Stockton-on-Tees Borough Council

Big plans, bright future

Adult Services and Health Select Committee Minutes

Date:
Tuesday, 14th June, 2016
Time:
16.00
Place:
First Floor Committee Room, Town Hall, Stockton, TS18 1AU
 
Please note: all Minutes are subject to approval at the next Meeting

Attendance Details

Present:
Cllr Mohammed Javed(Chairman), Cllr Sonia Bailey, Cllr Evaline Cunningham, Cllr Kevin Faulks, Cllr Lynn Hall, Cllr Stefan Houghton, Cllr Allan Mitchell, Cllr Mrs Sylvia Walmsley
Officers:
Liz Hanley, Natalie Shaw(DA&H), Peter Mennear, Sharon Jones, Gayle Nertney and Kirsty Wannop(DCE)
In Attendance:
None
Apologies for absence:
None
Item Description Decision
Public
ASH
7/16
COUNCILLOR MICHAEL CLARK
 
ASH
8/16
DECLARATIONS OF INTEREST
 
ASH
9/16
DRAFT MINUTES - 15TH MARCH 2016
AGREED that the minutes be approved.
ASH
10/16
SCRUTINY REVIEW OF DEPRIVATION OF LIBERTY SAFEGUARDS (DOLS)
AGREED that
1. The draft scope and project plan be approved
2. The information provided be noted.
ASH
11/16
MONITORING OF PREVIOUSLY AGREED RECOMMENDATIONS
AGREED that the assessments of progress set out in each progress report be approved.
ASH
12/16
QUARTERLY CQC INSPECTIONS UPDATE
AGREED that the information be noted.
ASH
13/16
MINUTES OF THE HEALTH AND WELLBEING BOARD
 
ASH
14/16
WORK PROGRAMME 2016-17
 
ASH
15/16
CHAIR'S UPDATE
 
4.30pm/5.15pm

Preamble

ItemPreamble
ASH
7/16
Following the sad news that Councillor Michael Clark had passed away, a minutes silence was observed.
ASH
8/16
There were no interests declared.
ASH
9/16
Consideration was given to the minutes of the meeting held on 7th March 2016.
ASH
10/16
The Committee considered the draft scope and project plan for the new in-depth review of the application of the Deprivation of Liberty Safeguards (DoLS). Members then received briefing information for the review that could be summarised as follows:-
- The budget that was available for DoLS was around 90k. Additional spend that would have to be made on an on-going basis around 550k. This was in place for 2016-17 but funding needed to be identified for future years.
- Details of the DoLS process, those eligible and the assessment process and timescales for reassessment.
- Report that had been considered by the Council's Cabinet detailing the latest data.

Members were informed that there were not enough available psychiatrists and Best Interest Assessors to meet demand. Priority has been given to learning disability and mental health packages in 24hour care, and the most restrictive packages in the community.

DoLS apply when the State was involved (i.e. the state had arranged the care package in question, or was paying for some or all of the care package). However the state may also be indirectly responsible as a result of the person being cared for in a setting registered by CQC Authorisations were specific to a particular setting and a new application would need to be made if the person moved into a new care home or hospital. Where a Deprivation of Liberty was occurring in a person's own home (including supported living settings), the deprivation must be authorised by the Court of Protection.

Three monthly care reviews of those under a DoLS authorisation; this was resource intensive but regarded as important to ensure the situation was kept under review.

Members then made comments that could be summarised as follows:-
- Why were there more cases in the North East? The North East region considered that it was applying DoLS correctly, and the vast majority of applications were being approved, which suggested that there were high number of cases where the DoLS applied. A recent LGA Peer review identified that the Council was DoLS compliant, yet other parts of the country had been judged non-compliant.

Whether Relevant Persons were paid? The majority of Relevant Persons Representatives (RPRs) were family members and not paid, although 10% of RPR appointments were provided by a commissioned service.

- Was there staff training in care settings to ensure they were having the training? The Council looks at ways to make sure DoLS training was implemented, and raises awareness of training availability to care home staff, and work was being undertaken to make it part of the QSF. The Care Quality Commission also looked at this as part of its inspections. Ultimately, providers could lose their registration if their standards were not maintained.

Members were informed that attendance at training had improved following work by commissioners.

A class action had been filed by four local Authorities to challenge the Government's stancethat the financial pressures resulting from DoLS and the Supreme Court judgement did not represent a ‘new burden'. Stockton Council was supporting the class action in principle. The Law Commission was reviewing the law in this area, but any changes would not come into force until 2020.

It was noted that a maximum of 3 Members could spend time with front line staff on 19th July 2016.

Members requested that information on the future funding of the service be included in the information submitted to the review. It was also noted that a separate report on the options for future financing of the service would be reported to Cabinet at the same time as the scrutiny review. Lean/efficiency work had been undertaken and more was planned, and this would be reported to Committee.
ASH
11/16
Members considered the assessments of progress contained within the progress updates provided on the implementation of the previously agreed recommendations from the reviews of Home Care and Access to GP, Urgent and Emergency Care.

The following information was provided for the Home Care update:-
- In relation to recommendation 7, it was planned that procurement of home care would take place as follows: Phase 1 (March 2017):2 extra care schemes plus 2000 hours of home care; Phase 2 (September 2017): 5000 hours of home care;Phase 3 ( March 2018): 1 Extra care scheme plus 150 hours of home care;Phase 4 (October 2019):1 Extra Care scheme plus 100 hours of home care.

Members questioned when 5 lamps would be given hours for Home Care. It was stated that this would begin is December/January time as part of a pilot scheme to involve the voluntary and social enterprise sector. They had no history of providing personal care and were being supported to do this, and the roll out would be in small stages.

The following information was provided regarding the Access to GP, Urgent and Emergency Care:-
- A session would be arranged for Members to gain greater insight into the Commissioning of GP services. Members queried if this could receive information on the new Hartlepool and Stockton GP Federation.
ASH
12/16
The Committee considered a report that provided an update on CQC inspection outcomes from 1st December 2015 and 31st May 2016.

Reports were be broken down as follows:
- twenty five Adult Care services were reported on (fifteen rated as Good, nine rated as Required Improvement, and one Inadequate);
- eight reports were released on Primary Medical Care (seven rated as Good and one Practice was Outstanding);
- four reports on Hospital/Other Health Care (two rated as Requires Improvement, and two rated as Good).

A summary of each report and links to the full version was provided.

A verbal update on Direct Health was provided by the Assistant Director. The provider had been rated as Inadequate once again during the reporting period. Some improvements had been made but these had not been sustained. A new manager was in place and Adult Services were holding weekly meeting with the provider. The key issues continued to be management and the administration of rotas.

There had been no referrals to Direct health for 3 month since the bar was put in place, however they still provided 3000 hours per week and so any transition to a new provider would have to be handled as part of a managed process. If a provider did lose its license during their contract period, Adult Services Commissioning Staff would progress contingency plans.
The Council was now more confident that providers would come forward for the contracts now that the fee rate had been agreed.

Members expressed their concerns on the numbers of services that required improvement. It was stated that plans were in place for those that required improvement and they were being monitored closely. Action Plans were created following any rating of less than Good, and these had input from the Commissioning Team, and Adult Care Management, Medicines, and DoLS Teams, where necessary.

It was noted that in some cases, it was preferable that a home received ‘Requires Improvement' rather than only just making a ‘Good' rating that may hide issues that needed addressing.

Members requested whether it would be possible to include the previous ratings of providers in the reports, but it was noted that the CQC had changed its inspection system and many of the providers were being rated under the new stricter regime for the first time.
ASH
13/16
The minutes of the Health and Wellbeing Board were noted.
ASH
14/16
The Committee considered its work programme. Members were informed that the Assisted Reproduction service Update would be considered at its meeting in September.
ASH
15/16
The Chair had nothing to update.

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