SCRUTINY COMMITTEE (SOCIAL CARE AND HEALTH)
Minutes of a meeting held on 3rd November, 2014
Present: Councillor R.L. Traherne (Chairman); Councillor Mrs. M.E.J. Birch (Vice-Chairman); Councillors Ms. R. Birch, K.J. Geary, Dr. I.J. Johnson, J.W. Thomas and S.T. Wiliam.
Also present: Councillor S.C. Egan.
554 APOLOGIES FOR ABSENCE –
These were received from Councillor R.J. Bertin.
555 MINUTES –
The Chairman, in drawing the Committee’s attention regarding discussion on the Improvement Plan – Annual Review of Performance 2013/14, advised Members that in order to "square the circle", the Committee’s views and comments should be referred to the Scrutiny Committee (Corporate Resources).
RECOMMENDED – T H A T the minutes of the meeting held on 6th October, 2014 be approved as a correct record, it being noted that the Committee’s views and comments in respect of the Improvement Plan Part 2 be referred to the Scrutiny Committee (Corporate Resources) for information purposes.
556 DECLARATIONS OF INTEREST –
No declarations were received.
557 DISABLED FACILITIES GRANTS ANNUAL REPORT 2013-14 (REF) –
On 22nd September 2014 Cabinet had received a report in respect of the performance for delivering Disabled Facilities Grants (DFGs) during 2013/14. The report had been referred to the Scrutiny Committee for information and to allow Members opportunity to review the performance of the service.
The Head of Adult Services advised the Committee that Members would be fully aware of the issues in respect of the delivery of DFGs and he advised Members to note that the performance in delivering Grants had improved.
Officer time and financial resources had been invested in the DFG service and improvements had been secured that had been reflected in the Council’s performance in relation to the national performance indicator over the past six years. The performance of the DFG service continued to improve during 2013/14. During the year the average time to deliver a DFG was 284 days. This was 62 days less than in 2012/13 which equated to an improvement of 18% on that year’s performance.
The performance of Local Authorities across Wales had also improved, with only five Local Authorities failing to improve their delivery times for DFGs. As a consequence, the Welsh average for 2013/14 saw a 12% improvement. While the Vale’s DFG service saw a greater improvement in its performance than the Welsh average, the Council’s position remained 18th in the Local Authority rankings for this performance indicator, and as a result it continued to be placed within the lower quartile.
The overall target performance for the year 2013/14 had been achieved and exceeded. The local performance targets for stages within the DFG process had been achieved for the enquiry to approval stage and the stage relating to approval to completion of the works. However, the target for the time taken from first enquiry to an Occupational Therapist (OT) recommendations being received had not been met.
While additional OT resources had been put in place by the DFG service, the OT service had a number of staff on maternity leave. Therefore, the additional staffing resources funded by the DFG service merely aided to support existing resources within the OT service. Furthermore, due to the demands on the OT service from priority cases, the OT service was unable to progress the necessary work on the DFG lists.
The Chairman sought clarification in relation to the required time that clients had to wait for an OT assessment, which currently had been calculated at 12 weeks. The Head of Adult Services advised that any actual performance below 12 weeks would represent an improvement. This was based on existing resources. However, in order for improvement in the delivery of DFGs, the waiting time needed to be reduced to at least five weeks.
A Committee Member questioned as to at what point would the service require additional OT support. In response, the Committee was advised that the DFG process had been subject to an ongoing review. The Business Improvement Team was currently in the process of conducting a review of the DFG process in order to establish whether any additional resources were required and where the resources needed to be focused. Members were advised that this review should be completed by the end of January or early February.
Referring to the employment of temporary OT staff, a Committee Member queried whether this would happen again. The Head of Adult Services advised that he was not sure whether additional OTs would help as it had been difficult to recruit new staff in the past. There was also an issue in respect of maternity leave and consequently additional staffing resources had merely supported existing resources.
Having considered the report, the Committee
RECOMMENDED – T H A T the report on performance for delivering Disabled Facilities Grants during 2013-14 be noted.
Reason for recommendation
In order for the Scrutiny Committee to assess the performance of the service.
558 THE VALE OF GLAMORGAN HEALTH, SOCIAL CARE AND WELLBEING PARTNERSHIP (DSS) –
The Head of Business Management and Innovation apprised the Committee on the work of the Health, Social Care and Wellbeing Partnership. For this item she was joined by the Manager for the Remodelling Social Care and Integration with Health Programme.
The overall Health, Social Care and Wellbeing (HSCWB) agenda for the Vale of Glamorgan was the responsibility of a Partnership which operated within the framework for strategic partnerships established by the Local Service Board and the Council. The two strands of work set out in guidance were managed primarily by two Boards which the Partnership had helped to establish. These were the Integrated Health and Social Care Programme Board and the Public Health and Wellbeing Board. Both Boards reported directly to the Local Service Board.
The Integrated Health and Social Care (IHSC) Programme Board oversaw the collaborative work undertaken between the Vale of Glamorgan Council, Cardiff Council, Cardiff and Vale University Health Board, Cardiff Third Sector Council and the Vale Centre for Voluntary Services to develop and support the growing number of joint services provided by health and social care services.
The Public Health and Wellbeing Board currently operated within the Vale of Glamorgan only. It comprised representatives from the NHS, the Local Authority and the third sector. The Board undertook responsibility for the collaborative work to address key health determinants for the population such as use of tobacco, food and physical activity, alcohol consumption and the uptake of immunisations. The priorities were determined by the public health evidence base and population needs assessments. The report gave an overview of discussions which were underway to revise the current structure and reporting arrangements for the Board.
The Leader of the Vale of Glamorgan Council was the Chair of the Governance Board for 2014-15. He was supported in this role by the Chair of the Cardiff and Vale University Health Board, Maria Battle, and the Councillor for Health, Housing and Wellbeing at Cardiff Council, Councillor Susan Elsmore, who were the Deputy Chairs.
The key work streams within this programme include:
· Intermediate Care Fund and Regional Collaborative Fund
· Work to take forward the extensive programme of commitments arising from these short-term funding streams was progressing well, as reported to this Committee in October 2014
· The Older People’s Framework
· Following initial review by the Scrutiny Committees of both Councils and the UHB Board, the Framework would now be shared with wider stakeholders, to encourage debate on how specific outcomes might best be achieved for older people.
In the longer-term, there were likely to be significant workforce implications arising from plans for changes to current service models and to review options for integration. In these circumstances, the Council's policies in respect of workforce changes would apply.
In referring to the establishment of the Integrated Health and Social Care Programme Board and the Public Health and Wellbeing Board, the Chairman queried the reason behind the creation of two separate boards. In reply, the Director of Social Services advised that there was a division of labour between the two Boards. The Public Health and Wellbeing Board had been set up in order to improve the public health and life expectancy of people within the community. As such its aim was to tackle issues such as obesity, smoking and excessive alcohol intake. The Boards therefore had different agendas, so there was a clear case for the two.
RECOMMENDED – T H A T the content of the report be noted.
Reason for recommendation
To ensure that Elected Members can exercise effective oversight of this important area of collaborative working.
559 IMPLEMENTATION OF THE SOCIAL SERVICES AND WELL-BEING (WALES) ACT 2014 (DSS) –
The Director of Social Services presented the report the purpose of which was to update Members in respect of the Social Services and Well-being (Wales) Act 2014 and the approach being taken to its implementation.
As a background summary, the Committee noted that in February 2011, the Deputy Minister for Social Services announced a new strategic plan for putting social services on a sound footing. The strategy entitled "Sustainable Social Services for Wales – A Framework for Action" set out Welsh Government plans to renew social services and social care for the next decade. The Deputy Minister made it clear that there would be significant changes in the social and financial context within which services were delivered and it was imperative that changes to social services needed to be made.
The strategic plan concluded that wholesale structural change was not necessary and that local government would continue to be accountable for service delivery, identifying need and determining service priorities. Highlighted at Section 3 of the strategy were eight priorities for action, in summary these were:
· A strong national purpose and expectation; and clear accountability for delivery;
· A national outcomes framework;
· Citizen centred services;
· Integrated services;
· Reduced complexity;
· A confident and competent workforce;
· Safeguarding and promoting the wellbeing of citizens; and
· A new improvement framework.
The strategy acknowledged that social services and social care were facing a real and unsustainable increase in demand across all categories of service users. It had been concluded that due to the pressure on public sector finances, the choice was either retrenchment or renewal. Retrenchment would see fewer people receiving services, with greater expectations for people to find their own solutions, increased burdens on informal carers and a growing number of disputes between services such as the NHS and social care about responsibility for services. Renewal meant focusing more clearly on delivery, including preventative services, and continuing to innovate and create sustainable services.
The Social Services and Well-being (Wales) Act received Royal Assent and became law on 1st May 2014. The Act was intended to transform the way social services were delivered through an approach that was focused on achieving the outcomes necessary to promote a person’s wellbeing. To achieve the aim the Act intended to ensure that people had access to clear information, advice and assistance. The Act also recognised the key role played by carers and also to the importance of prevention and early intervention. The Act would also provide greater consistency and clarity around people who use social services and their carers.
The Act would come into force in April 2016 and was made up of 11 main areas.
1 – Introduction (Sections 1-4 overview and definition of key terms)
2 – General Functions (sections 5-18, including well-being duty and outcomes, local arrangements for preventative services and the provision of information, advice and assistance)
3 – Assessing the Needs of Individuals (Sections 19-31 - adults, children and carers)
4 – Meeting Needs (Sections 32-58, including eligibility, direct payments, and care and support plans)
5 – Charging and Financial Assessment (Sections 59-71, including financial assessments and deferred payments)
6 – Looked After and Accommodated Children (Sections 74-125, including leaving care)
7 – Safeguarding (Sections 126-142, including a duty to report children and adults at risk and the role of Safeguarding Boards)
8 – Social Services Functions (Sections 143-161 including the role of Directors of Social Services, codes and intervention by central government)
9 – Co-operation and Partnership (Sections 162-170, including the role of LHBs and NHS Trusts and joint arrangements for the provision of adoption services)
10 – Complaints and Representations (Sections 171-183, including the provision of advocacy services)
11 – Supplementary and General (Sections 184-200, including provider failure and issues of residence).
A copy of the Act was attached at Appendix 2 to the report, while at Appendix 1 was a briefing note which provided an overview of the key provisions of the Act.
The Chairman asked if the Director of Social Services could comment on some of the challenges facing the service. In response, Members were advised of the scale of changes being implemented and the relative lack of narrative from the Welsh Government in respect of outcomes and expectations. There had been a lack of detail contained within the Act and he alluded to the publication of regulatory guidance which would be made available subsequently. He went on to advise that one of the major challenges related to increased demand for services during a period of austerity. In order to achieve the change, the service needed to consider different ways of working. He had some reservations whether the renewal of services would be effective without real retrenchment while there was also a need to look at how social care was financed within Wales.
In highlighting some concerns, the Director of Social Services advised that there was a need for clarity about the nature of the new Wellbeing Assessments and he commented upon the potential impact in relation to adult protection being placed on the same footing as child protection arrangements. He also doubted whether the Act was realistically cost neutral. The service would also need to assess the implications in respect of carers being considered on the same basis as social care service users.
A Committee Member queried whether there were any planned changes to the eligibility criteria for accessing services. In reply the Director of Social Services advised that there would be national criteria implemented that would be in line with those currently outlined by the Vale of Glamorgan Council.
In answer to a question regarding self-funders, Members were advised that implications from the Act would be considerable. The £55 cap had cost the Authority approximately £4.1m since its inception and this had brought a lot of self-funders into the care system. The Act also placed clear emphasis on early intervention programmes in order to deflect individuals into voluntary arrangements for their care provision.
Further to this a Committee Member queried whether any evaluation of the costs and impact of the Act had been undertaken. In reply the Director of Social Services commented that the WLGA were looking at the detail contained within the Act but he stated that Members should be mindful that even if this WLGA review highlighted significant cost implications, this was not likely to change the view of the Welsh Government. He offered reassurance to Members that the Vale was one of only a few Local Authorities within Wales to closely monitor arrangements in respect of the impact of the £55 cap and similar measures would be employed in respect of the Act. He also alluded to the necessity for a debate as to how balanced budgets within Wales could be achieved. There was a need for improved dialogue between health, social services and the Welsh Government.
In referring to preventative strategies, a Committee Member queried as to how wide ranging would the proposals be and whether they would include organisations such as Youth Clubs. The Director of Social Services stated that the timing of the Act was difficult for Social Services. This had been put together at the beginning of austerity and at a time when no one properly envisaged the scale of financial challenges to be faced. Many Local Authority activities and services impact directly upon wellbeing and many of these would be affected by reduced budgets. He alluded to the support work carried out with disadvantaged families and that, in the future the third and voluntary sectors may be a way of offering possible solutions.
Following a query in relation to the framework regarding the assessment process, the Director of Social Services advised that the intent was for greater emphasis on national standards and documentation that would lead to reduced scope for local interpretation. Implementation of the new standards would be monitored through changes in inspection and regulation.
The Director of Social Services went on to advise that an integrated assessment form had already been implemented on an all Wales basis and the service was always willing to work on national and regional levels. The directives from the Welsh Government seemed to offer proposals to improve aspects that the Council was already implementing. He stated there was a lot of evidence to show that the Council was providing services to a good standard. There was also the risk that the directives could stifle innovation and overlook the need for diversity.
A Committee Member asked if the Director of Social Services could elaborate upon the interface between health and social services and the effect this would have within the Vale of Glamorgan. The Committee was advised that the programme of integration was well developed within the Vale. The emerging consensus was that there would be a need for greater health investment within some areas of social care. He cited the examples of integrated community services and reablement, where health had successfully invested in joint service arrangements. Going forward there would be a need for more pooled budgets under the control of a single manager, similar to the joint working arrangements between social services and education in which costs were covered by the two directorates. The Act could assist in taking this approach further and could encourage health to invest in community based services and not just in acute health services. As a final note, he advised that the Vale of Glamorgan was well equipped to meet the future challenges and he alluded to the Reshaping Services Change Programme that was currently underway.
In considering the Act, the Committee
(1) T H A T the report be noted.
(2) T H A T regular updates about implementing the Act be received.
(3) T H A T the report be referred to Cabinet for consideration.
Reason for recommendations
(1-3) To ensure that Elected Members were kept informed about fundamental changes in the policy and legislative framework which underpins the work of Social Services.
560 INCREASING THE RANGE OF SERVICE PROVIDERS IN SOCIAL CARE (DSS) –
The Head of Business Management and Innovation presented the report, the purpose of which was to inform Members of the need to increase the range of service providers in social care within the Vale of Glamorgan.
In order to meet the challenges of increased demand and reduced resources, the Council had recognised a need to change the pattern of social care services.
A consistent theme emerging from the commissioning strategy had been the need to increase diversity in service provision by promoting and assisting the development of new models of delivery. The Social Services and Well-being Act (Wales) 2014 would make this a statutory duty for Local Authorities.
In recent years, the potential role for other types of service providers had begun to receive considerable attention, especially organisations such as social enterprises. The Department of Trade defined social enterprises as "businesses with primarily social objectives whose surpluses are principally reinvested for that purpose in the or in the community rather than being driven by the need to make profit for shareholders or owners".
Social enterprises would take many legal and organisational forms with their origins in different traditions and contexts. Social enterprises would typically concentrate upon their core business of delivering services to the community and build business models that would allow them to be sustainable while contributing to social and economic inclusion as well as to equality of opportunity. Social enterprises could be structured as a for-profit or non-profit organisation and may take the form of a co-operative, a mutual organisation, a community interest company or a charity.
A co-operative was a group of people acting together to meet the common needs of its members, sharing ownership and making decisions. A co-operative was not a charity but it was a non-profit organisation. All profits were given back to the co-operative's members. The three principles of a co-operative were: the subordination of capital; one person equals one vote regardless of that person's percentage of ownership; and dividing profits or margins among the members according to the percentage of business done with the co-operative.
A mutual organisation was based on concepts of mutuality and reciprocity. Unlike a co-operative, members usually did not contribute to the capital of the company by direct investment but derive their right to profits and votes through their customer relationship. A mutual exists with the purpose of raising funds from its membership or customers which can then be used to provide common services to all members of the organisation or society. Profits made would usually be reinvested in the mutual for the benefit of the members, although some profit may be required to sustain the organisation.
A Community Interest Company (CIC) was a business with primarily social objectives whose surpluses would principally be reinvested for that purpose in the business or in the community, rather than being driven by the need to maximise profit for shareholders and owners. CICs tackle a wide range of social and environmental issues and operate in all parts of the economy. By using business solutions to achieve public good, it was believed that social enterprises have a distinct and valuable role to play in helping create a strong, sustainable and socially inclusive economy. CICs were diverse. They included community enterprises, social firms, mutual organisations such as co-operatives, and large-scale organisations operating locally, regionally, nationally or internationally.
As part of their individual care plan, adults and parents of children with a disability could choose to be provided with Direct Payments, which enabled them to exercise greater control over the support they needed by providing an alternative to social care services provided by a Local Authority. A Direct Payment gave the person flexibility to determine how best to meet their social care needs, often by the employment of a Personal Assistant or by directly paying for services. This often helped to increase opportunities for independence, social inclusion and enhanced self-esteem. The Council was increasing the use made of Direct Payments, where appropriate and there was a clear potential for linking provision through social enterprises with the further development of Direct Payments. This was being supported via the tendering process which was now starting with regards to the Direct Payment service.
The Head of Business Management and Innovation was able to provide Members with financial information concerning the amount spent on private sector care provision. In terms of domiciliary care, from a total allocation of £14m, £1.2m had been spent on direct service provided by the Council whilst £12.7m had been apportioned to independent care providers. For residential care the total spend was £13.1m of which £2.2m was spent on internal provision and the remaining £11m allocated to the private sector. In relation to Children’s Services, from a total of £2.5m for foster care, 55% would be spent in-house and the remaining 45% allocated to the independent sector.
The Chairman asked if the Head of Business Management and Innovation could provide an indication as to some of the areas where the social enterprises could provide the service. The Committee was advised that within Wales, day services had been an area where there had been a growth of social enterprises, while meals on wheels had also seen a small scale expansion. Within England however, some much larger scale programmes had been reshaped, that in some areas covered domiciliary care.
In response to a query regarding the challenges faced by providers, the Head of Business Management and Innovation advised that it was the clear intention to involve all parties at an early stage in order to highlight the issues and to confront any barriers. In respect of barriers, Members were advised that the tendering process was an important consideration. Organisations within the third and voluntary sectors found it difficult to compete for tenders as they may not have the resources available. Corporate procurement would need to evaluate the tender process so as to reduce these barriers and in order to make the process fairer and more straightforward. At this point the Director of Social Services stated that the scale of contracts in the Vale had been on a relatively small scale, while some other Local Authorities tendered for much larger block contracts. The Act challenged Authorities to change the way services were delivered and empowered social services to review processes in order to provide greater choice.
RECOMMENDED – T H A T the content of the report and the commitment to secure an appropriate range of service providers in social care be noted.
Reason for recommendation
To ensure effective oversight of key potential developments in the delivery of frontline social care services.
561 AUTISTIC SPECTRUM DISORDER: COMMUNITY MONITORING AND SUPPORT PROJECT (DSS) –
The Autistic Project Lead Officer, in summarising the report, advised the Committee that this was a relatively small project and was aimed at providing a preventative service.
In 2009, an Adult Task and Finish Group established by the Welsh Government issued a report describing significant inconsistencies across Wales in services provided to adults with ASD. As a consequence, Local Authorities were given the opportunity to bid for grant funding. In partnership with Cardiff, the Vale of Glamorgan Council applied for funding to establish a Community Monitoring and Support project across part of the South East Wales Region. This was agreed by Welsh Government in April 2011, indicatively until March 2015
The service would offer short term low level support targeted at intervention which would promote the independence and autonomy of adults with high functioning autism and Asperger’s Syndrome. In essence the project helped support those individuals who were not eligible or did not meet the criteria for support from Social Services.
The type of support included offering individuals a clear point of contact for information and advice, reducing the risk of crisis and helping prevent enduring mental health problems by encouraging socialisation and directing individuals to social groups, local events and activities. The project would also profile unmet need and highlight any gaps in provision which could then be relayed to local steering groups and the Welsh Government for consideration. Funding for the project was allocated via Welsh Government on an annual basis and for 2014/15 amounted to £40,000. The service had been able to create many innovative opportunities for social contacts, such as a monthly forum that provided a means for adults to influence how the service developed and acted as a conduit for information to and from the local ASD Steering Group. A number of areas of good practice developed by the scheme locally had been adopted by other areas in Wales. For example, the Orange Wallet scheme was now providing improved access to public transport across Wales.
The project aimed to improve the social skills of individuals in order to help them focus and to improve their life chances. Close working arrangements had been employed with the Job Centre in order to improve employment skills and opportunities for people with autism and Asperger’s. The project was able to secure Welsh Government funding to run a specialist employment project in which specialist materials had been created and a job skills workshop delivered. As a result of this project, excellent links had been forged with local Job Centre Plus staff and the service had been able to delivery workshops jointly with them. To date 25 clients had been able to access the courses, 12 of them were residents within the Vale. Of these three were now in work, four were volunteering and three were actively engaged in the process of job seeking.
A Committee Member relayed their thanks to the Project Lead Officer for such an inspiring report which was a clear example of the effectiveness of a preventative service and showed how innovative approaches could make such a difference. Further to this, the Project Lead Officer advised that the need to tackle social isolation was very important and that the monthly forum, even though it was just a meeting, showed what could be achieved through a simple solution. The forum meetings allowed its members an improved routine and the chance to meet with other people of a similar disposition.
In referring to the short term funding arrangements of the project that would end March 2015, a Committee Member queried whether there was any indication from the Welsh Government as to whether funding would be renewed. In response, the Project Lead Officer advised that the current indication was that the funding would be renewed, but since then there had been a ministerial change. The Committee was advised that the funding for the project management role would be within the Council’s revenue settlement grant from 2015/16. This however differentiated from the Welsh Government grant that was allocated to support the project and its associated activities.
In referring to the "Socialeyes" social skills training programme, a Committee Member queried as to what was happening and whether any timescales could be provided. In response the Committee was advised that this programme had only recently commenced and had been based within Cardiff as this was the area where most of the clients resided. A number of individuals from the Vale were also part of the skills training which would take place within a meeting room that all individuals were familiar with and the programme was run by a tutor who had been diagnosed with autism.
In response to a query regarding an increase in the number of young people being diagnosed with autism, the Project Lead Officer advised that around 1 in 100 individuals would be diagnosed with autism. Significant improvements had been made in relation to the way that individuals were diagnosed. An important aspect of this had been around the improvement in training and in raising awareness within primary schools. The time to diagnose an individual was on average six months and 50% of cases showed that individuals had some form of autism. The Project Lead Officer stated that as a result of increased awareness and better pathways, there had been an increase in the number of people requiring support. Some individuals had not been diagnosed until they were in their 50s, 60s or 70s, but there were clear indications that the earlier the diagnosis, the better the outcome for the individual. At an early stage the brain’s ability to respond to treatment was greatly improved and so better outcomes could be achieved. Diagnosis was now far more accurate, particularly as a consequence of better multi-agency working.
The Chairman queried as to how individuals would be made aware of the project. In response the Committee was advised that this was the project’s biggest challenge as there was no way of knowing the true level of autism within the population. A range of promotional activities had been carried out such as the distribution of leaflets within doctors’ surgeries and libraries, the creation of a Facebook page and a website to highlight the work of the project.
In considering the report the Committee was keen for Cabinet to be made aware of the good work undertaken by the support project and also to highlight the issue of the short term funding and the need to ensure that the continued level of resources were available.
(1) T H A T the work being undertaken by the Autistic Spectrum Disorder (ASD) Community Monitoring and Support Project be noted.
(2) T H A T annual updates on the work of the project be received by the Committee.
(3) T H A T the report be referred to Cabinet and that Cabinet be requested to ensure that adequate resources are available for the ongoing work carried out by the project to continue.
Reasons for recommendations
(1&2) To keep Members apprised of the work of the ASD Community Monitoring and Support Project.
(3) To ensure that sufficient resources are available to continue and progress the work of the project.