Agenda and minutes

The Chairman welcomed everyone ot the meeting. Apoloies were received from Councillors David Chambers and Andy Fry.

None.

Members of the public wishing to take part should notify the Democratic Governance and Scrutiny Manager 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 23 March 2023).  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 Meeting held on 23 January 2023 were agreed as a correct record and signed by the Chairman.

Professor Keith Brown introduced himself to the Panel and explained that in addition to his role as Independent Chair of Worcestershire Safeguarding Adults Board, he was also Chair of the Safeguarding Adults National Network, therefore he had a fairly large national profile in safeguarding.

The Agenda included the Worcestershire Safeguarding Adults Board (WSAB) Annual Report for 2021-22, and the Independent Chair referred to the areas of work which had continued to be progressed. The main area of comment had been around the need for some work on referrals meeting Section 42 criteria, since there was an issue nationally when considering Safeguarding Adults Reviews (SARs) around co-ordination of care and support for vulnerable individuals to make sure people did not fall between services. Worcestershire now had a CARM framework (Complex Adult Risk Management) which was very positive, and the Chair praised the Council’s approach in its development. Work was also taking place to review processes around SARs to try and help bring down the time taken for Home Office sign-off.

Safeguarding referrals had increased, which the Council was commended for increasing resources to deal with and while some were not appropriate, a lot were very appropriate. Other areas of work included exploitation, and a review of rough sleepers. The Independent Chair felt safeguarding adults was well resourced and the Council was therefore well prepared for any inspection by the Care Quality Commission.

The Chairman invited questions and the following main points were made:

·         Regarding activity data, the question was asked about confidence that issues were not being missed and the Independent Chair agreed this was a pertinent question since strategies and systems were based on what was known. Fraud was an example of an increasing problem, where it was estimated that only 5% of issues were reported – and safeguarding systems were based on this limited data.  From his involvement in discussions about groups of people where there may be less insight, he believed the main one was lonely, older people who were isolated and therefore their voices were not well heard. For example, it was very revealing that follow up work on an exercise to assess the impact on wellbeing of older people who had been victims of fraud, by supplying call blocking devices – many had removed the blocks as they were so lonely, they preferred to receive the contact of fraud calls. He believed it was absolutely right therefore to explore new areas of safeguarding and to highlight inappropriate behaviour.

·         The WSAB Manager added that locally there was a lot of work taking place and an adult safeguarding network had been established to hear from organisations working at ground level.

·         Panel members agreed that greater reporting of safeguarding concerns indicated greater awareness.

·         Assurance was sought about how safeguarding systems would prevent homeless people falling through the gaps, which had been highlighted as a concern by district councils. The WSAB Chair referred to new understanding around self-neglect and capacity, and whether an individual had capacity to be able to  ...  view the full minutes text for item 468.

The Head of the Learning Disability Service (Head of Service) introduced herself to the Panel and thanked the members who had recently visited some of the social work teams, including the Learning Disability Team – staff had welcomed the interaction.

The Head of Service summarised the report and explained that the Learning Disability Service (LDS) supported over 1400 adults with a learning disability, across two teams located in the south and north of the county, with the addition of a Vulnerable Adults Team (VAT) which supported around 120 adults aged 16-25 who had Autism, associated learning conditions and learning difficulties.

A peer challenge review in 2019 had identified several areas for development, and the Head of Service was very pleased to report good progress.

There were now good joint working arrangements with the Integrated Care Board had continued with work towards a formal agreement for joint funding. The LDS had introduced the named worker approach which was national best practice. Investment in an external agency to complete the backlog of outstanding reviews for the LDS caused by historically low staffing had worked very well.

The transition of young people into the service from Worcestershire Children First continued to strengthen with good operational working between teams.

The Vulnerable Adults Team had been reviewed to ensure a robust staff team was in place to deal with anticipated future demand – this would continue to be a priority along with overall LDS recruitment and retention and preparing for CQC inspection.

The Chairman congratulated the nomination of a member of staff from the LDS team for a national award of Newly Qualified Social Worker of the year.

Questions and the following main points were made:

·         The cost and staffing numbers involved in the Learning Disability Review Project was queried, which the Officers undertook to verify. The aim of the project had been to complete a backlog of outstanding reviews which had built up due to inadequate numbers of staff, however going forward the LDS team was fully staffed.

·         Regarding capacity of the Vulnerable Adults Team, it was explained that demand for, and capacity of the existing Team was being reviewed.

·         The Head of Service agreed the importance of people having a named social worker, therefore there was a focus on staff retention and this was improving.

·         It was explained that the projected figures for the number of people aged 18-64 with Autistic Spectrum Disorders were based on public health data but would change over time.

·         The strengths based practice was very much the vision for the Service, and based on people using their own strengths and community links to identify what was needed to enhance lives, and to focus on can rather than can’t.

·         The difference between the Young Adults Team and the Vulnerable Adults teams was clarified; those being helped by the Young Adults Team had previously been supported by the Children with Disabilities Service, within WCF, whereas those transitioning to the Vulnerable Adults Team had been supported by other WCF teams, such  ...  view the full minutes text for item 469.

The Assistant Director for Commissioning explained that the report provided a further update on Charging Reform which establishes a fair cost of care, and the introduction of a Care Quality Commission (CQC) assessment regime on local authorities, following earlier reports to the Panel.

The Government had delayed implementation of the Charging Reform for two years until October 2025, however work to prepare for this would continue and the delay gave more time for the Directorate to verify data, refresh the website and to work on the redesign of the Adults Front Door. A considerable amount of information and guidance was still awaited from the Government. Staffing requirements would be quite significant and were being considered.

The Fair Cost of Care exercise focussed solely on the 18+ domiciliary care market and the 65+ general and nursing residential care market, using analysis of provider data to establish a median cost of care. The word ‘median’ was very important as it was being found to vary quite significantly, and while although Despite delay of moving towards a Fair Cost of Care, local authorities were still required to publish some of the documents they had been required to submit to the Department of Health and Social Care, which the Council had done. The process was ongoing, with a large number of unknowns. There was a whole separate exercise to communicate the changes to providers, however due to the complexities involved, had not been well understood or accepted.

Preparation for the new CQC assessments involved an enormous amount of work and the Council had been fortunate to be able to do a series of dress rehearsals with other local authorities.

The Chairman invited questions and the following main points were made:

·         When asked how the Council managed communication with care homes in such confusing circumstances, mindful of the existing pressures and the desperate need to avoid care homes closing, it was explained that the Council did all it could to identify the best use of resources when looking at fees, which was then out to the marketplace. Certain sectors had particular problems which may require work to shape the market. Unfortunately expectations had been set extremely high by the way in which the Fair Cost of Care exercise had been introduced.

·         In terms of market shaping, it was important to look at what need was envisaged for the future. For example, there were national and local strategies to support people to live at home where possible and safe patient discharge from hospitals may require more home visits.  Numbers of people entering residential care homes had declined however there were other needs around complex care including dementia – there would be a lot of work to consider these factors, and to try to work with the market and providers to try and encourage the market to adapt.

·         The Cabinet Member commented that despite the good intentions of the Government’s Charging Reform, he envisaged further delays and was not sure it would ever be implemented.

·         Panel members  ...  view the full minutes text for item 470.

Performance Information (Quarter 3 October to December 2022)

The Strategic Director for People summarised the main headlines from the key performance priorities for adult social care (Appendix 1). 

Regarding progress with completion of annual care reviews, it was highlighted to the Panel that while current performance of 85% was below the ambitious target of 95%, it was strong in comparison to other local authorities across the West Midlands, the average of which was 55-65% completion.

A Panel member suggested it would be helpful to have information about neighbouring local authorities’ performance to enable comparison, and it was agreed that consideration would be given about how to incorporate this.

Regarding the target for the number of people aged 65+ at home following rehabilitation, it was confirmed that good performance meant more people in their home environment and he would verify the wording of the report format.

The Strategic Director acknowledged a query about the use of the age 65+ which was now below the pensionable age, which he would feed into discussions he was involved in with partners at national level about future reporting of adult social care, due to go live the following year – and which was likely to influence the format for this Panel.

In-Year Budget Information for Period 9

The Senior Finance Business Partner summarised the main headlines for the forecast financial position for Adult Services (Appendix 2) and explained that there were no new risks.

It was clarified that the change in figures for the Adults Commissioning Unit was a reporting issue, since the headline figure had a lot of detail behind it, and included elements of the Better Care Fund.

It was clarified that increases reported in client numbers since 1 April for older people (4%) and learning disability (5%), that variations would occur as they were demand-led services, and assumptions were based on what was predicted, using the data available.

The Cabinet Member with Responsibility for Adult Social Care explained that the Directorate always tried to model as accurately as possible and were aware of demographic changes.  In respect of any predicted impact on services from the loss of elderly parent carers (for adults with disabilities) on demand for services, it was important to reassure elderly carers about the benefits of supported living arrangements.

The Panel agreed it was content with the Work Programme, which had also received input from Healthwatch Worcestershire, as part of the refresh exercise.

The following item was added:

Care market for older adults (including both residential care homes and domiciliary care) – Officers would carry out further scoping