Agenda item

To provide a joint presentation to the Committee. This will detail the County Council’s responsibilities under The Care Act and the support provided, before focussing on the Care Quality Commission Assessment.

The Committee received a combined presentation from Pete Sidgwick, Director of Social Care and Support and Ian Redfern, Head of Adults Practice and Safeguarding. This detailed the County Council’s responsibilities under the Care Act and the support provided, before focussing on the Care Quality Commission Assessment. The first part of the presentation covered the following areas:

• The three priorities:
  • Safeguard adults and protect them from avoidable harm.
  • Enhance the quality of life for people and delay and reduce the need for care and support.
  • Ensure that people have a positive experience of care and support.
• Adult Social Care – The Care Act 2014 and upper tier authorities
• General responsibilities in the Care Act 2014
• Specific aspects of the Care Act 2014
• The criteria for support
• Eligible outcomes
• The Mental Capacity Act 2005
• How we support people
• The people we support (all adults)
• The people we support (adults under 65)
• The people we support (adults 65 and over)

Members discussed the following areas:

• The presentation was considered interesting, informative and an important area for the Council. More information was sought on quality control from the customer’s perspective. The financial challenges required improved productivity and reduced costs. It was better to get the service right first time and to avoid costs linked to handling complaints and reviewing services.  Pete Sidgwick outlined how this was assured. Support for the provider market ensured they could deliver what was required. Providers were regulated by the CQC and they were inspected. The County Council also had an in-house quality assurance team. Finally, staff listened to feedback and complaints from residents on the care and support services received and took appropriate action to rectify concerns.
• Further information was provided about eligible outcomes and the use of community facilities, ‘out of county’ care and the differential on numbers of people using services. Some people needed support to meet friends, to go shopping or visit the library. This was about the County Council providing the support to enable this. It was in the context of meeting each person’s broader support needs and to focus on what mattered to the individual. The ‘Out of County’ aspect was a technical area, detailed in the Care Act, and it concerned responsibility to continue funding the support needs where a person relocated to another area for legitimate reasons. It meant Warwickshire would continue to fund such support costs in some cases and any disputes were referred to the Secretary of State for resolution. The average amount of support required was discussed and in general the support needed by younger adults tended to be greater than that for older people.
• The provision of reablement and aftercare following hospital discharge was raised. In particular, this concerned longer-term care by home carers rather than occupational therapists. There were two ‘enabling’ services, being the reablement service (occupational therapy) and a community recovery service (physiotherapy). There was an overlap between these services which were for a period of six weeks. The role of domiciliary care in enabling people to be independent was also discussed. Providers received training on this ongoing service area. The Councillor would pursue this area with officers after the meeting.
• Linked to the above, context was provided that around 1200 people received reablement support each year. The community recovery service was higher and for December was 400 people, more typically being 300 per month.
• Reference to a BBC report on assessment and eligibility for services. The report stated that people were able to get assessed, but few were eligible for support. Funding levels varied by area. The member would send the report to Officers so this could be discussed further outside the meeting.
• Clarity was provided on the differing pieces of legislation in force for care services. The Care Act 2014 was the main legislation, but some aspects of much older legislation were still in force. Linked to this the move to support people in the community rather than in an institution was confirmed.
• Discussion about the deprivation of liberty provisions and which organisation was the final arbiter. The County Council was responsible in some cases and the NHS for others, dependent on where the person was supported. The Court of Protection also had an arbiter role.
• It was noted that the presentation made no reference to the rehabilitation facilities at Ellen Badger or the Nicol Unit. There was no data on the reablement services they provided. These NHS facilities did not form part of the County Council’s statutory duties under the Care Act.

The second part of the presentation focussed on local authority Care Quality Commission (CQC) Aspects

• CQC assessments – a two-year process to assess all 152 authorities
• The four assessment themes
  • Theme 1: Working with people
  • Theme 2: Providing support
  • Theme 3: How the local authority ensures safety within the system
  • Theme 4: Leadership
• Evidence categories
• Pilot assessments
• Themes across all five local authority pilot areas
• CQC learning from pilots
• What we need to be able to do
• CQC next steps
• How WCC is preparing
• Readiness review
• The review team’s feedback
• Next steps

Members submitted the following questions and comments:

• A comment that people needing care didn’t always fit the system or their needs were not met, an example being where the person had the early stages of dementia. Pete Sidgwick referred to mental capacity and best interest assessments. The outcomes which people needed to achieve but which were unmet had to relate directly to a physical or mental impairment, as defined under the Care Act. There were other people who did not meet the criteria of the Care Act, but they still needed support. Mental capacity was a key area where the individual’s engagement with the assessment was important.
• Chris Bain provided context that this cohort was 7,500 of the County’s population, many whom would also receive NHS support which was assessed against different criteria. There were concerns about integration, whether this all worked for the benefit of residents, about delays and access to services. Poor communication where people did not understand what was being said to them was a particular challenge. Improving communication and the language used was linked to culture. The vast majority of a person’s contact with the NHS (90%+) was with primary care services. He asked how well it was linked into this process, so a holistic view was taken rather than looking solely at the social care aspects. Also, a need to ensure that mental health services were engaged effectively as the boundaries between services were not always clear and could overlap.
• Pete Sidgwick responded that the Integrated Care System would have an assurance process which was being developed. This would take more of a system approach and how different parts of the system would work together to meet patient needs. Ian Redfern added that this was a complex area. The pilot assessments included a specialist adviser with detailed knowledge. They ‘unpicked’ example issues helping to identify those issues resting with the NHS, with Social Care or a where a partnership approach was needed to work through them.
• Previously, data protection requirements could impede communication between agencies, but this was no longer the case and there were effective working arrangements in place. Officers confirmed the performance data which was considered by the scrutiny committees and Cabinet. This included data on the use of direct payments to support people with eligible needs. Many of the indicators were aligned to areas which the CQC would consider.

The Committee noted the presentation.