To receive an update on the quarterly performance and finance status for Health and Social Care.

 

The Committee is invited to review the risk register as published for the Audit and Governance Committee in March 2023.

Councillor Mary Aspinall (Cabinet Member for Health and Adult Social Care) introduced the report and highlighted the following points:

 

a)     The report provided a comprehensive overview of some of the key performance and activity metrics that were used by the Council and its Partners, including the Integrated Care Board (ICB) and Livewell Southwest;

b)    The information within the report was used operationally and strategically by officers and senior managers across all organisations to ensure the best possible outcomes for people using the health and social care system.

 

Rob Sowden (Senior Performance Advisor), Helen Slater (Lead Accountancy Manager) and Gary Walbridge (Head of Adult Social Care and Retained Functions) delivered the report, and highlighted the following points:

 

c)     Referral demand for Livewell Southwest’s services had remained steady and staff had been working to reduce waiting lists, evidenced by a decline in waiting lists for adult social care support and adult social care occupational therapy;

d)    Nearly 90% of people referred into social care would not go onto receive long-term adult social care support, so it was important to have alternative long-term care in the community, supported by the Care for Plymouth model;

e)     The number of people in the community waiting for a domiciliary care package had reduced despite a general increase in demand;

f)      On average in 2022/23, 66% of people left the reablement service with no ongoing needs, which was the most desired outcome;

g)     There was a challenge in relation to long term admissions and placements into residential and nursing care in 22/23 with admissions of people aged 65 and over increasing by 57%. Work was being undertaken with partners to better understand the factors behind this;

h)    The number of people in receipt of a supported living package was increasing, but the waiting list remained low;

i)      The number of people in receipt of direct payments was increasing, which was positive as it allowed people to spend money on care they wanted to receive. Plymouth was expected to level the benchmarking averages by the end of the financial year 2023/24;

j)      Safeguarding outcomes were fed into the quarterly Plymouth Safeguarding Adults Board. There had been a drop in cases requiring a full investigation in 2022/23, which had been attributed to an in-service review with partners to ensure best quality of the investigation process;

k)     96.9% of people in 2022/23 who were subject to abuse and thus a safeguarding investigation, had seen their safeguarding personal outcomes achieved partially or fully;

 

l)      Section 42 of the Care Act related specifically to safeguarding and set out the responsibilities and duties of the Council. A Section 42 inquiry would occur when the concern was significant enough to be investigated to ensure the safety of the person in question;

m)   Complaint numbers were monitored on a monthly basis but had remained relatively static;

n)    The Adult Social Care survey had been completed in February/March 2023 and Plymouth had consistently outperformed its similar local authorities, as well as the national and regional averages;

                         i.         The results had shown a high satisfaction rate, and high levels of feelings of choice and control;

                       ii.         Results had also shown an underperformance against a KPI that measured how easy people found to access information and advice;

o)    There had been an upward trend in carers assessments since June 2022;

p)    A considerable amount of work had been undertaken within the carers commissioning service to seek improvements;

q)    There was an improving long term trend within ‘no right to reside’ data

(the number of people who experienced delayed discharge) at University Hospitals Plymouth, but the average length of stays within hospitals had remained relatively static since October 2021;

r)     There had been a reduction in the number of hours lost to ambulance handovers however, data showed that the percentage of ambulances that were delayed over 15 minutes exceeded 80%, and the number of patients waiting for more than 12 hours in the Emergency Department was above average.

 

In response to questions it was reported that:

s)     Efforts would be taken to improve readability of data within future reports;

t)     Councillor Aspinall had received concerns from residents regarding challenges communicating with the Council and would address this through the Ageing Well agenda. Challenges faced by those who were digitally excluded would be investigated. Issues around communication had been an ongoing issue, and would remain a priority to be included in the business plan;

u)    Analysis of complaints across the Council was regularly undertaken and recommendations from the LGO were recorded and analysed to identify trends and levels of improvement, all of which were then reported back to the corporate management team and mitigations were applied as necessary;

 

v)     LGO recommendations relating to Health and Adult Social Care would be brought to the next meeting of this Committee;

w)   There were 99 residential and nursing care homes, and 6-8 domiciliary care providers that the Council worked closely with within the city. Reviews were regularly undertaken into the procurement of services to ensure best value;

x)    Details of the procurement and monitoring of these services would be brought to the next meeting of this Committee, to provide members further information on procurement, approach and mechanisms;

y)     Individual care arrangements were made through a brokering service that aimed to best match people to the most appropriate providers. A significant amount of work was undertaken by the Council to ensure people received the best possible quality of care;

z)     Anyone who was not satisfied with the care they received was encouraged to contact their provider in the first instance, who were obliged to look at each complaint, and respond. However, if this was not satisfactory or achievable, the public were able to contact the Council directly;

aa)  There had been concerns raised over the inconsistent standard of care received from varying providers. Issues surrounding the procurement and standards of care would be brought to the next meeting of this Committee;

 

bb) Data regarding waiting times for domiciliary and supported living packages would be included in future reports; 

 

cc)  Although data showed that ‘the number of people who were satisfied with the amount of control they had over their daily lives’ was above the national average, it had declined over several years and would be addressed in forward planning;

dd) Social Care had seen an improved position due to various improvement schemes run over the winter period. It was now necessary to exit some of these schemes and return to the usual business model however, it was vital to maintain the current standards achieved. Workforce challenges also showed signs of recovery, and would help sustain the improvements made;

ee)  People waiting for domiciliary care were triaged using a Red, Amber, Green (RAG) rating, with red being most in need of support. This list was periodically reassessed to ensure the rating was still relevant and appropriate, as it was recognised that people’s situations changed over time;

 

ff)    Oversight and support was provided by NHS England at a national level to understand the drivers behind the challenges being experienced in the Emergency Department, and to ensure that the most effective actions were being taken. This focussed on the flow of people through the hospital and how people could be better supported by other services within the community.

 

The Committee agreed to-

 

1.   Note the Health and Adult Social Care Performance report;

 

2.   Add the following items to the work programme for the next meeting:

 

                       i.    LGO recommendations relating to Health and Adult Social Care;

 

                     ii.    Procurement and standards of domiciliary care.

 

 

Helen Slater (Lead Accountancy Manager) introduced the Adult Social Care Finance Report and highlighted:

 

gg)  The adult social care budget for 2022/23 was just over £85 million, the biggest revenue budget within the Council, and had underspent at £83.22 million. This underspend had been used to meet pressures within Community Connections relating to homelessness;

hh) Domiciliary care and direct payments were the highest pressure areas, which were offset by an increased client and joint funding income, and additional grant funding;

ii)     In 2023/24 the budget was uplifted by £7.582 million following modelling on expected demand and having taken into account an increase in the national living wage and inflationary increases. However, there had been an increase in delivery plan savings targets of £3.712m, so the net increase was just £3.870 million;

jj)          The two largest saving targets related to managing demand across the care provider market and ASC package reviews, as well as transition packages for people going from Children’s Social Care into Adult Social Care. Additional income was expected through direct payment clawbacks;

kk)       Care package expenditure was the highest at over £103 million;

ll)          The main contract of the service was with Livewell for social care with a budget of £7.6 million;

mm)    There was a new provider of community equipment for 2023/24 with a contract of £1.54 million;

nn)       CRAG was the nationally set charging framework for people in residential and nursing care.

 

In response to questions it was reported that:

 

oo)There had been an 8.5% uplift in the budget for residential and care home fees but it was important to be cautious when comparing Plymouth’s market to those of neighbouring authorities because of significant differences in geography and location.

 

The Committee agreed to note the report.

 

 

Ross Jago (Head of Governance, Performance and Risk) introduced the Risk Management Monitoring Report and highlighted that:

 

pp) There were 22 strategic risks on the corporate register, six of which were red, and one of these fell within the remit of the Committee –‘the lack of adult social care workforce and growing fragility in the adult social care market’, which was improving;

qq) There were a number of amber risks including risk number eight which referred to health inequalities and life expectancy. It was recommended that  the Committee read the Plymouth Report, which fulfilled the requirement for a joint strategic needs assessment, and was due to be considered by the Health and Wellbeing Board;

rr)   Risk number 10 referred to adult social care reforms, which the Committee had been diligent in looking at over the previous 12 months.

 

The Committee agreed to note the report.