Agenda item

The Committee considered a report of the Director of Adults and Communities, the purpose of which was to provide the Committee with an overview of the Adult’s and Communities Department’s in-house provision of services which are required to be regulated and inspected by the Care Quality Commission (CQC). A copy of the report marked ‘Agenda Item 12’ is filed with these minutes.

Arising from discussion, the following points arose:

1. Members praised the team who had made astounding savings and had done incredibly well, despite resource pressures, to deliver the service to a high degree.

2. Members noted that no referrals to use the short break service had been turned down.  The service had only reached 40% capacity.  However, if capacity in a particular provision had been an issue one of the other units would be offered as there was a degree of flexibility across the service.
   
   
3. Work was being undertaken to look at short breaks and supported living services. With specific reference to short breaks, officers were looking to see if it would be advantageous for the Council to purchase short breaks from the external market, rather than provide them directly, which would address occupancy issues that came with high fixed costs, such as buildings and staffing. Occupancy was also subject to availability, being affected by the timing of people wanting the breaks, usually during the summer months and at weekends. Occupancy could also be limited by the needs of the individuals being supported, for example, people with complex levels of disability would need specialised equipment which meant only one person could use the equipment at a time.
   
   
4. Another option being considered was the possibility of selling spare bed capacity to other authorities and Health who did not operate their own internal services. A further option would be to offer occupancy to children’s services to consider using the spare capacity as respite for disabled children’s families where premises could be adequately segregated from adults. In addition, when children transitioned into adulthood, they might still require short breaks and could receive them at the same environment. It was expected this work would be completed by the end of the year, and an update would be brought to the Committee.

5. The issue of people being misinformed by partner organisations that the service was free for a six-week period needed to be addressed. Six weeks was generally a maximum period but was non chargeable until an eligible need had been assessed and demonstrated, or people needed to exit the service.

6. A Member raised concern that two venues in Hinckley and Wigston offering the Short Breaks Service had not been reinspected since 2017 and 2019 respectively, although noting both had been rated ‘Good’ at the time.  The Director reported that, although the CQC could be asked to inspect they were under no obligation to respond. Members were informed that an interim report published by Dr. Penelope Dash in July 2024 who had conducted a review into the operational effectiveness of the CQC included a number of comments and concerns particularly with regard to the delay in assessing both health and social care establishments, such as hospitals, primary care, dental care and local authority services. The report included a figure of 3.7years as an average wait for assessment, and 25% of providers had never had an assessment, some of whom were new providers. It was noted that some providers had not been assessed since 2015, and some hospitals and health care providers since 2011. A final report would be published towards the end of September 2024.

7. The rate of CQC assessments had fallen from 16,000 per year pre-pandemic, to around 7,000 post pandemic, with 10s of thousands of providers that required an assessment. Members agreed this was a concern but were reassured that the Authority had regular correspondence from the CQC asking whether anything had changed with a provider (a type of desktop review).  Whilst not a full assessment, the CQC did take a risk-based approach and would inspect if required.

8. It was noted that for the first time the Authority had a provision classed as ‘Requiring Improvement’. Although actions would have been taken to address concerns, that the service would have that label for several years until the next assessment. Members had visited the premises when it had received its rating and had been reassured the concerns raised by the CQC had been addressed and had also received anecdotal evidence from service users and families.
   
   
9. Members were further reassured that internal services had regular updates in respect of quality and performance, and also worked with independent sector providers if particular issues were raised, complaints made, or unsafe practices highlighted. There was also a mechanism to highlight concerns to the CQC or to ask them to reassess a service. Members asked if something could be done to inform Members internally regarding the CQC rating of a particular provider so they could provide assurance to residents if called upon to do so. The Director reported that the process by which local members were briefed when there was a home or service closure, or when a service was rated as ‘Inadequate’ by the CQC could be looked at to potentially extend to cover other concerns provided this did not make the process too onerous.

10. Work was being undertaken to make vacancies more attractive, updating job specifications, and advertising position in different ways and on different platforms. Efforts were also being made to encourage more younger people into the service, including going into schools and making the career pathway as attractive as possible. Another barrier to recruitment had been rural locations of some services which could be difficult for some people to commute to.

RESOLVED:

(a)  That the report on the Leicestershire County Council Adult Social Care Regulated Services be noted;

(b)  That the Director be requested to provide an update to the Committee in March 2025, regarding progress against delivery of the action plan.