Councillor Aspinall (Cabinet Member for Health and Adult Social Care) introduced the Adult Social Care Performance Monitoring Report and discussed:

 

a)     The report provided a performance update for Adult Social Care, including demand levels, waiting times, outcomes for people, and key system pressures and improvements;

 

b)    The report followed the recent Care Quality Commission (CQC) inspection of Adult Social Care, with Plymouth receiving an overall rating of ‘Good’, which was a significant achievement;

 

c)     Performance information was presented thematically, including front door and triage, Care Act assessment activity, review activity, occupational therapy (OT) waiting times, care?home demand, domiciliary care capacity, reablement outcomes and hospital flow indicators including “No Criteria To Reside”.

 

Julia Brown (Service Director for Adult Social Care), Gill Nicholson (Head of Innovation and Delivery, Adult Social Care) and Ian Lightley (Livewell Southwest) added:

 

d)    At the ‘front door’, no-one waited more than five days for an initial triage decision. This ensured everyone contacting the service received a timely first response and a clear decision on whether a full Care Act assessment was required, enabling earlier advice, information and signposting;

 

e)     Significant progress had been made on Care Act assessments. The average number of days to complete an assessment had reduced from over 200 days earlier in the year towards the 100?day target, and the very long waits of over 500 days had reduced substantially;

 

f)      The ‘waiting well’ arrangements had been fully implemented, including:

 

                     i.         proactive contact with people on the waiting list and clear updates on expected timescales;

 

                   ii.         established contact routes so people could notify the service if needs changed or risk increased;

 

                  iii.          risk?based prioritisation that enabled higher?risk people to be brought forward sooner;

 

g)     Review activity had shown a slight reduction in total reviews completed, reflecting a deliberate shift toward targeted, proportionate reviews that:

 

                         i.         focused on those at highest risk rather than solely on length of wait;

 

                       ii.         ensured reviews were proportionate, avoiding unnecessary full reassessments;

 

                      iii.         supported safe reductions in care packages where people no longer required the same level of support;

 

h)    Targeted reviews had identified individuals whose needs were more appropriately funded through NHS Continuing Health Care or other health budgets. This contributed to a realignment of funding responsibilities, ensuring the correct service funded the correct level and type of care and supporting budget sustainability across health and social care;

 

i)      OT waiting times remained a priority, with the waiting list including both Adult Social Care and health referrals;

 

j)      The overall picture for OT had improved, although around 18% of people were still waiting more than 300 days, which officers acknowledged remained too long;

 

k)     To address OT delays, Adult Social Care and Livewell Southwest had initiated a significant review of OT activity, including:

 

                     i.         development of a clearer shared definition of Adult Social Care OT, distinguishing longer?term care and independence?focused interventions from health rehabilitation;

 

                   ii.         review of pathways, demand and prioritisation for Section 2 and Section 9 activity to ensure referrals entered the correct pathway;

 

                  iii.          expansion of “waiting well” approaches within OT so people waiting were kept safe, informed and supported;

 

l)      Residential and nursing care placements remained broadly stable through November and December 2025, although short?term and step?down placements fluctuated as expected;

 

m)   The Council’s new care?home framework had gone live at the start of January with strong provider engagement;

 

n)    The care?home framework aimed to:

 

                 i.         support greater collaboration with the provider market;

 

                ii.         stabilise and contain fee levels while recognising inflationary and complexity pressures;

 

              iii.         better align the cost of care with need and outcomes for residents;

 

o)    Domiciliary care data for December showed a slight reduction in total people receiving domiciliary care, though new packages continued to fluctuate month to month;

 

p)    Officers were working closely with the domiciliary care market to ensure sufficient capacity to meet current and forecast demand, particularly in the context of winter pressures and hospital discharge;

 

q)    Reablement performance remained strong, with over 81.8% of people remaining at home 91 days after discharge, above the 80% historic target;

 

r)     The national benchmark for this measure had increased to 83.9%, which would apply from April 2026;

 

s)     Although the future target would be more challenging, officers were confident in the reablement service’s effectiveness and its contribution to keeping people well at home;

 

t)     Direct payments continued to show positive progress, with:

 

                 i.         an in?house payroll function strengthening control, resilience and value for money;

 

                ii.         increasing numbers of people choosing to manage their own care following a temporary dip in the summer;

 

              iii.         additional staff training so direct payments were routinely offered as a first?line option;

 

u)    The NCTR metric reflected the proportion of inpatients who no longer met criteria to remain in hospital. Plymouth’s NCTR figure had been hovering slightly above the 9% target at around 10% during the reporting period, although it fluctuated daily;

 

v)     At present, the NCTR position had improved to approximately 5%, demonstrating the system’s ability to restore performance rapidly. Keeping NCTR close to or below the target reduced the risk of unnecessary hospital stays, which could contribute to deconditioning and poorer outcomes;

 

w)   A key reason for delays for people with NCTR status involved arranging care?home placements, which took longer due to the need for care?home assessments;

 

x)    The system therefore prioritised a “home first” approach where appropriate, as discharge home with support could be arranged more quickly than care?home admission.

 

In response to questions, the Panel discussed:

 

y)     The Panel welcomed the reduction in the OT waiting list from around 742 to 652 and queried how “waiting well” and operational expectations would deliver benefits for residents. It was confirmed that the focus remained on maximising staff time spent on assessments and direct work, removing non?essential tasks and enabling clearer prioritisation;

 

z)     The Panel commended progress on Care Act assessment times and queried  when the 100?day target might be reached and what the next ambition would be. Officers clarified that around 11% of people were still waiting more than 200 days and roughly 108 people were waiting over 101 days at the time of reporting. There would be a continued focus over the next four to five months to reduce very long waits. Once the 100?day average was sustained, the next ambition would be to move toward most assessments being completed within six weeks;

 

aa)  Members expressed concern that rising demand pressures could squeeze preventative work despite the emphasis on early intervention during Budget Scrutiny. Officers acknowledged the risk but emphasised protected time for preventative activity and noted that backlog reduction had freed capacity for prevention;

 

bb)Members queried the drop in monthly Care Act assessment completions after a peak earlier in the year and asked what resilience would support a consistent level of around 180 completions per month. Officers explained that:

 

                 i.         winter pressures, sickness, annual leave and vacancies had affected capacity;

 

                ii.         earlier high completion levels reflected a greater proportion of less complex cases in the backlog;

 

              iii.         remaining cases were more complex, naturally lowering throughput;

 

              iv.         activity levels would stabilise as backlog and complexity reduced;

 

cc)  Members queried the NCTR figure and asked where the main discharge challenges remained. Officers advised that day?to?day variation was significant but current performance at around 5% was positive. Complex pathways, especially into care homes, created longer waits due to assessment and matching. Daily multi?agency calls reviewed individual delays and resolved issues. Supporting more people home first remained the most effective approach;

 

dd)Action: Members requested that future reports include data on reviews resulting in reduced or ceased care packages. Officers agreed to include this information in future reporting;

 

ee)  It was confirmed that 38 care homes had signed up to the framework and participation was expected to increase, particularly through the innovation lot. Incentives included clearer commissioning intentions and a more stable fee environment;

 

ff)    The Panel reiterated its appreciation of the work undertaken to improve waiting times, reduce long waits and respond to winter pressures, and noted the continued focus on prevention, market sustainability and system flow.

 

 

The Panel agreed:

 

1. To note the Adult Social Care Performance Monitoring Report;

 

2.     Action: Officers to analyse the spike in the percentage of reviews with increased costs in August and report back to the Panel;

 

3.     Action: Officers to include data on reviews resulting in reduced or ceased care packages in future performance reports.