Agenda item

The Director of Adult Social Care and Health Integration will be in attendance to provide an overview of the challenges the service has faced in 2021.

The Chair welcomed the Director of Adult Social Care and Health Integration to the meeting to provide a verbal presentation on the challenges the service has faced over the 12 months.

 

The Director stated that summarising this year was probably the hardest and had become a defining year in people's careers. Whilst restriction were being eased, the Director advised that we are not out of pandemic and must be mindful of this, due to other variates internationally. The vaccination programme was well underway by the NHS, however whether individuals required boosters was unknown and not all people can have vaccines/ boosters depending on their health needs.

 

Local authorities need to balance their responsibilities of care and business , and whist the Director acknowledges the corporate activity his interest is with the statutory adult social care.

 

The Director outlined that he became aware of the first local covid case in Stockton on 10 March 2020, however Covid had been on the Directors radar since Christmas on 2019, and we must learn from this year and look at how we might plan for the future, in case we are ever faced with a virus of this degree.

 

Year this has been unprecedented and our staff group, across the whole of the Council has been immense, and have shown real courage and supporting our residents of Middlesbrough.

 

Speaking within Adult Social Care, the Director outlined that financial necessity has meant the service has levelled back their structure over the years and as such there was not a huge amount of resilience built into our structure. However, when new things have come along we have had to reply on our staff being flexible in their working arrangements. Staff have shown personal  courage, as due to uncertainly of fatality at the start of the pandemic, and due to our roles e.g. continuing to work with vulnerable patients. Thankfully we have no lost any staff members to covid, but some have been quite unwell and staff and just carried on in their duties.

 

The Director began to discuss the areas which have been mostly affected, however outlined that he would by no means intentionally miss a service area, but the impact of Covid has been extensive and explaining all of the impacts would be impossible.

 

Care homes

 

The Director outlined that the Council operate and own one residential care unit and the rest are contracted to a Private Provider. He commended the care homes for their approach as sadly there have been a number of deaths within the care homes. There has however been no necessary correlation this year between deaths and poor practice.  The Director stated that a number of the care homes stepped up and openly agreed to work with patients who has/had covid 19, taking into consideration the guidance on infection control measures. Care homes have worked really hard over the past 12 months and have been inspiring. Care managers have had to make choices and take into account a balance of visiting against the greater good of the care home and ensuring their residents are safe. They have also had to take into account government guidance and guidance on infection rates.

 

The Council's Contracts and commissioning staff have worked alongside the care homes to provide guidance where possible and personal, protective, equipment (PPE). The Council made a decision early on in the pandemic to provide free PPE to each care homes. Staff worked out of hours to deliver PPE and the Director hoped that the care homes have felt supported during this year.

 

In terms of numbers of residents in care homes, there has been a reduction and this has been a result of covid 19 related deaths. The Council have a duty to the care home market and the Council has had to put in place occupancy payments to support them financially where occupancy has been low. Government had made grants available, however the Council is coming to the end of these payments as we enter a new financial year.

 

 

Day Care/ Respite Centres

 

The Director outlined especially during the first wave of the pandemic, all day centre provision was suspended, however as time as gone on and guidance has become clearer, we have been able to reintroduce these and during the most recent lockdown, an extent of day care provision has been able to continue. Some families have not felt comfortable sending their relatives to the centres due to the risk of infection, however staff have learnt more about maintaining infection and control rates and families feel safer as these centres offer valuable respite from their carer responsibility.

 

In terms of next steps, the Director indicated that they would look to fully reopen day care centres, depending on guidance issued and it is hoped this would in line with the Covid roadmap on 17 May 2021.

 

Provision

 

Our Estates Team have been working hard to look at provision e.g. those who have cognitive impairments, and the staying put agency have worked to provide ICT equipment in peoples' homes to enhance social communication during this time.

 

Social work assessments and care planning

 

The majority of social workers now work remotely and in the main this has worked well. Assessments have become remotely, as quite rightly, service users have felt nervous about allowing people in their homes, due to the risk of developing covid.

However in terms of the Council's safeguarding team, work with vulnerable individuals, and some of our hospital discharge work has meant that there has been a necessity to enter homes. This has been done on an individual risk assessment basis and staff have done this using full PPE. Some staff have had to isolate due to the contact they have had and the Council have supporting them during this time.

 

Core services

 

The Director also advised that he managed the public health team and there staff have worked hard in the test and trace and interpreting guidance.

The Director also manages the trading standards and public protection team and they have been involved in regulatory work in relation to covid  and test and trace s.ervice

 

Substance misuse, domestic violence and homelessness also falls within the Adult social care service . In terms of homelessness, the panel were made aware of the government's early initiative called 'Everyone in', which meant that if officers came across rough sleepers/ the homeless, regardless of their statutory rights, the local councils were asked to accommodate them, to minimise their risk to covid.  At the peak of covid, there were 103 individuals within temporary accommodation.  The service has to locate suitable accommodation, where individuals could socially isolate and provide support/ food and mobile phones in some instances.

 

The Director outlined that he felt this had been a really successful component. However, this has left the council with a number in temporary accommodation, so work is underway to work with RSLs' and HRMC to allocate funding to support move on accommodation.

 

The Director did mention that there are some individuals who are homeless/ rough sleepers, who did not wish to take up the offer of settled accommodation and this may be down to historic trauma and previous experience. Whilst they have continued to sleep, Middlesbrough Council officers have continued to have regular contact with them, and provided PPE and hand sanitiser where necessary.

 

The Chair queried whether all individuals who are homeless and who rough sleep have been vaccinated? In response, the Director advised that as part of the funding, one aspect of officers work has been to register those individuals with a GP/primary care networks,  which would place them on the route to becoming vaccinated. Some have been vaccinated due to underlying health conditions or their age.

 

2020/21- the year ahead

 

·         Reduced numbers in residential Care and this brings economic viability for some of the care homes.  The Council will look at how to work with our care homes to ensure we offer the range of settings that we need within Middlesbrough.  The Panel queried whether families are becoming more confidence in placing family members in care homes, to which the Director advised that there have been admissions during Covid , although these have not been of large numbers. It is hoped confidence will improve, once certainly of the level of Covid infection rates are known.

·         There have been delays in scheduled reviews of service users and we have low level support packages in place at present.

·         There has been a concern regarding loneliness and Isolation and Suicide rates.

·         Aging Better Middlesbrough who work directly with our older people highlighted that loneliness and isolation wasn't the biggest concern during the first lockdown, it was concerns about to access to NHS services. The Director therefore outlined the Council would work with Aging Better Middlesbrough, Clinical Care commissioning groups and health colleagues to identify individuals who have become more vulnerable due to health conditions over the past year. (e.g. unable to have continues contact with the GP).

·         Suicide rates- causes of death as a consequence of suicide take a while to be determined. The Director advised that people are showing signs of stress and isolation from the pandemic, and this is coming through our mental health services. The Council is working alongside its partners (Tees, Esk and Wear Mental Health foundation trust) and Redcar and it's been eluded that we are looking at a 5 year legacy to see the full effects the pandemic has had on individuals/communities. This could be neurological damage as a result of having covid, but also post -traumatic stress of those who have had covid but also family members/ staff members who have seen death as  consequence of covid.

·         Social care workers are now becoming to a position where they can visit service users , and restrictions are being eased so this can be facilitated.

·         This year will be challenging , as the service is still working with the pandemic and it will take a number of months /years to come back from this.

 

Following on from the presentation, a number of panel members made comments. A member commanded the work of Middlesbrough Council officers, however queried whether there were plans in place that in the future, we unfortunately were hit with a similar outbreak. The Director in response explained that there were winter flu plans/pandemic plans in place, however no-one knew that Covid would have such an impact. The service wass putting together lessons learnt however he outlined that the Council dispersed staff in 24 hours and remote working went extremely well and we have a flexible work group. The Shielding programme meant that Council staff had to undertake delivering support and  food packages and again, this happened within a 48 hour period and staff changed their roles literally overnight.

 

Practical plans- The service will continue to work remotely for the majority of time, however visits will be undertaken as well as providing day care. It is hoped that the lessons learnt and contingency plans will be brought about in the wider planning of the council.

 

A panel member also queries whether additional behaviour was being tracked, in response, the Director outlined that Middlesbrough does have a wide range of problems and additive behaviour is one. He advised that a the new integrated commissioning model for addiction, homelessness and domestic abuse was launched at the beginning of April and it was hoped that the new IT system would continue to develop support with these areas. The Director would be happy to further update the panel on these coordinated services if required.

 

The member also outlined that she would be interested to hear from the Staying Put Agency to understand the challenged that have been faced over the year. The Director applauded the Staying Put agency, although he mentioned their work , especially home adaptations, have been limited due to covid but it is hoped that this would now be able to recommence in due course.

 

The member lastly asked about funding and whether the Director had any concerns. In response, the panel were made aware that small local authorities are financially challenged, but the budget has been set for Adult social care but the evolution of health care would need to be considered, especially with the impending Green paper.

 

The Chair and Panel thanked the Director and his staff for this work and support over the past year.

 

AGREED

·         That the information be noted.

·         That a future presentation on coordinated services be brought back to the panel at a future meeting.

·         That the Staying Put agency be invited to a future meeting of the Panel.