Agenda and minutes

The Chairman welcomed everyone to the meeting. Apologies had been received from Panel members Cllr Grove and Cllr Rayner, and from the Cabinet Member for Health and Well-being, Cllr Hart.

Due to unforeseen circumstances, the Chairman would need to leave the meeting at 11am, at which point the Vice-Chairman would chair the remainder of the meeting.

Cllr Adams would need to leave the meeting around 11am.

Agenda item 6 (Review of the Care Market) -  Cllr Griffiths declared an interest as her daughter worked for an individual who may receive a personal budget.

Members of the public wishing to take part should notify the Head of Legal and Democratic Services, in writing or by email indicating the nature and content of their proposed participation no later than 9.00am on the working day before the meeting (in this case 15 March 2016). Enquiries can be made through the telephone number/email address below.

None.

Previously circulated

The Minutes of the meeting held on 21 January 2016 were agreed as a correct record and signed by the Chairman.

In attendance for this item were:

The Council's Adult Services and Health:

Frances Howie, Interim Director of Public Health

Rosie Winyard, Commissioning Manager for Substance Misuse.

Swanswell Charitable Trust (provider since April 2014):

Sian Battle-Welch, Worcestershire Service manager

Dr Steve Brinksman, Medical Director

David Lewis, Regional Director

Peer mentors who were also former service users

The Chairman welcomed representatives from Swanswell Charitable Trust (Swanswell), who had been invited to provide background about the service and an update on performance relating to successful completion of treatment for opiate users – which the panel had expressed concern about during its performance monitoring session on 21 January.

The new Interim Director of Public Health thanked the panel for its interest – in an area where the Council spent millions each year, and which had been a matter of concern for some years. The Director had a very positive feeling about the new provider; things were definitely being done differently, with energy and enthusiasm, although time would tell whether this transferred to improved results.

A presentation had been prepared, which it was hoped would give a real sense of the service, and which could also be used as a reference tool. Areas covered would include background to the new service, information about the Public Health indicator in question, Swanswell Service Design to improve outcomes for drug and alcohol treatment, effective treatment for opiate users and presentation from service users. 

The Commissioning Manager gave context for the £4.3 million a year contract with Swanswell, which had provision to be extended a further two years.  It was clarified that opiates included heroin, as well as other drugs. During a competitive tendering process, Swanswell stood out as the best by far, with a new service design for Worcestershire, which offered performance monitoring and value for money, and a focus on achieving successful outcomes with links to primary care. It was a quality service, which was evidence-based, with recovery focussed treatment interventions and which utilised community assets.

Public Health Outcomes Framework Performance indicators

Effectiveness of drug treatment was measured in various ways, including the two Public Health Outcome Framework (PHOF) Targets (successful treatment of drug treatment – opiate users and non-opiate users) which had featured in the Panel's performance monitoring. A broad range of other information was also used, reflecting the breadth of the service itself – such as National Drug Treatment Monitoring System reports, information from the service provider, external providers, service users, the Joint Strategic Needs Assessment, community safety information and return on investment tools.

The Panel was shown a graph indicating performance against the indicator (set by Public Health England) for successful completion of opiate users in Worcestershire 2010 – 14, and the England average. Worcestershire's performance ranked at 136 out of 149 local authorities in 2014, and after peaking at 6.8% in 2012, had not done well since, although this was also the case nationally – the lowest completion rate was Stoke on Trent (3.6%) and the highest was  ...  view the full minutes text for item 216.

(Cllr Griffiths, Vice-Chairman chaired the meeting from this point.)

In attendance for this item were:

Richard Keble, Strategic Commissioner, Worcestershire County Council and

Cllr Sheila Blagg, Cabinet Member for Adult Social Care.

Simon Patient, Managing Director of Heritage Manor Care Homes

Rob Gready, Managing Director of Eclipse Homecare

The Strategic Commissioner for Adult Services and Health and Cabinet Member for Adult Social Care, had been invited to provide an update on emerging findings from the review of Worcestershire's care market. Resilience and sustainability of the local care market was part of the Panel's 2015/16 work programme.

The review had been commissioned from the Institute of Public Care (IPC) – Oxford Brookes University in April 2015, prior to the 2016/17 settlement, and was therefore not completely rooted in the current financial or legal context. Work had been overseen by a Steering Group which included representatives from home care and care home sectors – two of whom were present.

The Cabinet Member was very pleased with the review and findings so far, which included valuable context, information and detail about the care market. The final report would be available by the end of the month.

The emerging findings pointed to a number of challenges:

·         The Council had a duty of care to ensure a diverse and sustainable market

·         Providing a 'fair' cost for good quality care, within the Council's resources

·         Recruitment and retention of staff was a significant issue, with competition from other, more attractive jobs

·         There was a risk of providers withdrawing their supply – although no current evidence of market failure

·         Basic supply/demand economics meant that the same (or rising) demand and less supply = higher price over time

·         Oxford Brookes had suggested that the current pricing and commissioning model was not sustainable over the longer-term – options for which were already being looked at.

A surprising finding was that less people moved into care over the previous year, possibly because of efforts to enable people to live independently – although of those already in care home settings, more moved from residential to nursing home settings, because of increased frailty.

It was clear that changes would need to be made and the review put forward a number of potential options:

Reviewing the 'pathway'

It was intended to look at how placements were made and make them more efficient in terms of adult social care.  The Directorate had already started working with clinical commissioning groups (CCG) to make Continuing Health Care placements more efficient and would be exploring joint purchasing with the CCGs.  The Directorate was already working with the health economy to redesign care pathways to become more integrated, simple, outcome focused, with home-based care and support as 'the norm'.

Workforce Issues

Improving recruitment would be necessary, which needed to be more than a portal and would be in collaboration with providers. The Directorate would explore how the care sector could be developed as a more attractive and rewarding career, which would require wide engagement, including with schools and  ...  view the full minutes text for item 217.

The Democratic Governance and Scrutiny Manager explained that the 2016/17 scrutiny work programme was being developed and that the Overview and Scrutiny Performance Board had agreed that this would include greater consultation with various groups, stakeholders and the public.

Adult Care and Well Being Overview and Scrutiny Panel members were invited to suggest topics, and the following were put forward:

·         Rape and sexual abuse – co-ordination and gaps

·         Learning Disability Services – revisit previous scrutiny

·         Review of the Care Market – ongoing monitoring

Peter Pinfield, Chair of Healthwatch Worcestershire, was invited to contribute, and suggested the following areas, which may also overlap with health scrutiny:

·         Sustainable Transformation Plans (Worcestershire working with Herefordshire to plan health and care services)

·         Mental Health Care

·         Clinical commissioning groups survey of residents' healthcare priorities

·         Care Act – 12 months on