Agenda and minutes

Apologies for absence were received from Councillors I.W. Davies and B.A.L. Roberts.

The Chair, on behalf of the Committee, thanked Councillor Rob Evans for arranging automated defibrillator training for members.  It was noted that automated defibrillators will be placed in County Hall and 3 Spilman Street in the near future.

There were no declarations of personal interest.

There were no declarations of prohibited party whips.

The Chair advised that no public questions had been received.

The Committee considered a report detailing progress against the actions and measures in the 2017/18 Well-being Objectives delivery plan relevant to the Committee’s remit, as at 30^th June, 2017.

The following questions/observations were raised on the report:-

·       Reference was made to the fact that we have a lot more older people to look after and officers were asked how discussions are progressing with the Health Board regarding the Through The Night Service.  The Head of Integrated Services explained that the Through The Night Service has been running for 7-8 years, however, the number of people receiving the service has been going down.  It is important to ensure that people are receiving the correct and safe service in view of the fact that complexity is increasing.  People who are receiving the service at the moment are extremely complex cases and officers are looking at how best to provide a service for them.  These discussions are ongoing and include looking at supporting these service users with community nurses in the future. Any progress will be reported to Committee;

·       Officers were asked for further information on Step Down Beds.  The Head of Integrated Services explained that the definition of Step Down Beds is discharging someone from hospital, not just to convalescent units but also to vacant beds in residential homes and care homes.  It was also important to consider Step Up Beds and avoid admission to hospital if possible.  She added that a review had been undertaken of all Step Up and Step Down Beds in Carmarthenshire to ensure best use.  Officers are aware that the correct use is not being made of Community Beds so the criteria for their use is being reviewed;

·       Reference was made to the fact that the measure relating to the rate of people aged 75+ kept in hospital while waiting for social care is on target, however, it was pointed out that in the past data was collected for a broader age range and concern was expressed that this measure was hiding data for the under 74 age group.  The Head of Integrated Services explained that 75+ is the criteria set by the Welsh Government six months ago for delayed transfers of care, however, it has not made a big change to the figures as there weren’t many under 75s.  She added that a lot of work is being done to ensure flow through our domiciliary care including looking at voids in sheltered complexes so that we can provide another pathway to avoid delayed transfers of care.

RESOLVED that the report be received.

The Committee considered the Revenue and Capital Budget Monitoring Report in relation to the Social Care and Health Service which provided an update on the latest budgetary position as at 30^th June, 2017, in respect of the 2017/18 financial year.

The Social Care and Health Service was projecting an overspend of £950k on the revenue budget and a net variance of -£6,936k against the 2017/18 approved capital budget. 

The following questions/observations were raised on the report:-

·       Asked how the projected overspend compared to the previous year, the Group Accountant explained that the report shows the projection as at June 2017 which is early on in the financial year.  She added that the pattern over the previous two years was that the overspend projection had reduced by the year end;

·       Asked how closely she works with the Health Service on their predictions, the Head of Integrated Services advised the Committee she finds it invaluable as it is in our best interests to help them understand the value of social care and the fact that we can only provide social care for those who need it most as it is not an infinite resource.  The Head of Mental Health and Learning Difficulties added that her staff work closely with colleagues at Hywel Dda as it was important to work together when reviewing packages, interventions and providing the right support at the right time.  She added that her team had won an award this week for collaboration;

·       Asked why there were no figures alongside the Crossroads Plan in the report, the Group Accountant advised the Committee that there should be no nil entries in Appendix C and she would ensure that the report is amended by the next meeting.

RESOLVED that the report be received.

The Committee received an Annual Report detailing the work of the Committee during the 2016/17 municipal year.  The report had been prepared in accordance with Article 6.2 of the Council’s Constitution which requires Scrutiny Committees to prepare an annual report giving an account of the Committee’s activities over the previous year.

The report provided an overview of the Committee’s work programme and the key issues considered during the year including those issues referred to/from the Executive Board and other Scrutiny Committees.  The report also provided details of development sessions and site visits arranged for the Committee as well as attendance data.

The following questions/observations were raised on the report:-

·       Reference was made to the Domiciliary Care Commissioning Framework and officers were asked what guarantees do we have in relation to staff turnover, conditions etc. as they are dealing with the most sensitive client group and some clients see up to 15 different carers per week.  The Head of Strategic Joint Commissioning explained that when the service was re-commissioned it provided an opportunity to look at various things such as the national living wage, travel time, travel cost etc.  Work has also been undertaken on workforce development and the issue of us being able to attract and retain staff.  The Head of Regional Collaboration added that the West Wales Care Partnership which comprises Carmarthenshire, Pembrokeshire and Ceredigion County Councils and the Health Board, is committed to developing a shared work strategy.  It is all about how we attract a robust and resilient workforce.  Resources have been identified to support training and development for commissioners to ensure that the best quality of care is provided;

·       Reference was made to the first recommendation on page 11 of the report where the end of the sentence appeared to be missing.  The Committee was advised that this would be rectified before the document was published.

RESOLVED that the Social Care & Health Scrutiny Committee’s Annual Report 2016/17 be endorsed, subject to the above-mentioned amendment.

The Committee considered its Forward Work Programme for 2017/18, which had been prepared in accordance with the Council’s Constitution which required Scrutiny Committees to develop and publish annual forward work programmes identifying issues and reports to be considered at meetings during the course of the municipal year.

Following a discussion, it was agreed that the following items be included in the Forward Work Programme:-

- Deprivation of Liberty (DoLs) Update

- Substance Misuse Update

- Trading Standards Update

- Carers Partnership Board Update (to include the Carers Strategy, Carers

  Assessments and Carers Forum)

- Welsh Language Services for Older People Update

- Ambulance Service Standards Update

It was also agreed that representatives from the Community Health Council and Public Health Wales be invited to a future meeting.

RESOLVED that the Forward Work Programme for the Social Care & Health Scrutiny Committee for 2017/18 be confirmed, subject to the inclusion of the above-mentioned amendments.

The Committee considered a report on Service Integration and Pooled Funds.  Under the Social Services and Well-being (Wales) Act 2014 (SSWBA), Councils and Health Boards have a statutory obligation to establish and maintain pooled fund arrangements in relation to:-

- the exercise of their care home accommodation functions;

- the exercise of their family support functions;

- specified functions exercised jointly in response to Population Assessments

  where such arrangements are considered appropriate.

The report detailed the regional arrangements that have been put in place to support organisations in meeting their obligations under the Act.

The following observation was raised on the report:-

·       Reference was made to the fact that we have an ageing population with more complex needs and although we want to keep people in their own homes sometimes there comes a point when you cannot cope.  The Head of Strategic Joint Commission advised the Committee that officers had undertaken a piece of work looking at the accommodation needs of older people which highlighted the need for nursing beds, complex nursing beds and EMI beds.

RESOLVED

9.1     that the Council’s statutory obligation to establish pooled funds           for adult care homes be noted;

9.2     that the regional arrangements established in order to meet           pooled funding obligations be acknowledged.

The Committee considered a report detailing Carmarthenshire’s Quality Assurance Arrangements including the Operation Jasmine Action Plan. 

The provision of adult social care has grown increasingly complex and diverse since 1990 when the NHS and Community Care Act introduced the concept of a mixed economy of care.  Each Local Authority was required to develop commissioning and contracting arrangements, particularly quality assurance systems, to ensure service users and carers receive reliable and safe services.   Alongside this development, the Care Standards Act 2000 also introduced explicit standards for care providers and established the regulatory body, the Care and Social Services Inspectorate Wales (CSSIW) to regulate and inspect care providers to assure the public of the quality of care provided both by Local Authority and independent care providers.

Since the inception of commissioning in 2002, Carmarthenshire has developed effective contract management and contract monitoring arrangements and our commissioning arrangements, including quality assurance systems, are considered effective and robust (CSSIW 2014, 2015 and 2016).

The Committee also considered the Operation Jasmine Action Plan which was developed in 2016 following an investigation into the neglect of older people in several care homes in North Wales.  The Action Plan for both West Wales (the three Local Authorities and the Hywel Dda University Health Board) and Powys is submitted to each Authority’s Local Operational Group for Adult Safeguarding.  For the purposes of accountability and governance, the Action Plan is reviewed and updated each quarter at both the Local Operational Groups before submission to the Regional Safeguarding Board.

The following questions/observations were raised on the report:-

·       In order to improve standards, it is important to monitor the Action Plan and officers were asked who is responsible for monitoring the Action Plan to ensure that there is development/improvement.  The Safeguarding and Commissioning Manager explained that if there is a specific action for a specific care provider then it would be up to the Commissioner to follow up on that;

·       In relation to responding to concerns, officers were asked how long it takes for something to be done.  The Safeguarding and Commissioning Manager explained that it is all about what is reasonable and proportionate.  Where there is evidence to indicate concerns are of a serious nature, the Authority will consider its contractual position including the termination provisions of the contract.  The Head of Mental Health and Learning Disability added that where there are concerns in relation to safety officers respond quickly.

RESOLVED

10.1    that the report and the Authority’s effective quality assurance           arrangements be noted;

10.2    that the Operation Jasmine Action Plan be noted.

The Committee considered the Council’s draft Annual Report for 2016/17 which included the second year progress report on the Corporate Strategy 2015-20, the Summary Annual Report 2016/17 and the full Annual Report.

When the Corporate Strategy was published in 2015/20 it was agreed that an annual progress report would be produced setting out 24 outcome measures to judge our progress against.  The Corporate Strategy would be reviewed for 2018/19 as the Well-being of Future Generations (Wales) Act 2015 requires our Well-being Objectives to be incorporated within the Corporate Strategy.

In previous years the Annual Report and Improvement Plan have been combined into a single document.  However, this year these documents have been separated because the new Well-being of Future Generations Act required the publication of our Well-being Objectives by the 31^st March and it therefore made sense to incorporate our Improvement Plan for the year ahead within that.  It would not have been possible to produce the Annual Report before the year’s end.

It was noted that it was a requirement of the Local Government (Wales) Measure that the Authority must publish an Annual Report on past performance by the end of October each year.

The following observation was raised on the report:-

·       Reference was made to staff absence and the pressure that staff are under.  Concern was expressed that staff will be under increasing pressure in view of impending cuts and efficiencies and it was important that this is monitored.

RESOLVED that the draft Annual Report, including the Second Year Progress Report on the Corporate Strategy, be received.

The Committee requested that the following items be added to the agenda:-

- Deprivation of Liberty (DoLs) Update

- Welsh Language Services for Older People Update

- Ambulance Service Standards Update

RESOLVED that the list of forthcoming items to be considered at the next scheduled meeting to be held on Thursday, 23^rd November, 2017 be noted.

RESOLVED that the minutes of the meeting of the Committee held on 20^th April, 2017 be signed as a correct record.