Agenda and minutes

Apologies had been received from Cllrs Rob Adams, Andy Fry, Tom Wells and Marcus Hart, the Cabinet Member for Health and Well-being.

Cllr June Griffiths (Vice-Chairman) took the chair in the absence of the Chairman.

Cllr June Griffiths declared an interest as her daughter works 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 11 May 2015). Enquiries can be made through the telephone number/email address below.

None.

Previously circulated

The Minutes of the meeting on 25 March 2015 were confirmed as a correct record and signed by the Chairman.

Attending for this item were Richard Harling, Director of Adult Services and Health, and Cllr Sheila Blagg, the Cabinet Member for Adult Social Care. The Chair of Worcestershire Healthwatch was also present.

The Director outlined plans to carry out a review of the care market in Worcestershire – resilience and sustainability of the care market is part of the Panel's 2015 work programme.

Most adult social care in Worcestershire is arranged privately and self-funded. Where people are eligible for council funding, adult social care is mainly commissioned from external providers. The Council currently contracted with 60 home care providers and 214 residential/nursing providers.

Context for the review

·         nationally there were concerns about the resilience of providers, especially in home care and residential/nursing care 

·         the reasons for this, backed up by feedback from providers locally, were due to an increased number and complexity of people requiring care, pressures on local authority funding and difficulties in recruiting staff

·         the population was ageing and people's needs were more complex

·         the Care Act gave the Council a new duty to ensure the sustainability of the market

·         new types of care were emerging, for example Extra Care

·         pressures on urgent care, for example to enable people to leave hospital,  were leading to a shift in availability of resources elsewhere

Scope for the review

Whilst the Directorate had a good understanding of care provided by the Council, less was known about other providers, and the review would aim to ascertain:

·         current state of the market – funding, capacity, financial viability, quality etc

·         likely impact of demand and supply pressures

·         how the Council could influence the market to ensure its sustainability

The review would include services to older people, people with learning disabilities, people with mental health problems and physical disabilities and extend to self-funders and council funded individuals.

The Council would oversee the review, which would be carried out by an independent agency to ensure that it was unbiased.

The Director provided further detail about home care and residential care in Worcestershire, which were the most commonly provided services.

Homecare

The Council funded 1700 older people's homecare, equating to 21,000 hours per week. The number of requests per day had increased, however the number of offers per request had decreased – the Council continued to be able to provide care but it was becoming more difficult. The average homecare package had increased to 12.6 hours per week.

Providers operated on a framework agreement with prices set in one of four tiers. The average hourly rate in Worcestershire was £15.80 (June 2014), which a recent comparison study revealed as amongst the most generous in the region. 'Key to care' (Report of the Burstow Commission on the future of the homecare work force) recommended £15.74 per hour as minimum. The Council had calculated that the composite minimum hourly rate should be £13.77, which took account of travel time, national minimum wage and 25% 'overheads and profit' for providers.

Residential / Nursing care

The Council funded 1500 older people  ...  view the full minutes text for item 189.

Attending for this item from the Council's Integrated Commissioning Unit, were Richard Keble, Head of the Unit and Caroline Kirby, Complex Needs Reviewing Officer.

Cllr Sheila Blagg, Cabinet Member for Adult Social Care was also in attendance, as well as Peter Pinfield, Chair of Worcestershire Healthwatch.

The Head of the Integrated Commissioning Unit provided an update on progress made on the Winterbourne View multi-agency action plan, since the 2011 Panorama TV programme exposed abuse of patients there.

At the time five Worcestershire people were patients at Winterbourne View (a private hospital for people with learning disabilities and autism, in Bristol). Whilst the abuse was a failure of the provider, Castlebeck, it was accepted that a large number of organisations also had responsibility, and within Worcestershire this included the Council and its health partners. A great deal of work had been undertaken since then to improve practice.

The protocol and pre-placement checklist introduced in 2012 was viewed as good practice and the accompanying action plan had been completed. All hospitals were routinely quality assured. Since 2013 placements for people with complex needs were commissioned by a Complex Needs Commissioning Team (part of the Integrated Commissioning Unit), on behalf of Worcestershire's three clinical commissioning groups (CCGs).

The five Worcestershire residents had since been reviewed regularly and were doing well in the community. The Panel was shown a graph to demonstrate the significant drop in numbers of Worcestershire people in locked hospitals, from 16 in 2011, to four in 2015, figures which would shortly reduce to two people.

Winterbourne View had led to review and transformation of care and practices, but also the overall culture around people being left in locked hospitals.  Whilst  there would always be times when, in a person's best interests, a secure environment was required, hospital stays were now shorter, and regularly reviewed.

Quality Assurance

The Complex Needs Reviewing Officer present set out the quality assurance process, which included visits before and during placements, and working with providers on any quality issues. A CCG funded health checker scheme, involved people with learning disabilities in reviewing locked hospitals from a patient's perspective, whose views were then reported back to the Learning Disability Partnership Board, and acted on – an example included changing a hospital gate, which had the appearance of a prison gate.

The Cabinet Member praised the team's hard work in reviewing both the patient and the placement.

It was confirmed that anyone spending time in a secure hospital had a named GP, as well as access to providers' weekly GP clinics, and an annual or bi-annual health check, also attended by the Reviewing Officer. Part of the role of Reviewing Officers was to ensure providers had contracts with local advocacy, and to facilitate contact for patients with their families. Some providers were happy to take people to visit their families.

Patients also had access to an appeals process.

Longer-term monitoring, post placement, was carried out by social workers, and patients who wished, would be brought back into Worcestershire,  ...  view the full minutes text for item 190.