Agenda item

This report provides Health and Adult Social Care Overview and Scrutiny Committee with a synopsis of the areas that the Portfolio Holder for Adult Services is responsible for which fall within the remit of this Committee.

Discussion

The Portfolio Holder for Adult Services introduced an update on the service areas that he was responsible for that fell within the remit of the Committee. Work being undertaken by Members and officers in relation to adult mental health was highlighted, including events such as Picnic in the Park, which was aimed at people with mental health difficulties. Some Councillors had attended mental health service meetings and met frontline staff, through which they were able to support a pro-active approach to tackling mental health issues.

Home First and Medway Integrated Community Equipment Service (MICES) had been a priority over the last year, with work having being undertaken with Medway hospital to enable people to be discharged home when they were ready. The Council had responsibility for this service and putting appropriate care packages in place, which was an expense for the Council. In relation to Community Care, there had been successful partnership working.

There had been an increase in the number of safeguarding concerns recorded in Medway. It was encouraging that after closure, the highest proportion of cases in Medway where action had been taken had resulted in the risk being removed. A visit to the Council by the Association of Directors of Adult Social Services (ADASS), was considered to have been useful. ADASS had looked at Safeguarding arrangements. The final report was not yet available but initial feedback had been positive, with a number of strengths and areas for improvement having been identified.

In the area of Public Health, a variety of work was being undertaken to combat drug and alcohol misuse. It was particularly concerning to the Portfolio Holder that of 1,200 people in treatment for substance misuse in Medway, around 25% of these were parents. There was a considerable amount of work being undertaken in relation to telecare and Technology Enabled Care Services (TECS) and there were plans to increase this provision.

The Portfolio Holder advised that he would be present to answer questions in relation to the separate Health and Wellbeing Board update report on the agenda.

The Committee raised a number of points and questions as follows:

Achievement of savings: A Member asked what confidence there was that forecast savings would be realised in view of the fact that it had not been possible to realise the planned savings for the current year, particularly those relating to the Adult Social Care diagnostic. She also questioned what had been learnt from the previous experience. The Portfolio Holder advised that how to ensure that forecast savings were made was being carefully considered and he was confident that it would achieve its aims. He was not able to provide further detail due to the budget setting process being ongoing.  One example of improving efficiency was Medway Integrated CommunityEquipment Service (MICES). This had brought together a number of services previously provided by the Council and other providers under a cohesive central provider. Work had been undertaken by Adult Social Care over the Christmas and New Year period to ensure that the service was able to cope with the extra demands of winter, with lessons having been learned from 2015.

Extra Care Housing schemes: A Member said that it was clear that Medway was falling behind other parts of the country in terms of the amount of Extra Care Housing being developed. It was questioned what the Portfolio Holder had done to influence the development of the Local Plan to ensure that more extra care housing was built. The Portfolio Holder said that he had recognised for a considerable time that Extra Care Housing was invaluable for many in the local community and considered it a priority, particularly as it could help to reduce social isolation and enable people to feel part of their local community.

Turning Point – In response to a question that asked for more detail about the Turning Point drug and alcohol misuse service commissioned by the Council, The Portfolio Holder advised that the service demonstrated how drug and alcohol dependency could be overcome and aimed to do this in a way that was sensitive to the needs of the individual. He had visited the service a number of times and suggested that it would be beneficial for a small group of Members to visit Turning Point to see the service for themselves.

Safeguarding: In view of the fact that the number of Safeguarding Adult Concerns recorded in Medway in 2015-16 had increased by 53% when compared to 2014/15, a Member asked whether there could be confidence that no issues were being missed and questioned how cases where individuals re-presented after having previously accessed the service were followed up. It was confirmed that the service was continuing to see an above average proportion of adults re-presenting. A need had been identified to undertake a detailed analysis of drug and alcohol misuse to inform the changes required. Officers were working to identify the risk to the individual and remove the risk, with the progress of individuals being monitored to help minimise the risk of regression. An Association of Directors of Adult Social Services (ADASS) Safeguarding Adults Peer Review had highlighted that there were areas for development, with work to address these already being underway. It was anticipated that the final ADASS report would be provided during February.

Post hospital discharge care: A Member asked how it was determined whether a patient being discharged from hospital could return to their own home or was more suited to another care environment. The case of an individual who had died while in a care home being reassessed to determine the most appropriate place for them to move to, was highlighted. The Portfolio Holder stated that the Council worked with Medway Foundation Trust to enable people to return home as much as possible. Medical opinion was that this was generally the best outcome for the patient, subject to them being provided with an appropriate package of care. Each case was assessed on its individual merit. The Portfolio Holder was sad to hear that a person had passed away while they waited for an appropriate care setting to be found, but was not in a position to comment further without having specifics details of the case. When any change was made in relation to the care of elderly people, it was important to consider all the factors and to involve the family in the decision making process.

Links between Business Intelligence and Public Health: One of the areas for development, in relation to safeguarding, identified by the Association of Directors of Adult Social Services (ADASS) Safeguarding Adults Peer Review was the development of stronger links between Business Intelligence and Public Health. A Member asked what the objective of creating stronger links was. The Portfolio Holder responded that intelligence in relation to care home provision was being developed in order to help ensure high standards with good quality provision.

Post discharge care of private patients: A Committee Member expressed concern that patients referred to private hospitals were not receiving adequate after care and felt that the post-discharge follow up should be the same regardless of whether the patient was being discharged from an NHS or private hospital. The Interim Director of Children and Adult Services advised that the use of private hospitals was normally for specific elective procedures, while emergencies were treated in NHS hospitals. Emergency admissions were more likely to require post-discharge care.

Services of Kent and Medway NHS and Social Care Partnership Trust (KMPT): In response to a Member question that asked what services KMPT provided in the community and how successful they were, the Portfolio Holder said that KMPTprovided some services in the community but it was recognised that improvements needed to be made.

Contingency planning for Care Home Places: A Member asked what contingency plans were in place in the event that there were not enough residential or nursing home places in Medway. The Portfolio Holder said that there were sufficient places available at present. Contingency planning involved working with neighbouring areas to facilitate the use of out-of-area homes, where required and vice-versa. The development of business intelligence would help to ensure that sufficient provision was planned for. Consideration could also be given to developing support for specific homes, but this would take time and resource. It was noted that there had been three care home closures in Medway over the last year, with only one of them being due to clinical concerns.

Decision

The Committee thanked the Portfolio Holder for the update provided and agreed that a Member visit to Turning Point would be arranged.