Agenda and minutes

Resolved:- That the minutes of the meeting held on 23^rd March, 2009 be approved as a correct record.

Mark Scarrott, Finance Manager (Adult Services) presented the submitted report which provided a financial forecast for the Adult Services Department within the Neighbourhoods and Adult Services Directorate to the end of March 2009 based on actual income and expenditure to the end of February 2009 and forecasts and income to 31^st March, 2009.

The approved net budget for Adult Services for 2008/09 was £68.5m and included funding for demographic and existing budget pressures together with a number of efficiency savings identified through the 2008/09 budget setting process.

During the year there had been a number of budget pressures within the service, mainly in respect of the delays in the implementation of shifting the balance of home care from in-house to the independent sector.  This was due to the decision taken by the Council to undertake a further round of consultation with Trade Unions and employees.  On 21^st January, 2009 Cabinet approved a revised estimate for the service of £1m and the latest report showed a projected balanced budget by the end of the financial year.

There still remained underlying budget pressures within residential care within physical and sensory disabilities due to an increase in demand and the average cost of care packages, increased demand and cost of direct payments, home care as a result of delays in shifting the balance and increased energy costs within in-house premises.

These pressures were being offset by additional income from continuing health care funding, slippage on developing supported living schemes within learning disabilities, slippage on vacant posts within assessment and care management and outcomes from management actions identified through budget performance clinics.

This overall forecast outturn also includes the impact of the delays in finalising the construction and opening of the two new residential care homes.  The decommissioning of the five residential care homes was now complete.

Budget clinics with Service Directors and managers continued to take place on a monthly basis to monitor financial performance against approved budget and to consider further options for managing expenditure within budget.

Resolved:- That the forecast balanced outturn against the revised budget for 2008/09 be noted.

John Mansergh, Service Performance Manager and Dave Roddis, Service Quality Manager gave a presentation in respect of the Review of Physical Disability and Sensory Impairment and Safeguarding Services.

The presentation drew specific attention to:-

• The Inspection Process
• CSCI Annual Performance Assessment Score
• Aims of the 2009/10 budget
• Summary of Investments from 2009/10 budget
• Physical Disability Self Assessment
  • Summary of Strengths
  • Summary of Weaknesses
  • Improvement Plan
• Safeguarding Self Assessment
  • Background
  • Improving Customer Access and Service Standards
  • Improving the way cases are managed
  • Improvement Performance and Quality
  • Putting in place a trained and skilled workforce at all levels
  • Service users are kept safe and in control
  • Improvement Plan

A report was also presented which detailed the proposed joint inspection by the Care Quality Commission of safeguarding adults (all ages) and physical disability services.

Inspection of Physical Disability and Sensory Impairment

There were six themes to the inspection:

• Universal services – will assess access to and quality of transport, leisure, shopping, employment, nightlife etc
• Promoting independence – will assess social care and health
• Preventatives services – will assess social care, health, information and VCS
• Specialist Provision – will assess social care and health
• Care Management styles – will assess social care
• Range of services – will assess social care and health

The review identified the following areas for the improvement plan:

• Limited information available on needs of physical disabilities in the borough
• Expensive out of borough placements
• No clear strategic and commissioning approach to services
• Lower than average provision of home care, short term and respite services
• Occupational therapy contract
• Assessment waiting times behind national average
• Waiting lists for aids and adaptations
• Low performance for disabled workers

Inspection of Safeguarding (all ages)

There was a KLoE (Key Line of Enquiry) for this inspection and the questions were:

• Is there any inter-agency framework for safeguarding adults?
• Has the CASSR specified in their contracts what they expect from providers to enhance the safety of vulnerable people?
• Are there clearly understood procedures for investigating individual cases of reported and/or suspected abuse of vulnerable adults?

The review identified the following areas for the improvement plan:

• Number of referrals that we continue to receive are higher than the national average
• Progress with the Highfield serious case review
• Access and communication with CSCI
• Progress with implementing the Deprivation of Liberty legislation
• Quality of case management
• Progress with the multi-agency strategy

Resolved:- (1) That the Cabinet Member note the joint inspection of safeguarding adults (all ages) service and physical disability and sensory impairment service by the Care Quality Commission

(2) That the Cabinet Member receives the presentation on the Directorate’s review of strengths and areas for development

(3) That the report and presentation be presented to the next Scrutiny Panel on 4^th June, 2009.

Shona McFarlane, Director of Health and Wellbeing presented the submitted report which outlined details of the consultation and proposed options for the future of the service currently provided at Park Lea.

The plan was to integrate the existing services, service users and staff into Oaks and Addison services.  This would be achieved by:

• Developing the existing outreaches for older people at Oak Trees and developing a new outreach service for older people at St Johns Church Centre in Swinton, at Swinton Potteries in Swinton and at Bakersfield Court in Herringthorpe;

• Increasing the number of places and days at existing outreaches currently provided by Oaks at St James Church Centre in Wath and Addison services at Durlston House;

• By increasing the number of places provided each day at the Elliott Centre and using the Elliott Centre as a Borough-wide service.

Consultation took place with a range of stakeholders including people who currently used day services, their carers/families, providers, community team workers, staff from across day services, Unions and the senior management team.  Methods included individual meetings, individual letters, open day events at Addison, Oaks and the proposed new outreach service.  Taster sessions at the proposed new venues were also set up.  Two open meetings were held at each venue as well as individually arranged meetings which were well attended – in total over 50 carers and families took the opportunity to visit either individually or at the open events.  Carers were very positive and wanted to know how soon the proposed move would happen.

People directly affected by the proposed changes were consulted on an individual basis and provided with the options available to them.  The consultation was completed by the most appropriate people, eg key workers/managers or in some identified cases the Group Manager.  All consultation meetings were recorded and confirmation letter would be sent to individuals confirming decisions reached following the approval of the proposals by Members.

Proposed Options

Option 1 – To attend the proposed new outreach service for older people

Option 2 – To transfer to Addison/Oaks

Option 3 – To transfer to the Elliott Centre

The consultation meetings had been very successful and no negative feedback had been received.  The service had been praised by carers and their families and whilst people would be sad to move from Park Lea, both service users and staff were eager to move and were excited by the changes.

A question and answer session ensued and the following issues were raised:

• Where did consultation take place?  Was it just at Park Lea or did it extend to service users and carers at Oaks/Addison?  It was confirmed that consultation had been undertaken with users and carers at Park Lea only, and there had been no resistance to the proposals.
• A comment was made that carers at Oaks/Addison were not happy that service users were being moved around to accommodate Park Lea service users
• Whether the service had already started.  Confirmation was given that instructions had been left that nothing would  ...  view the full minutes text for item 134.

Shona McFarlane, Director of Health and Wellbeing presented the submitted report in relation to a Single Line Management Structure for Intermediate Care Services.

The Intermediate Care Review and Joint Commissioning Strategy recognised that the development of a single line management structure for intermediate care services would ensure that there were clear lines of professional and operational accountability and service integration between health and social care professionals.  It would also ensure that there were clear lines of communication between both organisations in order to provide an effective intermediate care service.

The Enabling Care Manager (ECM) employed by Neighbourhoods and Adult Services (NAS) and the Strategic Therapy Lead (STLA) within Rotherham Community Health Service (RCHS) had recently agreed to a single line management structure and this had been endorsed by NHS Rotherham’s Human Resources and Priority 2 Intermediate Care group.

The Enabling Care Manager would become the single line manager and would work in partnership with the Strategic Therapy Lead to deliver the objectives set out in the Joint Commissioning Strategy.

The Intermediate Care Services include:

• Intermediate Care Assessment Beds (ICAB)
• Community Rehabilitation Team (CRT)
• Millennium Rehabilitation Day Care Centre

The Protocol would ensure delivery and adherence to the implementation of NHS Rotherham’s Human Resources and Organisational Development Policies and Procedures including:

• Professional supervision and organisation communication
• Annual/special leave
• Sickness absence management
• Travelling and subsistence expenses
• Grievances, bullying and harassment
• Disciplinary matters and capability issues
• Health and safety
• Learning and development
• Flexible working
• Equality and diversity in employment
• Recruitment and selection

The Enabling Care Manager would deal with complaints during monthly statutory visits which were then referred to the Local Authority’s complaints procedure.  Complaints were received regarding therapy input were referred to NHS Rotherham’s complaints procedure.

Operational Management

Operational management responsibility would be held by the Enabling Care Manager.  One to two monthly meetings would be led by the Enabling Care Manager which would involve two Clinical Therapy Leads who would engage in two-way communication on operational issues affecting the delivery, capacity and performance of the intermediate care service.

Professional Supervision

The Strategic Therapy Lead would be responsible for the professional supervision of therapy staff.  One to one monthly meetings involving RCHS staff only would be held between Professional Lead OT and the Clinical Lead OT and Professional Lead Physiotherapist and Clinical Lead Physiotherapist.  The Clinical Therapy Leads would be responsible for professional clinical supervision of operational management therapists and designated support staff through one to one meetings or peer supervision.

RMBC Organisational Communication

The ECM would be responsible for organisational communication which would be delivered through monthly business group meetings or one to one meetings.

RCHS/NHS

The Clinical Therapy Leads would attend the Adult Therapy Clinical Leads Group on a monthly basis and would be delivered through monthly intermediate care meetings.

Resolved:- (1) That the Protocol for Performance Management, Operational and Professional Accountability for Intermediate Care Services be endorsed.

(2) That the report be presented to the Scrutiny Panel on 4^th June, 2009.

Consideration was given to a petition received in respect of the proposed closure of Meals on Wheels and Laundry Services.

It was reported that there had been a misunderstanding in relation to this as there was no intention of removing these services, but to offer a better service to customers.  All current service users were to be visited and their needs would be assessed.  There was to be an all day event held at the Bailey Suite, where providers would be present to allow people to sample the food that would be on offer.  For those who were unable to attend on this day arrangements would be made for them to be visited.

Resolved:-  (1) That the petition be noted.

(2) That a response be sent to residents confirming that the services were not to be removed, but improved.

John Mansergh gave an update in relation to the Carers Information Centre.

Members were concerned that the service was under threat of being withdrawn by the provider, which was unacceptable as it was an integral part of our organisation.

The Strategic Director for Neighbourhoods and Adult Services agreed to make contact with Jeanette Mallinder to resolve this issue.

Resolved:- That the next meeting be held on Monday 27^th April, 2009 commencing at 10.00 am.