Agenda item

To consider the latest trends, priorities and pressures in terms of departmental performance as reported in the Quarterly Service Report for the fourth quarter of 2017/18 (January to March) relating to Adult Social Care, Health and Housing.  An overview of the key issues relating to the first quarter will be provided.

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

The Panel noted the Quarterly Service Report (QSR) which covered the fourth quarter of the 2017-18 financial year (January – March).

The Chairman thanked Councillor Tullett for his comprehensive list of questions which had been submitted and answered before the meeting and requested that they were appended to the minutes (available at Annex A).

Mira Haynes, Chief Officer Adult Social Care highlighted that the first phase of the transformation has been successfully delivered despite some challenges such as an unexpected Care Quality Commission (CQC) Local Area Review in September 2017. She reported that there had been good performance across the indicators but some areas were still red. The headline from the current quarter was that consultation had been undertaken with staff to integrate the expanded Integrated Care System and Long term care teams. East Berkshire Clinical Commissioning Group (CCG) proposal to manage the continuing Healthcare function was still work in progress. The Council was advertising for Personal Assistant posts which could be paid for by residents through direct payments.

Simon Hendey, Chief Officer: Early Help & Communities advised that the Homeless Reduction Act was a major change at the end of April 2018 which introduced the duty to undertake homeless prevention for 56 days by creating a personalised homelessness prevention plan. He reported that to date:

• 76 households were in triage
• 35 households were under intervention which was the stage before prevention
• 24 households were in the prevention stage which meant that they had a personalised agreed plan
• 49 households were in the relief stages receiving support
• the Council had accepted the homeless duty on 13 households

The Welfare and Housing teams were now combined which gave more opportunity to support residents and additional government funding was supporting ongoing recruitment to increase the number of officers to keep pace with demand.

Lisa McNally, Director of Public Health updated the Panel on recent public health activities including that there were no red activities to comment on. She reported that Bracknell Forest had pioneered more community focused interventionist approach initiatives which were very popular. The approach had been to set up activities with people rather than to them such as the community map and physical activity groups. She reported that more traditional, structured treatment approach such as NHS Stop Smoking campaigns had struggled recently to achieve uptake and a less medicalised approach was more successful. She explained that the Community Map now had up to 386 groups and thanked members of the Panel for their support populating it.  Groups such as Junior Parkrun, Martial Arts sessions which were inclusive of all physical abilities, “Who let the Dad’s out” crèche, walking groups with 50+ members and Checkmates chess groups in libraries had all helped to boost inclusivity for groups who otherwise feel socially isolated.

She reported that, in a short time period of only two years, the data suggested that this activity has had a positive effect on reducing social isolation issues and high re-admission to hospital levels. The approach was attracting national attention such as The National Centre for Mental Health featuring it and councillors from Medway Council visiting the Council to see how it works. The Director advised the meeting that the community groups involved would come together to form a marketplace to showcase what works well rather than the visitors touring locations around the borough.

The Director updated the Panel on the changes in approach to health visiting and that child development data had seen high levels of child development across the four key areas at the age of two which meant that Bracknell Forest children were having the best start in life.

Arising from questions and discussion the following points were made:

There has been a 10% decrease in the number of clients (Jun 17 to Mar 18) from 1160 to 1040 and a gross care cost reduction of 5%, (£30.5 Million in Oct 17 down to £29m in March 18)shown on the care cost 12 month trend analysis. Although costs were complicated by complex care cases the reductions were linked to ways of working with people such as the conversations model which was helping identify appropriate support early on and new technology was also being used to support residents.

There was an increase in demand during the summer months.  The approaching adulthood team work with children aged 14+ and there is a spike of demand when the school term ends and the team work closely with the Children Young People and Learning department.

It was explained that Adult Social Care had undertaken a procurement exercise for new domiciliary care providers. The previous level of 20 providers has been reduced to eight or nine and there were some transition and handover issues. During the process providers had stopped taking on packages of care but the new contracts were now in place and the Panel were assured that this situation had now been resolved.

The number of people needing double up calls (when more than one carer is required to attend a visit) over the last 18 months; had risen.  When people are discharged from hospital they are medically fit, but this did not mean they are physically fit and they often needed more support until the care package could be reduced.  More than one carer was required when someone needed support with a hoist or to be lifted.

It was observed that the success of getting people with complex needs out of hospital back into the community setting was costing the Council money but it was clarified that the intermediate care service was funded jointly with the CCG and the local authority. It was stated that the focus should be that hospital was not the right place for residents who were medically fit.

Members of the Panel requested further forecasting information on demand. Lisa McNally, Director of Public Health confirmed that this was possible using POPPI and housing data to produce a statistical model to show where costs and demand might go to give an idea of trends. Mira Haynes, Chief Officer Adult Social Care also agreed to share data Adult Social Care are working on.

The Panel were advised that a public health reserve had been built up over the last 3 years. Public Health grant funding had already been used to invest in the Community Connectors service to reduce social isolation.  In general, the intention is to shift budget to higher levels of need but that, before this could be done, it had to be demonstrated that savings were sustainable at lower levels of need first. More detail will be available.  Any recurrent underspend must be seen in the context of the reducing level the Public Health Grant being received by the Council.

The Panel were advised that Public Health would bring future proposals to be considered by the Council in more detail for scrutiny.

Simon Hendey, Chief Officer Housing, clarified that the capital under spend in 2017/18 is carried forward. That capital has to be used to fund adult social care capital expenditure and as such could be used to fund accommodation for people with learning disabilities or to contribute towards the capital costs of the Heathlands project if that proceeds. The latter use would generate additional revenue savings for the Council as it would replace the need for the Council to enter into borrowing to fund the project equivalent to the capital contribution that is made available.

It was explained that there were two parts to the Heathlands development. A 44 bed unit for Elderly, Mentally, Infirm (EMI) and a 20 unit Learning Disability (LD) accommodation.  The LD accommodation could not fit on the Heathlands site in planning terms. Thus a feasibility study has been commissioned on another Council owned site to assess whether the learning disability accommodation can be accommodated.

The Panel were advised that it was a long term conditions pilot had now become business as usual and the Council was working with three GP clusters – North, South and bordering with Ascot.

In response to a question regarding low targets it was confirmed that there was now zero risk that use of the website would exceed capacity.  Targets had been set based on what could be achieved but that the level of online services demand had exceeded expectations.

Work still needed to be done to extend access and points of contact and the Director advised that Local Government Association (LGA) funding had been applied for to provide kiosks in shopping centres and community centres were being considered

A children’s health and wellbeing website was currently in development.

The Director of Public Health agreed that the work of Public Health including strategic targets should be included in future drafts of the Council Plan and was interested to know what Members of the Panel wanted to see delivered.

Members reiterated concerns regarding the sickness statistics and queried whether an anonymous stress audit had been carried out and whether staff were taking sickness days instead of annual leave.  The Panel were advised that there were incidences of long term sickness included in the figures and that these absences were not attributable to work related stress.

The Panel were advised that managers follow the managing health policy and look for trends and patterns in absences.  They offer support where necessary and refer to occupational health if necessary. The Council was offering wellbeing courses, had created breakout spaces, counselling was offered for the Emergency Duty Team, agile working was offered and that there are professional support mechanisms in place to support staff members.

The Panel noted that the sickness levels were consistently elevated within the ASC team in every QSR and it was suggested that the data be further interrogated and those who are on long term sick be isolated from the numbers to give a truer picture of ‘occasional’ sickness patterns.  This would potentially provide further insight and help to explain the skew.

The Panel also asked to see how the sickness levels compared regionally and nationally to other ASC teams.  The Panel felt that further investigations and a proper analysis of the sickness levels were required.

The Chairman thanked everyone for their questions and answers.