Agenda and draft minutes

Adult Social Care and Health Overview and Scrutiny Committee - Wednesday 16 November 2022 10.00 am

Venue: Committee Room 2, Shire Hall. View directions

Contact: Paul Spencer  Senior Democratic Services Officer


No. Item



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Apologies for absence were received from Councillor Ian Shenton and Nigel  Minns.


Disclosures of Pecuniary and Non-Pecuniary Interests

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Chair’s Announcements

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Minutes of previous meetings pdf icon PDF 108 KB

To receive the Minutes of the committee meeting held on 21 September 2022.

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The Minutes of the committee meeting held on 21 September 2022 were approved as a true record and signed by the Chair.


Public Speaking

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Val Ingram addressed members, speaking to the written submission attached at Appendix A to the minutes. Councillor Margaret Bell, Portfolio Holder for Adult Social Care and Health responded and was aware of the issues at Upper Lighthorne as well as wider issues for provision of new or extended primary care facilities, linked to developments. The Portfolio Holder had undertaken research with officers on planned primary care facilities and extensions, there being eight, including that at Upper Lighthorne and one at Hartshill, which was virtually complete. She had asked the Chair and Chief Executive of the Integrated Care System (ICS) for a timeline of what was involved in establishing a new primary care centre, the key stages, the project plan and reasons why they could take so long to complete. She had also asked for an update on the provision of the seven outstanding sites. Councillor Bell then read from a written response provided by the ICB on this public question and a copy of that response is also provided in the appendix.


Councillor Bell concluded that this was an important issue. Perhaps the Committee may wish to add to its work programme to hear from the ICB Chair and Chief Executive about the plans to deliver the seven outstanding centres.  The Chair was supportive of this suggestion, speaking of the ongoing dialogue with ICB, that this was a county-wide issue and linked to backlogs in other parts of the NHS. It was agreed that the written reply from the ICB would be circulated to Val Ingram and to the committee.


Councillor Rolfe added that there was also a need to look at school provision and the ‘triggers’ for release of funding, as some children including those at primary schools were having to travel a considerable distance to access schools. The Chair acknowledged this as another county-wide issue. She spoke of the challenges around the use of Section 106 monies linked to development, the need for a joined-up approach and offered to refer this aspect to the Children and Young People OSC for its consideration. Councillor Mills spoke of his involvement in the Upper Lighthorne scheme, the frequent ‘stumbling blocks’, the scale of this development and need for additional primary care services.


Questions to Portfolio Holders

Up to 30 minutes of the meeting is available for members of the Committee to put questions to the Portfolio Holder: Councillor Margaret Bell (Adult Social Care and Health) on any matters relevant to the remit of this Committee.


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Chris Bain of Healthwatch Warwickshire (HWW) pursued the previous item, referring to the workforce challenges in primary care, the shortage of GPs and other staff. Councillor Bell understood that the ICB was considering different staffing models including that which provided for salaried GP doctors, rather than the traditional model where the GPs were partners in the practice. She touched on the wider service provision in primary care settings, including co-located pharmacies, nurse prescribers and mental health services. Finally, Councillor Bell spoke of the current requirement for a GP referral to access some other health services, such as diagnostics. There was current thinking about how this could be handled differently to ease pressure on primary care.


Questions to the NHS

Members of the Committee are invited to give notice of questions to NHS commissioners and service providers at least ten working days before each meeting. A list of the questions and issues raised will be provided to members.


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Integrated Care System pdf icon PDF 236 KB

Engagement with the Committee on the ICP Strategy and associated plan.

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The Committee received an update and presentation from Liz Gaulton and Rose Uwins of the Coventry and Warwickshire Integrated Care Board (C&WICB). Initially, background was provided on the Integrated Care System (ICS), a partnership of organisations that came together to plan and deliver joined up health and care services. It explained the role of the C&WICB and the IC Partnership, those which rested with local authorities, care collaboratives and provider collaboratives.


The report set out the requirements to develop an Integrated Care Strategy, to meet the assessed needs, from the previously developed Joint Strategic Needs Assessments (JSNAs). In Coventry and Warwickshire considerable work on integration had already taken place. The Integrated Care Strategy would build on this to further the required transformative change to tackle the significant challenges facing health and care. The strategy presented an opportunity to do things differently.


The ICP had agreed a work programme to develop the strategy, led by a working group and with input from key stakeholders. The draft strategy needed to be submitted to NHS England for review on 14th December. The report outlined the planned approach and format for developing the strategy, signposting to existing strategies, the mapping which had taken place and identification of proposed priority or ‘strategic focus’ areas. The draft priorities had been discussed at the Integrated Health and Wellbeing Forum, resulting in a series of commitments that would run through the strategy.


Details were provided on engagement activity, to ensure that development of the strategy and the Integrated Care 5-year Plan were done in an aligned and connected way. A separate engagement task and finish group had been established for this purpose which included broad representation from stakeholders. Wide public engagement was also planned with over 30 scheduled events, planning for more events and an online survey. Stakeholder engagement would continue with regular updates, including with this committee.


The requirements to produce a five-year Integrated Health and Care Delivery Plan were reported. The delivery plan would be refreshed before the start of each financial year and meet the reported statutory requirements from the Health and Care Act 2022. Further guidance was expected shortly from NHS England, which would be provided to members via a stakeholder briefing.


The report concluded by referring to the strategy content and next steps, as well as providing the national timeline for producing the strategy and the five year delivery plan.


The presentation included slides on:

  • Integrated Care - a huge opportunity.
  • ICS aims – improve outcomes, tackle inequalities, enhance productivity and value for money and support broader social and economic development.
  • The ICS vision.
  • Planning for the future – development of the Integrated Care Strategy and 5-year Joint Forward Plan.
  • The vision for integration and collaboration across the system to achieve the four key aims.
  • Grounded in the reality of now. The strategy would be built from local assessments, include consultation with Healthwatch and statutory components of national guidance. It would set out how assessed needs  ...  view the full minutes text for item 5.


Council Plan 2022-2027 - Quarter 2 Performance Progress Report pdf icon PDF 128 KB

For the Committee to consider and comment on the Quarter 2 organisational performance and progress against the Integrated Delivery Plan.

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Shade Agboola, Director of Public Health introduced this item and gave a presentation to pull out key messages. By way of introduction the report stated the wider national context which was a critical frame within which to view the Council’s performance. It reported the combined impact of political, global and macro-economic turbulence causing high inflation, rising interest rates and cost of living, increasing pressure on an already tight labour market, demand for public services and public finances.


The report summarised the Council’s performance at the end of the second quarter (April-September 2022) against the strategic priorities and areas of focus set out in the Council Plan 2022-2027. This report drew out relevant areas within the Committee’s remit from that presented to Cabinet on 10th November. Sections of the report together with detailed supporting appendices focussed on:


·   Performance against the Performance Management Framework

·   Progress against the Integrated Delivery Plan

·   Management of Finance

·   Management of Risk


The report provided a combined picture of the Council’s delivery, performance and risk. Overall Quarter 2 had seen a marginal decline in performance compared with the Quarter 1 position, reflecting the increasingly volatile, uncertain, and high-risk external environment. There were eleven key business measures (KBMs) within the remit of the committee. Of these, eight were reportable in this quarter, with six of the KBMs assessed as being on track and two were not on track.


The report detailed key emerging themes. These included increasing service demand, capacity issues impacting delivery across the organisation and difficulties in recruiting and retaining staff in a highly constrained national and local labour market.


There were notable aspects of positive performance, with the report highlighting that no care providers had exited the market due to business failure. Another area was the stability and performance in regard to the percentage of people under the age of 65, with eligible needs living in the community, who were accessing Adult Social Care.


There were some performance challenges, the main one being the number of people supported in residential or nursing care aged over 65. This had an upwards trajectory due to increased placements from the community and discharges from hospitals.


There were some actions identified as ‘at risk’. These related to capital programmes and projects, linked to current inflation levels and supply chain challenges. One of the Council’s strategic risks related to adult social care and health directly (widening of social, health, and economic inequalities post pandemic). Two others related to inflation and the cost of living. The economy might impact on service provision and service demand. At the service level, two risks had been higher than target for three consecutive quarters, those being the risk of care market failure and the risk of an ongoing impact on Public Health resources from responding to Covid-19.


The presentation included slides on:

·   Council Plan 2022-2027: Strategic Context and Performance Commentary

·   Performance relating to this Committee

·   Area of focus: Support people to live healthy, happy, and independent lives and work with partners to  ...  view the full minutes text for item 6.


Customer Feedback Report 2021/22 pdf icon PDF 94 KB

This report provides an overview of customer feedback received during 2021/22.

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Louise Church introduced this item, which reported back on the customer feedback received during 2021/22.


Adult Social Care services received four types of feedback, comprising comments, compliments, complaints and questions. There were 640 cases created during 2021/22 which was an increase of nearly 14% on the previous year. The report set out the different channels which customers could use to provide feedback and the increasing use of digital services through creating a ‘self-account’. During this period, the volume of cases processed and closed (191) had increased by almost 14% on the previous financial year.


The report referenced the service level targets for timeliness of response. It then provided a summary of complaint causes, complaints made to the Local Government and Social Care Ombudsman (LGSCO) and learning from feedback. The report provided notable highlights, including a new system and procedures to support better compliance with complaint responses and learning from customer feedback. An appendix to the report provided detailed information on the customer feedback received during this period, including graphs and tables to highlight the key data.


Members reviewed the report and appendix, raising the following points:


  • Reference to a table in the appendix, giving complaint case data and specifically that relating to Adult Strategic Commissioning. It was questioned if this was linked to care packages. Similarly, more information was sought on the data for adult older people in Stratford and increased cases linked to adult mental health. 
  • Louise Church noted that there was an increase in complaint cases around care homes and domiciliary care services. Reviews took place with care providers to look at such cases, take learning from them and especially around quality assurance aspects. Becky Hale provided background on how such complaints were routed previously, the changes implemented and how they were now handled in conjunction with relevant teams within the County Council. Largely it involved liaison with service providers to undertake internal investigations. There had been an increase in the number of complaints, but also the data was due to the way in which complaints were now managed. She then touched on the quality assurance and contract management aspects in assessing risks and determining required assurance activity, customer and provider visits.
  • More information was sought on the increased complaint cases linked to mental health. It was confirmed this concerned adult social care operational teams linked to mental health. There had been a small increase in complaint cases in this area. Context was provided that the data reported showed which section was leading on the complaint and there could be overlaps in some cases between commissioning and frontline services. An example was given to demonstrate this.
  • There had been an increase in complaints around finances, where people were not happy with their financial assessment and the increase in contributions required. This was likely to increase further as part of the adult social care reforms.
  • An outline was given on learning from complaints and the use of briefing notes for teams to improve practice. A recent example was improving  ...  view the full minutes text for item 7.


Work Programme pdf icon PDF 84 KB

For the Committee to review and update its 2022-23 work programme.

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The Committee discussed its work programme. The Chair reminded that a briefing note on drug and alcohol services had recently been circulated. The suggestion for a further update on GP services and access to primary healthcare would be considered at the next Chair and party spokesperson meeting.



That the Committee notes the work programme as submitted.