Agenda and minutes

Apologies had been received from Cllr Adrian Kriss and Cabinet Member with Responsibility for Adult Social Care Cllr Adrian Hardman.

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 Monday 4 December 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.

Mr Brendan Young asked questions in relation to the Agenda Item on How the Council Works with Carers.

The Chairman thanked Mr Young for his questions and confirmed he would receive a written response.

Previously circulated

The Minutes of the Meeting held on 13 October 2023 were agreed as a correct record and signed by the Chairman.

The Chairman welcomed Officers, representatives from Worcestershire Association of Carers (WAC) and two Carers to the meeting.  To introduce the Item, the Panel heard from the Carers who shared their own experiences of being a carer and their interaction with WAC.  A further statement was read out from a carer who was unable to attend the meeting and all 3 accounts highlighted the valuable support that WAC gave, especially the opportunities to meet other carers.

The Chairman invited questions and during the discussion, the following points were made:

·       When asked how the Council assesses the quality of care agencies, it was reported that quality improvement was an integral part of the new contract framework for independent focussed domiciliary care providers

·       Traditionally, agency activity nationally was broadly time and task based activity, however, the new arrangements allowed scope for flexibility and was based on outcomes – with services tailored to the individual

·       Officers reminded the Panel that there was a finite workforce available and the tailored response was more effective.  Carers were very supportive of the ability to tailor care to their own needs as it provided greater flexibility

·       The Panel supported the vision for all carers in Worcestershire and commended the Council’s mission to ensure actions were informed by lived experience

·       A recent survey of 280 carers in Worcestershire found that 21.5% of them reported having little social contact and feeling socially isolated.  In response to how this could be overcome, Carers outlined their experience of WAC organised activities, highlighting that the role of WAC was vital and it was important that the Council ensured that resources were available to make it happen

·       When asked whether WAC was under the radar if 21.5% of carers felt isolated, it was explained that all carers had to be first identified.  A GP referral was one way of signposting, but more could always be done to identify carers

·       WAC was seeing an increase in carers who were further into crisis as it was thought they needed to be in crisis in order to get any support

·       A Member asked about the differences between commissioning of Social Care and NHS Continuing Healthcare (CHC).  It was agreed to provide Members with further information after the meeting

·       In response to a query as to the level of scrutiny undertaken by Officers, there was ongoing monitoring through the Commissioning Team, Quality Assurance Team, Care Quality Commission and the NHS.  In addition, there was a statutory duty on the Council to collect carer feedback

·       Clarity was given that employees of care agencies were contracted by their Agency, not the Council, and therefore any terms, such as travel time, was an agreement between the Agency and the employee

·       In relation to the funding arrangement between the Council and WAC, the Council commissioned the Carers Hub

·       A Member asked how the figure of 53,000 unpaid carers in Worcestershire was known, to be informed that census data was used, however there had been a drop since the last census, which had  ...  view the full minutes text for item 500.

The Panel had received performance information for Quarter 2 (July to September 2023) and financial information for Quarter 2 (Period 6).

The Principal Management Information Analyst highlighted that the number of admissions to permanent care per 100,000 (aged 18-64) was reducing and Members should see a fall in the total annual figure in the next report.  In comparison, admissions to permanent care per 100,000 (aged 65+) were rising.  The Strategic Director commented that contributing factors included the increased number of older adults experiencing falls.  Nationally, Public Health was concerned that since the Covid pandemic there was an increase in people with fractured hips.

In response to the Panel’s request for the age profile of people admitted to long term care, the average age of adults aged 18 to 64 entering permanent care was 51 and 84.5 for those aged over 65.  This was positive and a good indication that reablement services were working well.

Although the number of Annual Care Package Reviews completed had risen to 85.7% in September, compared to 80.2% in June, it was still underperforming on the target rate for 2023/24 of 95%.  The Strategic Director highlighted that despite the target not being met, Worcestershire had the best performance in the West Midlands region.

In relation to the more detailed information requested at the last meeting, (admissions by primary support reason, 18-64), a Member asked whether there could be overlap in some of the categories.  It was clarified that the reasons were set nationally, however a clinical diagnosis would be used as the main reason, for example Learning Disability Support.  It was further clarified that the data provided was only for admission to bed based care.

The Director of Healthwatch Worcestershire highlighted a possible link with the level of carer support to the level of residential care.

The Deputy Chief Finance Officer referred to the corporate budget position as reported to Cabinet on 23 November 2023 which was an overall outturn forecast at Period 6 for a net overspend of £21.9m after the use of budgeted risk reserves.  Demand was rising in three key areas, adult social care, children’s social care and home to school transport leading to significant pressures.

In relation to Adult Services, a £8.9m gross overspend on placements was forecast, mitigated in part by use of a £3.6m additional grant.  Not only was the number of placements rising but the unit cost of placements was also rising.  Concern was raised that figures could escalate during the Winter period.

Questions were invited and in the ensuing discussion, main points included:

·       A Member asked about the progress of the Council’s voluntary redundancy programme, to be advised that the programme was still open, so it was difficult to speculate on the outcome

·       Although statutory services had to be met, all Officers had a requirement to check and challenge the market to ensure the Council was not overpaying for any service

·       The Strategic Director advised that choice was still a vital element of a placement, with families able  ...  view the full minutes text for item 501.

The Consumer Relations Officer briefly outlined the Agenda Report, highlighting that learning from complaints was vital for continued development.  For the period 1 April 2022 to 31 March 2023 there had been 250 complaints, an increase of 7% from 233 in the previous twelve months.  During 2022/23, the Local Government Ombudsman (LGO) had received 15 complaints and 16 were determined, of which 6 were upheld.

In the ensuing discussion, the following main points arose:

·       A Member asked about trends over time, to be informed that there had been an increase year on year.  Around 100 complaints had been received 5 years ago, in comparison to 250 in 2022/23

·       There had been an increase in the number of complaints that related to the standard of service received in the complainant’s view (65% in 2022/23, compared to 58% in 2021/22)

·       Complaints received about external care providers could be referred to the Council’s Quality Assurance Team

·       The Panel was pleased to learn that the number of compliments received had increased and was proportionate to the additional 1,500 people entering the system

·       The Report referred to examples of concerns that may be raised, including a lack of empathy or compassion shown to service users.  Members were advised that the category of staff attitude and behaviour was often more difficult to determine due to a lack of witnesses.  It was agreed that further explanation of the types of complaints would be provided after the meeting

·       A Member referred to the previous discussion on 28 September 2022 and was disappointed that a request for further narrative was not included in the Report.  Members acknowledged the need for anonymity and Officers agreed to determine a suitable level of information in future reports

·       Of the total number of complaints received in 2022/23, 6% had been escalated to the LGO.  For 2023/24, it was currently around 4% and figures were not dissimilar to national figures

·       A large scale safeguarding concern had led to the Directorate updating its Provider Concerns Process.  When asked how many people had been affected by the concern, it was agreed to provide Members with further detail

·       The Chairman thanked everyone present and requested a further report in 12 months time.

The Panel considered the Work Programme and no additional Items were added.