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SCRUTINY COMMITTEE (SOCIAL CARE AND HEALTH)

 

Minutes of a meeting held on 2nd February, 2015.

 

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

 

Also present: Councillor S.C. Egan.

 

 

832      APOLOGIES FOR ABSENCE –

 

These were received from Councillors Ms. R. Birch, Ms. R.F. Probert, J.W. Thomas and S.T. Wiliam.

 

 

833     MINUTES –

 

RECOMMENDED –  T H A T the minutes of the meeting held on 5th January, 2015 be approved as a correct record, it being noted that under 'Declarations of Interest’, Councillor Dr I. J. Johnson had received dispensation from the Monitoring Officer as opposed to the Standards Committee.

 

 

834     DECLARATIONS OF INTEREST –

 

No declarations were received.

 

 

835     PRESENTATION ON DIABETES –

 

Present for this item were Dr. Aled Roberts, Consultant Diabetologist, Cardiff and Vale University Health Board  and Fiona Kinghorn, Consultant in Public Health, Cardiff and the Vale University Health Board / Public Health Wales.

 

Dr. Roberts began the presentation by advising the Committee that 95% of cases related to Type 2 diabetes.  People with Type 2 diabetes would be insulin resistant, the prevalence of which was increasing.  Referring to Type 1 diabetes, Dr. Roberts advised that this represented a much small percentage of cases, just 5%, and would relate to individuals who would be insulin deficient. 

 

In highlighting some of the complications with Type 2 diabetes, Members were advised that a person could be either hyper glycaemic or hypo glycaemic.  Hyper glycaemia related to individuals with a high blood sugar level while hypo glycaemia related to a person with long term low blood sugar levels.  Other health factors included cardio vascular and heart disease, with strokes and peripheral circular disease most common.  A person with Type 2 diabetes could also be affected by nervous system damage, eye disease and kidney disease.   

 

Diabetes would be prevalent within 4-5% of the population and would consume large amounts of NHS funds.  Major identified risk factors for people related to advancing age and obesity, of which Wales had one of the highest obesity rates in the world.  Specific to the Vale of Glamorgan, the issues were a growing population along with an aging population.  Areas of high deprivation, poverty and disadvantaged individuals would be where diabetes was most common. 

 

Future projections of people with diabetes showed a significant increase.  At present within the Cardiff and Vale of Glamorgan Health Board area, as of 2013, there were 23,492 cases of diabetes which would be set to grow to over 30,000 by 2030.  The Committee noted that the population of over 75s was of significant risk within the Vale and showed a 58% increase by 2030. 

 

In treating Type 2 diabetes, Members were advised that lifestyle and diet changes were key factors.  The screening for complications and use of oral medication such as Metformin was important and more injectable medication was becoming available.  Blood pressure and blood lipid levels would need to be managed through the use of statins.

 

In terms of prevention of diabetes, the need to improve obesity and dietary requirements was raised. The Committee was advised that the Council was actively contributing to the Vale Food and Physical Activity Plan that focused on healthier eating and food poverty.  Implementation of the Cardiff and Vale UHB’s Optimising Outcomes Policy was underway which targeted those individuals as having a BMI of 40 or above and they are expected to be offered, accept and complete a programme of weight management support prior to any surgery.  42 weight management groups had been held across the Cardiff and Vale Health Board during the year along with 46 diabetes education groups, and 24 diabetes awareness sessions.  In summarising as to what actions the Vale of Glamorgan Council could additionally take, Members were advised that more could be progressed within work places and schools.  There was a need to promote healthy eating through the procurement and provision of healthy choices and healthy options, particularly in facilities such as leisure centres.  The Council should also promote the Healthy Options Award for catering and food retail establishments broadly compliant with the Food Hygiene Rating Scheme.  The Council could also expand the promotion of community healthy eating messages and cooking skills and should increase the uptake of free school meals. 

 

Another important element around prevention was tackling physical inactivity. Members were informed that schools played a key role, particularly in relation to school travel plans and smarter journeys to schools.  It was important to ensure that the Local Development Plan explicitly supports physical activity and promotes walking and cycling.  Additional actions that the Council could take included the need to ensure that at least 120 minutes of physical activity was delivered in schools each week.

 

In referring to the need to address smoking, this played a key part in the number of people with cardio vascular problems and heart disease.  At any point in engaging with the public, referrals to Stop Smoking Wales should be offered and all staff who have direct public contact should be offered 'Brief Intervention in Smoking Cessation Training’ and / or 'Making Every Contact Count’ training.  The Council should also ensure compliance with its non-smoking policy.

 

A Committee Member enquired as to what percentage of the NHS budget would be spent on diabetes.  In response the Committee was advised that across the whole of Wales 10% of resources would be allocated to addressing diabetes.  Many patients would be admitted to hospitals with illnesses that would not be recognised as attributed to diabetes.

 

The Chairman queried as to what the UHB would like the Council to do.  Members noted that, in respect of food and physical activities, the Local Authority had a significant role to play.  For instance, there was a need to promote healthy food options and this could be progressed via the revisiting of service level agreements in which greater consideration could be given to more healthy foods.  In terms of physical activity the Vale of Glamorgan was currently doing quite well, but targets for physical activity within schools had not been met and so more could be done to improve the performance. 

 

A Committee Member, as a representative for Llandough, commented upon some of the actions aimed at improving the physical activity for children and queried the impact that awareness raising had made.  The Committee noted that a key part of this was addressing behavioural issues and that, although most people were aware of the risks associated with increased weight and diabetes, there was still much to be progressed.  Two main issues that needed to be addressed included the rise in obesity rates in children and the level of calorie intake among middle to older age populations.

 

In reply to the Chairman’s query regarding the level of undiagnosed cases, the Committee was advised that on top of the number of diagnosed cases there would be approximately one third as many people again who would not have been diagnosed with diabetes.  Increased screening of high risk groups such as the obese and older people would be an important element in tackling this.

 

A Committee Member, referring to the indication that 57% of the adult population of the Vale of Glamorgan were overweight or obese, queried as to what was the best way to get the message across to people in their 40s, 50s and 60s who may be unable to participate in sport or physical activity.  In response, the Consultant in Public Health advised Members that the issue of obesity was very complex.  In some areas the Health Board would not know the causal pathway for people affected by diabetes.  Individuals could be influenced by their families and peer support networks and she made reference to 'Nudge Theory' in which clients benefit from talking to a therapist about their lifestyle in order to improve their choices and habits.  

 

The Committee queried whether additional funds and resources would make a difference to the level of diabetes.  Members noted that more money and resources would make a difference but that there were things that the LHB could progress without additional money.  There may be a need to lead change through policy and commissioning and through better health promotion and awareness-raising.  An example of this was illustrated through the use of vending machines in hospitals which were only stocked with healthy options as opposed to sweets, chocolates and sugar loaded snacks.  The importance of motivation was again reiterated to the Committee, in particular around the need to ensure that individuals make the correct decisions and choices.  A scheme which had begun in Glasgow was highlighted to Members, in which cash payments were made to pregnant mothers to encourage them to avoid smoking.  This had achieved some positive results.

 

The Chairman raised a question regarding the co-ordination of effort across all Council departments and was advised that the Council was fully on board and involved in formulating policies and strategies.  Further to this the Director of Social Services advised that the Vale Public Health and Wellbeing Board would co-ordinate the work conducted within the Vale.  The Board was multi-agency and was one of the first of its kind within Wales and soon a joint Cardiff and Vale Public Health and Wellbeing Board would be created so that more could be done on a larger scale.  One important area relating to diabetes was the link to poverty and deprivation and the ability of people to purchase healthy food.  In response the Consultant for Public Health advised that it was quite right to say that the level of deprivation affected a person’s access to healthy food options. 

 

In closing the debate, the Chairman noted the high importance of the issue and he thanked the representatives from the Cardiff and Vale University Health Board for their contribution.

 

RECOMMENDED – T H A T the content of the presentation regarding diabetes be noted.

 

Reason for recommendation

 

In order to provide the Scrutiny Committee with an improved understanding of the issues regarding diabetes within the Vale.

 

 

836     PRESENTATION ON THE VALE OF GLAMORGAN MULTI-AGENCY RISK ASSESSMENT CONFERENCE (MARAC) –

 

The Chairman advised the Committee that this presentation had been deferred and he asked if the Director for Social Services could provide Members with an understanding of the reasons behind this decision. 

 

The Director of Social Services informed the Committee that he had asked the Chairman for his permission to defer this item.  He advised that he had encountered some practical problems in securing an appropriate presentation for tonight’s meeting.  However, the main reason was the need to think again about the information that would be most relevant to Members of the Scrutiny Committee.

 

During a recent meeting of the Local Safeguarding Children Board, presentations were made by the MARAC Co-ordinator for Cardiff and by researchers from Bristol who were looking at the impact upon children.  The Board acknowledged the need to understand better the interface between the work done under the MARAC systems in responding to high risk victims of domestic abuse and the responsibilities of other safeguarding agencies to protect children and vulnerable adults.  Further work was to be undertaken. 

 

The Director of Social Services believed that there was a need to wait for this work to progress before bringing the findings to the Committee so that Members were given the most relevant information about how the Council and other agencies can respond effectively to the needs of those troubled families. 

 

RECOMMENDED – T H A T a presentation on the MARAC from the perspective of the victim be provided to a future meeting of the Scrutiny Committee.

 

Reason for recommendation

 

To ensure that the Scrutiny Committee has effective foresight and understanding of a key multi-agency public safety and safeguarding body.

 

 

837     REVENUE AND CAPITAL MONITORING FOR THE PERIOD 1ST APRIL 2014 TO 31 ST DECEMBER 2014 (MD) –

 

The Operational Manager, Accountancy, presented the report, the purpose of which was to update Members of the position in respect of revenue and capital expenditure for the period 1st April to 31st December 2014.

 

Revenue – the current end of year forecast for the Social Services budget was an overspend of £100,000.  A table and graph setting out the variance between the profiled budget and actual expenditure to date was attached at Appendix 1 to the report. 

 

Children and Young People’s Services – this service was currently anticipated to outturn £500,000 (3.5%) under the Children’s Services budget at year end.  The major issue concerning this service continued to be the pressure on the children’s placement budget.  However, it was currently projected that the Joint Budget for Residential Placements for Looked After Children could outturn with a £100,000 underspend at year end.  Work had been ongoing to ensure that children were placed in the most appropriate and cost effective placements, however, it should be noted that due to the high cost of such placements, the outturn position could fluctuate.  There were potential underspends elsewhere in Children’s Services relating to team budgets of £86,000, £50,000 relating to administrative staff, £50,000 on legal expenses, £60,000 due to additional adoption income and £154,000 on alternative means of provision and accommodation costs required for the current cohort of children.

 

Adult Services – this service was currently anticipated to outturn £600,000 (1.6%) over the Adult Services budget at year end.  This was due to a projected overspend of £800,000 (3.4%) against the Community Care Packages budget.  This was as a result of increased demand for services, particularly for frail older clients.  While the overspend this year had reduced, pressure on the budget would continue into the next financial year as the full year effect of current packages would result in a predicted increase in expenditure of around £1m.  The service would strive to manage demand, which would be supported through the reorganisation of the Care Management Team and the implementation of changes as a result of the Intermediate Care Fund (ICF) and the Regional Care fund (RCF) schemes.  The annual deferred income budget for 2014/15 had been set at £725,000.  As at 31st December 2014 income received was on target, however, there were houses that would be sold subject to contract, but for which the anticipated income was not high and therefore the year end projection had been maintained at a £100,000 under-recovery.  This position was included as part of the underspends elsewhere within Adult Services of around £200,000 which could be used to offset this position.  These areas were £125,000 on staffing, £26,000 on transport, £29,000 on premises and £20,000 on supplies and services. 

 

The ICF grant was only available within the 2014/15 financial year, and a cost pressure had been submitted for consideration as part of the 2015/16 budget process to allow for a transitional period for schemes to be evaluated.  The RCF grant had been approved for 2015/16; however, the amount available was 46% less than previously indicated by the Welsh Government.  This funding covered five collaborative schemes across the Cardiff and Vale region.  Proposals for the revised allocation of funds to the schemes had been submitted to the Welsh Government for consideration.  The allocation of grant to the schemes had been based upon priorities and availability of other funding sources and therefore the reduction had not been consistently applied across all areas.  The remodelling adult social care and integration with health strand had been given more favourable treatment.

 

Capital – Attached at Appendix 2 to the report was financial progress on the Capital Programme as at 31st December 2014, while at Appendix 3 to the report was non-financial information on capital construction schemes. 

 

The report outlined that the Boiler Replacement work at Hen Goleg had increased by £14,000 due to leaks being identified during works on the site.  This additional spend would be funded from a revenue contribution to the scheme.  Also, the start date for works to the Clock Tower were dependent upon receipt of Listed Building Consent.  This application should be received by CADW during February, with a decision being anticipated within 12 weeks.  The works would therefore not start on site until the next financial year.  It was therefore requested that £98,000 be carried forward into 2015/16. 

 

For all schemes where it was evident that the full year’s budget would not be spent during the year, the relevant officers were required to provide an explanation for the shortfall which would be taken to the earliest available Cabinet meeting.

 

Social Services Budget Programme Update – On 5th March 2014, Council had approved savings targets for 2014/15 and the initial savings targets for 2015/16 and 2016/17. 

 

As part of the Medium Term Financial Plan, approved by Cabinet on 11th August 2014, it had been agreed that the service remodelling savings, included in 2015/16 and 2016/17 would be re-phased and were now set at £320,000 in 207/18, £320,000 in 2018/19 and £330,000 in 2019/20. 

 

The Directorate was currently required to find savings totalling £3.97m by the end of 2019/20.  Total identified savings amounted to £4.156m which would show a surplus of £186,000.  This surplus was as a result of the Foster Carer Recruitment Project which could be used to mitigate any additional savings to be found in future years. 

 

The following table showed the approved savings targets and the savings identified by year.  It included the £293,000 identified in 2012/13 in excess of the saving target for that year. 

 

 

Savings Required

 

£000

Savings

Identified

 

£000

In Year Surplus/ (Shortfall)

£000

Cumulative Surplus/

(Shortfall)

£000

Previously Identified Savings

293

293

293

2014/15

713

454

(259)

34

2015/16

1,125

1,201

76

110

2016/17

1,162

1,238

76

186

2017/18

320

320

0

186

2018/19

320

320

0

186

2019/20

320

320

0

186

TOTAL

3,970

4,156

 

 

 

Contained within Appendix 4 was further detail on the progress for each savings project.

 

A report presented to Cabinet on 26th January 2015 regarding the Council’s Reshaping Services Change Programme acknowledged that the Social Services Directorate already had two major initiatives underway, these being the Collaborative Working Programme and the Budget Programme.  These Programmes already contained projects which were progressing the opportunities identified as part of the Reshaping Services Programme and savings targets were already included within the Budget Programme.

 

The Social Services Directorate was committed to achieving a balanced budget.  The Corporate Budget Programme Board for Social Services and project teams overseeing the plan would continue to develop it further and ensure delivery and progress.  Progress updates would be reported as part of the overall financial monitoring report for the Directorate.

 

In providing an update in regard to the Intermediate Care Fund (ICF), the Director of Social Services advised the Committee that despite his best efforts, the Welsh Government (WG) was unable to provide a definitive response around the plans for introducing the new Integrated Care grant.  He went on to advise that it was anticipated that most of the money would be apportioned to the NHS but that there may be a requirement for a pooled budget in order to progress some of the projects begun under the ICF grant money.  He informed Members that the service could provide a positive evaluation of the projects undertaken and that there was a good case for ensuring that these projects would continue. 

 

Further to this a Committee Member queried as to what effect changes to the ICF grant would have upon budgets.  In response the Director of Social Services advised that the timing of the announcement was very difficult for the Local Authority and it would have been better if this announcement had been made two or three months earlier.  He stated that there would be a need to make best use of the new Fund and RCF budgets in tandem and to look at what elements could be possibly funded through the RCF funding stream. 

 

A Committee Member asked if the Committee could be provided with some clarification of the Flying Start grant money approved by WG.  In response, the Head of Children and Young People Services advised that the grant would be used to fund three capital projects.  The first related to the setting up of a facility in Colcot, the second related to the Red Robins Project and was aimed at enhancing that facility and the third project was around improving the outside space at Cwm Talwg. 

 

In referring to the Flying Start facility at the Red Robin Nursery site, a Committee Member queried whether this would help ensure the future viability of the respite provision for disabled children, which was also located there.  In response, the Committee noted that the two were not connected.  The primary aim was to look at how best to use all physical assets and, although there were synergies, these were still separate services.

 

The Chairman queried whether any other plans for Flying Start capital projects were being drawn up and whether these could be devised more quickly.  The Director of Social Services commented that this was one of the burdens in having fixed term grants for capital projects.  It was difficult for the Service to devise plans around capital programmes when not enough detail was provided by WG when issuing capital grants, often at very short notice.  

 

In querying the future provision of respite care, the Committee was advised that some changes had been made to the start and finishing times for overnight respite stays. This had resulted in earlier pick up times, and thus a reduction in staffing hours, but had maintained the number of nights available.  The Committee also noted that the service was exploring possibilities around the use of the respite facility developed through the Penarth Learning Community. 

 

A Committee Member, referring to a report to the Scrutiny Committee (Housing and Public Protection) on options for increasing older persons’ accommodation, queried whether a similar report would be presented to this Scrutiny Committee.  In response, the Head of Business Management and Innovation informed the Committee that a similar report would be presented to the Scrutiny Committee, probably during the summer.  She further advised that an officer working group, of which she was the Chair, was looking at a number of options around older persons’ accommodation and was evaluating which were the most appropriate.  This project was supported by the Wales Co-operative Centre and a report would be presented to Cabinet in due course. 

 

Having considered the report, the Committee

 

RECOMMENDED –

 

(1)       T H A T the position with regard to the 2014/15 revenue and capital monitoring be noted.

 

(2)       T H A T the progress made in delivering the Social Services Budget Programme be noted and referred to Cabinet for information.

 

Reasons for recommendations

 

(1)       That Members are aware of the position with regard to the 2014/15 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.

 

 

838     DISABLED FACILITIES GRANTS PERFORMANCE REPORT FOR QUARTER 1 AND 2 2014-15 (REF) –

 

On 15th December 2014, Cabinet were apprised on the Council’s performance in delivering Disabled Facilities Grants (DFGs) during the first two quarters of 2014-15 and progress made on process changes.  Cabinet had referred the performance report to the Committee for consideration purposes. 

 

The Council had a statutory duty to consider and approve applications for DFGs where there was an identified need and where the property could be reasonably adapted.  DFGs funded the adaptation of privately owned homes to allow residents to live as independently as possible in their own home for as long as possible.

 

The delivery time of DFGs was a national performance indicator.  The Council had previously acknowledged its performance in delivering DFGs had to be improved, but despite this improvement, in 2013/14, the Council remained in the bottom quartile of performance for Local Authorities in Wales.

 

Over the past six years, the Council had been able to reduce the time to deliver DFGs down from an average of 1,046 days in 2008/09 to 284 days in 2013/14. 

 

The DFGs Performance Indicator was measured across all Welsh Local Authorities and reported as a national Performance Indicator.  The Performance Indicator sought to measure the customer’s experience of waiting for home adaptations and how it was measured was prescribed within national guidance.  The Indicator sought to measure the time between the resident asking the Council for help to adapt their home to the time their home was adapted. 

 

The Indicator only measured the time adaptation takes for works funded by a DFG.  There were no equivalent nationally measured Performance Indicators for adaptations requested and completed within the Council’s Registered Social Landlord housing stock. 

 

The guidance on measuring the DFG delivery time stated the time starts at the point a resident contacted the Local Authority requesting help with adapting their home, or at the point the Council becomes aware that an adaptation was required by a resident.  The second starting point occurred where the resident was already accessing Council services.  The clock stopped on a case when the adaptation was completed and safe to use. 

 

Once the clock started 'ticking', the guidance was clear that the clock could not be stopped and restarted during the processing of a DFG application.  For example, if a client went into hospital, on holiday or delayed the process for personal circumstances, this time delay would be included in the performance time. Therefore, while the service seeks to improve the delivery time to improve the applicant's experience, this needed to be balanced with an applicant's choice and circumstances.  If a delay occurred that impacted on the delivery time significantly, this would be reported through the performance reports.

 

The Committee was advised that this Council measured the delivery time in line with this definition and in the spirit in which the indicator was developed.  However, there was an alternative definition being used by some Councils.  In this alternative, enquiries for assistance to the Council by people wanting help to access their homes and bath were not considered a DFG enquiry until the Occupational Therapist had visited the person and completed an assessment even though they may have specifically asked for a disability adaptation.  If this OT assessment identified the need for physical adaptation (i.e. a DFG) and not equipment or minor works, this would be the point at which the time to deliver a DFG was started when measuring the DFG performance indicator.  If this starting point for the delivery time was used in the Vale of Glamorgan to measure performance, delivery time during quarter 1 and 2 would be 161 days.  In relation to 2013/14 performance figures, from the information available, this would have placed the Authority second in Wales using this alternative definition.

 

Performance of the DFG service continued to improve during quarter 1 and 2 2014‑15.  During this period, the average time to deliver a DFG had reduced to 217 days.  This improvement was due to the changes made to the service during December 2013 and January 2014. 

 

Compared to the published DFG performance figures for 2013/14 for Welsh Authorities, this performance would have ranked the Council 8th.  If the trend of improvement across all Local Authorities continued into these two quarters, this performance would be close to the Welsh average. 

 

A detailed breakdown of the DFG service performance at the half year was attached at Appendix 1 to the report.  This also included a summary of the customer satisfaction survey results which included clients’ feedback.

 

The report highlighted that, since November 2014, the Business Improvement Team had also been working with the DFG service using the Business Improvement Toolkit to identify improvements within the administrative process of the DFG service that would assist in improving the service. 

 

In quarter 3, 2014, an amended Council DFG Customer Satisfaction Form was introduced.  This would have generic questions that all Local Authorities across Wales will be using to enable benchmarking of service quality in addition to service delivery times. 

 

In answer to a Member’s query regarding clarification around the definition of 'agency’ and 'non-agency’ organisations, the Committee was advised that 'agency’ related to clients which were fully supported through the process through the use of a framework contract.  Non-agency clients could choose which partner agencies to carry out housing adaptation works, for example Care and Repair. 

 

The Chairman, in querying the impact following the involvement of the Business Improvement Team, was advised that their input had been very useful and productive.  Back in November, the Business Improvement Team went through the processes from the O.T. first contact to recommendations received by the DFG Team.  From this an action plan was formalised, which recommended ways of streamlining the process, e.g. how to reduce the number of contacts made between the service and its clients.  The Business Improvement Team would consider Stage Two of the process next.

 

Finally, the Committee were keen to express its thanks and gratitude to the staff.

 

Having considered the performance report, the Committee

 

RECOMMENDED –

 

(1)       T H A T the report on performance for delivering Disabled Facilities Grant during quarters 1 and 2 of 2014-15 be noted.

 

(2)       T H A T the progress made on process changes to improve the delivery of Disabled Facilities Grants be noted.

 

(3)       T H A T the Committee’s thanks and appreciation be passed on to staff members.

 

Reasons for recommendations

 

(1&2)  In order for the Scrutiny Committee (Social Care and Health) to review the performance of this service.

 

(3)       In recognition of the improved performance around DFGs and to offer the Committee’s thanks and appreciation to the staff for their hard work and commitment. 

 

 

839     REQUEST FOR CONSIDERATION OF MATTER (COUNCILLOR R.J. BERTIN) – THE MEALS ON WHEELS SERVICE (DSS) –  

In presenting the request, Councillor Bertin stated that recent reports in the press highlighted that the number of people receiving Meals on Wheels had dropped by half. It was therefore appropriate for the Scrutiny Committee to be provided with information regarding the numbers using the Meals on Wheels Service and the potential for future funding reductions. 

 

The Head of Adult Services, in response to the Request for Consideration, presented a report which advised that Meals on Wheels was a social care service that delivered hot meals to people at home which were assessed as being unable to undertake these tasks for themselves.  Within Barry, one Meals on Wheels route was currently facilitated through a Service Level Agreement with the Royal Voluntary Service.  Volunteers delivered the meals from Rondell House. 

 

At present there was no statutory requirement for the local authority to provide a Meals on Wheels Service.  However, the local authority must assess the needs of individuals to ensure that, where there eligible risk to independence, these risks were mitigated through the provision of services.  Those that experience risks associated with potential malnutrition would be eligible for a service to ensure that their needs were met.  This could be met in various ways and not just through the delivery of a hot meal by the local authority.  For example, frozen meal delivery services had proved to be popular.  The principle advantages were that individuals had greater choice over what and when they could eat, without any requirement for an assessment by Social Services.  Some schemes in other local authority areas would involve the provision of vouchers which could be used in local facilities such as cafes.  Additionally, a number of pension clubs and day services exist across the Vale of Glamorgan, providing not only meals but also an opportunity to engage with other people. 

 

Members noted that the use of the Meals on Wheels Service had reduced substantially across the United Kingdom.  Recent figures for England, reported following a Freedom of Information request, indicated that the number of elderly people receiving meals provided by local authorities had fallen in the last five years from 296,000 to around 109,000.  The position across Wales varied.  In 2013/14, six local authority areas did not provide a Meals on Wheels Service, with a further three indicating that they would discontinue it in 2014/15. 

 

Within the Vale of Glamorgan, the number of people that use the Meals on Wheels Service had reduced significantly.  The service was delivering approximately 112 meals per day in 2002 and now the figure was approximately 78.  At weekends, a reduced service would be in operation and would deliver approximately 40 meals to the central and eastern Vale.  The Meals on Wheels service at the furthest end of the western Vale was discontinued several years ago, following equipment failure in the local kitchen.  Alternative meal services were available.  Low demand levels and the additional distances involved in delivering to rural locations in the western Vale meant that recommencing the service in this area was likely to incur additional costs. 

 

The charge for a meal in the Vale of Glamorgan was £3.30 in 2013/14 and had risen to £4.10 in 2014/15.  This was to bring the charge closer to the costs of preparing and delivering meals.  Reductions for the numbers of meals provided meant that the expected rise in overall income through the price increase had not been fully realised.  Based on the existing level of use, the price per meal would need to rise by just over £1.00 for the service to become cost neutral. 

 

During 2013/14, the costs across Wales varied between £2.35 and £4.00.  In 2014/15, the cost varied between £2.60 and £5.00.  It was therefore evident that authorities across Wales were seeking to increase the income generated by the service to reduce their overall costs. 

 

In the Vale of Glamorgan, all Meals on Wheels were now prepared from the kitchen at Rondell House.  This had enabled the service to be sustainable to date, even though the number of deliveries had reduced.  However, the changing pattern of demand and the associated reduction in numbers meant that they would be prudent to initiative a more comprehensive review of the service to consider how the needs of the population could be best met in the future.  This would involve engaging with service users, carers and representative organisations to ascertain their wishes and views, including the merits of alternative models of provision. 

 

A Committee Member, in referring to the comprehensive review of the service, enquired as to when this was likely to take place.  The Head of Adult Services advised that this would depend upon where the Directorate wished to go with the Meals on Wheels Service, for example whether there was a need to find quick cost savings.  At the moment, the context of the review was too narrow to identify if the service would be viable at its current level in supporting around 80 individuals.  Further to this, the Director of Social Services commented that he understood the need for the Scrutiny Committee to be reassured but, as with all service matters and remodelling, there was a set process to be followed before any recommendations could be made which included, for example, engagement with service users. 

 

At this point, the Chairman recommended that a report in relation to the findings from the comprehensive review to be presented to the Scrutiny Committee before any formal decisions had been made. 

 

In referring to the decision to discontinue the service within parts of the Western Vale, the Committee was advised that this was as a result of a breakdown of the oven at the local kitchen.  This affected 23 service users, six of whom were able to make their own arrangements, while a further six agreed to be provided meals through an alternative model.  Four further clients had been in receipt of home care and thus their meal provision was provided as part of their care package, whilst for the remaining clients further information needed to be acquired.  It was noted that for those individuals who had received the alternative meal service positive feedback had been received and they had liked the flexibility and the choices offered by the changes.  Members were asked to note that there were a number of reasons as to why an alternative model might be better for the majority of people.  In terms of promotion of the Meals on Wheels Service, the Head of Adult Services advised that the service would encourage people to acquire services that would help them support themselves and he cited the Dinas Powys Luncheon Club as an example of this.  A traditional Meals on Wheels was not always the most appropriate way of meeting a person’s needs and could be fairly inflexible.  He advised that all Local Authorities in Wales offered an alternative Meals on Wheels Service provided through a commercial partner and he stated that he knew of six Local Authorities within Wales that did not provide any Meals on Wheels provision. 

 

The Director of Social Services stated that Council needed to be careful that it achieved value for money in all areas and it was important for the Council to consider how to make the best use of its resources.  Maintaining some services could potentially impact upon the budgets of other service areas and there was a need to consider alternative service delivery models where appropriate.

 

RECOMMENDED -

 

(1)       T H A T the Scrutiny Committee notes the content of the report.

 

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

 

(3)       T H A T a further report be received by the Scrutiny Committee detailing the outcomes and findings from the comprehensive review.

 

Reasons for recommendations

 

(1)       To ensure that the Scrutiny Committee can exercise oversight of the service.

 

(2)       In order to update Cabinet on the developments within the Meals on Wheels Service.

 

(3)       To ensure that the Scrutiny Committee had effective oversight of decisions affecting the Meals on Wheels Service.

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