Agenda and minutes

Apologies for absence were received from Councillors B Adams and Mrs and Mrs N F Clarke.

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

RESOLVED:

That the minutes of the meeting held on 8 September 2021 be approved as a correct record and signed by the Chairman.

(To receive a report from Cat Eglinton, Inspection Manager- Care Quality Commission (CQC),which provides the Committee with an overview of the role of the Care Quality Commission throughout the pandemic and the future direction of the CQC)

Consideration was given to a report by the Inspection Manager – Care Quality Commission, which provided an update on the work of the Care Quality Commission (CQC) in conjunction with Lincolnshire County Council.

The Committee was informed that the CQC was the independent regulator of health and adult social care in England whose purpose was to ensure health and social care services provide people with safe, effective, compassionate, high-quality care, using the monitoring of services to inform its inspection schedule.

During the Covid-19 pandemic, the CQC had adapted how they regulated their work within the health and social care system. Although routine inspection was paused temporarily, regulating continued through enhanced monitoring of services.

Driven by the need to adapt to the pandemic, the CQC had implemented new ways of working and had made progress in how services were monitored. The CQC would continue to monitor services using a risk based approach by using risk based decisions to inform inspection activity. Inspections would be carried out to services classified as having a significant risk and enforcement action would be taken where necessary to ensure that services were working at a safe and adequate standard.

Members considered the report, and during the discussion the following points were noted:

• Inspection teams were subject to their own internal monitoring which would include assessing the effectiveness of a risk based approach. Monitoring was undertaken using a range of methods including sampling, external quality measures, fluidity processes and formal evaluation.
• The CQC acknowledged that there were significant issues with staffing and within the social care sector. Inspectors would use their judgement when assessing high risk services to ensure that they were being fair to services with staffing issues that were unavoidable. Lincolnshire County Council (LCC) had implemented a workforce strategy in which they worked alongside the relevant partners to evaluate the most effective and creative ways to ease staffing issues.
• The CQC had a national team which received intelligence on unregistered care providers and took steps to proactively remove them from the market.
• As a regulator, the CQC did not have a quality assurance function and would not provide direct advice on matters. However when it was deemed appropriate, the CQC would signpost providers to local services.
• The role of LCC was to ensure that services were compliant with requirements and provide quality assurance, working with providers where change and support was required.
• Solutions to issues within the care sector often relied on a collective approach from a number of partners to find appropriate solutions.
• Of the nine care providers within Lincolnshire that had received an 'inadequate' rating from the CQC, three had been closed but had not yet been de-registered; one had been inspected and had indicated a level of improvement; and five were still deemed high risk, with enforcement work on-going and additional conditions required of their registration. If at any point the CQC were concerned about a service which was being monitored they would visit the service for an inspection and take action  ...  view the full minutes text for item 33.

The Chairman announced that discussions had begun regarding the establishment of a working group on hidden sugars in foods, as proposed by the Committee at their last meeting. The working group would support a sub group of the Health and Wellbeing Board.

Members were reminded that a training session on the Care Act would take place following the meeting.  

(To receive a report from Justin Hackney, Assistant Director - Adult Care and Community Wellbeing, which provides the Committee with an overview ofSpecialist Adult and Safeguarding Services)

Consideration was given to a report by the Assistant Director – Specialist Services, which provided an overview of Specialist Adult and Safeguarding Services in Lincolnshire, focussing on the following areas:

• Learning disability services, including Learning Disability Section 75 Agreement between LCC Lincolnshire Clinical Commissioning Group
• In house day opportunities, including developing a more expanded offer across day centre buildings
• Mental health related services
• Adult safeguarding
• Key priorities for 2021-22 within specialist adult services
• Key priorities for 2021-22 for safeguarding

Further to the report, the Committee was informed that Lincolnshire Partnership NHS Foundation Trust (LPFT) were commissioned to deliver the key functions for the assessment and care management function of mental health on behalf of LCC, which allowed them to coordinate clinical health services with social care services, meaning a more joined up experience for the service user.

Further explanation was provided on the Team around the Adult (TAA) project, which was a multi-agency approach that sought to help those who were otherwise struggling to engage with services, often people who were homeless, at risk of mental health issues, or addiction issues. Should a person be identified for the service, a TAA Strategy meeting would be held to ensure that the right teams of people were utilised to achieve the best outcome for the individual. The approach taken was specific to each individual needs as it was recognised that individuals had complex needs which required a tailored approach.

The Committee watched a video clip which provided an insight into the day to day activities part of day care services across the County. Officers commended the person centred planning and creativity of staff across the centres.

The Committee considered the report and during the discussion the following points were noted:

• The Lincolnshire Transforming Care figures were specific to adults with learning disabilities. Within Lincolnshire there were 30 people with learning disabilities and autism in inpatient facilities and detained under the mental health act, which was around 10% less than the national target. It was acknowledged that LCC were behind the trajectory however there was a level of confidence that the target would be met by the end of the calendar year. Officers emphasised the importance of ensuring the right services were able to be provided when patients were discharged.
• The Council hoped to expand their offer for day care opportunities as they were seen as essential to supporting people with mental health issues. 
• Providing an individual qualified for adult social care, there was no waiting list for day care opportunities. LCC hoped to expand the day-care offer so that it was inclusive to anybody with a primary support reason with an assessed need, rather than just those with learning disabilities.
• Members welcomed a preventative approach to adult care, with the use of day care facilities as a step to maximise independence across the adult care sector.
• Lincolnshire's suicide prevention strategy was led by Public Health and the rise in male suicides across East Lindsey was being investigated. The Committee was reminded that  ...  view the full minutes text for item 35.

(To receive a report from Pam Clipson, Head of Finance - Adult Care, which provides the Committee with an update on the financial position for Adult Care and Community Wellbeing for 2021-22)

Consideration was given to a report by the Strategic Finance Manager which invited the Committee to note the 2021-22 financial position for the  Adult Care and Community Wellbeing service.

The Committee was advised that the Adult Care and Community Wellbeing directorate were forecasting an underspend of £1.104m for 2021/22, which was largely due to maximisation of Covid-19 grants for the redeployment of workforce and commissioned services.

The Council continued to receive Covid-19 grant funding and were projecting full utilisation of the £29m within Adult Care and Community Wellbeing in 2021. The main areas of funding were £11.1m in outbreak management; £9.83m which had been passported to providers for infection control; £2m from a national discharge model which had been extended to the end of financial year; and £1.4m forecast for Lincolnshire's community testing infrastructure.

An early review of the September position suggested that early indicators were unlikely to change significantly from the £1.104m underspend projected in August 2021.

The medium term financial plan indicated some potential pressures greater than the base budget for 2022-23 onwards. This was driven by growing demand in working age adult social care services and the need to reflect the market conditions within the rates paid to commissioned providers.

The Committee considered the report and during the discussion the following points were noted:

• Debts over £25,000 were often property debts due to the Council having to operate under the provisions of the Care Act, meaning where there is was property that was assessable on financial assessment, people were entitled to join the third party payment process. legal representations from the Office of the Public Guardian had to be made and debts continued to accrue at a self-funding rate until all information had been provided to calculate the cost of care.
• The underspend of £1.104m would be available to cover cost pressures in other areas.
• An increase in demand and issues with recruitment had meant that there had been issues with the supply of homecare. The Council were struggling to compete with competitors on the price inflation.
• The £86,000 cap on lifetime care would not include 'hotel costs', which was the cost of the accommodation provided during the care. The 'hotel cost' would still be borne by the individual.
• Officers were anticipating that upcoming changes to the budget would impact . Assessments would be made once the budget had been announced. 
• The Hoplands Extra Care facility in Sleaford would consist of 60 extra care units with the potential for some learning disability bungalows.

RESOVLED:

              That the Adult Care and Community Wellbeing financial performance and         the key issues be noted.

(To receive a report from Emma Rowitt, Senior Project Manager - Corporate Property, which invites the Committee to consider and comment on a report to commence development on the Prebend Lane Scheme in autumn 2022, which is the subject of a decision by the Executive on 2 November)

Prior to the report being presented, the Committee resolved that:

In accordance with Section 100 (A)(3) of the Local Government Act 1972, the press and public be excluded from the meeting as the information due to be discussed was considered to be exempt information as contained in part 1 of Schedule 12A of the Local Government Act 1972.

Following a discussion, the Committee then moved back into public session and welcomed back the Press and Public for the remainder of the meeting.

­12:25 – Councillor R Wright left the meeting and did not return.

Consideration was then given to a report by the Head of Integration and Transformation, which invited the Committee to consider a report on the Extra Care Housing development at Prebend Lane Welton with LACE Housing Limited, which was due to be considered by the Executive on the 2 November 2021.

The scheme which would operate between Lincolnshire County Council (LCC) and LACE Housing Limited to provide Extra Care Housing for the anticipated demand in the West Lindsey district.

The report recommended that a further £1.6 million of the remaining £7.044 million designated capital programme budget be released to enable the Prebend Lane Scheme in Welton to commence development in autumn 2022, in which LCC would have nomination rights for a period of 30 years on 20 of the 62 units due to be developed, using a process of first refusal with no void risk.

The Scheme sought to provide alternative accommodation choice for older people and aim to maximise independence and improve wellbeing. LCC's contribution to the Prebend Lane Scheme would be on the condition that LACE Housing Limited acquired relevant approvals, obtains planning permission, and secured the additional funding required.

The investment would look to save £57,000 a year in terms of reduced outcare costs which would mean a return investment in year 23 out of the 30 year programme.

The Executive Councillor for expressed her enthusiasm for the project as an additional extra care scheme for Lincolnshire.

Members considered the report and during the discussion the following points were noted:

·       Extra Care Housing provided individual units and communal space that would reduce the risk of social isolation. Extra care housing was a form of specialist housing and was not formally defined, as it could include a range of support provided to individuals.

• All had their own housing agreement and had made a choice to live in an extra care housing development.
• The length of time that people spent in extra care housing was dependent on the level of need of the individual, but it was usually the case that people lived in extra care housing considerably longer than those going into care homes.
• Unlike people entering residential care, people who lived in specialist housing, such as extra care hosing, had rights as they owned or rented extra their property in extra care housing facilities.
• The proposed communal dining area would likely be a dining room with a lounge area, but the level of  ...  view the full minutes text for item 37.

(To receive a report by Simon Evans, Health Scrutiny Officer, which invites the Committee to consider and comment on its work programme for the coming year)

Consideration was given to a report by the Health Scrutiny Officer which invited the Committee to consider its work programme.

Members were referred to the Work Programme which could be found on 122-23. There had been no changes to the work programme since the publication of the agenda.

RESOLVED:

              That the work programme be noted.