Meeting documents

Purpose:

The Committee has been regularly reviewing and challenging Adult Social Care’s Better Lives transformation programme which is organised into three tiers.  This item reviews progress within Tier 3 "Living with Support".

Tier 3 focuses on delivering strength based, outcome focused approaches to long term support planning that encourage independence, progression and a reduction in reliance on traditional services.

Attendees:

Lin Hazell, Cabinet Member for Health & Wellbeing

Ms G Quinton, Executive Director, Communities, Health and Adult Social Care

Ms J Bowie, Service Director, Integrated Commissioning

Papers:

Report attached

Intended outcome:

For Members to assess whether sufficient progress has been made within the work streams to enable a successful and timely delivery of Tier 3 transformation.  For Members to seek reassurance that the projects within the work streams will deliver better outcomes for social care clients.

The Chairman welcomed Lin Hazell, Cabinet Member for Health & Wellbeing, Ms J Bowie, Service Director, Integrated Commissioning and Ms L Spencer, Lead for Transformation.

The following main points were made during the discussion.

·         The transformation programme was organised into three tiers:

o   Living Independently (Tier 1);

o   Regaining Independence (Tier 2);

o   Living with Support (Tier 3).

·         There were 9 workstreams within Tier 3, as follows:

o   Prevention Commissioning;

o   Mental Health services;

o   Direct Care and Support;

o   Housing and Equipment;

o   Planned reviews of existing care packages;

o   Transport;

o   Direct Payments;

o   New Learning Disability service model;

o   Continuing Health Care – create a single point of access for providers and reduce duplication.

·          A Member commented that the use of acronyms and structure of the report made it difficult to understand how many clients were affected by the proposed changes in services, what the actual spend was in each area and the impact of the service improvements on the clients.  Ms Bowie agreed to look into this and come back with the number of clients and the actual spend in each area.

ACTION: Ms Bowie

·         The Better Lives Strategy was about making sure individual service users had better experiences.

·         A Member sought assurance that the transformation work being undertaken was delivering the right level of care deemed acceptable by service users and families.  The Member commented that it was not just about delivering financial savings, the Committee needed to know that the quality of services had not been adversely affected.

·         Ms Bowie confirmed that the Transformation Board had requested evidence on the impact of the service changes, to include feedback from users and carers as well as measuring the impact via key performance indicators.

ACTION: Ms Bowie

·         A Member expressed concern about delivering the savings in this tier and asked particularly about the living with dementia financial savings in light of an increase in demand on services and the complexity of peoples’ needs.  Ms Bowie explained that the £285k savings sat within the mental health project overview and the savings would come from reviewing existing service users plans and looking at alternative provision.  The savings would be made from offering more independent tenancies to service users who are currently in residential homes and other types of support.  There would also be a review of s117 after care packages to ensure these were aligned with current policies and procedures.

·         A Member commented that it was difficult to see how the Better Lives Strategy was being delivered across all the tiers and suggested that future presentations needed to include action plans for each tier with deliverables and timeframes, as well as budget savings.  Ms Bowie confirmed that there should be consistent approach to reporting on the transformation programme.  

·         It was agreed that representatives from the HASC Select Committee would meet with Adult Social Care Officers to help shape and structure future reports on Transformation.

ACTION: Chairman/Committee & Governance Adviser/Jane Bowie

·         A Member commented that "cuckooing" (where drug dealers take over the home of a vulnerable person) was a real concern and having a consistent team of social workers was important so that signs of this criminal activity could potentially be spotted more easily.  The Member asked what was being done to address vacancies in the team.  Ms Bowie responded by saying that there were challenges around this and the service was working hard with the HR team to fill the vacancies.  Within the occupational therapy team, there was a "try before you buy" initiative in place and 6 OTs had been recruited as a result.  

·         It was acknowledged that getting the workforce mix right was important and there were training programmes in place for social workers and OTs.

·         Ms Bowie confirmed that all the work streams involved partnership working and cited, by way of example, the s75 agreement with Oxford Health in delivering the mental health work stream.

·         In response to a question about gaining feedback from service users and carers, Ms Bowie explained that both qualitative and quantitative feedback was obtained via a number of different routes, including Healthwatch Bucks and complaints and compliments directly to the service – the results of all feedback was triangulated.  Ms Spencer added that frontline staff were also being asked for their feedback to help shape the service redesign.

·         In response to a question about the s117 after care packages, Ms Bowie confirmed that the Council was reviewing their arrangements against best practice elsewhere to better understand and improve the effectiveness of care packages.

·         A Member asked whether there were any particular areas of concern/challenges within the work streams.  Ms Bowie highlighted the work around prevention and the challenges around some of the smaller, less connected communities that exist across the County.  She went on to stress the importance of having strong transport links and work to find solutions around community transport was on the agenda.

·         The virtual wallet for Direct Payments (DP) provision was being decommissioned and a new system called iCares was being rolled-out.  The savings in this area would be made by reviewing users of DPs to see who had not used their allocated funding.  Reviews of DPs should take place annually and work was underway to prioritise clients requiring a review.

The Chairman thanked the presenters.