Agenda item

The Committee will receive a presentation on the development of the new Adult Social Care Strategy.

Kate Harker, Head of Older People Commissioning provided a presentation to the Committee. This outlined the development of the new Adult Social Care Strategy which was in its early stages. The presentation included the following slides:

• Why produce an Adult Social Care Strategy?
• What will it look like?
• Context for the Strategy
• Strengths
• Challenges
• A note about engagement, consultation and co-production
• Strategy – emerging overarching priorities
• Emerging areas of focus under 'Safeguarding, Supported and Satisfied'
• Sustaining and building our strength based approach 
• Proposed solutions we anticipate will feature in the Strategy
• Any comments on the overall approach and development of the strategy
• Timeline for drafting, engagement and governance

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

• A member spoke of the challenges and workforce pressures faced. It was questioned if the minimum wage and reduced numbers of overseas care workers was having an impact. Kate Harker explained the annual inflationary increases in pay rates and for service provider funding. There had been workforce pressures, and care workers from abroad were employed. Currently there was bed capacity and providers had the staffing levels required to deliver services.
• The Chair commented that brokerage was important. In some cases, people had to move when their current placement could no longer be funded.  Kate Harker gave an outline of how brokerage would work, through specialist staff negotiating with providers for each placement to agree an appropriate price for the care required. The brokerage approach may ensure that care rates remained broadly the same and did not escalate, which would be viewed as a successful outcome.
• Reference to the five district and borough council local plans, it being questioned if the Adult Social Care Strategy was integral to them. Significant population growth was predicted and as people got older, they would need more support. The member referred to assistive technology, reminding of the projects of two NHS providers to support people at home. Social Care should join with the NHS in developing joint strategies to help people to be supported at home. This would improve quality and bring cost savings. It may be a role for this Committee to monitor.
• Pete Sidgwick reminded that this was an Adult Social Care strategy. The strategy was likely to reflect the work that was already taking place, including that required by the Care Act. However, there may be opportunities to do things better, in a more integrated way and to hear from service users and residents. Moving to how the strategy would be delivered, the assistive technology approach was a key factor to enable people to be as independent as possible. Such technology was already in use and there was a wish to innovate and to improve. Becky Hale spoke about housing with care, linking even more with districts and boroughs on the local plans and the opportunities through this strategy to develop the housing that would be needed for future residents. The Chair added that all councils had adopted the Health and Wellbeing Strategy, which required viewing everything from a health and wellbeing perspective. Monitoring by the appropriate portfolio holder of each district/borough council should improve the integration of this strategy with local plans.
• Chris Bain spoke of the pressures created through an imbalance between demand and capacity. There was a need to understand what was driving both aspects. He would like to see more emphasis on the role of carers and support for them, as the role of carers was crucial to the strategy’s success, and he urged it was given a slightly higher profile. 
• A comment that this was an inspired vision for a vast service supporting the most vulnerable residents. It was questioned how closely the CQC rating was examined when commissioning services. People were being discharged from hospital with more complex needs. A question on how the Council ensured the correct training was provided for those delivering care at home. Becky Hale confirmed that CQC ratings were checked when seeking tenders for services. Regular checks were made on the ratings of all commissioned services. Other mechanisms were the risk-based approach used by the quality assurance team and there was a service escalation panel which cut across both health and social care where there were concerns about provider quality. It was important to receive feedback from elected members and the public to inform of any concerns. It was confirmed that there were some care providers rated by the CQC as ‘Requires Improvement’.
• The presentation had shown the focus on empowering service users. Some slight changes were suggested to the language used which officers found helpful. It was also about how the information and advice was provided. The aim was to help people to remain independent. As their care and support needs increased, it was about maintaining independence, choice and control as much as possible. This had proved most challenging for those in care with significant and intensive care needs. The aim was to look at what could be improved. Pete Sidgwick added that the language was important, it needed to be consistent and be part of the ‘golden thread’ referenced in all the written materials. For the final strategy, this needed to be written from the resident’s perspective.
• People with dementia should not be viewed as complex customers. They were on a journey and needed to be supported by carers or family members in all health and care settings, but this was not recognised by some staff. A request that this was referenced in the strategy, which was viewed a helpful point. In care settings, some individuals had complex behaviours so securing better, tailored provision was a particular aim of the strategy. 
• A member asked how views on service improvements would be sought and if such research would be ongoing. The member noted the aims for co-production of the strategy, and the constraints referenced, asking if this could be a barrier to co-production. Kate Harker outlined the approaches to engagement on the strategy. Staff were being trained so they could hold ‘ordinary’ conversations with service users, aimed at gathering information on how they viewed their care, and what could be improved. This approach would give detailed feedback. There was work with providers too and staff would attend events like coffee mornings, group activities in care settings or at community centres to gather such feedback. Good co-production was continuous, to ensure that the services remained of good quality. This was a core role for Commissioning and the Quality Assurance Team.  Realistically, this process was engagement, and it might identify gaps and potential improvement areas. An example was used to show how this in turn could lead to co-production. Becky Hale added that through the strategy, areas for improvement would be identified. The Council could commit to a co-production approach for the review of those areas with an example used to illustrate this.
• The Chair referred to the timeline for production of the strategy, asking how the Committee could assist. She suggested a round table meeting may be useful to give more focus away from the formal committee setting, as there was a lot of experience between members and Healthwatch.

The Committee noted the presentation.