Agenda and minutes

The minutes of the meeting held on 7th April 2008 were approved as a correct record.

The minutes of the Review of Guardianship meeting held on 7th April 2008 were approved as a correct record.

Kim Curry, Director of Commissioning and Partnerships, presented the submitted report which set out a radical change to the way the Council spend their money to meet the social care needs and improve the health, well-being and quality of life for people in Rotherham over the next 15 years.

The strategy had been developed to deliver the following aims:-

• To meet the challenges for social care in Rotherham that the Joint Strategic Needs Analysis (JSNA) identified

• To change the way money was spent through undertaking the steps in the Commissioning Framework

• To show the difference that we will make for the people in Rotherham by delivering a recurrent 3 year action plan

The strategy complemented the Joint Commissioning Strategy that had recently been agreed with the PCT which focussed on both health and social care services where it was critical to provide an integrated and joined up way to improve outcomes for customers.  The areas of focus were:

• The management of long term conditions

• Intermediate care

• Older people with mental health problems

• Reducing hospital admissions from residential and nursing care

There were three key national policy drivers which shaped the development of the Commissioning Strategy.  These were:

·        Commissioning Framework for Health and Well-being (2006)

·        The White Paper ‘Our Health, Our Care, Our Say’ (2006)

·        The ‘Putting People First’ concordat (2007)

The local drivers were value for money and meeting the current and future needs. 

Adult Social Care in Rotherham had been rated as a ‘good’ service with ‘promising prospects’ under the Commission for Social Care Inspectorate’s new regime in 2007.  It was not expected that any improvement would be made on this rating namely due to:

• Performance in relation to helping people to live at home had deteriorated
• An over reliance on high cost in-house services which did not provide value for money nor accord with a comprehensively modernised service.

Despite the Council providing financial commitment in the last five years, to helping people to live independently, they did not possess the resources required to fulfil current and future need.

Demographic Factors continued to put pressure on budgets.  Adult Services and the PCT had undertaken a Joint Strategic Needs Analysis (JSNA) between March 2007 and January 2008 which outlined current and predicted health and well-being outcomes. 

The JSNA informed the new Commissioning Strategy and highlighted the following:

• People want to remain healthy and in their own homes
• People want to do things for themselves
• To improve value for money and better outcomes we need to move away from direct provision to commissioning diverse services from a range of providers
• People want to influence and be involved in commissioning decisions
• People want access to a range of different services so they can make a personal choice about which care package would keep them independent.

The action plan, which was appended to the report, set out how the actions arising out of the JSNA to improve outcomes would be implemented over the next 3 years and what these outcomes would be seeking  ...  view the full minutes text for item 121.

Mark Scarrott, Service Accountant (Adult Services), presented the report submitted, to inform members of the anticipated outturn against the approved Adult Services capital programme for the 2007/08 financial year.

The capital monitoring report provided detail of the approved capital programme for the Adult Services department of the Neighbourhoods and Adult Services Directorate, actual expenditure for the period April 2007 and 31 March 2008 and the projected final outturn position for each scheme.

The approved 2007/08 capital budget for Adult Services had been revised to take account of slippage in a number of schemes since the last report.  The main revision was in respect of the two new residential care homes which were experiencing some delays on completion.  Actual expenditure to the end of March 2008 was £9.2m, with a number of invoices pending payment for actual work completed.

Members raised concerns about the potential cost pressures in relation to the new residential care homes and in particular the delay from Economic and Development Services (EDS), who project managed the scheme, in determining the extent of the potential additional costs.  Members felt that the Director of EDS should be asked to report to the next meeting with an updated financial position.

Resolved:-  (1)  That the Adult Services forecast outturn for 2007/08 be received and noted.

(2)  That a report be presented to the next meeting in relation to the potential additional cost pressures in respect of the two new residential care homes.

Kim Curry, Director of Commissioning and Partnerships, presented the submitted report which set out proposed changes to the delivery of social care through individual budgets.  Individual budgets would promote a much greater choice in services for people with social care needs and empower them to take decisions affecting their lives, giving them greater choice and flexibility in how their needs were met.

They were a relatively new concept and would require considerable preparation prior to implementation.  It would include ensuring that service users, carers, staff, partner and provider organisations were signed up to and championing this approach in order to achieve a total transformation of the way services were provided and delivered.

Assessment and care management procedures and social work activity would need to be radically changed to make sure that everyone who was eligible for an individual budget was offered the opportunity to use on. 

A pilot scheme called “In Control” had been implemented for Mental Health service users to manage their care and had proved very successful with 93 service users moving from a direct payment to an individual budget.  This demonstrated the potential for other individuals living in Rotherham to benefit from this approach.

New management arrangements would be required to ensure individual budgets were implemented across all customer groups and it was proposed that an Individual Budgets Project Manager post be established.  Details of the post were appended to the report.  In addition it was proposed to reconfigure the existing staffing and support arrangements to achieve the roll out with minimal impact on customers.

A discussion and question and answer session ensued and the following issues were covered:

• What the difference was between direct payment and individual budget, for which a definition was given
• How the shift in care would affect the service user
• The need to ensure that a wide range of options were available.

Resolved:-  That the report be received and the direction of travel endorsed.

Shona McFarlane, Director of Health and Wellbeing, presented the submitted report which outlined proposed new names for the two new residential homes which were being built at Rawmarsh and Dinnington.

Each home required a name, to provide them with an official postal address, to enable a postcode to be allocated and to provide them with an identity in the locality.

The Cabinet Member, Ward members and the Dinnington St John’s Town Council had been asked to consider the following names:

• Lord Hardy Court, Rawmarsh – in recognition of Peter Hardy, long standing MP in the Wentworth area
• Davies Court, Dinnington – in recognition of David Davies, Town Council Leader.

Both suggestions had been fully approved by all concerned.

Resolved:-  That the recommended names for the new homes be approved.

Shona McFarlane, Director of Health and Wellbeing, presented the submitted report, outlined the plans to reshape domiciliary care services from a service which provided 60% of home care service in-house to one which provided 35% of services in-house.  The plans would seek to maintain the quality of services while significantly reorganising the allocation of resources to create greater capacity with Neighbourhoods and Adult Services to provide support to people to help them live at home for as long as possible.

As part of the process, trades unions had been consulted with, through both the Strategic Consultative Committee and separate meetings which had been arranged to update and outline plans.  Some problems had been experienced in getting the trades unions engaged, and whilst every effort had been made to arrange meetings to suit all representative availability, representation at meetings had been patchy and inconsistent.  This had resulted in some messages not being fed through or messages being misinterpreted and had required follow up meetings to provide explanation.

The Shifting the Balance Steering Group was set up in January 2008 and met fortnightly.  They co-ordinated the work of the sub groups detailed below:

• Weekly Impact Group
• Commissioning Group
• Reablement Team
• Communication Plan
• Turnaround Team
• Staffing Change Group

The Director of Health and Wellbeing outlined to members the purpose of each of the groups and their objectives.

Resolved:-  (1)  That the content of the report be noted

(2)  That a further report be received outlining detailed plans

 (3)  That this report be presented to the Adult Services and Health Scrutiny Panel for information.

Mark Scarrott, Service Accountant (Adult Social Services), presented the submitted report which provided outturn position for the Adult Services Department within the Neighbourhoods and Adult Services Directorate for the financial year 2007/08 based on actual income and expenditure to the end of March 2008.

He reported that the forecast position for the year was now an anticipated underspend of £107,000.  All management actions had been incorporated into the financial projections and additional underspends had been identified within Learning Disability services since the last report.  This had been mainly due to further delays in residential placements and additional income received.

There were still underlying budget pressures within Domiciliary Care services, including a shortfall in income from charges against the approved budget plus pressures within Physical and Sensory Disabilities.  This was mainly within residential care due to increased demand and an increase in the average cost of care packages.

The pressures had been reduced by:-

• Underspends in independent residential care and extra care housing within Older Peoples services
• Slippage in developing supported living schemes within Learning Disability Services and further additional income from continuing health care funding
• Achievement of management actions identified from budget performance clinics

Members asked whether it was likely that this figure would change again before the year end.  The Service Accountant confirmed that as part of the corporate timetable the accounts for 2007/08 would be finalised within the next 2 weeks and following that the final outturn position would be available.

Resolved:-  That the report be received and noted.

Tom Sweetman, Innovations Manager, gave a presentation on Occupational Therapy (OT) Services.

He gave an overview of where the service was in relation to backlog which had been slowly deteriorating since October 2007 and as at March 2008 stood at 21 months. 

He outlined action which had taken place to try to rectify the situation and these included:

• OT overtime made available across the entire service
• £29k contributed towards locum support/overtime
• Adaptations team working along OT’s to develop assessment process
• Errors in SWIFT system – Cases showing as being in the backlog were not real cases – resulted in 200 being removed.
• Telephone assessments put in place
• 2010 provided support through “man in van”
• Home Improvement Agency – undertook minor fittings

All of the above assisted in reducing the number in the backlog from 1180 to 490, and the average wait currently was 6 months.  It was hoped that by the end of April this figure would be down to 250.

The Innovations Manager then listed the suggestions for the way ahead.  This included:

• A full review of OT assessment and delivery process was needed
• Records on SWIFT were not being closed by OT’s but Neighbourhoods and Adult Services were.
• OT Services were still not at full staffing capacity but this was as a result of them awaiting the new Service Level Agreement
• The measures which were brought in to reduce the backlog needed to become the norm
• Mobile working
• Assessment Direct
• Establish Disability Living Centre to offer assessments and equipment.

Discussion and a question and answer session ensued and the following issues were covered:

• It was felt that the measures taken to remove the backlog of assessments were not sustainable in their current form
• The OT Service should not be highlighted as a distinct part of the Joint Commissioning Strategy
• There was a need to undertake a market testing exercise to ensure that the Council receives better value for money
• The Director of Commissioning and Partnerships raised the risks to performance and the impact upon other elements of the Joint Commissioning such as Intermediate Care
• Members felt it necessary for the report and presentation to be presented to the Adult Services and Health Scrutiny Panel
• Concerns were raised about Decent Housing and members asked for an update report in relation to the current position to be brought to the next meeting
• Members asked for a letter to be sent to the PCT from the Chair setting out their wishes for future provision.

Resolved:-  (1)  That the council reaffirm  its commitment to the Joint Commissioning Strategy, however the OT Service should not form a distinct part of the strategy

(2)  That a market test be undertaken

(3)  That a letter be sent to the PCT from the Chair

(4)       That the report and presentation by presented to the next Adult Services and Health Scrutiny Panel

(5)       That an update report be brought to the next meeting relating to the position on decent housing.

At the request of Members an update was given in relation to Age Concern and their decision to cease day care provision.

Sam Newton confirmed that all the people who were receiving day care were currently being assessed to establish whether they still required care.  She agreed to update members at a future meeting when everyone had been assessed.

The Chair asked for an update on the proposed closure of care homes, and in particular Listerdale Residential Home and Day Care Centre.

The Director of Health and Wellbeing confirmed that no care homes would be closed until the two new residential care homes had been opened and were functional.  Any day services that were situated within homes would be relocated prior to the home closing.

Resolved:-  That, under Section 100A(4) of the Local Government Act 1972, the press and public be excluded from the meeting for the following item of business on the grounds that it involves the likely disclosure of exempt information as defined in Paragraph 4 of Part 1 of Schedule 12A to the Local Government Act 1972, as amended.

Kim Curry, Director of Commissioning and Partnerships, presented the submitted report to inform members of the plan to commence discussions with Trade Unions and staff with the intention of transferring the Directorate’s Revenue and Payments Team to RBT Revenue and Benefits.

This key objective of this transfer would be to improve the experience for users/carers/intermediaries by improving response times, removing duplication, establishing single points of contact, extending payment opportunities and enabling people to better manage their finance.

The main function of the Revenue and Payments team was outlined, together with the customer and business related benefits resulting from the transfer.

A discussion and question and answer session ensued and the following issues were covered:-

• Whether RBT would close cash centres and only use pay points
• The charges involved with using pay points

Resolved:-  That the report be received and its content noted.