Agenda, decisions and draft minutes

To receive any apologies for absence.

Apologies were received from Councillors Tony Robbins and John Bailey.

To approve the minutes from the previous meeting.

The minutes of the Scrutiny Committee – Adults and Health held on 8 February 2024 were amended to include Cllr Hilary Bruce in attendance and then resolved that they be confirmed as a correct record.

The minutes of the Scrutiny Committee – Adults and Health held on 8 February 2024 were amended to include Cllr Hilary Bruce in attendance and then resolved that they be confirmed as a correct record.

To receive and note any declarations of interests in respect of any matters included on the agenda for consideration at this meeting.

(The other registrable interests of Councillors of Somerset Council, arising from membership of City, Town or Parish Councils and other Local Authorities will automatically be recorded in the minutes: City, Town & Parish Twin Hatters - Somerset Councillors 2023 )

There were no new declarations of interest.

The Chair to advise the Committee of any items on which members of the public have requested to speak and advise those members of the public present of the details of the Council’s public participation scheme.

For those members of the public who have submitted any questions or statements, please note, a three minute time limit applies to each speaker and you will be asked to speak before Councillors debate the issue.

We are now live webcasting most of our committee meetings and you are welcome to view and listen to the discussion. The link to each webcast will be available on the meeting webpage, please see details under ‘click here to join online meeting’.

There were public questions submitted on the Stroke Services Reconfiguration. As it is a topic that has already been covered in depth by the committee, the Chair chose not to allow these questions and instead read a statement of the latest update on this.

The statement read as follows: At the meeting on 8th February the Committee resolved to write to the Secretary of State for Health and Social care. That letter was sent on 15th February and to date there has been no reply. 

On 20th March Committee Members were invited to a briefing with the Chief Executive – Duncan Sharkey to clarify his role on the ICB. Mr Sharkey explained that he did not represent Somerset Council on the ICB. He was there as a Partner Organisation and in this role, he was expected to look at all the evidence presented and make an informed decision on the recommendation. He did ensure that those concerns raised by Councillors and other interested parties were included in the debate and then cast his vote freely in the best interests of all Somerset residents. 

To discuss the work programme.

To assist the discussion, the following documents are attached:-

(a)  The Committee’s work programme

(b)  The Committee’s outcome tracker

Please use the following links to view the latest Somerset Council Forward Plans and Executive Forward Plan of planned key decisions that have been published on the Council’s website:

Somerset Council Forward Plans

Somerset Council Executive Forward Plan

Resolved to add Social Care Workforce to the agenda of the next meeting on July 11^th.

Councillors raised concerns about the variation in dates from the work programme and invitations sent out, and it was confirmed that the dates had now been finalised and the correct dates were available online and invitations had been sent out.

It was proposed that there be an informal focus group in May to discuss elements of the committee and where they would like to be going forward. This was delegated to Democratic Services to organise.

There was also a request that the Social Care Workforce item be brought to the next meeting, and it was added to the agenda of the July 11th meeting.

To consider the report.

During the discussion, it was agreed that a report on the overdue reviews would be added to the work programme, to enable a deeper understanding of how they work and the challenges around them, as well as a report on Intermediate Care pathways.

Cllr Sarah Wakefield, Lead Member for Adult Services, introduced the report, and Christian Evans, Head of Finance Business Partnering, and Penny Gower, Service Manager – Adults and Public Health Finance, gave a presentation on the financial position of the whole council in Month 10 and Adult Social Care specifically, identifying the key drivers of the overspend and the in-year mitigations taken.

During the discussion, the following points were raised and responded to:

·       Very concerned about the number of overdue reviews. Would it be possible for a full report on overdue reviews? Yes, that can be added to a future agenda.

·       Can you expand on care home blocks? We have block contracts so that certain beds are available at a price we can afford. We are looking at what do we need and where, what is the utilisation of those, and we want utilisation to be 90-95%.

·       As we are demand-led, could we have a forward look at what the next year looks like, now that the budget for 24/25 has been set? We have had an increase in the 24/25 budget, and we have set the budget to people – basing it on people in and out. We have a very solid domiciliary care market based on international recruitment. However the coming change in law regarding visas for spouses means that may change. As we are now paying better, we have had care providers such as Brunel Care Home give feedback that the market is better. The other risk in terms of expenditure is care home failure – we have all heard of care home closures. If a large care home closes that would have a big impact. We have used data based on how many people die, how many people leave our service, how many people come to Somerset. We can’t budget for everything, and there is no wriggle room in the budget. If there is a change in legislation or other things that may happen, we will be able to bring that to you. We are monitoring and measuring these budgets like never before. We can now track budgets by individuals and this model has been looked at by 4 external partners. There is a trend increase of people who are self-funding whose capital has dropped below the £23250 maximum. We don’t have complete data on those who are self-funding. This year we have given a 3.2% rise to our providers. The cost of care has gone up 8-9%. Private customer increase is therefore between 8-15% - this has an impact on capital and it reduces below the £23250 maximum. Sometimes we have to move people because we cannot continue to pay the fee price for the care provision they are currently receiving.

·       Where do those people go? They will go to another care home that meets our fee rate. We try to get people as close as we can at a price we can afford that meets their needs. In future we need homes in the right  ...  view the full minutes text for item 57.

To consider the report.

Resolved to write to the Executive Committee to request assurance that the digital platform that ASC require to deliver this function of our data that Microsoft are working on with us is resourced and ready at an appropriate timescale, and that we have the capability to address this.

The committee agreed that the digital team working on this project would be added to the work programme to better understand the resource challenges.

Cllr Sarah Wakefield, Lead Member for Adult Services introduced the report, and Emily Fulbrook, Service Director – Adult Social Care Operations, and Emily Faldon, Newton Europe, gave a presentation which provided a refresh on the programme, progress so far over the first seven months, and looked at areas like Learning Disabilities and Preparing for Adulthood in focus.

During the discussion, the following points were raised and responded to:

·       Key to understand the program’s financial benefits – how do they value accrued benefit over time?

·       What about the challenges of the Voluntary Redundancy (VR) process? Need to ensure that we retain valuable staff that will be needed to make sure this process goes through seamlessly. Whenever there is VR and we lose staff there is fragility, there is a corporate risk.

·       On the programme plan, what does the grey mean? The grey is for things we have not yet started.

·       Data workstream - could the wider transformation in the council undermine this piece of work, and without this piece of work how will you be able to assess the other workstreams? The data visibility workstream is key, and we have taken that to the corporate transformation board to look at how we manage that. Microsoft our working with us and our IT systems to look at how we pull this together in future. We need a proper system but it will not happen overnight.

·       On page 56 – table of financial benefit summary. What is the reduced starts in residential care item? We are predominantly focused on residential starts coming through community teams – how many of them come from acute settings or care settings, looking at the different roots of getting into residential care. At the national context, people aren’t going in to residential care until they’re approximately 85. We need to monitor and manage it, and look at having the right processes in our hospital settings, if you come in from home you should be able to go back home.

·       Preparing for adulthood item – what about those who are placed in Somerset by other authorities? We have data on those who are in our system but not those from outside. We are working on recognising and understanding those in Somerset – we have data on every 14 year old. Not all of those individuals will come through to Adult Social Care when they turn 18. We are working with providers to identify those who are placed here from outside Somerset and the impact they may have. We are also linking with the ICB and looking at data from continuing healthcare, health funding for children. At any one time there are 700-800 people placed in Somerset by other authorities, these are supported by our health services but not our Adult Social Care services. We know a proportion of them, and many of them go back home. What should happen is we should be notified, there is a process that should be followed but this doesn’t always happen. If  ...  view the full minutes text for item 58.

To consider the report.

Cllr Sarah Wakefield, Lead Member for Adult Services, introduced the report, and Jon Padfield gave a presentation on key performance measures within Adult Social Care.

During the discussion, the following points were raised and responded to:

·       82.7% care providers have a CQC rating of Good or Outstanding. What about the 18%? There are a number that our QA team are actively working with to support them. When they become inadequate or requires improvement we stop placing people in those homes until they improve. We put an improvement plan in with them and have regular reviews. Where there are small areas we are unsure about we place with caution and are clear about who we place and why.

·       None of the providers were closed? The stats only refer to active CQC registration.

·       Calls that are being diverted – is there a follow up on what happens to those people if they are referred to voluntary or non-statutory service, how do we find out if those are resolved? The contact centre doesn’t follow up with everyone but does a dip sample to see if it was resolved. We also look at repeat callers where things were marked as resolved at the first call – it’s clearly not resolved.

·       Could we have feedback on this in the next performance report? Yes.

·       Is there a correlation between overdue assessments and reviews and the low level of unmet need – if we catch up is that going to make that worse? Yes, there probably is a correlation between the two. Care Act Assessments when completed will result in a paid service so will increase demand on our sourcing care team. We are working to understand that and monitor the two together, but we do have a good supply in the homecare market at the moment.

·       Quality audits – what actions are put in place to tackle those areas that are marked below? We now have a practice quality board in place, chaired by Principal Social Worker and Principal Occupational Therapist. We have some specialist OTs and Learning and Development Advanced Practitioners. The Board’s role is to bring things out from the audits, the learning from audits, Safeguarding Adults Reviews (SARs), and Learning from Lives and Deaths of People with Learning Disabilities and Autistic People (LeDeR).

·       Overdue assessments – assuming they are done on risk assessment basis, e.g. low risk ones waiting more than a year, is that correct? Yes – we do risk assess every single individual waiting for assessment. There is a priority matrix which is reviewed.

·       5% of people came out of hospital and into a bedded pathway. How many of those are appropriate because the right care wasn’t provided? There are some individuals that probably could have gone through to reablement. We scrutinise the decision in multidisciplinary transfer hubs to make sure the right decisions are made. Of those who go into intermediate care, around 40% of those individuals go on to home, not a long-term placement. Constantly reviewing that and  ...  view the full minutes text for item 59.

To consider the report.

The committee agreed to hold an informal meeting in May once the full report from the LGA peer review was released to go over it in detail, and a full member briefing to follow.

Jon Padfield, Service Manager – Policy, Performance, and Assurance – Adult Social Care, and Emily Fulbrook, Service Director – Adult Social Care Operations, gave a presentation based on the initial feedback from the LGA Peer Review recently undertaken.

During the discussion, the following points were raised:

·       Rather than improving the website, it is more important to focus on having someone at the end of a phone. Many elderly people don’t have access to support online.

·       There are too many acronyms, we should abolish them as there is too much time spent trying to understand.

·       Sometimes we are accused of being slow moving. As a committee, would be happy to say if things that need to go forward to make improvements, just take it to Executive Committee straight away.

·       Would like a full member briefing on this once we get the report. Important for all councillors to be aware of pressures and drivers.

·       Look forward to seeing the full report – plenty of food for thought and positives.

·       It would be useful to have a workshop on this report before it goes to a full member briefing, so Scrutiny can decide what is important.

·       Important to highlight that during the peer review, they were noting down things they were learning from us, had seen new ways of doing things and innovation.

It was agreed that the full report would be brought to the focus group to be held in May.