Agenda item

This report provides an update on the national legislative, policy and regulatory context that the Adult Social Care service currently operates in. It also describes key strategic activity taking place in 2022/23, alongside an overview of finance, performance and risks based on delivery in quarter four of 2021/22.

The Assistant Director for Integrated Commissioning introduced the report to the Panel and highlighted the following areas from within it.

The national picture

The Health and Care Act received royal ascent on 3rd May 2022 and laid down legislative foundations for an ambitious programme of national reform of Adult Social Care.

The Build Back Better programme aims to create a sustainable adult social care system that is fit for the future. It introduces new charging reforms for people who use social care and brings new statutory duties for local authorities. The programme has entered first phase of implementation, which means we will need more social workers, more financial assessors, and a new system to help ensure we support more people financially from April 2023.

Liberty Protection Safeguards (LPS) – a framework that will replace the Deprivation of Liberty (DoLs) – has now finished its parliamentary journey. Liberty Protection Safeguards will apply to everyone from the age of 16 years. While DoLs applies only to people in care homes and hospital, LPS will apply to people in supported accommodation, shared lives, and their own homes. New code of practice is currently out for public consultation until 4th July 2022. Government confirmed its intention to set a new fixed date for Liberty Protection Safeguards implementation post consultation to ensure that there is adequate time for implementation.

New Care Quality Commission (CQC) inspection regime for Adult Social Care (also referred to as Assurance framework) is expected to mirror the Ofsted inspection process and will begin in April 2023. The Adult Social Care Outcomes Framework that is being currently used to measure and compare performance of local authorities has been refreshed and is expected to be implemented alongside the new assurance framework. This means that we would need to have new performance management systems in place, with greater use of Business Intelligence tools, and develop more mature capability to evaluate customer experience, and evidence outcomes and impact at an individual, locality and system level.

The local picture

Health and Social Care Integration to join up care for people, place and population is continuing at pace nationally and locally. On 1st July 2022, the Banes, Swindon, and Wiltshire (BSW) CCG will be subsumed into the BSW Integrated Care System.

Recruitment to senior leadership posts in the new system is well advanced, with anew team of senior leaders joining over the next two months. New governance

arrangements, such as the Integrated Care Board and the Integrated Care Alliance are beginning to take shape, with system partners frequently coming together to collaborate to develop new ways of working at place and population level.

Our close working with the NHS and our wider community partners ensures we

continue to promote, maintain, and enhance people’s wellbeing and independence so that they are healthier, stronger, more resilient, and less reliant in the future on formal social care services. Doing this is better for people in terms of their longer-term outcomes and better for B&NES Council to help make funding go further. It is also better for system health partners as it will help reduce hospital admissions and the length of stay, and shift system focus from urgent care to anticipatory and community care.

Financial position

At the end of quarter three of 2021/22 financial year the forecast position for Adult Social Care is an underspend variance of £2.65m. This reflects the reduced number of package placements seen during 2020/21 which continued into 2021/22. Health funding arrangements have been extended to cover the second half of 2021/22 therefore, the impact of the expected demand from the ending of these arrangements has been reduced. These arrangements ended at the end of 2021/22 financial year and discussions have commenced across the health and social care system regarding ongoing requirements in 2022-23.

The final outturn position for 2021/22 is being finalised and will be fully reported in July.

Performance update

Adult Social Care performance is measured routinely and compared annually

between local authorities against a national set of indicators included in the Adult Social Care Outcomes Framework and the annual statutory Short and Long Term (SALT) Support performance report. B&NES SALT report for 2021/22 has been submitted earlier this month. National benchmarking data would be made available later in the year and will be included in future updates.

The service also routinely monitors its performance across a range of operational indicators, four of which form part of the strategic indicators reported to Cabinet monthly. Quarter 4 performance against these indications shows positive performance against the safeguarding and admissions to care homes measures, with variable performance against the reablement and reviews measures.

Risks

Adult Social Care service is facing several significant risks:

The impact of the pandemic has increased pressure on funding. Some of the pressure was mitigated by additional government funding but this ended in March 2022. However, some of the consequences of the pandemic have increased current financial pressures. Some of this increase may be temporary but underlying pressures are expected to build because of demographic changes, the long-term impact of COVID-19, rising care costs and the impact of Social Care Reforms.

The service is continuing to face persisting challenges in terms of our ability to attract, recruit, develop and sustain enough staff across a range of key roles, such as social workers, occupational therapists, Best Interest Assessors, financial assessors, and administrators. Local challenges are replicated across the health and social care system, and mirror national and, for some roles (i.e., therapists), international challenges. These skills shortages are one of the biggest challenges we face in providing a high quality and timely response across the health and social care system.

There is a risk that the service won’t have sufficient resources, time, and capability to prepare for and implement several strands of the Social Care Reforms simultaneously.

These risks are being mitigated through the work of the dedicated project team leading the preparation for the Building Back Better reforms and the process and system re-design projects that are delivering improvements to the adult social care case management and financial systems.

The Chair commented that the scale of work involved was clear for all to see. She asked how risks are being managed.

The Director for Adult Social Care replied that the service has a risk register which is reviewed on a regular basis. She added that this could be shared with the Panel when the next version of the update report is published.

Councillor Liz Hardman asked to what extent will the local authority be unable to deliver several strands of the social care reforms, given the limitations set out in the report and what are the main areas that are at risk.

The Assistant Director for Integrated Commissioning replied that priorities are being assessed weekly and that the Council has done some technical commissioning to attempt to plan ahead to enable resources are available.

She added that things such as the Care Quality Commission (CQC) inspection would have to take place no matter what and said that if the Liberty Protection Safeguards work was brought forward it would be a real challenge in terms of recruitment.

The Director for Adult Social Care said that a focus on business as usual remains in place alongside plans to develop the new model of Community Health & Care services. She added that some additional resources will be available nationally through the Government for work within Build Back Better.

Councillor Paul May said that alongside the dashboard he would have welcomed a form of knowledge statement that could give a commentary to the data that was shown. He also asked what the reaction from HCRG had been following the decision made by Cabinet.

The Director for Adult Social Care replied that reaction had been mixed, with some staff delighted at the decision and members of the management team being surprised. She said that she was also aware of some anxiety among staff.

She added that she was aware that HCRG had issued a statement regarding the decision and called on staff to continue their good work and to keep our services safe.

She said that Councillor Born meets with the Managing Director regularly and that extra resources have been put in place in respect of contract management.

Councillor May asked what impact Discharge to Assess will have on the contract.

The Director for Adult Social Care replied that funding for Discharge to Assess was set to continue for a year locally and that they were working on plans for the future.

Councillor Ruth Malloy asked which Universities were involved in the BSW Academy.

The Director for Adult Social Care replied that both Bath Universities were involved and that recently Dr. Sarah Green had been appointed BSW Academy Director. She added that there was to be an initial focus to recruit, retain and train the Domiciliary Care workforce and that an intern service was being provided at the RUH.

She said that further information on the Academy could be provided in a future report and that possibly Dr Green could be invited to attend.

The Chair stated that she liked this format of reporting and looked forward to the next version that would include the Risk Register and information relating to the BSW Academy.

The Panel RESOLVED to note the content of the report.