Agenda and minutes

The Chairman welcomed everyone to the meeting.  Apologies had been received from Panel members Jo Monk, Alan Amos and Adrian Kriss.

The Chairman agreed to a change in the running order of the Agenda, and Item 6 (Update on Developments with the Adult Front Door) was considered first.

Cllr Andy Fry declared a pecuniary interest regarding his employment for a Learning Disabilities provider which had connections to the Council.

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 12 October 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 14 July 2023 were agreed as a correct record and signed by the Chairman.

In attendance were:

Mark Fitton, Strategic Director for People

Hannah Perrott, Assistant Director for Communities

Kerry McCrossan, Assistant Director for Adult Social Care

Nikki Breakwell, Head of Service Adult Front Door

Cllr Adrian Hardman, Cabinet Member with Responsibility (CMR) for Adult Social Care

The Assistant Director (AD) for Communities introduced the report, which provided an update on progress with the Adult Front Door (AFD). The AFD was now the main point of contact for Worcestershire residents (18+), their families, carers and professionals who require access and support to services, information and advice.

The AFD had been created by combining the previous Adult Contact Centre, the Connect Health and Wellbeing, and the Here2Help Teams.

The new way of working enabled strengths-based conversations to take place at the earliest opportunity, and in many cases people would be given or signposted to advice and guidance to meet their needs, or referred to available community support. For those who needed more support, a small team worked proactively with Care Act eligible individuals.

Progress was beginning to be seen however the AFD was in its very early stages. Work was also taking place with partners to improve the number of contacts coming to the AFD which were not appropriate.

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

·         Regarding monitoring of the AFD model, the AD for Communities explained that this formed part of the CQC inspection, and that the social work team also audited cases – however at this early stage the quality assurance model was work in progress and she suggested would be better placed in six months’ time. Capturing feedback was very important and users of the AFD were contacted to verify if their needs had been met.

·         A further benefit of the AFD was that it provided more data about why people asked for help, which would be useful to share with partners to develop understanding and a more proactive approach.

·         A member suggested it would be helpful to include a range of scenarios in future updates to the Panel.

·         Panel members sought clarification about the significant demand of, on average, 48-55% avoidable contacts, and it was explained that there may be digital solutions to enable people to find information themselves. Reducing avoidable contact meant that there was more capacity to deal with demand.

·         When asked how people would know the correct route for their enquiries, it was clarified that currently, a large proportion of avoidable contact came from practitioners, who should know correct routes, whereas an element of avoidable contact from the public was to be expected and was managed.

·         In terms of promoting the AFD, a balanced approach was being taken to avoid overloading the new model, however there was a continued push to communicate the AFD to partners and there were plans to develop the website.

·         Examples of proactive partnership working included with the police, fire and ambulance services and public health.

·         The role of councillors and parish councils in spotting vulnerable individuals was acknowledged, although  ...  view the full minutes text for item 492.

In attendance were:

Mark Fitton, Strategic Director for People

Kerry McCrossan, Assistant Director for Adult Social Care

Richard Stocks, Senior Finance Business Partner

Sally Baldry, Principal Management Information Analyst

Cllr Adrian Hardman, Cabinet Member with Responsibility (CMR) for Adult Social Care

Performance Information for Quarter 1 (April to June 2023)

The Principal Analyst for the People Directorate summarised the main headlines from the key performance priorities for adult social care (Appendix 1). 

Although admissions to permanent care for those aged 18-64 had increased, social work teams worked constantly to minimise people entering long-term placements, and continued to monitor placements. The message was similar for those aged 65+ and best value principles were also always applied to placements.

As requested by the Panel, the performance dashboard now included a table to indicate the primary reasons for admission to residential and nursing care, with the highest number being personal care.

Regarding outcomes of short-term services, the complexity of needs had increased but results were still being achieved.

At the end of quarter 1, 80% of annual care package reviews were being completed, although it was highlighted that there was a range of performance, with some service areas as high as 90%, and the support from an external agency was bringing improvement.

Discussion points

A member queried the variance in the rate of admissions for adults aged 18-64 to permanent care, and was advised that factors included a wariness of entering these settings during the pandemic, which was now dissipating, plus increased severity of people’s health conditions. There was considerable variance nationally, and it was also pointed out that numbers of individuals concerned were small, therefore figures were more likely to fluctuate. The Strategic Director reported that nationally concerns had been raised to the Care Quality Commission about the need to understand variances in adult social care across the country.

Responding to a query as to why the Council’s performance for admissions to permanent care continued to be below the comparator average, the CMR for Adult Social Care said he did not believe the comparator average brought out the Worcestershire demograph, as the percentage of those aged over 75 was increasing considerably. The Assistant Director (AD) for Adult Social Care added that Worcestershire’s high proportion of self-funders was a factor, as well as significant numbers who entered permanent care following a period of continuing healthcare funding, and they are then transferred to the local authority when they are no longer eligible.

A discussion took place about the fact that residential care was often the default route and one which may be advised by the GP, and the Officers advised that it was very difficult for the Council to turn around these decisions without prior involvement, although there as good information on the Council’s website.

When asked to what extent adults of middle age entered long-term care, the Panel was advised that the majority would be adults with learning disabilities. The Director stressed that wherever possible the Council looked to provide alternatives to  ...  view the full minutes text for item 493.

In attendance were:

Mark Fitton, Strategic Director for People

Kerry McCrossan, Assistant Director for Adult Social Care

Cllr Adrian Hardman, Cabinet Member with Responsibility (CMR) for Adult Social Care

The Strategic Director for People (Strategic Director) apologised that the report author was unable to attend. He explained that statutory responsibility for homelessness prevention and relief lay with the 6 District Councils, however clearly adult social care had a role to play due to the complex nature of people who found themselves homeless, which may be for factors including mental health, substance issue or domestic abuse.

An example of a key area of involvement for adult social care was around people ending up in acute settings, and work was currently underway to bring better partnership working for those individuals.

The Chairman invited questions about the joint working involved in the Council’s work with partners, and the following main points were made:

·         A Panel member who was also a district councillor and was aware of the district council roles, sought further insight about the role of adult social care in Worcestershire, including paragraph 22 of the report (referring to Section 23 of the 2014 Care Act and the Housing Act 1996). The Strategic Director explained that adult social care did not have the final responsibility for accommodation, and that its role was more about wrap around care related to being homeless; if an individual had no care and support needs they would not have access to adult social care, although they may have housing needs.

·         A follow-up question was asked to verify that adult social care would be involved in the process of declaring an individual homeless, and it was clarified that this would be the case in a scenario where they had other needs.

·         A Panel member suggested that current processes did not feel client centred, referring to a recent example where an individual who was not coping well at home ended up in hospital, subsequently declared homeless and moved to temporary accommodation which would have been extremely disorientating – the Director explained that the decision about whether a district council had a role to accommodate an individual was up to the relevant district council; the County Council had no duty, although where an individual may have become homeless by their own behaviour, the Council would try to pick up the pieces.

·         Regarding suitability of temporary accommodation, the Assistant Director (AD) for Adult Social care explained that the health and housing sectors worked together, for example to ensure accommodation was suitable for health care needs to be given.

·         A comment was made that while the report conveyed how the Council worked with partners it did not necessarily set out how well this worked – the interface was critical to ensure people did not fall through the cracks. In response, the Strategic Director explained that the new cross partnership role referred to in the report (Head of Housing and Health) was bringing improvements and that she met regularly with partners.

·         In future  ...  view the full minutes text for item 494.

From the existing work programme, a report on how the Council works with carers was requested for the meeting on 5 December, to include feedback from carers.

Regarding packages of care, which was one of a number of areas the Overview and Scrutiny Performance Board had asked the Scrutiny Panels to look at as part of 2023/24 budget scrutiny, the Panel would determine whether any further scrutiny was needed after the forthcoming informal briefing on the care market.

The following were added to the work programme:

·         Update on CQC Inspection framework – for January 2024

·         All Age Disability Strategy

·         Self Neglect and Hoarding Policy

·         Update on the Adult Front Door (in six months’ time)