SCRUTINY COMMITTEE (SOCIAL CARE AND HEALTH)
Minutes of a meeting held on 1st February, 2016.
Present: Councillor R.L. Traherne (Chairman); Councillors R.J. Bertin, Ms. R. Birch, E. Hacker, H.C. Hamilton, Dr. I.J. Johnson, J.W. Thomas, S.T. Wiliam and Mrs. M.R. Wilkinson.
Also present: Councillor S.C. Egan.
791 APOLOGY FOR ABSENCE –
This was received from Councillor Mrs. M.E.J. Birch.
792 MINUTES –
RECOMMENDED – T H A T the minutes of the meeting held on 4th January, 2016 be approved as a correct record.
793 DECLARATIONS OF INTEREST –
No declarations were received.
794 ALTERNATIVE DELIVERY MODELS FOR THE PUBLIC SECTOR – REQUEST FOR CONSIDERATION OF MATTER – COUNCILLOR R.J. BERTIN –
Councillor R.J. Bertin had requested that the Committee receive an overview of the work undertaken by the Wales Co-operative Centre with Local Authorities to support the development of Alternative Delivery Models. For this item, the Committee welcomed Andrew Jones, the Business Development Manager.
In introducing his request, Councillor Bertin stated that he was pleased to have this presentation as the Council would need to look at its methods for delivering services and to look at possible alternatives. So it was good to look at various models. He commented that budget pressures were hitting the Council hard and that the Council would need to change how it delivered services and so he was interested to hear what options were available.
Mr. Jones began by advising Members that the Wales Co-operative Centre had two main roles, which were around assisting the development of social enterprises and providing consultancy support to Local Authorities. He went on to state that some of the benefits of social enterprises were that there was a greater level of staff ‘buy in’ which potentially resulted in lower staff turnover. Social enterprises were also potentially more productive and efficient. This was because of a flatter and more streamlined structure, which meant that social enterprises could be more dynamic and could respond more quickly to market changes.
In outlining the potential challenges that authorities may face when looking at alternative models of service delivery, Mr Jones stated that as new organisations would mainly rely on a single business contract, they would be quite vulnerable and this meant that there was a low success rate. Some of the challenges that new organisations would face included a complicated spin out process that included areas such as staff transfers through TUPE arrangements. Taxation was another major consideration and new organisations would need to familiarise themselves with the rules such as Corporation Tax. Furthermore, the Wales Co-operative Centre had advised organisations not to rely on a single contract and to carefully consider where the responsibilities for staff pensions would sit, and whether this was better externalised or kept in-house. In addition, the Committee noted that the transfer of assets both in relation to staff and buildings, the capacity of the staff and any potential skills gap could be challenging.
In terms of the process around change, Mr. Jones advised the Committee that this could be broken into a four stage process:
1. Appraisal of the options
2. Business planning
4. The post go-live period.
In looking at the options, Local Authorities would need to assess several forms of delivery models and would need to decide if proposals were desirable, viable and feasible. Once the preferred option had been identified, proposals would then progress to the business case / planning stage. Important elements of this stage included consideration of the drivers for change alongside an evaluation of the “do nothing” approach. Local Authorities should also undertake a market analysis in order to ascertain demand for the service and should consider the operating model and how the service would be governed. Other important matters included financial modelling and an evaluation of risks.
The third stage was around implementation of the business plan and included the establishment of governance arrangements and the transfer of staff, assets and liabilities. The fourth stage would be when the organisation would be ready to launch and go live. Mr. Jones stated that this would be where the real work would begin and when the organisation would try and turn itself into a viable business.
Mr. Jones then provided the Committee with an overview of some successful examples. The first example was in Rochdale; when faced with achieving savings of £40m, it had resulted in its Adult Services being outsourced. This was now run by a social enterprise called “Possibilities”. The Committee noted that Rochdale was on target to meet its saving objectives and that the key aspect from this example was that staff had a direct say in the running of the organisation.
The second example related to a smaller social enterprise in Salford, Manchester, called “Social Adventures”. This was a wellbeing social enterprise specialising in public health and social care contracts that ran alongside social businesses such as garden centres, community cafés and childcare nurseries. Social Adventures was made up of 30 members of staff and had an annual turnover of £700,000. Mr. Jones stated that what was evident from this example was that the organisation had managed to increase its non-core business (that part of the business that was not related to Social Services) by 70%. Also, the organisation had been able to create a network with other similar organisations which had resulted in these being able to link together to bid for bigger contracts and to provide greater buying power.
The third example was a social enterprise company created by the Royal Borough of Kensington upon Thames and the London Borough of Richmond upon Thames to provide their Children’s Services. This was a large company with a total of 600 staff and an annual turnover of £130m. Mr. Jones indicated that, between the two Local Authorities, £6m had been saved and importantly, services which had been assessed as adequate were now rated as good.
The final example was a social enterprise in Swindon called “Seqol”, which provided care and support for adults. Mr. Jones explained that this was a fairly small organisation with around 80 staff and an annual turnover of £40m. He went on to advise Members that this was a staff and stakeholder driven organisation, which year on year had exceeded both savings and performance targets. Also, the organisation had won a number of awards and had been able to reinvest profits directly back into its services.
This concluded Mr. Jones’ overview.
The Chairman, in querying the progress of Alternative Delivery Models in Wales compared to England, was advised that more schemes had been devised in England because budget reductions had been brought in two to three years before those imposed in Wales. Further to this query, the Director of Social Services stated that the context in Wales was somewhat different to that in England, because of issues around charging and eligibility. Councils in Wales were interested in a more sustainable model and this included greater diversity in terms of social care providers. The overall priority was deciding what was the best way to deliver services, for which consultation with clients was an important element. The Council therefore needed a balanced approach which included the need for continuity and he alluded to the risks associated with social enterprises and the problems that had been experienced when certain care agencies had folded.
In querying the reasons why social enterprises failed, the Committee noted the example of a company called Monwell, which was a social enterprise in Blaenau Gwent. The Committee heard that this organisation had gone out of business because of issues around governance and cash flow. A Phoenix project had been established to look at the issues more closely and to look at any lessons that could be learned from this example.
The Chairman thought the example in Rochdale appeared to be the “Holy Grail” of social enterprises and he asked why all Local Authorities in England were not doing this. In reply, Mr. Jones advised that a number of Local Authorities were doing so. However he felt that the most successful organisations were the ones which had been able to come up with their own solutions which they themselves had been able to find and which best met their individual needs.
At this point, the Cabinet Member for Adult Services, with permission to speak, stated that it was the supported view of Cabinet that the Council would have to carry on providing services with less resources and that the Council could no longer salami slice services in response to budget cuts. He explained that, if alternative models of service delivery were developed, responsibility for the success or failure of these would still come back directly to the Council. As a Cabinet Member, he would consider any proposals where Alternative Delivery Models could provide better services, but he was mindful that a lot of work would be required to ensure that the vulnerable people of the Vale were protected and that all the boxes had been ticked.
In reply to a Member’s query regarding the challenges around the size and scale of services in Wales, the Director of Social Services stated that in Wales often smaller scale projects had been developed and that regional and collaborative working offered the opportunity to commission services on a larger scale. He alluded to the approach adopted which was to keep the market honest and to ensure that the Council got the best deal for the people living in the Vale.
In closing this item, the Committee thanked Mr. Jones for his overview and the Committee looked forward to receiving more information as the situation developed.
RECOMMENDED – T H A T the overview on Alternative Delivery Models for services provided by the Wales Co-operative Centre be noted.
Reason for recommendation
To ensure that Members are aware of alternative models of service delivery and the approach being taken in other parts of the United Kingdom.
795 NATIONAL EXERCISE REFERRAL SCHEME –
The Committee received a PowerPoint presentation which gave an overview of the National Exercise Referral Scheme (NERS) and the Committee welcomed the Operational Manager for Leisure and the Exercise Referral Co-ordinator.
In beginning the presentation, the Exercise Referral Co-ordinator advised Members that the NERS was a physical activity scheme that was aimed at adults over 16 years of age. NERS was for people with a medical condition and who would benefit from exercise which provided a starting block for people to become more active and healthy.
The NERS consisted of a number of aspects. This involved a structured programme of exercise which included the use of gym and exercise classes alongside trained instructors who would monitor and motivate clients to achieve set goals and targets. Depending on a person’s physical condition, the NERS programmes lasted between 16 and 48 weeks. NERS had been evaluated in 2010 and it had been deemed to be cost effective against other traditional methods of treatment.
In terms of funding, the Committee was advised that the NERS was funded by Public Health Wales (PHW) via grant allocations which funded staffing and equipment costs. NERS would generate income for Leisure Centres and had led to an increase in membership, usage and secondary expenditure. The Committee also noted that the NERS was a partnership between PHW, the Welsh Local Government Association, the Vale of Glamorgan Council and the Local Health Board.
The Exercise Referral Co-ordinator then went on to outline some of the benefits for people being more active, these included:
- Better weight management
- Reduced blood pressure
- Reduced risk of heart disease and stroke
- Reduced risk of some cancers
- Reduced stress and anxiety
- Increased energy
- Improved mental and social wellbeing
- Increased strength, mobility, co-ordination and balance.
With regard to how the scheme worked, the Committee was advised that the NERS was accessed via health professionals with which each GP practice in the Vale having direct access to the scheme. The rate of referrals from GP surgeries varied, with the highest referrals from one GP being 70 individuals, to some referring just 2 or 3 individuals. Physiotherapists, dieticians and mental health teams could also refer.
Identified benefits for the Vale of Glamorgan included the recognition that people felt fitter, stronger and were able to do more and it was felt that as sessions were social, this was an added benefit to many vulnerable people in the community. In addition, therapists and health professionals had clear exit strategies in place for their patients. The Committee was then shown three short videos which highlighted the views of some people who had used the scheme.
Following the videos, the Director of Social Services was asked to comment. He stated that improving outcomes for people with long-term health conditions was a major part of the Council’s Corporate Plan and he conveyed his commitment to schemes such as this.
In querying the reasons for people being referred, the Committee was advised that 70% of clients would require some form of weight loss, while the remaining 30% had been referred for physiotherapy reasons. The Exercise Referral Co-ordinator also advised that more people would die from inactivity than smoking. There was a broad range of referral reasons, which would include people with high blood pressure or cholesterol, physical inactivity, risk of heart disease, obesity, osteoporosis or diabetes. The main focus of the scheme was diet management for which Food Wise was a free eight week weight management course that worked alongside the scheme’s 16 week programme. Further to this and in querying the referral process, the Committee was advised that a person could ask their GP to refer them or as it was easier to get an appointment, to ask their practice nurse to refer them.
A Committee Member questioned the dropout rate for the scheme. In reply, the Exercise Referral Co-ordinator stated that last year the scheme received 1,700 referrals of which 1,040 led to cases where people attended their first session. These figures also included those ineligible for the scheme. The Committee also heard that engagement was an issue, particularly around the fear that many people had about going to a gym. The Committee Member then raised another question regarding the capacity of the service. In response, the Committee was advised that the scheme was able to handle 20 individuals per instructor, which over the year made a total of 960 sessions.
The Chairman, in referring to relevant performance indicators for the scheme, was advised that there were a number of indicators that were reported to the Scrutiny Committee (Economy and Environment). The Operational Manager for Leisure also stated that the performance indicators gave an indication of what was happening but did not outline information around outcomes and he advised that most of the data would be analysed by PHW.
In reply to a query regarding the Leisure Contract arrangements with Parkwood Leisure and the payment threshold for the NERS, the Operational Manager for Leisure advised the Committee that the change in running of the service had not had any impact on this and the scheme that was in place was fair. He alluded to the reduced membership fees, which were not based on the ability to pay. He stated that facilities had improved as Parkwood Leisure had invested in the Leisure Services and would need to continue to invest as new competition came into the market place.
A Committee Member commented that a rough calculation showed that 1,700 referrals equated to about 1.5% of the total population in the Vale and he asked how did this fit in with profiling the needs of people in the Vale. In response to this, the Director of Social Services advised that a population needs assessment would be completed this year and from which a number of questions would come out, so it would be better to look at this then.
The Operational Manager for Leisure and the Exercise Referral Co-ordinator were thanked for their overview and having considered the presentation, the Committee
RECOMMENDED – T H A T the contents of the presentation be noted.
Reason for recommendation
To apprise Members of the Committee of an important service area that helped to improve the health of people in the Vale of Glamorgan.
796 REVENUE AND CAPITAL MONITORING REPORT FOR THE PERIOD 1ST APRIL TO 31ST DECEMBER 2015 (DSS) –
The Operational Manager, Accountancy, presented the report, the purpose of which was to update Members on the position in respect of revenue and capital expenditure for the period 1st April to 31st December, 2015.
The report outlined that the currently forecast for Social Services at year end was an overspend of £100,000 which showed an improved picture from the £300,000 overspend reported in the previous month. A graph and table 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.
In terms of Children and Young People Services, the service was anticipated to outturn £462,000 under budget at year end. The key issue for this service continued to be managing demand for the Joint Budget for Residential Placements for Looked After Children. Currently, it was forecast to outturn with a £250,000 underspend at year end. There were other potential underspends elsewhere in Children’s Services of £65,000 on staffing budgets and £135,000 on alternative means of provision and accommodation costs required for the current cohort of children. In addition, the Business Management and Innovation division was anticipated to underspend at year end and part of this variance was apportioned to the service areas; therefore, £12,000 of the underspend would be allocated to Children’s Services.
For Adult Services, it was current anticipated that this budget would outturn £617,000 over budget at year end. This overspend was due to a projected overspend on Community Care Packages of £850,000 as a result of continuing demand for services, particularly for frail older clients. The report advised that there was continued pressure on this area of the service to manage demand, not only to avoid a further increase in the overspend but also to achieve a reduction.
The annual deferred income budget for 2015/16 in Adult Services had been set at £739,000. As at 31st December, 2015 income received was £155,000 under recovered. It was currently being 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 also anticipated that there would be underspends of £200,000 elsewhere in the budget which could offset part of the overspend with £165,000 from staffing, £15,000 from Transport and £20,000 from Premises. In addition, the Business Management and Innovation division was anticipated to underspend at year end and part of this variance was apportioned to the service area; therefore, £33,000 of the underspend would be allocated to Adult Services.
With regard to Business Management and Innovation, the report stated that this budget was anticipating an underspend at year end of £100,000. This was made up of an underspend on staffing of £80,000 and £20,000 on Transport. Part of this budget would be recharged to Children’s and Adult Services, therefore, the underspend on this heading was shown as £55,000 with the remaining £45,000 being recharged thus resulting in the reduced internal recharge to Children’s and Adult Services.
For 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 updated on the individual areas of savings.
In relation to the capital expenditure, Appendix 2 to the report detailed financial progress on the Capital Programme as at 31st December, 2015. The report advised that for the Cartref Porthceri Electrical Upgrade / Southway Electrical Upgrade, the Social Services Lift Refurbishment scheme and the Residential Homes Call and Assistance Systems scheme were anticipated to underspend by £67,000. It was therefore proposed that this underspend be used to carry out further electrical works required at the homes.
In terms of the Hen Goleg Works, this scheme would be tendered in February 2016 and tenders would be due back in the middle of March 2016. Work was anticipated to start on the site late April 2016 and was anticipated to be completed in August 2016. It would therefore be requested that £221,000 of this budget be carried forward into the 2016/17 Capital Programme.
For the ICT Infrastructure project, further investigative works had been carried out for this scheme, to align it with the introduction of the Welsh Community Care Information System (WCCIS) which would allow information to be shared between different Health Boards and Social Services departments instantly. The new system would enable Social Services (Adult and Children) and a range of community health services to more effectively plan, co-ordinate and deliver services and support for individuals, families and communities. It would support information sharing requirements, case management and workflow for health and social care organisations across Wales. A carry forward of £400,000 into the 2016/17 Capital Programme was therefore requested.
Appendix 3 to the report provided non-financial information on capital construction schemes. For all schemes where it was evident that the full year’s budget would not be spent during the year, relevant officers were required to provide an explanation for the shortfall and this should be taken to the earliest available Cabinet meeting.
The Chairman, in referring to the £67,000 underspend related to the Cartref Porthceri Electrical Upgrade / Southway Electric Upgrade, queried as to why there was such a large underspend. In response, Members were advised that the initial identification of the work required had not highlighted that repairs as opposed to replacement was possible.
A Committee Member, in referring to the savings target B9 in relation to contract arrangements for domiciliary care, queried the impact following the increase in the National Living Minimum Wage. In response, the Interim Head of Business Management and Innovation stated that the working group was still meeting to discuss the savings target and it had been recognised that the Living Wage would impact on agencies and care providers. Negotiation was still ongoing.
In reply to a Member’s query regarding savings target A23 in relation to the Reshaping Services Strategy, the Head of Adult Services stated that the status of this target was red as it was spread over three years so this meant that the service could not say with any total certainty that the savings target would be achieved. The Committee Member also queried the status of savings target A3 in relation to care packages and the Member questioned how would this be improved. In reply, the Head of Adult Services explained that the only budgets available to reduce costs were the most difficult areas. The service was trying to target those contracts in which the Authority could reduce costs such as those around Learning Disability Residential Placements. The work revolved around improving the independence of service users and to work with them to find solutions. He also alluded to the demographic pressures that were present in the Vale, particularly around the number of older people coming into the service, which represented a real challenge. Further to this query, the Committee noted that feedback from individuals had been generally positive and the service had recognised that it was a very complex undertaking and wanted to work with service users on an individual basis to find solutions that best suited their needs.
A Committee Member asked for an update around the number of foster carers recruited for this financial year. In reply, the Head of Children and Young People Services stated that the target for this year was for eight new foster carers of which so far five had been recruited and three were in the process of being interviewed by the Panel in February or March. Therefore the service was aiming to hit its target, but not exceed it.
At this point, the Director of Social Services relayed to the Committee some of his thoughts around the savings targets. He stated that a main objective of the service, particularly in relation to domiciliary care contracts, was not to sacrifice the level and quality of care provided. He also alluded to the impact of the cap on the charge for domiciliary care services which affected the Vale of Glamorgan more than other Local Authorities in Wales and for which Welsh Government had indicated that no further adjustments would be made.
(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.
(3) T H A T the report be referred to Cabinet for its consideration and to highlight the progress in delivering the Social Services Budget Programme.
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 are aware of progress made to date on the Social Services Budget Programme.
(3) That Cabinet are kept informed of the progress made to date on the Social Services Budget Programme.
797 YOUNG CARER SERVICES: UPDATE REPORT (DSS) –
The Interim Head of Business Management and Innovation presented the report, the purpose of which was to update Members on support services for young carers.
As a background summary, the report advised that young carers were defined as children and young people under the age of 18 who had caring responsibilities for someone who had a physical or mental illness, a physical or learning disability or a drug or alcohol problem. The person that they looked after may be a parent, a brother or sister, a grandparent or other relative. They may provide practical or physical care, help with personal care, assistance with domestic tasks, and / or emotional support.
Regardless of their age, all carers had the right to an assessment of their needs as a carer. There was no specific legislation which referred to young carers as a distinct category, although each Local Authority had a duty to safeguard and promote the welfare of children in their area who were in need and to promote the upbringing of such children wherever possible by their families, through providing an appropriate range of services.
Where a child was providing a substantial amount of care on a regular basis for a parent, they would be entitled to an assessment of their ability to care and the Local Authority must take that assessment into account when deciding what community care services should be made available to the parent.
A previous report to the Scrutiny Committee in January 2014 described joint working between the Cardiff and Vale University Health Board, the Vale of Glamorgan Council and Cardiff City Council to meet responsibilities introduced by the Carer Strategies (Wales) Measure, especially in respect of improving information and engagement with carers. Better support for young carers had been a key objective for this joint working.
A separate report in July 2014 focused on support for young carers and highlighted a scoping exercise to identify the number of young carers in primary and secondary schools in the Vale of Glamorgan.
Informed by the scoping exercise and the Task and Finish Group, the Vale of Glamorgan commissioned a Young Carers Project delivered through Cardiff YMCA. Entitled “Time For Me”, this service provided opportunities for young carers to participate in social activities, events and short breaks outside the school and home environment. The report advised that starting in late 2014, the service was jointly funded by the Children and Young People’s Partnership (via the Families First funding) and by Social Services. This would build on the previous delivery model by introducing more individual case work to support young carers to improve their educational attendance and attainment.
Since April 2015, from Quarter 2 reports which showed that there were currently 47 young carers accessing the project, six of these had received one to one support in the home. 22 young carers had gained skills and a certificate by attending a sailing residential. Evaluations showed a 100% positive feedback for the informal respite. Additionally, the fulltime Young Carers Project Worker for the Vale of Glamorgan had been working with the Council’s Carers Development Officer in delivering a series of young carer awareness raising presentations to practitioners across the statutory sector and other organisations.
Under the auspices of the Carers Strategy Measure, staff from Social Services had been working with the young engagement workers from both the Vale and Cardiff, along with Cardiff YMCA, to consult with young carers. The purpose of these was to identify the information and support needs of young carers, particularly in relation to health services.
The report stated that at an initial meeting in November 2015, a group of young carers from the Vale and Cardiff came together to hear an explanation of the aims of the Carers Measure and to discuss potential for further engagement. As a result, 12 young people had volunteered to be involved in the planning of a wider consultation, which would include preparing and delivering a questionnaire, followed by a fun workshop to identify outcomes for statutory services to consider. It was hoped that this consultation would help establish a more regular dialogue between young carers, as a stakeholder group, and statutory services to help inform service delivery on an ongoing basis. Young carers would also benefit from extending the Carers Support Officer role to cover Children and Young People’s Services. A part time Carers Support Officer had been appointed to support both parent carers and young carers in respect of their information and assessment needs. Work was ongoing to ensure that young carers were identified and referred appropriately to the targeted support that the Council had in place.
In terms of resources, the report advised that the Young Carers Project was a joint funded project between Families First and Social Services. Families First would contribute £40,000 per year until March 2017 and £10,000 was being made available from the carers services budget in Social Services.
A Committee Member raised two queries. His first query related to raising awareness of young carers within schools. In reply, the Interim Head of Business Management and Innovation indicated the key was around engagement with schools and the need to build and sustain working relationships. She also stated that the new Carer Support Workers would have an important role and it would be necessary to tailor how the service engages with schools. The Member’s second query related to the use of the Carers Measure Funding for which £11,800 had been allocated to the Vale and Cardiff. For this, the Interim Head of Business Management and Innovation advised that a Carers Measure Group had been meeting regularly to discuss proposals around how the funding could be used and that the Group routinely considered the impact of the Social Services and Well-being (Wales) Act.
With regard to a Member’s query about the types of activities that were being provided to young carers, the Committee noted that a number of projects and social events were available. The Head of Children and Young People Services explained that the service had established the sort of activities that young carers wanted to participate in. Therefore, the service had moved away from the more standard activities such as bowling and going to the cinema and now more varied activities were available such as horse riding and yacht sailing. Feedback from young carers had indicated that they had valued the opportunity to spend time with other young carers and a period of respite had allowed them to feel refreshed. The service’s aim was not to remove the carer’s role from the young carers but to support them and their families so that young carers felt more resilient and confident.
In querying how the Council recognised young carers, the Committee noted that a new wellbeing survey was being rolled out to schools, which was called Selfie. The Committee requested that consideration be given to whether Selfie or a similar mechanism could be put in place in schools which would assist the Council to identify young carers and the Committee agreed for this to be considered by Cabinet. The Committee was also advised that specific details around how young carers were identified would be sent to Members via e-mail.
Further to these points, the Cabinet Member for Adult Services stated that it was important to remember the “all contacts count” approach and that the Council should look at more ways of identifying young carers. He also made mention of not losing sight of what health was doing, particularly around hospital discharges and whether parents would be relying on their children to look after them. He also alluded to the stigma in schools faced by young carers and the need to support young carers as much as possible.
Finally, the Committee agreed for a report updating on the developments around young carers to be provided on an annual basis.
Having considered the report, the Committee
(1) T H A T the work undertaken to support young carers in the Vale of Glamorgan be noted.
(2) T H A T the report be referred to the Scrutiny Committee (Lifelong Learning) for its consideration.
(3) T H A T the report be referred to Cabinet to highlight the need to develop further mechanisms to help identify young carers.
(4) T H A T update reports be received by the Committee on an annual basis.
Reasons for recommendations
(1) To ensure that Members continue to exercise effective oversight of an important function undertaken by the Social Services Directorate.
(2) At the request of the Scrutiny Committee (Lifelong Learning) to receive the report on an annual basis.
(3) To help the Council develop ways around the identification of young carers.
(4) To keep the Committee apprised of developments around young carers.
798 THE MEALS ON WHEELS SERVICE (DSS) –
The Head of Adult Services presented the report, the purpose of which was to update the Scrutiny Committee on how the Meals on Wheels Service was being delivered and the rationale for considering alternative ways of meeting the nutritional needs of those eligible for care and support from Social Services.
The report was a follow up to a previous Scrutiny report provided in response to an original Request for Consideration from Councillor R.J. Bertin, who had requested that the Committee receive information regarding the numbers using the service and the potential future funding reductions.
The report advised that Meals on Wheels was a social care service which delivered a hot meal at home to people who were assessed as being unable to undertake this task for themselves. In Barry, one route was previously made available through a service level agreement with the Royal Voluntary Service but this had been discontinued by mutual consent. The volunteer service now operated within Rondel House, supporting people who attended to engage in activities.
The report stated that there was no statutory requirement for a Local Authority to provide a Meals on Wheels service. However, Local Authorities must assess the needs of individual people in need and then ensure that, where there were eligible risks to independence, these risks were mitigated through provision of services. Those who experience risks associated with potential malnutrition would be eligible for a service to ensure that their needs were met. This could be done in various ways and not just through the delivery of a hot meal by the Local Authority. For example, frozen meal delivery services had proved to be popular. The principal advantages of this approach were that individuals had greater choice over what and when they could eat, without any requirement for an assessment by Social Services. Some schemes in other Local Authorities involved the provision of vouchers which could be used in local facilities such as cafés. Additionally, a number of luncheon clubs and day services existed across the Vale of Glamorgan. These provided not only a meal but also an opportunity to engage with other people, tackling loneliness and social isolation.
The report indicated that the use of the Meals on Wheels service had reduced substantially across the United Kingdom. Figures for England, reported following a Freedom of Information Request, indicated that the number of elderly people receiving meals provided by Local Authorities had fallen over the last five years from 296,000 to around 109,000 in 2014/15. In comparison, the position across Wales varied. In 2013/14 six Local Authority areas did not provide a Meals on Wheels Service although it had not been possible to obtain more up to date information.
In the Vale of Glamorgan, the number of people who used the Meals on Wheels service had remained similar since the figures were reported in 2015. The service then was delivering approximately 78 meals and this figure was now approximately 75. At weekends, a reduced service operated and approximately 29 meals were delivered to the Central and Eastern parts of the Vale. The Meals on Wheels service at the further end of the Western Vale was discontinued several years ago, following equipment failure in the local kitchen. Alternative meal services were available. Low demand levels and the additional distances involved in delivery to rural locations in the Western Vale meant that restarting a service in this area would likely incur additional costs.
The charge for a meal in the Vale of Glamorgan was £3.30 in 2013/14 and this had risen to £4.10 in 2014/15. This was in order to bring the charge closer to the costs of preparing and delivering meals. Reductions in the number of meals provided meant that the expected rise in overall income through the price increase had not been fully realised. The current cost per meal to provide the service (unit cost) was £5.34 which was based upon the existing number of recipients. The charge to them remained unchanged from 2014/15. The expected charge required to make the service cost neutral was in the region of £6 per meal. This had been calculated to include an anticipated reduction in the numbers of meals provided.
A review of the service had been undertaken. This included consultation with existing recipients to ascertain their views regarding the current provision and to determine their knowledge and understanding of alternative delivery models. The consultation document and a copy of the questionnaire were attached to the report at Appendix 1. The overall conclusions that emerged from the review were that high levels of satisfaction with the service continued and that individuals were not well informed about alternative options for meals.
Further analysis of the review information was underway. Consideration would need to be given to increasing the price of meals and to the promotion of alternative meal options. The service had deemed it helpful to examine the feasibility of the service being provided in the future by organisations external to the Council. It was proposed, therefore, to initiate some market testing to determine the extent of interest in this across Vale localities. Ideally, this would include exploring whether services could be made available across the whole of the Vale of Glamorgan.
A Committee Member thanked the Head of Adult Services for the update and the Member stated that he had been worried that service users were not being properly informed about alternative services should arrangements to the Meals on Wheels service be changed.
The Committee then asked if the Cabinet Member could relay some of his thoughts about the future of the Meals on Wheels service. The Cabinet Member indicated that, in his opinion, the Council needed to recoup its costs for providing the service but he recognised that low numbers of service users made this difficult for any company or organisation. The Cabinet Member went on to comment that one large provider was Wiltshire Farm Foods and he stated that observations through the Vale’s 50+ Forum had indicated that they had been well received. Furthermore, he advised that Wiltshire Farm Foods would not only deliver meals but they would also undertake physical checks of their service users and would refer people should they have any concerns. The Cabinet Member explained that the Council needed to look at the possibility of alternative service delivery such as through a large mutual company. He also mentioned that the Cardiff and Vale University Health Board had been able to provide a service at £3.10 per meal and he stated that the Health Board could do this because meals were produced in large quantities.
In answer to a Member’s question regarding services in the rural part of the Vale, the Head of Adult Services stated that issues had been down to a breakdown in kitchen equipment which had meant that around 20 individuals had been unable to access the Meals on Wheels service. He stated that companies such as Wiltshire Farm Foods offered a number of ranges of meals and would be able to better meet the dietary requirements of service clients.
(1) T H A T the contents of the report be noted.
(2) T H A T the report be referred to Cabinet to advise on how the Meals on Wheels service was being delivered and to highlight the rationale for considering alternative ways of meeting the nutritional needs of those eligible for support from social services.
(3) T H A T the progress to date be noted and that further reports on potential alternative service models be received.
Reason for recommendations
(1-3) To ensure that the Scrutiny Committee and Cabinet can exercise effective oversight of this service.
799 UPDATE ON IMPLEMENTATION OF THE SOCIAL SERVICES AND WELL-BEING (WALES) ACT 2014 (DSS) –
The Social Services and Well-being (Wales) Act 2014 would come into force in April 2016. The Committee had therefore requested regular updates on the progress being made in readiness for implementing the requirements of the Act in the Vale of Glamorgan.
The report updated the information considered by the Committee in January 2016, which included:
- Information on the Implementation Programme’s Task and Finish Groups as they reviewed the requirements set out in the new Regulations and Codes of Practice, to ensure they were fully understood and to put in place the necessary actions.
- Progress of the four national work groups, established to share best practice and produce consistent material on an all-Wales basis.
- Consultation on the final Code of Practice, in relation to part 8 of the Act on the role of Directors of Social Services) and the joint ADSS Cymru / WLGA response on behalf of local government. This Code of Practice would be laid before the Assembly in February 2016.
- Information on the series of technical briefings for the Tranche 1 Codes of Practice. These were described as “gateway” documents that summarised the key points for each code. Access to the briefings was again via the Care Council’s Communications Hub.
- An update on the national awareness raising campaign, led by Welsh Government, which would start in February 2016. The Council’s Communications team would be assisting in dissemination of the key messages.
- Progress update on the workforce development materials being developed by the Care Council for Wales.
- Information on the four Welsh voluntary organisations who had received funding to enable them to develop learning materials to support implementation.
Set up as part of the regional Implementation Programme led by the Director of Social Services for the Vale of Glamorgan, the nine Task and Finish Groups continued to meet. These Groups comprised: Information, Advice and Assistance (IAA); Planning and Promoting Preventative Services; Eligibility and Assessment of Need; Safeguarding (Adults and Children); Looked After and Accommodated Children; Advocacy; Performance Management; Workforce Development; Cooperation and Partnership.
Many other areas would need concerted efforts to ensure compliance with new legislative framework which comprised the Act itself, 23 sets of Regulations and 7 Codes of Practice. However, it had been necessary to prioritise some of the most important changes. Those 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.
Lead officers for the Groups continued to review the requirements set out in the new Regulations and Codes of Practice, to ensure that these were fully understood and to put in place the actions needed for implementation. Representation on these Groups included officers from each Local Authority, the Cardiff and Vale University Health Board and the Third Sector. Progress had been made on a series of technical briefings for the Tranche 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 report further advised that good progress was being made in setting up the Information, Advice and Assistance Service (IAA), especially in the area of Adult Services where the service was able to build upon the positive work undertaken in integrating social care and NHS staff and processes alongside Contact One Vale. Resources had been identified to secure for local use a customised version of the national information portal, Dewis Cymru, for Cardiff and the Vale region.
The region had been selected by the Social Services Improvement Agency (SSIA) to pilot a new training course aimed at officers working at the First Point of Contact so that they fully understood the changes introduced by the Act. This would include focusing on the “what matters” question in initial discussions with the people who could contact them. Discussion would take place in January with evaluation taking place in February before the training was rolled out to other regions.
Further to this, the report advised that the four all-Wales working streams would continue to meet. The region had sent officers to each of these Groups so that they could contribute to developing national toolkits / checklists and, where possible, avoid duplication and ensure that procedures and processes fitted in with the local context. The national checklist for Common Recording Requirements for Assessments had been completed. This would be made available to staff on the Getting In On The Act Hub.
The national training materials for the four core modules had been finalised and officers had been working with the external trainers to ensure that these materials were responsive to the service needs. A training plan setting out workforce requirements had been approved by the Regional Implementation Steering Group.
The Institute of Public Care at Oxford Brookes University was to provide support for the new Regional Partnership Board which would be established in accordance with statutory guidance under Part 9 of the Act. This stipulated that Local Authorities and Local Health Boards would be required to establish a Board to manage and develop services to secure strategic planning and partnership working between Local Authorities and Local Health Boards to ensure effective services, care and support were in place to best meet the needs of the respective populations. In its meeting on 4th February, the Integrated Health and Social Care Governance Board would consider a report, setting out how it would need to be reconstituted so that it complied with the Co-operation and Partnership requirements. The Institute had been appointed also to deliver training on the implications of the Act for Elected Members. Provisional dates for the training events in March 2016 had been agreed.
In January, the Wales Local Government Association produced an e-Bulletin for Social Services. This was attached at Appendix A to the report. Parts 3 and 4 gave an update on the Act. Part 12 contained a link to the “What Matters to You – Matters to Us” animated video, which outlined the changes being introduced with the new Act in a user friendly format.
The Chairman, referring to paragraph 17 of the report and the Welsh Government Minister’s statement around the uncertainty about UK reforms, asked if officers could explain what this meant. In reply, the Director of Social Services stated that this related to a policy vacuum around paying for social care services which was linked to the implementation of the Care Act 2014 England which had been deferred until 2020. This had meant that little work had been undertaken around the implications and costs of this Act (Care Act 2014). In those areas devolved to Welsh Government, it was looking to progress its own reform of the arrangements for paying for social care and support.
In reply to a Member’s question around how would future funding for implementing the Act be allocated to the Council, the Director of Social Services advised that for this current financial year, £414,000 had been allocated across the Cardiff and Vale region, with the Vale being the Lead Authority for this money. However, Welsh Government had yet to indicate how the £3m allocated across Wales for 2016/17 could be used.
A Committee Member queried Welsh Government plans regarding the national maximum charge for non-residential care and support services and the Member asked if the Council had contacted Welsh Government about this. In reply, the Director of Social Services stated that no other Council in Wales had made stronger representations to Welsh Government and Welsh Government had not yet provided clarity on the scope for change around the review of the charge or the eligibility criteria. He further advised that it was possible that there may be some adverse financial consequences for the Council following any potential change to this legislation.
(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 the 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 underpin the work of Social Services.