Agenda item

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

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 10^th 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 reduce health inequalities 

·   Projection

·   Integrated Delivery Plan

·   Financial performance

·   Management of risk

Questions and comments were invited with responses provided as indicated:

• From resident feedback, a member viewed that the care service was failing in both performance and delivery, with boundaries being crossed. He would raise the specific concerns with the Portfolio Holder and officers outside the meeting.
• A member read an extract of the report about service demands and capacity issues impacting on service delivery and difficulties in recruiting staff. She asked if this was linked to the Council’s salary scales and whether staff were leaving for alternate employment or whether there were not suitable candidates. Shade Agboola acknowledged that both were factors with some staff leaving to join NHS organisations. There were not enough staff currently and some were attracted by larger salaries elsewhere.
• Pete Sidgwick commented on the increasing demand for adult social care services and especially residential care, to a level that was now higher than expected. In terms of recruitment and retention this was both an internal issue for the county council and impacted on external service providers too. Pay was a factor, but there were others such as the employment market. The Council did have challenges on recruitment and some staff were leaving to work for agencies, which impacted on performance. The Council had to work within its budget levels and did look to provide other incentives where it could. The Chair viewed that this position would be reflected in many councils nationally and across all services.
• Councillor Bell spoke about the impact on external service providers. As well as shortages in domiciliary care staff, it also impacted on care homes. They may have bed capacity but staffing shortages would limit the number of beds that could be occupied due to safe care ratios.
• Becky Hale referred to the national recruitment campaign for the care market and local aligned work, including recruitment support to the independent and voluntary sector. She offered to share this information with the committee, to seek members’ support in providing local publicity. The Chair asked that it be shared with the media too, to seek their promotion of these roles alongside the internal communications activity.
• A member sought more information about the increases in care placements, asking if this was linked to a lack of community support.  During the Covid pandemic, voluntary support increased exponentially, but ordinarily finding volunteers was more difficult. In other European countries there was far more reliance on voluntary support. The Chair replied that this would require a big cultural change. During the pandemic many people who were furloughed had capacity to assist as volunteers.
• Pete Sidgwick gave an update on people going into permanent care. He spoke about community support, the previous challenges around domiciliary care staffing and the data now showed that more people were going into nursing home placements. This cohort needed intense support. The reasons for this may be linked to the pandemic, but it was not clear. People went into permanent placements where their needs required it, rather than their needs could not be met elsewhere. The increases in new placements were from community settings, not acute hospital discharges. It was about an individual’s needs, not pressures elsewhere in the system. From the live performance data, the reported trajectory was continuing.
• The Chair commented that care services were also required for younger adults with complex conditions. Any person could have an incident at any point in their life which required significant care afterwards. It would be interesting to have a breakdown of the numbers for each age range who required permanent care support. She then referred to the earlier points about recruiting carers, who may not necessarily be looking after an elderly person.

Resolved

That the Committee notes the Quarter 2 organisational performance and progress against the Integrated Delivery Plan, management of finances and risk and comments as set out above.