Agenda and minutes

9.1       RESOLVED to approve the minutes.

10.1     Apologies for absence were received from Cllr Ungar.

Disclosures by all members present of personal interests in matters on the agenda, the nature of any interest and whether the member regards the interest as prejudicial under the terms of the Code of Conduct.

11.1     There were none.

Notification of items which the Chair considers to be urgent and proposes to take at the appropriate part of the agenda. Any members who wish to raise urgent items are asked, wherever possible, to notify the Chair before the start of the meeting. In so doing, they must state the special circumstances which they consider justify the matter being considered urgent.

12.1     There were none.

The latest edition of the Forward Plan.The Committee is asked to make comments or request further information.

13.1     RESOLVED:

(1)  To note the Forward Plan.

(2)  To add Older People’s Day Opportunities Strategy to the Scrutiny Committee work programme for 16 November 2017.

14.1     The Chair of the Committee and the Chair of the Safeguarding Adults Board (SAB) paid tribute to the work of Angie Turner, former Head of Safeguarding, who had sadly passed away recently.

14.2     The Chair of the SAB introduced the Safeguarding Annual Report, highlighting the close work between agencies and an innovative pan-Sussex review of agencies’ capacity to undertake safeguarding which had been undertaken. He drew the committee’s attention to three key themes from the report:

i)             The completion of the first statutory Safeguarding Adults Review (SAR), which are required in cases where an adult has died within the local authority area, had care and support needs and where there is an indication that neglect or abuse played a role. The SAR report will be published in late October or early November and will include 23 recommendations covering seven areas.

ii)            The increase in the proportion of safeguarding enquiries related to domestic abuse (from 2% to 9%). The increase may be  a positive trend related  to work carried out through a multi-agency review and other awareness raising activity about the safeguarding aspects of domestic abuse. The audit undertaken identified many strengths and also areas for improvement. There has been significant work with primary care over the last year and there is now a named GP for safeguarding and piloting of a co-location worker from the domestic abuse Portal in Health and Social Care Connect.

iii)           The partnership protocol developed between the SAB, Local Safeguarding Children Board, Safer Communities Board and Health and Wellbeing Board in recognition that a number of priorities cut across these Boards. Its purpose is to clarify responsibility and accountability for various areas of work and it will be evaluated in a few months time, after 1 year in place.

14.3     The following additional points were made by the Director of Adult Social Care and Health in relation to the additional information on home care which had been requested by the committee:

·         There are home care representatives on the SAB and safeguarding awareness and training work does cover this sector. The SAB has recognised the particular vulnerability in relation to home care, which doesn’t have the same level of oversight in the home as other paid services.

·         There are three layers of assurance in relation to home care: 1) CQC regulates and rates the sector, including setting clear expectations in areas such as training and safeguarding 2) ESCC undertakes direct work with providers to support improvements in quality 3) the core safeguarding process, including awareness raising across all stakeholders and service users. Awareness raising ensures that people know how and when to raise concerns, and this is built into care planning and the set-up of care packages.

·         Safeguarding activity is monitored, with oversight of the data by the SAB. There will increasingly be comparative data available in relation to home care.

14.4     The Director also advised the committee of plans to undertake an Association of Directors of Adult Social Services (ADASS) peer review of safeguarding in  ...  view the full minutes text for item 14.

15.1     The Assistant Director - Strategy, Commissioning and Supply Management introduced the report, making the following observations:

·         Many of the issues outlined in the report are not unique to East Sussex but are part of general national and international trends.

·         The direction of travel in response to these trends is to use services differently and develop new forms of care.

·         There are ongoing programmes of work in East Sussex to mitigate the issues through East Sussex Better Together (ESBT) and Connecting 4 You (C4You).

·         Supplier relationship work has resulted in identifying a number of nursing home beds which can potentially be block contracted as and when needed.

·         The homecare supplier development programme has had a real impact on the sector and on care workers pay and conditions.

·         A bedded care strategy is being developed in order to obtain a more coherent view and subsequently recalibrate capacity.

·         Changes to the structure of ESCC’s contacting and supply team should have a real impact.

15.2     The following additional points were made in response to the committee’s questions:

·         Providers coming forward for the Care Home Plus scheme are not getting sufficient business from self funders. suggesting they may not be of the quality needed. This suggests that the care homes may not be of the quality required to provide the scheme. Higher quality providers are being proactively sought to offer the Care Home Plus model.

·         Social care assessments have never been a significant cause of delayed transfers of care (DTOCs).

·         Although there are nursing home vacancies evident in the data, these are not necessarily in the right place – fewer in the west of the county than the east. There is a further issue related to choice – people sometimes want to wait for a preferred placement.

·         There are a number of specialised developments advertised across the south east and marketed to people with high levels of income. ESCC is not in a position to pay the rates charged by these developments, both in relation to the cost of individual placements and due to the risk of inflating fees across the market.

·         Demographic pressures are reviewed as part of the budget setting process, using the Joint Strategic Needs and Assets Assessment (JSNAA) to identify projected need in different cohorts and therefore the type of services needed. Key cohorts are residents aged 75+ and particularly 85+, where needs for health and social care increase considerably. A modelling tool is in development through ESBT which will use current demand as a baseline and demonstrate the effect of making changes to the numbers of people supported in different ways (e.g. via technology). This will increase the availability and reliability of data but ultimately there will always be judgements about what is required.

·         The bedded care strategy is important in identifying demand and need and will be linked to an estates strategy as there will be a need to build or develop new nursing homes. East Sussex has numerous small and medium sized providers rather than more robust  ...  view the full minutes text for item 15.

16.1     In response to a request from the committee, the Director of Adult Social Care and Health provided some additional context for the report as follows:

·         Differing approaches are being taken in the ESBT area and the C4You area:

o   ESBT has a Strategic Investment Plan covering the total health and social care budget of c£864m. ESCC remains responsible for its share but budgets are fully aligned and there is a joint plan for making savings across the budget, based on reducing demand into acute care. This has meant that the NHS budget mitigates the impact of budget reductions in Adult Social Care as investment in social care reduces demand on more costly NHS services.

o   There have been discussions about aligning budgets in a similar way in the C4You area but High Weald Lewes Havens (HWLH) Clinical Commissioning Group (CCG) is currently taking a different approach based on aligning budgets with other CCGs. This means the Adult Social Care budget will continue to be set in a more traditional way in the HWLH area.

·         There has been a £27.8m savings requirement in Adult Social Care over three years (from 16/17). ESBT funding and additional Better Care Fund (BCF) money offset the level of savings required significantly in the current year (2017/18).

·         The original announcement of additional BCF monies indicated it was to be used in three ways: 1) to meet need; 2) to stabilise the market (hence fee increases); 3) to develop health and social care integration.

·         Delayed BCF planning guidance issued in July shifted the focus towards reducing Delayed Transfers of Care (DTOCs) and related performance indicators. Extremely challenging targets have been set for each local authority area. These changes led to the Local Government Association withdrawing support for the BCF guidance.

·         DTOC targets are based on the number of days of delay in hospital per 100,000 population. In East Sussex the NHS will be expected to reduce health related delays from 14.8 to 7.2 (i.e. c50% improvement). The social care delays starting point was 7.8 with an expectation to reduce to 2.9.

·         Local areas were required to submit a plan for using the BCF funding by 11 September and plans will be subject to an assurance process by October. Locally the impact of changes in direction has been well managed due to the existing partnerships in place, particularly in relation to ESBT as support for social care was already in the jointly agreed plan.

·         The DTOC target covers the whole year but there will be a review of progress in November based on the current trajectory. There have been suggestions that if the trajectory is not being met there will be some risk to local authority funding. However, a reduction in funding is likely to worsen the situation in areas not meeting the target.

·         The focus on DTOCs is linked to expectations of a very challenging winter for the NHS and social care. Part of the NHS Winter Plan is to reduce hospital bed occupancy to 85%  ...  view the full minutes text for item 16.

17.1     RESOLVED:

(1)  To postpone the item on services to prisons (post Care Act) from November to March.

(2)  To update the work programme as discussed during the meeting.