SCRUTINY COMMITTEE (SOCIAL CARE AND HEALTH)
Minutes of a meeting held on 21st May, 2015.
Present: Councillor R.L. Traherne (Chairman); Councillors Mrs. M.E.J. Birch, Ms. R. Birch, E. Hacker, H.C. Hamilton, Dr. I.J. Johnson, J.W. Thomas, S.T. Wiliam and Mrs. M.R. Wilkinson.
Also present: Councillor S.C. Egan.
51 CHAIRMAN’S ANNOUNCEMENT –
The Chairman took the opportunity to welcome Councillors E. Hacker, H.C. Hamilton and Mrs. M.R. Wilkinson to the Scrutiny Committee.
He also offered the Committee’s congratulations to the Head of Business Management and Innovation for her new appointment and thanked the officer for her hard work, honesty, openness and ability to effectively explain complex issues.
52 APOLOGIES FOR ABSENCE –
These were received from Councillor R.J. Bertin.
53 APPOINTMENT OF VICE-CHAIRMAN –
Councillor Mrs. M.E.J. Birch was duly elected Vice-Chairman for the current Municipal year.
54 MINUTES –
RECOMMENDED – T H A T the minutes of the meeting held on 13th April, 2015 be approved as a correct record.
55 DECLARATIONS OF INTEREST –
No declarations were received.
56 DEPRIVATION OF LIBERTY SAFEGUARDS (REF) –
On 13th April 2015, Cabinet was updated on the emerging implications for the Council of the Supreme Court judgement on the Cheshire West and Surrey cases in March 2014, which related to the use of the Deprivation of Liberty Safeguards 2009, and the impact upon the Social Services Directorate’s capacity to meet statutory obligations under the safeguards.
The Cardiff and the Vale Deprivation of Liberty Safeguards / Mental capacity Act (DoLS / MCA) Team continued to fulfil the Supervisory Body responsibilities required for DoLS on behalf of Cardiff and Vale UHB, City of Cardiff Council and the Vale of Glamorgan Council. This was overseen by a partnership management board consisting of senior representatives from each Supervisory Body. On behalf of the three Supervisory Bodies, the team was responsible for the following:
Co-ordination of DoLS assessments as requested by Managing Authorities
Supervised and managed the workload of over 40 Best Interest Assessors
Advised and supported health and social care teams across the sector in relation to MCA / DoLS issues
Provided training for care homes and all in-patient sites across the hospitals of Cardiff and the Vale of Glamorgan.
Since the Supreme Court ruling, the team had seen a 10 to 15 fold increase in the number of referrals, particularly from Care Homes.
It was notable that the number of referrals from hospital wards had not increased at the same rate.
Table A within the report showed the number of DoLS referrals per Supervisory Body. In terms of the Vale, the number of referrals had increased from 6 in 2013/14 to 401 between April 2014 and the end of January 2015. This represented 30% of the team’s activity.
Table B showed the number of completed DoLS assessments for each of the three Supervisory Bodies. For the Vale, 119 assessments had been completed which had accounted for 21% of the overall team activity. At present, there were still 282 outstanding assessments to be completed.
Where a Managing Authority (Care Home for the Local Authority or hospital ward for the LHB) made an Urgent Authorisation following a sudden and unforeseen event, they were in effect authorising themselves to deprive a person of their liberty for up to 7 days. The Managing Authority must request a Standard Authorisations from the Cardiff and Vale MCA / DoLS team at the same time as issuing their own Urgent Authorisation. The team then had 7 days to undertake a full DoLS assessment to consider an ongoing Standard Authorisation.
Standard Authorisation requests were made where a Managing Authority had reason to believe that they were depriving a person of their liberty or would deprive a person of their liberty within the next 28 days. The Supervisory Body then had 21 days to undertake a comprehensive DoLS assessment in order to consider authorising the Deprivation of Liberty.
The report outlined that Supervisory Bodies were at risk of legal challenge for not complying with the statutory timescales within the DoLS process. Essex County Council was recently ordered to pay damages of £60,000 following a breach of statutory timescales.
A breakdown of team demand and capacity was provided, which was as follows:
Number of requests for DoLS Authorisations was between 150 and 200 per month
- Each DoLS assessment would take between half and a full day to complete
- Each DoLS assessment must be authorised by a senior manager within the Supervisory Body (half an hour per authorisation)
Team Best Interests Assessors (BIAs) were currently undertaking approximately 60 to 70 DoLS assessments per month
Rota BIAs were undertaking approximately 20 assessments per month
A shortfall of between 50 and 100 DoLS assessments per month was leading to an increasing backlog of outstanding referrals.
The team would require an additional two full time Best Interest Assessors to reduce the backlog of care home DoLS and to ensure compliance for all new DoLS requests. This would cost the Cardiff and Vale Local Authorities in the region of £60,000 and £40,000 respectively.
In relation to people living in domestic settings, the report outlined that supported living arrangements provide care and support that may necessitate continuous supervision and control and require the person to live in a particular property where the support could be provided. This would constitute a Deprivation of Liberty. Within the Vale there were 150 people living in supported living accommodation with a potential that 75 of these cases to be deprived of their liberty.
Members were asked to note that people living in supported accommodation stood outside the Deprivation of Liberty Safeguards, so care managers / care co-ordinators for all identified individuals should consider an application to the Court of Protection for authorisation of the care regime. On the basis of legal advice, Cardiff and Vale Councils had identified a number of individual care arrangements (4 and 2 respectively) to take to the Court of Protection for consideration.
The Court of Protection was experiencing significant challenges in hearing the increased volume of cases and it had recently revised application arrangements to speed up the process.
The Chairman queried whether the recruitment of two best interest assessors had been fully costed and whether the service would appoint them. In reply the Head of Adult Services advised that the service would be getting the two new appointments, but the challenge would be in assessing whether this was sufficient to deal with the backlog. This would be something that the service would keep an eye on and report back to Scrutiny in due course. Further to this, a Committee Member queried as to what the situation would be like during 2015/16. In response the Head of Adult Services stated that in terms of personnel, this was something that the service could actively control and that there would be opportunity if needed for social work staff to be redeployed. He commented that there must be a ceiling in terms of numbers of people within care homes as there were a finite number of places but he was not sure whether the ceiling had been reached within hospitals as the same level of increase had not been seen. He also alluded to the need to review a person’s situation after 12 months, which would also have an impact upon resources.
In answer to a Committee Member’s query as to whether the court’s verdict in respect of DoLS covered the whole of the United Kingdom, the Head of Adult Services stated that he was not sure as Scotland came under a different judicial system. He agreed to clarify this and report back to Members. He went on to make mention of the £25m made available to Authorities within England, and that no additional support had been made available by the Welsh Government. For this reason, the Association of Directors of Social Services had made representations to Welsh Government, but as yet no decision had been made. He also stated that there was a need to streamline the assessment process and to look at how work was undertaken.
Further to this query, the Director of Social Services made a generic point in relation to the issue of how social services budgets were managed and the impact that case decisions made by Courts could have on services and resources. The Council would need to decide how it could manage the situation. It could either divert resources or increase funding.
A Committee Member questioned as to why there was a need to review the case after a period of 12 months and whether this was down to a person’s condition worsening. The Head of Adult Services advised that this may indeed be so but, regardless of this, after a 12 month period the service would have to re-examine a person’s situation to determine if it was still right to deprive the individual of their liberty. The service could determine to deprive a person of liberty for a shorter period, but this was less common. The main client group would be people who were in nursing / residential care homes and those at the end of life stages.
A Member commented that depriving a person of their liberty was a very serious matter and queried as to where all these cases had come from. In response, the Head of Adult Services explained that all referrals would come via care homes as this was something that the homes had to do when there were issues around a person’s mental capacity and they were unable to leave the home, often for their own safety. These homes had a responsibility to bring these cases to light as, if they did not, they could be open to criticism. He went on to state that following the change in law the service would need to make judgements between maintaining a person’s liberties or keeping them safe.
Officers were asked to clarify, in terms of cost, what could happen if the Council was taken to court. The Head of Adult Services advised that a recent case within Essex in which the Local Authority had breached the statutory timescales had resulted in a £60,000 fine for that Authority. He also advised that the backlog did present a significant risk for the Authority but that the Vale of Glamorgan was no better or worse than any other area within the UK.
Having considered the reference, the Committee
RECOMMENDED – T H A T Cabinet be requested to contact Welsh Government in order to seek financial support in view of the additional work that had been created.
Reason for recommendation
In order to address the need to mitigate the risks associated with deprivation of liberty safeguards within the Vale of Glamorgan.
57 IMPLEMENTATION OF THE SOCIAL SERVICES AND WELL-BEING (WALES) ACT 2014 (DSS) –
The Committee received its second monthly update in respect of the Social Services and Well-being (Wales) Act 2014 ("the Act") and the approach being taken to implementation. On 13th April 2015 Members received and noted the Director of Social Services’ response to the consultation regarding the first tranche of regulations and guidance regarding parts 2, 3, 4, 7 and 11 of the Act as issued by Welsh Government in November 2014. The Minister for health and Social Services, on 27th February 2015, provided a statement to Assembly Members about the emerging these from the first tranche of regulations, the related codes of practice and statutory guidance to be made under the Act. More than 300 substantive written responses from a wide range of individuals, representative groups, local government and professional organisations had responded to the consultation. The Minister stated that the overall response to the consultation was positive and that respondents were supportive of the principles and detail.
Work on analysing the responses in detail was still ongoing but a number of common themes had emerged:
The need for a comprehensive approach to learning and development to ensure staff across the sector and partners have the knowledge and skills to deliver the new requirements and organisations are supported to make the necessary cultural changes;
The need for a considered approach to transition to the new system;
The need to raise awareness among the public about the changes that will be introduced;
The need to ensure all delivery partners are fully engaged in considering the way resources are targeted on implementation;
The need to embed collaboration, not only in delivery through partnership arrangements such as Local Authorities and health boards, but also in policy delivery through different parts of the Act;
The need to continue to work together to embed new practice and arrangements beyond April 2016, including co-developing guidance around good practice.
There were concurrent pieces of work underway covering workforce readiness, awareness-raising among the wider population, and key regional implementation activity. The Care Council for Wales was the lead body for workforce development, and would lead on the development and implementation of a national learning and development strategy. This strategy was critical to implementation of the Act and would need sustained, deliberate and high profile leadership, which could reach out across a wide range of organisations and partners beyond the boundaries of the traditional social care sector. It would include a training deployment plan and a one stop shop information hub, playing a key supporting role for the sector in ensuring its own readiness for the changes the Act and its regulations would bring into force. It would be supported by £1m in 2015-16 from the social care workforce development programme. A further £7.1m from the programme, together with the Local Authority match funding already in place (making a total of some £11m) would support the development and implementation of cross-sector regional training plans, which would align with both the national strategy and regional implementation plans.
On this basis, regional partners would be required to prepare a self-assessment of readiness to implement the Act. The two Local Authorities, the Cardiff and Vale Health Board, Cardiff Third Sector Council and the Vale Council for Voluntary Services took part in the self-assessment, which had been submitted to Welsh Government on 30th January 2015. This was considered by Members at the meeting held on 13th April 2015.
In respect of preparations to ensure readiness to implement the Act, in order to support Local Authorities Welsh Government had made available the Delivering Transformation Grant in 2014/15, which totalled £1.5m across Wales. The Vale of Glamorgan and Cardiff were allocated £194,910 and this grant was managed by the Vale of Glamorgan Council on behalf of the partner organisations with the Director of Social Services in the Vale of Glamorgan acting as the Regional Lead Director. The Quarter 4 / end of year report which had set out what had been achieved using the Delivery Transformation Grant 2014/15 was detailed in Appendix 1 to the report.
To reinforce collaboration between local government and the NHS, the terms of the 2014/15 grant included the requirement to develop regional governance arrangements which reflect the national steering and engagement structure, with a Partnership Forum and Leadership Group. Locally, this had been established through the Integrated Health and Social Care Governance Board and a Strategic Leadership Group. The terms of reference of the Board had been reviewed on 14th April 2015 and the revised terms of reference was contained at Appendix 2 to the report.
Further to this, the report outlined that these may need to be reviewed again in response to Welsh Government Guidance in respect of Part 9 of the Act, which deals with co-operation and partnership. Draft guidance was likely to be available for formal consultation in May when the second tranche of regulations and guidance in relation to Parts 5, 6 and 9 of the Act would be issued, with a view of being laid before the National Assembly late in 2015. The second tranche would seek to create a system which secured outcomes for Looked After and accommodated children; drives regional collaboration; puts in place a system of charging, financial assessment and paying for care; supports the making of representations and provision of advocacy and addresses the issues raised by provider failure.
One of the other key deliverables of the grant was the development of a comprehensive regional implementation plan by the end of the financial year. This was contained at Appendix 3 to the report, which was submitted to Welsh Government on 31st March 2015.
In relation to funding for 2015/16, the report highlighted that the Welsh Government would continue to support local government and its partners in making the transition to the new arrangements. It had doubled the funding available through the Delivering Transformation grant to £3m in 2015/16. Subject to budgetary decisions, a further £3m in grant funding would be made available in 2016-17 to support the embedding process, with a view to transferring this sum into the Revenue Support Grant from 2017/18 in recognition of the ongoing change which the Act would be driving.
From this grant, the Welsh Government had allocated £414,648 to the Vale of Glamorgan and Cardiff region to continue the delivering transformation / sustainable social services agenda during 2015/16. Appendix 4 to the report set out a programme for delivery which would ensure the necessary resources were in place.
The Chairman queried progress made in relation to the creation of a Regional Citizen’s Panel. The Head of Business Management and Innovation advised Members that the service had a duty to consult on the impact of the Act and had decided to consult about service user representation within the governance arrangements.
In response to the Committee’s query regarding the potential use of social enterprises, the Head of Adult Services advised that growth in this sector was one of the outcomes following the review into day opportunities within the Vale. Examples of these were highlighted through the use of organisations such as Positive Images.
The Committee further enquired about the percentage of care provided â€œin-houseâ€ by the Council, and was advised that within the domiciliary care sector, 95% of the service was provided by independent sector organisations. Members were also advised that 80% of the residential care sector was covered by private care organisations.
In response to a follow up question as to whether this was likely to change, Members were advised that the Wales Co-operative Centre was looking into this and Members were asked to note that a review of accommodation with care provided to older people was underway. This would highlight what sort of service people would want and what the model would look like.
With regard to funding, the Committee was advised that there were three distinct funding streams, these being the Delivering Transformation Fund, the Regional Collaborative Fund (RCF) and the Intermediate Care Fund (ICF).
The Director of Social Services stated that funding was one of the main challenges facing the service and he alluded to the Welsh Government’s stance around the Act being cost neutral, despite the scale of new responsibilities and new statutory guidelines that would come about. He mentioned that the Transformation Fund was not a service development grant like the RCF and that the fund would be concurrent and would be integrated into the Revenue Support Grant.
A Member, referring to the delivery programmes detailed within Appendix 4 of the report, queried the current status of priorities 5, 11 and 14. He stated that many priorities within the appendices had missed the related deadlines and queried as to what was being progressed. In response, the Head of Business Management and Innovation advised that this was a significant dilemma for the service as the bids that had been submitted to Welsh Government had not been agreed and so some deadlines had slipped. The service was hoping that a reply would be received from the Welsh Government very soon. Further to this point, a Committee Member sought clarification as to how the service would operate when details around allocated money were received late within the financial year. The Director of Social Services explained that this was why it was such a complex issue to manage, particularly as proposals needed to be approved on a regional basis. The service would usually receive belated requests from the Welsh Government concerning how allocated funding should be used. Many of these requests would be aspirational ideas of Welsh Government, for which advice was not always clear as to how these aspirations should be interpreted and the Director felt that in many instances the Council was always playing catch up. Deadlines and actions could therefore never be fully set in stone but all the changes relating to the Act needed to be implemented by April 2016.
In response to the Chairman’s query regarding progress made with the new Community Care information system, the Director of Social Services advised that he had been able to attend a trial seminar around the new system and most of the delegates that he had spoken to had been impressed as to how the system worked. He alluded to the shortcomings within the current system but he offered a word of caution that the new system would not be installed quickly and that it may take between three to five years to be fully implemented. He explained that this was an extraordinary opportunity for services within Wales and that the sharing of information was of critical importance. It was also important to mention and recognise the good work that had been undertaken to get to this stage.
The Committee subsequently
(1) T H A T the report be noted.
(2) T H A T the Scrutiny Committee continues to receive regular updates about implementing the Act.
(3) T H A T the report be referred to Cabinet for information.
Reason for recommendations
(1-3) To ensure that elected Members are kept informed about fundamental changes in the policy and legislative framework which underpin the work of Social Services.
58 THE VALE OF GLAMORGAN HEALTH, SOCIAL CARE AND WELLBEING PARTNERSHIP (DSS) –
The Director of Social Services presented the report, the purpose of which was to update Members on the work of the Health, Social Care and Wellbeing Partnership. The report stated that the area of health, social care and wellbeing for the Vale of Glamorgan was a key component of the Council’s Community Strategy. The work was driven through two main partnership bodies, i.e. the Integrated Health and Social Care Partnership and the Public Health and Wellbeing Board.
The Integrated Health and Social Care (IHSC) Partnership oversaw the collaborative work undertaken between the Vale of Glamorgan Council, Cardiff Council, Cardiff and Vale University Health Board, the Vale Centre for Voluntary Services and Cardiff Third Sector Council, to develop and support the growing number of joint social care and health services.
The Public Health and Wellbeing Board originally operated within the Vale of Glamorgan only, with the responsibility for steering collaborative work that addressed key health determinants for the population such as the use of tobacco, food and physical activity, alcohol consumption and the update of immunisations. Following the development of a Joint Local Service Board with Cardiff Council, it was agreed that this partnership stream should explore how its original agenda might be best aligned with similar work within Cardiff.
The report outlined that the IHSC Partnership was benefiting from the revised governance structure which had been set in place 12 months ago with the aim of increasing the scale and pace of integration across health and social care services. Progress within a number of areas had been made. The first area related to a strategic review in which an independent consultancy had been commissioned by the Partnership to undertake a review of current resources and activity levels across community health and local authority services for older people. The work sought to identify key priority areas for further development. In April 2015, all members of the IHSC Governance Board confirmed their support for this programme and acknowledged the need for pooled or aligned funding across the agencies to support delivery. The final report would be discussed by the IHSC Strategic Leadership Team, which was attended by the Council’s Managing Director in May and by the Governance Board at the end of June 2015.
Another area of progress had been in relation to Delayed Transfers of Care (DToC). Following a meeting with the Deputy Minister for health, the IHSC Partnership had been asked to take a lead in ensuring a significant reduction in DToCs across Cardiff and the Vale of Glamorgan community. The Vale of Glamorgan local authority was able to demonstrate significant progress in this area over the past two years and, as such, it was in a position to share the learning from that process with other partners. The Vale would participate fully in ongoing data analysis, to explore the reasons for a recent increase in delays seen in January and February of this year. It should be noted that there had been a significant reduction in delays as of march 2015. Following further work to map out and change operational processes that hindered timely discharge, the IHSC Partnership would oversee a new performance management system and the delivery of remodelled services to be set in place through the Intermediate Care Fund and the Regional Collaborative Fund.
Members were advised that through the Intermediate Care Fund during 2014/15 the Partnership was able to test new ways of working across the health and social care system using the short term funding available. The Minister for health and Social Services had announced that recurrent funding of £20m would be used to continue Intermediate Care Fund projects which had shown themselves to be of positive advantage to the community. The funding was being made available through the University Health Board budgets and proposals had to be agreed by the IHSC Governance Board. Preparation of final evaluation reports was being undertaken in order to review the impact of the schemes undertaken in 2014/15 and to scope out the delivery phase of key components of the new programme, which would be implemented across the Cardiff and Vale Health Board partnership footprint. These included:
Development of a single point of access for citizens and health and social care professionals;
An accommodation solutions / resettlement project, providing a co-ordinator to work with patients and professionals to fast track discharge from hospital where an accommodation issue was preventing this;
Community Resource Team Reablement Plus which involved the provision of support by a multi-disciplinary team through step-down facilities leading to active recovery and reablement;
Preventative interventions / services, to maximise opportunities to enable people to live independently for as long as possible.
A full report of these proposals would be provided to Scrutiny following completion of the final evaluation and further discussion within the IHSC Partnership.
In relation to the Regional Collaborative Fund (RCF), it was advised that this three year (April 2013 – March 2016) funding stream continued to provide positive benefit for Learning Disability services reform and for broader adult services change through support for elements of the Vale Community Resource Team. The IHSC Governance Board approved the most recent Quarter 3 report for the RCF in April 2015 and initial discussions were already underway to identify ways in which funding for these services might be sustained in the longer term.
With regard to the implications of the Social Care and Well-being (Wales) Act 2014, Welsh Government required that each region should reflect the National Partnership Forum arrangements, to include representatives from other organisations such as the Care Council and the Independent Sectors.
In April 2015, the IHSC Governance Board endorsed the Regional Delivery Plan and agreed that its terms of reference should be amended to reflect the needs of the new Act, taking on the role of the Regional Partnership Forum for Health and Social Care and overseeing implementation of the Act. The resulting amendments to the terms of reference were provided at Appendix 1 to the report. These matters may need to be reviewed again in response to Welsh Government Guidance in respect of Part 9 of the Act, which deals with co-operation and partnership. Draft guidance was likely to be available for consultation in May.
The report outlined that for the Interim Carer’s Strategy 2015-2016, the IHSC Governance Board had approved that the Partnership should support delivery of this Strategy and it had endorsed the Action Plan for 2015-16. Regular performance reports would now be brought to the Strategic Implementation Group.
In addition, the Delivering Transformation Fund partners were currently preparing their bid in respect of the £414,648 allocated grant in order to support the ongoing development of integration and attainment of all aspects of the Social Services and Well-being (Wales) Act 2014 across Cardiff and the Vale of Glamorgan.
For the Community Care Information System, Members were advised that following completion of a national tendering exercise to secure a new electronic case management and information system for social care, mental health and community health care, the IHSC was undertaking a baseline assessment to inform how implementation of this new system may be achieved across the Cardiff and Vale of Glamorgan community. Further information would be provided to Scrutiny following completion of this process.
Work was also underway in respect of the Older People Framework to ensure appropriate links between this strategic document and the Ageing Well Delivery Plans currently being developed by the Local Authority.
For the Public Health and Wellbeing Programme, the report outlined that following recent proposals to develop a Joint Local Service Board between the Vale of Glamorgan and Cardiff, work had started to identify a model to improve public health and wellbeing across both areas which allowed for increased collaboration and joint working whilst respecting the specific needs of individual communities and the roles and responsibilities of statutory organisations. The Director of Social Services commented that a major focus would be around tackling obesity and that there were some early signs that people’s behaviours in respect of diets were starting to change.
The report also stated that the Public Health and Wellbeing Board had now been replaced with a joint structure including both the Vale of Glamorgan and Cardiff Local Authorities. The new structure incorporated the following elements:
Health and Wellbeing Performance Management Group
Membership comprised senior managers from across partner organisations, meeting every four months with the aim of:
- Ensuring delivery of existing action plans and that â€œbusiness as usualâ€ continued at a local level on tobacco, food and physical activity
- Ensuring links with ongoing work by the Area Planning Board, Healthy Schools and the Cardiff and Vale Immunisation Steering Group
- Scrutiny of Highlight Reports on the above
- Reporting to the Cardiff and Vale Joint Local Service Board (C&VJLSB)
- Inform work of the Task Force as set out below.
Health and Wellbeing Development Task Force
Despite concerted efforts across the Vale of Glamorgan, it was clear that significant work remained in order to reach the objectives set out within the Food and Physical Activity action plan. It had been agreed that obesity was now the key topic which would be prioritised, to introduce a renewed approach for prevention across the Vale of Glamorgan and Cardiff. On completion of an initial scoping phase, a full proposal would be brought to the C&VJLSB for approval.
A task force was being initiated to develop an ambitious, aspirational and innovative approach to tackling obesity and two pieces of work had been commissioned to inform the process:
- A review of best practice internationally
- Establishing a series of conversations with the general population (to include professionals, communities and individuals) to develop the vision of what should be achieved.
A Committee Member questioned the level of influence that the two bodies could have in relation to their limited resources and lack of statutory powers. In response the Director of Social Services stated that the Public Health and Wellbeing Programme was an alliance of many partner agencies and bodies. An important element of their work was evaluating which programmes worked effectively and they had identified that food security was an important consideration. For this people required wholesome food that was not too costly and there was a need to tackle poverty in parts of the country and target certain groups of people such as those on low income. He explained that positive outcomes achieved in other parts of the world had been backed up by laws and he cited changes made to people’s behaviour as a result of laws made requiring the compulsory wearing of seatbelts. Local Authorities could still effect change, for example, by encouraging people to partake in more sport and physical activities.
A Committee Member, referring to the partnership work around Delayed Transfers of Care, queried as to what were the problems within the system which prevented people being discharged from hospitals. The Head of Adult Services explained that this was a very complicated issue that covered two distinct geographical areas, the Vale of Glamorgan and Cardiff. So far for this year, the Delayed Transfer of Care figure had improved in the Vale but it was unclear whether this could be sustained. Specific to Social Services Delayed Transfers, the service had undertaken a review to identify where the breakdowns had been and whether there were other delays within the system. The main concern identified was in relation to the choice of care home being available to individuals. It was important to recognise that it was not just a simple case of allocating extra resources to cover this as this may have a knock on effect on another part of the service such as reducing the availability of places. Within the Vale of Glamorgan an action plan had been drafted in order to consider a number of areas and the choice of care home offered to individuals by Social Services was part of this, but Health input was also required. He offered Members reassurance that as the Committee had been tracking the Delayed Transfer of Care figure every quarter over a period of sometime, this would be something that he carefully watched and therefore would remain a main focus of the service as a whole.
RECOMMENDED – T H A T the contents of the report be noted.
Reason for recommendation
To ensure that Elected Members can exercise effect oversight of this important area of collaborative working.
59 THE VALE OF GLAMORGAN AND CARDIFF INTEGRATED FAMILY SUPPORT SERVICE ANNUAL REPORT 2014/15 (DSS) –
The Director of Social Services presented the report, the purpose of which was to provide Members with the Vale of Glamorgan and Cardiff Integrated Family Support Service (IFSS) Annual Report for 2014/15 prior to its submission to the Welsh Government.
As a background summary the report highlighted that through provision of its Flying Start, Families First and IFSS programmes, the Council would have in place a coherent framework for delivering the range of preventative, protective and remedial family support initiatives set out in relevant Welsh Government strategies. By providing intensive and specialist help to families where risks were escalating, the IFSS had a key role to perform in reducing harm to children and also the volume of avoidable admissions to the Looked After Children’s service.
The IFSS programme was intended to provide more holistic support to families by breaking down boundaries between local government and health, between adult services and children’s services. It was delivered by a combination of highly skilled professionals form social care and health, acting as a single workforce.
Under the Children and Families (Wales) Measure 2010, local authorities and the NHS had a joint statutory responsibility for ensuring delivery of an IFSS in their region. In July 2011, a consortium involving the Vale of Glamorgan and Cardiff Councils and the Cardiff and Vale University Health Board made a successful bid to the Welsh Government to become one of two regions in Wales chosen to implement an IFSS under Phase II of the national programme.
In accordance with the very detailed regulations which prescribed the way in which an IFSS must operate, the three organisations established a Management Board chaired by the Director of Social Services for the Vale of Glamorgan. The Management Board was supported by an Operational Steering Group which had responsibility for overseeing implementation and development during the first year of operation. Cardiff Council was responsible for the direct management of the service.
The IFSS was based at the Alps and it had been operational since the end of February 2012. The service had five principal functions:
Undertaking intensive direct work with families through the application of time limited, family focused interventions;
Providing advice and consultancy to practitioners and agencies on engaging complex families with parental substance misuse;
Working jointly with the case managers and others to ensure that the family can gain access to the services they need;
Spot purchasing services not otherwise available; and
Providing training on evidence based interventions for the wider workforce.
The report outlined that Section 64 of the Children and Families (Wales) Measure 2010 required an annual report on the effectiveness of the IFSS to be submitted to Welsh Government. The report for 2014/15 was attached at Appendix 1 to the report and this had been approved by the IFSS Management Board.
The Annual Report summarised the following:
Key achievements and outcomes
Effective partnership working
Challenges faced by the service
Priorities for 2015/16.
The Annual Report demonstrated that the IFSS was meeting expectations in terms of numbers of referrals and the outcomes achieved. It outlined the robust systems of data collection and analysis in place to demonstrate how families were referred and prioritised for support and the impact upon key areas of wellbeing such as education, parenting, relationships, alcohol or drug cessation. This was complemented by qualitative evaluation through service user and referrer feedback. These results demonstrated that the IFSS was taking a lead role in strengthening services to support some of the most disadvantaged children, those who were in need or at risk because of parental alcohol or drug dependence.
The main priorities for the year ahead would be to increase the number of referrals with which the team worked and to train the wider workforce in the IFSS model of intervention using Motivational Interviewing, Solution Focused and other cognitive behavioural techniques. At a local level, there were plans to strengthen the maintenance phase that followed IFSS intensive intervention and to embed the system for formal review of cases. In addition, the IFSS Board would continue to plan the structure and pattern of future service delivery and identify funding for the medium to long term.
The Welsh Government’s ten year strategy for Social Services included a commitment to a career pathway and ongoing qualification requirements for Social Workers, thereby enhancing professionalism and promoting high quality services. The national career pathway was intended to retain more social workers in practice roles and it consisted of four levels:
Newly qualified social worker (years 1 and 2)
Social worker (year 3 plus)
Senior social worker practitioner (3 years post qualified)
Consultant social worker (5 years post qualified).
The consultant social worker role within the IFSS was demonstrating that specialist and evidence based social work interventions (as part of planned, systematic multi-agency involvement in the lives of families) could have considerable impact and deliver better outcomes.
The Director of Social Services explained to Members that the dilemma facing the service was that it was relatively expensive, it only dealt with a small number of families and it was highly resourced. An important question may be whether this was the best use of resources and that a review of the service needed to be undertaken to assess whether it delivered value for money and the best outcomes for families. He also explained that the main priority of the IFSS was in relation to tackling substance misuse but he questioned whether the service should broaden its focus.
The Chairman, in questioning the allocation of resources, stated that on average each case would cost the service around £28,000. In response, the Director of Social Services advised that the Council had to provide the service and that there was benefit of working in scale with its partners but discussion on the way forward for the service would need to take place. He alluded to the highly prescriptive nature of the service that had to be provided in a specific and regulated way. There was a need to look at all the evidence in order to show if there were opportunities to undertake this work in a more cost effective manner and it seemed unfair to exclude this service from exercises around budgetary reductions.
In response to a Committee Member’s query regarding the number of cases in which no spaces were available, the Director of Social Services advised that this was the biggest concern identified by the Council. It would not mean that help was not provided to the families and the service would attempt to back fill cases when capacity was available. He stated that a question that he would like to ask was whether there was a need for such an intensive service in order to affect change. He considered that there was a need to test the methods used and to assess whether support needed to be undertaken this way and to identify if there were other ways of working.
Further to this point, the Director of Social Services advised that the programme used within the IFSS service was time limited and that support provided could not go beyond a specified point. In his opinion, the service should be far more flexible and he questioned as to why the service needed to be so prescribed if families were co-operating. He went on to state that the programme was entirely prescriptive and that results could be achieved in various ways and he questioned whether there was a need to always have the same level of professional input in all instances. He stated that he would have liked to have seen more flexibility built into the system.
A Committee Member then raised two questions regarding whether Welsh Government intended to review how the service operated and whether more qualitative data could be used in order to determine success. In response, the Director of Social Services agreed that it would be more useful if better qualitative data was available, such as getting behind the reasons for families cutting themselves off from mainstream services. In terms of outcomes, he was worried that a service like this may create dependency and that the service should be able to step back and provide continuous support but he recognised that this then created a danger of clogging up the system. He reiterated his previous point regarding the highly prescriptive nature of the service that did not allow the Council to make any adjustments to the programme. In terms of whether Welsh Government was aware of the Council’s concerns, he would need to consult with the Head of Children and Young People Services, but he would raise these points at the next Executive Board meeting of the Association of Directors.
When asked if the number of cases which were refused was creating greater need, the Director of Social Services indicated that the IFSS provided a top tier service and that the situation at present was being managed quite well. He alluded to the stability in terms of the number of Looked After Children which showed that services such as the IFSS did have a role, although in his opinion, he would like the service to be more regularly available and operate in a more flexible manner.
Having considered the report, it was
(1) T H A T the content of the Integrated Family Support Service Annual Report for 2014/15 be noted.
(2) T H A T the work being undertaken to provide intensive support to families, especially those where children were adversely affected by parental alcohol or drug dependence, be endorsed.
(3) T H A T the report be referred to Cabinet for consideration.
Reasons for recommendations
(1&2) To ensure that the Council’s statutory functions in relation to providing an Integrated Family Support Service were fully met in accordance with Welsh Government guidance.
(3) To draw Cabinet’s attention to the Committee’s assertions around the highly prescribed nature of the support work provided by the Integrated Family Support Service and the need to assess the cost effectiveness and impact of the service.
60 REGULATORY AUDIT PLAN 2015 (DSS) –
The Council’s Regulatory Audit Plan, produced annually by the Wales Audit Office, was presented to the Committee.
The Auditor General Wales was required to carry out an audit which discharged its statutory duties and fulfilled its obligations under the Public Audit (Wales) Act 2004, the Local Government (Wales) Measure 2009, the Local Government Act 1999 and the Code of Audit Practice. This involved:
Examination and certification of the Council’s financial statements to ensure they are "true and fair";
Assessment of the Council’s arrangements for securing economy, efficiency and effectiveness in the use of resources;
Audit and assessment of whether the Council had discharged its duties and met requirements of the Measure; and
Bespoke pieces of work aimed at enabling the Council to make improvements in economy, efficiency and effectiveness or financial or other management practices.
The Regulatory Audit Plan 2015 outlined work to be undertaken in the Council during April 2015 to March 2016 by and on behalf of the Auditor General. A copy of the Audit Plan was attached at Appendix 1 to the report. Key highlights were as follows:
Certification work would be undertaken on the Council’s grant claims and returns as part of the annual financial audit
The Council would be subject to an in-depth Corporate Assessment during 2015/16 (scheduled for February / March). This was a full review of the Council’s capacity and capability to deliver continuous improvement which was undertaken once every four years by the Auditor General Wales in addition to the annual â€œlight touchâ€ review.
Local government specific work was planned on the approach of Councils to income generation and charging for services, Council funding for third sector services and the effectiveness of local community safety partnerships.
A number of national value for money studies had been programmed to take place during the year, including picture of public services, regional education consortia, regeneration investment funding for Wales, flood and erosion risk management (focus on coastal flooding). These studies were funded by the National Assembly and presented to the National Assembly’s Public Accounts Committee to support its scrutiny of public expenditure. Where relevant Local Authorities would be required to provide evidence as part of the data gathering process.
The Regulatory Audit Plan was a product of negotiation between the Council’s Relationship Manager and other regulators of various services and was informed by a consideration of the risks and the challenges facing the Council, audit and inspection knowledge and the Council’s own mechanisms for review and evaluation.
The draft Plan was considered by Corporate Management Team and no changes had been made. The Audit Committee had also considered the draft Plan on 20th April 2015 with a referral made to Cabinet for final approval.
The Scrutiny Committee’s work programme was also tabled at the meeting for Members’ consideration.
RECOMMENDED – T H A T the Regulatory Audit Plan 2015 be accepted.
Reason for recommendation
To progress the regulatory work programme and to ensure that robust scrutiny of the Regulatory Audit Plan takes place.