Agenda and minutes

To approve as a correct record the minutes of the meeting of the Adult Social Care and Housing Overview and Scrutiny Panel meeting held on 16 January 2018.

RESOLVED that the minutes of the meeting of the Panel held on 16 January 2018 be approved as a correct record, and signed by the Chairman.

Arising from minute 79 relating to the Safe Places Scheme, the meeting was advised that no further information was available from the investigation into why premises had not signed up for the scheme but that this would be followed up after the meeting.

There were no items of urgent business.

Members are asked to declare any disclosable pecuniary or affected interests in respect of any matter to be considered at this meeting.

Any Member with a Disclosable Pecuniary Interest in a matter should withdraw from the meeting when the matter is under consideration and should notify the Democratic Services Officer in attendance that they are withdrawing as they have such an interest. If the Disclosable Pecuniary Interest is not entered on the register of Members interests the Monitoring Officer must be notified of the interest within 28 days.

Any Member with an affected Interest in a matter must disclose the interest to the meeting. There is no requirement to withdraw from the meeting when the interest is only an affected interest, but the Monitoring Officer should be notified of the interest, if not previously notified of it, within 28 days of the meeting.

There were no declarations of interest, nor any indications that members would be participating while under the party whip.

In accordance with the Council’s Public Participation Scheme for Overview and Scrutiny Mr Pickersgill of Wildridings & Central Ward submitted two questions to be considered by the meeting:

• What is being done to change the former care model which is now financially unsustainable especially with many of the care homes in financial crisis themselves (including Four Seasons)?

• Is Bracknell having to use its reserves?

The Chairman thanked Mr Pickersgill for his well informed questions and the Director of Adult Social Care, Health and Housing, Gill Vickers responded that for the previous year the directorate had been implementing a transformation programme intended to improve customer experience and reduce the risks in the market. The programme was aimed at supporting people in their homes and communities through initiatives such as:

• Early intervention (without assessing for eligibility) when individuals contact us for the first time
• Taking a ‘strength based approach’ helping individuals to problem solve and identifying support networks in the community and voluntary sector
• A new approach to ensuring the voluntary sector organisations are sustainable (providing a digital platform to enable them to market their services, for individual’s with Personal Budgets to buy their services online, removing the need for expensive and time consuming individual invoicing.  Also identifying unmet needs and posting information on this for the voluntary and private organisations for development opportunities

·         The Director explained that integrated intermediate care was available seven days a week until 8pm in the evening. The Council was working with health providers in nursing and residential homes to support people and prevent them going into hospital and providing care when they are discharged.

·         It was explained that the Council was also using technology to support people such as sensors for people getting out of bed.

·         Following the Care Act the Council’s early intervention work considered how to problem solve the issues such as signposting towards organisations or provision of money to support people (up to £500). A map of community groups had been built upon those that would welcome people referred to them. The Council was working with the voluntary sector to support groups to be sustainable even with reduced grants. People had individual budgets and used prepaid cards to pay for participation. The community hub and community connectors can help residents find the community groups, organisations and services available in Bracknell Forest..

·         The meeting was advised that if in hospital a patient was assessed on their way out which was termed ‘support discharge to assess’ in order to take the time to see what the individual needed. It was recognised that people do not function well in hospital . This could be provided over a period of up to six weeks to help determine whether they should return home or required residential care.

·         The Director moved onto the second part of Mr Pickersgill’s question by confirming that the council was using reserves but in a planned way. £2.5m of reserves had been identified to support the 18/19 budget but this was in line with  ...  view the full minutes text for item 89.

To consider the latest trends, priorities and pressures in terms of departmental performance as reported in the Quarterly Service Report for the third quarter of 2017/2018 (October to December 2017) relating to Adult Social Care and Housing.  An overview of the key issues relating to the fourth quarter will be provided.

Panel members are asked to give advance notice to the Overview and Scrutiny Team of any questions relating to the Quarterly Service Report where possible.

The Panel considered the latest trends, priorities and pressures in terms of

departmental performance as reported in the QSR for the third quarter of 2017/18

(October to December 2017) relating to Adult Social Care, Health and Housing.

The Director of Adult Social Care, Health and Housing made a presentation

highlighting recent and current activity:

·         Forestcare have won two external monitoring contracts with a total annual contract value of nearly £100,000.

·         Self Care week had been successful with a range of different activities including the biggest walking group session organised so far with 42 people taking part.

• The Council was sponsoring Dogs for Good project which had enabled two dogs to work with up to three people per day. One of the residents who had benefited form the scheme had attended the main arena at Crufts to help demonstrate the project. Despite the event being very busy he was relatively calm and was well supported throughout.

·         The percentage of people receiving social care who receive direct payments has risen to 43.5% against a target of 31.4%, which is very good performance.

• In relation to performance measure L178 regarding Household nights in bed and breakfast this had increased to 908. It was clarified that this related to single people due to issues such as arrears or convictions which meant that they spent up to a week in a bed and breakfast accommodation. Previously these figures did not relate to families but as of the night before the meeting a family was being accommodated in bed and breakfast but the team were working to help them move on.

Arising from questions and discussion, the Panel noted:

·         Early stage plans were in place to look at council sites for shared accommodation in the borough to support people on probation and another plan was to work with Probation to look at a large housing association to address this issue of accommodation

·         Revenue budget was forecasting an overspend but that was no longer the case in quarter four. A £1.1million saving was proposed and £1.8million had been achieved due to improving services rather than cutting them and was a credit to the staff team who had embraced the changes.

·         Direct payment RAG rating was red in quarter three but had since been updated to green.

·         4.4.14 Additional build on Healthlands was the joint EMI project whose RAG rating was red as the delivery had slipped by three months. It was due to open in December 2020 but this was now March 2021 due to working with multiple partners.

·         7.1.20 the transitions model is now working effectively so RAG rating altered to Amber

·         7.1.25 New intermediate care service model operational was showing in quarter three as red but was currently green as the project was back on track.

·         Suggestion to consider Hope into Action project in which churches bought properties in shared ownership, one individual looked after 4/5 people in the heart of the community to support people past the vulnerable stage. The Director welcomed all suggestions  ...  view the full minutes text for item 90.

The Panel received and noted the scheduled Key and Non-Key Executive Decisions relating to Adult Social Care and Housing.

Gill Vickers, Director of Adult, Social Care and Housing and Melanie O’Rourke, Head of Adult Community Team will run an interactive session on the Conversations approach with Members including case studies.

The 3 Conversations model has been adopted across Adult Social Care and is the way that we support people.  Our aim is to help people regain independence and control following illness or when the person has a Long Term Condition.  In essence, the model is a move away from unnecessarily protracted processes and questioning to one that is proportionate and driven by the person.

The previous approach  involved formal assessment of individuals’ presenting to Adult social care to ensure they met eligibility criteria.  This has been replaced with a more  has replaced with a more natural conversation to drill down on the presenting issues, problem solving together to find sustainable solutions.  The model can only work when we build on what is already working for the individual (their strengths).  Not only to find out what things the person has around them to help, but also to help the individual reflect and recognise the things they are succeeding with.   The approach focuses on applying a “Common Approach to Common Sense” enabling practitioners to be more creative and responsive using a three stage approach.  

The 3 stages are briefly illustrated below:

•           A 1st Conversation is aimed at helping people whether or not they are eligible under the Care Act.  The focus is on short term, quality interactions as early help or to prevent / delay need.

•           A 2nd Conversation focuses on Short Term Interventions to help the person to resolve an immediate need or crisis.  The aim of a 2nd Conversation is for the person to regain control and independence.

•           The 3rd Conversation is the point at which long term support is established under our statutory processes and duties (these will be people who meet our statutory eligibility criteria).

Head of Adult Community Team, Melanie O’Rourke provided the meeting with a conversation awareness session explaining the case for change, how the conversations approach worked, how this was being implanted in Bracknell and the difference it was making, Using case studies she demonstrated how this was changing the Council’s relationship with the people it supports.

The session challenged members present to consider two questions e.g. what it would take to contact social services and a risk that they would take that would cause concern to a Social Worker visiting them. These questions were discussed in small groups and then fed back to the meeting to consider how the new approach responded to these concerns.

Arising from questions raised during the discussion:

·         Positive feedback from the new approach would be circulated to members

·         The Council monitored and checked the needs of residents to make sure that they were safe. Personal Assistants were recruited through direct payments or residents could choose someone they know. Advice was provided to explain how they could protect themselves such as requesting DBS as well as using a prepaid card with the Personal Assistant having a separate card. There are also multiple methods of flagging concerns but it was recognised that this was a difficult conversation so this was addressed early on with residents so they were prepared.

·         Carers assessment were done separately to the person being cared for but the focus was on what they were struggling with and what support they needed. It was clarified that it was an ongoing process and that if a resident’s reassessment impacted upon their carer then the carer could request to be reassessed themselves to help them continue to provide support.

The Chairman thanked the Head of Adult Community Team for providing the briefing and concluded this was a positive approach to treat residents like adults, with both dignity and respect. It was noted that early intervention was key and the Council was working with the voluntary sector to help identify people requiring support.

Councillor Mrs Temperton suggested including information this approach in community newsletters such as Great Hollands Matters. Officers offered to also visit groups of residents to talk about this new approach if requested. It was also suggested that motivational questioning, the technique behind the conversations approach, could be offered to all members as part of the member development programme to support their work with residents.