Agenda and minutes

The minutes of the meeting held on 2 September 2019 were taken as read, confirmed and signed.

The Chief Executive reported that no questions had been received under Standing Order 35.

The Chief Executive reported that no questions had been received under Standing Order 7(3) and 7(5).

The Chairman advised there was one urgent item for consideration, a report of the Director of Adults and Communities, concerning the Fair Outcomes Policy for Adult Social Care.

The reason for the urgency was that the policy would be considered by Cabinet in January 2020 which was before the Overview and Scrutiny Committee’s next meeting.

With the agreement of the Committee, the report was considered under item 16 on the agenda (minute 50 below refers).

The Chairman invited members who wished to do so to declare any interest in respect of items on the agenda for the meeting.

All members of the Committee who were also district councillors declared a personal interest in the report on the Lightbulb Service (minute 43 refers).

Mr J Miah CC also declared a personal interest in the report on the Lightbulb Service as his mother was a service user.

There were no declarations of the party whip.

The Chief Executive reported that no petitions had been received under Standing Order 36.

The Committee considered a report of the Director of Adults and Communities, the purpose of which was to provide an update on the progress of developing and implementing the Adult Social Care Target Operating Model (TOM). A copy of the report marked ‘Agenda Item 8’, is filed with these minutes, along with the slides that were presented to the Committee.

The Chairman welcomed Stephen Knight of Newton Europe to the meeting for this item.

In his introduction to the report, the Director explained that there had been a change to the number of service users with a learning disability that had moved from residential care to supported living; this had increased to 29 from the 23 which had been stated in the report.

Arising from discussion, the following comments were raised:

      i.         In response to a query it was confirmed that the figures relating to people with learning disabilities in permanent residential care were based on a cohort of around 350 people. A programme to identify those who could move into more suitable accommodation, such as supported living, had already been in place but the work on the TOM had speeded up the process.

     ii.         It was suggested that it would be helpful for members to receive a further breakdown of data regarding older adults in residential care to provide for a better understanding of the statistical variance.

   iii.         It was noted that a proportion of the increased staffing capacity that had been identified through the TOM was being used to make improvements to the service user review and assessment process. New cases were being assessed more quickly and there was a higher rate of reviews taking place for long-term service users. By increasing the regularity of reviews, the Department would be able to monitor service user needs more effectively and respond to any changes to ensure the most appropriate support was in place.  The aim of maintaining service user independence was of fundamental importance.

   iv.         Concern was raised around the level of saving that the TOM was predicted to make and whether the quality of service would be compromised. The Director provided reassurance that the approach being undertaken was not about cutting services but about making improvements. It was important to note that not all savings associated with the TOM were cashable.  It was initially the intention that non-cashable savings would be re-invested back into the Department to improve service quality and customer satisfaction and to provide additional capacity for areas such as service user reviews.

RESOLVED:

(a)  That officers be requested to provide members of the Committee with a further breakdown of the data regarding older persons’ placements into residential care;

(b)  That the update on the progress of developing and implementing the Adult Social Care Target Operating Model be noted.

The Committee considered a joint report between the Director of Adults and Communities and Blaby District Council which provided an update on the Lightbulb Service. A copy of the report marked ‘Agenda Item 9’, is filed with these minutes.

The Chairman welcomed Quin Quinney of Blaby District Council to the meeting for this item.

Arising from the discussion and questions, the following points were raised:

      i.         Whilst service user waiting times were known for installing basic types of equipment; waiting times for installing other more extensive pieces of equipment, such as floor lifts and level access showers, could be more difficult to predict due to their complex and varying nature. To provide greater insight of the process, it was agreed that examples of end to end waiting times for equipment installation and timescales for when equipment was serviced, or repairs were made would be provided to members outside of the meeting.

     ii.         Whilst it was acknowledged there had been an underspend in Disabled Facilities Grant (DFG) funding by a couple of Leicestershire District Councils in 2017/18 – 2018/19, assurance was provided that all seven districts had achieved the 20 weeks target by the end of Quarter 1 2019/20 and performance thereafter was continuing to improve.  The Director undertook to provide members with figures of actual spend for 2019/20 quarter 1.  

   iii.         Changes to the Regulatory Reform Order had provided greater flexibility for local authorities to use DFG funding for wider purposes. However, challenges of spending the funding still remained and were recognised as an issue nationally; there were many contributory factors, including restrictions set by Central Government on how the funding was spent. This was a matter that the Senior Responsible Officers for the Lightbulb Service had raised with Central Government.

   iv.         Members were pleased to note that the partnership between the County Council and the district councils on the Lightbulb Service was successful and that all partners were supportive of the service.  Different partners were leading on different workstreams within the partnership; this demonstrated its strength.

    v.         Occupational Therapy was a key component of the Lightbulb Service. Technical assessments were now being carried out by other officers which had been allowing Occupational Therapists to concentrate on delivering more complex caseloads.

   vi.         In terms of ensuring the work of builders was of the required standard, the Lightbulb Service could assist in obtaining quotes and references, however currently the service user was ultimately responsible for procuring a builder. It was hoped that the development of a procurement framework for builders would provide greater stability for service users, particularly in terms of timeframes and work completion deadlines. Builders buy in to the framework would be essential.

  vii.         It was queried whether consideration had been given to subcontracting a single company to complete building works for service users as other Councils had done, it was confirmed that this option had been considered but at this time the procurement framework had been deemed the most suitable option. Reviews would be undertaken in future as necessary to ensure the best offer was in place for service delivery.

RESOLVED:

(a)  That the Director of Adults and Communities be requested to provide members of the Committee with examples of service user end to end waiting times for equipment installation and for when equipment is serviced, or repairs are made;

(b)  That the Director of Adults and Communities be requested to provide members of the Committee with the figures of actual spend of Disabled Facilities Grant funding for Leicestershire, by District for Quarter 1;

(c)  That the update on the Lightbulb Service be noted.

The Committee considered a report of the Director of Adults and Communities inviting comments on the draft ‘Delivering Wellbeing and Opportunity in Leicestershire: Adults and Communities Department Ambitions and Strategy for 2020-2024’, together with the associated consultation documentation.

A copy of the report marked ‘Agenda Item 10’, is filed with these minutes.

Arising from discussion, the following comments were raised:

i.               In response to a query concerning how people choose to identify themselves and whether there were enough options listed within the survey questions for respondents to select from, it was confirmed that these were standard terms that were ordinarily used by the County Council when in consultation with the public. However, Officers would review the options with regard to this consultation in light of the comments made, to ensure these were appropriately inclusive.

ii.             Members felt that some of the wording within the Strategy, particularly with reference to headings and definitions, could be strengthened and better aligned to the survey questions. It was important that the language used in the Strategy and the associated documentation was as clear and understandable as possible.

iii.            It was suggested that an additional question be included in the survey around service user experience, and what the Council could do to improve experience where this had been unsatisfactory. Officers agreed that a question pertaining to service improvement would be beneficial and that themes emerging from a recent feedback exercise could be used as a point of focus.

iv.            The Committee was pleased to note that the Strategy would be integrated across the department and confirmed that, subject to the amendments suggested above, it supported the questionnaire and consultation.

RESOLVED:

(a)  That the Director of Adults and Communities be requested to consider the language used with respect of the Strategy and the associated survey documentation to ensure this is as clear, understandable and inclusive as possible;

(b)  That the Director of Adults and Communities be requested to include an additional question in the survey with a focus on what the Council could do to improve service user experience where this has been unsatisfactory;

(c)  That the Committee’s comments on the draft Strategy and consultation process be submitted to the Cabinet for consideration.

The Committee considered a report by the Director of Adults and Communities which provided an update on the proposed way forward regarding the re-procurement of home care services. A copy of the report marked ‘Agenda Item 11’, is filed with these minutes.

Arising from discussion and questions, the following points arose:

      i.         The size and number of lots and providers would be carefully considered in relation to each area to enable service requirements to be met equally. It was recognised that the cost of providing care would be higher in rural areas; ensuring that the price of care reflected this was likely to be cost neutral as the majority of care was provided in urban areas.  The quality of care provided would continue to be monitored by the Department’s Quality and Contracts Team.

     ii.         Improvements to staff terms and conditions would be an area of focus. Particular consideration would be given to carer’s remuneration; it was especially important that carers were paid/reimbursed appropriately for non-contact time, including travel, which had previously been highlighted to the Department by way of feedback.

   iii.         The Committee sought reassurance that consideration would be given to the length of the contract and the importance of maintaining stability for providers. It was confirmed that a soft market test would be carried out to carefully assess all of the options available. Service sustainability would be a key priority.

RESOLVED:

(a)  That the update on the proposed way forward regarding the re-procurement of home care services be noted;

(b)  That the Director of Adults and Communities be requested to take the Committee’s comments on the updated approach into consideration as part of the forthcoming re-procurement.

The Committee considered a report by the Director of Adults and Communities which provided an overview of the ‘Transitions – Preparing for Adulthood’ programme. A copy of the report marked ‘Agenda Item 12’, is filed with these minutes along with a supplementary document containing positive feedback examples in relation to the programme, which had been circulated at the meeting.

The Cabinet Lead Member for Adults and Communities, Mr. R. Blunt CC, confirmed he was pleased with the progress the programme had made. This was a challenging area and one which had previously required a lot of improvement. There was still much work to do but the progress made so far was remarkable.

In response to comments raised, it was confirmed that the focus of the programme was the early identification, at the age of 14, of complex, challenging and high-risk young people who would require services in adulthood.

The Committee was pleased to note the work which the Adults and Communities and Children and Family Services Departments had jointly undertaken. The Committee welcomed the update and commended the officers and members that were involved in the process.

RESOLVED:

That the update provided on the ‘Transitions – Preparing for Adulthood’ programme be noted.

The Committee considered a report by the Director of Adults and Communities which provided an overview of the County Council’s Inspired to Care team’s work in relation to the external adult social care workforce. A copy of the report marked ‘Agenda Item 13’ is filed with these minutes.

RESOLVED:

That the update provided on the work undertaken by the County Council’s Inspired to Care team in relation to the external adult social care workforce be welcomed.

The Committee considered a report of the Director of Adults and Communities which outlined the current Care Quality Commission (CQC) ratings within the regulated adult social care services in Leicestershire. A copy of the report marked ‘Agenda Item 14’, is filed with these minutes.

The Committee was advised of an error contained in paragraph 6 of the report. It was clarified that the ‘inadequate’ rating for Community Based Adult Social Care (ASC) in comparator authorities marked as 0% was rated green and not red as had been stated.

Arising from discussion, the following comments were raised:

      i.         The Adults and Communities Department’s Quality and Contracts Team monitored and worked closely with service providers, particularly with areas of non-compliance. Members expressed interest in participating in a Care Home site visit, it was agreed that Officers would make arrangements for the New Year for those that had expressed an interest.

     ii.         In response to comments raised around Care Quality Commission (CQC) service ratings it was confirmed that the Department primarily focussed on improving the most concerning areas i.e. a service that had been rated as ‘requires improvement’ or ‘inadequate’.  Members welcomed this focus but also suggested that there should be a focus on supporting those homes rated as ‘good’ to achieve ‘outstanding’. It was clarified that an ‘unrated’ rating would be given to services that had not yet been inspected by CQC; for example, services that had newly registered. Of the inspections carried out in 2019, thirty-six percent of residential/nursing homes and community- based adult social care required improvement, it was confirmed that this had been based on a relatively low number of inspections. It was also important to note that CQC had changed its assessment criteria, making it more difficult for providers to receive a ‘good’ rating. 

   iii.         Leicestershire had over a thousand fewer residential and nursing care beds available than in comparator authorities. In terms of the perceived competition this could create for County funded residents, assurance was provided that the County Council would continue to invest in residential care to ensure there was sufficient capacity available for those in need.  In addition, the Council’s policy was to enable people to remain independent and in their own home for as long as possible. In the medium to long-term it was expected that, with an ageing population, demand would increase. The Social Care Investment Plan was in part intended to address this gap.  It would primarily focus on supported living and extra care but could also enable investment in residential care.

   iv.         The County Council had recently increased its fee rates and narrowed the gap between funded and self-funded service users.  This had enabled the Council to make placements at its own rates in the vast majority of places.

RESOLVED:

(a)  That officers be requested to arrange a site visit to a Care Home for those members of the Committee that have expressed an interest;

(b)  That the report on the current Care Quality Commission quality ratings within the regulated adult social care services in Leicestershire be noted.

The next meeting of the Committee is scheduled to take place on 20 January 2020 at 2.00pm.

It was noted that the next meeting of the Committee would be held on 20 January 2020 at 2.00pm.

The Committee considered an urgent report of the Director of Adults and Communities, concerning the Fair Outcomes Policy for Adult Social Care.

The report was urgent because the policy was required to be updated in line with legislation and would be considered by the Cabinet at its January meeting which was before the Overview and Scrutiny Committee’s next meeting. A copy of the report is filed with these minutes.

Members welcomed the proposed way forward regarding the forthcoming Policy refresh.

RESOLVED:

That the proposed way forward as part of the forthcoming Fair Outcomes Policy refresh be noted.