Agenda and draft minutes

The Chairman welcomed everyone to the meeting.  Apologies were received from Councillors Jo Monk and James Stanley.  

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 19 March 2024).  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 20 January 2024 were agreed as a correct record and signed by the Chairman.

The Chairman advised that Agenda item 5 (Worcestershire Safeguarding Adults Board Annual Report 2022/23) would need to be deferred to the next meeting as the Independent Chair of the Safeguarding Adults Board was unable to attend the meeting, due to unforeseen circumstances.

The Assistant Director (AD) for Adult Social Care introduced the update on Adult Social Care’s (ASC) role in the process of hospital patient discharges, which was an update the Panel’s previous discussion in November 2022.

The role of ASC meant that the focus for much of its capacity was around complex discharges, and the report set out the roles and performance of the three Council teams involved; the Onward Care Team, the Urgent Care Team and the Reablement Service.

The past 12 months to two years had shown that staff working across ASC, the community hospitals and acute hospitals, had merged well together and built good resilience, with good handovers and transfer of care as people moved through the different care pathways.

In summarising the report, the AD for ASC made the following main points:

·         The Urgent Care Team had been focussing on the pace of assessments (including mental capacity assessments), in order to enable patients to transfer to the next destination, whether that was to home or a community hospital – although this could be difficult during times when hospitals were at critical incident levels.

·         The Reablement Service operated to a high standard and the Council was frequently contacted about the model, its timeliness and outcomes.

·         The Care Navigation Hub was a new development, which was a programme to bring teams together to facilitate patient discharge and ultimately tackle some of the tricky issues involved. At this early stage, some good results were being seen in speeding up discharge and overcoming the barriers created in working across a variety of partners.

·         The report included challenges faced, a significant one being the sustained pressure on the hospital Emergency Department which prompted continuous demand and required a lot of capacity from partners.

·         In terms of performance, it was highlighted that this could be even better for Pathway 1 (people who can return home) but work was required on the numbers of referrals and the days of the week they came through, so that capacity was always fully used.

·         For Pathway 2 (those who cannot go home and need a rehabilitation bed), there were always sufficient referrals therefore work was required to understand the issue with flow.

·         For Pathway 3 (where there was limited rehabilitation potential and the patient would go to a care home bed for assessment), work continued to look at the effectiveness of the intensive rehabilitation unit and whether it was the right model for the Worcestershire system.

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

·         Regarding the Care Navigation Hub and issues identified so far, it was explained that capacity was always an issue, as well as resources. Continuing Healthcare (CHC) processes needed to fast tracked, and there were issues around homelessness, and housing also required quicker responses. The possibility of a pooled budget was being looked at, to overcome instances where debate over the responsible organisation caused delay, and the Hub would enable issues in the wider system to be identified and resolved.  ...  view the full minutes text for item 516.

The Assistant Director for Communities referred to the Agenda report which set out the financial pressures relating to Adult Social Care (ASC), which included increasing demand for services. Demand had increased by around 6% for the financial year, which the Council had taken proactive action to manage, and measures introduced were included in the report. 

The following points were highlighted:

·         Staffing reductions were being looked at in order to avoid a restructure exercise at this stage, mainly by removing vacant posts.

·         More work was required to prevent demand and referrals to ASC, by expanding work around the Adult Front Door (AFD), which was where care and support needs were accessed. Demand was reducing on the AFD and an update had been added to the Panel’s work programme.

·         Regarding the Council’s information and advice offer, a strategic plan had been developed, working with Healthwatch Worcestershire.

·         Currently around 85% of the focus of the Reablement Service was on patients discharged from hospital, therefore there was an initiative to increase capacity to all new customers presenting for adult social care. Pilots were taking place in Wychavon and Wyre Forest areas, although investment would be required to roll out this additional capacity.

·         Double handed care (where more than one carer was provided to deliver personal care in someone’s home) was now charged for, and the initiative to reduce it was a huge area of work.

·         In order to refresh staff understanding of the Choice of Accommodation Guidance Policy when meeting peoples’ needs, training had been provided to over 400 staff, and other local authorities had enquired about this cost avoidance guidance.

·         Regarding Independence Focused Domiciliary Care, contracts had now been awarded in all areas, to one primary and two secondary providers, and the Council was starting to work with these providers as the first points of call.

·         There had been a lot of interest from providers around the Older People’s Framework for Residential Care, which, similarly, would mean certain providers were the first point of call. The scheme enabled three tiers of care to be set within older people’s residential and nursing provision and was encouraging.

·         Where providers had been set up as the first point of call as part of contracts, it would be important that this was adhered to and work was in hand to ensure this.

·         Regarding work to ensure there was an approach to transitions of children in care to adults, it was explained that there were different legal requirements involved, and cases where care costs had been significantly reduced, an example being an individual whose care was costing approximately £6,000, reduced to around £600 – good outcomes were being achieved for individuals.

·         Overall, a great deal of activity was underway to manage demand and efficiency, which would be monitored monthly by the leadership team, to assess progress and whether more work was needed.

The Chairman invited questions and advised that the Panel wished to add the demand and efficiency initiatives to its Work Programme to look at in more  ...  view the full minutes text for item 517.

Performance Monitoring – the Panel had received information relating to quarter 3 (October to December 2023)

The Principal Management Information Analyst referred to the comparative data which had been added to the information provided about admissions to permanent care, which indicated that for adults of working age in Worcestershire there was a higher number of admissions than the comparator and England average. However, of interest was that Warwickshire, which was deemed the most similar area, had a rate of 25.3, which was much higher than 17.2 for Worcestershire. Additionally, the data for the rolling year to December 2023 showed that the number of admissions was reducing.

For admissions to permanent care for those aged 65+, performance in Worcestershire was not far from the comparator average, was below the England average and well below levels in Warwickshire (784 as opposed to 532.6). Figures for the rolling year indicated that admission levels in Worcestershire were increasing, and actions being taken to address this included the introduction of residential block beds and continued scrutiny of all Continuing Healthcare placements.

Information had been provided to show the average age of people moving into long term care, which for older people was 85 and for working age adults was 49. The primary reasons for entering long-term care for older people was personal care followed by memory and cognition, and for working age adults was mental health and disability.

Following recent discussion by the Panel about those people where social isolation was listed as their support reason, this had been looked into, and the Panel was advised that whilst that had been their initial primary support reason when they came to local authority, it was not the primary support reason for them moving into a permanent placement.

For outcomes of short-term services, the result for Worcestershire was good and had increased to 84% which was above the comparator average, and the figure for Warwickshire was 83%. A pilot was underway to develop more community based reablement.

Performance for people aged 65+ still at home and remaining independent following rehabilitation was just below 84% (outturn for the previous year) which was higher than comparators, although for Warwickshire was 94% - their very high performance may reflect the type of services being included in this indicator.

There was good news regarding performance of annual care package reviews, which at the end of December was just below 90% against the ambitious target of 95%. Additional support had been put in over the summer, but teams were now managing to increase the number completed despite continued high demand.

Discussion points

·       Regarding increased admissions to permanent care of older people, the Officers explained that this was monitored monthly to identify themes, however analysis showed there was no particular leading reason each month, but there was constant pressure. New admissions continued to be audited.

·       A Panel member remained concerned about the impact of social isolation and sought reassurance that there was awareness and resourcing of this need amongst older people. The Officers  ...  view the full minutes text for item 518.

The Panel considered the draft 2024/25 Work Programme, which was being refreshed as part of an annual exercise.

The Chairman thanked the Healthwatch Worcestershire representative present for the suggestions sent in and advised that these would be added to or incorporated into the Work Programme.

The Chairman also advised that the Panel planned to add initiatives considered as part of the discussion on managing demand and efficiencies.

In response to a query about the Public Telephone Network Switchover, and implications for care homes, the Interim Democratic Governance and Scrutiny Manager confirmed this had been looked into by the Corporate and Communities Overview and Scrutiny Panel.

A suggestion was made to consider opportunities for the Panel to hear from frontline staff for appropriate Agenda items. 

The Interim Democratic Governance and Scrutiny Manager would also follow up a query about whether the new Office for Local Government (Oflog) would have implications for the performance indicators monitored by the Scrutiny Panels.