HEALTHY LIVING AND SOCIAL CARE SCRUTINY COMMITTEE
Minutes of a meeting held on 10th October, 2016.
Present: Councillor R.L. Traherne (Chairman); Councillor Dr. I.J. Johnson (Vice-Chairman); Councillors R.J. Bertin, Ms. R.F. Birch, S.C. Egan, E. Hacker, H.C. Hamilton, S.T. Wiliam and Mrs. M.R. Wilkinson.
428 MINUTES –
RECOMMENDED – T H A T the minutes of the meeting held on 12th September, 2016 be approved as a correct record.
429 DECLARATIONS OF INTEREST –
No declarations were received.
430 PRESENTATION BY CHILD AND ADOLESCENT MENTAL HEALTH SERVICE (CAMHS), MRS. R. WHITTLE, COMMISSIONING LEAD – CARDIFF AND VALE CAMHS –
The Committee welcomed back Rose Whittle, the Commissioning Lead for the Cardiff and Vale Child and Adolescent Mental Health Service (CAMHS), who had been invited to update the Committee on progress made since her last visit, 12 months ago.
The Commissioning Lead began her presentation by advising that during 2014 stakeholder workshops had been held, which included general practitioners, in order to look at key issues affecting the CAMHS, and this highlighted areas of need and a requirement to focus on prevention. Following this, the Cardiff and Vale University Health Board decided to commission a “Risky Behaviour” service and was provided with additional funding from Welsh Government in order to expand the scope of the service to an early intervention and support service. During 2015/16, the Emotional and Mental Wellbeing Service was commissioned with support from Young Commissioners from Local Authorities which awarded the contract to the Third Sector Organisation named Change, Grow, Live. Committee was informed that this service went live on 2nd July, 2016 and 32 children from the Vale had been referred to date.
In highlighting the objectives of the Emotional Wellbeing Service, the Commissioning Lead advised that this was an early intervention and support service for people with mild to moderate emotional and mental health needs. It was aimed at young people of secondary school age, although older primary school children could receive support if services were appropriate. The service would offer rapid access to assessment via a single point of access and support offered through one to one or group interventions. The Commissioning Lead advised that although it was still ‘early days’ this service was working well.
The second element on the path to improvement was in relation to the Primary Mental Health Team. This was aimed at children with moderate mental health needs, around which the key performance target was to see clients referred from general practitioners within 28 days. The Commissioning Lead advised that this service had been transferred from Cwm Taf on 1st April, 2016 and had moved on to the PARIS Information system in order to improve the referral process. In order to reduce the waiting list, the service ran a number of “blitz clinics” during the summer months and additional staff had been recruited with more to be appointed but yet to commence in their role. Furthermore, the Committee noted that a review of the operational model was currently underway.
The third part of the programme was around a Neurodevelopment Service, the Commissioning Lead explained that this service mainly treated children and adolescents with autism or ADHD. There was a long waiting list for families and clients to receive a diagnosis and the appropriate support. Funding provided during the last financial year had enabled the service to develop a central point of contact which was now part of an agreed medical pathway. Since 1st June, 2016 a multi-disciplinary team was now in place with all referrals to the Neurodevelopment co-ordinator who was placed within St. David’s Children Centre. A new joint service between Community Child Health and Specialist CAMHS had been created with training conducted with School Additional Learning Needs co-ordinators. Furthermore, two nurses and one pharmacist had undertaken Independent Prescribing courses which had meant that the role of a nurse and a pharmacist had been combined. The Committee was advised that the aim was for a maximum wait of 26 weeks and at present the longest wait for support was a period of 19 weeks. In total, since 1st June, 2016, 498 referrals had been received.
In outlining the referral process to the Neurodevelopment Service, the Commissioning Lead advised that in terms of referrals from GPs, the Co-ordinator would liaise with parents around the completion of questionnaires and also with schools to gain all relevant information required before arranging an appointment with the relevant professional. In addition, feedback to parents would be provided regarding any diagnosis scheduled with the multi-disciplinary team. A letter would also be provided to the GP to inform of the assessment outcome. In terms of referrals from schools, the school would inform the GP that the referral had been made and the Co-ordinator would liaise with parents, again in relation to the completion of a questionnaire. Following the outcome of the assessment process, a letter would be sent to the GP for information.
In terms of initiatives to improve the number of individuals on the Service’s waiting list, the Commissioning Lead referred to the Primary Health Team which had run “blitz clinics” over the summer which had reduced the wait for Part 1 assessments from 36 weeks as at 1st April down to 12 weeks as at 21st September, 2016. It was hoped that additional staff would continue to improve this position.
The Community Child Health Team within the Cardiff and Vale University Health Board had taken over management of the Neurodevelopment waiting list from Cwm Taf with the waiting list scheme’s aim to achieve 26 weeks wait by 31st March, 2017. This currently stood at 100 weeks. The Commissioning Lead also explained that 159 cases had been inherited and that the average wait was now 85 weeks.
The Committee was advised that the Cardiff and Vale University Health Board had approved extra funding for a ‘brief intervention team’ based in the Cwn Taf’s Specialist CAMHS, with the aim of meeting a 28 day waiting time by August 2017. The current waiting time was 62 weeks and the Commissioning Lead stated that 83 children from the Vale were on the waiting list.
The Chairman, in referring to the 83 individuals from the Vale who were currently on the waiting list, queried whether their waiting times would be reduced. In reply, the Commissioning Lead stated that there was a level of confidence that the Cwm Taf Specialist CAMHS would achieve its targets and that it was working hard to do so. She added that there was a need to join up referral pathways as some individuals were not being supported by the correct service and so a clear flowchart of the pathways was required.
In terms of the national update in relation to specialist CAMHS, the Commissioning Lead referred to the Together for Children and Young People Framework, which was a multi-agency service programme aimed to reshape, remodel and refocus emotional and mental health services for children and young people in Wales. This was launched back in June 2015. In addition, Welsh Government had released a report on Baseline Variation and Opportunities Audit of CAMHS across Wales and a Framework for Improvement had been released providing clear definition of the role of Specialist CAMHS.
The Commissioning Lead relayed to Members improvement to the Crisis Care Services and advised that this related to children and young people that presented imminent risk of self-harm or harm to others arising from severe mood disorder, acute psychotic disorder or severe eating disorder. Members noted that this service had a target to see all children and young people within 48 hours and that from September 2016 there was a seven day a week service that operated from 10.00 a.m. to 10.00 p.m. During normal working hours (09.00 a.m. to 5.00 p.m.) health practitioners were contactable via St. David’s CAMHS. For out of hours, practitioners would be contactable through the University Hospital of Wales switchboard that was co-located with Adult Mental Health Crisis Services at Llandough Hospital. Furthermore, the Specialist CAMHS was accepting urgent professional referrals (typically from the University Hospital of Wales A&E department or Paediatric Unit and Primary Care Services) and was also accepting telephone referrals. In addition, urgent advice would be provided and, where necessary, assessment and brief follow up of those patients would be accessed across the seven day working week.
In reply to the Chairman’s query regarding the ability to recruit professional practitioners, the Commissioning Lead advised that a new psychiatrist had been appointed, but there was an issue around the junior training grades. She stated that there was a good relationship with the training course providers at Cardiff University and so it was hoped that progress around this would be made.
A Committee Member then asked two questions. His first was in relation to what would happen at the assessment stage, to which the Commissioning Lead advised that this would depend on which part of the service a person had been referred to. She did confirm that both the school and the GP would be properly informed. The Member’s second question was in relation to the transition to adult services. In reply, the Commissioning Lead stated that this was a key issue and that a lot of work around this was ongoing with partner organisations. She commented that CAMHS would support young people up to the age of 17 and there was a question in relation to support available to 17 and 18 year olds and whether it was appropriate for these individuals to be seen by services designed for adults.
With regard to the state of CAMHS on a national basis, a Committee Member commented that previous reports to Scrutiny had highlighted a number of issues and he asked what the national picture currently looked like. In reply, the Commissioning Lead stated that across Wales there were still some problems in regard to mental health support for children and adolescents. Investment had been made into new services and she alluded to the Welsh Government’s Together for Children and Young People Framework which showed that the issue did not just relate to CAMHS and that schools were vital too. She added that there was a need to have closer working relationships with school based counselling services and that there was a need to raise awareness about mental health. So there were still a lot of challenges to tackle.
The Committee queried the level of demand and the Commissioning Lead advised that investment had assisted in managing demand and allowed services to be properly coordinated. She stated that there were still challenges around the Primary Mental Health Team and work was ongoing in order to get the process right. In regard to management of waiting times, she stated that it was not known if the high rate of referrals would continue or if this would settle down. There was a need to look at and understand the trend of referrals, with the current work being around evaluating the number of specialist cases. The overall key objective for CAMHS was in meeting its 26 week target and so this would be closely monitored.
In querying the provision around the Welsh Language, the Committee was advised that CAMHS had been trying hard to improve the number of Welsh speakers in the service and a person had been recruited into a Welsh language post.
(1) T H A T the Commissioning Lead be thanked for her presentation.
(2) T H A T a further update report on progress be received in 12 months’ time.
Reasons for recommendations
(1) To offer the Committee’s thanks and appreciation to the representative from the CAMHS.
(2) To keep Members informed around developments to an important service area.
431 REVENUE AND CAPITAL MONITORING FOR THE PERIOD 1ST APRIL TO 31ST AUGUST 2016 (DSS) –
The Operational Manager for Accountancy presented the report, the purpose of which was to advise Members of the position in respect of revenue and capital expenditure for the period 1st April to 31st August 2016 regarding those revenue and capital budgets which formed the Committee’s remit.
Council, on 2nd March, 2016 (Minute Nos. 885 and 884 respectively) approved the Revenue and Capital Budgets for 2016/17. Reports monitoring expenditure were brought to this Committee on a regular basis.
In setting the Social Services budget for 2016/17, the use of £970,000 from the Social Services Fund had been approved.
It was currently projected that the Social Services budget would outturn with and adverse variance of around £1m.
A table and graph setting out the variance between the profiled budget and actual expenditure to date and the projected position at year end were attached at Appendix 1 to the report.
For Children and Young People Services, the major issue concerning this service for the coming year was the continued pressure on the children’s placements budget. Work continued 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. This budget would be closely monitored during the year.
With regard to Adult Services, it was projected that the Community Care Package budget could outturn with a variance of up to £1m by year end. This budget was extremely volatile and had been adversely affected this year by the increase in the cost of packages commissioned as a result of the introduction of the National Living Wage, the continued pressure on the budget from demographic growth and clients having increasingly complex needs. The final outturn however was difficult to predict. The final negotiations regarding fee levels were being concluded with service providers, but proposed increases were already above the level of inflation provided for within the budget.
The annual deferred income budget for 2016/17 had been set at £747,000 and, as at 31st August 2016, income received to date was £114,000 over-recovered. It was currently projected that this budget would outturn at £100,000 under budget by year end and this favourable variance was included as part of the projected overspend for care packages.
The report advised that the service would strive to manage growing demand and try to mitigate this position and some initiatives may be funded via regional grants in the current financial year. It was proposed that up to £1m be used this year from the Social Services Legislative Changes fund to cover the shortfall. Further details would be provided to the Committee during the course of the year.
In relation to Leisure Services, there was currently and adverse variance of £48,000 to the profiled budget which was as a result of high repair costs for vehicles during the start of the Grounds Maintenance season. It was however anticipated that this would reduce over the winter months and therefore it was currently projected that the overall budget would outturn on target.
In relation to the Social Services Savings Programme, the Directorate was currently required to find savings totalling £2.257m by the end of 2019/20. There was currently a surplus shown of £186,000 which was as a result of the Foster Carer Recruitment project, which was being developed in addition to the required savings targets. This surplus could be used to mitigate any increase in savings to be found in future years.
Appendix 2 to the report provided an update on individual areas of savings within the Social Services Budget Programme.
Within Adult Services, £100,000 of the full year savings generated from the Hafod Homes transfer had been offset against the £300,000 saving for Residential Services. Currently, there were no other approved plans in place to find the remaining £200,000 of this saving. Further consideration would have to be given to the way in which the saving could be achieved during the year. With regard to the Care Package Budget Reduction, the report explained that while was significant pressure on this budget, schemes had been put in place to deliver savings in this area by transferring domiciliary care clients to direct payments, by putting in place additional reablement capacity and by establishing a review team.
With regard to capital expenditure, Appendix 3 provided details of financial progress on the Capital Programme as at 31st August, 2016.
For the ICT Infrastructure Project, the funding for this was in order to implement an all-Wales scheme which was to enable the interfacing of a range of different systems across Local Authorities and NHS organisations. The system had been procured and was in the process of being rolled out across Wales. The system would be implemented in the Vale of Glamorgan during 2017/18 and therefore it was requested that the £400,000 budget be carried forward into 2017/18.
The report advised that it had been requested that a new capital scheme be included in the Programme for an upgrade of Wordsworth Park utilising Section 106 funding to the value of £75,000. In addition, as part of the closure of the 2015/16 accounts, funding had been set aside for upgrading play areas. It had now been requested that £200,000 be included in the Capital Programme for schemes as follows:
- Penarth Cliff Top £100,000
- Peterswell Road, Barry £75,000
- Cwrt Y Vil, Penarth £25,000
Furthermore, it had been requested that £18,000 be included in the Programme for an upgrade / replacement of play equipment and surfacing at Cwrt Y Vil Playing Fields utilising Section 106 funding of £18,000.
Appendix 4 provided non-financial information on capital construction schemes, from this Appendix, it was noted that most of the previous year’s schemes had now commenced and some were complete. Start dates had also been provided for new schemes for this financial year and these would be monitored closely to identify if capital schemes began to slip and to identify if further action needed to be taken.
The Chairman queried the programme of work in relation to the upgrading of play areas. The Operational Manager for Leisure stated that officers had been asked to assess playgrounds in the Vale and subsequently produced a priority list. He added that there were over 100 play areas throughout the Vale and so it was decided to concentrate resources on areas with high levels of visitors, such as Penarth.
A Committee Member queried how much of the budget shortfall could be attributed to costs as a result of legislative changes. In reply, the Operational Manager – Accountancy stated that this would be in the region of £500,000.
In answer to a query regarding the payment of travel time to staff of domiciliary care agencies, the Interim Head of Business Management and Innovation stated that this was complex. When finalising contracts for providers, the level of fees paid would take into consideration a number of legislative requirements, but it was then down to each individual provider as to how they spent the money allocated to them.
The Committee also noted that there would be further opportunity to evaluate the savings project as part of the 2017/18 budget settlement process. The Committee was also advised that an update report would be provided in regard to proposals for the respite service at Rhoose Road.
(1) T H A T the position with regard to the 2016/17 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 its consideration.
Reasons for recommendations
(1) That Members are aware of the position with regard to the 2016/17 revenue and capital monitoring relevant to the Scrutiny Committee.
(2) That Members are aware of the progress made to date on the Social Services Budget Programme.
432 QUARTER 1 (2016-17) PERFORMANCE REPORT: AN ACTIVE AND HEALTHY VALE (DSS) –
The Director of Social Services presented the report, the purpose of which was to present the performance results for quarter 1, 1st April to 30th June, 2016-17 for the Corporate Plan Wellbeing Outcome 4, “An Active and Healthy Vale”. For this item the Committee also welcomed the Operational Manager for the Shared Regulatory Service.
The report stated that as part of the review of its Performance Management Framework, the Council had recently adopted a new Corporate Plan (2016-17) which reflected the requirements of the Well-being of Future Generations (Wales) Act 2015 and identified four wellbeing outcomes and eight objectives for the Council.
An overall Amber RAG status had been attributed to wellbeing outcome 4, “An Active and Healthy Vale”, reflecting the positive progress made to date in making a different to the lives of residents and customers within a highly challenging environment.
For quarter 1, 14 out of 16 Corporate Plan actions under the Outcome were on track to be delivered giving an overall Amber performance statement for actions. An overall Amber performance status had been attributed to the quarterly measures reported against this outcome. Of the nine quarterly measures reported, performance was on or above target for six indicators with the remaining three missing target by more than 10%.
A detailed report outlining the progress at quarter 1 towards achieving Wellbeing Outcome 4 was provided at Appendix 1.
The Chairman queried progress in relation to service action plan AH5 and the development of an obesity strategy, a food and physical activity framework and a tobacco control action plan. In reply, the Interim Head of Business Management and Innovation advised that there was a lot of work to do in these areas but the key was around bringing all the work together. To do this, Public Health Wales had identified lead officers with whom the Council could work and a meeting had been scheduled to see how the actions could be progressed.
In detailing progress in regard to service action plan AH13 and the development of an effective commissioning strategy for accommodation with care for older people, the Interim Head of Business Management and Innovation explained that a market position statement had just been commissioned. In addition, information from the Population Needs Assessment would form the basis of the commissioning strategy. Further to these comments, the Director of Social Services added that the Directorate was still progressing plans, even without a commissioning strategy in place. He stated that the Intermediate Care Fund was key to this and that it was important to bring together the three areas of health, social services and housing. The Director also advised that a key challenge was in relation to the involvement of the private sector and so there was a need to broaden the range of partners that were able to work with the Council.
The Committee, in relation to the query regarding accommodation with care, noted that a number of proposals were being made for the development of extra care facilities. The Director of Social Services advised that the market position statement linked to this and that an update report to the Committee would be provided.
In highlighting progress in relation to the Shared Regulatory Services, the Operational Manager stated that for action SRS/A005 and the requirement to regulate the market place to ensure a fair, safe and equitable trading environment in which vulnerable groups were protected from harm, progress was on target.
For action SRS/A003, and the need to deliver food safety interventions, the Operational Manager explained that this had been given a red flag status and that A rated premises required a risk assessment within six months, B rated premises in 12 months and C rated premises within 18 months. For the service, all A and B premises had been properly risk assessed but there was a challenge in relation to the C rated properties. This measure had been affected by the recent appointment of new staff and the need to ensure that they were fully qualified and knowledgeable and so it had been decided to employ the service of contractors. The Operational Manager was also able to advise that C rated properties represented the lowest category of risk and that performance for quarter 2 had shown improvement. A Member was unhappy with the situation and it was agreed that he would submit a request for consideration so that this issue could be further investigated.
With regard to the delivering of health and safety interventions, the Operational Manager advised that this related to the inspection of residential homes and the Committee noted that all objectives for quarter 1 had been met. The final action in relation to the Shared Regulatory Services was the need to investigate sporadic outbreaks of communicable diseases. This objective was on target, although the Operational Manager advised that the data presented was for the region as a whole and that information specific to the Vale would be circulated to Members.
The Committee queried the performance of indicator VS/M033, the percentage of people who had completed the exercise referral scheme. In reply, the Operational Manage for Leisure stated that he would need to clarify the information presented and would email Members accordingly.
(1) T H A T the progress to date in achieving key outcomes in line with the Corporate Wellbeing Outcome 4 – “Residents of the Vale of Glamorgan lead healthy lives and vulnerable people are protected and supported” be noted.
(2) T H A T the performance results and remedial actions to be taken to address areas of underperformance and to tackle the key challenges identified be noted.
Reasons for recommendations
(1) To ensure that the Council clearly demonstrates the progress being made towards achieving its Corporate Plan Wellbeing Outcomes aimed at making a positive difference to the lives of Vale of Glamorgan citizens.
(2) To ensure the Council is effectively assessing its performance in line with the requirement to secure continuous improvement as outlined the Local Government Measure (Wales) 2009 and reflects the requirement of the Well-being of Future Generations (Wales) Act 2015 that it maximises its contribution to achieving the wellbeing goals for Wales.
433 CHILD SEXUAL EXPLOITATION (DSS) –
The purpose of which was to advise the Scrutiny Committee of the current situation regarding the approach taken to tackling Child Sexual Exploitation (CSE) in the Vale of Glamorgan. To answer some specific queries, the Committee welcomed the Principal Officer for Protection and Policy.
The report advised that the main characteristics of CSE could be summed up as follows:
- Abusers manipulating children and young people into sexual activities;
- The perpetrator exercises some power over the victim;
- The perpetrator will often use violence and / or intimidation;
- The perpetrator exchanges material and / or emotional gifts such as money or affection for sexual favours;
- The victim is vulnerable in one or more ways;
- The victim may be unable to see or to acknowledge that she / he is being groomed or abused;
- The victim may appear to agree to the relationship or to the abusive behaviour.
Because definitions and perceptions of CSE have changed, it was difficult to be certain about the true nature and scale of such abuse in Wales. However, it was known to happen frequently. It was not limited to any particular geographical area, ethnic or social background. Research by Barnardo’s in Wales over the last ten years showed that there were significantly more known cases of children and young people being sexually exploited in 2013/14 than in 2005. More children and young people were also being identified as being at significant risk of CSE
Following publication of statutory guidance “Safeguarding Children: Working Together under the Children Act 2004”, Councils were required to establish Local Safeguarding Children Boards (LSCBs).
The objectives of an LSCB are to:
- protect children within its area who are experiencing, or are at risk of abuse, neglect or other kinds of harm, and
- prevent children within its area from becoming at risk of abuse, neglect or other kinds of harm.
The Vale of Glamorgan and Cardiff established LSCBs in 2006; these merged as one regional LSCB in October 2013. The Cardiff and Vale of Glamorgan LSCB brought together senior representatives from each of the main agencies and professions responsible for safeguarding children. In Wales, the statutory responsibility for establishing the LSCB rests with the local Children’s Services authority. The Social Services and Well-being (Wales) Act 2014 introduced a strengthened, robust and effective partnership approach to safeguarding. The Part 7 Guidance for the Act sets out clear statutory responsibilities for local agencies, including Councils, in relation to safeguarding children (and adults).
Councils played a crucial, statutory role in safeguarding children, including tackling child sexual exploitation. However, they could not do this alone. It needed the co-operation of the wider community and partner agencies. Councils could use their links with police, schools, health professionals, and community and faith groups to highlight the signs and ensure people know where to turn if they have concerns. CSE was a difficult and unpleasant subject to discuss but having these conversations was crucial to effective action. Members would be aware of the independent report by Professor Alexis Jay into the handling of CSE by social services and police in Rotherham between 1997 and 2013. It was highly critical of "collective failures" of political and officer leadership.
There had been similar concerns expressed about other places such as Derby, Oxford, Bristol, Telford and Peterborough. These all demonstrated the key role performed by the Leader of the Council, the lead Member for Children’s Services, Scrutiny Committees and all Councillors in questioning and challenging responses to CSE in their local area. Subsequently, the Local Government Association produced a resource pack for Councils on good practice in tackling CSE. The Social Services Improvement Agency in Wales had recently issued three workbooks to support Elected Members in understanding various aspects of safeguarding – Safeguarding Adults, Corporate Parenting and Child Sexual Exploitation. Child Sexual Exploitation – It Can and Does Happen Here.
To date, there had been only one major case in the Vale of Glamorgan where multiple abuse was suspected. It involved a significant number of alleged victims, most of whom were resident in other Local Authority areas and all of whom were now adults. The perpetrator was already in prison, having been convicted of similar offences. The investigation had been conducted jointly and all the agencies worked together very well in what was a large-scale operation. Children potentially at risk and those who may have been abused were safe. The LSCB was currently carrying out a Child Practice Review to see what lessons could be learned. Two senior managers from the Vale of Glamorgan were currently members of the Child Practice Review Panel. The findings of the review would be shared with the LSCB during the autumn.
On the evidence currently available, most children who had been the subject of CSE strategy meetings since the Council started collecting local data had not been victims of organised abuse. The Council could not be at all complacent and considerable efforts were being made to tackle CSE in our area. The Cardiff and Vale LSCB had established a sub-group, led by the South Wales Police and including representatives from the NHS, probation and social services, to address operational issues. The Director of Social Services represented ADSS Cymru on the pan-Wales group established by the Children’s Commissioner, which was looking at areas requiring national policy and leadership.
At a local level, the Council complied fully with the All Wales Child Protection Procedures in addressing cases of suspected CSE. Where children / young people were considered to be at risk of CSE, an assessment of risk using the Sexual Exploitation Risk Assessment Framework (SERAF) tool was undertaken. Assessments with risk scores under 11 were discussed with the Principal Officer working in this Council and preventative measures were considered. Risk scores of 11 and upwards progressed to a CSE multi-agency strategy meeting. Cases which were seen to indicate ‘significant risk’ were referred automatically to the Directorate’s Principal Officer in Protection and Policy who convenes and chairs a multi-agency strategy meeting under the All Wales Child Protection Procedures.
To ensure that consideration was given to children or young people about whom there were concerns but where there was not a ‘significant risk’ score on SERAF, a process was in place whereby any agency or professional body may refer a case for consideration about whether there were agreed CSE concerns. If this was the case, the ensuing assessment would consider these issues and the case was referred to the Principal Officer in Protection and Policy who considered the level of intervention required. This might range from the provision of support services to proceeding with a strategy meeting involving relevant professionals. In addition, the new processes allowed the Council to capture more effectively data about the number of children where there were sexual exploitation concerns.
There had been 25 initial CSE strategy meetings between April 2015 and March 2016, relating to 32 children. There were 35 review meetings for children already known to be potential victims of CSE with ongoing work identified; some of these reviews would relate to the 25 new referrals. The response to each young person had included:
- consideration of any criminal matters by South Wales Police;
- consideration of the need to use child protection procedures; and
- support to be provided by social services and voluntary organisations as these were regarded as children in need.
Where ongoing concerns had been identified, review strategy meetings took place for each young person. Most alleged victims were aged 14-16 and they shared common characteristics such as poor attendance at school, low self-esteem, self-harm / suicidal thoughts and inappropriate use of the internet and mobile phones. Suspects were usually male and aged 19-40.
Since February 2015, the NSPCC have been providing a service to the Vale of Glamorgan in respect of children and young people who were at risk of CSE or where there were current concerns that they were being exploited. The NSPCC model allowed preventative work to be undertaken. The low-level risk cases assessments by their social work staff identified the best level of intervention for those currently suspected of being exploited and for those young people who were now able to recognise exploitative relationships. This service had already been offered where appropriate to the young people who had been the subject of a CSE strategy meeting and those children whose SERAF score identified low-level risk.
The South Wales Police now had a Detective Sergeant and two Detective Constables dealing specifically with children and young people who were at risk of CSE. In this role, the officers attended all the CSE strategy meetings in the Vale and Bridgend (both areas being part of the same Basic Command Unit).
The information meetings established in May 2015 had now been expanded and these were now referred to as the CSE Task Force meetings. Those in attendance were the Detective Superintendent, Vale Safeguarding staff, Education, the Practitioner Manager for the Social Services Duty Team, a Youth Service representative, a Youth Offending Team representative, the Looked After Children Nurse, the Safeguarding Nurse, a representative of the 15 Plus Team in Children’s Services and a Licensing Officer, if there were relevant concerns. The meetings took place every other month here in the Vale and on a monthly basis in the Bridgend area (because of the higher numbers of children identified).
CSE was an area where significant developments were happening at pace. The Police had developed a sophisticated data base / problem profile which pinpointed links between children at risk and suspected perpetrators of abuse across the Force’s area. This real-time intelligence allowed all agencies to target work to protect potential victims, to investigate criminal acts and to disrupt the activity of perpetrators. The strategy meetings were an effective means for the Police to gather both formal and ‘soft’ intelligence on perpetrators within the area, thus ensuring that local information about individuals, activities and locations was shared and monitored. Early information from the system indicated that CSE issues occurred more often in adjoining Local Authority areas and that, outside the Vale, there was some association with specific geographical locations or groups.
The South Wales Police had received a grant enabling them to employ workers from Barnardo’s to ‘de-brief’ children and young people who had been missing. The workers would look to establish where the children and young people had been and with whom they had been associating. The worker based with the police in Cowbridge had also undertaken sessional work with identified young people for up to six sessions.
One of the challenges for professionals working with children and young people who were most vulnerable was helping them to acknowledge that they were at risk of being exploited. Schools in the area had delivered a programme to children which was designed to raise awareness, especially regarding online abuse which involved their peers.
The Chairman referred to the one case in the Vale of Glamorgan where multiple abuse was suspected, and queried whether there were any lessons to have come out following the review by the LSCB. The Director of Social Services advised that the review had been completed, the outcomes of which would be published. He added that the review had commenced in April, so had been completed in a short timeframe and that this would be a useful report.
A Committee Member enquired whether enough awareness raising was being undertaken. The Principal Officer for Protection and Policy stated that there was never enough awareness raising and there was always more that could be done. Awareness raising was being carried out with schools and there was a programme that aimed to reach children, especially as online exploitation was a major problem. She added that youth workers would deliver the message and that she would attend all strategy meetings with information shared with the Police. A recent workshop around the Sexual Exploitation Risk Assessment Framework had been held which was well attended. The Principal Officer explained that most new starters would be well aware of her role and expectations and she also referred to the correlation between childhood trauma and cases of CSE, around which children were more likely to be exploited. Members noted that a CSE Strategy would soon be rolled out.
The Principal Officer was also able to add that there were always multi-agency training available and that there many opportunities available for schools, which included training such as Level 1 General Safeguarding and CSE Level 2.
The Committee, in querying the number of Looked After Children affected by CSE, was advised that the figures for the Vale were quite small and of the 32 children identified in 2016, only three related to a Looked After Child. Some of these were on the Child Protection Register but the vast majority, as intimated previously, had suffered from some form of childhood trauma that had made them more vulnerable.
In commenting on the work around CSE, the Director of Social Services stated that the Council’s approach was around early disruption of predatory behaviour. Therefore, close links had been established with the Police in order to limit the risk to children and young people. He also stated that the low figures for Looked After Children validated the Council’s approach in maintaining local placements which meant that Social Services were better placed to look after them.
(1) T H A T the contents of the report be accepted.
(2) T H A T an update report be provided in 12 months’ time.
Reasons for recommendations
(1) Following consideration of how the Council was carrying out its duties to identify, reduce and eradicate the risk of Child Sexual Exploitation within the Vale of Glamorgan area.
(2) In order to monitor developments aimed at reducing and eradicating the risk of Child Sexual Exploitation.
434 UPDATE ON HOW THE COUNCIL IS MANAGING INCREASED DEMAND FOR FAMILY SUPPORT SERVICES (DSS) –
The Head of Children and Young People Services presented the report, the purpose of which was to update the Scrutiny Committee on how the Council was meeting the challenges of increased demand for family support services.
The report advised that the Commissioning Strategy for Children and Young People Services 2013-2018 set out how the Council and its key partners intended to meet the wellbeing and social care needs of children, young people and their families within the resources available. It described the tiered model of services that was in place to guide the way in which resources were allocated and helped with decision-making in individual cases.
Work to implement the model within Children and Young People Services and in partnership with other Directorates across the Council, the NHS, the third sector and the independent sector had produced significant results. By ensuring a focus on early intervention and preventative action across all service provision for children, the Council was able to support families to stay together and to reduce the need for children to be looked after outside of their families. This had helped the Council to manage demand for care and support at lower levels of intensity / intrusiveness.
It was recognised that some of the difficulties which children and young people experienced were as a consequence of factors affecting other members of the family. On the basis of evidence from programmes such as Flying Start, a consensus had emerged that the best way to support families (particularly those in poverty) was through whole-family services which were provided in an integrated way by a range of agencies and professional disciplines and which were tailored to the needs of individual families. Critical to the success of the Families First programme was the “Team Around the Family” approach, which had been used extensively across the United Kingdom. There was good evidence for positive outcomes.
Most family support services were provided through the use of fixed-term grants from Welsh Government which required robust arrangements for partnership working between agencies. The Families First grant from Welsh Government was provided to Local Authorities to improve outcomes for children, young people and families. Each Local Authority had to develop a Families First Action Plan which would set out how they would implement the programme locally and contribute towards nationally accepted outcomes. The report stated that there had been challenges this year, following an 11.65% reduction in the grant funding available. The Families First Management Board had worked hard to maintain the delivery of frontline services and the Vale of Glamorgan programme currently provided funding for the following projects:
- Families Achieving Change Together (FACT) team;
- Raising awareness of welfare rights;
- Disability focus;
- Partnership for young parents;
- Putting families first;
- Young people support programme;
- Young carers;
- C-Card scheme.
The report also outlined the work of Flying Start, the Integrated Family Support Service (IFSS), the Communities First Programme, the Youth Engagement and Progression Framework and the Supporting People Programme, providing an overview of the key activities undertaken by each agency along with their strategic objectives and outcomes.
A multi-agency Management Board oversaw both Flying Start and Families First with a common membership. This comprised of representatives of the Cardiff and Vale University Health Board (UHB), Glamorgan Voluntary Services (GVS), Learning and Skills and Children and Young people Services. A Poverty Alignment Group, established across the four poverty strands, looked at common features, joint working and closer alignment of project delivery and project outcomes, in line with Welsh Government’s suggested direction of travel.
In the context of high service demand and the need to avoid long waiting lists, the FACT team experienced high levels of referrals around which the Management Board had considered strategies to address the issues. Firstly, the team undertook visits to all referring partners to raise awareness of what constituted an appropriate referral. Secondly, to ensure that referrers themselves did not stop working with families while awaiting a response to a referral, the FACT team ceased holding a waiting list but also looked at ways to broaden the service being offered. Initially, in relation to Tier 2 referrals, in November 2014 a Resource Panel was piloted where families that were referred to FACT but assessed as being below the team’s current threshold, were referred to the Panel. This operated until March 2015 and the Panel had met on several occasions. Subsequently, the process proved cumbersome and unproductive as it became obvious that referrers felt that this was just another route to FACT, even though it was chaired by an independent officer and it was made clear at all points that the referring agency should maintain oversight of the family.
While use of the Resource Panel was being piloted, alternative models of delivery were explored and contributed to the final Resource Panel Evaluation. The report was presented to the Families First / Flying Start Management Board in March 2015, and it was decided to end the Resource Panel pilot and to pilot instead a signposting service aimed at Tier 2 demand.
Launched in July 2015, the Families First Advice Line sought to take initial requests for referrals to FACT. It then offered information, support and advice prior to signposting professionals and families to available services or confirming the need for an assessment (thereby reducing the need to refer to FACT).
The Families First Advice Line had been growing steadily during 2015-16. 114 calls had received a response. Most enquiries had been managed through telephone contact, although the Advice line staff had the capacity to undertake home visits, which occurred in 17 cases. 68 calls had come directly from parents / carers, reinforcing the need for help and advice to be available. A survey of those contacting and using the Service was being carried out which would assist the Management Board in evaluating its effectiveness.
The report outlined that the number of referrals to the FACT team during 2015/16 had reduced. The Directorate was evaluating whether the Advice Line had helped to achieve this outcome, validating the decision to establish this service. Quarter 1 referrals remained constant as schools ensured that families deemed vulnerable were offered and gained support prior to the summer break.
The Committee noted that the Families First Plan was delivering ten effective projects. Numbers accessing the service showed a slight increase in numbers for each of the last three years. Since the programme began in 2012/13, there had been an increase of over 270% in the number of families benefiting from Families First services and over a 500% increase in the number of children and young people benefitting.
Families First had worked closely with Communities First and Flying Start to ensure families received seamless and holistic services, not restricted by age and geography. Across these partnerships and under the banner of the Poverty Alignment Group, some of the projects funded through Families First had been expanded through the secondment of Communities First staff helping to deliver the same family support models (Transitions and Putting Families First). Another Families First project, the Partnership for Young Parents, was managed by Flying Start. Recently, Flying Start and Communities First jointly funded a shared Health and Wellbeing Social Worker post. This model of working, pioneered in the Vale of Glamorgan and joining up the three main poverty-related grant programmes, was now being promoted at a national level.
Under the Poverty Alignment Group, all four programmes had contributed to:
- delivering a Parenting Conference to over 90 professionals;
- mapping and aligning parenting provision;
- revising terms of reference to support greater alignment;
- mapping support for teenage parents (exploring services for low birth weight babies) and NEETs;
- working with Public Health to consider options for a more co-ordinated approach to various priorities across the four programmes that are shared with Public Health such as tackling childhood obesity (awaiting a report from Health to consider current methods of funding Dietetics), sexual health, mental and emotional health;
- exploring the roll out and delivery of programmes including “love food, hate waste” and links to food banks;
- sharing information on European Structural Fund (ESF) projects and delivering a joint workshop with the Youth Service to raise awareness of this;
- organising a second shared Networking Event which launched DEWIS locally;
- working on a report discussing how we align the four programmes further, exploring barriers and enablers;
- participating, as one of the early adopters, in the Common Outcome Framework (COF pilot) devised by Welsh Government to closer align joint outcomes, although it had now withdrawn the idea;
- delivering joint training on various areas including raising awareness of poverty, Nurture and other parenting training, and safeguarding;
- taking forward a Team Around the Family ethos in Flying Start and Supporting People, looking at the principles but not replicating the FACT approach;
- planning an awareness-raising workshop across all four programmes and members of the Poverty Alignment Group to improve knowledge, understanding and referrals and build in some common approaches to how the teams work;
- considering a joint database;
- pooling skills and resources regarding website development;
- exploring how recent research reports, including “Adverse Childhood Experiences”, could be taken forward and exploring joint work on key features such as domestic abuse.
By targeting the projects that were funded in order to help children and young people most at risk, Families First made a significant contribution to developing the Youth Engagement and Progression Framework (YEPF). The report advised that much of this work was delivered in conjunction with the Youth Service. The YEPF had audited youth provision and implemented mechanisms for early identification of those most at risk. Once identified, a key worker was assigned and a referral to support systems made, again seeking to reduce the need for more intensive forms of provision. As a result of implementation of the YEPF, it had been reported that there had been a consistent reduction in NEET (Not in Education, Employment and Training) young people in the Vale.
The Chairman queried whether anything more could be done in order to avoid duplication of work in regard to the four programmes aimed at tackling poverty. The Director advised that this would depend on national initiatives to come from Welsh Government. The Welsh Minister had proposed better alignment of the grant money paid to Local Authorities and so there was opportunity to consider how the money was spent. The Committee was also advised that there were currently no known proposals to allocate funding to the Revenue Support Grant.
A Committee Member queried the withdrawal by Welsh Government of the Common Outcome Framework pilot. In reply, the Director of Social Services stated that a ministerial advisory group had been established in order to develop a coherent strategy for Children and Family Support services. For this there would be a number of strands and a broad range of representatives.
In reply to a question regarding demand management, the Committee was advised that the advice line had made a difference which now allowed self and professional referrals. There were more referrals being resolved over the telephone with a lot of signposting to other agencies. Furthermore, FACT was not handling referrals that were more appropriate for others and so improvements had been made to the ‘front door’ part of the service.
RECOMMENDED – T H A T the approach taken to provide appropriate levels of family support services to manage growing demand, especially within the service provided by the Families Achieving Change Together team be noted.
Reason for recommendation
In light of the contents of the report.
435 ASSISTIVE TECHNOLOGY AND DEMENTIA CARE TASK AND FINISH GROUP (DSS) –
The Head of Adult Services presented the report, the purpose of which was to update Members on progress made in delivering the action plan developed through the Assistive Technology Task and Finish Group.
The former Scrutiny Committee (Social Care and Health) set up a Task and Finish Group to examine the potential contribution that Assistive Technology could make in developing a dementia-supportive community in the Vale of Glamorgan and to help enable people to live independently and with a better quality of life. The Group comprised six Members and was politically balanced.
During the course of the review, the Task and Finish Group was able to complete a thorough investigation and to make well considered recommendations for improving the responsiveness of the service. The Group also recognised that further work was needed before major decisions could be taken in relation to longer-term planning.
Overall, the Group concluded that Assistive Technology could be of considerable help to people experiencing dementia and also to their carers. However, national research, information from partners and data from existing services did not provide conclusive evidence that it was likely to deliver significant savings. Given the budgetary pressures that the Council faced, the Group made recommendations for improvements which it regarded were realistic and measured and which identified the further work required to develop the service for the future. A detailed action plan was agreed, to ensure that the recommendations were implemented and that progress could be measured.
The plan contained 15 action areas. An updated version was attached at Appendix 1 to the report. The report advised that the progress made against each action indicated that the majority were either complete or had become part of ongoing business.
In terms of staffing arrangements, the report advised that due to the small size of the Telecare team, an ongoing review was being undertaken to ensure that the Directorate had a resilient and effective team model fit for future delivery.
Since the plan was agreed, the numbers of people receive Telecare had grown for service users of both Tele V and Tele V+. As of August 2016, there were 730 active Tele V users and 137 Tele V + users. Committee noted that the rate of growth had slowed during this financial year, with an additional five Tele V+ users and no increase in the number of Tele V users.
The Committee was advised that the service had purchased equipment to support people with dementia. This included bespoke decoration and two reminiscence pods for use at Rondel House day service. Tablet computers were also made available for the care homes managed by the Council and the older people’s day service, to support communication and provide additional activities. Specifically they were being used to allow video contact with relatives living in other countries, choosing items of clothing, accessing games and to store photos at events that would be viewed by residents and their families.
The Chairman commented that one of the main challenges was in relation to staff resilience and the size of the Telecare team and he queried whether this had resulted in the low take-up of Telecare services seen so far during the current financial year. In reply, the Head of Adult Services stated that this had had a small impact but there were other challenges such as issues around the Supporting People grant. He also alluded to the opportunity of working on a regional basis with Cardiff Council, and that there was a need to regroup and consider future possibilities.
In terms of identifying savings, the Head of Adult Services explained that during the review it was recognised that Telecare was unlikely to provide real savings but it did provide a lot of reassurance. Detailing savings was a complicated undertaking, and he alluded to the possible savings within the area of domiciliary care.
The Committee agreed that as a document, the action plan could be closed off and it was also agreed that the Committee would receive an update on an annual basis.
(1) T H A T the report be accepted and referred to Cabinet for consideration.
(2) T H A T an update report be provided in 12 months’ time.
Reason for recommendations
(1&2) To apprise Members of the progress made.
436 UPDATE ON IMPLEMENTATION OF THE SOCIAL SERVICES AND WELL-BEING (WALES) ACT 2014 (DSS) –
The Director of Social Services presented the report, the purpose of which was to provide an update in respect of the Social Services and Well-being (Wales) Act 2014 and the approach being taken in regard to implementation.
The report advised that the Act came into effect on 6th April, 2016. The Committee had requested regular updates on the progress being made in implementing the Act in the Vale of Glamorgan.
The report therefore provided an update on the information considered by the Committee in March 2016, which included:
- progress of the four national work groups, established to share best practice and produce consistent material on an all-Wales basis;
- progress on the amendments to the eligibility / assessment of needs process, to ensure compliance with the national assessment checklist;
- an update on the use of the national training materials for the four core modules and the briefings for staff to ensure that they received an overview of the four key areas of change;
- an update on inclusion in the new “Better Conversations” training course that had been piloted by the Social Services Improvement Agency (SSIA), aimed at equipping officers working at the First Point of Contact;
- an update on the national awareness raising campaign, led by Welsh Government, which started in February 2016;
- information about the National Independent Safeguarding Board which would work alongside the regional Safeguarding Boards (adults and children) to secure improvements in safeguarding policy and practice throughout Wales;
- an update on the local co-production workshop held in February to explore how best an independent professional advocacy service for adults could be provided;
- information about the duty on Local Authorities and Local Health Boards to carry out a regional population needs assessment by March 2017;
- an update on resource implications (financial and employment).
In summary, the Director of Social Services stated that 6th April was another step, albeit a fundamental one, on the journey towards full implementation of all the changes required by the Act. He advised that good progress had been made in all areas, including the reform of current services, the revision of current policies to ensure that they were compliant with the new statutory framework, and achieving the shifts in organisational culture that was needed. Furthermore, he added that the decision to focus on business continuity as well as change had been vindicated by the Council’s success in minimising the disruption caused to existing service users and carers or those wishing to make referrals. However, the Director stated that the Council was beginning to see the impact that it was having in practice and upon Council resources. Although there were clear benefits in changing the ways in which citizens were supported, this had been very time consuming and caused some issues in relation to managing demand. One direct consequence appeared to have been an increase in the waiting times for Adult Services.
The Chairman, in referring to the increase in waiting times, queried whether evidence of this could be shared with Welsh Government. In reply, the Director of Social Services stated that this would be the right approach to take and that there was quantitative evidence as well as comments from care practitioners that could be provided. The Director also added that the changes to practices introduced by the Act had less immediate impact in areas such as mental health and Children’s Services but they did require significant and urgent changes in Older People’s Services which was the biggest area of demand. It was not a surprise that waiting times would be affected as a result of adopting a new approach.
A Committee Member stated that some Local Authorities had been struggling with implementing the new Act and he praised the proactive approach adopted by the Vale. He also added that funding was always going to be an issue and he commented that Welsh Government should consider the level of the cap on charges for community care packages.
In reply to a query as to what would happen in cases where service users considered that they were not being appropriately listened to, the Director of Social Services advised that the service worked on the premise that the person’s voice must be heard and recorded throughout their care journey. If individuals felt that this was not the case, then there were many routes that they could explore such as advocacy and through the Council’s complaints procedures. For the service, a major aspect of the reform was in relation to the change in entitlement to services for carers and so it was important to ensure that all carers were aware of this.
The Committee, in discussing future progress reports, requested that an update be received early in the New Year and that this be in tabular form, reflecting each section of the Act, which would make it easier for the reader to appreciate how well the Council was doing. It was agreed that this update would be as a Region and not specific to the Vale.
(1) T H A T the contents of the report be accepted.
(2) T H A T an update be received in March 2017.
(3) T H A T the report be referred to Cabinet for consideration.
Reason for recommendations
(1-3) To ensure that Elected Members are kept informed about the impact of changes in the policy and legislative framework which underpins the work of Social Services.