Agenda item

This report provides an Adult Social Care Service update to the Panel on ASC performance measures, ASC commissioned services, ASC provider services and the report also includes an update on Public Health and the Community Wellbeing Hub.

The Director of Adult Social Care addressed the Panel and highlighted the following points from report.

Performance – December 2024

·  The latest National Adult Social Care Outcomes Framework (ASCOF) data was published 1st January 2025. Of the 22 National measures B&NES performs better than the England average in 17 measures, better than the South West average in 18 measures and we are in best quartile in the country for 12 measures.

·  The number of people with long-term services funded by Adult Social Care (ASC) at the end of December 2024 was 1,844. This was an increase of 26 on the previous figure of 1,818 as of December 2023. The service has completed 688 Care Act Assessments and 53 Carers Assessments in the last 12 months. 80% of Care Act Assessments lead to a service being provided to the individual.

·  Occupational Therapy assessments continue to be a focus of high demand, receiving on average 85 new requests per month, robust management has seen the numbers waiting for assessment reducing from 247 people waiting to 201 people waiting, with 137 people waiting for an assessment from an Occupational Therapy Aide and 64 people waiting for an assessment from an Occupational Therapist; this is the lowest figure for 12 months. All referrals are risk rated and prioritised accordingly and people waiting have a point of contact should their needs become more urgent.

·  Our Mental Health teams continue to experience increased demand of approx. 10% more referrals month on month. Between April 24 and September 24, we received 244 referrals for detention under the Mental Health Act, with 197of those referrals accepted by the Approved Mental Health professionals for a full assessment. The AMHP team works with people of all ages, although the numbers remain relatively low in comparison with other age groups, we have seen a 50% increase in requests for under 16s to be detained under the Mental Health Act in the last 12 months.

Commissioning

·  On 11th November, the Council introduced a Strategic Commissioning Hub that has oversight and responsibility for implementing a new all-age commissioning model across the Early Help, Special Education Needs, Children and Adult Social Care portfolios. This strategic initiative is aimed at improving efficiency, standardising commissioning processes, and enhancing service delivery for the residents of B&NES. The design for a single team was based on 5 core principles; Start Well, Live Well, Age Well, Commercial and Quality Assurance.

Newton House

·  Newton House is a 5-bed house in Twerton owned and operated by Dimensions. It provides residential respite for families of adults with learning disabilities and/or autism, also known as short breaks. In January 2024 Dimensions identified that the service had become financially unviable. Following a review by the commissioning team, Dimensions decided to change the service provided at Newton House and sent a joint letter to families of the current service users advising of the planned change of use from February 2025. This was an error because alternative provision had not been identified for all of the 22 existing service users, so the change of use has been put on hold while that work is done.

·  In December the Council wrote to families to reinforce how important it is that families can access respite, and to offer reassurance that the council will work with Dimensions to ensure continued access to the current arrangements at Newton House until alternative arrangements, for those people who need them are in place. Following the letter to families, Dimensions confirmed that bookings for the service will continue until the review of each person is completed.

·  While this work is underway, Newton House will continue to provide a respite service whilst alternative options are put in place. Of the 22 people who were using Newton House, three have moved into long term care so no longer require respite. 14 people have had an alternative respite offer identified. No decision will be made about the future of this facility until suitable alternatives are in place for the families affected.

She thanked the public speakers for attending and addressing the Panel and said that in addition to the update, Dimensions have been asked to arrange a meeting for all the affected families to attend. She said that she wanted to find the right approach for all concerned.

Adult Social Care Provider Services

·  ASC have a large provider service, which includes Care Homes, Extra Care Housing, Learning Disabilities Day Services, Supported Living, Shared Lives and Employment Services.

·  From September 2024, management of the Care Homes and Extra Care Housing moved from the Assistant Director of Operations & Safeguarding to the Assistant Director of Adult Regulated Services and Governance.

Community Partners

·  The Council continues to deliver a programme of recommissioning of community support services provided by B&NES third sector across Early Help, Housing, Adult Social Care and Public Health portfolios. Commissioning intentions have been developed and informed through ongoing collaboration with community partners and market engagement events.

Becky Brooks, Director, 3SG addressed the Panel. She said that a good working relationship had now been established with the Council and that they have listened to the concerns raised by the sector.

She added that it was important now to have a timeline in place so that the organisations concerned are able to plan, in terms of staffing, leases, budgets and pay.

She explained that one further meeting is planned to be held prior to the procurement process and that the Director of Public Health and Executive Director of Place, B&NES, BSW ICB have been invited to attend.

She stated that the sector will need to understand how decisions are made and for the regular dialogue to continue. She added that they remain concerned about the amount of savings required and frustrated by the Government regarding the impact that the increase in National Insurance contributions will have on the 3^rd Sector.

Councillor Liz Hardman stated that she did not feel that the issues around Newton House had yet been properly addressed. She said that many families require this respite service and that it should remain open.

The Director of Adult Social Care replied that she was not in a position to give an assurance that there would be no changes to the current arrangements and that a meeting with Dimensions was planned to take place later in the month. She added that she would attend a future meeting of the Panel and provide them with an update.

Councillor David Harding said that a timeline of how this decision was reached, and the possible next steps was required and suggested whether it would be appropriate for a representative from Dimensions to attend a meeting of the Panel. He added that if the service is being underutilised then efforts should be made to see which families would benefit from using it.

The Director of Adult Social Care replied that there was no future timeline at this stage as discussions were ongoing.

Councillor Joanna Wright commented that she felt that the public were not being listened to on this matter and said that those in receipt of the service currently should be asked what more is needed. She asked that the Cabinet Member for Adult Services and the Director of Adult Social Care return to the Panel with more detail.

The Director of Adult Social Care replied that they would bring a timeline back to the Panel. She added that she has heard the comments today that there is more demand for the service and would welcome service users involvement in potential future discussions.

The Chair asked that the Panel receive a report from Adult Social Care detailing the respite services that are available within B&NES.

Councillor Wright referred to section 3.2.6 of the report and the fact that 85 new requests for an Occupational Therapy assessment are received per month. She asked what was being done to review the level of staff required in this work area.

The Director of Adult Social Care replied that there has been a decrease in these numbers since April 2024 and that this area was very much part of the prevention agenda as those that do receive Occupational Therapy in a timely manner do benefit and are less likely to require further services.

The Assistant Director for Operations & Safeguarding added that they have made an investment in 2 Occupational Therapist apprenticeships and were looking at further ways to bring in support to help reduce the backlog. She added that a review of patient pathways was ongoing and that additional resources have been allocated to our first response team.

Councillor Wright asked if the ICB were involved in this work as it was known how important it is for people to stay at home for longer if possible and transfer back to home from hospital.

The Assistant Director for Operations & Safeguarding replied that the Reablement Service has access to its own Occupational Therapists and equipment and therefore they do not see the same level of delays.

Councillor Wright referred to section 3.3 and asked if an explanation could be given for the term ‘commercial assurance’.

The Director of Adult Social Care replied that they have identified that further work needs to be done within the sector around having additional commercial expertise in order to increase the quality of service and decrease the price.

The Head of Commissioning added that they have reorganised their available resources in order to make sure that they have dedicated officers who can strengthen the relationship with the providers they use. She explained that it remains financially challenging and that every amount of the allocation from Government is invested in the sector.

She added that there is a strong, technical focus to their negotiations and that Quality Assurance is so important to both service users and staff.

Councillor Wright referred to section 3.6.5 and the remaining Public Health contracts and asked how the Council were making sure these services continue to run whilst this re-procurement was ongoing.

The Director of Public Health replied that the procurement process does take time but the majority of the contracts mentioned in the report will be decided through the Direct Award process which is quicker. She added that sufficient time has been allocated for those contracts that do need to go through the competitive process. She said that throughout the process they have been working with the local Medical and Pharmaceutical Committees.

Councillor Wright urged the local members of the Labour Group to contact representatives of the Government to reiterate the effect their decision on National Insurance contributions is going to have on charities and Local Authorities.

Councillor Lesley Mansell said that she was horrified to hear the accounts this morning from the public regarding the provision at Newton House. She said that if Dimensions had first raised viability concerns in January 2024 why were the Council not made aware earlier.

She said that if the service is being underutilised then more should be done to advertise it. She asked that officers make sure that an Equalities Impact Assessment is completed as part of the decision-making process.

The Director of Adult Social Care replied that the commissioners of the service were aware of the concerns from Dimensions in January 2024. She added that she welcomed the opportunity to review the options for respite offered locally. She stated that an Equalities Impact Assessment would be carried out as part of this process.

Councillor Mansell requested that any future report to the Panel regarding respite should detail how the procurement process works.

Councillor Hardman asked the Director of Adult Social Care if she was aware of the potential change of use decision by Dimensions in January 2024.

The Director of Adult Social Care replied that she was not. She added that the Cabinet Member and her now receive monthly briefings so that they are notified of any such changes. She said that the commissioners would have been working within the policy and the budget framework which is why it had initially not been raised with her.

Councillor Hardman asked if the Strategic Commissioning Hub mentioned in section 3.3 could be confused in any way with the Community Wellbeing Hub and was there any overlap in this work.

The Head of Commissioning replied that she could supply the Panel with a separate briefing if required. She explained that five teams have been brought together to act as one to give flexibility to be able to respond to both local and national pressures. She added that the Council is a partner of the Community Wellbeing Hub and continues to provide investment and commission direct support through the Hub.

Councillor Hardman commented that it was good to hear that dialogue between the Council and the Community Partners had improved. She asked though what was the status of the previously proposed £802,000 cuts.

The Director of Adult Social Care replied that they hoped to establish a procurement timeline within this month. She added that she had been able to use some additional funding from the Department of Health to alleviate some of the pressure.

Councillor Ruth Malloy referred to section 3.2.5 and asked how frequently a review should be carried out.

The Director of Adult Social Care replied that a review should take place at least annually and that for some people it might be 3 – 4 times a year if their level of needs change.

Councillor Malloy referred to section 3.6.2 and asked that if there are to be ‘named health visitors for families with children up to the age of 4 and a named school nurse for each secondary school’ what arrangements are in place for primary schools.

The Director of Public Health replied that there was a smaller group of school nurses that are supporting a cluster of primary schools.

Councillor Malloy commented that she would be interested to see the Council’s plan for future respite services and said that options need to be considered for when the parents of a person requiring support become too old to look after them. She added that she would like the option of whether Newton House could have a flexible use of short / long term care to be explored.

The Director of Adult Social Care replied that a review of respite services for younger people, working age adults and older people would take place to make sure that we are able to manage the demand.

Councillor Alison Born, Cabinet Member for Adult Services added that regarding the older age parents of service users, this was something that they do need to have a better plan for and were looking into.

Kevin Burnett referred to section 3.2.1 and asked how the performance figures compare now with ones prior to the service coming back in house. He also asked for an update on how staff currently feel with regard to decision making / flexibility.

The Director of Adult Social Care replied that the biggest improvement is regarding reablement and the quality of it which has seen around 90 less days of people needing to return to hospital.

She added that where improvement was still required was the number of people who choose to have a direct payment.

She said that in terms of staffing that the majority of those that have moved across from HCRG have been offered B&NES terms and conditions and a consultation is about to begin on that. She added that some staff do struggle with the decision making processes of the Council by comparison.

Kevin Burnett referred to section 3.2.7 and asked if there was a reason behind a 50% increase in requests for under 16s to be detained under the Mental Health Act in the last 12 months and what actions have been taken to support this area. He added that around 20% of referrals were not accepted for a full assessment and asked what then happens for those people.

The Director of Adult Social Care replied that there had been a consistent increase in mental health numbers post the Covid pandemic. She added that their commissioning intentions are clear and follow the guidance of the Care Act and that they were now finalising this in order to make sure that nobody should be allowed to fall through the gaps.

The Assistant Director for Operations & Safeguarding added that there were some common themes and that a thematic review has been agreed to be carried out on behalf of the Community Safety Partnership to particularly look at needs of young females. She added that for the 20% of referrals that are not accepted they are referred to other services and supported by other teams.

Kevin Burnett referred to section 3.5 and asked if the Council were at a point where they know what services they want to commission, if any have been removed, and if so, what the knock-on effects will be.

The Director of Adult Social Care replied that a further meeting was due to take place on 28^th January and that it was vital that we receive that information from 3SG.

Kevin Burnett asked if having a named school nurse for each secondary school would be a new way of working for the local Multi Academy Trusts.

The Director of Public Health replied that there has been no response that she is aware of from the Multi Academy Trusts regarding this point.

Kevin Burnett referred to section 3.6.4 and asked what work Everyone Health Ltd were going to focus on, was it weight management.

The Director of Public Health replied that they are looking to co-develop some work areas with Everyone Health Ltd and the local communities. She added that where previously issues such as individual weight management interventions have occurred and people had been issued with Slimming World vouchers this would now be replaced by attempting to have a more specific local community solution to help manage their weight more effectively.

Kevin Burnett referred to section 3.7.3 and asked when the two Care Homes that have been identified as ‘requires improvement’ would be inspected again and have the actions identified been carried out.

The Director of Adult Social Care replied that a robust improvement plan is in place and that they have been working on reducing the number of agency staff used within these homes.

The Assistant Director for Adult Regulated Services & Governance added that there is a continuous improvement plan in place that the Director of Adult Social Care has complete oversight of. She added that they intend to continue with unannounced visits from Care 4 Quality on these sites and said that good progress is being made. She said that the plan is discussed on a weekly basis.

Kevin Burnett asked how staff felt about the continuation of the unannounced visits.

The Assistant Director for Adult Regulated Services & Governance replied that it should be seen as part of their inspection preparation process and believed that staff were well supported within this process.

Councillor Lesley Mansell asked that the Panel receive information about what the process is for receiving any reasonable adjustments in school and their expected timescales.

Councillor Mansell asked what interventions were to be introduced to attempt to reduce the number of under 16s requested to be detained under the Mental Health Act.

The Assistant Director for Operations & Safeguarding replied that a piece of work was ongoing between colleagues in Children’s Services and the Community Safety Partnership to understand the pathways into these assessments.

Councillor Mansell referred to the issue of equalities and said that within the report as well as stating that there were no adverse impacts, no positives had been listed either. She added that matter of any protected characteristics had not been addressed.

Councillor Wright commented that the signposting of services and facilities like the Community Wellbeing Hub needs to improve to help our families become more aware of what they could possibly receive in terms of support.

Councillor Alison Born stated that there was information relating to SEND on the Livewell B&NES website and was aware that the Community Wellbeing Hub were looking to expand their services with regard to Children & Young people.

Becky Brooks, Director, 3SG added that she was aware of these developments at the Hub and was looking forward to how the service can be enhanced.

The Panel RESOLVED to note the progress and updates for Adult Social Care.