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SCRUTINY COMMITTEE (SOCIAL CARE AND HEALTH)

 

Minutes of a meeting held on 10th March, 2014

 

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

 

 

907     APOLOGY FOR ABSENCE –

 

This was received from Councillor E. Hacker.

 

 

908     MINUTES –

 

RECOMMENDED – T H A T the minutes of the meeting held on 10th February, 2014 be approved as a correct record.

 

 

909     DECLARATIONS OF INTEREST –

 

No declarations were received.

 

 

910     REVENUE AND CAPITAL MONITORING FOR THE PERIOD 1ST APRIL 2013 TO 31ST JANUARY 2014 (DSS) –

 

Committee received a report which advised of the position in respect of revenue and capital monitoring for the period 1st April 2013 to 31st January 2014 regarding those revenue and capital budgets which formed this Committee’s remit.  The Committee also received an update on the progress made on delivering the Social Services Budget Programme. 

 

It was currently projected that the Service would outturn within target at year end. 

 

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 £498k.  Any overspend at year end would be funded in proportion to the original contributions made to the joint budget i.e. £448k (90%) Social Services and £50k (10%) Education.  In addition to the joint budget, a high cost placement provision of £1.46m was established as part of the budget setting process for 2013/14.  To date, £145k of the provision had been committed, which was in addition to expenditure incurred within the joint budget.  There were potential underspends elsewhere in Children’s Services of around £195k 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 £40k on alternative means of provision and accommodation costs required for the current cohort of children.  In addition, other areas of underspend were £50k on the legal expenses budget, £90k additional adoption income and £15k on administrative staff.  The Business Management and Innovation division was anticipated to underspend and any variance apportioned to the service areas, therefore £32k of the underspend would be allocated to Children’s Services.  It was currently anticipated that there would be a £221k overspend.

 

Adult Services – the major issue was the continuing pressure  on Community Care Packages, the Division’s most volatile budget and 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 £645k.  Actions therefore still needed to be taken to review all processes and to address this shortfall.  There were potential underspends elsewhere in Adult Services of around £493k which could be used to offset this position.  These areas were £230k following the closure of Bryneithin, £222k 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 variance would be apportioned to the service areas and therefore £80k of the underspend would be allocated to Adult Services.  This would result in a currently anticipated overspend of £72k.

 

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 £112k.  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 structures in the Protection and Policy section.  This underspend has meant that there had been a reduced internal recharge to Children’s and Adult Services of £112k. 

 

Areas of savings had been identified this year which were £293k over the required target.  This could be used to offset the overspend identified above and a balanced budget was currently projected for year end.  An issue which may 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 January 2014. 

 

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.

 

Members enquired how the Directorate was coping with Winter pressures and were informed that the Directorate was dealing with an increased volume of work reasonably well, although there were financial consequences and some areas were approaching full capacity.

 

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 be 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.

 

 

911     DEMENTIA 3 YEAR PLAN (DSS) –

 

Dr. Suzanne Wood, Consultant in Public Health Medicine, was present for this item.  Committee were informed of the development of a Dementia 3 Year Plan for the Vale of Glamorgan and Cardiff, with the assistance of a PowerPoint display.. 

 

A copy of the draft Cardiff and Vale Dementia 3 Year Plan was attached at Appendix 1 to the report.  It had been developed for people with dementia and their carers, to help them live as well as possible with the consequences of the illness.  The Plan was the outcome of close co-operation between the Vale of Glamorgan Council, the Cardiff and Vale UHB, Cardiff Council and Third Sector partners. 

 

Much work had been done both nationally and locally to improve services for people with dementia and their carers.  However, gaps remained and there was a need to plan for the predicted increase in demand for services across health, social care and the Third Sector.  Estimates showed that across the Vale of Glamorgan and Cardiff the numbers of people with dementia related illnesses would increase by 54% between 2012 and 2030.  The increase would be larger in the Vale of Glamorgan due to the anticipated larger increase in the size of the elderly population.

 

A wide range of services were available specifically for people with dementia and their carers.  These were provide by statutory agencies (the Memory Team, Mental Health Services for Older People, Community Resource Teams, day services), the independent sector (residential and domiciliary care) and the Third Sector (Alzheimer’s Society, Age Connects, Crossroads Care in the Vale, etc.). 

 

In order to support as well as possible people with dementia and their carers, the environment in which they live needed to be inclusive and dementia-aware.  One way of doing this was to a 'dementia supportive community'.  This was defined by the Alzheimer’s Society as: 'one in which people with dementia are empowered to have high aspirations and feel confident, knowing they can contribute and participate in activities that are meaningful to them'.  It was planned that pilots for two such communities would take place, one in Barry and one in Cardiff West, prior to further roll out across the Vale and Cardiff.  This would build upon the work being done nationally through Dementia Vision to ensure that the public had a better understanding of dementia.

 

Diagnosing people with dementia in a timely fashion was critical in ensuring that treatment and support was given in the earlier stages of the illness.. This could enable people to be cared for at home for longer, especially as earlier diagnosis could help to link carers into informal support networks and into organisations that provided advice and guidance, as well as ensuring that they received an assessment in their own right.  The Memory Team provided a diagnostic and early support service for people with suspected dementia.  Later in the illness, the person may need access to Mental Health Services for Older People or other local authority social services for additional care and support and advice.  Much everyday care and support could be given by NHS primary care staff, independent providers and a variety of Third Sector organisations. 

 

Services also needed to be shaped around the needs of people whose dementia affected them at a younger age (under 65).  The younger onset community dementia service was nearing completion, and the inpatient unit was being established in Barry Hospital.  However, further consideration was being given to developing 'accommodation with care' models to allow the Council and the UHB to commission jointly different forms of supported living for people with young onset dementia.

 

Members enquired how dementia sufferers could be treated with respect when their carers had so little contact time, and were advised that this was a difficult issue.  A Care Plan was produced for all clients, and the challenge was to provide that level of care within the overall package.  It was felt that over provision could create levels of dependency on the part of the client.

 

A Member enquired as to the usefulness of Telecare in assisting dementia sufferers to lead as fulfilled a life as possible and Dr. Wood said there was an intention to produce a Telecare Strategy.  Scoping work was to be undertaken with both Councils to see where increased use of Telecare would be most beneficial – this would be a significant piece of work.

 

A further Member made a plea for Councillors, including Town / Community Councillors, to be involved in dementia awareness training. 

 

RECOMMENDED –

 

(1)       T H A T the contents of the report and the draft Dementia 3 Year Plan be noted.

 

(2)       T H A T the progress made in planning across agencies and organisations how to improve care and support services for people with dementia and related illnesses be noted.

 

(3)       T H A T Members of the Council and Town / Community Councils be encouraged to attend dementia awareness training.

 

Reasons for recommendations

 

(1)       To ensure that Scrutiny Committee is aware that a three year plan for dementia services was being developed.

 

(2)       To ensure that Scrutiny Committee notes the progress that has been made in developing this plan by means of collaborative working and listening to the voice of people who have dementia and their families.

 

(3)       To ensure Members of Scrutiny Committee have an opportunity to influence the contents of the Dementia 3 Year Plan. 

 

 

912     IMPROVEMENT PLAN PART 1 (IMPROVEMENT OBJECTIVES 2014/15) (DSS) –

 

Endorsement of proposed improvement objectives for 2014/15 was sought from the Committee. 

 

The Corporate Plan was a key means of the Council complying with the Local Government Measure 2009, which required the Council to set “improvement objectives†annually and demonstrate continuous improvement.

 

The Corporate Plan 2013-2017 was approved by Cabinet in 25th February 2013 following extensive consultation with key stakeholders and partners.  The Plan set out a four year vision for the Council, structured around eight priority outcomes which reflected the priority outcomes in the Community Strategy 2011-2021.  These outcomes were also reflected in service plans for 2014/15 and had informed the development of service outcomes and objectives.

 

Eight improvement objectives were proposed for 2014/15 including four carried forward from 2013/14 which had been amended to reflect the areas of focus for further improvement work in 2014/15.

 

Two objectives applied specifically to this Committee, namely:

  • To increase sustainability and stability of Looked After Children and young people’s placements (Objective 2)
  • To support more people towards independence (Objective 3).

Appendix 1 to the report outlined the proposed objectives for 2014/15 and provided a rationale for each objective. 

 

Challenging targets had been set against all measures for improvement, reflecting the Council’s commitment to continuously improve the services it provided to citizens of the Vale.  At the same time, the Council was also mindful of significant financial and service demand pressures over the coming year and key targets and milestones for proposed improvement objectives had been set within this context.

 

It was a requirement that the Council’s improvement objectives and the proposed objectives would be published on the Council’s website during March 2014 inviting comments from the public.  At the same time, other key stakeholders including the Local Service Board, town and community councils, voluntary sector organisations and local chambers of commerce would be asked for their views.  Proposals would be made to Cabinet based on the findings of the consultation.

 

RECOMMENDED – T H A T the proposed improvement objectives for 2014/15 be endorsed.

 

Reasons for recommendation

 

(1)       To ensure the Council identified key annual improvement priorities for 2014/15 in line with the requirements of the Local Government (Wales) Measure 2009.

 

(2)       To ensure that improvement objectives focus specifically on those areas where there is a need for improvement, reflecting the work being undertaken across the Council to improve the quality of life for Vale residents.

 

(3)       To enable the Council to more easily demonstrate achievement of its priorities.

 

 

913     THE VALE OF GLAMORGAN AND CARDIFF INTEGRATED FAMILY SUPPORT SERVICE ANNUAL REPORT 2013/14 (DSS) –

 

Committee were requested to consider the 2013/14 Annual Report for the Vale of Glamorgan and Cardiff Integrated Family Support Service (IFSS) prior to its submission to the Welsh Government.

 

The IFSS programme was intended to provide more holistic support to families by breaking down boundaries between local government and health, between adult services and children’s services.  It was delivered by a combination of highly skilled professionals from social care and health, acting as a single workforce.

 

Under the Children and Families (Wales)  Measure 2010, local authorities and the NHS had a joint statutory responsibility for ensuring delivery of an IFSS in their area.  In July 2011, a consortium involving the Vale of Glamorgan and Cardiff Councils and the Cardiff and Vale University Health Board made a successful bid to the Welsh Government to become one of two areas in Wales chosen to implement an IFSS under Phase II of the national programme. 

 

The IFSS had been operational since the end of February 2012 and had five principal functions:

  • Undertaking intensive direct work with families through the application of time-limited, family focused interventions
  • Providing advice and consultancy to practitioners and agencies on engaging complex families with parental substance misuse
  • Working jointly with the case managers and others to ensure that the family can gain access to the services they need
  • Spot-purchasing services not otherwise available
  • Providing training on evidence-based interventions for the wider workforce.

Section 64 of the Children and Families (Wales) Measure 2010 required an annual report on the effectiveness of the IFSS to be submitted to Welsh Government.  The report for 2013/14 was attached at Appendix 1 to the report and had been approved by the IFSS Management Board. 

 

The annual report summarises:

  • Key achievements and outcomes
  • Effective partnership working
  • Challenges faced by the service
  • Priorities for 2014/15.

The report demonstrated that the IFSS was meeting expectations in terms of numbers of families receiving help and the outcomes achieved.  It outlined the robust system of data collection and analysis in place to demonstrate how families were referred and prioritised for support and the impact upon key areas of wellbeing such as education, parenting, relationships, alcohol or drug cessation.  This was complemented by qualitative evaluation through service user and referrer feedback.  The results demonstrated that IFSS was taking a lead role in strengthening services to support some of the most disadvantaged children, those who were in need or at risk because of parental alcohol or drug dependence.

 

The main priorities for the year ahead would be to increase the number of referrals and aim towards a target of 100 families and to train the wider workforce in the IFSS model of intervention using Motivational Interviewing, Solution Focused and other cognitive behaviour techniques.  At a local level, there were plans to strengthen the maintenance phase following the IFST intensive intervention.  In addition, the IFSS Board would continue to plan the structure and pattern of future service delivery and identify funding for the medium to long term.

 

The Welsh Government’s ten year strategy for Social Services included a commitment to a career pathway and ongoing qualification requirements for Social Workers, thereby enhancing professionalism and promoting high quality services. 

 

The Consultant Social Worker role within the IFSS was already showing that specialist and evidence-based social work intervention (as part of planned, systematic multi agency involvement in the lives of families) could have considerable impact and deliver better outcomes.

 

RECOMMENDED –

 

(1)       T H A T the contents of the Integrated Family Support Service Annual Report for 2013/14 be noted.

 

(2)       T H A T the work being undertaken to provide intensive support to families, especially those where children were adversely affected by parental alcohol or drug dependence, be endorsed.

 

Reason for recommendations

 

(1&2)  To ensure that the Council’s statutory functions in relation to providing an Integrated Family Support Service were fully met in accordance with Welsh Government guidance.

 

 

914     SOCIAL SERVICES QUARTERLY PERFORMANCE: QUARTER 3 (DSS) –

 

The Business Management and Innovation Team, Adult Services and Children and Young People’s Services Third Quarter Performance Monitoring Reports were presented for the Committee’s consideration.

 

RECOMMENDED – T H A T the Third Quarter Performance Monitoring reports be noted.

 

Reason for recommendation

 

In order for the Committee to exercise effective scrutiny of the services.

 

 

915     PROTECTION OF CHILDREN: UPDATE REPORT (DSS) –

 

Committee were advised of the work of the Social Services Directorate in protecting children during the period April to December 2013. 

 

The report addressed the following issues:

  • The number of child protection referrals received and the number of those that progressed to investigation
  • The number of child protection conferences held and the number of conferences held within timescale
  • Any child protection issues that had arisen through the audit process
  • The current position on the merger of the Vale of Glamorgan and Cardiff Local Safeguarding Children Boards
  • The number of Strategy Meetings held under Part 4 of the All Wales Child Protection Procedures 2008 concerning allegations of professional abuse and a summary of the outcomes of those
  • Consultation with children and families who have been involved in the child protection process.

The report demonstrated that the statutory safeguarding responsibilities of the Social Services Directorate on behalf of the Council were being fulfilled to a high standard. 

 

All referrals to Children and Young People Services were received by the Intake and Family Support Team.  A decision on their appropriateness, priority and subsequent management should be made within 24 hours.  The latest (third quarter) performance in respect of this screening process was above target at 96.32%. 

 

Between April and December 2013, 805 referrals were received by the Division.  Of these, 443 progressed to a strategy meeting and / or investigation under Section 57 of the Children Act 1989.  The number of cases which resulted in a referral being made for a child protection conference where the referral reason was 'possible child abuse' was 42, a core assessment was undertaken in all these cases.

 

The overall number of child protection conferences held between April and December 2013 was 201.  199 of these were held within the statutory timescale. 

 

Part 4 of the All Wales Child Protection Procedures provided the framework of actions to be taken when there were child protection concerns in specific circumstances.  Between April and December 2013 there were a total of 24 referrals which met the threshold for consideration under Section 4.3 which concerned allegations of the abuse of children by professionals / staff members. 

 

20 had been concluded, 3 were awaiting the outcome of Police investigations and one the outcomes of disciplinary procedures.  The outcome of these 20 was as detailed below:

 

Dismissal, deregistration, loss of licence (notified to DBS and professional / regulatory body)

Unsubstantiated

Retracted

Additional training for staff and changes to Policy and Procedures

Disciplinary / capability procedures initiated by employer

5

5

4

4

2

 

The Vale of Glamorgan procedural audit process for Social Services was well established and included auditing child protection processes  The issues identified during the most recent audit included the need to revise the format for recording the initial and ongoing core group meetings that followed child protection registration, and ensuring that statutory visits to children on the child protection register and the associated records of the visit were recorded on the electronic case management system in a timely way following the visit.

 

The Local Safeguarding Children’s Board also had a programme of audit which examined the effectiveness of all agencies working together under the All Wales Child Protection Procedures.  The Audit Sub-Group of the Cardiff and Vale of Glamorgan LSCB was currently auditing the cases of children whose names had remained on the child protection register for longer than 18 months. 

 

The programme for the merger of the Cardiff and Vale of Glamorgan LSCBs was now concluded.  The constitution and governance arrangements were approved by both Councils in September 2013.  The Board was currently chaired by the Director of Social Services from the Vale of Glamorgan.  The make-up of the standing sub-groups of the Joint Board had been agreed in line with Welsh Government guidance, and the terms of reference for each sub-group had been harmonised between the two preceding Boards and approved by the Joint Executive Board.  Agreement had now been reached on membership and representation at each level of the Board structure. 

 

A process of consultation with children and families involved in the child protection process was underway.  This was a very sensitive area of work and, despite efforts to engage with young people and families, there had been only two respondents to date.  The consultation would continue and action taken to tackle the low take-up.

 

RECOMMENDED –

 

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

 

(2)       T H A T intormation about the work undertaken to protect children continues to be reported to this Scrutiny Committee on a six monthly basis.

 

Reasons for recommendations

 

(1)       To increase awareness of the priorities, challenges and risks involved in this crucial area of work.

 

(2)       To ensure effective scrutiny of a key function undertaken by Social Services on behalf of the Council.

 

 

916     THE VALE OF GLAMORGAN SOCIAL SERVICES DIRECTORATE SERVICE PLAN 2014/18 (DSS) –

 

Service Plans for the following services were presented:

 

-               Adult Services

-               Business Management and Innovation

-               Children and Young People’s Services.

 

The Service Plan was a key component of the Council’s planning framework.  It supported the delivery of the day to day business activities of the Council, its Corporate Plan 2013-17 and, ultimately, an overarching Community Strategy. 

 

As part of his statutory duties, the Director of Social Services was required by the Welsh Government to produce an annual report on the effectiveness of social care services in the Vale of Glamorgan and on plans for improvement.  This took into account other key documents namely the Social Services Budget Programme and recommendations from the Care and Social Services Inspectorate Wales Annual Review and Evaluation of Performance Process.  The Service Plan was intended to complement and not replace these planning arrangements.

 

The Service Plan provided a four year overview of the Directorate’s work and set out how it contributed towards achieving the key outcomes and objectives as outlined in the Corporate Plan.  It outlined what the Directorate was trying to achieve, why this was important, how it would be achieved, how we would monitor progress and what success would look like. Each year, the Plan would be reviewed and updated, ensuring it demonstrated continuous improvement. 

 

The actions within the Service Plan would inform Team Plans and personal development objectives for individual members of staff via the Personal Development and Review System.  Outcomes and targets at all levels were scrutinised as part of the Council’s performance and monitoring arrangements. 

 

Having fully considered the Plan, it was

 

RECOMMENDED – T H A T the content of the Service Plans 2014-18 be noted.

 

Reason for recommendation

 

In exercising effective scrutiny of the Service Plans for the service areas.

 

 

917     TASK AND FINISH ACTIVITIES FOR 2014/15 (HDS) –

 

Committee was updated on Scrutiny reviews being undertaken and were requested to agree a process for Scrutiny Committees to consider topics for review in 2014/15. 

 

The Scrutiny Committee Chairmen and Vice-Chairmen Group at its meeting on 27th February 2013 gave consideration to a report for prioritising Task and Finish activities for the current Municipal Year.

 

The Scrutiny Committee Chairmen and Vice-Chairmen Group subsequently agreed its priorities for 2013/14 as follows:

 

-               Priority 1 – Traffic Management – the impact of traffic flows within the County, including reference to sustainable travel

-               Priority 2 – To be agreed following completion of Priority 1.

 

As in previous years, each Scrutiny Committee was required to recommend items to be put forward for review to the Scrutiny Committee Chairmen and Vice-Chairmen Group to prioritise.  In order to assist the process, Committees were asked to limit the number of such items to two per Committee.

 

It was suggested that Committees consider items that had been highlighted resulting from the number of surveys and questionnaires that had already been undertaken with the public, by the Council. 

 

Committee also noted that any member of the public could request that an item be considered by a Scrutiny Committee by completing a Scrutiny Review Topics Suggestion Form, which was available on the Council’s website and / or from the Democratic and Scrutiny Services Section. 

 

Having considered all options available, it was

 

RECOMMENDED –

 

(1)       T H A T the update on Scrutiny reviews be noted.

 

(2)       T H A T the process for considering reviews in 2014/15 as contained within the report and as previously endorsed by the Scrutiny Committee Chairmen and Vice-Chairmen Group, be agreed.

 

(3)       T H A T the review to be submitted for consideration on behalf of the Scrutiny Committee (Social Care and Health) be as follows:

  • An examination of the potential contribution assistive technology can provide in the development of a dementia supportive community in the Vale of Glamorgan through enabling people to live independently.

 

Reason for recommendations

 

(1-3)    In recognition of the role of Scrutiny and to facilitate Scrutiny Committee work programmes as outlined in the Council’s Constitution.