Agenda and minutes

There had been no apologies for absence received. However, it was noted that Councillor Mrs M J Overton OBE had advised that she would be arriving late to the meeting.

There were no declarations of interest at this point in the meeting. All declarations of interest will be recorded within their relevant items.

RESOLVED:

          That the minutes of the meeting held on 1 December 2021 be        approved as a correct record and signed by the Chairman.

During this item, Councillor K E Lee declared a personal and pecuniary interest as an employee of the National Health Service at Lincoln County Hospital and therefore did not take part in the discussion for this item.

The Executive Director – Adult Care and Community Wellbeing advised the Committee that Christmas and New Year had been a challenging time for health and social care staff, with a number of incidents affecting Lincolnshire’s Hospitals. Covid-19 and winter-related pressures at Pilgrim Hospital, Boston including the level of staff absences, were showing the initial signs of easing. Lincoln County Hospital had also declared a major incident as a result of pressures face by Covid-19. It was also noted that there had been an incident with the loss of water supply at Grantham Hospital, but the situation was improving.

Despite pressures within the care sector, the service remained stable. Vaccination rates provided a level of protection and covid related absences were gradually improving.

The Committee supported the Executive Councillor for Adult Care and Public Health in thanking the Council’s homecare, occupational therapy and social care staff for their work over the Christmas period to keep services running.

Members were reminded that a briefing on the adult social care reform white paper - people at the heart of care, would take place following the meeting.

The Chairman also informed the Committee that the Free Sugars Working Group would be initiating discussions on the possibility of preparing a series of emotional material which would raise awareness on the sugar content in common foods, working alongside the Council’s Communications Team. 

(To receive a report by the Head of Finance – Adult Care and Community Wellbeing, which details the Council's budget proposals for Adult Care and Community Wellbein) for the financial year 1 April 2022 – 31 March 2023 and the assumptions made given the national context)

Consideration was given to a report by the Head of Finance – Adult Social Care and Wellbeing, which invited the Committee to consider a report on Adult Care and Community Wellbeing Budget Proposals 2022/23 which was due to be considered to the Executive on the 8 February 2022.

It was forecasted that the service would remain within the proposed budget for 2022-23, subject that the subject to the Council’s approval of the introduction of a deferred 3% adult social care applied to cover the cost pressures at any costs arising from the social care reforms in 2023 which were currently covered via a dedicated grant.

She outlined the proposal which detailed that the proposed budget would be sufficient for the Adult Care and Community Wellbeing Service,

The main increases in cost within the budget were:

• £6.262m in respect of the financial rate paid to providers. The largest cost pressure facing adult social care related to the rate paid for care across all services and service types, with a rise in the National Living Wage to £9.50 per hour
• £3.507m reflecting demand across adult social care, particularly in working age adults and mental health, with around a 4% increase in demand for services
• £2.273m new costs arising from the Market Sustainability and Fair Cost of Care Fund 2022 to 2023 published December 2021, in which the Council had received a grant to support the market and move towards paying the fair cost of care. There were conditions alongside the grant that would be predominantly to support the market to move towards paying the fair cost of care as per the social care reforms in the ‘Build Back Better’

The Committee was advised of the key improvements within the service which were underway or due to commence in 2022/23, which included: 

• Continued investments in front line services including housing, reablement, digital technology and community-based services
• Financial Assessment Improvement Programme which aimed to make the process easier to navigate for the individual and provide clarity on the charges through its charging policy
• Continuing to utilise the Better Care Fund (BCF)/Improved Better Care Fund (iBCF) as the vehicle which brought NHS and local government together and delivered the core conditions of the grant

The Council were yet to receive the national guidance which would provide further details of what would be included within the Better Care Fund. However, confirmation had been received that the iBCF would include an inflationary uplift paid directly to the Council of just over £1m.

Members were referred to the table at paragraph 5.1 of the report, which summarised the social care reform announcements to date, highlighting Lincolnshire County Council financial allocation, where it was known. Of the £5.3bn that had been included within the Building Back Better fund within the Autumn statement, £3.6m had been allocated for the fair cost of care in the capital thresholds, and £1.7m had been allocated to support the Council’s wider social care system.

In order for the Council to ensure that they were  ...  view the full minutes text for item 52.

(To receive a report by the Director of Public Health, which invites the Committee to consider a report to the Executive which seek approval on Public Health Arrangements for Greater Lincolnshire, which is due to be presented to the Executive on 1 February 2022. The views of the Committee will be reported to the Executive as part of their consideration of this item)

Consideration was given to a report by the Executive Director – Adult Care and Community Wellbeing and The Director for Public Health, which invited the Committee to consider a report on Public Health Arrangements for Greater Lincolnshire, which was due to be presented to the Executive on the 8 February 2022.

The report sought the Executive’s approval for a pilot scheme of Public Health arrangements across Greater Lincolnshire which would see the Lincolnshire County Council (LCC) Director for Public Health to be formally seconded on a fixed term basis to both North Lincolnshire and North East Lincolnshire Councils as the Director for Public Health for each authority. A management structure would be put in place to ensure all other staff were in a position to be effectively managed. The Director for Public Health would undertake the statutory duties for each authority and put in place a governance structure to ensure political scrutiny and engagement in decision making.

The main aim of the pilot was to improve the offer to and health and wellbeing of the people of Greater Lincolnshire.

There were advantages and benefits of bringing the public health delivery mechanism together, including creating efficiencies and effectiveness in terms in having one approach to certain areas, such as substance abuse.

The Committee were referred to the proposed management structure and governance structure, as set out in Appendix A to the Executive report. It was proposed that a governance structure be established in which a single governance board comprising Executive Councillors and a senior lead officer from each authority to agree priorities and share decision making, with the Director for Public Health being made accountable to the governance board operationally and tactically. The DPH would be statutorily accountable to the three Leaders and Chief Executives of each Council for the discharge of all core public health functions and for the Public Health Grant allocation. It was noted that the Lead Consultants for Public Health at each authority would provide day to day management and contact within each local authority area.

It was proposed that the changes would provide a single management structure for Public Health within Greater Lincolnshire so expertise, knowledge, skills and efficiencies could be shared across the three authorities. The Director for Public Health for Greater Lincolnshire would be supported by a Lead Consultant in each of the upper tier areas, and the Lead Consultants would be the operational and tactical leads for each of the three authorities.

Each local authority would retain responsibility for the ring-fenced grant funding allocated to it by the Department of Health. However, where it makes sense to do so, grant funding would be used collectively to achieve greater efficiency or if mutually beneficial.

Consideration was given to the report and during the discussion the following points were noted:

• The Committee welcomed the proposal as a pilot scheme. It was recognised that it was a good initiative with the potential for collaboration and innovation between three local authorities. 
• It was suggested that a set  ...  view the full minutes text for item 53.

(To receive a report by the Director of Public Health, which presents the Director of Public Health's (DPH) Annual Report 2021)

Consideration was given to a report by the Director for Public Health, which introduced the Director of Public Health Annual Report for 2021, as set out at Appendix A. The report being a joint report between the Director for Public Health and the Executive Director – Children’s service, with the focus being the health of children and young people in Lincolnshire, and the impact of Covid-19 on this population.

The Director for Public Health emphasised the importance of delivering services designed for children and young people as well as a need to focus on improving education around physical activity, diet, nutrition and emotional and mental wellbeing, which were the three core elements that help to create a healthy child and a healthy adult..

The report referred to Child Health within Lincolnshire, in particular the burden of disease, morbidity, mortality and the health and healthcare available to young people in Lincolnshire. It was important to address the fact that the number of years lived with disability reflected the impact an illness had on the quality of a person’s life before it was resolved or led to death and to address these individual issues and the effects that they had on children.

The Committee was informed that children in deprived areas were more likely to live in an area without water fluoridation, which risk factors contributed to poorer dental health for children living in more deprived areas.

One of the most significant impact on Children and Young People which had arisen from Covid-19 was the indirect impact of the school closures and the impact on social isolation and the impact this had had on their level of education and their mental health and wellbeing, which had led to an increase in referrals for behavioural problems, sleep difficulties, complex health issues and additional needs and speech and language.

Overall, children had faced significant challenge in terms of disruptions to learning and development as a result of the pandemic; there had been an increase in child obesity as a result of mental ill health and isolation.

The Director for Public Health emphasised the importance of ensuing that the services available for children and young people were designed specifically for them and not adopted versions of adult services, with a particular focus on physical activity, diet, nutrition, emotional and mental well being and the prioritisation of education opportunities in order to address health inequalities.

Consideration was given to the report and during the discussion the following points were noted:

• It was suggested that it would be beneficial to promote nutrition, education and health opportunities within the national curriculum so that children were educated from a young age.
• A concern was raised that children in more deprived communities with no access to fluoridated water had higher levels of dental health and it was suggested that this topic be explored further, particularly with the lack of NHS dental provision in Lincolnshire which was an ongoing concern.
• As a result of the challenges faced by the pandemic, progress  ...  view the full minutes text for item 54.

(To receive a report by the Assistant Director – Adult Care and Community Wellbeing, which provides an introduction to the presentation that will be provided to the Adults and Community Wellbeing Scrutiny Committee in relation to an Overview of Adult Frailty and Long Term Conditions)

During this item Councillor K E Lee declared a personal and non-pecuniary interest and left the meeting for the remainder of the item.

Consideration was given to a report by the Interim Assistant Director – Adult Frailty and Long Term Conditions, which introduced a presentation which provided an overview of the Adult Frailty and Long Term Conditions service area.

The Committee was informed that the service area supported all adults over the age of 65 or any adults with a disability. The service had 370 staff and a budget area of £120 million. The service worked closely with the Council’s commercial team, domiciliary care providers, residential care homes and health systems, in particular acute hospitals and community health services.

The Head of Adult Frailty and Long Term conditions provided a general overview of the service, which included the following:

• The structure of the 15 adult care teams from across the county, which were divided into 3 areas West, South and East
• There were approximately 9,715 cases open to the teams in 2020/21, in which there were over 20,000 requests made to the teams and 4674 assessments completed.
• The highest age profile for the service was increasing, with the highest age profile for those between the ages of 80-99, which was increasing.
• A new concept of initial conversations based on in depth strength based conversations were introduced in 2020-21, of which only 42% of went into a full assessment.
• Of the 4,674 assessments completed, 75.13% had been completed within 28 days.
• Of the 4066 reviews that had been undertaken, 93% of all eligible customers were reviewed.

The Head of Integration and Transformation then provided an overview of the Occupational Therapy Service, which included the following:

• There were 70 whole time equivalents working across the service, which was a mix of occupational therapist and community care officers

• A skill mix had been undertaken to ensure coterminous, geographical boundaries with the districts
• The service received around 6,500 referrals within 2020-21
• Around 56% of first contacts were resolved within the first 28 days.  90% were completed within 100 days. Service pressures had meant that not all referrals could be completed within the 100 days. However, work was ongoing as an integrated pathway with NHS colleagues to better understand community provision and to increase provision and increase capacity for other things such as hospital discharge
• The also supervised extra care housing projects, the NHS Continuing Healthcare interface and was the Better Care Fund Lead

The Head of Service - Hospital and Special Projects outlined her role and provided an overview of the Hospital and Special Projects service area, which included the:

• Details of the Hospital and Special Projects team structure
• There had been 11,000 and 77 discharges from acute hospital sites in 2021, of which 22% of the discharges went on to have an assessment or review from hospital services
• Since April 2021, 4,446 patients had been discharged, with 20% of them require an assessment or review
• Staff worked seven days a week and were  ...  view the full minutes text for item 55.

(To receive a report by the Health Scrutiny Officer, which invites the Committee to consider its forward work programme)

Consideration was given to a report by the Health Scrutiny Officer, which invited the Committee to consider its work programme, as set out on pages 86-87 of the agenda pack.

The Committee noted the addition of further items on the Improvement Programme and Financial Assessments which would be added to the Work Programme accordingly.

RESOLVED:

          That the work programme be noted.