Agenda item

In attendance for this item were Cllr Adrian Hardman, Cabinet Member with Responsibility (CMR) for Adult Social Care, Avril Wilson, Interim Director of Adult Services and Mark Astbury, Interim Head of Finance.

The Chairman explained that performance and in-year finance monitoring was now scheduled for all the scrutiny panels on a quarterly basis. The format of information was still being worked on and it was hoped this would be improved for the future. The Chairman asked the Panel to highlight any further performance information (PI) required.

Performance Monitoring

The Director of Adult Services provided context for the performance information, including the Panel’s recent overview of the Adult Services Business Plan and the national Adult Services Outcome Framework (ASCOF) which enabled a focus on national performance indicators and comparison with other local authorities.

During the Panel’s discussion, the following main points were made:

Admissions to Permanent Care per 100,000 (18-64) - ASCOF 2a(1)

·         The Director highlighted this as an area of concern, since Worcestershire was a heavy user of beds, higher than the comparator figure. Work was in hand to understand the reasons for this, which would then be reported back through an action plan. Once an individual had been placed in residential care it was difficult to move them, although this could still be an option where it was safe to do so.

·         When asked about any other related national PIs, the Director agreed to forward details of action plans from the Association of Directors of Adult Social Services (ADASS). The Panel was reminded that its work programme now included an annual update on the full set of (ASCOF) outcome measures and the Director suggested these be circulated again in case Panel members wished to incorporate any other PIs into the quarterly monitoring sessions.

·         A member suggested that progress for both under 65s and over 65s did not look much different and the Director said that she felt the Council was doing better than previously although this was against quite a low base. The data indicated the need to be wary of Worcestershire’s demograph which may bring further challenges as more people got older.

Admissions to Permanent Care per 1000,000 (65+) – ASCOF 2a(2)

·         The Director pointed out that while ASCOF 2a(2) figures were above the national comparator level, this was starting to level off with fewer high-end packages of care and it was felt that the 3C model was starting to take effect.

·         Figures were high due to pressures to move people through the hospital system and the Director highlighted the importance of people’s choices being respected and not being inappropriately placed in residential care - she referred to some disturbing recent research by Newton on the numbers of people being wrongly placed due to delayed transfers of care (DTOC) pressures, which she would circulate.

·         A member pointed out that the graph lines for the comparator and England average figures were quite close and asked why this performance level was so much better than for Worcestershire? The Director explained that possible reasons may include better performing health systems, less pressures from ageing populations, or more fully developed alternative provisions – Chartered Institute of Public Finance (CIPFA) data on nearest neighbour comparator data could be circulated.

% of people with no ongoing social care needs following reablement after hospital discharge – ASCOF 2d

·         The Director advised that performance was improving and nearing the England average, which was very pleasing.

% age 65+ at home following rehab – ASCOF 2b

·         Performance towards this target was doing less well and the Directorate was doing some work with the NHS on redesign of reablement capacity and provision, which it was hoped would provide insight – the Panel asked about timescales for this work, which the Director would verify

·         The Director undertook to check why figures appeared to have declined since March 2016

Delayed Transfers of Care

·         The Director highlighted that this was the measure around which there was so much concern and although it was not necessarily a great measure of the overall system, the Council was performing quite well. Joint figures with the NHS were also doing quite well although the system was very challenged, and people were being delayed. A plan was being worked on although Worcestershire Acute Hospitals Trust remained in special measures, which created strain.

·         The Director undertook to circulate figures for the national average

·         The Director clarified that figures were cumulative through the year and reported on the last Thursday of the month. A very small number may be ‘super stranded patients’; those who had been in hospital over 21 days

·         The Director pointed out that analysis of DTOC was hugely complex even for professionals.

·         In response to a question, the Director clarified that the way in which joint category figures were judged depended on how they were funded and the different pathway, for example if they were funded by the Better Care Fund. Targets for DTOC had to report in early September

Annual Care Package Reviews Completed

·         A lot of effort had been put into this area, especially since many care recipients would have come into contact with services before introduction of the 3C approach.

General points

A member asked about a Bill being debated in Parliament on the Mental Capacity Act, and the Director advised that this had originally been thought to be a quick fix, however it was now likely to cost the Council £750k approximately per year, therefore the Cabinet Member for Adult Social Care had written to Parliament about this additional financial burden and the Director believed many other representatives were doing so.

In response to a question about whether staff vacancies or use of agency staff impacted on the quality of Adult Services, the Director advised that all temporary staff were given an induction appropriate to their level of experience, regular supervision and subject to audit. Team Managers also had responsibility to support staff and monitor quality. Recruitment of social workers for Adult Services was different to Children’s Services, use of agency staff was dropping and she was confident in the recruitment and monitoring of staff.

A member asked what were the Directorate’s signals of success, and the Director referred to good feedback from the public and carers, delivering services with the finances available, learning from exit interviews, recruitment and retention rates, case audits and staff feedback.

A member referred to the Healthwatch report ‘People’s Experiences of Adult Social Work Services’ (included in the agenda background papers to item 5) which suggested some lack of understanding around the role of social workers and the Director and CMR agreed that some work on this would help the public as well as promoting social work as an employment opportunity.

In relation to performance monitoring, the following information was requested:

·         ASCOF performance indicators – re-circulate and members to advise if additional indicators to be added to the quarterly monitoring

·         Admissions to Permanent Care (ASCOF 2a)

Ø  ADASS action plans

Ø  (CIPFA) data on nearest neighbour comparator data

·         % age 65+ at home following rehab – ASCOF 2b

Ø  timescales for work on reablement

Ø  explanation for decline in performance since March 2016

·         DTOC

Ø  figures for national average performance

Ø  Newton research article

·         details on the length of staff induction for social workers

·         As a general point, the Panel was keen that in future, finance figures for Learning Disabilities were differentiated from those for Older People Services

In-year finance monitoring

The Interim Head of Finance referred to the Agenda information (Resources Report - Revenue and Capital Budget Monitoring to Period 10), which had been submitted to Cabinet that morning. In summary the Council was coming to the end of a difficult financial year with a forecast overspend of £2.9m after management action.

Paragraphs 27-29 of the Report provided context to the forecast overspend of £13m, which remained unchanged over 4 months, demonstrating it was more under control. In total the Service would deliver savings of over £7m during the financial year including almost £1m of new savings which had been achieved in under 6 months. Details of directorate budget variances over £250k were included at Appendix 2 of the Report.

Questions were invited and the following main points were made:

·         It was agreed that this year’s milder winter would have reduced pressure on services

·         When asked about any impact from vacancies in support services, the Officers advised that there may have been an indirect impact from vacancies of overall Council support services.

·         A member suggested that the Directorate was now in a more confident position financially, having removed previous unrealistic savings targets and reached the end of the year with as little overspend as possible. The CMR agreed, although he was not complacent and for the coming year was keen to know the position on one-off grants, the social care precept and the awaited Green Paper on Social Care.

·         A member asked about mitigation plans should the projected savings from the 3C social work model fall short and was advised that plans to review areas of highest risk were being developed. The CMR felt that targets were realistic, but the problem was that some care packages were very expensive.