Agenda and minutes

The Chairman confirmed the arrangements for the remote meeting.

Apologies had been received from the Cabinet Member with Responsibility for Adult Social Care, Mr A I Hardman.

None.

Members of the public wishing to take part should notify the Assistant Director for Legal and Governance, 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 21 September 2020). Enquiries can be made through the telephone number/email address below.

None.

Previously circulated

The Minutes of the Meeting held on 27 July 2020 were agreed as a correct record and would be signed by the Chairman.

Senior Officers from the People Directorate had been invited to the meeting to provide an update on residential and nursing care provision following on from a 2019 scrutiny task group on quality assurance and more recently, the Government’s requirement for all Councils to put in place a COVID Care Home Support Plan.

Officers went through the Agenda Report and the following main points were made:

·         The ‘Worcestershire Care Home Hub’ had been established in March 2020.  Made up of health, public health and social care partners, this pooled capacity and resource had provided a strategic lead to co-ordinate and facilitate action to support and advise providers with the aim of minimising outbreaks, cases and deaths in homes

·         Intensive work had taken place to support care homes to put in place effective infection prevention and control measures.  The pressure on providers across the County was immense, a picture replicated nationally

·         A large amount of data was being collected nationally on a regular basis, through the ‘national capacity tracker’, enabling comparisons to be made and for contingency planning to be undertaken nationally

·         This data would also help review and shape the care home market in Worcestershire, underpinning the proposed new model of care of ‘Home First’

·         Members were reminded that in Worcestershire the care home market was fragile, in part, with some providers at risk of financial difficulty.  In addition, there were gaps in the market, such as for patients with more complex needs or for high needs dementia care.  The longer term piece of work to develop the market would aim to mitigate the gaps   

·         Cases of COVID-19 in care homes was increasing, mainly amongst staff and there had been increasing quality concerns putting additional pressure on managers and providers.  In all cases, Officers were working closely with providers to assist and if necessary, compile action plans.

In the ensuing discussion, key points included:

·         When asked whether patients discharged from hospital to a care home were being tested for COVID-19, it was reported that systems were now in place to do so and central Government had recently published guidance to ensure that all patients being discharged back to a care home would need to be tested

·         The national capacity tracker was linked to infection control monies and providers had an incentive to complete the tracker.  Questions included areas such as vacancy rates and discharge.  Officers agreed to share the list of questions asked

·         A Member asked whether care homes were getting enough support with testing, to be informed that the situation had been challenging in part, however, was improved and care homes were deemed a priority.  It was clarified that an outbreak constituted 2 or more cases and as of 31 August 2020, 69 care homes, out of 179, in Worcestershire, had experienced outbreaks

·         In relation to a question about external quality assurance visits being undertaken, it was reported that the Care Quality Commission (CQC) had suspended visits.  Officers agreed to follow up with CQC as to when they envisaged restarting  ...  view the full minutes text for item 365.

The Council’s Provider Services Manager drew attention to the following points when taking the Panel through the Agenda Report and Presentation:

·       Reablement was defined as a short term (up to six weeks) goal-focussed intervention, providing support and confidence to enable an individual to recover or maintain physical functions, such as mobility or walking support, in their own home or care home.  The support may come from Occupational Therapy or Physiotherapy and it did not replace the need for social work nor appropriate assessment

·       The Council’s Community Reablement Pathway, suitable for all adults aged 18+ regardless of additional needs, was due to commence in April 2020, however, due to the COVID-19 pandemic, delivery was put on hold with the hope that the 7 day running service would now commence in late October 2020.  Since April, Staff had been utilised in other work areas, such as supporting patients who were discharged home from hospital

·       Referrals would be made via operational teams, such as the hospital based Onward Care Team, with individuals allocated a professional who would be the key contact throughout the whole process, including assessment, review and any handover in relation to long term social work or further provider intervention.  The Pathway was available to all residents, including self-funders, and could be used as a hospital or care home admission avoidance opportunity.  Prisoners from the two County prisons were also eligible for referral

·       It was envisaged that appropriate ongoing rehabilitation support would be identified early, after Care Act assessments had taken place and financial assessments undertaken, which would move away from the traditional ‘Time and Task’ support available

·       Residents were instrumental in developing and agreeing their own reablement plan, with Staff working with all health and social care partners to ensure that the desired outcomes were embedded in any future provision, ultimately aiming to reduce demand on hospitals and care homes.

In the ensuing discussion, the following key points were made:

·       A Member asked how people would be referred into the Community Reablement Pathway and it was clarified that if the individual was in a hospital setting, the Onward Care Team would always take the ‘Home First’ approach.  If an individual was at home, referrals could come through a social worker as part of the 3 conversation model of care

·       When asked how confident Officers were that there was sufficient resource to commence the service in late October, given that Staff were redeployed on COVID-19 duties, it was reported that based on current modelling, no issues were foreseen

·       Referring to the Agenda, which highlighted a number of benefits including a saving of £1.5m, a Member queried how this would be achieved.  It was clarified that the figure included cost avoidance measures, such as lower demand long term for domiciliary care and care home placements, the deletion of surplus posts and organisational restructure.  The Senior Social Work Lead added that nationally, other Local Authorities had seen the effectiveness of reablement, resulting in less long term support

·       Given the uncertainty surrounding any long  ...  view the full minutes text for item 366.

The Panel had been provided with performance information for Quarter 1 (April to June 2020) and financial information for period 3.

Performance

Officers reminded Members that the report was presented to them on a regular basis and indicators focussed on the key priorities of reducing long term care and keeping people living independently for as long as possible.  The four Adult Social Care Outcomes Framework (ASCOF) measures were reported nationally and reported on a rolling year basis, with the latest data available to June 2020.

As expected, due to the COVID-19 pandemic, there had been a reduction in Admissions to Permanent Care per 100,000 in both 18 to 64 years (ASCOF 2a(i)) and age 65+ (ASCOF 2a(ii)).  In comparison, although not shown, there had been an increase in demand for domiciliary care and an increase in hours provided over the period.  Historically, Worcestershire had a higher rate of admissions in comparison to other local authorities and it was pleasing to note the figure reducing.

The two indicators associated with reablement were showing positive trends.  ASCOF 2d, the % of people with no ongoing social care needs following reablement after hospital discharge, had always performed well, however from April 2020, provisional figures showed that numbers were down, attributed to new ways of working.  Likewise, with the % of 65+ at home following rehabilitation (ASCOF 2b), there was good performance against the target, although more fluctuation due to more complex cases going through the service.

The Panel heard that the indicator for Delayed Transfers of Care had been stopped nationally and discussions had been taking place on a replacement reporting measure.  Locally, discussions had continued with the Onward Care Team, who had reported that patient flow through the hospitals was working well.

The final performance indicator on Annual Care Packages Reviews Completed showed that the target of 95% had not been met for some time, however, there had been a slight improvement in Quarter 1.  Monitoring was in place, however, performance fluctuated across different teams due to the complex nature of some cases and funding reviews in light of the COVID-19 pandemic.

The Strategic Director for People would be looking at all performance indicators, with the expectation of introducing a set of measures which were outcome focussed and supported the People Directorate vision.

In the ensuing discussion, the following points were made:

·         With rolling year data potentially masking the true picture, it was agreed that month on month data for admissions to permanent care would be provided to the Panel to demonstrate an improvement over time

·         When asked whether Officers expected a decline in the use of Care Homes, it was reported that Worcestershire’s strategy was to keep people living in their own homes and as independently as possible for the longest time, with initiatives such as supported living and extra care designed to help.  Performance was going in the right direction, with improvements year on year

·         A Member asked about the interventions in place to improve the number of Annual Care  ...  view the full minutes text for item 367.

Members had nothing to add at this time.