Agenda and draft minutes

Apologies for absence had been received from County Councillors Andy Jenns and Chris Mills, from Councillors Colin Cape (Nuneaton and Bedworth Borough Council), Pam Redford (Warwick District Council) and from Nigel Minns.

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The Chair thanked Councillor John Holland for chairing the previous meeting. She referred to the useful pre-committee briefing on performance monitoring and a bespoke software application Power BI. In her view, the overarching priority for the Committee was integrating health and social care with a focus on prevention rather than cure and addressing health inequalities. The Chair suggested that this Committee and the Children and Young People OSC meet jointly to undertake a local Covid inquiry. This would look at the learning which could be drawn from the pandemic to assist with responding to any future pandemic. It could also provide a focus on activity now to respond to differences seen over the last two years.

To receive the Minutes of the committee meeting held on 27 September 2023.

The minutes of the Committee meeting held on 27 September 2023 were approved as a correct record and signed by the Chair.

The Chair welcomed Karen Skinner to the meeting. She was aware of the topic on which Ms Skinner would speak and undertook to write to Stratford-upon-Avon District Council on this matter, should that be the Committee’s conclusion.

Karen Skinner addressed the Committee. A copy of the submission is attached at Appendix A to these Minutes. She provided additional background on the concerns being raised on behalf of tenants of an Orbit Housing independent living scheme at Rosalind Court in Stratford-upon-Avon. She spoke about housing and care, the overnight care service and the mandatory charges being levied to tenants on which clarity was being sought.

Points of clarification were that the housing provider was Orbit Housing and the service charges related to the District Council. The Committee would take advice and a written reply would be provided to Karen Skinner. The Chair reiterated that she would lobby the District Council to look at this matter. 

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.

None.

Members of the Committee are invited to give notice of questions to NHS commissioners and service providers at least 10 working days before each meeting. A list of the questions and issues raised will be provided to members.

None.

The Coventry and Warwickshire Integrated Care System is developing a joint all age strategy for Palliative and End of Life Care, on which the Committee’s formal support and endorsement is sought.

The Coventry and Warwickshire Integrated Care System (C&WICS) was developing a joint all age strategy for Palliative and End of Life Care, on which the Committee’s formal support and endorsement was sought. At its meeting on 27 September, the Committee received a comprehensive presentation and report on this matter. Kathryn Drysdale from the C&WIC Board was in attendance to respond to any further questions from the Committee.

The Committee was asked to approve the recommendations shown in the document pack, specifically to give its support to the final version of the five-year strategy and associated two-year delivery plan for the strategy.

The following questions and comments were submitted, with responses provided as indicated:

• Several members raised concerns about the shortage of care staff to fulfil the aims of the strategy. This was a significant project requiring considerable investment. Kathryn Drysdale acknowledged the concerns. A system approach would be taken to look at the workforce requirements, planning and having clear pathways to make the most efficient use of staff. There was not yet an identified funding stream. She touched on some of the ways the system might work differently, with a needs analysis, assessing the costs of someone going into hospital against using a community care option. It was not yet possible to give a clear answer on the two key questions of staff and budget, but examining individual aspects and then designing a system approach would show how this could work more effectively. An example was provided of the palliative and end of life care options being implemented in the north of the County.
• Members questioned how this could be taken forward without the resources or staffing to achieve the strategy aims. Staff were already stretched, and it was anticipated that the shortage of carers would place even more pressure on them.
• Members acknowledged the aspirational but challenging proposals without the allocation of additional funding. As well as needing frontline staff, additional resources would be needed to undertake a data gap analysis. A concern was frontline resources being redeployed to do this work, impacting on service delivery. The concerns raised at the previous meeting remained.
• Clarification was provided on the reasons why this item had been resubmitted, to assess whether the Committee was supportive of the strategy and associated delivery plan.
• Members had found the documents easy to read and informative. The services provided currently were very good and it was questioned what would be changed as a result of the strategy. Kathryn Drysdale agreed that the services provided were excellent. There was no intention to change service levels, but to work more effectively in shaping the pathway of care and provide a range of options for palliative and end of life care. The current arrangements worked for many people, but there were some underserved communities.
• A point about choice and preference at the end of life. Some people did not have close family. In the north of Warwickshire, there was no bedded end of life care provision.  ...  view the full minutes text for item 5.

For the Committee to consider and comment on the Quarter 2 Integrated Performance Report (period covering April - September 2023).

The Committee received the Integrated Performance Report, which gave a retrospective summary of the Council’s performance at the end of Quarter 2 (April - September 2023) against the strategic priorities and areas of focus set out in the Council Plan 2022-2027. Key sections of the report focussed on: 

·   Performance against the Performance Management Framework

·   Progress on the Integrated Delivery Plan

·   Management of Finance

·   Management of Risk

The Chair referred to the pre-committee briefing session on performance and the Power BI platform. Questions and comments were submitted on the following areas:

• Clarity was provided on the target and actual data for people supported in residential or nursing care, both for people aged under and over 65 years of age. In both cases this was an area where the current target was being exceeded, so it was ‘not on track’. This was an area where it would be useful to provide additional context in the report and an offer was made to circulate a briefing note.
• Referring to the above point, it was questioned if there was an increasing trend in service demand. Pete Sidgwick said there had been an increase in the number of people being supported and of those, a higher proportion were in residential or nursing care placements. There was a financial impact and currently, the cost per placement was also higher. A perceived contributor was the worsening health and wellbeing of an aging population. Reference also to the national datasets, against which Warwickshire had historically compared favourably. It was reported that the local data had increased but all areas were seeing a similar growth in data for these indicators. Increases in NHS activity also had an impact on the number of people requiring onward care.
• A member asked if increases in the cost of living was a contributor. This view was not shared by officers, it being seen more as the worsening health and wellbeing of the older population with significant care and support needs. The Chair added that people were living longer with acuity of need and increased frailty.
• It was noted that the strategic risk register had been refreshed, with three areas relating to Adult Social Care. Clarity was sought on the classification of risk which differed in two sections of the report. It was agreed that this be researched, and clarification would be provided to members.
• Reassurance was sought on the falling data for number of carers receiving support each month. There had been no change in policy or procedures in this area delivered by the Carers’ Trust. The data did fluctuate with factors such as school holidays having an impact. There had been a lot of work to improve performance in this area and it was expected that the data would now level out.
• There was concern at the forecast budget overspend for Adult Social Care, it being asked if the forecast was realistic or if the end-of-year position could be even worse.  Officers responded that the position would become clearer as the financial  ...  view the full minutes text for item 6.

The Committee will receive a presentation from Public Health.

The Committee received a presentation from Dr Shade Agboola, Director of Public Health. She provided context that there was no longer a requirement for Covid testing and that adults who had Covid were asked to stay home and to avoid contact with others. For children with any winter illness, those feeling well enough could attend school. The presentation covered the following areas:

• National Covid update – a slide with data on the people testing positive for Covid in the last seven days and patients admitted to hospital. Overall, there had been a reduction of 1903 cases representing 21.8% for positive tests and a reduction of 327 hospital admissions, which was a 9.7% reduction. A government website contained updated information. There was no national testing, so the reported figures were from tests at hospital.
• The Covid data for Warwickshire showing numbers of cases, the change in data over the past week, first episodes and reinfections. As testing was no longer mandatory, the case data was from testing in healthcare settings. Overall, the number of cases had reduced by 41, a 34% reduction.
• A Covid vaccination update was provided for each of the five district and borough areas. This showed the number of vaccinations, the eligible population and the percentage uptake in each area. Residents in all but one of the care homes had been vaccinated.
• A flu vaccination update showing the eligible cohorts, number of vaccinations and respective population numbers, the uptake to date, targets, and remaining numbers of vaccinations to achieve the target for each cohort. Particular reference to the low uptake of flu vaccination of children aged 2-3 years, and those at primary and secondary school.

Discussion took place on the following areas:

• The Chair asked if flu vaccinations took place in school and whether there was a refusal from parents for the vaccine to be administered. She asked for the age profiles for vaccination of primary and secondary school children. Shade Agboola confirmed that eligibility was for all primary school children and for secondary school children in years seven and eight, but this was being increased each year. Parental consent was required which remained a key challenge despite schools offering an easy way to give consent digitally. There was choice whether to have the vaccine by injection or nasal spray.

• A member considered the low uptake of Covid booster vaccinations was disappointing. It would be interesting to compare the data from when the vaccine first became available. A point about providing reminders via text message.
• The member asked if there had been any Covid deaths in Warwickshire recently, and the impact of the latest Covid strains. Dr Agboola would research the position on Covid deaths. People who had been vaccinated would still be protected against the newer strains of Covid. The virus would continue to mutate, and people would catch Covid, but the vaccination reduced the risk of serious illness and death.
• There had been a reduction in uptake of Covid vaccination. Points about herd immunity, and that  ...  view the full minutes text for item 7.

For the Committee to review and update its work programme.

The Committee reviewed its work programme. The Chair provided details of the items added to the programme recently, also confirming her wish to focus on prevention and wellbeing. Discussion took place and it was agreed that the following items be considered at the February Committee meeting:

• Care needs for people aged under 65 and the placements they were supported in.
• Development of the Adult Social Care Strategy
• The preparedness for the Care Quality Commission inspection. This would report the feedback from an upcoming peer review.
• Children’s continence services.

Resolved

That the Committee updates its work programme as outlined above.