To note the quarter 3 performance report for adults and wellbeing.

The performance report was presented by the director of adults and wellbeing, highlighting key points and areas for future exploration.

Key achievements were identified as:

•           a new approach in dealing with complex cases to ensure they were person-centred and giving greater ability to assess and review;

•           new contracts for sexual health and substance misuse and seeing benefits of new approaches;

•           responding to closure of a care home with 5 days’ notice which presented pressure and complexity in assessing and moving residents safely. The team performed well and all residents were placed safely; and

•           care service recruitment presented a challenge in responding to the vibrancy of the county.

Aims were summarised as:

•           to actively work to ensure Care Act responsibilities were met and case reviews fulfilled. This would provide a solid baseline that all have proper assessment; and

•           moving forward following delays in launching the WISH service to ensure a quality service was being provided. The service was working on ensuring it covered the whole population. The service would be going live in the next few days and officers were working closely with the operator, SIL (Services for Independent Living).

Members’ attention was drawn to the dashboard information in the report. In particular, residential care numbers, as placements were never the preferred option over people remaining in their own homes. Officers were working to ensure staffing was structured to ensure ongoing engagement for early intervention and provide support at suitable points.

An overspend of 0.1% of the gross budget was forecast and whilst few other services were working within budget, there was discomfort with an £88,000 overspend.

The director for adults and wellbeing identified items for focus:

•           provider failure/closure of residential homes as a common issue due to financial circumstances. There was close working to ensure that there are mechanisms to ensure that homes can stay open or residents have a smooth transition to new accommodation;

•           promoting independence and no longer commissioning visits of less than thirty minutes; New arrangements would be in place early in 2017-18 in order to take time to get the service right and not rush implementation. 

A member commented on the commissioning of home support services as being the ideal way forward although there was concern regarding rurality and how costs were identified in carrying out provision in rural areas.  Isolation was also a concern and it was considered that this was the primary reason for lonely people going into residential accommodation.

The director for adults and wellbeing acknowledged that loneliness was a key factor in reducing wellbeing and deterioration and could be as harmful to health as smoking and this was being addressed.  Growth in residential care was a national phenomenon and benchmarks were being considered.   More needed to be done to address community resilience to support people and avoid decline.  Rurality was a factor in providing domiciliary care and from 1 October 2015 there had been a rural premium for those people living more than 5 miles of the centre of Hereford or the market towns to support travel costs. There needed to be greater understanding of the impact of the ratio between contact time and travel time and how the workforce could be used more efficiently and increase journey efficiency.

A member commented on the terminology and abbreviations contained in the report’s commentary on the WISH project making the information hard to understand. The director of adults and wellbeing clarified that there were three separate technical issues. One referred to WISH, which had been delayed but was now due to launch within days. The second referred to the electronic document record management system (EDRMS), which had also been delayed but was now on track for its revised launch. However, the third issue, the upgrade of the social care case management system had been proving more problematic. The new system would make things easier and there was now confidence that issues were being addressed although this was not as quick as would have been preferred.  The system upgrade would enable mobile and remote working and ensure care act compliance. This was a significant upgrade and it was challenging. The people using it were vital for its success so there were plans to ensure there was proper training and support in place, rather than treat it purely as a technical exercise. There was confidence that there would be arrangements in place to go live in April.

In answer to a member’s comment on the fragility of the care home market and ongoing assurance of quality and continuity, the director for adults and wellbeing explained that the sector was diverse in composition and mostly locally owned. There was a statutory responsibility for them to be monitored by the CQC, although the CQC’s financial monitoring was limited to the larger national chains. The council was responsible for monitoring smaller ones though this remained challenging in part due to lag between the end of an operating year and their publishing their accounts. There was therefore some reliance on local intelligence. Moving vulnerable people at short notice was always to be avoided if at all possible, as there was a link to mortality due to residents’ limited resilience to recover from the impact of moving. 

The vice-chairman asked about progress on the development of pop-up hubs particularly in market towns and village halls to support WISH. It was confirmed that although the service was primarily focused on signposting people to the website, there remained a place for face to face resources. There would be a physical presence in Hereford and also pop-up resources, which were advertised in the Hereford Times. 

A member asked about the services that would be ceasing and which were statutory. It was clarified that that via the Care Act there was a clear statement of what the statutory services were. These included a responsibility to undertake assessments where required and ensure the provision of the care needed to meet national thresholds and have regard to wellbeing. There was a broader definition than previously, where focus was on delivery of care.  Safeguarding was also now a statutory role.

All service areas were looking at securing the best value for money to address demand appropriately and there would be consideration of where there were areas of duplication or insufficient added value. Staffing structures were being considered along with all block contracts to make full use of resources. The full range of services were being considered as consultation was underway on service redesign.  No area of the directorate’s activities was being left unscrutinised.

A member referred to the audit and governance committee work plan, explaining that there had been a report presented on significant findings of risk, in which had been identified agency staff screening.  There was concern that there could be gaps in employment history and lack of references not followed up, and so assurance was sought on this matter.  Assurance was given that there was awareness of these issues and that there was close working with Hoople and human resources to identify issues and address them.

RESOLVED

THAT:

(a)        the quarter 3 performance data (as shown in appendices) be reviewed; and

(b)       future performance reports would focus on exception, rather than provide commentary on total performance.