Apologies for absence were received from Councillor CA Gandy.

To receive details any details of members nominated to attend the meeting in place of a member of the committee.

Councillor DW Greenow acted as a substitute for Councillor CA Gandy.

To approve and sign the minutes of the meeting held on 2 October 2018.

RESOLVED:

That the minutes of the meeting held on 2 October 2018 be confirmed as a correct record and signed by the chairperson.

To receive declarations of interests in respect of Schedule 1, Schedule 2 or Other Interests from members of the committee in respect of items on the agenda.

There were no declarations of interest.

To receive any written questions from members of the public.

For guidance on how to submit a question to the committee, please see: https://www.herefordshire.gov.uk/getinvolved

The deadline for receipt of questions is 5pm on Wednesday 21 November 2018.

Please submit questions to: councillorservices@herefordshire.gov.uk

Accepted questions will be published as a supplement prior the meeting.

There were no questions from members of the public.

To receive any written questions from members of the council.

Deadline for receipt of questions is 5pm on Wednesday 21 November 2018.

Accepted questions will be published as a supplement prior the meeting.

Please submit questions to: councillorservices@herefordshire.gov.uk

There were no questions from councillors.

To seek the views of the adults and wellbeing scrutiny committee on the budget proposals for 2019/20 as they relate to the remit of the committee.

The draft budget for adults and communities was introduced by the Director Adults and Communities (DAC) and the Chief Finance Officer (CFO)

The DAC outlined the priority of the Adults and Communities directorate to establish a strengths based modelling approach to the provision of care services. The approach made an assessment of the need of clients of care services and sought to involve the local community and community-based organisations in the provision of care and support. The policy involved a reduction in cost but customer satisfaction with services had increased. It was explained that a number of existing care clients had been assessed under the old model of provision of care but were still in the system. A weakness in the previous framework and resulting assessments of care had caused a lack of autonomy for care clients and in some cases an over prescription of care packages. Targeted reviews were being undertaken to increase the level of independence to clients to ensure care packages were suitable to meet the level of need. The DAC provided details of the Community Development project to establish the support that existed in local communities and local initiatives which could be undertaken to enhance support.

During the debate the committee raised the comments outlined below:

·         It was queried what clients of care were required to provide for themselves before determining what would be included in a care plan. The DAC explained that the role of families was included in strength-based modelling and an assessment of community support. A holistic offer was made to the client including all suitable support within the local community; the role of the community broker was highlighted as an important feature of access to community support. It was explained that other local authorities were looking at the approach of the Council as a potential example for their provision of care services in the future.

·         The reviews of care packages were queried and the frequency of such reviews. The requirement for delicacy during reviews was highlighted in the communication of any reduction in the provision of care. The DAC confirmed that 80% of care plans were currently reviewed annually. The need for sensitivity during changes to care packages was acknowledged but it was important that over prescription in packages was addressed to avoid clients becoming dependent on a level of care that was not required. Under the strengths based model a reduction in the care package was mitigated by community support available.

·         In the event that a care package review resulted in an assessment of a requirement for an increase in the provision of care, the committee queried how reactive the service was to respond to this increase in need. The DAC acknowledged that an improvement to the speed of response was required which the Home First service sought to achieve.

·         The committee queried the number of self-funders for care and whether there was an increasing number that the Council would have to support financially as their level of assets decreased to  ...  view the full minutes text for item 30.

To review the performance of the Home First service one year on from its commencement and to discuss progress.

The committee received a report concerning the Home First service, as attached to the agenda. Amy Pitt, Head of Partnerships and Integration (HoPI) introduced the report and provided the presentation in appendix. Justine Bennett, Operational Service Manager (OSM) and David Farnsworth, Wye Valley Trust (WVT) were also in attendance to provide detail on the work of the home first service. The HoPI explained that the service was part of integrated working in Herefordshire to reduce admissions to hospital, address delayed transfer of care through reablement and contribute to the strengths based model. 

The committee made those points below in the discussion that followed:

·         The challenge in providing two carers to clients who required support was queried. The recruitment of staff who did not drive was questioned. The OSM provided an update on recruitment to the service with staff now numbering 31. It was confirmed that it could be struggle to allocate 2 carers to attend to clients particularly if they did not drive. People who were suitable to join the service were employed even if unable to drive.

·         The committee questioned those clients who did not need the level of service provided by Home First but were unable to access services of need from alternative providers. The OSM explained that some clients did not want to leave the service and some private providers were unwilling to take on clients with complex needs.  

·         The link to nursing services was also raised. Mr Farnsworth, WVT, explained that there was a clinical interaction with the service with nurses and therapists. It was outlined that some clients would require the support of a district nurse.

·         It was queried whether recruitment was a problem for the service. The OSM confirmed that there was no problem in the recruitment of carers to the service.

·         The committee queried whether the service would utilise the electronic appointments facility used by WVT. Mr Farnsworth explained that the WVT were in discussions with a company to develop a new facility for appointments. The OSM confirmed that currently the Home First service used a paper based appointments facility but there was potential to link to the new system being developed in future.

·         The committee considered the performance of the service against the 91 day checks required. The use of written letters was suggested to increase the level of response by elderly clients. It was queried whether attempts were made to contact next of kin in the event of an absence of response by the client. The OSM explained that under the performance measures clients must respond within three attempts at contact by the service. It was confirmed that next of kin were approached if their contact details were held. There was contingency planning in place for clients who did not respond to attempts at contact.

·         The committee queried how the service took account of winter pressures and prioritised discharges during visits to clients. The OSM confirmed that a planning group regularly looked at cases entering and leaving hospital and  ...  view the full minutes text for item 31.

To consider the committee’s work programme for 2018/19.

The committee received and noted its work programme for 2018/19. It was explained that as part of the work shop proposed for the forthcoming workshop on 10 December concerning ‘Health and care system leadership, integration and Better Care Fund’ detail was sought on the following:

·         What the Health and Wellbeing Board does as the system leader;

·         An update on the STP and Integrated Care Organisation;

·         A general update on the Better Care Fund; and

·         A briefing note in advance of the workshop.

The statutory scrutiny officer outlined planning that was in progress to enable the scrutiny committees to consider any alternative budget that was received from political groups at the Council. All three committees would consider an alternative budget and submit recommendations to the general scrutiny committee.