service would outturn within target at the end of the financial year.

 

Children and Young People’s Services – the major issue was the need to manage continued pressure on the children’s placements budget.  The current projected outturn for the jointly funded Residential Placements budget for Looked After Children was an overspend of £530k.  Any overspend at year end would be funded in proportion to the original contributions made to the joint budget i.e. £477k (90%) Social Services and £53k (10%) Education.  In addition to the joint budget, a high cost placement provision of £1.46m had been established as part of the budget setting process for 2013/14.  To date, £223k of the provision had been committed which was in addition to expenditure incurred within the joint budget.  There were potential underspends elsewhere in the Children’s Services of around £226k which could be used to offset this position.  The increase in expenditure on the joint residential budget had resulted in a reduction in expenditure of £71k on alternative means of provisions and accommodation costs required for the current cohort of children.  In addition, other areas of underspend were £50k on the legal expenses budget, £85k additional adoption income and £20k on administrative staff.  The Business Management and Innovation division was anticipated to underspend and any variance be apportioned to the service areas.  Therefore, £34k of the underspend would be allocated to Children’s Services.  It was currently anticipated that there would be a £217k overspend.

 

Adult Services – the major issues was the continuing pressure on Community Care Packages, the Divisions’ most volatile budget the one most dependent upon levels of service demand which were not entirely within the Council’s direct control.  At present, the projected year end position was an overspend of £685k.  Actions therefore still needed to be taken to review all processes and to address this shortfall.  There were potential underspend elsewhere in Adult Services of around £525k which could be used to offset this position.  These areas were £230k following the closure of Bryneithin, £254k on staffing and £41k on Premises.  With the levels of savings required for 2014/15 and 2015/16, budgets were being re-examined during 2013/14 with a view to their possible realignment as part of the consideration of new models of service delivery.  Future savings were planned for these areas and some positions and premises costs were lower than expected as a result of the commencement of some of these plans ahead of schedule.  The Business Management and Innovation division was anticipated to underspend and any variances be apportioned to the service area.  Therefore £84k of the underspend would be allocated to Adult Services.  This would result in a currently anticipated overspend of £76k. 

 

Business Management and Innovation – the majority of this budget was recharged to Children’s and Adult Services and was, therefore, showing a breakeven position at year end.  The position before recharges to services was an underspend of £118k.  This was made up of an underspend on staffing, mainly due to staff vacancies which were held prior to the introduction of the new staffing structure in the Protection and Policy section.  The underspend meant that there had been a reduced internal recharge to Children’s and Adult Services of £118k. 

 

Areas of savings had been identified this year which were £293k over the required target.  This could be used to offset the overspends identified above and a balanced budget was currently projected for the year end.  A major issue which would affect the service between now and the end of the financial year was the impact of winter pressures.  This could not be quantified but would be closely monitored and reported to future meetings.

 

Appendix 2 to the report detailed financial progress on the Capital Programme as at 31st December 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 as part of the overall financial monitoring report for the Directorate.

 

In view of the comments regarding the possible impact of winter pressures, the Chairman enquired if the winter pressures had started to impact on the service.

 

Committee were advised that it was difficult to predict, but hospital admissions had escalated in the past fortnight.  The Directorate’s spare capacity was being utilised and it was possible the Directorate would experience a difficult few weeks.  Whilst the Directorate built in certain contingencies, the Directorate had also improved its response times and increased the number of care hours available. 

 

The Directorate was regularly reporting to the Welsh Government on how it was coping with the pressures but had not reached the stage where it was not possible to meet demand.

 

Furthermore, there were fewer cases of Delayed Transfer of Care outstanding at present.

 

A Member, in referring to the underspend on staffing resources in Adult Services enquired if the Council was operating 'under safe guidelines' and was advised that the situation was under control.  Vacancies could be for a number of reasons such as delays in filling posts.  Whilst the figure contained in the report seemed large, it was part of a very large budget. 

 

The Chairman referred to the overspends in the Looked After Children budget and was advised that the Foster Carer Strategy was to reduce the use of Independent Fostering Agencies and to reduce the number of residential placements. 

 

There was an approved annual saving of £150k for the next three years for LAC Residential Placements. 

 

RECOMMENDED –

 

(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 in delivering the Social Services Budget Programme be noted and referred to Cabinet for information.

 

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 Members are aware of the progress made to date on the Social Services Budget Programme.

 

 

816     SEWIC ADULT BROKERAGE HUB (DSS) –

 

Committee were updated regarding the work of the regional adult placement procurement hub established by the South East Wales Improvement Collaborative (SEWIC).

 

SEWIC was formed by the Leaders and Chief Executives in each local authority supported by ten Directors of Social Services (Vale of Glamorgan, Bridgend, Cardiff, RCT, Merthyr Tydfil, Blaenau Gwent, Caerphilly, Torfaen, Newport and Monmouthshire).  Through SEWIC, work was being undertaken to improve the provision and commissioning of social services in the region.

 

One of the improvement projects managed through the Collaborative was the Adult Brokerage Services.  The regional 'high cost / low volume' adult procurement hub was established to provide direct intervention in the social care market and to rationalise new placement procurement activity across the region, thereby ensuring transparency of costs, better matching of needs and placements and increasing placement choice for service users.  The service was used mainly for individual placements that cost of £600 per week for clients with a Learning or Physical Disability.

 

The aims and expected outcomes of this collaborative arrangement were developed by the SEWIC Programme Board and later confirmed via an independent review:

  • To develop a single, streamlined point of access for placement choice and fee negotiation – changing culture and practice in local authorities / health boards
  • To develop a thorough understanding of provider costs for existing and new placements
  • To achieve better outcomes for individuals
  • To gather information and intelligence to influence local and regional commissioning
  • To develop a greater understanding of the local and regional provider markets
  • To reduce the workload of social workers / local authority / health boards’ commissioning units for high cost placements.

The Adult Brokerage Service went live in June 2012.  Since that time, it had received 151 referrals, 11 of them from this Council. 

 

The use of a regional brokerage service and the commissioning intelligence that this generated had enabled commissioners in SEWIC to identify a series of service user needs that were not being met comprehensively or locally in all cases.  The service gaps included:

  • Respite care – especially for adults with a physical disability
  • Specialist substance misuse services
  • Services for individuals with Korsakoff’s Syndrome
  • Specialist services regarding Autistic Spectrum Disorder
  • Services for those with multiple / complex needs.

Work was now ongoing to identify the level of shortfall regarding these services.  If the volume of demand was sufficient, work would be undertaken to consider the feasibility of commissioning these services on a regular basis to ensure a local provision for individuals within the SEWIC areas.

 

The collaborative arrangement had developed positive and productive working relationships and dialogue with a wide range of accommodation services, care and support providers.  The aim of the work had been to gauge the appetite of all stakeholders to engage in developing local, cost effective and flexible specialist services as an alternative to the current provision, which was often located far from the service users’ home and did not always represent value for money.

 

To progress this work, the proposed work programme for the Adults Brokerage Service for 2014/15 was:

  • Align Telecare, Accommodation and Adult Brokerage Service work streams to ensure that both accommodation and care were considered together
  • Continue and conclude the programme of regional / national fee negotiations with large care providers
  • Build on market engagement initiatives with Registered Social Landlords and care providers – there were now examples of providers changing practice in response to regional market engagement initiatives and these would require further encouragement and support
  • Explore potential options for regional and sub-regional commissioning for specialist services and make recommendations to the SEWIC Programme Board
  • Research new and novel service responses that support independence and move-on
  • Analyse new ways to 'incentivise' providers to provide alternatives to 'full occupancy' model
  • Work with local authorities to produce regional Market Position Statements.

Members noted that legal advice was being provided by Cardiff Council to SEWIC. 

 

Members were advised that it was cost effective if every participating Council sought legal advice from one single Council. 

 

Furthermore, Committee were advised that SEWIC was an evolving organisation and there was a need for it to engage with Health Boards and push towards more integrated services. 

 

The issue was not just one of cost, but also one of quality.  Joint working provided advantages to all participatory bodies. 

 

Members were advised that the Vale of Glamorgan Council had needed only 11 placements over the past two years.

 

RECOMMENDED –

 

(1)       T H A T the work of the SEWIC Adult Placement Procurement Hub be noted.

 

(2)       T H A T the proposed work programme for 2014/15 be noted.

 

Reason for recommendations

 

(1)       To ensure Members had oversight of the work being undertaken to ensure that long term placements are procured in a cost effective way and meet service user needs.

 

(2)       To ensure Members are aware of the forward work programme.

 

 

817     THE VALE FAMILY INFORMATION SERVICES (DSS) –

 

Committee were updated on the work of the Vale Family Information Service (FIS) which enabled parents and families to gain access to information and advice about services that would help support them and give them a better quality of life. 

 

The Vale Family Information Service provided information and advice to parents and carers of children in the Vale of Glamorgan (as well as to professionals working with families) about the following areas:

  • Registered and unregistered childcare
  • Parent and toddler groups and activities and services for children and young people
  • Holiday play schemes and leisure activities
  • Education and health and wellbeing services
  • Family support services
  • Services supporting children with special needs
  • Services promoting the Welsh language
  • Help with childcare costs and benefits for parents
  • How to become a child minder or start a career in childcare.

The Vale FIS had achieved the National Association of Family Information Services Families First Award (October 2012).  The Vale was the sixth local authority in Wales to receive this accolade. 

 

Between October 2012 and September 2013, the FIS received the following enquiries:

  • 2,473 enquiries direct to the service
  • 28,830 page views to the FIS web pages
  • 2,001 online childcare enquiries
  • 375 online family support enquiries.

The nature of enquiries was varied, ranging from parents wanting to return to work and needing childcare and help with childcare costs and parents who were at the end of the tether, with a number of children who had special needs and wondering how to cope during the school summer holidays.  FIS would make referrals to various organisations, often helping parents or professionals from having to make numerous phone calls and perhaps getting the run around. 

 

The team also provided an outreach service.  They had introduced the FIS School Certificate, to encourage schools to promote the service to parents and they attended school parents’ sessions and new intake sessions.  Eleven schools had now achieved the certificate and four were working towards Level 2.  The scheme had been recognised as an example of good practice and was now being adopted regionally.

 

In noting that eleven schools had achieved the Certificate, Members enquired if this should be achieved by all schools, and Members were advised that this was the intention.

 

A Member expressed the view that he would wish to see an increase in play schemes operating through the medium of Welsh and was advised that the Council regularly carried out needs assessments to ensure that there is sufficient provision in all areas to meet linguistic choice.

 

FIS had been given funding to support and relaunch the Index of Children with Special and Particular Needs.  The grant was used to employ a part time Index administrator and there were now 266 children registered on the Index and receiving information regularly.

 

Members enquired as to the criteria for being placed on the Index and were advised that it was for parents to define if their children needed help, and to put their child’s name forward.

 

The Chairman suggested that Committee may wish to receive regular updates by way of an Annual Report on the Vale Family Information Service, which should be added to the work programme.  This was agreed by the Committee. 

 

RECOMMENDED –

 

(1)       T H A T the work of the Family Information Service be noted.

 

(2)       T H A T regular updates on the work of the Service be brought before future meetings of the Committee by way of an Annual Report.

 

Reason for recommendations

 

(1&2)  That Members exercise effective oversight of an important local authority function undertaken by the Social Services Directorate.

 

 

818     REGULATORY REPORTS – IMPROVEMENT TRACKING (MD) –

 

The report sought to update the Scrutiny Committee on the above matter since it was last reported to the Committee in September 2013.  The report in itself set out the summary of recommendations and proposals which were included in regulatory reports and to track implementation of improvements to address those recommendations / proposals.

 

Set out in Appendix 1 to the report was a list of all recommendations / proposals made in regulatory reports since January 2011 where recommendations / proposals had not yet been fully implemented.  This included:

  • Care and Social Services Inspectorate Wales Annual Review and Evaluation of Performance 2011-2012 (November 2012) - actions completed.
  • Care and Social Services Inspectorate Wales Review of Adult Services and Vale Community Resource Service October 2011 (February 2012) - remaining actions to be deleted as they are no longer relevant.
  • Wales Audit Office Report on Delivery of Disabled Facilities Grants (November 2011) - actions well underway.
  • Care and Social Services Inspectorate Wales Annual Review and Evaluation of Performance 2010-2011 (October 2011) - actions well underway.

The Scrutiny Committee was asked to confirm that those actions that fell within the remit of the Committee that were identified as such had been completed and if agreed to refer the matter to the Audit Committee where they would be removed from the tracking report.  Once removed these completed actions would be archived along with the minute reference to maintain a clear audit trail.

 

Recommendation / Proposal

Reason for Activity

Progress Update

CSSIW Annual review and Evaluation of Performance 2011-12 (November 2012)

4. Continue to review how service can reduce the numbers of people experiencing delayed transfers from hospital.

There has been an increase in people experiencing delayed transfers from hospital – this has been attributed the Western Vale now being included in the data as well as difficulties in the mental health older people service, where half of all delays can be accounted for.

Completed.

 

The rise in the level of delayed transfers of care from hospital for reasons involving the Council in 2012-2013 has been addressed. An integrated discharge service is now in place in addition to the recently developed Community Resource Service, both of which have had a significant positive impact on Delayed Transfers of Care.

 

In 2013/2014 the service committed to developing integrated social care and health assessment and care management teams for all adult services in partnership with the Cardiff and Vale University Health Board

 

A DToC project group has been set up to monitor the rate of DToC on an ongoing basis and to ensure appropriate actions are in place

6. Commissioning person centred services for younger adults with complex mental health problems which are age appropriate.

Younger adults with mental illness who require intensive support are being placed in residential care designed for older people. This is not in line with person centred service provision.

Completed

 

It has been agreed that the UHB will lead in the development of a commissioning strategy for adults of working age with mental health problems.

CSSIW review of Adult Services and Vale Community Resource Service October 2011 (February 2012)

5. The consistency and quality of care plans requires further improvements.

There has been an increased development of an outcome based approach, some improvements in the construction of individual care plans and greater emphasis on priority outcomes that address risk to independence and well-being. However, the consistency and quality of care plans requires more work.

Deleted

 

This recommendations is no longer relevant as new  assessment framework due to be implemented in December which will consolidate improvements already made

6. Reviews need to be effectively evidenced on case files.

Reviews are being undertaken but are not yet effectively evidenced on case files.

Deleted

 

This recommendations is no longer relevant as new  assessment framework due to be implemented in December which will consolidate improvements already made

7. Reviews need to capture information about the quality of commissioned services to better inform commissioning and procurement processes.

There have been complaints about commissioned services such as the quality of care provided by agency workers. However, other service users value the services provided. These experiences need to be recorded and used to inform further commissioning processes.

Deleted

 

This recommendations is no longer relevant as new  assessment framework due to be implemented in December which will consolidate improvements already made

CSSIW Annual Review and Evaluation of Performance 2010-2011 (October 2011)

Adult Services

9. Develop and improve reporting on the outcomes achieved for and by service users.

The Vale has begun to use an outcome focussed version of the Unified Assessment process. This should enable it to focus on the outcomes that citizens are deriving from the services they receive. The Vale needs to develop an outcome focus to contracts for services.

Deleted

 

This recommendations is no longer relevant as new  assessment framework due to be implemented in December which will consolidate improvements already made

Annual Improvement Reports

Data Quality Review (August 2013)

1.  SCC/001 – The rate of delayed transfers of care for social care reasons per 1,000

population aged 75 or over.  Minutes are generated for every monthly delayed transfer of care case meeting. These should be circulated to all parties concerned and discussed as the first agenda item at the next meeting. This will record all patients discussed and the

agreed outcomes.

The testing showed that the information recorded on the HOWIS system was incorrect and did not reflect the validated delayed transfer of care cases.

 

Completed. Duplicate systems remain in place to ensure accurate monitoring.

  

RECOMMENDED –

 

(1)       T H A T the above actions be agreed as completed.

 

(2)       T H A T the matter be referred to the Audit Committee for further consideration.

 

Reason for recommendations

 

(1&2)  In order to achieve continuous improvement of Council services.

           

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