Agenda Item No. 4
The Vale of Glamorgan Council
Healthy Living and Social Care Scrutiny Committee: 13th June, 2016
Report of the Director of Social Services
Older People's Commissioner for Wales - Introduction
Purpose of the Report
- To help prepare Scrutiny Committee for attendance by the Older People's Commissioner for Wales.
- That the Scrutiny Committee notes the role of the Commissioner and her work programme.
- That Scrutiny Committee notes the Vale of Glamorgan Council's response to Reviews undertaken by the Commissioner.
- The Scrutiny Committee notes the required actions and the Directorate's response to the report 'Dementia: More Than Just Memory Loss'.
Reasons for the Recommendations
- To ensure that Members continue to exercise effective oversight of important functions undertaken by the Social Services Directorate.
- To brief Members about the requirements placed upon the Council to meet the action points raised by the Commissioner in her report "A Place to Call Home? - A Review into the Quality of Life and Care of Older People living in Care Homes in Wales", published in November 2014.
- To ensure Scrutiny Members are aware of the report 'Dementia: More than just memory loss' (Appendix 4) and the actions required to ensure implementation.
- The Older People's Commissioner for Wales, Sarah Rochira, is an independent voice and champion for older people across Wales. The Commissioner has legal powers to review the adequacy and effectiveness of law, policy and strategy affecting the interests of older people in Wales.
- The Commissioner's role and statutory powers are defined by the Commissioner for Older People (Wales) Act 2006 and accompanying Regulations. The Commissioner must ensure that:
- Older people in Wales are made aware of the existence and functions of the Commissioner's office.
- Older people in Wales are made aware of the location of the Commissioner's office or offices and the ways in which they may communicate with the Commissioner and her staff.
- Older people are encouraged to communicate with the Commissioner and her staff.
- The views of older people are sought as to how the Commissioner should exercise her functions and as to the content of the Commissioner's annual work programme.
- The Commissioner and her staff make themselves available to such older people in the older person's locality.
Relevant Issues and Options
- Using her powers under the Act, the Commissioner undertook a formal review into the quality of life and care of older people in residential care in Wales. The Report, "A Place to Call Home? - A Review into the Quality of Life and Care of Older People living in Care Homes in Wales" was published in November 2014. She concluded that: "Too many older people living in care homes in Wales have an unacceptable quality of life". The key findings were grouped under four headings: day-to-day life; health and wellbeing; people and leadership; and commissioning, regulation and inspection.
- The Commissioner wrote to all local authorities in Wales, outlining requirements for action. The letter to the Vale of Glamorgan included cross-cutting themes and also specific observations relating to the Council's own Part 3 care homes. The Council prepared two responses for the Commissioner's consideration and these are attached at Appendices 1 and 2. The Commissioner responded to our proposed action plan, stating:
"Your response clearly demonstrates a commitment to delivering the change required that I outlined in my Care Home Review and clearly details action you have in place or will take to deliver the intended outcomes. Your organisation has proposed the proactive development of new services or processes which have the potential to progress as best practice. For example, you fund a Discharge Liaison Service which provides independent support and advice to individuals and their families to enable them to plan their discharge from hospital. I am therefore satisfied that your organisation is already complying with the majority of my Requirements of Action or is committed to taking the action necessary to deliver the required change".
- The Commissioner identified training for residential staff in respect of dementia care as an area in need of attention and our proposed actions were accepted by her. She has indicated that she will be reviewing progress 18 months after completion of the initial Care Home Review, to ensure that the Council has acted in accordance with the agreed actions.
- The Directorate has also prepared, with Cardiff Council, a joint action plan in response to "In Search of Accountability: A review of the neglect of older people living in care homes investigated as Operation Jasmine". This Welsh Government review is also referred to as the 'Flynn Report'. A copy is attached at Appendix 3.
- The Directorate is committed to providing and commissioning high quality care for older people in the Vale of Glamorgan, working with our partners to ensure that there is continuous improvement and support for care providers.
On 14th March 2016, the Older People's Commissioner for Wales released a report called "Dementia: More Than Just Memory Loss", which "clearly sets out what action needs to be taken by those providing public services to ensure that people living with dementia can have the best quality of life for as long as possible. Delivering this change is not only good for people living with dementia and their carers, but also good for the public purse."
- The report sets out a number of actions that need to be delivered to address the issues identified by the research, including work to ensure that primary care services are more dementia supportive and their working practices reflect the needs of people living with dementia and their carers; training for staff to ensure they have sufficient knowledge and understanding to respond to the needs of a person living with dementia in an appropriate and sensitive manner that protects their dignity and respect and minimises distress; and greater post-diagnosis support, including a single point of contact to provide information and advice on the services and support available that can be accessed whenever required.
- The Commissioner wrote to public service leaders across Wales, seeking assurances that they will deliver the change required on behalf of people living with dementia and their carers. This response is due by 1st July, 2016. The actions outlined in the report are contained at Appendix 4.
The Vale of Glamorgan Council is well placed for delivering the actions required by the Commissioner. We have developed and implemented the regional Dementia three-year plan 2014 - 2017. The Corporate Management Team, and the Public Services Board have both considered the report and a joint response is currently being prepared. The Commissioner will undertake a programme of follow-up work to ensure that public services are delivering upon their commitments
- In addition, the Commissioner also wrote to the Council (16th February 2016) relating to the Guidance on Equality and Human Rights Impact Assessments and Scrutiny. Our equalities team have worked with the Commissioner's officers to ensure that Equality Impact Assessments undertaken by the Council comply with this Guidance.
- The Commissioner also wrote to us on 31st March 2016 in relation to 'Top up Fees' for care home placements. She noted concern that the use of top up fees was being used to disguise the costs of direct care and that there was no transparency as to what these 'top up fees' or 'third party payments' were being used for. Third party payments should only arise where the person has decided to choose a more expensive home than the Authority's standard contract rate and there is a requirement for the person/family to pay extra costs. Other 'top up payments' are where the care home charges the resident for additional services, sometimes unknown to the Authority.
- The Vale of Glamorgan Council is currently working with providers regarding fees and conducting an exercise where they must demonstrate their costs before we will consider additional payments, whether this is paid for by the Local Authority or as a 'top up' fee. We concur with the message that homes should indicate to residents what their charges are for.
Resource Implications (Financial and Employment)
- There are no direct resource implications as a consequence of this report. However, there are significant cost pressures for the Council associated with demographic factors and changes in government policies, including introduction of the new National Living Wage. This will have an impact upon the rates for care services that the Council will need to set as a commissioner of independent care provision.
Sustainability and Climate Change Implications
- Effective delivery of commissioning responsibilities helps to ensure that the Council's assets are managed efficiently and effectively. It also helps to ensure that best use is made of the resources available for social care services, establishing sustainable models of assistance and support as well as contributing to the most appropriate ways of meeting the needs of vulnerable people.
- There are no climate change implications as a direct result of this Report.
Legal Implications (to Include Human Rights Implications)
- The Regulation and Inspection of Social Care (Wales) Act 2016 received Royal Assent in January 2016. Implementation will have a considerable impact upon the provision and commissioning of care services, especially when new areas of the social care workforce such as residential and domiciliary care staff become regulated.
- Part 1 of the "Commissioning Framework and Good Practice guidance" is issued under Section 7(1) of the Local Authority Social Services Act 1970 and it provides standards with which local authorities are expected to comply. Commissioning practice should not place constraints on people's statutory rights to have their need for social care met by the services which the Council makes available under the relevant legislation. Legal Services are consulted in respect of issues in respect of commissioning and/or de-commissioning decisions.
- The Commissioner for Older People (Wales) Act 2006 and the Commissioner for Older People in Wales Regulations outline the role and remit of the Commissioner. The Act outlines the action that the Commissioner is able to take to ensure that the interests of older people are safeguarded and promoted when public bodies discharge their functions and also the assistance that the Commissioner may provide directly to older people in certain situations.
Crime and Disorder Implications
- There are no direct crime and disorder implications as the result of this report. However, should there be issues identified in reviewing care homes, both within Council run homes and the independent sector, the necessary actions to consider any potential criminal offences would be considered in conjunction with South Wales Police, in line with the Protection of Vulnerable Adults procedures.
Equal Opportunities Implications (to include Welsh Language issues)
- Commissioning of care services has to ensure that they are accessible to all those eligible to receive them and this will require Equalities Impact Assessments to be carried out, where appropriate.
- Under Section 7 of Social Services and Well-being (Wales) Act 2014, a person exercising functions under this Act in relation to an adult falling within section 6(1)(a) or (b) must have due regard to the United Nations Principles for Older Persons adopted by the General Assembly of the United Nations on 16 December 1991.
- The work outlined in this report addresses the following corporate objectives outlined in the Corporate Plan 2016-2020:
- Wellbeing Outcome 1: An Inclusive and Safer Vale
- Objective 2: Providing decent homes and safe communities
- Provide appropriate accommodation and support services for particular vulnerable groups.
- Wellbeing Outcome 2: An environmentally responsible and prosperous Vale
- Objective 4: Promoting sustainable development and protect our environment
- Improve access to public transport for people aged 60+ by promoting and increasing take up of Welsh Government Concessionary Travel Schemes.
- Wellbeing Outcome 4: An Active and Healthy Vale
- Objective 8: Safeguarding those who are vulnerable and promote independent living.
Policy Framework and Budget
- This is a matter for Executive decision.
Consultation (including Ward Member Consultation)
- The issue relates to all areas supported by the Vale of Glamorgan Council and so there has been no individual ward consultation in relation to this matter.
Relevant Scrutiny Committee
- Healthy Living and Social Care.
Suzanne Clifton, Interim Head of Business Management and Innovation
Lance Carver, Head of Adults Services
Philip Evans, Director of Social Services