Agenda item

(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 based at three hospitals in Lincolnshire and the neighbouring hospitals
• There were currently significant pressures for the service, particularly relating to hospital discharge
• There were six community based hospitals in Lincolnshire. The transfer of care team supported discharges from the 34 health funded transitional care beds in the County
• Further information on the Discharge to Assess model was provided

The Interim Assistant Director – Adult Frailty and Long Term Conditions outlined the key priorities for the Adult Frailty and Long Term Conditions team, which included: working with the occupational therapy to develop integrated working; developing further capacity for extra care housing; building on strength based practice within area teams and focus on the development of the physical ability team and to develop an integrated pathway within the hospital team.

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

• The Committee expressed a view that they would like to see a more streamlined process for the assessment of adult care needs
• The Committee reiterated the need for innovation within the recruitment of adult care staff.
• There were a number of community care assistants who now worked as occupational therapy assistances to the occupational therapy team. Members welcomed the progress made on the recruitment of occupational therapists within Lincolnshire. It was noted that University Lincolnshire Hospital Trust had reorganised their occupational therapy service to concentrate almost exclusively on discharge. Officers were working to bridge any gaps within the occupational therapy service.
• The Integrated Discharge Hub involved a multidisciplinary team working together in the same room to assign individuals to a pathway for discharge and assess the level of therapy they needed. The team met in person on a daily basis.
• As it was one of the busiest areas, people on the East Coast did not need to travel for care assessments and would be met by a worker where possible.
• There were a high number of initial assessments that did not lead to a full assessment where the individual could be supported by the voluntary sector or other things within the community.
• There were seven teams with 70 members of staff within the occupational therapy service, with some members of staff covering more than one area.
• Members were reassured that plans were progressing to meet the high demand for adult care services in Mablethorpe.
• The extra care housing programme included a number of schemes that were in progress to increase the number of extra care schemes across the county. The schemes sought to develop a housing programme for older people and working age adults. There were a number of other schemes proposed across the County which would provide alternative accommodation for people who do not want to move into residential care.
• At the beginning of the pandemic, the majority of assessments within the adult frailty and long term conditions service were made by telephone, however it was now expected that most assessments for the most complex cases would be carried out face to face. Most initial assessments were carried out by telephone which was highly successful. It was agreed that a percentage breakdown of the means of assessment be provided to the Committee.
• As part of the adult care improvement programme, changes had been introduced, such as initial conversations, to ensure that there was a more proportionate response when assessing peoples needs in future.
• Officers acknowledged that there was a large drop from 20,000 contacts received to 4,764 assessments carried it. Members were reassured that many of the contacts recorded were duplication or not relevant. Information would be reviewed in future reports to ensure it is as clear as possible. The vast majority of the recorded contact would not be from individuals, but external partners that were recording information or from calls to customer service agents who were often able to signpost to further information.
• Assurance was provided that the discharge to assess model was based on acquiring the information needed to ensure that it was relevant and appropriate to enable a person to be discharged safely. This involved communicating with the people that had been involved in the individuals care and hospitals to formulate a care plan which would enable a person to be discharged safely. Each person would be contacted 24 hours after discharge to assess their arrangements and arrangements were made to complete a full assessment in the individuals own home at their convenience.
• Apprenticeships within the service had been highly successful in supporting and retaining staff within the service. All staff which had undertaken the social work degree had continued to work within the Council. The retention of people who had been trained within the Council had been excellent.
• There were currently 10 social workers undertaking a social work degree on the apprenticeship programme who would qualify in 2023;  three apprentices due to graduate in 2024 and three people on an occupational therapy apprenticeship due to graduate later in 2022; two people on an occupational therapy apprenticeship due to graduate later in 2025 and two Learning Disability nurses in training.
• Work was ongoing to look at innovating ways for recruitment within the sector. A report would be brought to the committee in the coming months.
• The Executive Councillor for Adult Care and Public Health advised the Committee that there a winter summit had taken place in which the Council worked with Council ran homecare providers, which had made available initiatives which would ensure employees felt valued for their hard work. The initiatives had included participation in pension schemes; flexible working arrangements; an increase in the hourly rate and developing training opportunities.
• The Care Awards were due to take place in March 2022 which would highlight the good work that was done by carers.

RESOLVED:

          That the report be received and the comments made be noted.