To receive apologies for absence.

Apologies were received from Councillors Mrs J. A. Hyde, Mrs J. E. Pemberton and Mrs G. A. Powell

To receive details of any Member nominated to attend the meeting in place of a Member of the Committee

Councillor Brig P. Jones CBE substituted for Councillor Mrs J. A. Hyde.

To receive any declarations of interest by Members in respect of items on this Agenda.

There were no declarations of interests made.

To approve and sign the Minutes of the meeting held on 17th June, 2003.

RESOLVED: That subject to amending the minutes to record that Cllr Mrs M. D. Lloyd-Hayes was Chairman and Cllr. Mrs. P. Andrews was Vice-Chairman in place of those listed, the minutes of the meeting held on 17th June 2003, be approved as a correct record and signed by the Chairman.

To inform the Committee of the Social Services Inspectorate (SSI) report on Herefordshire Social Care performance 2002-03

The Committee were informed of the Social Services Inspectorate (SSI) Report on Herefordshire Social Services Care Performance 2002-03.

The Director of Social Care and Strategic Housing reported that the SSI reported annually on Social Care Performance and that this SSI report, attached to the agenda report at appendix 1, came following the publication of the Joint Review report presented to Cabinet on 10th July 2003.  The SSI report endorsed the sustained children’s service progress and reminded the Council of the performance challenge in older people’s services.

During the course of discussion the following principal points were noted:

• The increased use of the Herefordshire Direct Payments scheme was welcomed.

• That, while both staff and users or carers were involved with the signing off of assessments, this was ultimately the responsibility of the line manager.  This practice had been reviewed as part of a quality audit of procedures.

• The Committee noted that rural transport problems were outside the scope of the report.

RESOLVED: That the report be noted.

To bring to the Committee’s attention the Social Services Inspectorate’s (SSI) evaluation of Herefordshire’s “audit of services” to children in need in response to the practical recommendations of the Victoria Climbie Inquiry.

The Committee were informed of the Social Services Inspectorate’s (SSI) evaluation of Herefordshire’s “audit of services to children in need in response to the practical recommendations of the Victoria Climbie Inquiry”.

The Head of Social Care (Children) reported that the Government’s principal response to the Laming report was in the document “Keeping Children Safe”.  A Green Paper “Every Child Matters” had also been published and contained recommendations, which linked to “Keeping Children Safe”.  The implications of both documents for Herefordshire would need to be considered and reported to a future meeting.   Each Social Services Authority completed a framework entitled “Audit of Services to Children in Need in Response to the Practice Recommendations of the Victoria Climbie Inquiry”.  Herefordshire’s self-audit had been scrutinised by the SSI and a copy of a letter from the Director of SSI which accompanied the Performance evaluation was appended to the agenda report.   This indicated that the evaluation of current services was positive and stated that Herefordshire was serving most children well, and its capacity for improvement was promising.  The Head of Social Care (Children) reported that a future report for Committee would bring together an update on progress on the Climbie audit and any additions prompted by the Green Paper.

The Committee congratulated those concerned for achieving this positive grade.

RESOLVED:

That

(a)         The evaluation of the Council’s audit of Lord Laming’s Inquiry recommendations be noted;

and

(b)         The Director of Social Care and Strategic Housing update the Committee on the audit at a future meeting, including any additional requirements reflected in the Green Paper ‘Every Child Matters’.

To provide an update with regard to the development of an Extra Care Housing Scheme within Hereford.

The Committee received an update with regard to the development of an Extra Care Housing Scheme within Hereford.

The Head of Strategic Housing Services reported that a housing needs analysis had been undertaken to support the need for Extra Care Housing provision in the County. The main findings of the analysis together with details of the current position regarding capital and revenue costs were set out in the report.  He highlighted that concerning the Supporting People funding, an indicative level of £150,000 had been suggested by the Extra Care Housing Trust as the level required to support such a scheme.  However, it was not possible to “set aside” this level of funding.  A project brief for the selection of a preferred partner Registered Social Landlord (RSL) was being prepared. This included a submission of financial information to develop the Extra Care Housing provision.  He further reported that a bid would be submitted to both the Housing Corporation and the Department of Health to attract additional resources to the County.

He further reported that the potential site, identified at the former Local Authority nurseries, Ledbury Road, Hereford, had received Cabinet support on 25th September, 2003.  If required, work would be undertaken to assist in the relocation of Unity Gardens to an alternative site.  A detailed report outlining the costs of the scheme following the selection of the partnering RSL and other progress would be submitted to a future meeting.

The Committee noted that the Primary Care Trust (PCT) would be responsible for health care provision in the final scheme and in recognition of this would have a contribution to make to the scheme’s design.

RESOLVED: that the report be noted and further updates be presented to future meetings.

To inform the Committee of the background and implications of delayed transfers of care (delayed discharges) within Herefordshire.

The Committee were informed of the background to implications of delayed transfers of care (delayed discharges) within Herefordshire.

The Head of Social Care (Adults) reported that delayed hospital discharges were a complex issue with a range of causes and solutions which generally fell into three categories: individual, organisational and structural levels, and these were further defined in the report.  She reported that currently on a weekly basis, an average of between 16 and 20 people were delayed in Hereford Hospitals.  Between 3 and 5 of those could be directly attributed to social reasons.  She also reported upon the deliberate policy of moving patients, who were fit for discharge but who were unable to be appropriately placed, into the community hospitals in order to ensure capacity within the acute trust.  She further reported that a number of initiatives to improve the patient pathway through the system were underway and these were further described in the report.

In relation to the Reimbursement Scheme, introduced by the Community Care (Delayed Discharges) Act 2003, the Head of Social Care (Adults) reported that the stated intention of the Act was that Social Services should pay for the care of an individual as soon as they became the responsibility of the Service.  A Reimbursement Grant accompanied the Act under which Herefordshire had received £172,000 part year funding. The implications of the scheme and the grant were detailed in the report.

The Head of Social Care (Adults) introduced Mrs Fiona McLeod of the Department of Health’s Change Agent Team.  While Hereford was not a ‘hot spot’ for investigation she had agreed to visit and undertake a brief review.

Mrs McLeod commented upon the issue of delayed transfers of care at Community Hospitals and the policy of their use to free up the community hospitals, which she felt clouded the true number of delays counted for reimbursement.  She emphasised that the issue was not just the numbers involved but the whole care of the person.  She also commented that an area of concern was the number of people waiting to go into the acute hospital, and in particularly the availability of funding.  She highlighted a local issue concerning the use of ‘top-up fees’ and whether they were only applied in exceptional circumstances.

The Committee debated the issue of patients becoming institutionalised.  The longer they were in care the less likely they were to be readily capable of going home.  It was noted that the Leominster whole systems pilot scheme had been able to free up the patient pathway through the system and experience from this pilot would be used to inform further developments.   The Committee also debated issues relating to the ‘risk averse’ attitude to patient welfare and the implications of the ‘Reimbursement Scheme’.

RESOLVED: That the report be noted and further reports be made on delayed transfers of care, and the implication of the reimbursement scheme.

To consider and approve the Stage 3 report and outcomes of the Best Value Review of Carer Support Services.

The Committee considered the Stage 3 report and outcomes of the Best Value Review of Carer Support Services.

The Head of Social Care (Adults) presented a report on the review together with a copy of the detailed review report, which had been circulated separately for members.  She briefly outlined the background to the review and commented that the scoping exercise had proved complex due to the nature of the service.  The Review Group’s recommendations were set out in the report.

The Director of Social Care and Strategic Housing commented that the review had been a thorough piece of work.  However, she expressed a number of concerns regarding the recommendations, particularly the likely impact upon resources within the Directorate.

The Committee appreciated the important work undertaken by carers in the County and noted the estimated cost to the County were this work to be financed by the Council.  The Committee agreed that the review process had been rigorously applied and, not wishing to hold up the review process, recommended that the review proceed to the next stage.  However, in view of the concerns expressed regarding resource implications it was suggested that the Chairman, Vice-Chairman, Cabinet Member (Social Care and Strategic Housing) and the Director meet with the Review Group to discuss the recommendations, reporting back to Committee in due course.

RESOLVED: That the Stage 3 report be submitted to the Strategic Monitoring Committee for consideration and it be suggested that the Chairman, Vice-Chairman, Cabinet Member (Social Care and Strategic Housing) and Director meet with the Review Group to discuss the recommendations in relation to Directorate resources.

To inform Members of the progress of the Best Value Review and the Stage One report of the Review process: the initial diagnosis and analysis.

The Committee were informed of the progress of the Best Value Review and the Stage One report of the review process: the initial diagnosis and analysis.

The Children’s Services Manager reported that Stage One of the review had been completed and copies of the stage one report had been circulated to Members separately.

The Committee briefly discussed the work of the Fostering and Adoption Service and noted the fluctuating numbers in care.  They also discussed the Council’s position as Corporate Parent and suggested that the Director arrange for a seminar be held for all Members of the Council to inform them of the implications and their responsibilities.

RESOLVED: that

(a)    the Best Value Review Stage One Report on Fostering and Adoption Service be accepted and;

(b)    a seminar be held for all Members of the Council on the implications of the Council as Corporate Parent.

To inform the Committee of the budget monitoring position for Social Care and Strategic Housing for the first four months of the financial year 2003/04.

The Committee were informed of the budget monitoring position for Social Care and Strategic Housing for the first four months of the financial year 2003/04.

The Head of Business Services reported upon the budget position and highlighted that the overspend carried forward from 2002/03 had been £582,000.  She reported that key risk areas had been identified within the budget, which included assumptions made about residential and family placements for children, fairer charging income projections and grants income.  Initial budget planning included some limited contingency provision to meet unquantified but likely pressures during the year. 

In relation to Strategic Housing she reported that while an underspend of £191,000 had been carried forward to 2003/04 this had been allocated to projects and the projected year-end position indicated a small underspend of £5,000.

The Committee appreciated the demonstration of efficiency in the Directorate and the business like approach to the need to balance the budget against service provision.

RESOLVED: that the budget monitoring report for the first four months of the financial year be noted.

To advise members on arrangements for monitoring the Herefordshire Plan.

The Committee were advised of arrangements for monitoring the Herefordshire Plan.

The Committee were informed of the partnership arrangements for delivering the Herefordshire Plan.  The report detailed responsibility for delivering and monitoring each of the 10 ambitions; the Cabinet Member within whose remit the ambition fell and the Scrutiny Committee responsible for scrutinising progress.

The Committee discussed the degree of integration between Directorates in achieving the ambitions.  It was suggested that the Strategic Monitoring Committee consider the level of monitoring allocated to scrutinising the achievement of the Plan.  It was further suggested that consideration might usefully be given to producing an accessible, public summary of the Plan.

RESOLVED: that the report be noted and it be recommended that Strategic Monitoring Committee consider the level of monitoring allocated to scrutinising the achievement of the Plan.

To receive a presentation by the Cabinet Member (Social Care and Strategic Housing) informing the Committee of policy issues affecting this programme area and the main priorities.

The Committee received a presentation by Councillor Mrs. L.O. Barnett, Cabinet Member (Social Care and Strategic Housing) on the policy issues affecting this programme area and the main priorities.

The Cabinet Member referred to the SSI and Audit Commission report, which stated that, at the present time, Herefordshire Council Social Care was serving some people well with promising prospects for the future.  She commented that an action plan to improve services had been produced which would be the foundation of change and innovation over the lifetime of the present Council.  The challenge and aims for the Cabinet and the Directorate would be to drive forward change and innovation necessary to serve all vulnerable people well.

The following are the main points of the presentation:

• There seemed to be a lack of understanding regarding the areas covered by Strategic Housing, which needed to be tackled, and she proposed that a seminar for members on this issue be arranged.

• More developments were needed in housing to support improvements in the County. This would be achieved by continuing to work closely with the Primary Care Trust (PCT) and other partners; good budget management and efficiency across the partnership.

• As reported in an earlier item, while there was a budget deficit, the budgets were being managed effectively.  Staff would continue to find new and innovative ways to provide the services within existing resources.

• Budget plans for 2004/05 and onwards indicated a need for more financial investment, particularly for older people.

• A priority must be to reduce the delay in vacating hospital beds and the Council must avoid fines for delays.  She acknowledged that government targets imposed upon the hospitals complicated the issue.  The development of a 22 bed Intermediate Care Centre at Hillside would only address the problem in part.

• A report was expected on the STARRS pilot project based at Leominster Community Hospital.  This would provide an opportunity for joint working with the PCT to support and enhance Community Reablement Services.

• Supported housing, based on the Supporting People Strategy and the SMART House, would be investigated to see whether further technology would assist in keeping more people in their own homes.

• Negotiations with Shaw Homes were progressing.  This would be a ten million pound investment, where five residential homes owned by the Council would be managed by the partner, and monitored by the Council.

• A report was expected to go before Cabinet shortly on the provision of affordable housing.

• The business case for investment in older peoples’ services would be finalised in the autumn of this year.

The Cabinet Member summed up that the main priorities for the programme area were to:

• Continue to work with the Primary Care Trust to reduce the delays in vacating hospital beds;

• Continue significant changes in the delivery of Home Care Services over the next 18 months;

• Ensure continued progress on the Local Public Service Agreement (LPSA) targets relating to older people and homelessness;

• Seek an early decision on “A Care Village” for Hereford City and request  ...  view the full minutes text for item 23.

To give further consideration to the work programme for the Committee.

The Committee considered the work programme for the Committee.  A copy of the current programme had been appended to the report.

RESOLVED: That the work programme be noted.