Agenda item

In attendance for this item were the Director and Assistant Director of Adult Services, as well as the Cabinet Member with Responsibility (CMR) for Adult Social Care.

The Chairman asked the Director to provide an overview of the direction of travel for the Council’s Care and Support Services, which had been endorsed that morning by Cabinet. The Panel then had the opportunity for questions, in order to determine whether any further scrutiny was required at this time.

Referring to the Cabinet report, the Assistant Director highlighted the background to the new direction for the Council’s Care and Support Services. These included changes to Adult Services since 2014, the review over the past year of all services directly provided by Adult Services, the development of the new Strategy for services directly provided by the Council for Care Act eligible adults, additional investment in Howbury House and the creation of a Community Re-ablement Service.

As part of the Council’s commitment to taking a strategic commissioning approach, all services directly provided by Adult Services had been reviewed over the past year and where appropriate officers had sought to identify alternative providers. However, following tendering and market engagement, it had not been possible to find alternative providers, except for Timberdine Nursing and Rehabilitation Unit which was transferred to Worcestershire Health and Care NHS Trust.  This was largely due to the implications of TUPE transfer.

In light of the commissioning challenges, the Directorate carried out a review and the report outlined the resulting Strategy which represented a shift from the Council being at arms-length, to the new more engaged role of seeing itself as one of a range of providers in the market. Importantly, where the Council provided services, these should be exemplary and always be rated at least ‘good’ by the Care Quality Commission.

The new Strategy was also about the Council being innovative and sharing learning with the independent sector; quality of life was key.

The report to Cabinet also related to Howbury House, a residential care home in Malvern for older people with dementia which had been invested in to use innovative technology to enhance care at reduced cost. The plan was for Howbury to showcase its achievements to the wider market.

Regarding plans for re-ablement, Cabinet had been asked to approve the business case of extending the current service run by the Council into the community, an area which the market was not currently able to deliver. The Council’s current re-ablement service performed well with very skilled staff and it was recognised that provision of intensive support over a 6 week period was an opportunity to turn someone’s situation around, as well as achieve savings based on people not requiring ongoing care packages.

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

·         Panel members queried whether there was flexibility with the 6 week timetable for re-ablement when required, and the Director advised that the 6 week timescale was based on national good practice and evidence, however the Director also clarified that if someone needed longer, the door was not closed.

·         A member expressed concern that people could feel a sense of abandonment once care was withdrawn, however the CMR pointed out that this was likely to result from the individual experiencing social isolation after being used to someone being present. The Panel was advised that the re-ablement service performed above national indicators, and on average 2 and a half to 3 weeks of re-ablement were required, however members were urged to pass on details of any individual cases where there were concerns.

·         A member asked how residents were adapting to the new technology at Howbury House and was advised that equipment was tailored to the individual and enabled them to stay there, which was their home. The technology could pick up movement or unexpected behaviour, for example someone getting out of bed at 3am, which meant residents could be monitored without the need to knock on doors and wake people up; this also meant fewer staff were needed. Some technology was still in development, for example to incorporate electronic records which were otherwise time consuming to maintain.

·         A member asked about the role of the Occupational Therapist in re-ablement and was advised that a big part of their role was carrying out assessments to make recommendations for adaptions and equipment, which would enable an individual to do what they were previously able to do. When asked whether this worked in the same way as the 3 Conversation model, the Director confirmed that it was a part of it.

·         The Director welcomed the suggestion that councillors could inform social work teams about local community groups in their areas and explained the most practical way would be to use the relevant form, which she would forward.

·         The Director spoke about the importance of integrating services, including a forthcoming workshop to bring key players together including housing, as well as Telecare and Age UK; this was an exciting opportunity and she agreed to report back to the Panel.

·         A member asked about weaknesses in Worcestershire’s private sector care home market and was advised that the make-up was predominantly individual homes rather than large care home groups; whilst this avoided the pitfalls of multiple closures, there was some concern about future sustainability since individual family-owned businesses could be difficult to sell on as a profitable business. A strategic piece of work would be needed to look at raising the profile of the care industry to make it a viable part of the economy. It was agreed that what the market needed was something in between large and small scale, and the Director advised that this gave care homes more flexibility with staffing, although she was in no way criticising family businesses as many were doing a great job.

·         The CMR pointed out the irony that in many ways the ultimate goal for Adult Services was for everyone to be able to remain living at home, however it was accepted that there would always be a need for alternative provision. In response to a member’s comment that extra care facilities could provide a lively and community-based setting for some people, the Director clarified that extra care facilities were regarded as someone’s home.

·         The CMR commented that getting re-ablement right would be really helpful in breaking down the cycle of repeat visits to acute hospital care.

·         It was agreed that Panel would wish to receive regular updates on the progress of the Re-ablement Service.

·         A member asked about Adult Services provided in prisons and to travelling communities. The Assistant Director advised that there were no specific services for the travelling community, however he provided details about the Council’s responsibilities for assessing and providing care and support needs of prisoners, which had been given to councils under the Care Act 2014. Care to prisoners presented challenges in terms of access and strict clearance processes, which was helped by using a standalone team, and was an example where the Council was best placed to deliver the service itself.

·         A member asked whether the Disabled Facilities Grant could be used for adaptations and was advised that it was not at present, although work was taking place with the district councils to enable the most flexible system possible. A review of occupational therapy was being done by Worcestershire Health and Care Trust and some districts used the grant to pay for OT assessments to overcome long delays.

·         Comments was invited from the Worcestershire Healthwatch Chairman present about the direction for the Council’s Care and Support Services, and he believed it was a good model which would be supported by users and carers; moving forward, co-production with these groups may be an area for scrutiny.

In summing up, the Chairman agreed it would be helpful for the Panel to keep abreast of the development of re-ablement services, and to verify with the CMR that co-production working formed part of taking forward the new approach.

The Director undertook to report back to the Panel on the forthcoming workshop with housing about integrated working and to liaise with the Scrutiny Officers regarding circulation of the form for councillors to inform social work area teams of local community groups.