Agenda item

Attendees:

-       Councillor Paul Cockeram – Cabinet Member for Social Services

-       James Harris – Strategic Director – People

-       Chris Humphreys – Head of Adults and Community Services

The Cabinet Member for Social Services introduced the report and gave the Committee an overview of the key achievements within the Service Area. During the introduction, the Cabinet Member outlined the positive work that had been undertaken during very difficult financial times. The Cabinet Member drew the Committee’s attention to the Performance Indicator (PI) related to the Delayed Transfers of Care. It was explained that even though the PI was categorised as RED, the shift into RED had been later in the year. The six days was still a great achievement, when put in the context of what it was it has been over the past 5 years, the journey to achieving what it was this year was down to the way the service was managed and supported. The people that had caused the Delayed Transfer of Care figure to rise were not those in the acute hospital and wards, but those in the community hospitals with long term and debilitating issues. It was these people that require a lot more intervention and support to leave hospital, longer assessments to ensure that their best interested were catered for when devising their package of care.

The Head of Service provided detailed information on the challenges with targets within social services changing and evolving during the year, this had made a number of actions and PIs invalid. The definition of which people counted towards reablement figures was changed mid?year causing issues with end of year reporting.

The Strategic Director – People complimented the Cabinet Member and Officers for their management of the Adult and Community Services budget. A budget of over 40 million kept within one percent was a great achievement, especially if taken against the background of increasing demand and constant changes. The Cabinet Member explained that the Regional Partnership Board had been a massive help in allowing the Council to manage so well.

The Committee asked the following questions;

·                Had ‘Action 1.03 – Establish a joint health and social care IAA provider forum to share information and good practice’ started? The Officer informed the Committee that work towards completing this action had began.

·                The actions that are listed from pages 18 to 23 in the agenda pack were predominantly ‘In Progress’, with the exception of one, some of these Actions were for the five year life of the Corporate Plan. The Committee would like more information on how much progress has been completed for each of the Actions. The Head of Adults and Community Services explained that this was something that had been discussed with the Performance Team who produce the Service Plans. The Actions might change in the future to those that were a one off and not business as usual actions that would continue indefinitely.

The Member requested information on a number of programmes, projects and initiatives named in the report, but not explained. The Head of Service explained the four to be;

-           ‘Homes First’ – had been running since October 2018 and was funded from the WG Transformation fund. Newport ran the programme on behalf of the partners in Gwent. The aim of the service was to support those people that arrived in hospital but did not need to be admitted. The service worked 7 days a week and allows those that have been admitted to return home earlier. This was done through starting the adaptation and discussions around leaving hospital as soon as the person was admitted.

-           ‘My Mates’ – provided support to people with learning difficulties to attend social events to limit the social isolation they face. This service was funded through the Integrated Care Fund (ICF).

-           DEWIS was a website sponsored by the WG. The aim of DEWIS was to collate all of the possible support services into one place so anyone with a question or need can be directed to the most suitable place with ease. One of the Members raised concerns around the number of older people that do not have access or the ability to use the internet. Officers and Cabinet Member accepted this, the Cabinet member continued to say that there were sometimes problems with DEWIS around it not being entirely up to date, due to the onus being on the individual organisations to update their own information on the site.

-           Ask Sara was an online self-assessment tool for people to complete if they were struggling with remaining independent at home. An example was given if someone was struggling to climb the stairs, they could use the tool to see what options were available to them at that point and if they required it they could purchase it for themselves. The Head of Service explained that the non for profit organisation that ran the site was very carefully managed by professionals, and any advice given was of the best quality.

·                The Cabinet Member informed the Committee that there was a fund of £1.4 million for home adaptation for people living in Newport. This fund was limited and the Council was realistic about its uses and what it could achieve for those in need in Newport.

·                The Committee stated that it was encouraging to hear the successes of the service area, one area of concern to the Committee was the reduction of packages of care provided, and spoke about how a reduced package of care would limit the opportunities to prevent future hospital admissions. The Cabinet Member and Officers explained that there was an annual review of a package of care and if the individual felt that their circumstances had changed and they required more support, they could request a reassessment. The reablement team had moved to an intake model which meant that individuals were provided with the support at the earliest possible time, while allowing the Council to manage the money and resources available in a more effective efficient manner.

·                The Committee enquired as to what changes have taken place in Frailty Care and would the service look to expand to include people with Dementia, as the number of people requiring this type of care would be expanding considerably in the future. The Cabinet Member explained that a care package was put in place for six weeks, and then it was reviewed top assess its suitability.

·                The Committee questioned whether Adults and Community Services had had difficulty recruiting staff and the reasons behind this. The Officers explained that recruiting staff was an issue for health and social care services everywhere, not just Newport. The Members were reassured by Officers that this was not an issue with carers not being paid enough, as the terms and conditions in Newport were much better than other areas. Some of the problems with recruiting include the individuals needed to be mobile across sometimes large areas, but the Council was looking at walking routes and other forms of transport. Another difficulty was the competition faced by other sectors, such as employment in retail.

·                A Member enquired as to the staffing levels and the full time staff equivalent of vacancies. The Officer informed the Committee that there were around 90 hours vacant. These positions had gone out three or four times this year. This did not mean there would be a reduced service for people in need of care, but the Council was recruiting to run a larger service. The Cabinet Member explained that cuts were needed due to cost pressures and there would likely be further cuts over the next few years, but the Council was in a better position than counterparts in more rural Wales. The Officers last point explained that they would not hold onto a vacancy to make savings.

·                The Members of the Committee questioned the relationship with the Health Board, and the challenges in the partnership and the allocation of resources. The Cabinet Member responded by informing the Committee that in the past the blame culture of the Health Board blamed the Council for the number of people ‘blocking beds’, the Health Board reported to Welsh Government that around 80 people were still in hospital due to the Council not supporting them to leave, but when the Cabinet Member and the Head of Service looked at these figures it was more like 14 or 15 resulting from the Councils actions. Since the introduction of the Integrated Care Fund the working relationship has brought all the partners closer together. The relationship was quite good, but there had been some issues. The Welsh Government had provided over a million pounds to alleviate the service pressures caused during winter, which was for all partners to jointly allocate. The Health Board spent this money without any discussion with the Council or other partners. When we raised this as an issue with the WG the Minister in Welsh Government explained that this would not happen again, and they would discuss this with the health board. The Cabinet Member felt there were other issues around how the Council received a funding increase of 0.3%, whereas the Health Board received an increase of 0.7%. The Health Board were able to overspend, whereas the Council must meet their budget. The Cabinet Member stated that he believed that all partners should be treated equally, but felt that this was not the case.

·                The Members wished to know about the partnerships with other Local Authorities and if this had an impact on savings. The Cabinet Member explained that a lot of the work was going well and the Cabinet Members from each authority have a positive working relationship. The Strategic Director described the strategic partnership between the five authorities in Gwent. The strategic partnership boards include; Adults, Children, Housing and, Care and Disabilities. There was a meeting that engages all the Directors, Key Officers and representatives from the third sector, the main observation of the partnership was they were about working together in a myriad of different ways. Conversations would start on individual points and localised issues but soon developed in larger, more strategic issues and how to address things collectively.  That way of collective working was embedded into the Regional Partnership Boards practices.

-           The Cabinet Member added how far the partnerships had come along. ICF being an example of how it had developed, and the greater support the Council was receiving from the Health Board.

·                The Members spoke of the financial information outlined in the report and how it looked like Adults and Community Services were underspending in the majority of its service areas to cover the cost of Managed Care, which was over spent by 1.2 million pounds. The Officers informed the Committee that what the financial information did not show you in the report was the size of the Managed Care budget, which was by far the largest, if it did you would have seen that the underspend in proportion was not that great. The Officer said that it would not ‘squeeze’ budgets to cover overspends, it was just how the bigger picture played out.

·                The Officers explained that the Welsh Government had changed its policy on collecting data and this included the carer support measure. Welsh Government found that the resources required to send out questionnaires to all carers was too great for the return they received and were looking for alternative options to collect qualitative and quantitative data from carers. The Members raised concerns that these people would not be forgotten. The Cabinet Member reassured the Committee that locally the Council were monitoring the service Carers received. This included monitoring the complaints and compliments received, and unannounced visits to all of Newport’s care services. The Officers also spoke about how no information bypassed the Council, even if it was collected for a national measure. Welsh Government share all information with the Council for service improvement.

·                The Committee queried the MTRP table and the information it contained. The Committee wished to know if the overspend indicated for each month was carried over or was the service area overspending by the same amount each month. The Officer explained that the overspend was carried over month by month. The amount of 80 thousand pounds was an unrealised saving from 2018/19, which would be made in the 2019/20 financial year instead.

·                The Committee were informed that the Transformation Grant money that was funding the projects supporting the Delayed Transfer of Care (DTOC) measure would come to an end in mid-2020/21. These projects include the Home First, In Reach, Reablement and Step up Step Down. If these projects were to continue in Gwent then the partner Local Authorities would need to find the money to fund them, the sense of partnership and our relationship with the Health Board were real positives here. The Cabinet Member stated that the problem of sustainability was difficult to solve. Once the projects were set up, functioning and saving money, the funding was removed. The Cabinet Member believe that if the projects were successful enough then the health board would step up and provide the necessary funding. The Strategic Director explained that if the DTOC measure remained at an average of six, over the next year, then it would have been a great achievement. This was due to the increasing demand for resources, which were being limited and cut year on year.

·                The Committee enquired as to what impact the changes in hospital infrastructure would have on services? The Officers explained that these concerns had been fed into discussions with partners and WG. There would be an all members seminar in July that would cover, in more detail, the infrastructure changes in Gwent and the impact these would have on service delivery for the Council. The Officers informed the Members that they had modelled the changes and the impact was fewer beds and a higher turnover of people. People with acute needs would be admitted into the Grange hospital and would be moved to a different hospital for the rest of their treatment. The challenges which had been identified included the system’s ability to cope with the increase pace of turnover, different lengths of stay and the increasing demand on community based services, when people were moved home earlier. The Committee raised concerns that by moving people home at an earlier stage in their recovery then new issues would be created for others. The Cabinet Member agreed with the Committee sentiments and stated that if people wanted a high level of care then they would ultimately have to pay for it.

·                The Cabinet Member informed the Committee that if they wished further information on any of the items discussed today, they were more than welcome to ask for a scrutiny briefing or they could arrange an all member seminar.

Conclusions

The Committee made the following comments and recommendations to the Adult and Community Services;

·                The Committee recognised the difficult times facing Adult and Community Services and the pressures the service area was under. The Members wished to thank all of the staff and Cabinet Member for their hard work and dedication to providing the best services possible for the citizens of Newport.

·                The Committee requested that they were informed of the WG new measures when they were released.

The Committee wished to make the following comments and recommendations to Cabinet on the overall service plan report;

·                The number of actions labelled as ‘In Progress’ did not provide enough detail for the Committee to scrutinise. The Committee would have liked the amount of progress to have been quantified as a percentage to highlight how close the service area was from completing the action.

·                The Committee found that some actions were actually just ‘business as usual’ measures, which could of, in effect have no end and would continue indefinitely was of concern. If the action was ‘business as usual’ and had no end date then it would inhibit the Committees ability to scrutinise the performance effectively. The Committee recommended that the action in the report are reviewed by the Cabinet Members and ensure that all actions were SMART, allowing for effective and efficient scrutiny.

·                The Members raised concerns that through the service plans they received only a small snap shot of the service area, this was problematic for the Committee due to the complexity and depth of Adults and Community Services.

·                The Committee questioned the amount of information contained in the financial analysis section of the Service Plan. The Committee recommended that further comparative information be provided in the future. This included a budgetary figure for the Service Area Teams to gauge the deficit or underspend, and a clearer graph for the 2018/2019 Delivery of MTRP Saving table with additional information on differences.