Agenda and minutes

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Members of the public wishing to take part should notify the Assistant Director for Legal and Governance in writing or by e-mail indicating both the nature and content of their proposed participation no later than 9.00am on the working day before the meeting (in this case 15 July 2022).  Further details are available on the Council's website.  Enquiries can also be made through the telephone number/e-mail address listed in this agenda and on the website.

None.

Previously circulated

The Minutes of the Previous Meeting held on 20 May were agreed as a correct record and signed by the Chairman.

(Indicative timing: 2.05pm – 2.50pm)

By way of introduction, attention was drawn to a number of areas within the Agenda Report, mainly that the NHS nationally continued to be under significant pressure as a result of the COVID-19 pandemic and in Worcestershire, the two acute hospitals were experiencing significant delays in urgent care and in ambulance hospital handover delays. 

Traditionally, Worcestershire had a high number of people admitted to long term care after a hospital stay which was not compliant with national guidance where the expectation was that 95% of people would be discharged home, with only 45% of those requiring some support.  The different discharge pathways were explained alongside some of the challenges experienced.

The level of scrutiny and activity undertaken to try to improve the situation locally was outlined, including plans to progress the recommendations made by NHS England and Improvement.  It was noted that the challenges around COVID-19 remained and some of the work had stalled at times due to the impact of COVID on staff absence. 

The Council had provided support through an Integrated Intermediate Care service, which had recently been extended as it had been proven to help with admission avoidance and also provided speedier discharge from hospital.

A further pilot project, providing an enhanced level of domiciliary care was also showing good promise.  Up to 4 discharged patients could be taken each day, discharged a day earlier than expected and have up to 4 days of reablement support at home, with an option to increase to 10 days.     

Members were invited to ask questions, with the following key points being raised:

·         In relation to the high numbers of people admitted to long term care from hospital and how the County compared to other local authorities, national data would be provided to Panel Members after the meeting

·         Individual circumstances could affect the pace of discharge, such as personal choice, a change to a care package or a wait for certain service

·         When asked how well partners were working together on discharge planning, it was reported that protocols could be improved.  The two main issues for the Council were the timely booking of patient transport and the organisation of medications to take home.  Criteria led discharge was being piloted locally, a concept which was successfully established in other areas

·         Delays due to necessary home adaptations did occur as need was not always known in advance, however, small purchases could be authorised by the Onward Care Team to avoid further delay.  Asked if a patient could go home without the required adaptation, it would depend on the individual circumstance and support available

·         In relation to ambulance hospital handover delays, the situation was not straightforward although it was suggested that some system processes could be strengthened

·         Workforce pressures throughout the health and social care system remained, despite market forces supplements being applied.  There was a particular lack of therapists which impacted on discharges

·         A Member asked whether sufficient detail was received from the hospital about patients waiting for discharge to be informed that  ...  view the full minutes text for item 436.

(Indicative timing: 2.50pm – 3.15pm)

The Panel was reminded that they received an overview of the Care Quality Commission (CQC) Assurance Framework at its March meeting and the update provided now was to update Members on progress.

In summary, from April 2023, a new inspection and assurance framework would be in place and although final details had not been announced, guidance had been issued about the elements which would be included.

Worcestershire was leading the way nationally and Officers reported that the self-assessment programme should be completed by the end of August 2022.  A range of self-assessment tools and Care Act compliance check list had been developed and it was planned that any improvements would be carried out in time for April 2023.

Stakeholder engagement, including partners, staff and health professionals, was important to the process and Officers were proud of the ‘Building Together’ approach.

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

·         Co-production was an important element of adult social development and a requirement of the Care Act and a member queried whether this included a broad range of the population.  In response officers reported that a survey was launched in July 2022, advertised through a number of media campaigns, carers networks, hospitals, foodbanks, GP surgeries, Healthwatch and other outlets.  People were also sought to join the ‘Building Together Forum’ and Volunteer Peer Network.  The survey was adapted to suit different client groups and available in a number of formats

·         A review of the survey results was planned and the questionnaire and consultation results would be shared with the Panel

·         Some of the self-assessment tools were now nationally recognised after development in Worcestershire and future updates would be coproduced

·         The Building Together Forum aimed to bring together people with lived experience.  It was agreed that Members would be provided with information to distribute within their own networks

·         It was known that any CQC inspection team would want to speak to a range of people to ensure that there was a consistent thread among all stakeholders and visible across documentation.  For example, over 100 staff had already been involved in workshops to make early gains before April 2023.

(Indicative timing: 3.15pm – 3.45pm)

The Panel had received a Report which outlined the Government’s Adult Social Care Reforms and the potential impact in Worcestershire.  In summary, the Government had announced that a ‘Care Cap’ would be introduced from October 2023, meaning that no one in England would spend more than £86,000 on their personal care over their lifetime. 

In advance of this, the County Council would need to establish a ‘Fair Cost of Care’.  This was being developed with finance and audit colleagues and scheduled for agreement by Cabinet before submission to Government by mid October.  One development since the publication of the Agenda was that people already paying for their own care would need to wait an additional 18 months before applying for the fair cost of care.

Members asked a range of questions which were responded to as follows:

·         A care home placement in Worcestershire cost in the region of £700 - £800 per week, but this varied dependent on the level of care required

·         The process in developing a Fair Cost of Care was extremely complex with huge implications for the Council and providers.  Local Authorities nationally had generally accepted the social care reform objectives, however had collectively expressed that the central government money earmarked to enable councils to pay for the fair cost for care was inadequate

·         Nationally, it was predicted that an additional 4,300 social work staff would be required to support the process and the Council was already investigating what skills would be required to fulfil requirements, for example what specific work required a qualified social worker or what skills were required to undertake other tasks

·         Nationally, workforce pressures remained and all local authorities were seeking the same skilled staff.  In addition, levels of demand across domiciliary care had increased by over 4% each year and the NHS Recovery Plan placed far more pressure on domiciliary care

·         The Cabinet Member with Responsibility (CMR) for Adult Social Care reminded Members of the National Insurance levy which was being used to reduce the NHS backlog and at some point in future would be used to support adult social care

·         The Worcestershire Care Market had been stable, however, new pressures across residential and domiciliary care, including rising utility bills, the cost of fuel and general inflation were evident.  Furthermore, residential homes were currently at around a 20% vacancy rate.  COVID-19 grants, amounting to £31.5m across all providers, had masked the financial situation, however as there were no further grants available, business pressures were foreseen

·         Homes usually aimed for no more than a 10% vacancy rate, however the number of people entering residential care was decreasing.  A large amount of disruption was predicted if Care Homes became unviable as residents would need to be moved.  It was thought that a purpose-built facility may be cheaper to maintain and run than an older smaller property and new settings continued to open around the County

·         It was suggested that not all providers had a clear understanding of the implications of the Fair Cost  ...  view the full minutes text for item 438.

(Indicative timing: 3.45pm – 4.10pm)

The Panel was advised that at the end of the financial year 2021/22, the Directorate had broadly broken even, despite an increase in demand of 5%, on average, across all client groups.  Alongside demand, increased unit costs had also put pressure on budgets especially across Older People, Learning Disabilities and Mental Health.  One off sources of income, such as COVID grants, additional funding and vacancy management had helped achieve the breakeven position.  The Panel was warned that the 2022/23 financial position would be very pressured, which was the picture reported nationally.

An update was given on the previously reported vacant posts in Mental Health.  Following a successful recruitment campaign, using market forces supplements, posts had been filled.  Members were assured that there had been no significant delays in service delivery.

A summary of Quarter 4 performance for 2021/22 was provided.  Some indicators showed lower performance than in 2020/21, however, compared to 2019/20, performance had generally improved and there were no areas of particular concern.  The number of admissions to permanent care was broadly kept under control across all ages and outcomes of short-term services and rehabilitation had performed especially well, noting that clients with more complex needs were now being supported in the community. 

In relation to a query as to how targets were set and whether some should be more ambitious, Members were advised that targets were generally set based on performance in the previous year alongside other factors. 

(Indicative timing: 4.10pm – 4.15pm)

Members agreed to add an update on the Role of Adult Social Care in Complex Hospital Patient Discharges at its September meeting and schedule an update on Adult Social Care Reforms at an appropriate time in the future.