Invitees:

Cllr P White - Cabinet Member Adult Social Care Health and Wellbeing

Darren Mepham - Chief Executive 

Jackie Davies - Head of Adult Social Care

Carmel Donovan - Integrated Community Services Manager

Ian Oliver - Group Manager, Commissioning and Transformation

The Scrutiny Officer introduced the report on the Social Services and Wellbeing (Wales) Act 2014 which provided an update on the new National Eligibility Criteria and the process which will be applied to all people requiring managed care and support services; and updates on Supporting Vulnerable People and the Meals at Home service. 

The Head of Adult Social Care reported that Cabinet at its meeting on 3 February 2015 approved a proposal to raise the Council’s eligibility criteria from moderate to that of substantial and critical subject to consultation.  She stated that Cabinet at its meeting on 16 June 2015 received a report on the progress against the consultation events that were carried out on the proposed change.  She highlighted the stakeholder groups which been engaged and received presentations on the new Act and Eligibility Criteria.  

The Head of Adult Social Care informed the Committee of the new National Eligibility Criteria which was made up of two parts, the first of which was to assess if care and support intervention can address the need, risk or barrier or enhance the resources that will enable the individual to achieve their personal wellbeing outcomes.  The second part of the process is the determination that the individual’s wellbeing outcomes cannot be met, or cannot be sufficiently be met, solely through care and support co-ordinated by themselves, their family or carer or others.  She stated that the interim arrangements pending the national Eligibility Criteria proposed had been implemented.  The new eligibility criteria would be applied to all people requiring managed care and support services.   

The Head of Adult Social Care outlined to the Committee how the Council supports and funds a range of third sector agencies to support people within the community through prevention and wellbeing services. 

The Head of Adult Social Care informed the Committee of the work being undertaken across the Western Bay Community Services Board which had seen the development of an intermediate care team known as the Community Resource Team, made up of health and social care staff.  This team delivers short term interventions that address needs at a time of personal crisis or when people’s needs change, with the aim of maximising recovery and ongoing independence.  She stated that the Regional Board was currently finalising a formal legal agreement known as a Section 33 agreement which would be a pooled fund arrangement across health and social care.  The financial contribution to the Pooled Fund arrangement will be £2,145,000 from BCBC and £2,187,043 from Abertawe Bro Morgannwg University Health Board with a total pooled indicative value of £4,332,043. 

The Head of Adult Social Care informed the Committee of case studies and comments received from users of the Community Resource Team. 

The Head of Adult Social Care also informed the Committee of the work being undertaken to re-model the Meals at Home service. 

The Committee referred to the categories used to assess service users in relation to eligibility criteria and requested definitions for each category.  The Committee also questioned what had happened to the 73 cases which had been incorrectly categorised.  The Committee questioned what had happened to the remaining 132 cases to be reviewed.  The Group Manager Older People informed the Committee that service users assessed as moderate might be in need of regular weekly support in some aspects of daily living.  There would be no service users at deficit as a result of being assessed in accordance with the new eligibility criteria.  Alternative support / providers would be sought for service users assessed as being in need of moderate support, for example in relation to providing assistance with shopping.  The Group Manager Older People informed the Committee that service users can be moved from one category to another but would not be disadvantaged through this process.  She stated that there is a bespoke system of review of service users in place.  The review is strength based and about assessing needs and risk and barriers to independence with reviews taking place regularly.  Once a service user’s care is stable, reviews would usually take place annually. 

The Committee questioned how a service would be removed from a service user.  The Group Manager Older People informed the Committee that it was not about removing a service from a service user but it was about recognising the barriers people face with disability and frailty and finding ways to overcome those challenges by finding a mutually agreeable solutions..  The Group Manager Older People stated that no service user would be put at risk.  A member of the Committee stated that the duty to assess was about empowering people and independence. 

The Committee questioned whether there is an assessment tool in place.  The Group Manager Older People informed the Committee that the Council is required by the Welsh Government to use the integrated assessment framework for older people and the principles of this have been applied across all adult services.  From April 2016 eligible wellbeing outcomes would be looked at in relation to what matters to service users.  The framework was about strengths, resources and what matters to people and the Directorate is part of a national pilot project developing national outcome measures.  The Group Manager Older People informed the Committee that there was no prescribed tool to date but it was focused on individuals and what matters to them.  The skills of Social Work staff would be used to assess service users and meet their well-being outcomes.  

In response to a question from the Committee as to the composition of the CRT, the Group Manager Older People stated that the Team is multidisciplinary and comprised of a few hundred staff, both males and female staff and offers enabling and reablement services in order to maximise what matters most to the individual.  There is a focus on maximising the independence of individuals. 

In response to a question from the Committee as to the financial contribution made by the ABMU, the Group Manager Older People stated that the contribution made by the ABMU is £2,187,043, with the Council’s contribution being £2,145,000 and commented that the service is very much an integrated service.  Long-term care and NHS continuing health care was outside the remit of the CRT.  The grant funding of £9m had been used across the Western Bay region.  The Group Manager Older People informed the Committee that the Minister had announced that intermediate care funding would continue; the funding will be routed via ABMU of which the County Borough would receive £300k.  The focus of this funding was preventing people from going into hospital and getting people discharged from hospital sooner.  The Cabinet Member Economic Development and Regeneration informed the Committee that the CRT had delivered savings to the ABMU but these savings would not be realised to the Council until there was full integration of health with local government. 

The Committee questioned whether recipients of direct payments were able to purchase the services of the Council.  The Head of Adult Social Care informed the Committee that service users would be able to purchase services from the Council from direct payments from April 2016.  When questioned, the Head of Adult Social Care informed the Committee that service users in the moderate category may only have 1 or 2 hours of support per week.  Service users who have 4 calls per day generally would not be placed in the moderate category and were likely to have substantial or critical needs.  A member of the Committee commented that people would pay less to the private sector than to the public sector for services.  The Head of Adult Social Care informed the Committee that the Council was going through a remodelling of homecare services.

The Committee asked how therapeutic services were accessed.  The Group Manager Older People stated that people were able to access therapeutic services as part of the CRT, free of charge for up to 6 weeks, as part of their Reablement programmes, which could be for a longer duration where appropriate. 

The Committee questioned whether there had been a decrease in the take up of the Meals at Home service as a result of the increase in charges and also questioned the take up of the afternoon tea service.  The Head of Adult Social Care informed the Committee that there had been no decrease in take up of the Meals at Home service since the increase in charges and there had been a 10% take up since the introduction of the afternoon tea service which has been running for one month.   

The Committee thanked the invitees for their contribution.

Conclusions

            The Committee noted the report, which provided the Committee with an update on the consultation and engagement with stakeholders about the changes that the Social Services and Wellbeing (Wales) Act, 2014 will bring.  The report also included updates on Eligibility Criteria, Supporting Vulnerable People, working with the 3^rd Sector, Regional Community Services Project Board and the Meals at Home service.

·         Members were pleased to learn that there was a clear commitment from ABMU Health Board, including an equal contribution to the pooled fund agreement, which  will enable an improved ‘whole system’ approach.

·         Members were concerned that there is currently no recognition for the Authority for the contribution it makes to savings as a consequence of partnership working.

·         Members queried what has happened to people who have not been re-categorised as a result of the review.

·         Members were concerned that support provided by BCBC costs substantially more than the same services provided by the private sector. 

            Further information requested

·         Members requested typical examples of how service users have been categorised to illustrate how the process is carried out and what sort of criteria has been used. 

·         Members requested a copy of the assessment scale used to identify, monitor and measure outcomes for service users.

·         Members requested a detailed breakdown of the cases of the 132 people previously in the 'moderate' category who were not reallocated to another category, including details of what has happened to them following the review.

·         Members requested a list of private residential and domiciliary service providers in BCBC.

·         Members requested further information on whether BCBC are considering using the 'self-directed support' approach, currently used in England and recently piloted in Wrexham, where service users are helped to take control of their own support using a personal budget plan.