Agendas, Meetings and Minutes - Agenda item

Agenda item

Peer Review Feedback

Minutes:

The Strategic Director for People (the Director) and the Assistant Director for Adult Social Care had been invited to report on the feedback received from the Peer Review of Services for Adults with Learning Disabilities and Autism, which took place in February 2020.

 

The Director took the Panel through the presentation attached to the Agenda report.  In summary:

 

·         The Peer Review team consisted of senior adult social care professionals from around the West Midlands.  Over 3 days, they spoke with various stakeholders, including Senior Leaders, Officers, Partners, Councillors, Carers and Representatives from the provider market 

·         The Key Lines of Enquiry were clearly stated:

o   Is there a collective understanding, across the County Council and partners, of the profile of spend and demand pressures we face from increasing complexity and demand from people with Learning Disabilities and Autism?

o   Is our current model for service delivery and support for people with Learning Disabilities and Autism fit for purpose and affordable?

o   What opportunities does the Council have to work in partnership to co-produce a sustainable model for delivery?

·         The Peer Review team’s findings were broadly summarised as follows:

o   Adult Social Care would benefit from corporate vision

o   Council Leadership would benefit from harnessing enthusiasm from partners to work together

o   Lack of direction was foreseen as a major risk for the Council especially when needing to address financial challenges

o   Progress measures would need to be agreed

o   There were good examples of community assets and system developments

o   The Team highlighted the loyalty to Worcestershire from all those who were engaged in services.

·         The newly formed People Directorate’s priority was to ‘ensure Worcestershire residents are healthier, live longer, have a better quality of life and remain independent for as long as possible’, recognising that this would only be achievable through co-production with Partners

·         A Council commissioned report had found that Worcestershire’s demand for adult services differed to the national picture in that targeted interventions (Tier 2) were much lower in Worcestershire (4.9%) than nationally (20%) and Services (Tier 3) were much higher in Worcestershire (26%) than nationally (10%).  Developing the Universal and Self Service (Tier 1) and targeted interventions (Tier 2) would be critical in managing demand

·         Plans had been developed to address some of the findings with cross Council/Partner Delivery projects highlighted to the Panel, such as an integrated customer model, an all age disability offer, aligned commissioning and organisational development.

 

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

 

·         Although the vision and delivery on place and infrastructure was noted as commendable, concern was expressed about the lack of clarity around the corporate vision

·         The report had recognised some good work, such as the Transforming Care Partnership which had achieved national recognition for supporting people with learning disabilities and autism, and their families and carers, to agree and deliver local community support.  Although the number of customers was low, the way in which the service was commissioned and supported was commended

·         Learning Disability Social Work teams had been transferred back to the Council in April 2019 to improve practice and control, however, partnership working with health colleagues continued to be key.  Mental Health Social Work teams would also transfer back to the Council in 2020.  These moves were in line with regional best practice

·         In response to a question about the relationship between the reported plans as a result of the Peer Review and the overarching Adult Services Business Plan 2018-2022 (discussed by the Panel in January 2019), the Director reminded the Panel that adult social care was now just one part of the newly formed People Directorate, which also included Public Health, Communities and the Council’s working relationship with Worcestershire Children First.  It was therefore timely to refresh strategies for all elements of the new People Directorate

·         When asked for timescales for such a refresh, it was suggested it would be some time as stakeholder engagement was vital, alongside the need to collaborate with health economy partners

·         The Director was asked to share the Business Plans with the Panel when available

·         A Member asked for an explanation as to why the Peer Review had reported an absence of clear vision.  In response, the Director highlighted that the Report had also stated that all the right elements were present for future success and reminded the Panel that to demonstrate a vision, leadership was key.  The Assistant Director added that adult social care leadership had been fluid for a number of years, there had been 7 Directors in the last 8 years, each with a different view of how things should work

·         The Report also stated that a lack of direction was starting to impact on practice, which was a major risk for the care and health system.  The Director qualified this by reminding the Panel of the Key Lines of Enquiry and that partnership working was key for future success.  Members noted that Continuing Healthcare, for example, was not where it needed to be

·         When asked how the Council encouraged positive partnership working across health and social care, the Director reminded the Panel that there was a national aspiration, through the NHS Long Term Plan, for Integrated Care Systems (ICS) by April 2021.  An ICS would bring together local organisations, creating shared leadership to redesign care and improve population health

·         In response to a question about the level of benefits of joint working with health partners during the COVID-19 response phase, the Director believed that there was some very positive work and some learning to take forward.  The freedoms and flexibilities given by the Government had been welcomed, alongside the way in which funding had been allowed to be used differently

·         Looking to the future, the Director was keen to understand why Worcestershire had higher numbers of residents in Residential Care and Nursing Homes, in comparison to the national average, and develop mechanisms through the voluntary and community sector to reduce this demand

·         In addition, the financial impact was not sustainable and measures would need to be taken to reduce the reliance on Tier 3 Services and enhanced support to ensure equity of service delivery.  Promoting independence was vital and learning from best practice, such as Herefordshire, had been instigated

·         The Director agreed to check whether the Peopletoo Report could be shared with the Panel

·         The development of the Council’s Here 2 Help scheme, set up as a response to COVID-19, was to be investigated for longer term community support

·         The Director expressed concern about the resilience of the Care Market and bed occupancy as the Worcestershire model was not currently fit for purpose.  Although there had been active engagement with providers who had worked remarkably well and flexibly during COVID-19, discussions around future provision were required

·         In response to a query about how success could be measured, it was reported that outline business plans were to be discussed as part of the Council’s budget setting process beginning the following day

·         A Member was encouraged to hear about the desire to co-produce future delivery programmes, with the Director adding that the philosophy should very much be ‘designing with’ rather than ‘doing to’

·         The Cabinet Member with Responsibility (CMR) for Adult Social Care commented on the Peer Review that he felt on reflection, the process was odd and he had only had the opportunity to contribute to the Review as part of a group discussion.  The feedback in respect of the quality of the casework was disappointing but resolvable.

 

The Director Representative from Healthwatch Worcestershire was invited to comment on the discussion and agreed with the points raised.  It was vital to address the needs of the individual whilst at the same time support the family or carer, however, the statutory duty of the Care Act was fortunately very clear.

 

In summary, it was agreed that the:

 

·         Director would check whether the Peopletoo Report could be circulated to the Panel

·         new People Directorate Plans would be shared with the Panel as and when appropriate.

Supporting documents: