Agenda and minutes

To receive any declarations of interest.

There were no declarations of interest received at this point in the meeting.

The minutes of the Adult Social Care and Services Scrutiny Panel meeting held on 30 March 2022 were submitted and approved as a correct record.

The Director of Adult Social Care and Health Integration will provide the panel with a verbal update regarding the integration of health and social care.

The Director of Adult Social Care and Health Integration provided Members with an update regarding the integration of Health and Social Care; the following points were made:

• The transition from the current Clinical Commissioning Groups (CCGs) arrangement to the Integrated Care System (ICS) was almost complete, with the switch over due to take place on 1 July 2022.
• The Chief Operating Officer of the ICS was now formally in place, alongside other senior personnel.
• Structurally, the ICS would comprise an Integrated Care Board (ICB), i.e. the formal NHS Board where financial authority and financial allocations for the region would sit, and below that, an Integrated Care Partnership (ICP).  Membership of the ICB was stipulated within legislation, whereas the ICP would provide opportunity for local partners to come together to share their priorities and commissioning aspirations.  This would then ‘feed into’ the ICB for deliberation around decision-making.
• The geography of the North East and North Cumbria ICS was larger than any other, not necessarily by population, but area size.  Representations had been made to the Chair of the ICB throughout the development exercise, which indicated that a single ICP across the geography would not be practical and would mean that individual places would struggle to be heard.  It was explained that following the development stages, the NHS had formally announced that the area would have sub-ICPs: the Tees Valley sub-ICP would comprise the five Tees Valley local authorities and would largely reflect the same footprint as the current CCG model.  The Director envisaged that much would feel the same in terms of day to day practical operation, and that benefits pertaining to the prevention agenda and the longer term equalities agenda would arise from this.
• Each local authority area had been asked to look at ten operational priorities in Adult Services and in Children’s Services within Public Health.  Senior officers from those respective authorities would be meeting on 1 July 2022 to discuss converting those locally identified priorities into a set of themes for the ICP.  The five themes / priorities identified in respect of Adult Services were:

-        Ageing well;

-        Sustainability (with a large focus on workforce challenge);

-        Hospital discharge and admission avoidance;

-        Mental health; and

-        Prevention and inequalities. 

It was explained that these themes would be regularly referenced in local inter-agency meetings because they had emerged from work undertaken with the CCG, colleagues in the VCS, and Public Health.  It was felt that this approach would also facilitate joint working locally within the ICS.

During the discussion that followed, a Member queried the progress of the transition from the CCG to the ICS arrangement and whether any issues had been either envisaged or experienced.  In response, the Director indicated that, at present, the senior officers within the ICS had been appointed, which included the accountable officers who would work with the respective local authorities for the various geographical areas.  It was indicated that not all of the final appointments had been made for the senior  ...  view the full minutes text for item 22/3

The Director of Adult Social Care and Health Integration will provide the panel with an overview of the main service areas within Adult Social Care’s remit, and outline the priorities, key issues and challenges for the year ahead.

The Director of Adult Social Care and Health Integration was in attendance to provide an overview of the service area.

Reference was made to the operation of Adult Social Care in relation to its structure and profile.  The Director outlined the various teams and services that comprised it; identified the relevant Executive portfolios; and highlighted such matters as: community inclusion; equipment service support; independent care services and commissioning to external providers; and support provided by the Voluntary and Community Sector.

A Member made reference to the work of the Estate team and queried whether direct payments were included within this.  In response, it was indicated that they were not included.  The Director explained that Middlesbrough Council was one of the earlier authorities to embrace this approach, which had become a normal part of the support plans that all Social Workers put in place.  The work of the Estate team was narrower than that.

With regards to challenges facing the service area this year, Members heard that these included:

• NHS reform and the necessity to ensure a sufficient presence and representation for Middlesbrough Council and the Tees area (reference was made to the sub-ICP and priorities for the local area);
• Adult Social Care reforms, of which there were three elements:

·      Charging reform, which related to how individuals paid for their care.  Proposals had been made by the government and plans to respond to this were currently being devised.  A project plan was being led by the Head of Resident and Business Support; the Director chaired a reform board.  It was explained that a substantial increase to staffing resources in responding to the reforms would be required; however, staffing was currently an issue for all Local Authorities.  It was felt that there would be a significant funding challenge around this, particularly in areas where there was a high number of self-funders (Middlesbrough did not fall into that).

·      Fair Cost of Care – the service area had been mandated to undertake an exercise, which related to a payment framework for care providers and examining the real cost of care provision (e.g. rising utility, insurance, fuel and food costs).  There was a requirement to report the outcome of this work to the government by October 2022.  Consideration was given to the cost of care provision in Middlesbrough in comparison to other areas, and potential pressures that this could cause.  Reference was made to the Medium Term Financial Plan and related considerations within this.

·      Care Quality Commission (CQC) Assurance Framework and the future inspection regime; the full framework was currently awaited.  It was indicated that from April 2023, the CQC would start a benchmarking process and operate a two-year inspection cycle.  Reference was made to inspections undertaken over the last 12 years; the austerity period and current demands.  Activities including short peer reviews and discussions with Children's Services around service improvement and lessons learned would be taking place over the summer, which would assist with work around self-evaluation and awareness.  A former director had also  ...  view the full minutes text for item 22/4

The Democratic Services Officer submitted a report, the purpose of which was to assist Members in considering and agreeing the panel’s work programme for the 2022/2023 Municipal Year.

A list of topical issues and the suggestions received in respect of the scrutiny panel's remit were contained in the submitted report.  It was suggested that the scrutiny panel should select a maximum of two topics for full review, along with several short topics and updates.  It was noted that there was one review from the previous year to be completed: ‘The Role of the Voluntary and Community Sector (VCS) in Supporting Adult Social Care (with a focus on Covid-19 Recovery)’.

The Director of Adult Social Care and Health Integration provided additional information and some further topical and update suggestions to Members, which included the provision of statistical data in relation to service demand.

Members discussed the information provided by officers at the meeting, the topics suggested in the report, and the suggestions made by those Councillors present, which included ‘Hospital Discharge’ and ‘Charging Reforms and Fair Cost of Care’.

Following discussion, Members agreed the following items for the 2022/2023 Work Programme:

Main Topics:

1.      ‘The Role of the Voluntary and Community Sector (VCS) in Supporting Adult Social Care (with a focus on Covid-19 Recovery)’ - current review topic (work to continue from the next meeting - 7 September 2022); and

2.      ‘Hospital Discharge’ (final title TBC in due course, but the review will focus on the impact of the cost of care and the impact of care worker recruitment on hospital discharge and the Council’s Adult Social Care services.  The impact on lone adults will also be assessed as a supplementary ‘feed in’ area of focus).

Updates:

1.      Integration of Health and Social Care (standard agenda item);

2.      A performance report in respect of increases in service demand will be provided on a quarterly basis.  As reporting systems and processes are currently being reviewed, this will commence from Autumn/Winter 2022;

3.      Charging Reforms and Fair Cost of Care – updates to be provided as work progresses; and

4.      Previous scrutiny review – ‘The Recruitment and Retention of Staff Within Adult Social Care’.

AGREED that:

1. The information provided was received and noted; and
2. The topics listed above, would be submitted to the Overview and Scrutiny Board for approval.

The Chair will present a verbal update on the matters that were considered at the meetings of the Overview and Scrutiny Board held on 27 April 2022 and 11 May 2022.

The Chair provided a verbal update on the matters that were considered at the Overview and Scrutiny Board meetings held on 27 April 2022, 11 May 2022 and 22 June 2022.

NOTED

A proposed schedule of meeting dates for the Adult Social Care and Services Scrutiny Panel for the 2022/2023 Municipal Year was submitted for Members’ consideration.

A brief discussion ensued with regards to the venue for the meetings and whether or not these would be held virtually or in person.  Further updates would be provided in due course.

AGREED that the proposed meeting dates for 2022/2023 were approved.