To receive apologies for absence.

Apologies were received from Councillors ME Cooper, MJ Fishley and MD Lloyd-Hayes.

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

There were no named substitutes.

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

To approve and sign the Minutes of the meeting held on 29 June 2009.

RESOLVED: That the Minutes of the meeting held on 29th June 2009 be confirmed as a correct record and signed by the Chairman.

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

There were no suggestions for future scrutiny.

The Cabinet Member (Social Care Adults) will comment on the key achievements or topics for improvement in the past year in her programme area as it relates to the Committee; what matters will need to be addressed in the coming year and issues with which she may wish to involve Scrutiny in the future.

The Cabinet Member (Social Care Adults) presented her report.

The Cabinet Member took the Committee through her report, and highlighted the following areas in particular:

·         That management of Adult Safeguarding cases had improved significantly since the independent report that had been undertaken in February 2009, and new procedures were being finalised. 

·         Home care services had been overhauled and new plans had succeeded in achieving strong collaboration with Home care providers. 

·         She expressed concerned regarding the ongoing problem of identifying and helping self funding carers.  The Associate Director of Integrated Commissioning would be considering a strategy to manage the situation.

·         That there was a continuing struggle when controlling the budgets for the Service.  The lack of the appropriate IT system undoubtedly increased the work load on staff.  The correct technology was imperative if staff were to work collaboratively across Social Care and the PCT.

·         That homelessness should be kept as one of the priorities, and she suggested that the Committee should receive a bi-annual report on

·         That the increased closeness of the partnership working between the Council, the PCT and Hereford Hospitals NHS Trust should be welcomed, but added that it was important that Adult Social Care should not be lost within a large organisation and should be subject to the appropriate levels of due diligence and scrutiny.

The Chairman thanked the Cabinet Member for her presentation, and said that she agreed that the Health Scrutiny and Adult Social Care & Strategic Housing Committees did need to work together more closely.  She did not believe that the Committee should be amalgamated into one, but said that there was an argument for holding joint meetings to address specific areas of interest to both Committees.

In reply to a question, the Associate Director of Integrated Commissioning said that work on a joint strategic needs assessment was being undertaken.  The Integrated Commissioning Team was also working on a local dementia strategy.  A progress report would be provided to the Committee within six months.

RESOLVED: That the report be noted.

To receive an updated report on the delivery of Major Adaptations using the Disabled Facilities Grant.

The Committee received a report on the significant increase in demand for the delivery of major adaptations to homes using the Disabled Facilities Grant. The Private Sector Housing Manager reported that at current referral levels, there would be a shortfall on the assessed budget requirement for 2009/10 of £1,016k.

She went on to say that the delivery of major adaptations to the home involved two distinct stages. The first was an assessment by an Occupational Therapist (OT) within the person’s home. This was then referred to the Private Sector Housing team to deliver the adaptation, using a Disabled Facilities Grant (DFG).  There were scheduled rates for the most common works that were required; the most commonly requested was for level access showers, for which the Council had twenty three contractors who had shown an interest in undertaking the work. 

A specific Housing Occupational Therapist post had been provided in 2006, located within Private Sector Housing. The post was currently vacant.  Part of the remit of the post had included the development of an Accessible Properties Register with the aim of ensuring that adapted properties could be re-used to maximum effect. Initial work had been undertaken to look at a consistent classification of adaptations to properties particularly in the social-rented sector, and how they could be allocated through the Choice-Based Lettings system.

In the ensuing discussion the following points were raised:

·         That the level access showers, the most common adaptation requested, cost between £2k and £7k.  The price had risen over a period of years for a variety of reasons.  It was noted that it was intended that the new priced schedule scheme would reduce the cost of installation.  A new software system would allow the team to provide real-time prices for units, and would provide the team with the names of the eight contractors offering the best prices for the work for individual cases. 

·         That the needs of the individual were assessed by an Occupational Therapist (OT), and alternative options were offered.  It was important that an OT was in place to be able to assess the needs of individuals on the waiting list for housing.  The Director, Integrated Commissioning added that the wider issue of Occupational Therapists within the PCT, Social Care and Housing would be considered shortly.

·         In reply to a question from a Member, the Private Sector Housing Manager said that the adaptations waiting list system, whereby applicant’s names were taken from the waiting list on a strict ‘high priority score first’ basis had been instigated last summer. Whilst it was a transparent system, it should be considered that any waiting system was unlawful; the Council was utilising the system to manage present circumstances until the deficit could be addressed.

·         In reply to a question from a Member regarding people who had brought their own homes and were now unable to move to more suitable accommodation, she went on to say that there were options for helping people in these circumstances.  The Disabled Facilities Grant did have  ...  view the full minutes text for item 139.

To advise members of the financial position for the Adult Social Care budget within the Join Commissioning Directorate, and the Strategic Housing budget within the Regeneration Directorate for the period to 31^st July 2009.  The report provides the variations against budget and a projected outturn for the year

The Committee received a report on the financial position for Adult Social Care and Strategic Housing revenue budgets for the period to 31^st July 2009. The Management Accountancy Manager reported that the Adult Social Care budget had a forecast outturn position of an overspend of £2.6 million. The forecast was based on existing commitments which had been carried forward from 2008-09 together with the additional commitments identified in 2009-10 which had been projected forward.

The final outturn position for 2008-09 for Adult Social Care was £713k overspent. The true value of on-going commitments brought forward was approximately £930k. Inflation on contracts at an average increase of 1.7% had added £700k across service costs for 2009-10.  One of the main area of overspend was Learning Disabilities where an overspend of £1.344m was projected. This was mainly as a result of 21 new clients coming from Children’s Services in 2009-10.  These transition cases would be re-assessed, and it was likely that the costs would go down as a result.  One of the other areas of overspend was Older People, which was forecast to overspend by £945k. This was due both to the cost of existing commitments and an additional 11 residential placements and 2 nursing packages which had been agreed in 2009-10. 

He went on to say that budget savings arising from the implementation of Framework I system were due to be transferred from Adult Social Care towards the overall corporate savings target for Herefordshire Connects. Additional area based grant of £200k had been allocated by the Herefordshire Partnership and budgets would reflect this.  Supporting People, on the other hand, was projected to remain within budget. The underspend on previous year funding was £4.83m. The 2009-10 grant to be received was £5.88m. The forecast assumed that the remaining underspend would be carried forward.

In the ensuing discussion, the following points were made:

• That the Supporting People budget was tightly regulated, and had to be spent for the purposes that it was allocated for.  The underspend would be utilised within the next three to four years

• That Children’s Services and Adult Social Care should work more closely together in the future in order to ensure that a smooth transition was in place for those with learning disabilities.

• In reply to a question from a Member, the Associate Director of Integrated Commissioning reported that savings had been made as a result of the transfer form the old Clix system to Frameworki.  A post had been lost from the Performance and Information team, as well as others that were no longer required.  Combined with vacancy controls, this had resulted in savings of £200k. 

• Additional budget of £200k had been allocated from the Area Based Grant (ABG) by the Herefordshire Partnership and would be used to support carers’ in the County.

• That Homelessness continued to be the main pressure on the Strategic Housing Service.  There were 125 households in the system, of which fourteen were in temporary accommodation.  The need to reduce the numbers of  ...  view the full minutes text for item 140.

To report on the national performance indicators position and other performance management information for the Adult Social Care and Strategic Housing Divisions within the Joint Commissioning and Regeneration Directorates.

The Committee received a report on the progress against the performance targets for Adult Social Care and Strategic Housing for 2009/10.  The Associate Director of Integrated Commissioning reported that the Care Quality Commission (CQC) had made their annual inspection of the Council in August.  Their initial report indicated that there had been good progress made in some areas.  Better commissioning arrangements had meant that improvements in homecare had been singled out for comment.  The lack of a clear audit trail outlining the impact on those individuals concerned might impact on the score for the current year, but would ensure that the Council was in a good position for a better score in 2010.

She went on to say that there had been difficulty in interpreting NI 131 (Delayed transfer of care form hospitals) as it covered a number of causes.  Social Services were only one of these, and was low in the County, with only 20% of cases being affected.  These delays were largely as a result of the choice of establishment by the individual being unavailable, and not as a result of inaction by the Service.

The Associate Director of Integrated Commissioning went on to say that NI 136 (People supported to live independently through Social Services (all adults)) was clearly one of the more important indicators, and it was important that the Council should collect it in the same manner that other Authorities did.  At the moment, because of the way this was recorded, it appeared that the Council was a lower performing authority than it actually was.  When figures for those who lived in the County and were supported by their family were included, it was apparent that the Council was performing well. 

The Associate Director went on to say that the Department of Health (DoH) had set a stretch target of 30% of services users receiving individualised budgets by 2011 for N1 130 (Social Care clients receiving Self Directed Support).  Concern had been expressed at this level by other Authorities. Individualised budgets could help those with a low dependency on services, but they didn’t help those with more complex care needs.  As the DoH had also no yet delivered the National Resource Allocation System, it was hard for the Council to deliver against this target.  Other authorities were not yet addressing this target, as they were not yet clear as to what the financial implications would be.

She went on to say that NI D40 (Clients receiving a review) was performing poorly, as there were four care homes across the County which were struggling to deliver an adequate rating.  There was a significant amount of work to be undertaken whenever a care home returned a poor or zero rating in order to ensure the safety of service users.  The Council would work to improve establishments before taking perceptive action, as life changing moves for the elderly were to be avoided as much as possible.

RESOLVED: That

a)      That the report be noted;

To receive a report on the progress of the Provider Services Review.

The Committee received a report on the Provider Services Review.  The Director, Integrated Commissioning reported that procurement for partners to run mutual health care provision was in hand and that there was closer integrated working between the Hereford Hospitals NHS Trust, the PCT and the Council.

RESOLVED: That the report be noted.

To consider the Work Programme.

The Committee noted its Work Programme.

RESOLVED: That

a)      That the work programme be approved and reported to the                Strategic Monitoring Committee;

and;

b)     a scoping statement on the Scrutiny Review of Home Care should be provided to the next meeting.