Agenda item

The Health and Wellbeing Board is asked to consider and comment upon the programme of work underway to support Adult Social Care Reform in Warwickshire.

The Health and Wellbeing Board received a presentation from Pete Sidgwick, Assistant Director for Adult Social Care. This summarised the current requirements and progress to deliver adult social care reform in Warwickshire with a focus on the care cap, Fair Cost of Care (FCoC) and Care Quality Commission (CQC) oversight.  Health and social care integration was not a focus for this presentation but remained a priority, as evidenced through the joint working and development of the Coventry and Warwickshire Integrated Care System.

The work programme provided a consolidated and joined up response to the objectives, key features and requirements of Government policies/white papers relating to adult social care reforms: 

·       Build-back-better: Our plan for health and social care Sept 21 & Jan 2022 update 

·       "People at the heart of care" adult social care reform white paper 

·       Market Sustainability and Fair Cost of Care Fund

·       Health and Care Integration - Joining up care for people, places and populations  

The presentation expanded on the key messages with slides on:

·       Adult Social Care Government Policy Reforms

·       General points:

o   High level ‘indications’ lacking detail

o   Multiple aspirations being articulated amongst requirements

o   A landscape which doesn’t keep to timescales

o   Lots of national, regional and local ‘views’

o   A number of significant financial implications within the reforms without the clarity on funding streams

o   Questions if the pace of delivery is realistic

·       The overarching approach and officer leads.

·       CQC oversight (People at the Heart of Care)

·       Cost of Care Cap (Build Back Better)

Debate took place on the following areas:

·       The Chair recognised the considerable work underway to respond to these changes and significant implications of them.

·       Points about packages of care following hospital discharge. The benefits of rehabilitation in step-down care and ensuring that all required equipment was provided in a timely way, as this benefitted patients significantly. It was confirmed that the County Council administered the discharge to assess pathway on behalf of health and the approach taken was considered to be correct, with support out of hospital. The involvement of the CQC was also considered to be the right thing to do with regulation likely to drive improvements, hearing the customer voice and a focus on carers. There had been a step change in hospital discharge, and it was expected that the number of people being supported would increase. The challenges would remain going into the winter period.

·       A request for regular information to be provided to the County Council Network (CCN) and Local Government Association (LGA). The CCN was considering this area in detail. The proposed timescales were considered to be unrealistic with delays being sought, not least due to government ministerial changes. The cost elements were raised and potential impact for care home viability questioned. There was variance amongst local authorities of the percentage costs being used and submitted to the government as part of this process. It was confirmed there was a continuous dialogue and information sharing took place with the CCN, LGA and County Council Treasurers. The challenges around timescales were significant as were the financial aspects. There was a loss of income for the Council and some of the projections did not stack up, so the funding aspects needed to be addressed. There was a need for the FCoC and the care cap would have a positive impact for the care market.

·       A discussion about the CQC involvement, variance in interpretation of the Care Act requirements and especially record keeping. It was questioned if an additional IT system would be needed and if there was potential to collaborate with others. Interpretation of Care Act compliance was tested through the courts and the Ombudsman. The customer aspects were less easy, but it was unlikely there would be a uniform approach. On record keeping this would be a challenge for the CQC, due to the different ways data was collected. These could use a strength based, tick box or conversation approach. It was more about the ‘so what’ question and the impact to ensure needs were identified and met. There was a need for metrics but also a supporting narrative to explain the data. A standardised approach was unlikely, but it was for local authorities to demonstrate the good work taking place and the challenges faced. There may be additional IT system needs for the Care Cap aspects. If additional time was granted perhaps a national system could be developed which would be beneficial as this was a complex area.

·       A question about the recruitment and training of additional care workers. WCC did support the market on recruitment campaigns, training and development. Having a buoyant domiciliary care market was a key factor. The FCoC would provide additional grants and ensuring correct pay rates would be important. Further points about the perceptions of care work and the success stories of progression to other roles and services.

·       Nigel Minns added that a comprehensive report was considered at the Adult Social Care and Health Overview and Scrutiny Committee in June, which could be shared.

In closing the item, the Chair asked for periodic updates by briefing note.

Resolved

That Health and Wellbeing Board notes the programme of work underway to support Adult Social Care Reform in Warwickshire.