The Cabinet Member for Adult Social Care and Health, the Acting Strategic Director of Adult Care, Housing and Public Health and the Assistant Director - Strategic Commissioning,attended the meeting to provide a report on the model of delivery of Adult Care in Rotherham. It was noted that the report had been submitted following a request made by members at the meeting of the Overview and Scrutiny Management Board meeting held on 28 July 2021 (Minute No.31 2021/22).
In introducing the presentation, the Cabinet Member for Adult Social Care and Health noted the significant progress and improvements that had been made in the delivery of Adult Care services in recent years that had included changes to the service delivery model and a total service restructure that had been based on an overarching strategic vision for the service.
In introducing the presentation, the Acting Strategic Director advised that Rotherham, just like many other areas across the country was facing the combined challenge of rising demand for services and available resources not keeping pace with demand. In the context of Adult Social Care and Commissioning, these challenges included a greater number of older people who required support and an increase in the number of young adults in Rotherham with complex needs who were transitioning from children’s services into adult’s services along with rising care costs.
The Acting Strategic Director advised that the ultimate aims of care and support were to support individuals and families to live the best life that they could and as independently for as long as possible, utilising the assets within their community to support their health and wellbeing and to protect the most vulnerable residents from physical and emotional neglect.
The Acting Strategic Director made a presentation that detailed the Adult Social Care core pathway that explained the duties for the local authority, how the operating model worked in Rotherham and defined what this meant for the people who may need the Council’s support.
The presentation provided information on:
· the Care Act 2014 and its requirements for local authorities.
· how the model of delivery aimed to put each individual at the centre of the Rotherham Adult Social Care model.
· the Adult Social Care Core Pathway.
· Adult Social Care First Contact, detailing how referrals were received and how performance was measured.
· the benchmarking activity that took place with other local authorities.
· the assessment processes for Adult Care Services.
· support, care and planning.
· the number of residents currently accessing support.
· how performance in Adult Care service delivery was measured and details of areas of service delivery that were working well and areas where
improvement was required.
Members welcomed the report and presentation noting how useful it had been to be shown the entire process for how Adult Care services were delivered, as they as elected members only normally got to see the end of the process when services were being delivered. Members also noted with approval the person-centred approach of the delivery model that placed each individual and their needs at its centre.
Members noted that currently around 3,500 residents were receiving support and services from Adult Care Services and asked how the service could be sure that it was reaching all of the residents in the Borough who required support. Members also noted that the number of residents in receipt of services appeared to be low. The Acting Strategic Director advised that whilst the number of residents in receipt of services did appear low, the numbers of residents in receipt of service were as expected for an area the size of Rotherham. The Acting Strategic Director noted that unfortunately there would always be some residents who were in need of support who did not access the support they needed, but assured members that close partnership working with housing and neighbourhood teams ensured that as many eligible residents as possible were referred for support. The Acting Strategic Director advised that residents who after an assessment were not eligible for support from Adult Care Services would be signposted to alternative services who could provide appropriate support for their needs.
Members asked how long after an initial referral had been made did it take for an assessment of their needs to be carried out. The Acting Strategic Director advised that timescales could vary and could be impacted by a number of factors such as work force capacity. The Acting Strategic Director noted that 28 days had been a target for the completion on an initial assessment but advised that as all assessments carried out were proportionate to each individual’s needs then complex assessments could take longer to complete. Members asked for further information on how new and developing support needs were picked up after an initial assessment for services had been made. The Acting Strategic Director advised that some service user’s cases were permanently open due to their needs and were subject to regular monitoring with these service users’ needs being regularly reassessed in order to ensure that their needs were adequately supported.
Members welcomed the approach to delivering services that placed each individual at the centre of the delivery model and asked what consultation had happened with service users in its design and how ongoing feedback on how services were delivered was gathered. The Cabinet Member assured members that the requests of each service user for how they received services were always listened to and considered but noted that in some circumstances that some individuals did require advice and guidance on the range of services that were available to them and that would be most suitable for their needs. The Cabinet Member also noted that service user satisfaction was a key performance indicator that was monitored as part of the Council Plan. The Assistant Director - Strategic Commissioning advised how engagement with service users was a key principle in effective and person-centred service delivery but noted that to do this effectively was a very complex process. The Assistant Director detailed some of the engagement and consultation work that had been carried out with service users in the development of services.
Members noted the aspiration of the service to keep residents in their own homes for as long as possible and asked how this worked for the residents for whom a move straight into residential care was the best option for them. The Cabinet Member advised that the main objective of the service was to keep adults in their own homes for as long as possible as evidence had shown that this approach delivered the best outcomes for individuals as it had been shown that individuals recovered more quickly in their own homes with the correct support than in a residential setting. The Assistant Director noted that the range of services that could be delivered by Adult Care was very wide-ranging and often complex, and as such individuals may initially only consider options that were familiar to them such as residential care as they may not be aware of the other options that would enable them to receive support in their own home. The Assistant Director noted that in the past that the option of residential care had been overly relied on in Rotherham as a solution for care needs and that the move to deliver more services to enable residents to stay in their own homes for longer was a positive change.
Members expressed concern regarding the use of community assets and the support for individuals that was provided by family and other networks. Members noted that while informal carers did provide a huge amount of support that it was important that such support was not over relied on as it could place a huge amount of strain on the individuals who were providing care. Members noted the important statutory role of the Council in providing services and sought assurance that an over reliance was not being placed on informal carers. Members noted the information that had been provided in the presentation regarding the provision of care services and asked what measures were being taken to guarantee the provision of care and support to all residents who were in need of services could be maintained. The Cabinet Member noted that whilst some care packages were extremely costly to provide, it was not only the Council’s statutory duty, but his own commitment to ensure that appropriate care packages were always provided that met every individual’s needs. The Cabinet Member noted that how care packages may be delivered in the future may be impacted by changes in how the Government chose to fund Adult Care. The Acting Strategic Director assured members that model of service delivery for Adult Care was not about rationing services or over relying on informal care but in empowering individuals to make choices on options for their care that they may have not been aware were available.
Members asked for further information on why Rotherham was not performing as well as other neighbouring and comparable local authorities on the key performance indicator of the number of patients still being in their own homes 91 days after a hospital discharge. The Acting Strategic Director noted the wide range of options that were available to individuals on their discharge from hospital. The Acting Strategic Director stated that in some circumstances an individual’s preference and choice would have been to return home, but that due to changes in their circumstances this return home may not be sustainable in the long term. The Acting Strategic Director advised that it was important to note that whilst an individual may within 91 days have to go into residential care that they had had the ability to make a choice about being able to try a return to living in their own home which was a key part of the service delivery model.
Members asked for further information on the processes for the tendering of Adult Care Services and noted that this may be an area in which Scrutiny could look at it more detail in future. The Assistant Director advised that the commissing process for services was governed by both the relevant legislation as well as the financial procedure rules as detailed in the Council’s Constitution, and as such the processes followed in all tendering activity would always be open and transparent. The Assistant Director noted that during the pandemic that on some occasions a different approach had had to be taken to the tendering of services in order to ensure stability of the local adult care service market so as to ensure services could continue to be provided to those who required them.
Members asked how service users were involved in assessing the quality of services they received. Members noted that a frequent complaint that they received regarding the provision of services was in the lack of consistency in the staff who were providing their care. The Assistant Director noted that there was national set of quality measures that the Council used to assess service user satisfaction. The Assistant Director advised that information on the quality of service provision was gathered by engaging with service users as much as was possible, noting that feedback was easier to gather in some settings such as centres for those with learning disabilities than others, such as from residents receiving care in their own homes. The Assistant Director noted that due to the pressure on services and the different way that many services had been delivered during the pandemic that the opportunities to gather feedback had been reduced over the previous two years.
Members asked whether the council’s delivery model for Adult Care services would be able to cope with the changes created by amendments that had been made to the Care Act that were due to come into force in October 2023. The Acting Strategic Director assured members that planning for the changes due in October 2023 had already started and that an officer working group had been formed in order to support the Council’s response to the planned changes. The Acting Strategic Director noted some of the potential challenges that the changes would create for delivery of Adult Care services including a potential increase in the number of residents requiring support. The Acting Strategic Director assured members that the delivery model would be able to respond to the changes but noted that there may be issues with services having the capacity to cope with demand.
Members asked whether the previous two years of the pandemic had highlighted any improvements to service delivery that would be maintained into the future. The Cabinet Member noted the positive impact that volunteers had had during the pandemic, notably in how they had assisted in the running of foodbanks. The Cabinet Member also noted the improved community spirit that had been created as a result of the pandemic and the positive impact that this had had for individuals and communities. The Assistant Director noted that increased digital engagement during the pandemic had been good for some service users in accessing services. The Assistant Director also advised that increased online communication had also been beneficial for engaging with service providers and delivery partners.
Members asked for further information on how Adult Care service provision, and in particular provision that adequately met the individual and specific needs of those requiring support would be commissioned in the future to meet the needs of the ageing BAME population in Rotherham. The Cabinet Member noted that Rotherham in comparison to other areas had more rapidly ageing population and as such would be seeing a greater number of older residents who would need care and support in the future who may have different needs to the current older population. The Cabinet Member assured members that planning was taking place in order to prepare for the increased demand for services that this increase in the older population in Rotherham would create. The Assistant Director advised that the commissioning and creation of services would always be intelligence based and as such future commissioning activity would always be responsive to the needs of the older population in Rotherham at any given time.
Members asked for further information on how service users were, where appropriate, were supported into volunteering opportunities. The Cabinet Member noted the strong links that the Council had with Voluntary Action Rotherham and how the support that they provided regarding volunteering opportunities. The Assistant Director advised that the Pathways programme delivered by housing colleagues used volunteering as a key route to support individuals to develop and to move onwards in to paid employment. The Assistant Director also noted the success of the Community Hub during the pandemic in utilising and developing people as volunteers and reaffirmed the Council’s commitment to building on the success of the Community Hubs moving forwards.
The Chair thanked the Cabinet Member for Adult Social Care and Health, the Acting Strategic Director of Adult Care, Housing and Public Health and the Assistant Director - Strategic Commissioning for attending the meeting and answering member questions.
1. That the report be noted.
2. That the presentation “Adult Social Care – our model of delivery” be circulated to all elected members.
3. That consideration be given by the Acting Strategic Director Adult Care, Housing and Public Health and the Head of Democratic Services to delivering an all-member seminar on the model of delivery of Adult Social Care delivery in Rotherham.
At this point Councillor Clark vacated the Chair. Councillor Barley then took the Chair for the following item.