Agenda and minutes

The Chair welcomed everyone to the meeting.

The Chair will draw attention to the emergency evacuation procedure as set out under Note 5.

The Chair drew attention to the emergency evacuation procedure.

There were none.

At this point in the meeting declarations of interest are received from Members in any of the agenda items under consideration at the meeting. Members are asked to indicate:

(a) The agenda item number in which they have an interest to declare.

(b) The nature of their interest.

(c) Whether their interest is a disclosable pecuniary interest or an other interest, (as defined in Part 4.4 Appendix B of the Code of Conduct and Rules for Registration of Interests)

Any Member who needs to clarify any matters relating to the declaration of interests is recommended to seek advice from the Council’s Monitoring Officeror a member of his staff before the meeting to expedite dealing with the item during the meeting.

There were none.

The Panel confirmed the minutes of the previous meeting as a true record and they were duly signed by the Chair.

The Cabinet Member will update the Panel on any relevant issues. Panel members may ask questions on the update provided.

Councillor Alison Born, Cabinet Member for Adult Services addressed the Panel and highlighted the following areas from her update. A copy of the update will be attached to these minutes as an online appendix.

ASC Performance

The number of people with current long-term services funded by Adult Social Care is 1,872. In addition to this there are 406 carers with current services funded by Adult Social Care.

There are 48 people currently waiting for a Care Act assessment of their needs, this is an improvement on the previous month of 59. 457 (from the 1,872) are waiting for an annual review of their needs, again this is an improvement trend from 527. The average wait is 8 months overdue, and the longest wait is 11 months overdue.  All reviews are risk rated and prioritised accordingly.

Our Mental Health teams continue to experience increased demand, approx. 10% month on month. We have received 104 referrals for detention under the Mental Health Act since April 2023 with 97 of those referrals accepted by the Approved Mental Health professionals.

Finance

Whilst the number of packages provided continued to be below previous levels during the first part of the year, we are now seeing an increase (average of 25%) in year on year activity. Package costs have also increased during the year (average by 12%), due to the economic and market factors that are currently being experienced across the country.

In addition, referrals to the services are increasing in complexity which adds to the budgetary pressure and work continues with health colleagues to review and agree the correct funding model for the services required.

ASC Provider Services Update

The council operates 5 Extra Care Schemes, 3 Care Homes (CRCs) and 1 care agency. The 5 extra care schemes remain rated as good by the CQC and the 3 care homes are rated overall requires improvement but with good in key areas such as caring and safety. Our home care service has yet to be inspected by CQC.

The service has undertaken a comprehensive review of its delivery and costs and will be consulting in October and November on our future plans for the service, a final decision will be made via a Single Member Decision in January 2024. Recruitment to the services continues to improve with our vacancies reducing from 70 to 22 across the services.

Community Catalysts working in B&NES

Strategically, we want to empower people to make their own care and support decisions, as well as ensuring a sustainable, competitive marketplace, with capacity to support the needs of our residents.

To this aim we are working with Community Catalysts as our strategic partner to increase the number of small community enterprises in B&NES that will use their skills and passions to provide a wide range of help and support to local people.

Our recently appointed dedicated B&NES Catalyst is working with three enterprises, supporting them through the development programme, and is engaging with a further ten  ...  view the full minutes text for item 36.

The Panel will receive an update from the B&NES, Swindon & Wiltshire Integrated Care Board (BSW ICB) on current issues.

The Director of Place, B&NES, BSW ICB addressed the Panel and highlighted the following areas from her update. A copy of the update will be attached to these minutes as an online appendix.

BSW ICB Prescriptions Ordering Direct – Proposals for the future

BSW ICB has developed a proposal for an organisational change to stop BSW ICB’s Prescriptions Ordering Direct (POD) in its current form and look at potential options for the future of repeat prescribing. We look forward to engaging with members on the proposal over the coming weeks.

Primary care is one of the most dynamic and innovative parts of the health service and ensuring our busy primary care system across BSW is supported and resourced fairly and equitably is an important focus for BSW ICB.

The context has also changed since POD was first launched in 2017. One of the ambitions set out in the national Delivery plan for recovering access to primary care is to enable patients in over 90% of practices to order repeat prescriptions using the NHS App by March 2024.

We have looked at scaling POD across the system, however it is clear that the levels of necessary financial support required would not be achievable. Other POD services have now closed or are in the process of closing across England for very similar reasons. 

We are now actively engaging with our staff ahead of a formal consultation on potential changes to POD. During this period, we would like to offer you and elected members with a role and interest in health services a meeting to discuss the proposal in more detail if helpful. Our engagement period will run up until 2^nd November inclusive.

After the engagement period and our consultation with staff, we will consider all comments received from our colleagues, yourselves and other stakeholders and will decide on the way forward. We will also feedback to you the outcome of the consultation and engagement process once we have gathered all the information we need. 

The BSW Primary and Community Care Delivery Plan (PCCDP)

The BSW ICB Board has approved a Primary and Community Care Delivery Plan (PCCDP) for BSW. The PCCDP builds on existing BSW strategies, including the BSW Together Integrated Care Strategy and Implementation Plan as well as national policy and guidance.

This delivery plan also incorporates feedback from over 40 stakeholders including primary care GPs, integrated care board (ICB) members, the clinical oversight group, and the integrated community-based care (ICBC) programme.

It sets out a number of priorities to deliver transformation for primary and community care and reflects the engagement work completed with service users, providers and wider stakeholders to identify initiatives and solutions to deliver our ambition.

Winter planning

As our health and care system continues to experience unrelenting demand challenges and operational pressures, we are continuing to work with our partners to deliver existing demand management and capacity improvement plans.

Operationally there continues to be significant joint working in the locality under our Home is Best  ...  view the full minutes text for item 37.

The Assistant Director for Strategy, Transformation & Governance introduced this item to the Panel and highlighted the following areas from the presentation.

Community Services Transformation Programmes Structure

Programme One - ASC Redesign & Community Partners

Programme Two - Public Health

Programme Three - Community Based Integrated Care (B&NES)

ASC Transfer of Services (approx. 240 staff)

Key cabinet decision made on 10th November 2022 to transfer services:

4 departments involved in the transfer.

·  ASC Social Work Functions (PD01)

·  Direct Payments (SD23)

·  Learning Disabilities Social Work Functions (SD43)

·  Learning Disabilities Provider Provision (SD43)

Enabling Workstreams

Workstreams - reporting to Programme One Board

·  HR & HR Operations

·  IM&T, Systems, Reporting and Information Governance/Data Protection

·  Finance & Procurement, including transactional activity sub-groups

·  Communications and Engagement

·  Operational Redesign

Governance and Assurance

·  Monthly Lead Member Briefing

·  Monthly Trade Union Briefing

·  Regular updates to CMT and SLT

·  Internal Audit July to Sept - Level 4 Substantial Assurance

Informal HCRG Care Group staff briefings

·  Two informal staff briefings sessions held May and June (Adult Social Work Teams and Provider Services)

·  Focus of sessions included Transfer of Undertakings (Protection of Employment) - TUPE and what is means for individuals.

·  Next sessions booked in November 2023

Key Milestones and Achievements

·  Confirmation of all Terms & Condition’s (T&C’s) – Sirona, Agenda for Change, Local Government and HCRG Care Group

·  Commencement of the payroll build of T&Cs – September 2023

·  Creation of seven workstream groups – corporate enabling functions

·  Confirmation of all Information Technology equipment requirements across all teams – tender document for the purchase of required equipment drafted – September 2023

·  Ongoing due diligence – HR, finance, estates, provider activities, staff training

·  Creation of a communications and engagement strategy – workforce, service users & stakeholders

Next Steps & Key Milestones

·  Setting the operational budget for service delivery

·  Review of mobilisation costs

·  Continued due diligence across Programme One

·  Completed review of estates and premises

·  Completed review of day services activities – how services operate

·  Formal consultation with HCRG Care Group staff

Internal Audit – ASC Transfer Governance and Programme Management (draft report Sept 2023)

Level 4 – Substantial Assurance – The systems of internal control are good with a number of strengths evident and substantial assurance can be provided as detailed within the Assurance Summary.

Governance Update & Next Steps

Programme 1 ASC Transfer & Community Partners and Programme 2 Public Health

·  B&NES Cabinet 9th November – Update on progress with ASC Transfer and decisions to be taken on model for delivery of services as of April 2025 covering Community Partners and Public Health and decision to participate in ICBC procurement process for Community Health (BSW).

·  Proposal to come back to Scrutiny Panel after November 2023 Cabinet decision on future operating model for community services for B&NES.

The Director of Place, Bath and North East Somerset, BSW ICB addressed the Panel.

1 Year Direct Award 2024-2025 – HCRG Care Group (B&NES)

·  Single Member Decision implemented 26th July 2023 to endorse the proposal for an interim 1 year arrangement for commissioning of the Community  ...  view the full minutes text for item 38.

The Chair asked for clarification as to why no member of the Scrutiny Panel had been asked to take part in the Peer Review.

Councillor Alison Born commented that the Peer Review was carried out as inspections from the Care Quality Commission (CQC) were due to commence in January 2024. She added that the full Peer Review report was due to be available to be published very soon.

The Assistant Director – Operations introduced this item and highlighted the following areas from within the presentation. She explained that this information was being shared with the Panel in advance of the publication of the full report.

She stated that the Local Government Association (LGA) has been providing this service to Local Authorities in advance of the expected future inspections. She added that Scrutiny Panel and the Health & Wellbeing Board are not normally involved within this LGA Peer Review process.

Key Messages – Strengths

·  Well led organisation with a positive workforce culture built upon mutual respect and values.

·  Clear corporate purpose with strong political and corporate leadership in supporting Adult Social Care

·  Kind, collegiate, generous staff “we don’t keep a good idea to ourselves”

·  Self-aware – no surprises and plans in place to address some of the challenges as reflected in the Self-Assessment

·  Partnerships and strong relationships

Key Messages – Considerations

·  How systems, processes and data are used to best effect to inform practice and performance oversight

·  Opportunities for further development of practice and oversight through simplification of structures and insourcing plan

·  Ambitious plans with many strategic and operational initiatives planned in next 6 months as part of longer-term plan

·  To support delivery of plans may wish to consider the range of support and advice that is available externally as well as internal resource required

·  Co-production

CQC Assurance Themes

·  Working with people

·  Providing support

·  Ensuring safety

·  Leadership

Case File Audit Findings – review of 6 cases

Strengths

·  Safeguarding – Evidence provides reassurance that people are being kept safe and that risks are appropriately identified and managed Robust and well recorded Safeguarding Adults Management (SAM) oversight including clear actions as well as timeframes for the completion of actions. Well written and proportionate safeguarding minutes.

·  Learning Disabilities – Very clear evidence of relational practice, taking a person-centred approach and working beyond the boundaries of the Care Act.

·  Approved Mental Health Practitioner (AMHP) - Evidence of skilful recording which provides a strong sense of who the human being is balanced with the process, legal literacy and professional opinion.

Considerations

·  Safeguarding – Although there was evidence that people were being involved in safeguarding and that their views were taken into consideration, principles of Making Safeguarding Personal could be further developed and evidenced in the way practitioners record.

·  Mental Capacity – More focus is required on Mental Capacity Act and the consistent application of the fundamental principles underpinning legislation and practice. The gravitas of decisions around mental capacity must be given due consideration. Greater consideration of involving Care Act Advocates and Independent Mental Capacity Advocates when appropriate  ...  view the full minutes text for item 39.

This report is an opportunity to explore and consider the issues and the responses currently in place to support both the wider Care and health workforce in B&NES and specifically the workforce related to the provision run directly by the Council.

The Senior Commissioner, Community Transformation introduced the report to the Panel. She said that she hoped that it contained within it enough information to give them an understanding of both the services that the Council runs and those that it commissions.

Councillor Michelle O’Doherty asked how sustainable it was to have roughly a third of the workforce over 55 years of age and if it was known why there was a low uptake of staff, only 33%, who have a care qualification. She stated that she would like to see it made more of a highlighted career and would welcome the Panel discussing the issue in more detail at a future meeting.

The Senior Commissioner, Community Transformation replied that the work that has been carried out with United Care B&NES, jointly the Council and the RUH, has been important and contributed to the level of pay and terms and conditions that are in place. She added that they have also worked closely with their provider organisations on the challenges highlighted in the report.

Councillor Joanna Wright referred to section 3.3 of the report and asked what the hourly rate for home care is that meets the thresholds recommended by the Home Care Association.

The Senior Commissioner, Community Transformation replied that it is £25.42 and that this is a combined rate based on hourly, half hourly and weekend/evening shifts. She added that this was now seen as the Council’s starting point and linked to our ‘Fair Price of Care’.

Councillor Wright asked if any further comment could be given on the creation of the BSW Academy Domiciliary Care Steering Group.

The Senior Commissioner, Community Transformation replied that the Director of Adult Social Care has led this work alongside the ICB to investigate the concerns and challenges particularly for domiciliary providers. She added that around 12 months ago, following Covid and Brexit, it was very difficult to find domiciliary care provision. She explained that Dr Sarah Green is leading this brief across the ICB to look at how the workforce can be supported under Suzanne Westhead’s leadership.

Councillor Wright asked if the work of the Steering Group has proved useful.

The Senior Commissioner, Community Transformation replied that it has and has enabled a range of opportunities to discuss their challenges. She added that there is a high degree of staff turnover to contend with and that this can sometimes add to the issues connected with additional training.

Councillor Wright referred to section 6 of the report, Risk Management, and said she was concerned about the issues mentioned within it.

The Senior Commissioner, Community Transformation replied that she wanted to highlight these issues to the Panel as the number of older people needing care is increasing year on year and the funding associated with that is not likely to keep pace. She added that most of the staff are on the minimum wage for what is a skilled role. She stated that good terms and conditions need to be in place for  ...  view the full minutes text for item 40.

This report presents the latest workplan for the Panel. Any suggestions for further items or amendments to the current programme will be logged and scheduled in consultation with the Panel’s Chair and supporting officers.

The Chair introduced this item and noted that the following subjects had been raised during the course of the meeting.

·  Invite the Chair of the B&NES, Swindon & Wilshire ICB to a future meeting.

·  School Meals (Provision / Cost / Free School Meals take-up)

·  Sustainable Care Workforce

·  Dental Health

·  Pharmacies

·  Children with complex needs

·  EHCPs (focus on time to access / delivery in place)

·  Role of the ICB SEND member across B&NES

·  Community Resource Centres consultation

·  Adult Social Care self-funders