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SCRUTINY COMMITTEE (SOCIAL CARE AND HEALTH)

 

Minutes of a meeting held on 4th January, 2016.

 

Present:  Councillor R.L. Traherne (Chairman);Councillors R.J. Bertin, Ms. R. Birch, H.C. Hamilton, Dr. I.J. Johnson, J.W. Thomas and S.T. Wiliam.

 

Also present: Councillor N. Moore

 

 

713     APOLOGIES FOR ABSENCE – 

 

These were received from Councillor Mrs. M.E.J. Birch (Vice-Chairman); Councillors E. Hacker and Mrs. M.R. Wilkinson.

 

 

714     MINUTES – 

 

RECOMMENDED – T H A T the minutes of the meeting held on 30th November, 2015 be approved as a correct record.

 

 

715     DECLARATIONS OF INTEREST –

 

No declarations were received.

 

 

716     COMMISSIONING DOMICILIARY CARE SERVICES FROM THE INDEPENDENT SECTOR: FOLLOW UP REPORT (DSS)

 

The Interim Head of Business Management and Innovation presented the report, the purpose of which was to update the Scrutiny Committee on the outcomes of the inter-disciplinary inquiries made in respect of allegations broadcast on the BBC television programme, “Week In, Week Out”, about 1st Grade Care domiciliary care agency.  For this item, the Committee welcomed the Regional Director and the Area Manager from the Care Social Services Inspectorate Wales (CSSIW).

 

The report was provided in response to a Request for Consideration from Councillor R.J. Bertin and it followed up on a report presented to the Scrutiny Committee on 13th July, 2015.

 

The report outlined that 1st Grade Care had been in operation within the Vale of Glamorgan since 2011 when it was first registered with the CSSIW.  During this time, the organisation had not had concerns raised that had warranted it being managed within the Council’s provider performance measures, which were used to monitor and improve the delivery of care commissioned by the Council from independent social care providers.  1st Grade Care was registered to provide care to individuals in their own homes and the following categories:  older persons, older people with dementia, physical disabilities, sensory loss / impairment, and mental health. 

 

The ”Week In, Week Out” programme which was broadcast on 9th June, 2015 reported that 1st Grade Care had left a 92 year old woman alone on the floor when she fell.  The programme stated that the care provider had been accused of ordering a member of staff to leave the service user and go to another call before an ambulance or relative arrived.  The member of staff was interviewed on the programme and wished to remain anonymous.  In addition, the programme reported that the family of the service user had many concerns with 1st Grade Care, including missed and shortened calls. 

 

The report advised that the Contracts Team within Social Services had a robust monitoring function in place.  Once alerted to the issues highlighted by the “Week In, Week Out” programme, staff had worked with 1st Grade Care to identify any issues regarding quality of care and to take remedial actions so that all service users were safeguarded.  Staff had visited the organisation on three occasions, developing an action plan which was being carefully monitored.  Key themes identified through the monitoring process echoed some of the earlier observations by the CSSIW but had not been judged necessary to make use of the Authority’s escalating concerns process.

 

It was noted that 1st Grade Care had worked constructively with the service’s contract monitoring officers.  They had been willing to accept support, to share information requested by staff and to learn from any errors.  There had been a clear commitment to providing a high quality service. 

 

The electronic monitoring system introduced by 1st Grade Care to prevent missed or late calls had not been able to deliver the reports originally requested by the Contracts Team within the Action Plan.  The service was therefore concerned as they were unable to validate progress.  1st Grade Care had been working with the vendor of the system, and it had been concluded that they could not provide the reports.  However, the provider had offered Contract staff the opportunity to view the system at the office to validate this action point.  1st Grade Care had been able to demonstrate that it had a robust system in place and that the office was appropriately staffed to monitor missed and late calls.  The action plan had been amended to reflect this position.

 

The Protection of Vulnerable Adult (POVA) Team in the Vale of Glamorgan was able to contact the member of staff.  She confirmed that this was the instruction given and that she did leave the service user alone.  She was unable to remember the date or time of year this occurred.  She alleged that advice to leave the service user had been given on other occasions. 

 

Following this, a detailed chronology was constructed, cross-matching information from several sources.  This identified all falls that the service user had experienced during a 15 month period.  All information held by a number of agencies confirmed that the service user was not left alone at any time.  There was documentary evidence that domiciliary carers were present for a handover to paramedics on the occasion which appears to have been the one described in the programme.  The POVA investigation found that on no occasion was the service user left alone following any of her falls while she was receiving support from 1st Grade Care.  There had been no concern raised at the time of the alleged incident.  It was reported that the gap between the alleged incident and the “Week In, Week Out” programme was believed to have been at least two years.

 

In summary, the Interim Head of Business Management and Innovation was able to  outline that the POVA team had fully investigated the allegation in collaboration with other relevant agencies, including the Welsh Ambulance Service, the provider, South Wales Police and the CSSIW.  The investigation concluded that there was significant evidence which contradicted the claims made in the programme and the outcome was recorded as “disproved”. 

 

At this point, the Regional Director for the CSSIW was asked to provide a verbal update following its recent inspection of 1st Grade Care.  The Regional Director began by advising Members that it was important to clarify exactly what was meant by issuing a non-compliance order.  She explained that during inspections the CSSIW may find some breaches of regulations that were technical and that did not directly impact upon service users.  However, some breaches did and it was these for which a non-compliance order would be issued. 

 

In relation to the issue of non-compliance, the report advised that the CSSIW annual inspection of 1st Grade Care in September and October 2014, which was published on 9th June, 2015, highlighted that a non-compliance notice regarding staff training (Regulation 16(2)(a)) had been served  on the registered person for the service.  There were other areas of concern, these related to (i) number of suitably qualified staff (Regulation 16(1)(a)), and (ii) continuity of care (Regulation 16(1)(e)), but these did not result in non-compliance notices. 

 

The CSSIW had since conducted a further baseline inspection of 1st Grade Care which started on 13th May, 2015.  “Week In, Week Out” was broadcast while the Inspectors were completing their work and so the CSSIW extended the exercise, conducting further visits.  Their final visit took place on 2nd July, 2015.  The inspection report was published in September 2015 and the following areas of improvement against the previous inspection were noted:

 

  • The non-compliance notice issues at the previous inspection with regard to staff training was found to be met and progress against Regulation 16(1)(a) and Regulation 16(1)(e) had been made and there was no evidence of ongoing non-compliance.  The report advised that the CSSIW had judged the organisation as compliant in the area of staff training but it had issued another non-compliance notice, this being Regulation 13(a) – Non-compliance – processes needed to be put in place to enable the agency to monitor late and missed calls and to take appropriate actions in a timely manner when issues arise to ensure service users’ safety and wellbeing.

 

In response to the non-compliance notice, 1st Grade Care advised inspectors that they had improved their monitoring arrangements (including installation of an electronic monitoring system), and they believed suitable arrangements were in place.  The system was designed to enable them to track any late or missed calls, alerting on-call staff / supervisors to take action.  This would include ensuring that there was adequate support and timely communication with the service user.

 

Since issuing the inspection report in September 2015 and after further visits in October and November 2015, the Regional Director from the CSSIW commented that there had been no further issues in relation to the operation or quality of service provided by 1st Grade Care which would have an impact upon service users.  Improvements had been made but the CSSIW would be vigilant and would be monitoring the situation.

 

The Chairman expressed his personal disappointment that the Managing Director from 1st Grade Care had not accepted the Committee’s invitation to attend tonight’s meeting.  The Chairman, however, stated that a written statement had been provided, which the Chairman agreed to read out.  This statement explained that the Managing Director of 1st Grade Care was pleased with the findings of the report being presented to the Scrutiny Committee, and he felt that the Local Authority’s investigative conclusions were reflective and accurate as to the allegations made in the “Week In, Week Out” programme.  He was pleased with the latest CSSIW inspection report, in particular that the service was now fully compliant with domiciliary care regulations and would aim to continually be so.  His statement also advised that in consideration of the level of public attention that this matter had achieved, he believed that his being present at the meeting would only encourage further public and press interest.  He recognised that the allegations made in the “Week In, Week Out” programme had sadly placed significant attention to that of a person who had passed away and he did not wish to augment anguish to this individual’s family.  He looked forward to continually working constructively with the Local Authority and in providing a quality care service to residents of the Vale of Glamorgan. 

 

The Director of Social Services then added that a thorough Protection of Vulnerable Adults (POVA) investigation had been conducted in which all agencies had worked well together.  He assured Members that the findings could be relied upon but he also stated that the Service could not afford to be complacent.  He commented that the Service had in place a raft of safeguards which also included close relationships with the CSSIW and care providers.  He was mindful, however, that some additional safeguards would be helpful and some of these were being introduced by the new Registration and Inspection Act.  For example, there would be increased registration of the social care workforce.

 

Councillor Bertin, with regard to his original request for consideration, then commented that he was pleased that a full investigation had been carried out and he queried whether a reminder could be sent out to providers stating that individuals should not be left alone when requiring urgent medical attention.  He also queried whether, as part of the POVA investigation, the family had been spoken to and if any dialogue had been made with the BBC since.  In reply the Interim Head of Business Management and Innovation confirmed that a reminder would be sent to providers and that it was standard practice for a carer to remain with a client.  The authorisation for this additional support was very quick, requiring only a simple phone call.  With regard to involvement of the family in the POVA process, the Committee was advised that this would be double checked and reported back to Members.  The Director of Social Services explained that the BBC had been helpful in providing additional information and that the Service would not want to deter any individual or organisation from raising concerns.

 

A Committee Member enquired as to what percentage of domiciliary care was provided by 1st Grade Care.  Officers were not able to be specific, but they confirmed that 1st Grade Care was one of the Council’s largest providers.

 

Members were keen for reporting arrangements to be put in place that advised the Committee of those providers for which the Council had concerns about service delivery and performance.  With regard to this query, the Director of Social Services explained that the dilemma here was that there was a continuum of support provided to agencies that were experiencing difficulties in meeting care standards or in running their business.  He commented that agencies would be going through ‘managed steps’ of improvement and so careful consideration was needed of when to bring concerns to the attention of the Committee.  It was agreed that, due to the sensitive nature of such reports, these would have to be discussed as a Part II agenda item.

 

The Committee

 

RECOMMENDED –

 

(1)       T H A T the current arrangements for working with the independent domiciliary care sector be noted to ensure that it provides safe and effective care and support services.

 

(2)       T H A T the contents of the report and actions to address concerns relating to 1st Grade Care be noted.

 

(3)       T H A T Scrutiny Committee receives an update in six months on the quality assurance processes in place to support the commissioning of high quality domiciliary care services and how the Directorate is responding to issues within the sector.

 

(4)       T H A T a reporting framework be established to advise Members of the Committee of those providers where there are ongoing and significant concerns regarding service delivery.

 

Reasons for recommendations

 

(1-3)    To ensure effective scrutiny of a key function undertaken by the Council.

 

(4)       In order to keep Members apprised of issues affecting domiciliary care providers.

 

 

717     DRAFT CORPORATE PLAN 2016-20 (REF) and PERFORMANCE MANAGEMENT FRAMEWORK (REF) –

 

The Chairman had decided that the references from Cabinet on the Corporate Plan and the Performance Management Framework were closely aligned and therefore, agenda items 5 and 6 could be considered at the same time.

 

For these items, the Leader of the Council presented the reports which advised that on 14th December, 2015, Cabinet had endorsed the draft Corporate Plan 2016-20 and had approved changes to the Council’s Performance Management Framework.  Both of these had been referred to all Scrutiny Committees for their comments. 

 

In April 2015 Welsh Government passed the Well-being of Future Generations (Wales) Act and the new Corporate Plan was closely aligned to this.  The Act placed a duty on Councils to carry out sustainable development which meant the process of improving the economic, social and cultural wellbeing of Wales.  The Act required the Council to set and publish wellbeing objectives by April 2017 that maximised its contribution to achieving the wellbeing goals which were attached as Appendix A to the report.  In addition, supplementary information on the Corporate Plan was tabled on the night which provided Members with an overview on which of the existing Scrutiny Committees would be responsible for scrutinising the proposed Corporate Plan actions. 

 

The draft Plan, attached at Appendix B to the report, had been drafted in parallel with the Medium Term Financial Plan (MTFP).  The priorities for the next four years had been developed in full recognition of the financial climate and achievability of the actions associated.  There was also recognition that in light of future budgetary decisions, there would be a need to review and potentially amend the Plan.  Increasingly, the Council would need to work with its partners and communities to identify alternative ways of delivering services.

 

The draft Plan contained a revised vision and set of values for the Council.  The vision was for the Vale of Glamorgan to have “strong communities with a bright future” and the Plan was framed around four wellbeing outcomes, these being ambitious, open, together and proud.  The Plan also stated the Council’s approach to strategic planning and recognition of the need to have robust arrangements in place.  This was followed by details of actions linked to the internal workings of the Council which would be instrumental in ensuring that there were foundations in place to promote sustainable development.  The Plan concluded with details of how the Plan would be monitored.

 

The Plan had been drafted to ensure the Council’s contributions to the wellbeing goals was demonstrated and had taken account of a range of performance and engagement information to ensure it reflected what customers and partners were telling the Council.  The proposed wellbeing outcomes being:

 

•           An inclusive and safe Vale

•           An environmentally responsible and prosperous Vale

•           An aspirational and culturally vibrant Vale

•           An active and health Vale.

 

The Committee was advised that for each of the four wellbeing outcomes there would be two wellbeing objectives together with a series of actions. These outcomes, objectives and actions would be developed through the consultation process.

 

The Plan also stated the Council’s approach to integrated strategic planning and recognition of the need to have robust arrangements in place.  This was followed by details of actions linked to the internal workings of the Council which would be instrumental in ensuring that there were foundations in place to promote sustainable development.  The Plan concluded with details of how the Plan would be monitored.

 

In terms of the Performance Management Framework, the relevant Cabinet report outlined that the Council had a strong performance management track record which had been evidenced in previous Annual Improvement Reports (AIR) by the Wales Audit Office.  However, the recent AIR for 2014/15 identified the following two proposals for improvement: 

  • P1 Refine performance reporting arrangements to ensure data was presented in a way that provided a balanced picture of performance and of the outcomes being achieved
  • P2 Improve reporting so that cross-directorate / cross-service activity was considered in the context of delivery of priorities rather than completion of service-based actions.

The Council’s Performance Management Framework (PMF) set out the way in which the Council undertook performance management across the Council.  This Framework enabled the Council to regularly asses, report and scrutinise performance in order to support continuous improvement of tis activities.

 

The PMF brought together the Council’s key planning, monitoring and evaluation processes through an integrated suite of documents.  These included the Community Strategy, Corporate Plan, Service Plans, Team Plans and Personal Development Plans and demonstrated the contribution made at a variety of levels of the organisation to the Council’s priority outcomes. 

 

The report outlined that the Corporate Plan would be monitored on a quarterly basis by an overall corporate health scorecard report and supplemented by specific quarterly reports for each of the four wellbeing outcomes. 

 

“Corporate Health” would be illustrated from a number of perspectives:

 

•           Performance against wellbeing outcome / objectives

•           Resources (finance / savings, people, assets and ICT)

•           Customer focus and risks. 

 

Future reports would incorporate a Red, Amber and Green status for each of the wellbeing outcomes to give a snapshot of overall progress.  A brief position statement would be provided for the quarter covering the wellbeing outcomes and corporate health performance overall.  A brief summary of achievements by outcome would be provided as well as areas of underperformance / key challenges across the corporate health perspectives being highlighted with remedial actions to address these going forward.  These quarterly overview reports would be presented in a dashboard / scorecard format designed to make the information contained in it as accessible as possible. 

 

The report outlined that four quarterly wellbeing outcome and objectives scorecard reports would demonstrate progress against each of the wellbeing outcomes and associated objectives.  Informed by performance data collected from Service Plans, these reports would demonstrate the cross-cutting nature of the well-being outcomes and draw together evidence from the wide range of service areas involved in completing the various actions associated with each well-being outcome.  A brief position statement from the sponsoring Director would be provided for the quarter.  A brief summary of achievements by objective would be provided and areas of underperformance / key challenges highlighted, including a description of any remedial actions required to address these going forward.

 

These proposed developments included amending the Scrutiny Committee structure from May 2016 to align it with the well-being outcomes of the Corporate Plan.  It was proposed that the Terms of Reference for the existing “service based” Scrutiny Committees be reviewed to reflect the Council’s four well-being outcomes and to support the cross-cutting nature of the new Plan.

 

In addition to the four well-being outcome-based Scrutiny Committees, the existing Scrutiny Committee (Corporate Resources) would be replaced with a committee responsible for Corporate Resources and Performance.  In addition to this, the Council would therefore have the following Scrutiny Committees in operation:

 

•           An Inclusive and Safe Vale Scrutiny Committee

•           An Active and Healthy Vale Scrutiny Committee

•           An Environmentally Responsible and Prosperous Vale Scrutiny Committee

•           An Aspirational and Culturally Vibrant Vale Scrutiny Committee.

 

The proposals were not merely a change in the name of Committees, but rather they represented a refocusing of scrutiny activity on the way in which the Council’s actions were delivered against its intended outcomes.

 

Quarterly wellbeing outcome and objective reports would be reported to the relevant committee, with the overall corporate scorecard report being presented to the Corporate Resources and Performance Committee.

 

The Chairman, in referring to objectives in the Corporate Plan aligned to children and young people, stated that he was surprised that there were not any direct references to Looked After Children.  In response to this, the Head of Children and Young People Services said there certainly hadn’t been an intention to exclude Looked After Children from corporate action or monitoring, as seen in the Corporate Parenting Panel.  However, there was a balance needed between plans where Looked After Children were distinguished from children as a whole and the second where Looked After Children would be regarded as part of all activities concerning children.  Further to this, the Leader stated that the Plan would be overarching and the aim was to do with moving away from ‘working in silos’.  He referred to Service Plans (which would provide more detail) and he stated that the Scrutiny Committees would still be able to deal with topics should they choose.  The work of scrutiny would also be aligned to the corporate objectives to make sure that service performance was holding up.  In terms of Looked After Children, he commented that this group would come under the active and healthy Vale outcome and he alluded to this being a corporate responsibility, which could come under the remit of all Scrutiny Committees.

 

With regard to performance management, the Chairman queried as to how the Director of Social Services Annual report would fit in with the new Framework.  In answer to this, the Director of Social Services outlined that the Social Services and Well-being Act would reinforce the statutory requirement for a Director’s report.  He also referred to the future instances in which the Committee would look at themes and so would need to consider reports that covered a broad range of areas, not only corporate plan outcomes and objectives.  The aim of the new Framework was therefore to move away from an over-reliance on performance indicators to using in addition more qualitative information in which observers would be able to see evidence of outcomes achieved.  The year ahead would be one of transition as we worked out how to manage properly the performance management requirements of both the Social Services and Well-being Act and the Wellbeing of Future Generations Act. 

 

In considering the future reporting mechanisms around how the four outcomes would be presented before the Scrutiny Committees, the Leader clarified that the new Scrutiny Committee (Corporate Resources) would have responsibility for looking at the performance of the Council as a whole and this would be very similar to how Corporate Resources currently scrutinised the Council’s finances.  The Leader also stated that the aim was to try to ‘mesh’ together all the various services of the Council under relevant outcomes and objectives.  Further to this, the Director of Social Services drew Members’ attention to paragraph 12 of the report, regarding the new Performance Management Framework.  This highlighted the introduction of scorecards for the each of the four wellbeing outcomes.  The scorecards would be informed by officers from various Directorates and would show if the Council was achieving its objectives.

 

A Committee Member commented whether the use of the Red, Amber and Green status provided precise enough detail, particularly when concerns could be across a broad range of service areas.  The Member also asked whether the Corporate Plan was ambitious enough.   In reply, the Director of Social Services stated that officers had made a considerable contribution to the plan to ensure that there was a good balance.  He also stated the framework was still ‘work in progress’ and that the Member had raised a matter that was already being looked at.

 

The Chairman suggested that the wording of the action “provide and promote a range of early years services that support the benefits of early development in achieving better outcomes” be reviewed to ensure that it was clear as to what this was intended to deliver.  The Head of Children’s Services responded that this could indeed be looked at to ensure it was clear.

 

In querying the service action within the Corporate Plan to ‘align the activities associated with Families First, Flying Start and Communities First programmes to tackle child poverty’, Members were advised that the challenge here related to the way that grant money was allocated by Welsh Government and how this money was spent.  The Committee also heard that Welsh Government had recognised that family support services were disjointed and this action would help the Local Authority to deliver services.

 

A Committee Member suggested that the Corporate Plan should be revised to include a statement to outline that the Council would work with its partners to look at the skills required of the workforce to assist job creation.  The Member also suggested that an additional value could be for the Council to develop a positive sense of community.  With regard to the name of the Committee, he put forward the ‘Health and Wellbeing Scrutiny Committee’ as an alternative.  The Committee agreed that these three suggestions should be put forward for consideration.

 

Having considered the Corporate Plan, the Committee

 

RECOMMENDED –

 

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

 

(2)       T H A T the views of the Committee as outlined in the minutes be forwarded to Cabinet, with special regard to the Committee’s suggestions as outlined above.

 

Reasons for recommendations

 

(1)       That Members are aware of the revision and changes to the Corporate Plan.

 

(2)       To inform Cabinet of the Committee’s views and suggested amendments to the Corporate Plan as part of the consultation process.

 

With regard to the Performance Management Framework, the Committee

 

RECOMMENDED –

 

(1)       T H A T the proposals for changes to the Council’s Performance Management Framework be noted.

 

(2)       T H A T the views of the Committee as outlined in the minutes be forwarded to Cabinet.

 

Reasons for recommendations

 

(1)       That Members are aware of the proposed changes to the Performance Management Framework.

 

(2)       To inform Cabinet of the Committee’s views and suggested amendments to the new Framework.

 

 

718     REVENUE AND CAPITAL MONITORING FOR THE PERIOD 1ST APRIL TO 30TH NOVEMBER 2015 (DSS) –

 

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 30th November, 2015. 

 

The report outlined that the current forecast for Social Services at year end was an overspend of £300,000.  A table and graph setting out the variance between profiled budget and actual expenditure to date and the projected position at year end were attached at Appendix 1 to the report. 

 

In terms of Children and Young People’s Services, this service was anticipated to outturn £450,000 under budget at year end.  The key issue for this service continued to be managing the demand for the Joint Budget for Residential Placements for Looked After Children, however, currently it was forecast to outturn with a £250,000 underspend at year end.  Work had been ongoing to ensure that children were placed in the most appropriate and cost effective placements, however, it was noted that due to the potential high cost of each placement, the outturn position could fluctuate with a change in the number of Looked After Children.  There were potential underspends elsewhere in Children’s Services of £65,000 on staffing and £135,000 on alternative means of provision and accommodation costs required for the current cohort of children. 

 

For Adult Services, the service was currently anticipated to outturn £750,000 over budget at year end which remained at the same level as projected last month.  This overspend was due to a projected overspend on Community Care Packages of £950,000 as a result of continuing demand for services, particularly for frail older clients.  The report outlined that whilst every effort would be made to improve this position, it could not be guaranteed that this position would not deteriorate further by year end as this budget was extremely volatile and there was a continued demand for services, which may increase over the winter months.  The annual deferred income budget for 2015/16 had been set at £739,000 and as at 30th November, 2015, income received to date was £112,000 under-recovered.  It was currently projected that this budget would outturn at £100,000 over budget by year end and this adverse variance was included as part of the projected overspend for care packages.  It was anticipated that there would be underspends of £200,000 elsewhere in the budget which could be offset as part of this overspend with £165,000 from staffing, £20,000 from Transport and £15,000 from Premises.

 

With regard to the capital expenditure, Appendix 2 to the report detailed financial progress on the Capital Programme as at 30th November, 2015.  The report advised that for the Flying Start Grant, Emergency Powers had been used to approve the inclusion into the 2015/16 Capital Programme of a £9,500 grant from Welsh Government for works at the Flying Start Butterflies Playgroup.  The work would consist of significant refurbishment to the toilets and food preparations areas. 

 

Appendix 3 to the report provided non-financial information on capital construction schemes.

 

In relation to the 2015/16 Budget Programme, the Directorate was currently required to find savings totalling £3.568m by the end of 2019/20.  At present, the Budget Programme showed a surplus of £186,000 which was as a result of the foster carer recruitment project.  Appendix 4 to the report provided an update on the individual areas of saving. 

 

The Chairman queried if winter pressures had affected services.  In response, the Head of Adult Services stated that this was a mixed picture and that local hospitals were not doing too badly.  He advised that additional staff had been recruited to the Community Resource Service to help with the discharge of people from hospital, but the Service had needed to clarify with Health colleagues to ensure that the referral process was being used correctly.

 

A Committee Member, referring to saving target A3 around a reduction in the Care Packages budget, enquired whether the Service would look to reduce the costs of undertaking assessments.  The Head of Adult Services explained that this saving target related to the total cost of care that included Domiciliary, Day and Residential Care and he stated that the service had been able to achieve savings by streamlining processes.  The total saving of £125,000 was aligned to help Learning Disability and Mental Health clients to live more independently.  Going forward into 2016/17, the Service would be looking at the greater use of Direct Payments and the use of Reablement Services along with a review of the commissioning of Day Services.

 

In referring to saving targets within Business Management and Innovation, the Committee was advised that further information on B6, which was around savings against the carer support services, would be circulated to Members via email.  In addition, referring to saving target B9 around Contract Arrangements for Domiciliary Care, a Committee Member asked, if in the area of procurement of services, whether the Directorate was working with any neighbouring Local Authorities.  In reply, the Director of Social Services commented that the Vale of Glamorgan Council was one of the most efficient commissioners of care services in the region.  He stated that there were advantages of entering into larger scale contracts but there were also advantages of maintaining a wide and broad range of service providers.

 

The Director stated that the Council’s strategy for procuring services was to maintain a diverse market that helped providers to stay in business and that the Service would be looking at joint commissioning of services with the Health Board.  He also briefly alluded to the joint procurement of Learning Disability and Mental Health placements through the South East Wales Improvement Collaborative and also to the joint working of the Children’s Commissioning Consortium Cymru (4Cs) for the regional commissioning of children’s placements.

 

Furthermore, the Committee also heard that the status of this target (B9) was red, as this was a challenging area for which progress of the working groups had been affected by things such as the introduction of the new national living wage.  The Service was looking at developments in other Local Authority areas and the Committee was advised that progress would be reported at a later meeting.

 

A Committee Member commented that he had noted that the status of saving target A6 (Residential Services) had changed from red to amber and he queried how this saving target would be progressed.  In reply, the Head of Adult Services explained that this would be managed as a specific Reshaping Services project and would be linked to a review of the broad range of accommodation with care available for older people.

 

In answer to a Member’s question as to whether budgetary underspends were down to less demand for services, the Committee was advised that most underspends related to savings generated around staffing costs. 

 

As a final query, a Committee Member commented that he had recently visited the Ty Dyfan Care Home in Barry and it had been observed that there were a number of empty beds at the home and he queried if there were any plans around the use of these beds.  In response the Head of Adult Services advised that there was an empty wing at the home which had been too costly for Hafod to run.  He stated that there were 12 beds in total but due to the layout of the building 8 beds would be a more realistic number.  He advised that the use of these beds would be looked into.

 

Having considered the report, the Committee

 

RECOMMENDED –

 

(1)       T H A T the position with regard to the 2015/16 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 2015/16 revenue and capital monitoring relevant to this Scrutiny Committee.

 

(2)       That Members and Cabinet are made aware of the progress made to date on the Social Services Budget Programme.

 

 

719     UPDATE ON IMPLEMENTATION OF THE SOCIAL SERVICES AND WELL-BEING (WALES) ACT 2014 (DSS) –

 

The Scrutiny Committee had requested monthly updates in respect of the Social Services and Well-being (Wales) Act 2014 (“the Act”) and the approach being taken around implementation.

 

In summarising some of the latest development, the Director of Social Services explained that the statutory framework now included the Act itself, 23 sets of regulations and 7 codes of practice.  He commented that all these, plus 9 technical briefings, represented an intense volume of information that staff would have to get to know.  This was a basis for going forward but was a huge volume of detail for people to understand by the April implementation date.

 

The report further detailed that the lead officers for the Implementation Programme’s task and finish groups continued to review the requirements set out in the new Regulations and Codes of Practice, to ensure that they were fully understood and to put in place the necessary actions.  Representation on these groups included officers from both Local Authorities, the Cardiff and Vale University Health Board and the Third Sector.  The areas currently regarded as providing the greatest challenge were the development of the Information, Advice and Assistance Service, the assessment and eligibility process and the new financial assessment and charging requirements.

 

The Association of Directors of Social Services (ADSS) Cymru and the Welsh Local Government Association had agreed to co-ordinate the work of the six regional implementation collaboratives, funded from the Delivering Transformation Grant.  The four national working groups, established to share best practice and produce consistent material on an all-Wales basis, had now met.  Cardiff and the Vale of Glamorgan region had sent officers to each of these groups so that they could contribute to the development of national toolkits / checklists and, where possible, avoid duplication and develop procedures to meet the local context.  Where appropriate any issues not able to be resolved locally were being escalated to the national level.

 

Consultation on the final Code of Practice, in relation to Part 8 of the Act (the role of Directors of Social Services) closed on 4th December, 2015.  ADSS Cymru and the Welsh Local Government Association responded to this consultation on behalf of local government.  This Code of Practice would be laid before the Assembly in February 2016. 

 

Progress had been made on a series of technical briefings for the Trance 1 Codes of Practice.  These were described as “gateway” documents that summarised the key points for each Code: 

 

•           Technical Briefing: Measuring social services performance

•           Technical Briefing: Part 2 - Information, Advice and Assistance

•           Technical Briefing: Part 2 - Population Assessment and Prevention

•           Technical Briefing: Part 2 - Social Enterprises

•           Technical Briefing: Part 2 - Well-being and overarching duties

•           Technical Briefing: Part 3 - Assessing needs

•           Technical Briefing: Part 4 - Care Plans

•           Technical Briefing; Part 4 - Direct Payments

•           Technical Briefing: Part 4 – Eligibility.

 

The national training materials for the four core modules were still being finalised.  External trainers, to deliver workforce development on a prioritised basis in February and March, had been assigned through the national call off arrangements.  A training plan was being developed to include the period prior to implementation and the months after.  Additional resources were also available to help deliver awareness training to Elected Members and to provide support for the new Regional Partnership Board which would be established under Part 9 of the Act.  The Minister had written to Health Board Chairs and Chief Executives, Cabinet Members for Social Services, Directors of Social Services and Regional Chairs to emphasise the importance of workforce development in the lead up to the implementation of the Act.  A copy of the letter was appended to the report.

 

In terms of financial support, the report outlined that Welsh Government had doubled the funding available through the Delivering Transformation grant across Wales to £3m in 2015/16.  Subject to budgetary decisions, a further £3m in grant funding would be available in 2016/17.

 

The Chairman queried the amount of time remaining in order to roll out the associated training programme and in response to this, Members were advised that the service would have to prioritise staff training according to need and that not all staff would be fully trained by the implementation date. The Chairman also asked for a date to be agreed for the briefing of councillors on the Act.  The Director agreed to find a suitable date and promulgate it after consultation with Cabinet Members

 

In referring to the introduction of a new provision of up to six weeks free reablement services to enable a person to maintain or regain their ability to live independently, the Committee was advised that the eligibility for this may not only include those individuals being discharged from hospital and may relate to all individuals receiving care. 

 

In considering the report, the Committee

 

RECOMMENDED –

 

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

 

(2)       T H A T the Committee continue to receive regular updates about implementation of the Act.

 

(3)       T H A T the report be referred to Cabinet in order to provide an update around the approach being taken to implement the Social Services and Well-being (Wales) Act 2014.

 

Reason for recommendations

 

(1-3)    To ensure that Elected Members are kept informed about fundamental changes to the policy and legislative framework which underpins the work of Social Services.

 

 

720     COMMUNITY MENTAL HEALTH SERVICES (DSS) –

 

The Operational Manager – Mental Health presented the report the purpose of which was to update the Scrutiny Committee on developments in community services for adults with mental health problems in the Vale of Glamorgan. 

 

The report stated that Community Mental Health Teams (CMHT) were at the heart of secondary mental health care in Wales.  CMHTs would receive referrals from primary care providers and undertake screening assessments while offering a range of specialist assessments and interventions and delivering a constructive discharge policy. 

 

CMHTs worked within the secondary Mental Health Sector, providing care and treatment to people with unstable and severe mental health problems.  People requiring care and support for mild to moderate and stable severe mental health services were routinely managed through primary care and Third Sector support organisations. 

 

Within the Vale of Glamorgan, Social Services staff worked in partnership with the Cardiff and Vale University Health Board in community mental health teams, these being located in Barry, Penarth and Cowbridge. 

 

The Integrated Managers for each CMHT would be responsible for ensuring that the teams had systems and staff in place to be able to make emergency, urgent and routine assessments and to provide suitable advice, care or treatment to adults with mental health problems in their area.  The Integrated Managers were employed jointly by the University Health Board and the Vale of Glamorgan to deliver this function. 

 

Prior to the introduction of integrated management of CMHTs, the social work service was co-located with other professionals in team buildings and offered a distinct traditional social work service secondary to health colleagues’ interventions.  Now a much more inclusive service was on offer to a wider range of the population and which supported a more person centred initial assessment, allowing earlier social interventions leading to better outcomes and quicker discharge from services.

 

Each CMHT operated a duty function where two health or social care professionals were available to accept referrals and undertake a screening assessment during office hours.  During the first six months of 2015/16, the three CMHTs received an average of 145 referrals each month and undertook an average of 103 assessments.  On average, 42 referrals per month were redirected to other services of help without a formal assessment. 

 

The report stated that each referral to the CMHT was prioritised according to the risk and need of the service user.  Referrers were requested to telephone the CMHT duty worker when making an emergency or urgent referral.  Emergency referrals were offered a face to face appointment with two mental health professionals within four hours.  Urgent referrals were seen within two days, and routine referrals were provided with an appointment within four weeks. 

 

Mental Health Services acknowledged that people living with complex social systems which could have an impact on their mental health, the assessments therefore take into account the person’s mental health and their social circumstances and aim to provide advice in relation to medical treatment and psycho-social interventions to assist in providing a sustainable recovery.  On average, 70% of people referred to a CMHT did not require ongoing care co-ordination after an assessment and short term intervention. 

 

The Committee was advised that the Vale of Glamorgan operated a rota of Approved Mental Health Professionals (AMHP) to provide functions required under the Mental Health Act 1983.  This included ensuring that the Local Authority had sufficient numbers of mental health professionals available at all times to undertake Mental Health Act assessments of people requiring emergency care.  Some individuals may need to be detained in hospital for a period of assessment and treatment on a compulsory basis, in the interests of the person and / or the public.

 

During the first six months of 2015/16, the Vale of Glamorgan AMHP service undertook 89 Mental Health Act assessments and made 65 applications for compulsory detention in hospital. 

 

In terms of interventions, the report advised that through working with Allied Health Professionals, other Local Authority departments or Third Sector organisations, the Vale of Glamorgan CMHTs supported people to live independently to recovery focused care and treatment.  The majority of people using Mental Health services would be offered care and treatment by a Consultant Psychiatrist and a social worker or Community Psychiatric Nurse (CPN).  The role of the social worker in a team was to support people to regain their role within the family or community and assist them to make constructive changes to their lives and behaviours that promote mental wellbeing and reduce potential for further deteriorations.  This could be achieved through direct psycho-social interventions such as mindfulness, cognitive behavioural therapy and family support alongside robust risk assessments. 

 

The Vale of Glamorgan Assistant Social Worker and Community Support Workers had worked alongside the CMHT Care Co-ordinators to develop a service to meet their long standing and often overlooked need.  There was much evidence to show that mental illness and the effects of medication could have a significant impact on the person’s motivation and ability to maintain a healthy lifestyle.  The service recognised that people with a chronic serious mental illness had a life expectancy of less than 10 to 20 years when compared with the general population.  To meet this need, the service had developed and set up healthy lifestyle groups that supported people into a more healthy diet and exercise. 

 

The Vale of Glamorgan CMHT also supported and supervised 24 adults with severe mental health problems who were restricted under Part 3 of the Mental Health Act 1983, which was concerned with people involved in criminal proceedings or under sentence. 

 

Detailed within Appendix 1 to the report was a comparison of total spends on Adult Mental Health Services against the Welsh Government figures for all Local Authorities in Wales.  This included the number of adults with two or more psychiatric diagnoses and these figures showed that the Vale of Glamorgan was the lowest spending Authority on mental health services in Wales. 

 

In querying these figures, the Committee was advised that the Vale of Glamorgan was very effective at working closely with Third Sector organisations and its NHS partners and the Service would try many approaches which would help facilitate improvement in people’s lives.  The Vale of Glamorgan also had low numbers of people within residential care and did not have any individuals placed within a nursing home.  In addition 50 individuals were currently receiving domiciliary care and these numbers were relatively small, which highlighted that the service was extremely efficient and effective at treating mental illnesses.

 

In outlining some of the pressures within the Mental Health Service, the Operational Manager – Mental Health, highlighted the number of referrals for which people did not require ongoing care co-ordination after an assessment.  He stated that this accounted for 70% of referrals and took up a massive amount of professional time with some workers indicating that this could be as much as a third of their overall time.  To address this, the Service was looking at alternative models of service delivery.

 

The Operational Manager – Mental Health further advised that Whitchurch Hospital in Cardiff was due to close and would be replaced by a new facility located at Llandough Hospital.  This was a state of the art facility and would provide service users with top quality care.  It was planned that patients referred to the new ward in Llandough would be offered treatment that would help maintain social interaction and improve independence.  The new wards would result in better working arrangements with the CMHTs.

 

In terms of treatment offered and work undertaken by the Service, the Committee heard that most people referred to the Service would not require a period of time within a psychiatric hospital.  With regard to support provided, individuals requiring a secondary mental health services would have a psychiatrist allocated under Sections 1 and 2 of the Mental Health Act.  Much of the work effected by Community Practitioner Nurses (CPN) would be around the monitoring of medication and side effects and to work with an individual and their families in order to improve social context e.g. by trying to get someone back into work.

 

The Committee was also advised that the main risk factors within the community could be highlighted as genetic, socio-economic and stress and that it was difficult to say whether the economic difficulties experienced within the United Kingdom were responsible for increasing demand for services. 

 

Members also heard that the Service did not have a waiting list and that all emergency referrals would be seen within four hours.  However, the demand for psychotherapy services was considerable and there was a significant waiting list for this service.

 

In reply to a Member’s comments around lone working, the Operational Manager – Mental Health explained that all initial assessments should be conducted by two members of staff.  It was common though, for CPNs to work on a one to one basis but only after they had really got to know an individual.

 

A Committee Member, referring to the 40 or so referrals each month that did not require ongoing support, queried as to what would happen to these individuals.  In response the Operational Manager – Mental Health stated that most of these individuals would be signposted to Third Sector organisations such as MIND and these organisations would be able to offer support.  Members were advised that any individual referred to the service would not be left without any support or advice being offered. 

 

In clarifying the use of the Mental Health Act, the Operational Manager – Mental Health advised that an Approved Mental Health Practitioner would be on duty every day and their role was to support the Community Mental Health Teams around the use the Mental Health Act.  He reiterated the numbers of self-assessments carried out in 2015/16 in which 89 Mental Health Act assessments and 65 applications for compulsory detention in hospital had been made.  These represented a significant number of interventions, but it was important to recognise that the detention of an individual against their will was a last resort.  He further advised that Part 3 of the Mental Health Act referred specifically to those individuals who were undertaking criminal court proceedings in which the court had decided that instead of a prison sentence urgent Supervision Orders needed to be put in place.  At present, the Service was working with 12 individuals who had been referred under Section 37/41 of the Mental Health Act in which the court had decided these individuals should not be in prison but under certain restrictions. 

 

Having considered the report the Committee

 

RECOMMENDED – 

 

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

 

(2)       T H A T a report detailing developments in adult mental health services be received on an annual basis.

 

Reason for recommendations

 

(1&2)  To inform the Scrutiny Committee of the developments in community mental health services in the Vale of Glamorgan.

 

 

721     3RD QUARTER SCRUTINY DECISION TRACKING OF RECOMMENDATIONS AND WORK PROGRAMME SCHEDULE 2015/16 (MD) -

 

The purpose of the report was to advise Members of progress in relation to the Scrutiny Committee’s recommendations and to confirm the updated / amended Work Programme Schedule for 2015/16.  Appendix A to the report detailed progress to date for the municipal year 2014/15, Appendix B detailed the progress in relation to the 2nd Quarter July – September, Appendix C showed progress for the 3rd Quarter October – December and Appendix D outlined the Work Programme Schedule for the work of the Committee for the forthcoming months.

 

In referring to Appendix A and the Committee’s recommendation around the introduction of a Young Carer’s Card, the Committee agreed that in order to progress matters the Chairman should write a joint letter with the Cabinet Member for Children Services and Schools, to the Welsh Government Minister for Health and Social Services, to advise of the significant delays experienced with the publication of Welsh Government guidance.  The Committee agreed that the requested report regarding the work of local Multi-Agency Risk Assessment Conferences (MARAC) be included within the Corporate Safeguarding Report that was regularly referred to the Committee.  It was also felt that a further report on Bryneithin would be unnecessary and it should be removed from the work programme. The Committee agreed that an invitation to the Children’s Commissioner should be pushed back to the autumn months.  Finally, the Committee also agreed that a presentation around child obesity be presented, which would follow on from a similar briefing regarding the issues around diabetes.

 

Having considered the report the Committee

 

RECOMMENDED – 

 

(1)       T H A T the following recommendations be deemed completed.

 

13 July 2015

Min. No. 226 – Request   for Consideration - Commissioning Domiciliary Care Services from the   Independent Section (Councillor R.J. Bertin) – Recommended

(2)   That a representative from the CSSIW and   the provider be invited to attend a future meeting to answer any questions   and to allay any concerns that Members may have.

CSSIW   attended the Scrutiny Committee meeting on 4th January 2016.

Completed

05 October 2015

Min. No. 457 – Revenue   and Capital Monitoring for the Period 1st April to 31st August   2015 (DSS) – Recommended

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

Cabinet,   on 2nd November 2015, noted the contents of the report.

(Min.   No. C2956 refers)

Completed

Min. No. 458 – Update on   Implementation of the Social Services and Well-Being (Wales) Act 2014 (DSS) – Recommended

(2)   That the Committee continue to receive regular   updates about implementation of the Act.

Added   to work programme schedule.

Completed

(3)   That the report be referred to Cabinet for   information.

Cabinet,   on 2nd November 2015, noted the contents of the report.

(Min.   No. C2957 refers)

Completed

Min. No. 462 – 2nd   Quarter Scrutiny Decision Tracking of Recommendations and Work Programme   Schedule 2015/16 (MD) – Recommended

(2)   That the work programme schedule attached   at Appendix D be amended as follows and uploaded to the Council’s website:

  •   The Older People’s Commissioner for Wales be invited to attend a   meeting of the Scrutiny Committee – to outline some of her current concerns;
  •   The Children’s Commissioner for Wales be invited to attend a Committee   meeting to outline some of her current concerns;
  •   The Regional Adoption Services Manager to provide an update to   Members.

 

 

Work   programme schedule updated and uploaded to the Council’s website on 16th October   2015.

Completed

02 November 2015

Min. No. 553 – Update on   the New Vale, Valleys and Cardiff Regional Adoption Collaborative (DSS) – Recommended

(2)   That a further report be received by the   Committee in line with the requirements of the Partnership Agreement.

Added   to work programme schedule.

Completed

Min. No. 554 – Autistic   Spectrum Disorder: Community Monitoring and Support Project (DSS) – Recommended

(2)   That the Scrutiny Committee continues to   receive an annual update on the work of the project.

Added   to work programme schedule.

Completed

Min. No. 555 – Report on   the National Social Services Conference, June 2015 (DSS) – Recommended

(2)   That the Scrutiny Committee receives an   annual report concerning the themes and topics discussed within the   Conference.

Added   to work programme schedule.

Completed

Min. No. 556 – The Vale   of Glamorgan Health, Social Care and Well-Being Partnership (DSS) – Recommended

(2)   That the Scrutiny Committee continue to   receive updates about the Vale of Glamorgan Health, Social Care and Wellbeing   Partnership.

Added   to work programme schedule.

Completed

(3)   That the report be referred to Cabinet for   information.

Cabinet,   on 30th November, 2015, noted the contents of the report.

(Min.   No. C2987 refers)

Completed

Min. No. 557 – Update on   Implementation of the Social Services and Well-Being (Wales) Act 2014 (DSS) – Recommended

(2)   That the Scrutiny Committee continue to   receive regular updates about implementation of the Act.

Added   to work programme schedule.

Completed

(3)   That the report be referred to Cabinet for   information.

Cabinet,   on 30th November, 2015, noted the contents of the report.

(Min.   No. C2988 refers)

Completed

30th November,   2015

Min. No. 615 –   Implementation of the Social Services and Well-Being (Wales) Act 2014 (DSS) – Recommended

(2)   That the Committee continue to receive regular   updates about implementation of the Act.

Added   to work programme schedule.

Completed

 

(2)       T H A T the Work Programme Schedule attached at Appendix D to the report be amended as detailed above and uploaded onto the Council’s website.

  

Reasons for recommendations

 

(1)       To maintain effective tracking of the Committee’s recommendations.

 

(2)       For information.

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