Agenda item

The Directors of Adult Social Care, Children’s Services and Public Health will be in attendance to provide the Panel with an overview of the services provided across their Directorates, and to highlight the strategic and departmental priorities for the coming year.

 

The Deputy Director of Delivery for the North East and North Cumbria Integrated Care Board (ICB) will be in attendance to provide the Panel with an overview of the Tees Valley health landscape; key health issues, challenges and opportunities; and matters for Members to note over the next twelve months.

 

Recommendation: That the Panel notes the information provided and considers the information when formulating its Work Programme (next agenda item).

The Chair welcomed the following to the meeting:

 

·        Mark Adams - Joint Director of Public Health.

·        Erik Scollay - Director of Adult Social Care and Health Integration.

·        Joe Tynan - Executive Director of Children’s Services.

 

The Directors were in attendance to provide the panel with an overview of the services provided across their Directorates, and to highlight the strategic and departmental priorities for the coming year.

 

The Chair also welcomed Katie McLeod, Deputy Director of Delivery for the North East and North Cumbria Integrated Care Board (ICB) to the meeting, who had been invited to provide the panel with an overview of the Tees Valley health landscape; key health issues, challenges and opportunities; and matters for Members to note over the next twelve months.

 

Each of the Directors delivered, in-turn, a presentation to Members.

 

The Director of Adult Social Care and Health Integration focused on the broad portfolio of work that Adult Social Care encompassed; associated legislation; departmental structure; and key challenges and issues.

 

In terms of key legislation, focus was given towards the Care Act 2014 and the Mental Capacity Act 2005.  Details around the use of this central legislation in supporting and safeguarding individuals impaired by physical or mental impairment or illness, and how decisions were taken for those individuals, were provided.  It was noted that these were Council duties, not Adult Social Care duties, and therefore all staff working for the Local Authority, particularly those working closely with members of the community, had a duty to maintain awareness of the needs of individuals, and to raise any concerns as appropriate.  A comparison between previous legislation and the Care Act was made; it was highlighted that the current legislation placed individuals at the centre and built both their needs and aspirations into their care planning.

 

The panel was provided with an overview of the staffing structure and the range of services provided by Adult Social Care.  These were as follows:

 

·        Access and Safeguarding.

·        Approved Mental Health Professional (AMHP) Service.

·        Community Mental Health (including former Psychosis and Affective Disorder Teams).

·        Autism Day Centre.

·        Community Inclusion Service.

·        Connect Service.

·        Deprivation of Liberty Safeguarding (BIAs).

·        Domestic Abuse Support.

·        East and West Locality Social Work.

·        Estates Support.

·        Forensic Mental Health/Learning Disabilities.

·        Homelessness Support.

·        Hospital Social Work (including weekend service).

·        Learning Disability and Transitions Social Work.

·        Levick Court.

·        MAMMS (Handyperson) Scheme.

·        North Ormesby Day Centre (Frailty and Dementia).

·        Occupational Therapy.

·        Older People’s Mental Health.

·        Reablement Team / Middlesbrough Mobile Reablement Unit.

·        Service Improvement Programme.

·        South Tees Integration Programme.

·        Staying Put Agency (including Digital Inclusion developments).

·        Tees Community Equipment Service.

·        The Orchard Day Centre.

 

The importance of partnership working in delivering these services was highlighted to the panel. 

 

It was explained that key external relationships existed with:

 

·        Cleveland Police.

·        Independent Providers.

·        NHS Integrated Care System.

·        South Tees Hospitals NHS Foundation Trustees, Esk and Wear Valleys.

·        Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV).

·        Tees Safeguarding Adults Board (TSAB).

·        Voluntary and Community Sector / MVDA.

 

Key internal relationships existed with:

 

·        Children’s Services.

·        Environment and Community Services - Community Safety.

·        Finance Directorate - ASC Finance, Financial Assessment and Welfare Rights.

·        Finance Directorate - Contracts and Commissioning.

·        Public Health.

 

Members were appraised of the priorities within the Directorate, which sat within the Adult Social Care draft vision and strategy and therefore currently being reviewed.  At present, these were as follows:

 

·        Priority 1 - promoting wellbeing and personal and community resilience.

·        Priority 2 - maximising recovery and promoting independence so people can live independently in their own communities for as long as possible.

·        Priority 3 - improving the quality of life for people with care and support needs.

·        Priority 4 - providing choice and control for people who have care and support needs.

 

In terms of the key issues and challenges currently being experienced, these were outlined as follows:

 

·        Impending Care Quality Commission (CQC) inspection.  It was explained that, to date, the CQC was in the very early stages of a new inspection regime.  Only one Local Authority in the North East had completed an inspection since the changes were implemented, with an outcome report currently awaited.  Knowledge regarding the processes was therefore limited.

·        Financial Imperative to deliver the Adult Social Care transformation plan (£5.75M in 2024/25, which equated to circa. 10% of the budget); modernisation included “The Three Conversations” approach / digital resources.

·        Increasing complexity.

·        Rising/latent demand.

·        Recruitment / Staffing.

·        North East and North East Cumbria ICB (NENC) Changes/ relationship with Place Team.

·        Need to push towards greater focus on prevention – Locality Working / knowing our communities / reflecting our communities.

·        Homelessness pressures.

·        Domestic Abuse prevalence.

·        Market sustainability – Care Act duty.

·        Understanding demand and commissioning approaches.

 

Following the presentation, a Member queried the processes around the new CQC inspection arrangements and the level of involvement that Elected Members would have.  In response, the Director explained that the CQC would have arrangements in place to speak to a variety of stakeholders.  However, further details were unknown at present as only one Local Authority in the region, out of thirteen, had been inspected to date.  In terms of the notice period given for inspections, it was explained that once notice of an impending inspection had been received, the department had three weeks to forward requested documents, such as vision documents, etc.  The inspection would then take place within a six-month period following that.

 

The Chair thanked the Director for the information provided and invited the Executive Director of Children’s Services to deliver his presentation.  The Director of Children’s Care and the Strategic Lead for Inclusion and Specialist Support Services were also in attendance to provide information.

 

The panel was provided with a staffing structure of each department within Children’s Services, which was broken down into Education and Partnerships, and Children’s Care.

 

In terms of Education and Partnerships, the Strategic Lead for Inclusion and Specialist Support Services explained that this comprised the following teams:

 

·        Achievement: Family Hubs (a new model for identifying and supporting families) and EYFS; Ethnic Minorities Achievement Team (EMAT) and English as an Additional Language (EAL); Safeguarding and Compliance; Achievement Hubs; and Literacy / National Literacy Trust (NLT).

·        Inclusion and Specialist Support Services: Education Psychologist Service (a statutory function working with schools to provide additional support to children); Sensory Teaching and Advisory Service; Inclusion Assessment and Review (this included the operation of an inclusion and outreach service to provide early intervention to children to prevent exclusion); and Resources and the Local Offer.

·        Access to Education: Strategic School Planning; Virtual School; Admissions; Education Welfare Service and Elective Home Education (EHE); and Children Missing Education (CME).

·        Head of Partnerships: Operations and Partnership Management for the Youth Justice Service (Middlesbrough and Redcar); Risk Reduction; South Tees Safeguarding Children Partnership and Children’s Trust; and Lead Guidance for SHiFT.

 

In terms of the priorities for Education and Partnerships, these were placed into the categories of Challenges and Innovation and Transformation.

 

Regarding Challenges, the panel was informed that these comprised the following:

 

·        Increasing Permanent Exclusions.

·        Increasing Education Health and Care Plans.

·        Increasing pressures on High Needs Funding.

·        Falling school roll contrasted with increasing pressure in some parts of town.

·        Low School Readiness.

·        Low attendance.

 

Regarding Innovations and Transformation, Members noted the following:

 

·        Sector Led Improvement Partner (SEND).

·        Inclusion and Outreach Model.

·        Delivering Better Value Programme.

-        SEND and Inclusion Clinics.

-        Workforce Development.

-        Review of Placements.

-        Transitions.

·        Place Planning.

·        Family Hubs.

·        Attendance Project / White Paper.

·        Turnaround / Instant Justice.

·        PROCLAIM.

·        Attendance Strategy and VCAP Project.

 

Members were advised that a consultation exercise in respect of the Inclusion and Outreach Model had recently commenced.  The new model would be implemented in September 2024.

 

With regards to SEND, the Director highlighted that, having gained the highest rating during an inspection last year, the authority would not be inspected again for a further five years.  However, there was national debate currently taking place as to whether the regime ought to be paused, which the new Government was reviewing.

 

In terms of suggestions for the scrutiny Work Programme, Vulnerable, Exploited, Missing, Trafficked (VEMT) children was raised as a potential topic.

 

A Member referred to Academies and queried the division of management responsibility between the Local Authority and Academies themselves.  In response, it was explained that Academies reported directly to the Department for Education, rather than to the Local Authority.

 

A Member referred to place planning and queried the development of a new school in Middlesbrough, i.e. whether it was primary or secondary.  In response, it was confirmed that it was for primary provision.

 

With regards to the transitions element of the Better Value Programme, a Member queried whether this was focused upon the Y6/Y7 transition, and/or others.  In response, it was explained that work covered the various transition points and looked at streamlining options and provision of appropriate support.

   

The Director of Children’s Care provided Members with information regarding the staffing structure and priorities of the service.

 

It was explained that Children’s Care comprised of the following:

 

·        Stronger Families: Early Help; Family Practitioners; NEET Support Team; MACH Co-ordinators.

·        MACH, Assessment and EDT: MACH - two Social Work teams and partners; Assessment service - five Social Work teams; Emergency Duty Team.

·        Safeguarding and Care Planning/ Children with Disabilities: Six Safeguarding and Care Planning Teams; Pre Birth Team; Aspire; Children with Disability Service – two teams; Short Breaks; Occupational Health.

·        Children Looked After (CLA); Pathways Team; Leaving Care Team; Four Fostering teams (Recruitment, Retention and Kinship).

·        Residential/ Supported Accommodation: Five in-house homes for children; Two supported accommodation; Residential Project lead.

 

In terms of the priorities for Children’s Care, these were outlined as follows:

 

Challenges

 

·        High demand.

·        High number of children who were in the care of the Local Authority, subject to Child Protection/ Child in Need Plans.

·        Consistency of practice and performance.

·        Permanent staffing.

·        External placements for children.

·        Recruitment of foster carers.

·        In house homes for children.

·        Improvement notice from the DfE.  It was indicated that this notice had been in place since 2019 and sign off was currently awaited.  Following an inspection, the authority had moved from ‘requires improvement’ to ‘inadequate’ in March 2023.  Children’s Services was still on an improvement journey, with work continuing with Partners in Practice in Islington, and others.

 

Innovation and Transformation

 

·        Investment into the expansion of homes for children.

·        Partners in Practice (Islington).

·        Family Hubs.

·        SHiFT.

·        Pitstop.

·        DfE grants – Reunification project.  It was explained that this work focused on returning children to parents and families and gain local foster carers.

·        Recruitment strategy.

·        Fostering Pathfinder.

·        Supporting families.

 

The Executive Director provided current statistics in relation to the number of children who were:

 

·        Children Looked After - 496.

·        Child Protection - 325.

·        Child In Need Plans - 476.

·        Care Leavers - 256.

 

It was indicated that a steady reduction in the numbers was being seen.

 

In response to a question from a Member regarding Early Help numbers, the Executive Director indicated that this was currently 773.  There were 877 in May 2024, and the figures had been around the 800 mark since October 2023.  The Director of Children’s Care explained that the numbers had fluctuated; Middlesbrough’s threshold was different to Redcar and Cleveland’s. Consideration was given to the impact of Family Hub work and the level and appropriateness of support being provided to families by the different teams within Children’s Care.

 

A Member referred to the provision of homes for children and queried the development of further homes; the current number of children placed out of area; and resources required.  A comparison was made to historical practice and Cleveland County Council outsourcing homes to private organisations.  In response, the panel heard that the Local Authority currently had six residential provisions in place, with officers looking to increase this by two initially.  There were presently 69 high-cost placements that officers were looking to reduce.  The aim was to build a robust edge of care service and a DfE grant had been awarded to support this work.  Members recognised the requirement to balance financials with the needs of young people, and to ensure that these were being met.  Members were also mindful of recruitment practices and noted the challenge officers faced in recruiting appropriate personnel to vacancies.

 

The Chair thanked the Directors for the information provided and invited the Director of Public Health, South Tees to deliver his presentation.

 

Members were informed of the various challenges currently being faced in South Tees, which included the following:

 

·        Higher levels of: Smoking; Obesity; Addictive behaviours; Poverty; Suicide; Illnesses; Mental ill health; and Complex needs and vulnerabilities, amongst others.

·        Lower levels of: Life expectancy; Physical activity; Housing standards; and Educational attainment and training, amongst others.

 

The following statistics in respect of life expectancy were highlighted to the panel:

 

·        Life expectancy at birth (2020-22) of males and females born in Middlesbrough, in comparison to those across the wider North East, England and the highest Local Authority:

 

 

Males:

 

Middlesbrough	North East	England	Highest LA
75.4	77.2	78.9	83.7

 

Females:

 

Middlesbrough	North East	England	Highest LA
79.5	81.2	82.8	86.3

 

·        Male life expectancy at birth by Ward, in relation to deprivation: Central Ward in Middlesbrough - 69.4 years; Hutton Ward in Redcar and Cleveland - 84.3 years.

·        Middlesbrough healthy life expectancy: Males – range: 58.8-75.4 years. Females – range: 60.6-79.8 years.

 

Details regarding Public Health’s statutory duties and responsibilities were outlined to Members.  It was explained that to achieve these, a five-programme approach with four business imperatives and three levels of intervention across the life course (Civic, Service and Community) had been devised.  In essence, the prevention of ill health, such as smoking cessation services and improving physical activity, together with the reduction of vulnerabilities at a population level, for example: homelessness, was key. 

 

Members were appraised of a Health Determinants Research Collaboration (HDRC) project, which commenced in 2022.  It was explained that the health of the public was fundamentally influenced by the wider determinants of health, e.g. education, employment and transport, and that the work of Local Government impacted these drivers, but to what extent was relatively unknown.  Consequently, the need to better support Local Government in becoming more research active and further build the evidence base, had been recognised.  In 2022, NIHR awarded over £50m in funding to 13 Local Authorities across the UK to develop HDRCs in their localities.  Middlesbrough Council, as lead bidder, in collaboration with Redcar and Cleveland Borough Council and Teesside University, applied for and were granted funding of £5.2m over five years to establish a HDRC across the two Local Authorities.  It had an organisational wide focus and would create the culture and infrastructure for and to facilitate research, but not do actual research.  The vision, aims, objectives and missions associated with the HDRC were outlined to the panel.

 

With regards to horizon scanning and service challenges, funding issues were highlighted.  It was explained that there was uncertainty about future funding in relation to:

 

·        Holiday Activities and Food (HAF).

·        Head Start.

·        Vulnerable Funding Streams due to end in March 2025: SSMTRG, ICB and Changing Futures.

 

Whilst it was anticipated that HAF and SSMTRG would continue in some form post March 2025, until clarity was achieved this could result in significant staffing issues and impact on service capacity to deliver and meet demand.  In essence, this could potentially reduce the quality of the service offer.  It was highlighted that South Tees was currently in the top 10 HAF performers nationally.

 

Reference was made to the YGT and a shirt to a widening and deepening model.  Challenges associated with this work were possible. 

 

The Chair thanked the Director for the information provided and invited the Deputy Director of Delivery, Tees Valley Local Delivery Team NENC ICB, to deliver her presentation.

 

The Deputy Director provided an overview of the Tees Valley health landscape; key health issues, challenges, and opportunities; and matters for the panel to note over the next year.

 

The scale and size of the population covered, and the associated health challenge, was outlined to Members. 

 

The population was broken down into whole population statistics, Children and Young People, and Adults.  Focus was made on matters including: inequalities; most prevalent long term conditions; and risk factors. 

 

The North East and North Cumbria patch was the largest Integrated Care System (ICS) in England, serving a population of 3.1m with a £7billion budget.  A map showing the areas covered by the 170,000 strong workforce was shown to Members.

 

A staffing structure, together with the role and responsibilities of the Local Delivery Team, was provided to the panel.  The importance of achieving and maintaining consistency in messages across the area was highlighted.

 

In terms of key issues, challenges and opportunities, these were outlined as follows:

 

·        Key clinical focus areas included: Respiratory Health; CVD Health; Anxiety and Mental Health; Autism; and Learning Disabilities.

·        An ambitious Work Programme focused on: Longer and healthier lives; Fairer outcomes for all; Better health and care services; and Giving children and young people the best start in life.

·        Health and Well-being Board Strategy Refresh.

·        Financial challenges across the ICS.

·        Partnership place-based opportunity for discussion and review.

 

Regarding matters of note for the next year, these were provided as follows:

 

·        Special Allocation Scheme (SAS) – this related to GP practices’ experience with aggressive and violent individuals, and the removal of said individuals from the respective GP practice.  As there was still obligation to provide care for such individuals, GP practices had been asked whether they would support a scheme pertaining to the reassignment of patients to other practices.  It was explained that an expression of interest exercise was undertaken across practices in Middlesbrough and Redcar, to advise of an opportunity to provide the SAS Directed Enhanced Service (DES) in the South Tees area when the current contract ended on 30 September 2024.  One expression of interest had been received and the ICB was now supporting conversations with the provider to secure this future provision back in the local area.

·        Dental recovery progress updates – it was suggested that this could potentially be considered as an update at a future meeting.

·        Speech and Language Children and Young People Services – it was indicated that discussions around this were currently taking place.  It was suggested that this could potentially be considered as an update at a future meeting.

·        Children’s Mental Health – a review of the ‘Getting Help’ system to improve equity and equality in the Tees Valley was currently taking place.  It was indicated that the aim was to bring together one consistent pathway to service.  Next steps for the review would be taking place in August; it was hoped that the revised model would be in place by April 2025.

 

The Chair thanked the officers and invited representative for their attendance and contributions to the meeting.

NOTED