Agenda item

This report details the areas covered by the Portfolio Holder for Adults’ Services which fall within the remit of this Committee.

Discussion

Committee Members raised a number of questions which were responded to as follows:

Budget Deficit, Extra Care Housing and liaison with mental health – A Member raised concerns about the size of the budget deficit, the impact of this on services, particularly for vulnerable people and also the need for increased Extra Care housing as 1,500 people in Medway were eligible with there only being 239 units available. The Member also asked what discussion had taken place with the Kent and Medway NHS and Social Care Partnership Trust (KMPT) to ensure that the impact of service change was minimised.

The Portfolio Holder said that a ‘deep dive’ was being undertaken into both statutory and non-statutory services in order to see where there was scope for change. There was a need to provide value for money. Medway had previously always managed to identify funding to support voluntary sector provision but it was not possible to yet say what changes would be made.

It was acknowledged that there was a gap between current Extra Care Housing needs and provision and that the provision of Extra Care housing could make a significant positive impact on lives. New provision included Rogallo Place, near Rochester Airport and Atlas Place on St Mary’s Island. A future scheme was planned for Rochester Waterfront. One challenge to the provision of Extra Care housing was that was that developers were able to sell properties after planning permission had been granted. The provision of such housing was a high priority. In relation to KMPT, discussions were taking place about the establishment of a Safe Haven in Maidstone to accommodate people, from across Kent and Medway, detained under Section 136 of the Mental Health Act. 

The Director of People, Children and Adults’ Services said that Adult Social Care (ASC) had faced significant pressure, although the provision of additional funding for Winter Pressures had been useful and had enabled demand to be managed more effectively. The introduction of the Three Conversations approach in ASC would help to increase early intervention. Additional funding of £2.6 million for Children and Adult Social Care was due for the next year, some of which was ring-fenced for winter pressures.

Winter Pressures, Three Conversations Model and housing targets – A Committee Member highlighted Winter Pressures and the risk of an increased number of patients being discharged from hospital early. She also asked how ASC, using the Three Conversations Model, was working with partners to avoid possible duplication and suggested that there should be higher targets for the provision of affordable housing.

The Director of People advised that Medway Maritime Hospital, Adult Social Care and Medway Community Healthcare worked in partnership to plan discharges. It was acknowledged that activity had previously been fragmented. Work was taking place with Medway NHS Clinical Commissioning Group to create an integrated discharge service. This would help to avoid duplication. ASC already had access to the Rio mental health software package that mental health professionals used. This helped to facilitate joint working but there was a need to further strengthen this area.

Delayed Discharges of Care – In response to a Committee Member who commented on Medway having low figures for hospital Delayed Transfers of Care, the Portfolio Holder said that the target for the latest time for a patient to be discharged in Medway had changed from 6pm to 5pm. Work with the hospital had helped to reduce the impact of winter. The Care Team was working with people due for discharge to ensure that they could be discharged to a safe environment as soon as possible. Delays attributable to Medway ASC in 2017/18 were 1.8 bed days per 100,000 people. This compared to a national average of 4.3, which ranked Medway 44^th of 152 local authorities nationally. Improvement had continued in the current year with the Year to Date figure standing at 1.5.

Social Isolation – A Committee Member was disappointed that social isolation / loneliness had not been mentioned in the report, despite it being a Health and Wellbeing Board priority. He also raised concern that some Members had acted unprofessionally during recent discussion of the Social Isolation Task Group report at Cabinet. The Portfolio Holder considered social isolation to be very important and that the work of the Task Group had also been very important. He appreciated the depth of the Task Group’s work and considered that the correct stakeholders had been involved in the work and that the recommendations made by the Task Group were good. The Portfolio Holder was happy to accept the recommendation that he should be an ambassador for work to address social isolation. It would be important for the Council to feed back to central Government how Government could help support the work. Arriva had attended a Task Group meeting and the Portfolio Holder considering that it was important for the Council to be consulted about any proposed changes to bus routes in view of the impact that these could have on levels of social isolation. The Portfolio Holder undertook to feed back to the Leader of the Council concerns raised about Member conduct at Cabinet.

Patient care after discharge, Telecare and Public Health funding reduction – A Member emphasised the need to ensure that patients received appropriate care after discharge and that their families were supported as appropriate. He also asked how much telecare was utilised in Medway and what the impact of reductions in Public Health funding from the Government would have on Medway.

The Portfolio Holder said that patients due to be discharged were assessed by the hospital and social care team to ensure that it was safe to discharge them and that appropriate care arrangements were put in place. There had been an increase in the use of telecare. One example of telecare in Medway was a wrist worn falls detector. When a possible fall was detected, a staff member would visit the person to check that they were ok. The Portfolio Holder said there was a need to encourage firms developing housing provision locally to use Medway Telecare systems. In relation to Public Health budgets, both statutory and non-statutory services were being looked at to ensure that any service reductions were kept to a minimum and to ensure that Public Health could have the maximum possible impact in terms of preventing ill health and promoting good health.

The Director of Public Health clarified that reductions in the ring fenced grant for Public Health had been ongoing since 2015, with 2019/20 being the final year. The Government’s Comprehensive Spending Review would confirm the amount of funding available for each local authority.

Funding for non-statutory bodies – In response to Members who said that any reductions in funding for non-statutory services, could lead to increased demand for statutory services, the Portfolio Holder said that each service would be considered on a case-by-case basis. It was acknowledged that any reductions could lead to longer term costs in other areas. Work would be undertaken between Public Health, the NHS and other partners to consider the implications.

Work with voluntary sector – The Portfolio Holder confirmed that Adults’ Services engaged with various voluntary sector groups. Examples highlighted included Walderslade Together (WALT) and WHoo Cares.

The Deputy Managing Director of Medway NHS Clinical Commissioning Group (CCG) said that the CCG had recently procured a Medway wide Care Navigation service. This would help people to find organisations that could support them, as their needs required. Involving Medway had established links with voluntary sector organisations, such as WALT, WHoo Cares and Arches Local. This included sharing information and engaging with hard to reach communities.

People supported in their own homes – The number of older people supported to live in their own homes had fallen slightly compared to previous years. The Assistant Director of Adult Social Care said that this was due to increased prevention, with people being supported sooner. The Care Act included a requirement to prevent, reduce and delay needs arising. This was being delivered through the Three Conversations approach. Services were being provided in different ways and increased direct payments to recipients of adult social care was leading to increased flexibility, choice and control.

Impact of Brexit – In response to a Member question about what discussion had taken place with Medway Hospital and with Medway CCG in relation to Brexit, the Portfolio Holder considered that the impact was likely to be minimal but that no one could be sure. The Director of People said that he was aware that regionally, some discussions had taken place, but that it was considered that the impact on the Adult Social Care workforce in Medway was likely to be minimal. The Deputy Managing Director of Medway NHS CCG added that NHS England had appointed a team of 200 people to consider issues across the country.

The Portfolio Holder thanked the Committee for its work.

Decision

The Committee thanked the Portfolio Holder for attending the meeting and for the update provided.