Agenda and minutes

An apology for absence was received from Councillor Mrs A Reynolds.

It was noted that the Chief Executive, having received notice under Regulation 13 of the Local Government (Committees and Political Groups) Regulations 1990, had appointed Councillor C E D Mair as a replacement member of the Committee in place of Councillor Mrs A E Reynolds for this meeting only.

There were no declarations of interest made at this point in the meeting.

RESOLVED

That the minutes of the Adults Scrutiny Committee meeting held on 7 September 2016 be agreed and signed by the Chairman as a correct record.

The Chairman welcomed to the meeting the Executive Councillor and Executive Support Councillor, Officers, and Councillors Mrs Judy Renshaw and Jackie Kirk, (two members from the Health Scrutiny Committee for Lincolnshire).

The Chairman extended thanks to two members of the Committee, Councillors S R Dodds and H N J Powell, who together with Executive Support Councillor for Adults, Councillor C R Oxby had visited Carers FIRST on Tuesday 11 October 2016.

A reminder was also given to members concerning the Committee's budget workshop on Wednesday 30 November at midday.  It was noted that the Committee's formal meeting would be on the 30 November as planned at 10.00 am.

The Chairman invited Councillor H N J Powell to update the Committee following her attendance at the Bourne Carers Association meeting at Scott House, Bourne.  Councillor Powell advised that the meeting had also been attended by Justin Hackney, Joint Commissioning Specialist Services, and Barbara Simpson, Independent Social Worker.  The Committee noted that the main issues raised were: the availability of television points; the security on the front door; the reception arrangements; and the space available for service users.  Overall, a lot had been achieved within the space available.  The Committee noted further that with some alterations more could be achieved, for instance moving the workshop to the outside area, which would free up the old workshop space to be used as a dining room.  It was noted that Officers would be looking into the issues raised.

(To receive an update report from Jane Mason (County Manager – Carers).  A representative from Carers First and Serco will also be in attendance)

The Chairman welcomed to the meeting Malcolm Ryan, Operational Services Manager (Lincolnshire) Carers FIRST, Gill King, Carer, Linda Harrison, Business Operations Manager, Serco, and Jane Mason, County Manager, Adult Care & Community Wellbeing, Lincolnshire County Council.

The County Manager, Adult Care & Community Wellbeing introduced the item, advising the Committee that over the last five months the new Lincolnshire Carers Service had been delivered by Serco and Carers First.

It was reported that the Care Act 2014 had introduced new legal rights for carers to obtain support; and that the Children and Families Act 2014, also entitled parent carers and young carers to an assessment of their needs.  It was reported further that more carers in Lincolnshire were being identified and this was in line with the national trend. 

Since the contract was awarded on 1 June 2016, Carers FIRST had focussed on the operational aspects of the service.  It was also noted that a quality assurance and performance programme and framework had been designed to ensure a quality service.  It was noted further that a service review of the Serco Carers Service had been completed to evaluate how the commissioned service met carers' needs effectively and efficiently in terms of practice and process in the context of the requirements of the Care Act and the Children and Families Act.

Malcolm Ryan, newly appointed Operational Services Manager (Lincolnshire) Carers FIRST introduced himself to the Committee; and provided some background information pertaining to the Lincolnshire's Carers Service, which made reference to:-

·         Prevention – This identified that there needed to be earlier identification; and more promotion and publicity through various means;

·         Referral for statutory assessment or universal support – The Committee was advised that the service was a collaborative service between the customer service centre and Carers FIRST, which provided one gateway whereby a carer could self refer, or be referred by a professional;

·         Direct Support – It was noted that carers support co-ordinators undertook statutory carer's assessment.  A wellbeing summary was also completed with all carers to check that the carer was healthy, coping; and that staff were able to provide them with additional information, and signpost the carer for help and further advice.  It was also highlighted that the service provided emotional support, and that data had identified that of the carers in the east of the county, a high number accessed mental health services.  As a result of the findings the service was looking at holding some themed workshops to address some of these issues.  The Committee were also advised that in Kent Carers FIRST operated a support plan (referred to as 'Carers Star'), which was a way of identifying what was needed for carers.  It was noted that the plan was being implemented in Lincolnshire and the data captured would then be used to evaluate the Carers Strategy and inform future service planning; and 

·         Governance – The Committee was advised that Carers FIRST made sure that whatever was done was for the best for carers.  Some case studies were provided  ...  view the full minutes text for item 35.

(To receive a status report from Lynne Bucknell (County Manager – Special Projects and Hospital Services), which highlights to the Committee the current delayed transfers of care for the first quarter of 2016/17)

In the absence of the speaker for the Care Quality Commission – Adult Social Care Inspection report, the Chairman agreed to take item 7 next.

The Committee gave consideration to a report from Lynne Bucknell, County Manager, Adult Care and Community Wellbeing, which highlighted current delayed transfer of care for the first quarter of 2016/17.  It was noted that there was an improvement in performance for Adult Care, but that the arrangements in United Lincolnshire Hospitals NHS Trust continued to need further support to significantly improve performance, in particular around the flow of people through the acute hospitals.

Appendix A to the report provided the Committee with details of the transitional care pathways in Lincolnshire, which had been shared with the Adults Scrutiny Committee at its April 2016 meeting.

Page 25 provided the Committee with information as to what was happening locally.  It was reported that since 10 April 2016 the average days delayed per week attributable to Adult Care had dropped from 50 to12, this was a 75% reduction in days delayed attributed solely to Adult Care.  It was noted that the main reasons for adult care delays were the Reablement and Home Care services not being available for a person when they were medically fit for discharge. The other reason for delays was attributed to having to wait for care homes to assess.

The Committee noted that work was ongoing with health colleagues, Age UK and a whole range of organisations and providers across the County to focus everyone on HOME FIRST.  The principles being agreed were detailed on page 26 of the report presented; and that Appendix B to the report provided a copy of a document to define HOME FIRST.  It was highlighted that this was the start of a whole social care movement in Lincolnshire and that it would be an ongoing target for all Adult Care and Health Practitioners to challenge each other to achieve more people going HOME FIRST.

It was reported that Healthwatch Lincolnshire had recognised the challenges delayed transfers of care placed on services and the impact of patients and families.

In conclusion, the Committee noted that there was an improving position for Adult Care in Lincolnshire, but there was still a great deal of work still to be done to support partners and the whole system to improve flow and further reduce delays.

During discussion, the Committee raised the following points:-

·         Attendance at ward round meetings – The Committee was advised that Adult Care staff attended some ward round meetings in Lincoln;

·         Discharge – One member enquired as to whether on occasions patients were actually being discharged too soon.  The Committee noted that the Health Scrutiny Committee for Lincolnshire had had the information to consider at their meeting, and the Committee could not influence what hospitals do.  It was therefore a matter for the Health Scrutiny Committee for Lincolnshire to scrutinise, rather than the Adults Scrutiny Committee.  Some members of the Committee highlighted that there were areas which overlapped.  The  ...  view the full minutes text for item 36.

(To receive an update report from Deanna Westwood (Inspection Manager, Care Quality Commission), which provides the Committee with information on the progress and themes arising from the Care Quality Commission inspections of Adult Social Care Services in Lincolnshire)

The Committee gave consideration to a report from Deanna Westwood, Inspection Manager, Central Region, Care Quality Commission, which provided a position statement on the progress and themes coming out of the Care Quality's (CQC) inspections of Adults Social Care services in Lincolnshire.

The report highlighted that the Committee was to bear in mind that the CQC was not subject to Local Authority Scrutiny, and that the relationship was an informal one based on an understanding, trust and joint aspiration to improve services by sharing insight and complementing each other's roles. 

It was reported that there had been a reduction of six services providing nursing care since the CQC last attended the Adults Scrutiny Committee; and a reduction of 257 nursing care beds.  It was reported further that there had also been a reduction in domiciliary care provision from 85 services to 79 services.

Page two of the report provided the Committee with details of current ratings compared to those presented at the earlier meeting.  The ratings as at October 2016 were:-

·         Outstanding  1

·         Good  199

·         Requires improvement       80

·         Inadequate    1

Page 3 of the report provided information relating to how Lincolnshire compared to neighbouring 'shire' authorities.  The table identified that nationally Lincolnshire was working well.

It was reported that most health and adult social care services in England were providing good quality care, despite a challenging environment, but there was still a substantial variation in care.  It was also noted that some services were failing to improve and therefore there was some deterioration in quality.  It was highlighted that the majority of GP practices were providing good quality care and were leading the change in service design. 

Overall, the CQC had identified that Adult Social Care had been able to maintain quality, but there were indications that the sustainability of adult social care was seriously challenged in some parts of the Country.  Of the care homes and home care agencies that had been rated as inadequate, 77% had improved when they had been re-inspected.  It was noted that until recently, the growth in demand for care for people with greater needs had been met by a rising number of nursing beds, but it was highlighted that this bed growth had stalled since April 2015.  It was also noted that hospitals were under increasing pressure; and that it would be increasingly difficult for NHS Trusts to make improvements to acute care unless they were able to work more closely with adequately funded adult social care and primary care providers. 

During discussion, the following points were raised:-

·         That the frequency of visits made to an establishment would be determined by the rating.  If the provider was high risk, then they would be subject weekly/monthly visits.  It was agreed that a printed list of the homes showing ratings would be circulated to members of the Committee;

·         A question was asked as to who would be responsible for closing a provider down.  The Committee noted that the local authority and the CQC  ...  view the full minutes text for item 37.

(To receive a performance report from Emma Scarth (County Manager – Performance, Quality and Development), which provides the Committee with the results of the Adult Care User Survey 2015 – 16)

Consideration was given to a report from Emma Scarth, County Manager, Adult Care and Community Wellbeing, which provided the Committee with results of the Adult Care User Survey 2015/16.

It was reported that the survey had been designed to cover all service users aged 18 and over receiving services funded wholly or in part by the County Council Adult Care during 2015/16; and it was aimed to learn more about whether or not services provided were helping service users to live safely and independently in their own homes; and the impact this had on their quality of life.

The six outcome measures were detailed on pages 31 and 32 of the report presented.  Appendix A provided the results of the above said survey.

A summary of finding was detailed on page 32 of the report.  The Committee was advised that there had been a response rate of 44%, which was higher than the 36% average for England.  It was highlighted that overall, the survey had resulted in a positive picture.

During consideration of the results, the Committee made the following comments:-

·         How did Lincolnshire compare with other authorities?  The Committee was advised that the authority had performed above average; and

·         Access to the survey – It was reported that the survey had been a postal survey.

RESOLVED

That the report be noted.

(To receive a presentation from Judith Hetherington Smith (Chief Information and Commissioning Officer), on the progress with the implementation of ICT support to support adult care services)

The Committee received a short verbal update from Judith Hetherington-Smith, Chief Information and Commissioning Officer, which advised that the implementation date for MOSAIC of 31 October 2016 would not now be achieved, as a result of a third party not having undertaken the required security checks in relation to software and data storage, during the final preparations for going live.  It was confirmed that over 2,300 staff had been trained on MOSAIC, and the system was ready for implementation.  The implementation date was now expected to be during November 2016.  Staff groups would be accessing MOSAIC at different times on the implementation date to ease in the new system and avoid breakdowns.

RESOLVED

            That the verbal update be noted.

(To receive a report from Simon Evans, Health Scrutiny Officer, which invites the Committee to consider its work programme for the coming months)

The Committee received a report which provided them with an opportunity to consider and comment on the content of its work programme for the coming year.

RESOLVED

That the Adults Scrutiny Committee Work Programme as detailed in Appendix A be noted.