Agenda item

The following were in attendance:

Paula Furnival, Strategic Director for People

Kerry McCrossan, Service Manager

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

The Strategic Director for People referred to the presentation slides in the Agenda and explained that sixth months into her role, the rationale for the new Strategy was to provide a strategic approach and clear objectives for the newly established Directorate and how it worked with others. A triangle was used to show how the Directorate and its partners would co-produce ways of working with citizens to enable them to ‘be well and stay safe’, ‘be independent and connected’ and to ‘be supported’.

In terms of driving best practice and managing demand and costs, various pieces of work had been undertaken, for example the Peopletoo analysis and the recent peer review; the triangle indicated the three tiers of services and the pattern of access in Worcestershire, against best practice and gross budget expenditure of £239m.

For universal and self-service (Tier 1), in Worcestershire 69% of contacts were resolved at this point against the best practice figure of 70%, however for targeted interventions (Tier 2) only 4.9% of contacts were being resolved, against the best practice figure of 20% and 26% cases were progressed to Tier 3, which was more than the 10% that national best practice suggested. The discrepancy between a good operating model and what the Council was achieving was the fact that people’s needs were not being anticipated earlier on.

The aims of the Strategy were to achieve a clear aim which was outcomes focused, co-produced and met needs by maximising the use of resources and the workforce. The aim was to give a clear offer to enable people, easy to access, and to reduce duplication in buildings, systems and processes.

Key drivers for the Strategy had been drawn from the earlier work referred to. The three strategic pillars of change, underpinned by a range of different projects, were a person-centred approach, shaping services and shaping an effective market. Work to look at how customers accessed council services and information included potential use of libraries as a first point of call.

In terms of how the Strategy would be delivered, a series of workstreams had been created through the ‘case for change’ process. Work streams sought to involve a broader range of partners, for example plans to build on progress achieved with the voluntary and community sector (VCS) tackling homelessness during COVID-19, through a longer-term, more sustainable partnership. Workstreams had been approved through the Senior Leadership Team and Cabinet and each would be led by a senior manager. A very important factor was the belief that you do not always need more money to do things better, and often more collaborative working and co-produced plans were the solution. One example was care home admissions from hospital, which had dramatically decreased during COVID-19 – it was explained that while the Directorate had developed relationships with health colleagues over a number of years, COVID had increased joint working and understanding with the result that patients were not making decisions about their long-term future from an acute hospital bed, which was not good practice and this could potentially save the Council just under £10m a year.

In terms of what this meant for services, a ‘One Worcestershire’ approach would be the way forward, which would mean services becoming more joined up or co-located, and consultation was taking place with staff about this to ensure they understood the approach and had the opportunity for questions.

The work outlined was hugely important and motivational for the Director and her team in managing how the Directorate budget was used and was essentially about getting to people sooner and encouraging them to look after one another within the community.

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

·         Panel members welcomed the positive approach set out by the Strategy.

·         Commenting that the Strategy was very focused, the Chairman hoped it would reduce numbers of people going into care, which she was aware had been an ongoing challenge.  The fact that costs would not necessarily go up was also commended.

·         A Panel member was confused as to why someone would decide to go into a care home rather than stay in their own home and the Director suggested that this could have been attributed to decisions being taken when people were at their lowest ebb rather than after a period of recovery. Recent closer working with health colleagues had shifted the balance between a focus on medical needs and being risk-averse, to the wants of the individual. COVID-19 was another factor and it would remain to be seen whether sufficient work had been done to change cultures and to invest in resources needed to support people in the community, of which colleagues from the Clinical Commissioning Group had been very supportive.

·         A Panel member asked about instances where an individual’s envisaged outcomes were not as realistic as those provided or if they were unable to decide for themselves due to dementia? The Director explained that social workers were very skilled in working with individuals and their families, and advocacy was also available.

·         The Chairman asked about the challenge of partnership working and the Director acknowledged that when she started in post she had perceived a lack of clarity around the role and value of Council services within the Herefordshire and Worcestershire Sustainable Transformation Partnership, which she hoped she had helped to clarify. Conversations to further integrated working with partners were going extremely well and in 4-5 months’ time there would be the opportunity to apply to be an integrated care system, if the Council chose to do so.

·         The Chairman invited comment from the CMR, who agreed that the shift in partnership working brought by COVID-19 and resultant decrease in people moving to residential care was interesting, since it had been worked on for a number of years; work through COVID, a new Director and approach had achieved a lot.

·         Comment was invited from the Healthwatch representative present (John Taylor, Director), who agreed the Strategy was very positive, and asked about plans for co-production and availability of advocacy. The Director agreed the importance of co-production, which would take place with those who importantly could take time to engage, for example the VCS, as well as through people practicing together and sharing skills. The Council had contracts to provide advocacy but it was also important to listen to an individual’s family and friends.

·         A Panel member endorsed the approach of enabling people to make informed decisions about their future care at an appropriate time and referred to a resident who had been at the point of going into residential care and was now managing very well at home.

·         Another Panel member highlighted the need for communication, and referred to her 91 year old neighbour who had been sent home from hospital with no support, despite needing both physical and mental aid, and whilst being able to pay for support, it was unclear as how to access the requried support. The Service Manager present acknowledged that advice and information were needed much earlier so that people were not faced with sourcing such information at this difficult stage. The Contact Centre and Locality Teams could provide information and it was envisaged that the launch of the reablement service would also help in such instances.

·         In response to a query about who checked that hard to reach people were getting warm food each day, the Director explained that this was not the remit of the Council, unless food and nutrition was part of an individual’s support package, however the Here2help scheme was a mechanism for people who were concerned. For children, the Council had just been awarded £1.6m to provide support during the school holidays.

·         The Director confirmed that mental health as well as physical health needs would be considered as part of a patient’s discharge from hospital.

The Chairman thanked the Director and requested updates on the various workstreams of the Strategy, which the Director would be happy to provide. Dementia Centres were also suggested for future discussion.