To receive apologies for absence.

Apologies were received from Councillors H Davies, MD Lloyd-Hayes, JE Pemberton and JK Swinburne.

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

Councillor PGH Cutter substituted for Councillor JK Swinburne.

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

GUIDANCE ON DECLARING PERSONAL AND PREJUDICIAL INTERESTS AT MEETINGS

The Council’s Members’ Code of Conduct requires Councillors to declare against an Agenda item(s) the nature of an interest and whether the interest is personal or prejudicial.  Councillors have to decide first whether or not they have a personal interest in the matter under discussion.  They will then have to decide whether that personal interest is also prejudicial.

A personal interest is an interest that affects the Councillor more than most other people in the area.  People in the area include those who live, work or have property in the area of the Council.  Councillors will also have a personal interest if their partner, relative or a close friend, or an organisation that they or the member works for, is affected more than other people in the area.  If they do have a personal interest, they must declare it but can stay and take part and vote in the meeting. 

Whether an interest is prejudicial is a matter of judgement for each Councillor.  What Councillors have to do is ask themselves whether a member of the public – if he or she knew all the facts – would think that the Councillor’s interest was so important that their decision would be affected by it.  If a Councillor has a prejudicial interest then they must declare what that interest is and leave the meeting room.

Councillor PGH Cutter declared a personal interest in agenda item 7: Adult Services and Strategic Housing Performance Monitoring. Councillor AE Gray declared a personal interest as a service provider in agenda item 9: Learning Disability Action Plan – Final Report. 

To approve and sign the Minutes of the meeting held on 19 March 2008.

RESOLVED: That the Minutes of the meeting held on 19 March 2008 be confirmed as a correct record and signed by the Chairman subject to the first two lines of resolution (a) being amended to read “The Committee believes that the recommendations to improve services for Mental Health and Physical Disabilities…”

To consider suggestions from members of the public on issues the Committee could scrutinise in the future.

The Chairman reported receipt of a number of questions relating to support for carers which she intended to be dealt with under agenda item 7: Adult Services and Strategic Housing Performance Monitoring.

To report on the national performance indicators position and other performance management information for the Adult Social Care and Strategic Housing Divisions within the Adult and Community Services Directorate.

(Councillor PGH Cutter declared a personal interest.)

The Committee considered the national performance indicators position and other performance management information for the Adult Social Care and Strategic Housing Divisions within the Adult and Community Services Directorate.

The Improvement Manager presented the report.   He informed the Committee that 10 performance indicators, rather than 9 as stated in the report, were now on target and it was hoped that of the five indicators currently rated as amber two would be achieved. 

In the ensuing discussion the following principal points were made:

·         In relation to target D54 – equipment delivered within seven days, it was noted that whilst performance in actually delivering the equipment was excellent there could currently be an interval between the equipment’s delivery and its installation.  It was reported that to overcome this delay a plan was in place for equipment to be delivered and installed by the same person.

·         The correlation between the performance figures presented to the Committee and the performance information included in the Corporate Plan was clarified, it being confirmed that the Committee had the most up to date performance information before it.

A number of questions received from Mrs. P. Fender, Welsh Newton, Monmouth are set out below together with the answers given in reply.

Question 1

Freedom of Information request responses have informed carers that there have been no business plans for the carers Grant; this years Grant is £772,000.  Because there have been no records, precisely how is this money being accounted for?

Response

The Carers' Grant is fully used to provide support for carers, including respite - which is known as short breaks. 

The Grant is spent in line with the "Joint Commissioning Plan for Carers' Services 2007-2011.  This plan was approved by the Adult Commissioning Board which is a joint decision making body of both the PCT and Adult Social Care.  Membership of the Board includes the lead Councilor for adult services, the Chair of the Board of the PCT, the Director of Adult and Community Services, the Director of Commissioning from the PCT and a representative from the Alliance.

The Plan outlines the Council’s commissioning intentions.  A number of organisations are funded to provide services in line with those recommendations. The organisations that are funded will have their own business plans.  Our contract monitoring officers meet with the organisations to monitor delivery of the services according to the Service Level Agreement that we have with them.

The type and volume of service to be provided is outlined in the Service Level agreements and contracts that the Council has agreed with the individual organisations.  The organisations provide information on who is receiving services to the Adult social care information section and this forms part of the evidence that is used in collating our performance against P.I.s relating to carers' support.  We have a carer's assessor post in each of the locality teams to ensure that carers have their needs assessed and that their need  ...  view the full minutes text for item 51.

To provide an update on the projected outturn as of the end of February for the financial year 2007/08 for Adult Social Care and Strategic Housing.

The Committee considered an update on the projected outturn as at the end of February for the financial year 2007/08 for Adult Social Care and Strategic Housing.

The Interim Finance Manager Adult and Community Services presented the report.  He said that the projected overspend on Adult Social Care had reduced to £3.4 million and explained the background to this calculation as described in the report

Additional funding had been allocated for adult social care within the Medium Term Financial Strategy.  Using this funding alongside additional income from fairer charging, new grant funding and revised arrangements with the Primary Care Trust meant that progress was expected to be made to achieving a balanced budget for 2008/09.

The forecast outturn for strategic housing was a break-even position, with an overspend on homelessness offset by savings in other housing budgets.  However, expenditure on homelessness remained a volatile and unpredictable area.

In the ensuing discussion the following principal points were made:

·         The performance of Medicare, the home care nursing agency, in delivering home care services was questioned.  In reply the Head of Adult Social Care said that Medicare had not been providing the level of service specified in their contract with the Council.  Officers had worked with Medicare to improve services and the number of complaints had now reduced. 

·         A further question was asked about the number of other contracted care providers and their level of performance.  It was replied that there were some 5-6 block contracts of the type in place with Medicare alongside a range of other arrangements for service provision.  No concerns of the type occasioned by the performance of Medicare had arisen with the other block contracts.

·         It was agreed to provide a briefing note to Members on the range of preventative measures being taken to tackle homelessness.

·         It was agreed to provide a briefing note to Members on the increase in nursing and residential packages, clarifying whether these were new packages or packages the Council had to fund because those receiving them had ceased to be self-funding.

·         It was noted that the Directorate was discussing free nursing care costs with the Primary Care Trust to ensure that everyone who was eligible for the service would receive it and that this might have a beneficial effect on the final outturn position.

·         That Members of the Committee had consistently expressed concern about the funding pressures faced by the Adult Social Care Service, recognising amongst other things the stress placed on staff in seeking to manage these pressures and take remedial action.  It was to be welcomed that it now appeared that there was a prospect of the budget balancing in 2008/09.

·         The position on the occupancy of the residential facility for older people at Leadon Bank, Ledbury was discussed.  The Head of Adult Social Care explained that the contract with Shaw Homes had assumed full occupancy of the extra care flats.  There were various reasons why this had not materialised including changed circumstances of service users whom it had been expected  ...  view the full minutes text for item 52.

To consider the Adult Social Care Service Plan.

The Committee considered the service plan for adult social care for 2008/09. 

The Head of Adult Social Care presented the report.

She informed the Committee that the plan built on work in the previous year to modernise and improve adult social care.  The underlying principles were: supporting people to remain independent, working more closely with health services and  providing high quality services that were value for money.

In discussing the way the plan was written it was recognised that the Plan had to serve a number of audiences including Inspectorates and the Council’s own planning requirements.  The Head of Adult Social Care said that it was intended to produce an at a glance one page summary of the key principles and key actions in the plan which would be made available to all staff.

There was a brief discussion of the specific development of two flats at Ross-on-Wye adjacent to Woodside for emergency respite and rehabilitation listed at page 3 of the plan as an achievement in 2007/08.  The Head of   Adult Social Care confirmed that following further assessment the flats had been deemed unsuitable for this purpose.  She clarified that the development of two sites for adults with learning disabilities, one of which provided for 6 units in Ross-on Wye was a separate initiative.   It was requested that the Local Members be briefed.

In response to a question about the development of affordable housing that could accommodate those with autism, who formed about a quarter of those requiring affordable housing,  it was reported that work was being carried out to look at the specification of this accommodation.   A Member drew attention to work some Councils had already done on this issue.

RESOLVED:   That the report be noted and progress on implementation of the Service Plan monitored through the quarterly monitoring reports.

To update the Committee on the Council’s response to the Commission for Social Care (CSCI) report on the Learning Disability Service.

(Councillor AE Gray declared a personal interest.)

The Committee considered a final report on the implementation of the action plan for learning disability services prepared following the Commission for Social Care Inspection in January 2007.

The Head of Adult Learning Disabilities reported on progress, the last update having been provided to the Committee in December 2007. 

It was noted that following completion of the action plan development of the learning disability service had been incorporated into the overall adult social care improvement programme and service plan.

The Head of Adult Learning Disabilities in presenting the report had commented in particular on the action taken to ensure that all service users had had their needs reviewed.  She informed the Committee that an independent organisation had been contracted to carry out a number of the reviews.  The quality of some of this work had been considered unsatisfactory and 20% of the reviews were still judged to be so.  A reduction in the contract price had been negotiated. 

The challenge remained to switch investment into personalised services which needed to be rolled out across social care as a whole.

In the course of discussion the following principal points were made:

·         It was asked how the Service would ensure that it would keep up to date in carrying out reviews of service users needs. In reply the Head of Adult Learning Disabilities said that investment of £600,000 per annum had enabled additional capacity to be provided to undertake reviews.  She noted that the introduction of personalised budgets would entail a different role for social workers and the local authority with less time spent arranging services.

·         Asked about support provided to those developing personalised budgets the Head of Adult Learning Disabilities said that a number of lessons had been learned from the pilot project.  One was that a significant number of people had been found to need more support in making their own arrangements than had been envisaged.  An arrangement had been made with Herefordshire Independent Living for them to provide a brokerage service to help determine what support needs were required.

·         Recruitment issues were raised.  The Head of Adult Learning Disabilities said that there was difficulty in recruiting to permanent social worker posts.  However, it was thought that it would be possible to recruit people to carry out specific tasks on time limited contracts.

·         In reply to a question about the funding of improved health screening by GPs for people with learning disabilities it was confirmed that the Primary Care Trust had provided funding.

RESOLVED:   That progress against the action plan be noted and the developments within the learning disability service in future be reported as part of the overall adult social care improvement plan.

To consider the Committee’s work programme.

The Committee considered its work programme.

The Chief Executive Herefordshire Council/Herefordshire Primary Care Trust reported to the Committee on the strategic review of provider services suggesting that the Committee would wish to add this item to its work programme.

He said that the University of Birmingham had been commissioned to carry out a review to be completed within six months to look at the best configuration of health and social care provider services.  The aim would be to see if the right services were being provided to the right people in the right place including care provided in Hereford Hospital.  The review would also be looking at the integration of health and social care services and the provision of mental health services, noting that the Primary Care Trust was only one of a very few in the Country that directly managed mental health services.  He emphasised that the review was not a mechanism for closing facilities.  The review was intended to look at how provision could be organised in the most effective way making the most effective use of resources. 

He had agreed in informing the Health Scrutiny Committee of the review on 3 April to make progress reports to that Committee and proposed to report similarly to the Adult Social Care and Strategic Housing Scrutiny Committee.

In response to comments the Chief Executive acknowledged that the disparity between the growth in funding for the Health Service and funding for local authorities was a complication.  It would be important to take account of this in devising solutions locally.

It was noted that discussions were ongoing with the Primary Care Trust about the development of joint packages of care.

The Committee welcomed the intention to provide it with updates on the review of strategic provider services.

The following further additions to the programme were made:  scoping statement on the review of carers’ support, service plan monitoring, and a review of transition from hospital to home.  It was noted the review of housing allocation policy was also due to report.

RESOLVED: That the work programme as amended be approved and recommended to the Strategic Monitoring Committee.