Adult Social Care and Health Select Committee Minutes

Date:
Tuesday, 18th May, 2021
Time:
4.00 p.m.
Place:
Jim Cooke Conference Suite, Stockton Central Library, Stockton, TS18 1LD
 
Please note: all Minutes are subject to approval at the next Meeting

Attendance Details

Present:
Cllr Evaline Cunningham (Chair), Cllr Jacky Bright, Cllr Clare Gamble, Cllr Mohammed Javed, Cllr Tony Riordan (sub for Cllr Lynn Hall), Cllr Paul Weston
Officers:
Jane Edmends (FD&BS); Emma Champley, Rob Papworth, Catherine Buller, Julie Nisbet (A&H); Gareth Aungiers (Xentrall); Michael Henderson, Gary Woods (MD)
In Attendance:
Nikki Brown, Ben Brown (The White House Care Home); Maureen Massey, Nettie Daniel (Allington House Care Home)
Apologies for absence:
Cllr Lynn Hall, Cllr Bill Woodhead MBE
Item Description Decision
Public
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78/20
DECLARATIONS OF INTEREST
 
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MINUTES OF THE MEETING HELD ON 20 APRIL 2021
AGREED that the minutes of the meeting on the 20th April 2021 be approved as a correct record and signed by the Chair.
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MONITORING THE IMPACT OF PREVIOUSLY AGREED RECOMMENDATIONS
AGREED that:

1) the progress update be noted and assessments for progress be confirmed.

2) a further progress update be provided at a future Committee meeting.
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MONITORING THE IMPACT OF PREVIOUSLY AGREED RECOMMENDATIONS
AGREED that the progress update be noted and assessments for progress be confirmed.
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WELL-LED PROGRAMME - UPDATE
AGREED that the Well-Led Programme update be noted.
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WORK PROGRAMME 2021-2022
AGREED that the Adult Social Care and Health Select Committee Work Programme for 2021-2022 be noted.
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CHAIR'S UPDATE
 

Preamble

ItemPreamble
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There were no interests declared.
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Consideration was given to the minutes from the Committee meeting held on the 20th April 2021
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Consideration was given to the assessments of progress on the implementation of the recommendations from the previously-completed Scrutiny Review of Temporary Accommodation for Homeless Households. This was the second progress update following the Committee’s agreement of the Action Plan in June 2019, and key developments in relation to outstanding actions were recorded as follows:

• Recommendation 3 (That in response to increasing service demands, the Council explores options for alternative models for ‘temporary’ accommodation with Housing Providers): Following the initial failed tender, a series of provider engagement sessions has led to the development of a new contract tender specification (deadline for submissions was the 20th May 2021). It was hoped that the new contract would be in place from the start of October 2021.

• Recommendation 4 (That the Council continues to develop detailed understanding of those who are ‘hardest to house’ and the barriers to accessing (and maintaining) accommodation, and explore new forms of appropriate housing options for this client group): Several strands of progress outlined including continued engagement between the Gateway Team and commissioned temporary accommodation providers, the establishment of bespoke roles to support and engage those who were ‘hardest to house’, the securing of additional funds to provide immediate access accommodation for this client group, and ongoing work with Thirteen Housing Group regarding a bid to provide further supported ‘move-on’ accommodation. It was also noted that the provider of what had been a homeless hostel in Portrack was looking to sell that facility to another provider (though not for the same use).

The Committee thanked Stockton-on-Tees Borough Council’s Housing Services Manager for this latest update and asked if the department linked-in with other Council directorates and external partners when considering arrangements around homelessness, particularly since other issues (e.g. mental health) can often be associated. Members were informed that individuals could be experiencing a number of complexities which prevent them from ‘moving-on’, and that the Council works closely with several other internal teams (e.g. Adult Safeguarding) and external organisations (e.g. CGL) where necessary.

A query was raised regarding the provision of accommodation for those being released from prison, specifically around communications prior to their release if they require support (sometimes an individual may think they have a place to go to when they actually do not). Two approaches were noted - the first involved the ‘duty to refer’ of prison staff (this applies when an individual has completed their sentence), and the second exists in the form of a Designated Prison Worker who liaises directly with a prison. The need for individuals who were coming out on licence (prior to completing their sentence) to have somewhere to go was also highlighted - for these people, the Probation Service can sometimes have a role.

The Committee was informed that, for 2020-2021 (the start of this period coinciding with the early stages of the COVID-19 pandemic), the Council had engaged with 96 individuals requiring temporary accommodation, 56 of whom had successfully ‘moved-on’. Members sought details around post-pandemic planning amid the potential for increased demand on homelessness services. Assurance was given that the Council was fully-staffed and had tried to engage private landlords (i.e. contact the Council before they serve any notice) and tenants in an attempt to limit the need for temporary accommodation - work was being carried out with the Communications Team to get publicity out, though there remains uncertainty around how many may need such help (it was therefore difficult to be certain about the Council’s ability to respond). The Government’s recent commitment to end rough sleeping and its announcement of an associated new fund was noted - the Council had already submitted a bid to access a proportion of this funding but would not know for several weeks if it had been successful.
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Consideration was given to the assessments of progress on the implementation of the recommendations from the previously-completed Scrutiny Review of Care Homes for Older People. This was the first progress update following the Committee’s agreement of the Action Plan in July 2020, and whilst the ongoing pandemic had limited the ability to advance some areas of the Action Plan, several key developments were recorded as follows:

Recommendation 2 (That the importance of personalised care be promoted through all contacts the Council and partners have with Care Homes; in particular the development and deployment of a varied activities programme tailored to individual needs and co-ordinated by a designated member of staff): Positive outcomes achieved in the HenPower Project (recognised by BBC News and Alzheimer’s Society) - Mandale House Care Home had secured £10,000 from the Big Lottery Fund to further invest into the project. Activity Co-ordinator Network had formally met twice since December 2019 with good engagement from relevant care home staff (who had since created an informal network to further share ideas). Support during COVID-19 was also outlined.

Recommendation 3 (That the benefits of technology for supporting personalised care are championed and promoted to all care homes in Stockton on Tees; in particular, the deployment of electronic solutions for records and medicine management should be supported by the Council): Several technological developments highlighted including work with the Tees Valley Clinical Commissioning Group (TVCCG) on providing digital solutions to the Borough’s care homes, provider engagement sessions to ascertain the potential for a digital care home, and maximising technological opportunities to support care throughout the pandemic (including the creation of ‘The Hub’, a remote information-sharing platform for care home managers).

Recommendation 4 (That contract monitoring and quality assurance systems ensure that appropriate staffing levels are maintained in care homes): Although the anticipated PAMMS review could not be completed due to the pandemic, the Council was able to ensure safe staffing levels were monitored and maintained since the emergence of COVID-19 through weekly support calls to providers.

Recommendation 9 (That the summary of Care Quality Commission inspection results, reported each quarter to the Adult Social Care and Health Select Committee should include greater context including trend information of quality ratings and information about providers): Trend analysis had been prohibited due to the pandemic-enforced suspension of the CQCs routine inspection programme.

The Council’s Strategic Development Manager (Adults and Health) was commended for a comprehensive update which, despite being adversely impacted by COVID-19, had demonstrated several aspects of positive progress. With regards recommendation 2, Members were particularly pleased to hear that day activities, although needing to be adapted / newly-introduced, had never stopped within care homes themselves during the pandemic period (only outdoor activities or people coming into settings were restricted).

The Committee queried when further work and engagement to establish a specification for digital care planning and medication management (recommendation 3) would be undertaken - it was subsequently noted that conversations were scheduled to take place with the TVCCG in the near future to move this action forward.

Members stressed the need for continued assurance around care home staffing levels during these COVID-19 times and were informed that providers’ onsite staff numbers had been, and would continue to be, carefully monitored via the Capacity Tracker. The healthy relationships between the Council and local care home providers bred confidence that necessary information in relation to any staffing (and other) issues would be provided in the future.
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The Committee received a presentation on the Council’s Well-Led Programme which provided a further update on developments around this leadership programme for the Borough’s Registered Care Home Managers. Led by the Council’s two Transformation Managers for Residential Care, Registered Care Home Managers who had been part of the programme were also in attendance to reflect on their experiences and the benefits it had brought them following their involvement. Key features of the presentation included:

• Setting the Scene - Changing relationships (before Well-Led): Previous relationships with the Council were transactional rather than personal and contact between providers was limited. From a Council perspective, Care Quality Commission (CQC) ratings for the Borough’s care homes in 2018 were lower than the national average, with only half rated good for leadership. CQC evidence that well-led care providers delivered better quality outcomes for people accessing their services led to the creation of the Well-Led Programme concept which had subsequently and significantly strengthened relationships between providers, the Council and its partners.

• What is Well-Led (the collaborative begins…): Created through partnership- working between the Council, care providers, the CQC and the NHS North East and Yorkshire Leadership Academy, ‘leadership’ (as opposed to ‘management’) was at its core. It promoted detailed discussion and self-reflection, helped managers better understand themselves and their behaviours, and built strong peer relationships. To date, three cohorts (offering 65 places) of care home / home care managers, deputy managers and aspiring managers had gone through the programme since 2019.

• Leadership and Peer Support Network: A network formalised after the success of the first cohort and facilitated by the Council’s Transformation Managers for Residential Care, it provides a safe space for care home managers to share issues with those often going through similar experiences. Guest speakers are also invited to address the network.

• Success: Before the programme began, eight care homes had an overall CQC grading of ‘requires improvement’ (nine for the ‘Well-Led’ domain of CQC reports) - after the programme was implemented, there were only two graded ‘requires improvement’ (three for the ‘Well-Led’ domain of CQC reports).

• The White House (partnership-working, ‘outstanding’ CQC and publicity): One of the first to access the Well-Led Programme, it was a turning-point both personally and professionally. It broke down barriers with other care providers and developed meaningful relationships through shared experiences as well as foster closer engagement with the Council. A crucial moment was the advice from the CQC in relation to the merits of sharing good practice - the subsequent evidencing of partnership-working ultimately contributed to the achievement of being graded ‘outstanding’ for the first time. The care home’s ‘Residents on Ice’ activity was also picked-up by the national media bringing further exposure on a wider scale.

• COVID-19 (doing things differently…): Strong leadership was vital in keeping residents safe and guiding staff through these challenging times. Another round of the Programme was therefore recommissioned, this time to be delivered virtually. The established Leadership and Peer Support Networks went virtual too, ensuring managers could still access support.

• Allington House (journey to Well-Led): Rated ‘requires improvement’ by the CQC in 2018, cultural changes were required to raise the bar. An important early factor was getting involved with the Leadership and Peer Support Network and realising that others faced similar issues and concerns. Participating in the recent virtual Well-Led Programme brought much self-reflection and personal-learning, providing tools to take back into the care home that enhanced the ability to work effectively with fellow senior staff - residents and their families have since noted many positive changes.

• The Hub (a central space for providers and partners to work together): Whilst it may have been portrayed that care homes had become cut-off due to COVID-19, providers witnessed an overwhelming influx of guidance and support from the Council, with health and social care working alongside each other in a further strengthening of existing relationships. Despite the pandemic crisis, the creation of ‘The Hub’ brought a more light-hearted experience for those involved and aided the continuation of collaboration and connection between care home providers and their local partners.

• The Journey Continues: Being well-led is not just about an individual as a leader - it’s about having both the strength and vulnerability to open up and work with others. As providers navigate out of the pandemic, the lessons learnt will remain, and they, the Council and other health and care partners will seek to build on previous successes of the Well-Led Programme.

The Committee strongly commended all those involved in the Well-Led concept and thanked Officers and the care home providers in attendance for an excellent and inspiring presentation that brought much-needed positivity in the midst of ongoing COVID-19 pressures. The willingness to share good practice was particularly pleasing to see as it can be very easy for high-achievers to keep the methods of their success to themselves.

A query was raised around any experiences of COVID-19 vaccination hesitancy amongst local care home staff. Aside from a handful of isolated cases in some settings, the large majority of staff had been very positive about getting the vaccine, though the odd concern was noted in relation to what people had read on social media (particularly amongst the BAME community). Care homes and the Council (including Members) had supported campaigns to encourage take-up and this had translated into a high proportion of vaccinations across the local care sector.

Referencing the challenge around staff turnover, the Committee asked for confirmation of the number of individuals who had gone through the Well-Led Programme. To date, 40 places were provided in the first two (2019) cohorts (34 completed), with 25 places available for the third (2020) virtual cohort (16 completed - some drop-outs due to outbreaks occurring within settings). There remains much interest in the Programme across (and beyond) the Borough, with plans in place for a future fourth cohort.
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Consideration was given to the Committee’s current Work Programme. The next meeting (the first Task and Finish Group session in relation to the Scrutiny Review of Multi-Agency Support to Care Homes during the COVID-19 Pandemic) was scheduled for Thursday 20th May 2021, whilst the next formal Committee meeting would take place on Tuesday 22nd June 2021 and would include an update from Tees, Esk and Wear Valleys (TEWV) NHS Foundation Trust in response to a recently-released CQC report.
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The Chair had nothing further to report.

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