BOROUGH OF POOLE – HEALTH AND SOCIAL CARE OVERVIEW AND SCRUTINY COMMITTEE – 8 SEPTEMBER 2014

BOROUGH OF POOLE

HEALTH AND SOCIAL CARE OVERVIEW AND SCRUTINY COMMITTEE

8 SEPTEMBER 2014

The Meeting commenced at 6.00 p.m. and concluded at 8.43 p.m.

Present:

Councillor Mrs Evans (Vice Chair in the Chair)

Councillors Adams, Mrs Cox, Goodall (substitute for Mrs Hodges), Maiden (substitute for Meachin),Matthews,Mrs Pratt, Rampton, Wilson (6:03pm onwards)and Mrs C Wilson

Also in Attendance

Councillor Mrs Rampton, Portfolio Holder for Health and Wellbeing

Jan Thurgood, Strategic Director – People Theme

David Vitty, Head of Adult Social Care – Services

Phil Hornsby, Head of Commissioning and Improvement, People Services

Natalie Batcock, Project Manager- Strategy Directorate

Jane Ashman, Chair of the Bournemouth and Poole Safeguarding Adults Board

Linda Bolen - Dorset Healthcare University NHS Foundation Trust

Members of the public present: None

HSC30.14APOLOGIES FOR ABSENCE

Apologies for absence were received from Councillors Mrs Hodges, Meachin and Pawlowski.

HSC31.14DECLARATIONS OF DISCLOSABLE PECUNIARY INTEREST

There were no declarations of any disclosable pecuniary interest.

Other Non-Statutory Interest Members wished to be recorded

Councillor Adams declared an interest as his daughter was in receipt of Disability Living Allowance (DLA).

Councillor Maiden declared an interest as his daughter was employed at Poole Hospital.

Councillor Mrs Cox declared an interest as an employee of Lewis Manning.

Councillor Matthews declared an interest as his wife is an employee of a Adult Social Care provider.

HSC32.14MINUTES

RESOLVED that the Minutes of the Health and Social Care Overview and Scrutiny Committee held on 1 July 2014, having been previously circulated, be taken as read, confirmed and signed by the Chairman as a correct record.

HSC33.14ANNUAL REPORT OF THE CHAIR OF THE BOURNEMOUTH AND POOLE SAFEGUARDING ADULTS BOARD
The Chair of the Bournemouth and Poole Safeguarding Adults Board introduced the April 2013- March 2014 Annual Report to Members and explained that the Report was now approved by the Board.
It was explained to Members that the Care Act would be implemented in April 2015, and there were substantial elements relating to safeguarding in the Act.
Members were advised that Poole was engaged in ‘Making Safeguarding Personal’ and this was also linked to the Care Act.It was explained that the initiative put individuals at the heart of the process andPoole’s participation in “Making Safeguarding Personal” should ensure person-centred safeguarding practice.
Discussion and comments included:

  • A Member queried the discrepancy between the number of safeguarding alerts between Bournemouth and Poole? It was explained that work was being undertaken to understand the differencebetween the two and it was suggested that there may be differences in criteria. It was advised that the Borough of Poole had a threshold closer to the expected level.
  • A Member expressed concern with the number of safeguarding referrals in the 85-94 age category,previously known to the Local Authority (LA), as shown in Table 1. It was explained that the age profile for Poole was higher and therefore this may account for the difference in figures.
  • It was questioned why there was a much higher level of individuals with dementia, for whom a safeguarding referral had been made, in Poole thanin Bournemouth, as shown in Table 4. The Committee was advised that this could be explained by categorisation to a degree, rather than the issue being more prevalent in Poole than in Bournemouth.
  • A Member queried why there were 129 cases of neglect from Social care support or service paid, contracted or commissioned, in Poole, as shown in Table 5? The Chair of the Bournemouth and Poole Safeguarding Adults Board advised that they would investigate these figures and report back to the Committee.
  • A Member commented on how concerning it was that both the case studies in the Report demonstrated a lack of communication and the learning points focused on the need for clearer communication.
  • A Member commented on the high level of risk to individuals, in particular in care homes and their own homes, as outlined in Table 6. The Member explained that care staff wereunder immense pressure in terms of their workload, and with limited time to spend with individuals, this may explain why neglect becamea problem. The Member commented that until remuneration of carers improved, neglect was likely to continue.
  • It was questioned whether there were any links between safeguarding adults and drug and alcohol abuse, and if so how could this be improved? It was advised that there were fewer links with drugs and alcohol from Poole than Bournemouth and the way to tackle this problem was through improving communication.
  • It was highlighted that it was important to improve the public message on safeguarding. The Chair of the Bournemouth and Poole Safeguarding Adults Board advised that work was being undertaken with Healthwatchinvestigating how to improve communication with Members of the Public, and one Healthwatch Board Member had agreed to be the Safeguarding Champion.
  • In response to a question on whether there were regular checks on care staff, Members were advised that all home care in Poole was delivered by agencies and where the Council had contracts, these are monitored by the Council. All Care Providers had to have systems to check the quality of care they are providing. The Head of Commissioning and Improvement, People Services outlined the various additional checks that are carried out by the Care Quality Commission (CQC), the Council’s Service Improvement Team, and social workers.
  • A Member questioned the Bournemouth and Poole Safeguarding Adults Board’s relationship with the Care Quality Commission (CQC)? It was explained that an annual meeting took place for the CQC to share any issues. It was advised that at an operational level there are regular meetings.
  • A Member commented that it was important to consider the statistics in the Tables that showed low numbers, as well as, focusing on the high numbers.

The Vice-Chairman (in the Chair)thanked the Chair of the Bournemouth and Poole Safeguarding Adults Board.

RESOLVED that:

The Report be noted.
Voting: For - Unanimous

HSC34.14ADULT SOCIAL CARE PEER CHALLENGE OF SAFEGUARDING

The Head of Adult Social Care -Services explained to Members theoutcomes of the Borough of Poole Adult Social Care safeguarding, undertaken in March 2014 by the Local Government Association and presented the Action Plan developed in response as follows:

Themes:

  • Thresholds for referrals;
  • Effectiveness and Visibility of the Safeguarding Adults Board;
  • The effectiveness of Safeguarding training;
  • Internal audit processes and management arrangements;
  • Ensuring the voices of people who experience safeguarding processes are heard.

The Findings:

  • The overwhelming view was that there had been significant progress overall in the policy and practice of adults safeguarding;
  • There was passion and ambition to improve outcomes for vulnerable adult’s right throughout the council and across the range of partners that were met with;
  • The lead for the above came right form the top of the organisation, with strong and clear political leadership;
  • There were very purposeful senior management staff within the council who had led the significant improvements in safeguarding;
  • There had been confidence in the governance arrangements that had been put in place. the Safeguarding Adults Board and its independent chair has served Poole well and ensures there are effective systems in place to ‘oversee’ the system of safeguarding with a clear and well thought through infrastructure.

More to do:

  • Need to better involve carers in the safeguarding process;
  • Need to strengthen practitioner skills to deal with financial abuse;
  • Need to ensure that the internal audit is making a difference to practice;
  • Work was in hand to ensure consistent application of thresholds for accepting safeguarding alerts are applied across organisations;
  • Consideration needed to be given to the level and nature of administrative support for safeguarding.

For the Safeguarding Adults Board:

  • Helping stakeholders to know about the Safeguarding Adults Board role;
  • It was felt that the Safeguarding Adults Board could strengthen the focus on prevention and early intervention;
  • It was felt that the Safeguarding Adults Board was beginning to, but had not fully, explored the ‘critical challenge’ role it needs to adopt;
  • The Safeguarding Adults Board may, it was suggested, wish to take a greater ‘champion’ approach, advocating for a stronger voice for service users;

Next Steps:

  • Taking part in a national pilot looking at safeguarding outcomes;
  • Preparing for the Care Act implementation;
  • Implement action plan in response to the Peer Challenge;
  • A Safeguarding Adults Board action plan in response to the Peer Challenge;
  • Poole News Article;
  • Taking part in the national “Making Safeguarding Personal” programme.

Discussion and comments included:

  • Members commented that the favourable outcome of the Report and the summary of feedback were very reassuring in taking safeguarding seriously. The Members congratulated the officers for bringing in an external body.
  • A Member commented that the systemised approach to learning through until 2015 seemed long term. It was explained that learning from safeguarding was an ongoing process and with the Care Act not implemented until April 2015, it was necessary to continue to work to gather information.

The Vice-Chairmanthanked the Officer for the presentation.

RESOLVED that:

(i)The Peer Challenge Report be noted.

(ii)The Action Plan, developed by the Borough of Poole Adult Social Care, in response to the Peer Challenge report, be noted.

Voting: For – Unanimous

HSC35.14FAIRER CONTRIBUTIONS AND CHARGING REVIEW

The Strategic Director- People Themeexplained to Membersthe changes to the Adult Social Care Fairer Contributions Policy. Members were advised that a number of factors on the financial forecasts for adult social care in 2015/16 had worsened. This included the likelihood of less funding being transferred from the Dorset Clinical Commissioning Group to Adult Social Care than had previously been anticipated by both partners. The reduction in the level of assumed funding would be reported to the next Committee.

The Head of Adult Social Care- Services and the Project Manager- Strategy Directorateexplained to Members about “Fairer Contributions and Charging” and changes to the way service users were financially assessed were explained as follows:

Four Proposed Changes:
The full year recurring additional income:

Disability Related Expenditure: £456,000

Adjustment of home care billing: £180,000

Day Service Meals: £35,000

Removal of care cap on contributions: £12,000

Members noted the disability related expenses as follows:
Costs which would no longer be considered as Disability Related Expenses (DRE):

  • privately arranged care, including respite care;
  • private domestic help, including cleaning, window cleaning and gardening;
  • equipment, including manual wheelchair, powered wheelchair, powered bed, turning bed, powered reclining chair, stair lift, and hoist;
  • communications (telephone, internet, and TV);
  • extra costs of holidays;
  • incontinence pads;

It was explained that the maximum amount on other items and services was proposed, including:

  • extra bedding;
  • special clothing or footwear;
  • Chiropody;
  • transport (in excess of mobility payments);
  • keysafe and locked medicine storage equipment;
  • Prescriptions

It was explained that no changes were proposed to the following:

  • costs of community alarm systems;
  • extra laundry costs;
  • extra costs of special dietary needs

Members considered the changes to the way in which people contribute to the costs of their home care:

  • It was proposed that the costs of home care should reflect the real cost to Borough of Poole of providing that care;
  • This was currently the case for visits provided in multiples of one hour, but not for shorter visits;
  • The costs of care visits would go up for some people, but it would still be the case that no one would pay more than they are assessed as being able to contribute.

It was explained that the removal of the maximum charge for services would be £450 per week:

  • There was currently 8 service users who would be effected by this proposal;
  • It would still be the case that no one will pay more than they are assessed as being able to contribute, in line with Fairer Contributions Policy.

Other items that Members considered included:

  • Proposed Pricing Structure
  • Methods of Consultation
  • Timescale
  • Impact on Service Users
  • Case Studies

Discussion and comments included:

  • In response to a concern over the removal of incontinence pads as adisability related expense, it was advised thatthe NHSprovided continence equipment and the proposal was that it should not be the responsibility of the Borough of Poole to subsidise theseitems.
  • Members commented that it was important to ensure the consultation process was “fit for purpose”, with clarity on how the changes would take place and how it would affect individuals.
  • A Member questioned whether the individual’s income was assessed or the total income of the household? It was advised that only the individual finances were taken into account, not other household savings or incomes.
  • In response to how the living costs were calculated, it was advised that this was worked out on the basis of a pension credit formula.
  • A Member commented that it was unreasonable for the cost of a hot meal to increase by 50% and the increase may stop people purchasing hot meals at the Day Centre. It was advised that even though an all inclusive model of £6.00 per day would be implemented, there was still the option available to purchase individuals items. It was also explained that these costs were benchmarked against Meals on Wheels, to ensure they were not excessively priced.
  • A Member commented that if these services were to continue being offered, these changes were necessary because savings needed to be made, and under current pressures, there were no alternatives.
  • A Member commented that this was an excellent report, but would need to be applied as sensitively as possible.
  • It was commented that the Fairer Contributions Policy was introduced four years ago and there had been no change in the charge of Day Centre meals since.It was suggested that it would be unwise to leave an increase in costs for such a long period in future.
  • A Member queried as to whether the payment for home care staff (for 15 minutes and 30 minutes slots) could be bought in bulk, to save costs? It was explained that bulk buying time would not be accurate because there are cost differentials that reflected the costs of providing care in blocks of less than an hour.

The Vice-Chairman (in the Chair) thanked the Officers for their presentation.

RESOLVED that:

i)Members scrutinised the proposals, including the consultation process.

ii)A further report on the outcome of the consultation be presented to the Committee in January 2015.

RECOMMENDED that

The Portfolio Holder for Heath and Wellbeing be requested to approve a public consultation exercise on the proposals set out in this Report, subject to any changes recommended by the Committee.

Voting: For – Unanimous

HSC36.14BETTER CARE FUND RE-SUBMISSION
The Strategic Director- People Theme explained the key aspects of the Better Care Fund, including the aims, the policy changes and an explanation of the pooled budget. It was highlighted that Government had in July 2014 required all health and social care communities to revise plans so that the aim of reducing hospital admissions become the top priority. This had meant that plans had had to be re-drafted over the summer and the detailed actions planned now focused on reducing what was a currently rising trend of hospital admissions in the local area.

Changes had also occurred in the financial arrangements and partners were now agreeing a £54 million pooled budget across Bournemouth, Poole and Dorset. Discussions were also taking place about a potential local agreement to transfer funding from the Dorset Clinical Commissioning Group to the three local Councils to support adult social care. It was now very likely that the sum that would be transferred to the Council would be far less than the £1.8 million previously anticipated. Negotiations were continuing between partners over this.

The Better Care Fund must be approved by the Bournemouth and Poole Health and Well-Being Board and submitted to Government on 19th September. Government evaluation of all local plans would be completed by mid-October.

Members considered the implications of the revised Better Care Fund conditions and the updated draft Better Care Fund Plan.

Discussions and Comments included:

  • Due to GPs not working at weekends, emergency admission levels increased, placing Poole Hospital under immense pressure. A Member also commented on the Ambulance Service and queried whether this was changing to incorporate dealing with people in their own homes? The Head of Commissioning and Improvement advised Members that the Ambulance Service had been expanded to treat people in their own homeswith paramedics using Hear and Treat and See and Treat methods. A Member commented that it was critical that diseases such as e-coli and meningitis, did not go undiagnosed and GPs were fundamental in making decisions on people’s treatment.
  • Members commented that the Better Care Fund was an extremely complex topic and suggested that it would be useful to spend time in a future Committee going back through the Better Care Fund in greater detail as they did not have time to fully consider the implications. A Member suggested that a separate seminar on this topic, open to all Members, would be extremely useful to enhance Member understanding.
  • A Member enquired about the position of Bournemouth Borough Council and Dorset County Council with regard to the Better Care Fund? It was explained that the Borough of Poole was meeting with both Authorities at the Health and Well-being Board on Wednesday 17 September 2014 to discuss financial implications. All the three Councils had challenges in the 2015/16 budget and the funding of social care. Currently it was the intention that more resourcing of adult social care initiatives would be from pooled budgets in 2016 but this was dependent on transformation change including the use of expenditure and on acute services.
  • Members commented that Members of the Public needed to be made aware of the changes. It was noted that although the 111 telephone service had largely been a success, Members of the Public still visited the Accident and Emergency Unit for non-urgent treatment, if GP’s were not available, especially at weekends.
  • Members acknowledged the realisation of improvements across health and social care on benefits including reduced demand on health service, improved outcomes for patients and increased efficiencies were required.

RECOMMENDED that: