Agenda item - Adult Social Care Improvement Plan Update

10.1 Cllr Mitchie Alexander, Cabinet Member for Communities, Equalities, Public Health, & Adult Social Care presented the report to the committee. She was joined by Genette Laws, Corporate Director for Homes and Care, and Andy Witham, Director for Commissioning & Partnerships. Cllr Alexander’s main points included:

·       The background to the Adult Social Care Improvement Plan

·       Peter Hayes, appointed by the Department of Health to oversee the section 50 notice, has recognised the improvements

·       Anticipation of the section 50 notice being reviewed in the autumn

·       Improvements in annual reviews and wait times in teams

·       45% for 25/26 annual reviews completed on time, with plans to get to 55% this year, compared to 29% at the point of inspection

·       1876 reviews needed to be completed by March 2027, needing to reach 469 by June 2026. Having reviewed 448, they were behind by 21 reviews, which they felt meant the target was achievable

·       A new waiting safely framework formalising the process across teams and giving transparent data on how long and how many people are waiting

·       A senior safety programme manager appointed for reablement

·       60% positive outcomes from reablement, with no ongoing care needed at 50% and reduced care needs at 10%

·       New categorisation for residential admissions removes cases with mental health needs from returns data, bringing the council in line with other local authorities

·       Moved from 15^th in peer group to 3^rd for residential and nursing placements for 18-64 year olds

·       Moved from 14^th to 7^th in peer group for residential and nursing placements for people aged over 65

·       Preparations for an inspection later in the year, although unconfirmed. This would now be five days rather than three days. The full process will take 19 weeks rather than 12 months.

·       Clear ratified evidence of progress against areas highlighted by the CQC

10.2 Cllr Guilmant spoke about the positives changes and moving up the league tables, he asked for information about the section 50 review and work with the Department of Health and why it was coming in the autumn, and what would move the council overall from Requires Improvement to Good. Cllr Alexander said that the section 50 review would be carried out by Peter Hayes from the Department of Health. Andy Witham spoke about the dedicated review team that were really making a difference and that this was best practice. Genette Laws said that reviews at 55% would still not be rated at good, and looking at other authorities some were at 70-75%, which is the aspiration for next year. She said that Peter Hayes was encouraged by the fact that the council recognised where work was needed and efforts focused on, which wasn’t his experience elsewhere.

10.3 Fiona England asked what flags for burnout there were for unpaid carers of children aged 18 to 24, and if emergency placements had risen as a result of assessment delays. Andy Witham said that the waiting safely framework will help identify people needing support. Genette Laws explained that assessment was initially to see if people were eligible and that these were done as quickly as possible. She said that reviews were once people were receiving a service and the aim was to do these annually. In terms of emergency placements, she said that she was not aware of any that have occurred while waiting for an assessment, and that was why the waiting safely framework was in place.

10.4 Cllr Shanks said that it was good to see improvements, spoke about the TBM reports and Adult Social Care overspends. She asked if identifying more need was meaning more spending, and that people often thought of Adult Social Care as older people but that it was also younger people, and how co-production was feeding into the review. Genette Laws said that financially they were overspending as they were making sure to meet people’s eligible needs and that meant they had more demand than in the budget. She said that the profile of working ages adults to older people was about 50/50 compared to even some of the London Boroughs were it was 60/40 in terms of 60% older people, meaning Brighton & Hove was unique in the number of people with mental health and physical disabilities and learning disabilities, which are the most expensive in terms of weekly costs. She said that they had aligned the savings and mitigations programme for the financial year with the improvement journey, including £888k for reablement and £1.2m for reviews.

10.5 Cllr Miller asked how the assessment improvements were being benchmarked, and what the KPIs were. She also asked about the prioritise actions and updates with shortfalls, such as safeguarding, governance, learning, and safe pathways. Genette Laws said that there was a monthly meeting chaired by the Director for Adult Social Care with Peter Haye from the Department of Health. She said that there is a dashboard and a team dedicated to measuring the progress in terms of delivery. She said that alongside monthly meetings there was a quarterly report to the Corporate Leadership Team. In terms of the areas mentioned she said that practice was really good and that once people were receiving a service in Brighton & Hove, the experience is broadly positive and that the issue is that it takes too long in terms of the initial assessment. Cllr Miller said that this was not reflected in the report. Genette Laws said that the issue was going to cabinet every six months and that she would ensure reports cover these areas. Andy Witham said that the focus was on the section 50 notice to get this removed but that other areas were being looked at.

10.6 Kendrick Tugwell said that it was good to see improvements. He asked how the Adult Social Care department were working with children’s services and local schools to ensure that children with complex SEND needs transitioning into adulthood are not falling through any gaps. Andy Witham spoke about the transition strategy which looks at exactly that, and that they were in the process of hiring a programme lead to lead the delivery of that strategy. He said that the transition strategy had been to scrutiny before and that it could come back with an update on progress at a later date.

10.7 Cllr McNair asked what the main reasons were for the low judgements. Genette Laws said that the reasons for the section 50 were that they were not focused on reviewing people once they were in placements, which was a decision about how staff were deployed, which was identified before the inspection and why they introduced the reviewing team. At the inspection it was at 29% but that was already increasing to 45% by the end of the inspection. In terms of waiting times for inspections, she said it was probably about not being agile enough to not only recognise there was an issue but to think about solutions. She said that she was proud of the team for trying some different ways of working in order to reduce the wait time, which has gone from months to weeks, but there was still more to do. She said the third area that has contributed is the geography of the city and affordability of affordable housing. She said that they had a relatively high number of working age adults placed outside of the city, even if it is just over the border in Shoreham. She said that in terms of inspections that would be outside of the city even though it is easy for the family to visit. For county councils with a larger footprint, they could have people even within their boundaries having to travel large distances. She said things like Brickfields would help bring working age adults back.

10.8 Cllr Guilmant spoke about financial strains on the service as it is a statutory service and asked how they were fighting against it, or if it needed national reform. Andy Witham spoke about the preventative work done to help people early on, but said that if someone had an assessed need, then they had to meet it. Genette Laws said that they needed to reflect that people were living longer and unhealthier in later years, meaning demand is becoming more complex. She spoke again about the 50/50 profile of older people and working aged people and said that an increasing number of the working age adults have co-occurring support needs, such as mental health and substance misuse issues.

10.9 Cllr McLeay asked about contingencies if the numbers needing assessments were to rise. Genette Laws said that they carried out forecasting and scenario planning every year in the budget. She said that they wanted to get preventative measures better and where there was preventative need how to support it in a timely way. Andy Witham said that the development of the reablement offer focuses a lot on hospital discharges but is shifting to those who come through the front door.

10.10 Dr Anusree Biswas said that it was good to see the positive trajectory of improvements and welcomed the launch of the waiting safely framework. She asked what framework was used or people to qualify for the list and how it was prioritised. Genette Laws said that it was not so much that people qualified for the list, but that the team were looking through the case details of each person waiting to understand if there were any risks that would require a phone call to check in on them. She said that they took case notes with details of the issues that people were waiting for in terms of assessment, and that they looked at everyone who was waiting. The focus of the phone calls was those where they think there are risks but that everyone got called.

10.11 Cllr Miller spoke about prevention and reablement, including her experience of reablement following a stroke. She said that because she hadn’t had physio which would have prevented a problem with her scoliosis, she suffered a slipped disk and had to have private physio which she could afford, but that many could not do so. She also spoke of the need to improve pavements and encourage people to be more active and not driving so much. Genette Laws said that Brighton & Hove was one of the least inactive cities in the country. She said that there was more to do for those who are inactive and more to do to help people make more healthy lifestyle choices.

10.12 Fiona England said that adults with learning disabilities die 15 years earlier than the rest of the population. She said that transition planning was key and wanted all areas of the council to work together focusing on what is available for young people with learning disabilities as they deserve healthy and active lifestyles. Genette Laws agreed that the Transition Strategy needed to be the anchor in which they thought about the outcomes and the life chances of those young people with disabilities. She said that dentistry and good oral care was vital to a healthy life. She said that she hoped the next time the Transition Strategy came back to committee that it was less focused on process and more on outcomes and impact.

10.13 Cllr Mackey said that she was pleased that progress was being made and asked about the process of involvement of families. Andy Witham said that they used various methods of capturing resident voices such as Health Watch and annual surveys to all users and carers. He said that when designing services, such as Brickfields, they involved service users in the design.

10.14 Cllr Winder asked about the difficulties of predicting demand and what planned interventions would help with this. She also asked about the importance of health hubs and how they would encourage socialisation and keeping residents active, as well as saving the council money. Genette Laws said that broadly the idea for health hubs was to bring health closer to where people where so that they could engage and do more self-care, which would help in the long term. She said that in terms of interventions they had the Better Care Fund which helps to pull not just resources together but knowledge and planning to response to the needs of residents in the city. She said that regarding forecasting they did have modelling that helps to anticipate what the numbers would be and that for the coming year they would include the impact of the reablement offer and more timely reviews. Andy Witham said that they have developed the integrated community teams, which are health lead teams involving social work teams, to bring support and services closer to people in their communities. He said that some of the strategies were cross cutting and city-wide strategies such as the Learning Disability Strategy and the Autism Strategy, which in the long run would help the council to help those individuals.

10.15 RESOLVED – People Overview & Scrutiny Committee notes the progress of the Adult Social Care Improvement Plan.