Agenda item

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 Adults addressed the Panel, a summary is set out below and a copy of the update will be attached as an online appendix to these minutes.

HCRG

The Council and the CCG continue to work together on the future of the community services contract following the unexpected sale of Virgin Care to Twenty 20 Capital. We met with representatives of Twenty 20 Capital and HCRG on March 29^th to discuss the new owner’s vision for the service and work continues on the revised options appraisal. The options appraisal and recommendations will be discussed by the Panel prior to a decision being made by Cabinet and the CCG ahead of the June deadline.

Update on system pressures and recruitment to Care posts

The local health and care system remains under considerable strain. Shortages in social care capacity continue to have knock on effects on the hospital system and also on ambulance services.

Within the local care home sector 47 residents and 65 staff are currently suffering from Covid.

Good progress is being made on recruitment to the in-house home care service that we are developing in partnership with the RUH. We are hoping to interview the care-coordinator in the next few days so the service should become operational soon. We are also currently seeking new tenders to increase homecare capacity in the area.

As of 6^th April the RUH had 27% of their beds ready for discharge and 72 Covid patients, which required 50 further beds to be closed due to quarantine procedures. 150 staff members were also absent due to Covid.

Staffing Update - Adult Social Care

Two new Assistant Director posts have been created to reflect the current complexity of work in adult social care and the fact that the Community Resource Centre provision has transferred back from Sirona to B&NES Council. Nathalia Lachkou recently moved from Oxfordshire County Council to the AD Commissioning role and we had a very strong field for the AD Operations interviews on Thursday 7^th April.

Debbie Forward is retiring from her senior Commissioning manager role at the end of April, Deborah Wolfson has been appointed as an interim to cover this important work for three months as we interview this week for a permanent replacement.

Future changes within adult Social Care

Build Back Better - Adult Social Care Charging Reforms. This incudes the lifetime cap of £86k on the amount anyone in England will need to spend on their personal care in a residential setting, alongside a more generous means test which is presently an upper capital of £23,250 which will raise to £100,000.

Adult Social Care are preparing for the new CQC inspection framework. It is expected that CQC will share the framework in early summer and the key focus will be on local authorities and integrated care systems with a consistent set of themes, from registration through to ongoing assessment. The CQC assessment framework will go live in 23/24.

The Mental Capacity (Amendment) Act amends the Mental Capacity Act 2005 and received Royal Assent on 16 May 2019. The Department of Health and Social Care (DHSC) has yet to publish details for when the full implementation of Liberty Protection Safeguards (LPS) will need to be in place.

B&NES Wellbeing House

Some concerns have been raised about a recent reduction in service in the Wellbeing House in Bath. The collaboration between Curo Housing and Bath Mind to provide crisis support at the wellbeing house was for a duration of two years, to provide additional capacity during the pandemic. That came to an end on 31 March and the service has reverted back to its original delivery model of a wellbeing retreat managed by Curo Housing from 1 April.

Following an independent review of crisis services, B&NES and the CCG are in the process of tendering for the acquisition and management of a crisis house. We expect to announce the outcome of this process by mid-May.

Englishcombe Lane Site

As part of the ASC Transformation work, we are aiming to bring as many people as possible back from out of area placements which will require the development of specialist accommodation for people with complex needs. This includes the possibility of using the Englishcombe Lane site for a small scale scheme that would provide accommodation for some of our most disadvantaged residents whilst also safeguarding and enhance the Tufa and other ecological features of the site. A meeting has been held with local residents to update them on this potential development.

Councillor Liz Hardman referred to the Future Changes within Adult Social Care section of the report and asked how will charges above the £86k cap be met and is there a danger that there will be a shortfall in what our residential care homes can charge.

The Chairman added that he would appreciate a written answer to be able to give a well informed response to residents who may have queries on this matter.

The Director of Adult Social Care said that a national consultation had concluded on April 1^st and that further amendments were therefore likely and so a written reply would not be easily forthcoming. She added that she hoped to be able to provide some degree of clarity to the Panel in June.

Councillor Alison Born said that payments within the £86k were only in connection to residential care and any previous payments for community care will not be counted. She added it was only the care element of any placement that would be taken into account and that people would therefore be expected to pay their residential costs which would be around £200 a week. As an example she said that if you were paying £1,000 a week for a placement then only £800 would count towards the £86k cap. She added that should people reach the cap and the responsibility transfers to the Local Authority then the expectation is that they continue to pay the £200 if they can afford to.

She added that it was her understanding that the clock will not start in terms of any payments until October 2023.

Councillor Paul May wished to thank Debbie Forward for her work for the Council and asked if she was to be directly replaced or would any structural changes be made.

The Director of Adult Social Care replied that an appointment to the post had been made and that they would begin their role in July. She added that some structure changes would take place underneath this post so that more of a focus can be given to working on Autism support.

Councillor May asked what level of provision would be in place at the Englishcombe Lane site.

Councillor Alison Born replied that the site would be staffed 24 hours a day as the level of need required for the individuals concerned was expected to be complex.

Councillor Andy Wait asked if the figures concerned on the £86k cap based upon paying £800 a week (£1,000 - £200) amounted to two years in a nursing home before not having to pay.

The Director of Adult Social Care replied that the evidence was not in place yet to give a definitive answer as it would depend on the amount of capital the individual in question had, the level of care required and the cost of the home.

She added that the cap only comes into effect on those individuals that have come into care as a result of an assessed need being approved by the Council. She said that some people do however choose to enter a home of their own will.

Councillor Born added that the reforms are going to result in a great deal more work for departments within Adult Social Care.

The Director of Adult Social Care added that additional accounting systems will need to be put in place alongside a system that identifies where individuals are metering up towards the cap and to then offer them further advice. She said that additional staff would also likely be required to carry out assessments, both in terms of health & social care and finance.

Councillor Gerry Curran commented that he welcomed the move to provide complex needs support closer to home and said that it was important to staff the new site with people who have the right skills.

Kevin Burnett asked for confirmation that financial contributions to community support will not count towards the cap.

Councillor Born confirmed that it would not.

Kevin Burnett asked if the current discussions with HCRG were about whether they can fulfil the extension to the contract that was originally granted to Virgin Care – on the same terms and conditions - or is there something else that is being discussed.

Councillor Born replied that the terms of the contract remain the same, that there were concerns about the breach of trust caused by the transfer of ownership and that discussions were ongoing as to whether HCRG has the same values and approach as Virgin Care had shown previously. 

Kevin Burnett asked has access to the Wellbeing House been reduced from 1^st April and if what Bath MIND had brought to the project was now being achieved in a different way.

Councillor Born replied that the original remit of the Wellbeing House had been to focus on crisis prevention but that had been extended during the pandemic to help people in crisis. Additional staffing had been provided through a partnership with MIND. The house has now gone back to the pre-pandemic model, offering support but without 24 hour staffing.

The Director of Adult Social Care added that the Wellbeing House was currently full and that it had been a two year contract awarded through Covid funding that had enabled the addition of a crisis service and that the providers had chosen not to continue with the service as funding ceased.

The Chairman stated that he had visited the Wellbeing House on two occasions and said it immediately ensues comfort which was vitally important to those that visit and stay there. He said that it would be welcome if the service at the House could be provided 7 days a week.

The Director of Adult Social Care replied that the House will resume provision in its original form and that the crisis beds service would be in addition.

Councillor Born said that provision will continue at the House 7 days a week.

Councillor Joanna Wright asked what action could be taken with regard to the 27% of beds that were ready to discharge at the RUH.

The Director of Adult Social Care said that this situation comes down to two key issues, workforce and demand. She stated that they were in the process of increasing available domiciliary care to 1,000 hours a week. She said they were also working with HCRG to increase the use of Community Hospitals for people to use as step down facilities.

She added that the current increase in Covid numbers was also causing a particular challenge.

Councillor Wright asked if any capital budget could be used to fund any interim space.

Councillor Born replied that work has been done to try to provide interim measures with the use of a ward at St Martin’s Hospital, the Care Hotel in Bath and the use of some care home beds as part of a step-down service. She added that capacity does remain an issue due to patients becoming stuck in a particular setting and staffing due to sickness.

The Chairman asked for confirmation that the Care Hotel is a temporary provision.

Councillor Born replied that it was only a short term funded project and was due to close at the end of the month.

The Director of Adult Social Care added that usage of the hotel had actually been quite low for B&NES residents and had been used more by those from Wiltshire. She added that over the past two years £7m has been invested into community services through the Better Care Fund and we need to now make sure that people have a better experience throughout their visits to hospital and coming back out into the community.

She said that workforce numbers and retention remain the big issue and that this was a national problem.

Councillor Wright commented that with the closure of the Care Hotel that will put pressure back on the RUH as it will be their beds that will be used instead.

Councillor Paul May said it was really about the total of resources available across the system and that focus should be put on integrated care from when an individual comes into a hospital and their pathway back to the community.

Councillor Born said that the hope now was that Covid numbers will start to decrease which will lessen demand across the system.

The Chairman thanked Councillor Born and the Director of Adult Social Care for their update to the Panel.