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SCRUTINY COMMITTEE (SOCIAL CARE AND HEALTH)

 

Minutes of a meeting held on 19th May, 2014

 

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

 

Also present: Councillors S.C. Egan and N. Moore.

 

 

17        APOLOGY FOR ABSENCE –

 

This was received from Councillor R.J. Bertin.

 

 

18        APPOINTMENT OF VICE-CHAIRMAN –

 

RECOMMENDED – T H A T Councillor Mrs. M.E.J. Birch be appointed Vice-Chairman of the Committee for the current municipal year.

 

 

19        MINUTES –

 

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

 

 

20        DECLARATIONS OF INTEREST –

 

No declarations were received.

 

 

21        THANKS –

 

The Chairman began by offering thanks to Mr. C. Hope, the Democratic and Scrutiny Services Officer for his hard work and commitment in supporting the Scrutiny Committee (Social Care and Health).  It was agreed that the Chairman should write to him.

 

 

22        PRESENTATION: NEALE-KENT WARD AT BARRY HOSPITAL – CARDIFF AND VALE UNIVERSITY HEALTH BOARD –

 

Present for this item from the Cardiff and Vale University Health Board (UHB) were Mr. Peter Landstrom, Head of Operations and Delivery; Abigail Harris, Executive Director of Planning and Dr. Joe Grey, Clinical Director. 

 

Mr. Landstrom delivered the presentation entitled "Improving our Services for Older People in Cardiff and the Vale of Glamorgan"; he began by informing Members that it was important to receive feedback and views from the Committee as part of the engagement process. 

 

It had been recognised that the population in Cardiff and the Vale of Glamorgan was changing and that the average age of people coming into hospital as in-patients was circa 85+.  Older people often had multiple health care needs placing increasing demands on all areas of health provision.  It was therefore imperative for modern, effective and efficient specialist older people’s services to be centred round the person.  It had also been recognised that older people spent too long in hospital which often resulted in a loss of independence and taking longer to recover.  There was an identified need to move away from hospital based, inpatient, long term care and to support people to maintain their independence for as long as possible. 

 

The Cardiff and Vale UHB aimed to build on the strategic themes formulated in the draft Older People’s Framework which recognised:

 

·         The central and pivotal place for older people in our services

·         The expert and focused care of the older person necessary throughout their care pathway

·         The need to develop and deliver more continuous and integrated care of older people across settings and hospitals

·         The opportunity to put older people’s care at the centre of medicine in Cardiff and the Vale

·         The creation of a clinical Gerontology Directorate in August 2013.

 

Mr. Landstrom, alluded to the current service challenges facing the Cardiff and Vale UHB:

 

(i)        Separated and isolated sites, impacting upon the provision of joined up comprehensive care

(ii)       Services operating out of poor quality and isolated buildings (Rookwood / West Wing)

(iii)      Difficulty in caring for patients who become unwell whilst receiving rehabilitation support due to limited out of hours medical cover and medical staff covering multiple sites

(iv)      Systems under stress through a stretched nursing and therapies staffing resources to support effective multi-disciplinary team working

(v)       Hospital based services not set up in the right way at the moment – and an inability to deliver integrated care across the whole patient journey.

 

In identifying the fragmentation of configured services it had been recognised that the first steps were to change services in order to provide increased and co-located specialist care for older people on a smaller number of sites in an improved environment, that medical cover in and out of hours needed to be improved and that resources focused on rehabilitation and early and consistent input into patients’ entry pathways be increased.  There was a need to balance day services with the potential to increase Elderly Care Assessment Service (ECAS), to support the move away from traditional long stay community hospital models. 

 

What could change?

 

·         Increase specialist input at the first point of entry into all acute services (equity across Cardiff and the Vale)

          -     Establish a Frail Older Persons Advice and Liaison (FOPAL) Service at Llandough

·         Expert presence on both acute sites providing complex frail expertise and rehabilitation whilst patients are acutely medically unwell

          -     Transfer wards to Gerontology at the Heath and Llandough

·         Create a single specialist hub for Medical, Stroke and Orthopaedic Rehabilitation, with improved medical cover

          -     Transfer Rookwood W6 and West Wing MRU

          -     Increase Medical Rehabilitation in-patient capacity

          -     Transfer West Wing ORU

·         Align our services under one Clinical team wherever possible

          -     Transfer all Stroke services to a single team

          -     Transfer all Orthopaedic care to a single team

·         Provide Complex Frail Care and Comprehensive Geriatric Assessment (CGA) services from St. David’s and Barry Hospitals only

          -     Decrease the overall bed base for CGA / Frail Care

          -     Close Elizabeth and Neale and Kent wards and increase St. David’s capacity

·         Balance Day Hospital capacity across three sites

          -     Transfer Rookwood Day Hospital to St. David’s

          -     Increase Barry Day Hospital Capacity

·         Potential to consolidate and increase ECAS services

          -     Consider option to transfer ECAS to Llandough hub increasing to 10 sessions per week and increasing new patient capacity

·         Ensure fit for purpose MDT input into Gerontology Patients throughout the system

          -     "Reinvest" released staffing resources to support improved medical cover in, support increasing ward nursing levels and therapy resources

          -     Ensure when older people need acute care they get the same service whether admitted in the Heath or Llandough

          -     Ensure we are focussing resources on Rehabilitation and putting the experts around the patient not moving patients between services / sites

          -     Start to make changes that support the aims of the Older Person’s Framework and meet the needs of our patients.

 

Reference was made as to how the proposals would start to improve the level of care for patients.  To begin with older people who require hospital care should receive the same expert input throughout their pathways, regardless of where they accessed the care.  Increased rehabilitation focus and capacity, and the concentration of resources, would make sure that older people would be supported to return to the community and live as independently as possible.  It would be possible to deliver an improved patient experience when in hospital by no longer providing services from poor quality and / or isolated locations.  Co-locating services would ensure that there was a more flexible and robust medical cover that would remove the need to transfer patients between sites if they became ill. 

 

In concluding the presentation, Mr. Landstrom asked Committee Members to help the engagement process by considering these three key questions:

 

1.         Do you think we have missed anything in our vision for older people’s hospital services?

 

2.         Are there any things that you believe need to be taken into account or that we might have missed when assessing the impact of these ideas?

 

3.         Are there other changes to our Specialist Gerontology services you think would further help us to achieve the desired outcomes, either immediately or in the longer term?

 

Members were advised that answers and feedback for these questions were not needed now and that all the details were shown on the Cardiff and Vale UHB’s website and that feedback could be received in an informal and formal way.  Mr. Landstrom thanked the Committee for the opportunity to deliver the presentation and to be able to outline the Cardiff and Vale UHB’s plans and proposed developments. 

 

In alluding to the current progress made in respect of the engagement process, an Elected Member asked the representatives from the Cardiff and Vale UHB to summarise the plans for Barry Hospital and comment upon the affect upon people within the Vale of Glamorgan as services are relocated closer to the Cardiff area.  In reply, Ms. Harris advised the Committee that the proposals set out by Mr. Landstrom were only a small part of a much larger jigsaw that feeds into the Older People’s Framework.  As such, the plans set out proposals for greater and wider range of services to be provided at Llandough rather than at the University Hospital of Wales.  Part of these plans also included the improvement to the bus provision to the hospital in Llandough.  In reference to Barry Hospital she commented on the important part Barry Hospital has in providing services.  The Community Resource Team (CRT) at Barry Hospital was an important development and the Ear Nose and Throat (ENT) Unit had recently moved to Barry Hospital; these were some examples following integration of the commitment to keep important services and activities within Barry. 

 

Further to these points, Mr. Landstrom, commented that discussion with staff was a very important aspect of the engagement and consultation process.  The Cardiff and Vale UHB fully recognised the need to take into account all views and opinions in respect of plans to remodel service delivery.  He also advised Members of the relatively low number of admissions into Barry Hospital from local residents and, in many cases, there was a need for people to be transported between hospitals for specific services and that under the plans outlined people would receive care closer to their homes.  For example, an increased day hospital provision would help rebalance the service. 

 

In commenting upon the changes to Barry Hospital, the Clinical Director, Dr. Grey, advised the Committee that the Cardiff and Vale UHB wanted to see more equity in the location of services.  It was important for patients to receive the right treatment at the right time, particularly at the start of their journey.  Rehabilitation was a key element in ensuring a person’s independence but this input went hand in hand with medical and clinical support. 

 

A Member, in agreement with the creation of Centres for Excellence, made reference to discussions with local constituents who had advised that, in their opinion, the level of engagement by the Cardiff and Vale UHB about changes to Llandough had been minimal.  Llandough should be seen as more than just a hospital and it was important to understand and take on board comments from local people.  The Committee Member thought it was advisable for the plans and proposals to consider wide ranging issues other than clinical aspects, such as road access and transport links.

 

The Chairman enquired with the Cardiff and Vale UHB representatives whether there would be any increased costs for the Vale of Glamorgan Council following these proposals, given the shift from some people receiving in-patient treatment within their community based hospital to receiving help at home or in residential settings. 

 

In response, Ms. Harris advised that under the present system patients were continually shunted from one clinical site to another.  It was not the aim of the review to close Barry Hospital but to ensure resources are used properly in order to ensure that people get well as soon as possible.  People stay in hospital for far too long and that the provision for community based hospitals would still exist, but there was a need to balance service demand. 

 

Mr. Landstrom commented that there may be different clinical / medical activity rates and the Cardiff and Vale UHB would therefore plan with service providers in local areas where patients live.  The current plan was linked to the Older People’s Framework, with the main focus being the appropriateness of the care people receive at the right time.  As a result the Cardiff and Vale UHB did not envision any additional costs but there would not be the need for the same level of local hospital in-patient provision and they would create better links between the CRT, GPs and Social Services that should ultimately make patients better off. 

 

The Committee were further advised that there should be benefits for people who enter the care system in the future and for those who should receive their care under the new and improved Older People’s Services.  At this point the Director of Social Services stressed the importance for rigorous and detailed assessments being carried out when in-patients are moved as a result of ward closures, as happens in residential care so that individual and family concerns are addressed.  He felt it was vital for all parties to agree collectively so that the right decisions are made to meet the needs of the client.

 

In response to a Member’s query regarding timescales and the closure of wards and how the plans are to be future-proofed, the Committee was advised that the current timetable indicates that the engagement process would be concluded by the end of May.  Following this the Community Health Council would meet on 3rd June to discuss the relevant options but there may be further need for more consultation depending on the Health Board’s final decision.  Once the decision to progress has been made it is perceived that changes would be implemented before the winter months in order not to put elderly people through unnecessary disruption during the winter period.  In respect of future-proofing plans the Cardiff and Vale UHB representatives commented that this was a big challenge due to the changing population and aging profile of patients, however if changes are not made then they would be back here in one to two years’ time discussing further and more drastic changes. 

 

In closing the debate the Chairman noted the high importance of this issue and that the Committee was concerned with the possibility of additional costs being incurred by the Council following the implementation of the plans.  It was therefore agreed that the contents be referred to Cabinet for consideration. 

 

RECOMMENDED – T H A T the contents of the presentation and the accompanying consultation document be forwarded to Cabinet in view of the potential for increased costs to the Council.

 

Reason for recommendation

 

For Cabinet to consider the proposals outlined by the Cardiff and Vale UHB in respect of changes to the older people’s services in view of the potential for increased costs to the Council. 

 

 

23        DISABLED FACILITIES GRANT PERFORMANCE 2013-2014 QUARTERS 2 AND 3 (REF) –

 

The Committee Members were advised on the Council’s performance delivering Disabled Facilities Grant (DFG) in Quarters 2 and 3 of 2013-14. 

 

The quarterly report for the DFG service performance for Quarter 2, 2013-14 was attached at Appendix 1 and the quarterly report for the DFG service performance for Quarter 3 2013-14 was attached at Appendix 2.

 

The overall DFG performance was within local targets but as indicated in Appendix 1 total time to deliver a DFG for children and therefore the total time to deliver all DFGs increased in Quarter 2.

 

The decrease in performance was down to two DFG applications in respect of children exceeding 700 days in their delivery from first point of contact to completion. 

 

Case 1 - Total delivery time 700 days

·         Issue 1: The client first contacted the Council requesting assistance on 25th October 2011.  The Occupational Therapist (OT) assessment was carried on 28th August 2012, and the DFG team did not receive the initial OT’s recommendation until 20th December 2012.  This equated to 422 days of the total delivery time.

 

Action – Adaptations for children to be prioritised.  If the child was not already a client of the OT service, the request for an assessment was now passed to the OT within the DFG service without delay.

 

·         Issue 2: On 9th January 2013 a survey was carried out and the applicant requested additional work which lay outside the original OT assessment.  On 11th January 2013 the surveyor requested additional information from the OT with regards to the applicant's request.  It was not until 28th March 2013 that the OT response was received following their investigation into the extra work request.  This investigation by the OT involved obtaining further information from Health Colleagues about the need for the work.  The request for the extra work was not supported and no amendment was made to the original assessment.  Schedule of works and plans for the grant could not be finalised until this request for additional work was confirmed or refused.

 

Action: The OT employed within the DFG team would reduce the time delay in seeking clarification over assessments.  However, in some cases the OT who carried out the original assessment would still be required to be consulted.

 

·         Issue 3: Once on site the builder did not complete work to the correct standard required.  The builder was required to carry out remedial work at his cost.  In addition, the applicant requested further work which on this occasion was supported by the OT.  This required a specialist company to be used.  As this work had not been undertaken previously this resulted in a delay whilst suppliers were identified.  This equated to 209 days in the total delivery time.

 

Action: The DFG team was now aware of specialist contractors providing specific services and products so delays can be avoided in sourcing for future cases.

 

Case 2 - Total delivery time 741 days

·         Issue 1: The client first contacted the Council requesting assistance on 24th August 2011.  The OT assessment was carried out on 13th June 2012, and the DFG team received the initial OT’s recommendation on 8th August 2012, once research into appropriate adaptations had been carried out by the OT.  This equated to 350 days in the total delivery time.

 

Action – Again, as above, the children’s OT assessments for adaptations were now prioritised and forwarded to the DFG Team OT without delay.

 

·         Issue 2: Following the survey of the property plans and a specification were developed before an asbestos survey was requested.  This extended the application process.

 

Action – Asbestos surveys were now commissioned earlier in the process and undertaken while the schedule of works and plans were produced to reduce the delivery time.

 

·         Issue 3: Once on site there were delays in the main contractor completing their work.  This had the knock-on effect of delaying the specialist flooring contractor completing their work, who in turn requested renegotiation of the tender price and the contract period.  This request was refused and resulted in the specialist contractor withdrawing from the grant which triggered the need to source another specialist contractor for the specialist play flooring. This equated to 246 days in the total delivery time.

 

Action: As with Case 1, additional specialist contractors have been identified to avoid future delays.

 

The Chairman noted the importance for the Committee to see the improved performance in relation to the DFG delivery time. 

 

A Committee Member, in referring to the 97% of clients that felt the adaptation made it easier to live at home or independently enquired as to why this was not 100%.  In response the Principal Housing and Pollution Officer advised the Committee that this was as a result of one client whose initial DFG adaptation did not meet his/her expectations or need.  There had subsequently been a second DFG undertaken and that client had since indicated that he/she was satisfied with the adaptation provided. 

 

In terms of being able to draw comparisons between the current performance levels to future performance rates, the Principal Housing and Pollution Officer advised Members that the Council will continue to report DFG performance on an accumulative basis and that the Council was in a much better position. A permanent Occupational Therapist (OT) employed directly by Public Protection started in November 2013 and that the waiting times for an OT assessment had reduced from three months in August 2013 to the current rate of 8-9 weeks.

 

A Committee Member asked what was the most significant factor causing delays in the DFG process.  The Principal Housing and Pollution Officer advised Members that the issues in regard to the conducting of OT assessments had been tackled along with the issues associated with the tender process.  The process was now far less rigid with more overlapping of stages resulting in a more seamless system. 

 

Having considered the contents of the report the Committee subsequently

 

RECOMMENDED – T H A T the performance for delivering Disabled Facilities Grant in Quarters 2 and 3 of 2013-14 be noted.

 

Reason for recommendation

 

To advise Committee Members of the Council’s performance in delivering Disabled Facilities Grant in Quarters 2 and 3 of 2013-14.

 

 

24        CORPORATE SAFEGUARDING (REF) –

 

Cabinet, on 7th April 2014, received a report the purpose of which was to update Members on the work undertaken to improve corporate arrangements for safeguarding and protecting children and young people, the effectiveness of the Safer Recruitment Policy and recent changes to the Disclosure and Barring Service (DBS).  Cabinet had referred the report to the Scrutiny Committee for information. 

 

In 2011, the CSSIW and Estyn published a report following their joint investigation into the handling and management of allegations of professional abuse and the arrangements for safeguarding and protecting children in education services in Pembrokeshire County Council.  Concerns were raised about the quality of corporate working to safeguard and protect children by the local authority.

 

Following that report, a Corporate Safeguarding Working Group was established in this Authority to learn lessons from the Pembrokeshire report and to ensure that arrangements for protecting children and young people in the Vale were robust.  The group produced an action plan to improve safeguarding across the Council (attached at Appendix A to the report|) and Cabinet agreed a Safer Recruitment Policy for the Council and Schools (January 2013).

 

The Corporate Safeguarding Group continues to monitor the safeguarding arrangements within the Local Authority, including recruitment within the Council and schools.  Monitoring of the Safer Recruitment Policy in respect of new and existing employees is undertaken by TransAct and Human Resources on a scheduled basis and by Internal Audit as part of their ongoing audit programme.

 

With reference to improvements needed, particularly in some schools to achieve complete compliance with the requirements of the Policy, the Chairman of the Committee queried if officers were content with the current arrangements.  In response the Director of Social Services advised Members that schools had been given a period of time to adopt the Policy to fit with the cycle of governor’s meetings.  100% compliance should be achieved in all cases and individual responsibility lay with the Headteacher of each school. 

 

A Committee Member queried if the DBS system would work better than the CRB approach and had the DBS update service made a difference.  The Director of Social Services informed Members that the DBS system relied on Police records which held information about criminal convictions and police intelligence; rigorous use of DBS checks and other safeguards did help to deter unsuitable people from obtaining jobs which give them access to vulnerable groups including children. 

 

RECOMMENDED – T H A T the work that has been undertaken to improve corporate arrangements for safeguarding and protecting children and young people and changes to the administration of DBS be noted.

 

Reason for recommendation

 

To ensure that the Council and its schools adopt good practice in their arrangements for safeguarding and protecting children and young people, including procedures for carrying out safeguarding checks on works, volunteers, agency staff and contractors with unsupervised access to children and vulnerable people.

 

 

25        SETTING A STANDARD CONTRACTING RATE FOR PLACES IN INDEPENDENT RESIDENTIAL CARE HOMES FOR OLDER PEOPLE (DSS) –

 

The Head of Business Management and Innovation presented a report, the purpose of which was to update Members on the work undertaken to set a standard contracting rate for places in independent residential care homes for older people. 

 

Setting a standard contracting rate for places in independent residential care homes for older people was a complex issue.  With the assistance of external experts, the Council adopted in 2007 a robust methodology for use when determining annually the fees payable to independent providers of residential care for older people.  The toolkit took into account the actual costs incurred for delivering care. 

 

Statutory guidance on commissioning social services was provided by Welsh Government, setting out the responsibilities of local authorities in this area of work.  The Commissioning Framework Guidance and Good Practice was issued under section 7(1) of the Local Authority Social Services Act 1970.  The Framework has two parts.  Part 1 contained 13 standards; these provided the benchmark against which the effectiveness of local authority commissioning activity can be measured.  Standard 9 states that "Contracted social care services offer value for money and are fit for purpose".  Standard 10 states that "Commissioners have understood the costs of directly provided services and have acted in a way to promote sustainability".  It makes clear that the local authority "will have to take into account the full range of demands on them and their strategic priorities, as well as the resources they have at their disposal in developing their commissioning strategies".  This guidance had been an integral part of the ongoing work to establish a fair price for independent sector residential care homes placements on an annual basis. 

 

The Council had worked closely with the independent care sector to consider the cost of providing residential care for older people in the Vale of Glamorgan.  When the fees were set for 2013/14, officers were requested to continue meeting with representatives of the sector to establish whether it might be possible to reach a three year agreement as a means of providing additional business certainty for both providers and the Council. 

 

The independent care home sector had been requested to supply up to date information regarding their running costs.  By October 2013, all but one of the homes had returned their data and this information had been used to inform the work with the sector.  As agreed by Cabinet, all of the care homes that provided their financial data received a 2% interim uplift in fees, which was backdated to April 2013. 

 

A small working group consisting of officers and representatives from the sector worked on the data, clarifying some anomalies.  The outcome of this work was considered by Cabinet on 28th April 2014, the report of which was attached as Appendix 1 to the report.  The table below describes the decisions agreed by Cabinet:

 

Type of Provision

Fee for 2012/13 per resident per week

Fee for 2013/14 per resident per week

Fee for 2014/15 per resident per week

Fee for 2015/16 per resident per week

Fee for 2016/17 per resident per week

Residential Care for Frail Elderly

£489

£504

£524

£540

£556

Residential Care for Older People with Dementia - incentivised

£542

£558

£580

£597

£615

 

The Chairman, alluding to the concern of independent providers in respect of nursing home placement fees, enquired as to the progress made with the further work agreed to be undertaken.  In response the Head of Business Management and Innovation advised the Committee that there is individual dialogue underway with some individual providers and that the issue of nursing home fees would feature in a three way dialogue between the Vale of Glamorgan, the Health Board and the independent residential homes sector. 

 

A Committee Member enquired if local authority run homes could provide the same level of service as that provided in the private sector at the same cost.  In reply Members were advised this was not the case but local authority homes did incur some additional costs not associated with the private sector.  Our commitment is to obtaining evidence about the costs actually incurred and to taking these into account when setting fees - for example, future changes to pension provision. 

 

Committee Members, when querying the level of agreement shown by providers, were advised that it was difficult to get complete agreement from all providers.  The Council recognised the importance of sustainability within the independent care home sector but the Council also had an obligation to ensure best practice and value for money for its tax payers and to ensure a fair outcome for all.  Ongoing negotiations, were taking place with the Local Health Board in respect of how to address any differential in the costs between residential care and nursing home placements. 

 

Having discussed the above, the Committee

 

RECOMMENDED – T H A T the work to set care home fees for 2013/14 and for the next three years be noted.

 

Reason for recommendation

 

To ensure that the Scrutiny Committee can exercise effective oversight of an important local authority function undertaken by the Social Services Directorate.

 

 

26        COLLABORATIVE PLANNING OLDER PEOPLE’S SERVICES (DSS) –

 

The report sought to update the Scrutiny Committee on the work being undertaken by the Integrating Health and Social Care Services Programme with regard to planning older people’s services.

 

The Integrating Health and Social Care Services Programme was in place to increase the scale and pace of work to join up health and social care services across the Cardiff and Vale region where there were clear benefits to service users and patients. The Programme included the following partners:

 

·         the Vale of Glamorgan Council;

·         Cardiff Council;

·         Cardiff and Vale University Health Board (UHB);

·         Vale Centre for Voluntary Services; and

·         Cardiff 3rd Sector Council.

 

In July 2013, the Kings Fund and the Welsh Institute for Health and Social Care were asked to work with the Programme partner organisations to review integrated working and to assist in determining priorities.  A key part of the task had been to develop better structures for working together and an agreed vision for older people's services.

 

In May 2013, the Welsh Government introduced the third phase of its Strategy for Older People in Wales, to cover the period 2013-2023.  Called "Living Longer, Ageing Well', the document outlined the following vision for older people:

 

·         That people in Wales feel valued and supported, whatever their age; and

·         That all older people in Wales have the social, environmental and financial resources they need to deal with the opportunities and challenges they face.

 

A Statement of Intent had been prepared in response to the Welsh Government’s Framework for Older People’s Services. The Statement was endorsed by the local authorities in the Vale of Glamorgan and Cardiff, the Cardiff and Vale UHB, Cardiff Third Sector Council and the Vale Centre for Voluntary Services.  The document also contained details of the governance arrangements to manage the joint working.  A copy of the Statement of Intent was attached at Appendix 1 to the report.

 

The Statement of Intent detailed that work would be taken forward across five specific areas:

 

·         Joint planning for Winter pressures;

·         Delivering the Framework for Older People's Services;

·         Providing an accountability structure;

·         Ensuring compliance with the Social Services and Well-being Act; and

·         Project management of health and social care partnership working.

 

The partnership had also developed its own Framework for Older People; it outlined the agreed vision for older people's services over the next five years. The document was based upon the fundamental principle that services should be planned around the needs of the individual in such a way as to prolong their independence and wellbeing within their local community for as long as possible.  A copy of 'Meaningful and Purposeful Lives: A Framework for Older People in Cardiff and the Vale of Glamorgan between 2014 to 2019' was attached at Appendix 2 to the report.

 

The Framework identified the following key themes for ensuring that older people:

 

·         Live as healthy and fulfilling a life as they can in old age, at home wherever possible, with a range of services supporting them to do this;

·         Along with their carers, know where they can receive information, support, resources and advocacy in the community to live independently at home for as long as possible;

·         Have timely assessment, including access to a GP or assessment for social services and housing to promote independent living;

·         Receive informed and guided care about services that may be received, so that the different steps of treatment and care (where appropriate) are clearly understood and shared decisions made;

·         Receive co-ordinated Health and Local Authority services that are integrated to minimise duplication of assessment and provide "joined-up" care; and

·         Be given information about quality assured, value-for-money long term care and support options and alternatives should these services be needed.

 

The Framework built on the Wyn Campaign, which pioneered locally greater integrated working between the partner organisations in respect of services for older people.  The Campaign had sought to promote healthy ageing and person-centred models of care and support.  The work of this programme was now embedded in the way this Council and the UHB collaborated in the provision of services.  For example, in the past year, all members of the Community Resource Teams had been co-located within three separate sites across the Vale of Glamorgan and Cardiff, providing a more consistent and co-ordinated reablement service.  This had been supported by ongoing work to develop an effective information sharing system.  Other schemes underway included a pilot to signpost people to appropriate services that support independent living and wellbeing.

 

Short-term funding had been made available by the Welsh Government to develop new models of service for older people in order to achieve the vision outlined above. This money had been awarded via the Regional Collaboration Fund (RCF) and the Intermediate Care Fund (ICF).  Within the Vale, this money was funding the following initiatives.

 

RCF

 

·         Enhancement of the Community Resource Team: the additional funding was providing additional staff, input of services from the third sector and the development of a mobile working solution to enhance the effectiveness of the service;

·         Revision of the Unified Assessment Process: work was being done to simplify the process of assessment in accordance with recent Welsh Government guidance;

·         Joint Commissioning: we were looking for opportunities to commission jointly services across the Vale, Cardiff and the UHB;

·         Assistive Technology: We were assessing current use of assistive technology and ways in which this could be improved; and

·         Occupational Therapy Service: additional resources had been made available to improve the response times for people requiring the service

 

ICF

 

·         Communications Hub: development of a fully integrated locality social care, housing and health team to deal with initial enquiries;

·         Accommodation with care: establishment of a specialist accommodation team for older people, together with the creation of reablement units;

·         Expanding the range of reablement services available ;

·         Developing quality assurance systems to monitor standards across all service providers and to support them by sharing best practice ;

·         Implementing the Dementia Plan.

 

The funding available from the RCF across the region was £785,000 in 2014/2015 and the Vale of Glamorgan was the lead authority for this project.

 

The ICF fund had awarded the Vale £1.1m revenue and £557,000 capital funding to be spent during this year.  Cardiff Council was the overall lead authority for this funding stream.

 

In response to the Chairman’s query regarding future scrutiny arrangements and the level of scrutiny following integration the Director of Social Services commented that democratic scrutiny was a crucial area that still needed to be properly resolved.  This would be a key piece of work over the next two years and would require joint planning between the Vale of Glamorgan Council, Cardiff City Council and UHB.  An important aspect of the scrutiny function would revolve around budget and finance monitoring to ensure grant money was spent appropriately and that virements could be managed correctly. 

 

A Committee Member sought assurance that the collaborative agreement would be adhered to.  In response the Committee was advised that some health services straddled different health board boundaries and that some Vale of Glamorgan residents would be receiving services from other health boards.  Patient flow was thus a very important priority and the UHB is in dialogue with neighbouring health boards to ensure that the quality of care provided was consistent.  Further to this the Head of Adult Services commented that patient flow represented a difficult interface to manage with many people in the Vale assigned a GP operating under a different health board.  To keep disruption at a minimum, a definitive guide had been developed in order to help people navigate through the social care and health system and to ensure that all partner organisations could signpost people to the correct services appropriately.  This guide would however need to be revisited and updated.  In light of the current issues identified at the Princess of Wales Hospital the Head of Adult Services had met with senior managers of the hospital to discuss the issues and their effects. 

 

In reference to page 7 of the Statement of Intent attached at Appendix 1, an Elected Member noted that for 11 of the 16 principles progress was shown as being unsatisfactory despite the level of work undertaken in respect of integration.  The Director of Social Services explained that there were some complicated aspects to resolve but that the scores reflected the combined performance of both Cardiff and the Vale of Glamorgan.  There had been a high level of organisational churn within some of the partner organisations.  He offered some reassurance as a result of the stability in respect of the Heads of Services and senior management within the Vale of Glamorgan and that the Council was fortunate to have many officers with a high level of experience and local knowledge that newly appointed staff may not fully possess.

 

RECOMMENDED – T H A T the progress of the Integrating Health and Social Care Services Programme in developing new strategic approaches to meeting the needs of older people for case and support services be noted.

           

Reason for recommendation

 

To ensure that Elected Members exercise effective oversight of an important local authority function undertaken by the Social Services Directorate.

 

 

 

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