Agenda item

This reports intention is to update Children’s and Adults Health and Wellbeing, Policy Development Scrutiny Panel on the progress to date on transformation of Adult Social Care.

Councillor Alison Born, Cabinet Member for Adults introduced the report to the Panel. She explained that the intention of the Plan was to bring services in line with best practice across the country.

She said they want to enable our services to make better use of the local voluntary and community services, ensure that we can support people at an earlier stage in their life and to improve access to services.

She added that they were also working on the connections between Children and Adult Services and the transitionary period between the two.

She notified the Panel of the seven workstreams to the Plan:

·  Early Intervention & Community Resilience

·  Optimising the Social Care Front Door

·  Social Care Processes and Interventions

·  Reablement

·  Community Mental Health Services Framework

·  Transitions

·  Redesign Liquid Logic

The Director of Adult Social Care said that work on the Plan began in the Summer of 2021 and elements had already begun to change due to new directives that are being / will be introduced.

She explained that work was ongoing across the service in terms of the Care Bill and Integrated Care System.

She said that the financial reforms will inevitably change their approach further as there will be areas of work that require a particular level of focus. She added that this was in addition to a new assessment framework being introduced by the CQC (Care Quality Commission).

She stated that the biggest area of focus would be on Transitions, in particular young people aged between 14-25, to be able to give them a good journey through this period of their life. She added that this would mean working with the individuals, their families and schools as much as possible.

She said that a robust 3^rd sector provision was in place and that the Council works very closely with them alongside HCRG.

She recommended that the Panel at some point receives a presentation on the new Mental Health Framework provision that is available. She added that workforce was also an issue in this area and the challenge therefore to have the right people in the right place.

She said that there was an intermediate care focus to reablement through the use of physiotherapists and occupational therapists and that the intention is to increase patient flow through this area where possible.

She said that she felt that a good start had been made but it was acknowledged that there was plenty of work still to do.

The Chairman said that he felt that it was not a comfortable position to be in having to find savings of £4m over the next three years alongside the changes that have been outlined.

Councillor Liz Hardman asked how the savings will be achieved, if at all, given that the report highlights rising care costs and social care reforms.

The Director of Adult Social Care replied that a three-year financial strategy had been agreed in November 2021 and that they have worked very hard to make sure that people are not adversely affected as a result of these decisions.

She explained that discussions were underway regarding the £500,000 saving identified for the Learning Disability Pool Review and to recognise the increasing needs and complexities of the client’s that are funded from this. She added that this will recognise the appropriate funding split for the client’s needs rather than the current split of 23/77 (Health/Social Care) applied to all. She said that if a ratio of 50/50 is achieved then this would see this saving realised.

She gave a recent example of a transition from Child to Adult Services where through assessing different forms of provision and discussion with the family concerned the costs were able to be reduced by 50%.

She stated that work was already underway for the expansion of the Supported Living Service and to bring individuals back into this process and to live more locally.

She said that currently £1m had already been identified as savings that could be achieved this year.

Councillor Hardman asked why the decision on whether the contract will be extended with HCRG Care Group for the delivery of community health and adult social care in B&NES could have a significant impact on the delivery of transformation in adult social care services in the future. 

The Director of Adult Social Care replied that officer time and resources involved in the HCRG discussions is detracting from work they could be doing in relation to the Transformation Plan.

Councillor Hardman referred to Reablement and commented that the aim of the transformation project is to deliver improved flow across the B&NES system, to reduce the ongoing pressure within health and social care reducing delays in discharge from hospital. She asked how this will be achieved in the context of a shortage of carers.

The Director of Adult Social Care replied that a great deal of work is ongoing to attempt to increase the workforce locally. She said that they were working with Bath College and Bath University as 50 young people were currently doing Health & Social Care studies and were looking for placements.

She stated that the RUH and HCRG were also working on a joint approach with regard to the international market, such as the Philippines and Mexico to recruit extra resources. She added that they were also seeking to upskill current staff through a paramedic approach to training.

The Chairman asked if the 50 young people was an exceptional figure.

The Director of Adult Social Care replied that she was not sure but that it was important to be able to find these placements for them so that they are able to gain vital experience in the RUH and community services. She added that the challenge would then be to retain their services locally long term.

Councillor Hardman asked if it were known which of the Transitions options presented was likely to deliver the objective of ensuring a seamless pathway for all young people with complex needs transitioning to adulthood.

The Director of Adult Social Care replied that the appraisal was nearly complete but that no clear winner had yet been identified. She said that they would be able to feedback on this in due course once discussions had taken place with individuals, their families and the professionals involved.

Councillor Gerry Curran said that it was important to begin talking about the transition process from an early age, possibly 14, so that the right information is gathered. He felt that it was important that this process includes talking to the Disabled Children’s team within the Council and staff from within the Special Needs Schools.

He added that he supported the move to find placements for the 50 young people from Bath College / Bath University as it not only gives them vital experience, it provides our system with additional support.

Councillor Joanna Wright asked why savings of this nature had not been made before if it is so easily achievable.

The Director of Adult Social Care replied that it was not an easy process to go through, but that it had been almost a constant process for the last 4 – 5 years to look at ways in which services can be delivered more efficiently.

Councillor Wright asked for further comment on the proposal to redesign Liquid Logic and asked if consideration had been given to using Microsoft Pathway through Adult Social Care system.

The Director of Adult Social Care replied that Liquid Logic was the preferred records keeper and that a detailed procurement process would have taken place prior to its installation. She added that it was felt that this was a more intuitive system for staff to use.

She added that they were now looking to make adaptions to it to improve it in light of the new areas of work that are incoming, re: finance and reforms. She said that Liquid Logic also had the ability to bridge across to a system that is used by the Mental Health team.

Councillor Wright gave an example from when a family member was in receipt of care and the lack of a constant record within the system which meant having to have the same conversation on different occasions with the district nurse, doctor and Sirona.

The Director of Adult Social Care acknowledged that this is an area that does require improvement and said that the hope was that through the digital work of the ICB (Integrated Care Board) this would get better.

Councillor Wright asked if further conversations were required over future use of the capital budget to make sure investment in IT is at its required level.

The Director of Adult Social Care replied that work on the Integrated Care Record was underway which will allow the RUH and Community Services to be able to share patient details. She added that they would then need to ensure that the connection could be made to GP surgeries.

Councillor Paul May commented that in future reports he would like to see more detail with regard to the implications on people / outcomes alongside the priorities that have been outlined.

He also asked about Thrive, which he understood was a universal system to help support young people and wanted to know how that fed into any Transitions work.

The Director of Adult Social Care replied that for future reports they could look to include the experience of individuals, their outcomes and case studies. She added that she would recommend that the Panel receives a presentation on Mental Health at a future meeting to see how Thrive fits into the current work.

Councillor Andy Wait asked if the reason for the amber rating for the Community Mental Health Framework was mainly due to a staffing / workforce issue. He also asked if the RAG ratings definitions could be supplied to the Panel.

The Director of Adult Social Care replied that she would reply in writing on the RAG ratings definitions and ask that they be circulated to the Panel. She added that there is a struggle to recruit and retain staff within Mental Health Services and that this was coupled with an increasing demand for these services.

Councillor Ruth Malloy asked to what extent was the Council going to need to rely on the voluntary sector to provide help with Social Care.

The Director of Adult Social Care replied that the third sector within B&NES was very well developed. She said that MIND were working with AWP and the Council on a new community approach model to Mental Health. She added that resources were in place to support ongoing work with the third sector.

Councillor Malloy asked if on an informal level was there anything in place in terms of using groups such as resident’s associations, churches and the home library service to keep in contact with older people who might be feeling isolated in their homes.

Councillor Alison Born replied that Age UK were commissioned locally and they do community work around befriending and building up social networks. She added that churches do also play their part in this area. She said that the third sector work was currently within the HCRG contract and therefore linked into our community services.

The Director of Adult Social Care said that a good example of their work was within the Wellbeing Hub and that it has the ability to provide a great deal of information regarding services through the Community Agents.

The Panel identified the following focus points for next update report:

·  Savings – progress / any effect on services

·  Individual experiences / case studies

·  HCRG

·  Community Mental Health

·  Survey of individuals receiving care

·  IT support / resources

The Chairman commented that it could well be best to have an updated report on the seven identified workstreams that also includes a focus on the points raised by the Panel.

The Director of Adult Social Care replied that she felt a timely update would be able to be given in six months from now – October 2022.

The Panel RESOLVED to;

(i)  Note the content of the report and identified the areas of focus mentioned above for the next update report due to Panel.

(ii)  Agree the reporting frequency into Panel of every 6 months for oversight of the progress made with Adult Social Care Transformation Plan.