Agenda and minutes

Resolved:- That the minutes of the meeting held on 23^rd November 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 2010 based on actual income and expenditure to the end of October 2009.

The approved net revenue budget for Adult Services for 2009/10 was £72.9m. Included in the approved budget was additional funding for demographic and existing budget pressures together with a number of new investments and efficiency savings identified through the 2009/10 budget setting process.

The latest budget monitoring report for Adult Services showed some underlying pressures, however after taking account of a number of achieved savings and assuming the achievement of all management actions it was forecast that there would be an overall net overspend of £225k by the end of the financial year.

Management actions of £1.139m had been identified to reduce the budget pressures. A total of £640k had already been achieved to-date and were now included in the detailed forecasts. This reduced the underlying pressures to £724k and left a balance of £499k management actions to be achieved by the end of the financial year.

The latest year end forecast showed the main budget pressures in the following areas:-

Home Care as a result of delays in shifting the balance of provision to the independent sector (£674k). The 70/30 split was achieved at the end of July 2009 and the balance had now moved beyond 70/30 towards an 80/20 ration that the Cabinet recognised as the optimum level based on experience elsewhere in the country.

Increase in residential and nursing care short stays over and above approved budget for clients with a physical and sensory disability (+£144k).

Independent sector home care provision for Physical and Sensory Disability clients had increased by an additional 970 hours since April 2009, a further 38 clients were now receiving a service. This was resulting in an overspend of £347k against the approved budget.

 A significant increase above approved budget in clients receiving a Direct Payment within Physical and Sensory Disabilities and Older Peoples Services (£380k).

Additional one-off expenditure was being incurred in respect of the costs of boarding up, removal of utilities and security costs at the former residential care homes prior to them transferring to the Council’s property bank (£200k).

Delays in the implementation of budget savings agreed as part of the budget setting process for 2009/10 in respect of meals on wheels (£240k), laundry (£160k) and the bathing service (£40k).

Continued pressure on the cost of external transport provision for Learning Disability Day care clients (+£134k).

These pressures had been reduced by :-

 Additional income from continuing health care funding from NHS    Rotherham (-£269k).

Delays in the implementation of new supported living schemes within Learning Disability services (-£290k).

Savings within independent residential care due to an increase in income from property charges (-£555k) and slippage in intermediate care spot beds (-£40k).

Savings on the reconfiguration of Extra Care housing (-£315k).

Planned delay in  ...  view the full minutes text for item 66.

Mark Scarrott, Finance Manager (Adult Services) presented the submitted report which informed members of the anticipated outturn against the approved Adult Services capital programme for the 2009/10 financial year.

It 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 to the 18 November 2009 and the projected final outturn position for each scheme.

Actual expenditure to the mid November 2009 was £312k against an approved programme of £1.5m. The approved schemes were funded from a variety of different funding sources including, unsupported borrowing, allocations from the capital receipts, Supported Capital Expenditure and specific capital grant funding.

The following information provided a brief summary of the latest position on the main projects within each client group.

Older People

The two new residential care homes opened in February 2009. The balance of funding (£230k) related to outstanding fees and the cost of any final minor works.  

The Assistive Technology Grant (which included funding from NHS Rotherham) was being managed jointly and was being used to purchase Telehealth and Telecare equipment to enable people to live in their own homes. There was a procurement plan to spend the remaining funding which included lifeline connect alarms, low temperature sensors and fall detectors within peoples homes. A small element of the Department of Health specific grant (£13.5k) issued in 2007/08 to improve the environment within residential care provision was carried forward into 2009/10. Plans to spend the remaining balance of funding were being reviewed.

Learning Disabilities

The small balances of funding (£10k) carried forward from 2008/09  were to be used for the purchase of equipment for Parkhill Lodge and within existing supported living schemes.

The refurbishment at Addison Day Centre (Phase 2), funded from the Council’s Strategic Maintenance Investment fund was now complete and awaiting final invoices.

Mental Health

A small balance remained on the Cedar House capital budget and would be used for the purchase of additional equipment.

A large proportion of the Supported Capital Expenditure (SCE) allocation had been carried forward from previous years due to difficulties in finding suitable accommodation for the development of supported living schemes.

Suitable properties continued to be identified and spending plans were being developed jointly with RDASH.  The possibility of funding equipment purchased for direct payments was also being considered to reduce the current pressures on the mental health revenue budgets and was included as a management action (£50k). Further options were also being considered to provide more intensive supported living schemes with a range of providers and to fund a range of new assistive technologies for mental health clients, which would support their independence with access to 24 hour support.

Management Information

The balance of the capital grant allocation (£85k) for Adult Social Care IT infrastructure was carried forward from 2008-09 and used with this years grant allocation to fund the Adults Integrated Solution as part of introducing electronic care management.

Resolved:- That the Adult Services forecast  ...  view the full minutes text for item 67.

Consideration was given to a report presented by Dominic Blaydon in relation to the Strategic Review of Intermediate Care Services. 

It was proposed that Day Care, Community Rehabilitation and Residential Teams be merged and co-located.  A new multi-disciplinary health and social care team would be set up to support service users through the intermediate care pathway.  The service would adopt the Common Assessment Framework and deliver integrated health and social care plans.

Millennium would become a dedicated hub for intermediate care services in Rotherham providing day rehabilitation, a Single Point of Access and a focal point for all service delivery.  There were significant benefits to this service model.  It would establish a clear service identity with a range of services being delivered from the same site.  Co-location of staff would facilitate effective communication and peer support.  Greater integration would improve efficiency and help develop a person centred approach to rehabilitation.

The Strategic Review recommended that a programme of refurbishment was carried out on Millennium to make it fit for purpose and proposed that capital grant was transferred from the NHS Rotherham Operational Plan to Rotherham MBC to pay for the necessary works.

It was proposed that Rothwel Grange was decommissioned as an intermediate care facility and that a new residential unit be developed at one of the new local authority residential units.  The plan was to convert one wing of 15 beds into intermediate care provision by December 2009.  This was dependent on vacancies becoming available during this timeframe.  Vacancies were being held at present, and used for respite provision in order to maintain bed occupancy.

The new-build homes were fully compliant with National Care Standards and the Disability Discrimination Act.  Bedroom sizes were spacious, en-suite facilities were provided, doorways and corridors had been widened for the use of disability and bariatric equipment. There was also ramped access to the building.

It was proposed that Fast Response beds were decommissioned and that the savings made were reinvested to improve performance, outcomes and quality elsewhere in the service. There were a number of reasons why it was appropriate to decommission the service:

The unit cost per patient was prohibitive.

There was capacity in the intermediate care residential units to fill the gap left by loss of beds

The intermediate care residential units could meet the needs of people referred into the service

Reducing bed capacity would help improve performance on bed occupancy across the service

Decommissioning would release savings that could be reinvested

It is proposed that the maintenance service was reconfigured so that it delivered time-limited rehabilitation and community integration programmes. The service would continue to provide day care services to current service users for up to 6 months. There were also 4 service users who originally attended the Crinoline House day centre in 1998.  Upon closure of this centre, Elected Members promised that anyone who still wanted to attend in a social care capacity would be allowed to do so. Commissioners were fully supportive of honouring this agreement. 

            The  ...  view the full minutes text for item 68.

John Mansergh, Service Performance Manager presented the submitted report which outlined the 2009/10 Quarter 2 Key Performance Indicator (KPI) results for the Adult Social Care elements of the Directorate.

At the end of the quarter, 75% of Key Performance Indicators (KPIs) were on target compared to 57% at the end of the 1st Quarter.

The following performance measures did not achieve their quarter 2 targets;

NAS 1 (PAF D40) Percentage of clients receiving a review

Productivity levels had improved since August but the indicator was currently rated as ‘off target’.  The indicator was slightly closer to target than reported in the 1st quarter performance report and, based upon the actions we had put in place following a corporate performance clinic held on 24th September 2009, it was predicted that we would achieve our year end target. Performance had increased from 17.92% to 35.59% since the 1st quarter of the year.

A performance clinic had been held with RDaSH (Rotherham, Doncaster and South Humberside Mental Health Trust) in August 2009 and since then they had doubled their review rate over the past two months and had put an action plan in place with an aim to review 100% of their clients by year end.

The following performance management actions were in place to improve performance;

Team managers to authorise all reviews so that they can be counted.

Arrangements made for telephone reviews to take place on clients in receipt of Rothercare service.

Provider reviews to be undertaken and counted for clients in residential and nursing care placements.

RDASH to update their records and ensure all reviews undertaken this year are counted.

NI136 (Vital Signs 3) People supported to live independently through social services  (LAA)

This indicator included a combination of people that were receiving care managed services following a community care assessment and those people that are receiving services from the voluntary sector. 

Current performance levels indicated that 5,572 service users were being helped to live at home, which was an improvement of 61 since the 1st quarter. This score was based on last year’s voluntary sector figures plus people currently in receipt of an assessed care package.

To achieve next year’s target approximately 2,000 extra service users would need to be helped by the end of the year.  The frustration with this indicator was that a lot of prevention activity was not captured within the definition for this indicator. So for example, the 900 telecare installations that would be undertaken this year and the provision of 14,000 items of equipment were not included within the definition. These were national issues which were being debated.

The following performance management actions were in place to improve performance;

Intermediate Care and Community Rehabilitation services would be captured within the indicator (these were currently not included).

The list of providers for our Grant Funded Services return (the mechanism we had to use to capture people receiving services within the voluntary sector) had been updated.

All providers had been visited to ensure  ...  view the full minutes text for item 69.

This item was deferred to a future meeting.

Tom Cray, Strategic Director for Neighbourhoods and Adult Services presented the submitted report which summarised the result and findings of the 2008 social care Annual Performance Assessment (APA) process for Rotherham conducted by CQC (Care Quality Commission) which was published on 2^nd December 2009.

The 2009 adult social care Annual Performance Assessment (APA) identified that Rotherham was ‘Grade 4: Performing excellently’ Authority which, based upon a slightly different and now a harder test assessment methodology, was an improvement on the score achieved in 2008. The judgements were made on a sliding scale of ‘performing poorly’, ‘performing adequately’, ‘performing well’ and ‘performing excellently’.

The following outcomes were just some of the reasons why CQC had rated the adult social care service as ‘performing excellently’ this year. Progress made included:

o             Investigating an additional 275 safeguarding referrals during the year and training 2,000 staff to make people safer and feel safer,

o             Social workers undertaking an additional 1,297 pieces of activity compared to the previous year meaning that we were able to change care packages as and when people’s lives changed

o             We had reduced the average length of stay in ‘intermediate care’ services from 55 days to 35 days meaning that people were going home quicker and staying at home which was where the vast majority of people  wanted to be,

o             837 vulnerable people were given help through assistive technology such as bogus caller alarms targeting the elderly,

o             The Consultation Cafe involved over 250 users of Meals on Wheels in a direct consultation - 97 % satisfaction rating from our customers.

o              An additional 1,168 disabled people were provided with minor equipment this year to help them to continue to live independently, 

o             Waiting times for Occupational Therapy assessments had improved from 20 months to 7 weeks,

o             The Council was helping 132 more people to live at home and carried out 219 more assessments on carers than last year,

o             High levels of customer satisfaction for services,

o             There had been significant improvements in waiting times for new social care assessments and care packages, and

o             There was a reduction of 54 older people admitted to permanent residential and nursing care last year as they were able to remain at home.

Adult social care services were assessed under the methodology of the Social Care Outcomes Framework. The CQC report set out high level messages about areas of strength and areas for development for the next 12 months. The judgements were made under the following outcome areas;

• Improved health and emotional well being,
• Improved quality of life,
• Making a positive contribution,
• Exercise choice and control,
• Freedom from discrimination and harassment,
• Economic well being,
• Maintaining dignity and respect, and a separate and now unscored judgement relating to;
• Leadership, and

• Commissioning and Use of Resources.

The key areas of strength affecting people using our services noted within the CQC report were:-

• Working with partners the council could demonstrate improvement in the differences in how healthy people were  ...  view the full minutes text for item 71.