Andy Williams (Lead for Adult Social Care, Livewell Southwest), Gill Nicholson (Head of Innovation and Delivery), Julia Brown (Service Director for Health and Adult Social Care), Gary Walbridge (Strategic Director for Adults, Health and Communities), and Ian Lightley (Chief Operating Officer, Livewell Southwest) delivered the Adult Social Care Activity and Performance Report and discussed:

a)     The report was structured into four sections: Care Act Assessments, Care Act Reviews, Occupational Therapy (including minor adaptations), and Commissioned Services, with additional updates on domiciliary care, reablement, direct payments, and hospital discharge performance;

b)    Significant progress had been made in reducing the Care Act assessment waiting list, which stood at 301 in September against a target of 200, compared to 800 eighteen months ago;

c)     The average time to complete an assessment from allocation was 16.9 days, and 178 assessments had been completed in the reporting period;

d)    A more targeted approach was being adopted to support the system, recognising that clearing backlogs had increased demand for domiciliary and residential care. This work was linked to the Council’s Budget Containment Plan, including reviewing whether needs had changed and adjusting priorities accordingly;

e)     The sustainable waiting list target of 200 was based on modelling that assumed processing within 28 days, though this would be reviewed once achieved;

f)      The percentage of long-term service users with an assessment within the last year had risen to 57.4%, approaching the national target of 60.7%. Productivity remained strong despite added responsibilities, and the most long-standing reviews were complete;

g)     Further efficiencies were limited, but focus remained on reviewing new cases promptly, reducing waiting lists, and delivering timely responses. Review waiting times were improving in line with assessment work;

h)    Local stretch targets were set annually based on comparator authorities and national performance;

i)      Increased costs following reviews were attributed to increased need rather than inflation. Data on reviews resulting in reduced or ceased care packages would be added to future reports;

j)      The number of people waiting for Section 2 occupational therapy assessments had reduced, but further work was needed to bring waiting lists down. The average waiting time was 192 days, which was acknowledged as too high;

k)     Livewell had initiated an improvement programme aligned to wider transformation, focusing on early intervention, community-based support, and initiatives such as encouraging private equipment purchases, reintroducing care and repair services, and better use of community hubs;

l)      Plans included raising the minor adaptation budget threshold, streamlining access to basic equipment through self-referral, and partnerships with local suppliers to release capacity within the team;

m)   Challenges included historic data issues between systems, which had now been resolved, and workforce pressures. A phased recovery plan was in place to reduce waiting times over 12 months, applying learning from Care Act assessment improvements;

n)    There had been an increase in residential and nursing care placements for adults over 65, rising from 368 in October last year to 391 currently, creating budget pressures;

o)    Work was ongoing to review care packages and ensure appropriate step-down from hospital discharge to home where possible. Individuals discharged into residential care were contacted within 24 hours and seen within 48 hours, with a target of resolving Pathway Two cases within 42 days;

p)    Increased demand for domiciliary care was noted, with work ongoing with Independence at Home and internal brokerage teams to increase capacity and ensure timely, person-centred support;

q)    Reablement performance was positive, with 81.6% of individuals remaining at home after 91 days, above regional benchmarks. Average length of stay in reablement was 4.7 weeks against a six-week target. Plans were in place to expand reablement services citywide;

r)     Uptake of direct payments had returned above target, with 635 individuals (over 20% of current users) now using this option. The banking service had been brought in-house, and work continued to promote direct payments through Livewell social workers;

s)     While “No Criteria to Reside” figures had deteriorated earlier in the year, recent weeks had seen improvement, with Plymouth’s position benchmarking well nationally. Collective work continued with Devon and Cornwall colleagues to maintain performance through winter.

In response to questions, the Panel discussed:

t)     The Panel suggested exploring whether housing associations could undertake simple adaptations, such as installing handrails, without requiring a full occupational therapy assessment. Officers agreed this was a practical idea and confirmed it would be investigated further;

u)    The Panel requested year-on-year data to identify seasonal trends and asked for distribution analysis of waiting times, including banding and prioritisation methods. Officers confirmed that historic data could be provided, noting that previous methodology changes might affect comparability;

v)     The Panel expressed concern about the availability of care staff to meet increasing demand for home-based care and reablement services. Officers confirmed that recruitment had improved post-pandemic, market capacity was currently stable, and work continued to ensure continuity of care and effective workforce deployment;

w)   The Panel emphasised the importance of maintaining independence for individuals discharged from hospital and ensuring they were placed in appropriate settings. Officers outlined commissioning work to embed reablement approaches in care homes and confirmed efforts to match individuals to suitable environments, including consideration of cognitive needs;

x)    The Panel raised concerns about individuals without dementia being placed in homes where most residents had dementia, potentially leading to isolation. Officers acknowledged this challenge and confirmed that placement decisions aimed to match individuals to appropriate settings wherever possible;

y)     The Panel queried whether early discharge from hospital contributed to increased residential placements. Officers confirmed that collaborative work was underway with hospital teams to ensure least restrictive options were considered and that individuals were supported to return home wherever possible;

z)     The Panel queried challenges with the uptake of direct payments. Officers advised that Plymouth performed well compared to other authorities but aimed to further improve figures next year, promoting choice and control for service users;

aa)  The Panel asked whether individuals were being signposted to private occupational therapy assessments and how many had taken this route. Officers confirmed that while advice was given, data on private assessments was not routinely captured.

1.   Action: Officers to explore opportunities for housing associations to undertake minor adaptations without requiring a full occupational therapy assessment;

2.   Action: Officers to provide year-on-year data to identify seasonal trends and include distribution analysis of waiting times, including banding and prioritisation methods;

3.   Action: Data on reviews resulting in reduced or ceased care packages to be added to future reports;

4.   Action: Officers to provide data on the proportion of community-based assessments resulting in a formal package of care at the next meeting.

The Panel agreed:

1. To note the Adult Social Care Activity and Performance Report and the progress made across all areas.