The Director of Adult Social Care and Health Integration, Erik Scollay, will be in attendance to provide the Panel with an overview of the main service areas within its remit and an outline of 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.
The Director made reference to the operation of Adult Social Care in relation to strategic priorities, which were built into the Council’s Strategic Plan; directorate priorities, which were also visible through the Strategic Plan; and to current key issues.
Prior to detailing the current key issues to the Panel, the Director responded to a number of questions that Members had.
A lengthy discussion ensued in relation to Adult Social Care finance and the provision of services, which covered the following matters/topics:
· The budget setting process for Adult Social Care and how the figures were calculated in terms of the Council’s input, together with individual contributions (i.e. means testing).
· The impact of the COVID-19 pandemic, including the increasing number of temporary residential care placements that needed to be finalised with permanent arrangements, and an inflation in some community care package costs. It was envisaged that following what had been a very peculiar year, which had offered some savings through a reduction in the number of people in residential care, this year would be artificially more expensive as a consequence of dealing with people in the wrong place, and the recovery costs. Work was currently taking place in relation to the impact of COVID-19 and projecting for the year ahead. It was explained that the underspend from last year would provide a ‘recovery reserve’ of almost £1.6m this year, which would be available to help manage any unpredicted costs that may arise. This year would be complicated and require very close financial monitoring.
· Middlesbrough’s demographics in terms of means testing and the financial support that the Council provided for residential care placements.
· The current state of Adult Social Care nationally and the anticipated release of a Government Green Paper in this regard.
· Ownership of care homes and the commissioning of care services.
· Achievement of value for money and the appropriate level of quality for the Council and residents (reference was made to a piece of work currently being undertaken in respect of Levick Court, which was the only residential unit owned by the Council, and achieving best value of money for that).
· Regulation of care homes, i.e. external regulation and internal regulation. It was explained that the Care Quality Commission (CQC) was the external regulating body and the inspectorate of care homes, which in effect provided license to operate and monitored standards. The Council shared intelligence with the CQC and worked with them. From an internal perspective, the Council operated its own quality marker, whereby Contracts and Commissioning Officers would carry-out inspections against contractual terms, which resulted in star ratings and subsequent differential charging rates (depending upon the facilities that care homes had). Reference was also made to monitoring care homes from a safeguarding perspective, i.e. responding to any concerns raised.
· With regards to the current state of Adult Social Care nationally and the need for reform, reference was made to the boundaries between the NHS and social care in terms of funding, and the systems that had been established locally to help determine how costs would be met. Financial models were currently being discussed by the Government, with a Green Paper currently awaited.
· A Member commented on the inevitable rising cost of care; an ageing population; the attitudes, expectations and planning that will be needed in relation to means testing and individuals being required to pay for/contribute to their care costs; and the importance of ensuring that the Council achieved good value for money where it was being expended.
· In respect of financial assessment (means testing), Members heard that one of the challenges for Middlesbrough was that the area had a large number of financially disadvantaged individuals who were not required to pay for their care, more so than in many other Local Authority areas. In addition, it was indicated that Middlesbrough had a community where people did spend a greater percentage of their adult lives dealing with chronic ill health, before passing away prematurely. Consideration was given to the Care Act and the notion of tertiary prevention in this regard, i.e. providing support to individuals earlier in order to stop health problems exacerbating (wherever possible). It was felt that investment in taking preventative measures, such as providing physical interventions (e.g. diet, clean air, increased exercise) would offer a more sustainable basis for looking at cost reduction, as opposed to focusing solely on the value for money issue. Preventative measures, however, did take time to implement, which required both commitment and consistency.
· In response to a query regarding financial assessment and the selling of property/treatment of capital, it was explained that there was a complex set of regulations around this. If a person needed to enter residential care and they owned their own property, they would not be required to sell their house at the point of entering residential care. In some instances, a charging order could be placed on the home, which in essence meant that the Local Authority received its portion of the value of the house when the person passed away. The purpose of the charging order was to allow the asset to increase in value or to provide income. In terms of the treatment of capital in cases where relatives also resided in the respective property, there was also a set of regulations around that, which would depend on particular circumstances.
· Members discussed the preference for supporting residents to live independently in their own homes for longer; the number of care home places per head of population that Middlesbrough used, which historically had been one of the highest nationally; the alternative options to entering care homes, including extra care housing; progression that had been made within the care home sector over the last circa. 15 years, including an increase in the variety of activities offered to residents, improved regulation and more sophisticated contract monitoring and safeguarding processes; and ensuring that the needs of individuals were met.
· In response to an enquiry regarding respite services, Members heard that Adult Social Care had operated with suspended and then subsequently limited day care and respite services during the pandemic, although those services were now resuming. It was indicated that the ongoing limitation for the service referred to social distancing regulations and a reduction in room capacity numbers. It was unclear at the present time as to what would happen once restrictions were eased on 19 July 2021.
· The Panel heard that in addition to individuals residing in residential care homes or within their own homes, extra care (assisted living) and independent supported living provision was also available. Extra care support provided individuals with a tenancy within a semi-communal building, with care being provided by a contracted agency. Independent supported living usually consisted of establishing a contract with a housing provider to purchase and set-up a property, which could then accommodate two or three individuals with learning disabilities. Another care provider would then be commissioned to provide support to those individuals.
Following this discussion, the Director outlined the key issues currently facing Adult Social Care, as follows:
· Volume and complexity of cases – it was explained that following a quiet spell during the pandemic, all aspects of the service were now exceptionally busy, with an increase in more complex cases also being seen.
· Domestic Abuse Bill – Members heard that following new legislation, the Local Authority’s responsibilities in terms of meeting the needs of victims of domestic abuse had broadened. A needs assessment in respect of this had recently commenced.
· Integrated Care System – reference was made to the reconfiguration of health services and the current uncertainties regarding the impact that this may have for health services commissioned locally.
· Blended working arrangements – Members were advised that in response to the pandemic, staff would be offered a blend of office and remote working from home. It was explained that social workers learnt by osmosis, spending time with colleagues and shadowing experienced members of staff. It was also how social workers decompressed after stressful events, by discussing matters with their colleagues. It was felt that these changes would require a period of adjustment.
· Workplace stress – it was highlighted that staff, without exception, had been magnificent during the pandemic. Many social workers had been required to continue carrying-out visits throughout the COVID-19 period, and there was a feeling of concern that stress would manifest itself during the ‘returning to normal’ process.
The Chair thanked the Director for the information presented.