Agenda and minutes

Councillor Stewart Lilly attended in place of Councillor Anthony Gearing.

Councillor David Wilmshurst declared a personal interest at Agenda Item 7 by virtue of being on the Management Committee of Chinnor Community Centre which runs a day centre three times a week.

To approve the minutes of the meeting held on 8 June 2010 (AS3) and to note for information any matters arising on them.

The minutes of the meeting held on 8 June 2010 were approved and signed.

Mr Dermot Roaf, Chair of the Oxon LINk Stewardship Group, addressed the Committee on behalf of the Stewardship Group at Agenda Item 8.

10:30

Contact: Alan Sinclair, Programme Director – Transforming Adult Social Care (01865) 323665

It has been agreed that a report on transforming Adult Social Care will be brought to every meeting of this Committee (AS5) and will include detail on self directed support.

The above report includes a short update on progress in relation to the policy for the operation of personal budgets for Adult Social Care in Oxfordshire (the Resource Allocation Policy), together with the Quarterly Milestones self assessment report (Refer Annex 1).

Mr Sinclair will attend to answer any questions the Committee may wish to ask.

The Self Directed Support Task Group is also invited to give its progress update to the Committee as part of this item.

[Task Group comprises Councillors J. Hannaby, S. Hutchinson & L. Sanders].

The Committee is invited to track progress and conduct a question and answer session.

The report before the Committee (AS5) included a short update on progress in relation to the policy for the operation of personal budgets for Adult Social Care in Oxfordshire (the Resource Allocation Policy), together with the Quarterly Milestones self assessment report (Annex 1).

Mr Alan Sinclair (Programme Director – Transforming Adult Social Care) attended before the Committee, together with the Cabinet Member for Adult Services, in order to answer any questions which the Committee wished to ask.

The Committee noted the update from Mr Sinclair as detailed in report AS5.

Mr Sinclair reported as follows:

In relation to Social Capital/Community Building the work undertaken by the Institute of Public Care was now completed and a revised approach would be taken in this area. A document had been produced which identified characteristics where communities were and were not supporting people well and the Directorate wanted to devise a checklist based on this evidence for communities to use.

Issues challenging TASC were:

• transferring existing long term service users (c 3000) to personal budgets by April 2010. There was a large number of people to be transferred, all of whom would need reviewing and  were likely to  be given a smaller budget than the current cost of the services they were receiving (although it was anticipated that they will be able to purchase services more cheaply in future);
• revamping the ICT system – this is the area of TASC where the least progress was being made. The required capital investment was still to be confirmed in the current financial climate, which was appropriate given the circumstances. (Capital investment was agreed shortly after this meeting);
• officers were struggling with implementing the workforce strategy. However, they were right to stall, as this too needed to be re-examined in light of less money.

The Committee then conducted a question and answer session. A selection of the Committee’s questions, together with Mr Sinclair’s responses, is listed below:

• In relation to Milestone 3: Prevention and cost effective services – the document states that by April 2011 there should be evidence that cashable savings have been released as a result of the preventative strategies and that overall, social care has delivered a minimum of 3% cashable savings. The likelihood of achieving the milestone by this date has been assessed as ‘fairly likely’. Surely this should say ‘very unlikely’, won’t it take years to be quantifiable?

The overall impact will be longer term, but we need a system where we can record soon that an intervention has led to an outcome and to a reduction in expenditure. In terms of falls prevention and continence services, work here has an immediate outcome and payback. Careful monitoring needs to take place so that we can see where the financial savings occur.

• How fundamental is a properly functioning ICT system for self directed support – such as assessments and record keeping – surely this must be dependent on a properly functioning system? When are you going to get it and what are you  ...  view the full minutes text for item 79/10

The Committee is invited to receive the update from the Oxfordshire LINk.

The Committee noted the Oxfordshire LINk update (AS6(a)) which was given by Mr Chant (Help & Care). The current work plan would run for the final 7 months of the contract with Help & Care, which would end in March 2011. Staff were still collecting and scoping issues that would be on the table into 2011. Discussions would take place in the autumn regarding the transition year before Healthwatch came into being in April 2012.  

Ms Sue Butterworth and Mr John Hutchinson will represent the LINk Stewardship Group for this item.

The Committee is invited to receive the interim report from the LINk research project relating to Self Directed Support.

The Committee noted the Interim report for the LINk research project relating to self directed support (AS6(b)) which was presented by Mr Hutchison and Mrs Butterworth (Oxfordshire LINk). The Group had difficulty in finding enough people receiving self directed support to come forward – even using the council’s contacts – and was only able to interact with 4 people receiving self directed support, one of whom was using a personal budget, the rest of whom were using traditional services. The report before the Committee today was an interim report. Despite this, very useful comments were coming forward and a full report would be provided to this Committee’s October meeting.

The Committee is invited to receive the annual report and conduct a question and answer session.

The Committee noted the Oxfordshire LINk Annual Report (AS6(c)), which was presented by Mr Chant. Development work was needed to recruit a more diverse group of people to the Oxon LINk. Work was underway to try to engage with unrepresented communities. The subgroups had connections with user led organisations and smaller organisations. The development officers had been working hard to increase diversity and officers had been recruiting a wider range of participants to take forward the three health projects: GP appointments - extended hours, Podiatry Services and Community Mental Health - access to Psychological Therapy services.

11:20

Contact Officer: John Jackson – Director for Social & Community Services, tel (01865) 323574

The Director for Social & Community Services will give a presentation on the proposals on Day Services for Older People.

The Cabinet Member for Adult Services will also attend for this agenda item to answer Members’ questions.

The Committee is invited to comment on the proposals.

The Director for Social & Community Services, together with the Cabinet Member for Adult Services and Mr Andrew Colling (Service Manager Contracts – Social & Community Services) attended before the Committee for this item.

The Director for Social & Community Services gave a presentation on the proposals for the Strategic Commissioning Framework for Day Opportunities for Older People, a copy of which is appended to these Minutes and to the signed Minutes.

The Committee noted that:

·        the commissioning proposals for the Resource and Wellbeing Centres (RWBCs) were not asking for a lower quality or level of service than that currently provided and therefore asking for expressions of interest should not lead to worse outcomes;

·        there were differing views between current users of the RWBCs and people receiving a personal budget;

·        there had been no opposition to the proposal that Tier 2 services be based on the 14 ‘Closer to Communities’ locality areas (based on the market towns);

·        stakeholder feedback was that the county council did not necessarily need to provide transport, but that transport did need to be provided (eg by volunteers);

·        transport was still a contentious issue:

o       The Director for Social & Community Services was not convinced that value for money was being obtained from existing transport services, and did not see transport provision as a core function of Social & Community Services;

o       however, the Transport Advisor pilot scheme was proving successful (Oxfordshire Travel Advice Line, 01865 323738, oxtail@oxfordshire.gov.uk. This service provides free impartial journey planning and advice for people aged over 65 and those with a high level of support needs and is also able to provide information on joining a transport scheme as a volunteer, and promote relevant services);

o       many people would not volunteer to perform intimate tasks, but would volunteer for cleaning, house help and driving.

The Committee then asked a number of questions.

The Director for Social & Community Services undertook to provide information to all members of the Committee on how many of the Council’s vehicles are specialist vehicles and whether they can also be used for other purposes.

The Cabinet Member for Adult Services undertook to provide written responses to the Committee’s more detailed questions, as listed below:

·        What happens to Centres if they do not generate sufficient income?

·        How can we encourage youth/inter-generational work?

·        Please advise on Volunteer Driver Insurance.

·        How do we intend to support people to access transport?

The Committee then AGREED to advise the Director for Social & Community Services as follows:

Service Provision

This Committee:

• notes current service users’ appreciation of the Council’s Resource and Wellbeing Centres (RWBCs) and their wish for the Council to continue to run them; whilst recognising that because evidence suggests that people with personal budgets choose alternatives to traditional day services it is necessary for the Directorate to put the RWBCs out to tender to ensure that they are well placed to attract people with personal budgets in order to generate sufficient income to be sustainable;
• endorses the Directorate’s intention to market-test services, as a  ...  view the full minutes text for item 81/10

12:10

Contact Officer: John Jackson, Director for Social & Community Services, Tel (01865) 323574

The NHS White Paper ‘Equity and Excellence: Liberating the NHS’, sets out the government's long-term vision for the future of the NHS. The vision builds on the core values and principles of the NHS - a comprehensive service, available to all, free at the point of use, based on need, not ability to pay.

It sets out how the government intends to:

• put patients at the heart of everything the NHS does;
• focus on continuously improving those things that really matter to patients - the outcome of their healthcare; and
• empower and liberate clinicians to innovate, with the freedom to focus on improving healthcare services.

The Department of Health is consulting on elements of these proposals.

In particular, the Department would welcome comments on the implementation of the proposals requiring primary legislation, and will publish a response to the views raised on the White Paper and the associated papers, prior to the introduction of the Bill.

A full copy of the White Paper can be viewed by clicking on the link below or by going on to the Department of Health Web site:

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_117353

Copies of the ensuing consultation documents can also be found on the Department of Health Web site:

• Liberating the NHS: Increasing democratic legitimacy in health

• Liberating the NHS: commissioning for patients – consultation on proposal

Hard copies of all of the above documents have been circulated to all members of the Committee and placed on public deposit.

A paper setting out issues and points for discussion is attached at AS8 - to follow.

The Director for Social & Community Services, accompanied by the Cabinet Member for Adult Services, Ms Sonia Mills (Chief Executive – NHS Oxfordshire)and Dr Jonathan McWilliam (Director of Public    Health) will attend for this item in order to answer any questions which the Committee may wish to ask.

The Committee will consider the changes in light of:

(1)   Public Health

(2)   Democratic Accountability  

(3)   Adult Social Care including integration with health.

The views of this Committee will be taken into account in considering what response the Cabinet will make to the White Paper.

The Committee is invited to discuss its views on the consultation questions and to forward its comments to the Oxfordshire Joint Health Overview and Scrutiny Committee.

13:10 – 13:40  SANDWICH LUNCH

The Committee had been provided with copies of the NHS White Paper ‘Equity and Excellence: Liberating the NHS’, together with the following consultation documents: Liberating the NHS: Increasing democratic legitimacy in health and Liberating the NHS: commissioning for patients – consultation on proposal. The Department of Health was consulting on elements of the proposals and welcomed comments on the implementation of the proposals requiring primary legislation. A response to the views raised on the White Paper and associated papers would be published prior to the introduction of the Bill.

The Committee had before it the following papers:

·        Public Health in Oxfordshire: Implications of the Coalition Government’s Plans

·        Health White Paper - Implications for Adult Social Care (report by Director for Social & Community Services)

·        The NHS White Paper (report by Health Scrutiny Review Officer)

·        Local Democratic Legitimacy in Health (report by Health Scrutiny Review Officer).

and was asked to consider the changes in light of:

·        Public Health

·        Democratic Accountability

·        Adult Social Care including integration with Health.

The Director for Social & Community Services, together with the Cabinet Member for Adult Services, Dr Jonathan McWilliam (Director of Public Health) and Ms Sonia Mills (Chief Executive – NHS Oxfordshire) attended before the Committee in order to discuss issues arising from the White Paper and to answer the Committee’s questions.

Mr Dermot Roaf, Chair of the Oxon LINk Stewardship Group, addressed the Committee on behalf of the Stewardship Group, drawing the Committee’s attention to the points set out on the schedule of addenda as listed below:

The Oxfordshire LINk (Local Information Network) succeeded (in 2008) the former Patient Forums and the even more former Community Health Council as a way in which the public could comment on local health and social care.  It consists of about 650 members of the public who have registered an interest - of whom eight elected volunteers form a "Stewardship Group" to co-ordinate responses to their concerns.  The County Council appointed Help and Care of Bournemouth to develop the LINk and support the volunteers from August 2008 to March 2011.  The LINk has certain statutory powers to require commissioners and providers of health and social care to answer questions and allow visits.  It does not deal with individual complaints. It has reported on matters of concern to the Health Trusts, to Social Services and to the two Scrutiny committees.  I am the Chair of the Stewardship Group and have been discussing the White Paper with other Chairs in the South East. I am speaking on behalf of the Stewardship Group; the wider membership has not been consulted and Help and Care may well have different views.

The White Paper proposes that the LINk be transformed into a local "HealthWatch" in 2012 with similar duties, except that the County Council can, if it wishes, commission advocacy and other help for individuals and their complaints. The HealthWatch would be set up by and accountable to the County Council and would also be accountable to a national quango "HealthWatch England".

The Stewardship  ...  view the full minutes text for item 82/10

13:40

The Director for Social & Community Services will give an oral update on key issues.

The Committee noted the update from the Director for Social & Community Services as listed below:

National level

·        The NHS White Paper (Refer previous agenda item);

·        The government’s spending review – submissions for efficiency savings had been made by each department (these were not public) and directorate. The Director for Social & Community Services had been working on the adult social care submission which would be approved by the Local Government Association Executive on 16 September;

·        Funding of long term adult social care – the government had now come forward with proposals to look at funding – the Commission had a quite broad terms of reference and was due to report next summer. There would then be a White Paper on adult social care in 2011;

·        Support for younger adults with disabilities – decisions had been made in March to cut back on the Independent Living Fund which awards payments directly to people with disabilities to support the cost of their personal care and/or domestic assistance. The government had also increased the amount that local authorities must contribute to support packages to £340 per week which was causing pressures for adult social care. The Director for Social & Community Services stated that he had just received a letter from the Department for Health which stated that the funding might be transferred to social services. New applicants would not be entitled to any funding. Discussions with the Association of Directors of Adult Social Services (ADASS) had not yet taken place. Adult Social Care was quite heavily dependent on such benefits and Supporting People funding, as well as other funding.

Local Level

·        Internal Home Support Service– the future of this was a challenging issue. Discussions with staff would need to take place. There was a very good internal work force but people with personal budgets could choose where to go to for care. The Resource Allocation Policy assumed an hourly rate of £15 per hour for home care. This was in line with the average rate. Some local authorities in the South East paid £12 per hour. The cost of employing a home support worker was currently £11 per hour. The Directorate were going to market to get providers would provide services for £15 per hour.

·        Carers’ Strategy– the Directorate had been heavily involved with a number of different forums regarding carers’ issues and the Director had recently spoken to a large group of carers about their issues. It was important to emphasise that the changes in service provision for carers was not being driven by the need to make efficiency savings but about enabling people to look after themselves and to reach a much larger number of carers. Although some people did heavily use the carers’ centres, they were only being used by approximately 15% of carers in Oxfordshire and money was being spent on buildings and infrastructure which could be better invested elsewhere. The key point was the need to reach more people and better advertise existing services to them. The  ...  view the full minutes text for item 83/10

14:40

                  Contact Officer: John Jackson – Director for Social & Community Services, tel (01865) 323574

                  The Director will give a presentation to the Committee which will provide a high level overview of the services provided by the Directorate and the challenges which will need to be addressed to meet the target.

                  The Committee is invited to receive a presentation from the Director.

The Director for Social & Community Services gave a presentation to the Committee which provided a high level overview of the services provided by the Directorate and the challenges which would need to be addressed to meet the savings target. A copy of the presentation is appended to these Minutes and to the signed Minutes.

With regard to the finer detail on the slides, the Committee noted that ‘Income’ was the money paid by non-eligible service users and that the gross spend on Supporting People was not from the Directorate’s budget as the Director was not the decision maker (it is wholly grant funded and overseen by the Commissioning Body). However, a significant amount of Supporting People money funded services in Adult Social Care, for example, a £5m contribution to Learning Disability Services. There was limited scope to increase the Directorate’s income although there would be increased charges for home support and day services. The major demographic pressures were coming from older people and the increasing number of young people with a profound disability reaching adulthood and living for longer.

The key point was that the county council needs to find £200m from its non-school budgets (£500m) which is 40% of the budget. All services need to look at how they can contribute to this. However, it would be important to protect those areas of spending which will cost the County Council more money in the longer term if they are reduced in the short term (eg support for carers). The government spending review would report on 20 October and more information would be released late November/early December.

The Committee noted that there was a statutory requirement to meet eligible care needs but that the Directorate has discretion regarding how to meet those needs. The Directorate faced significant challenges in making further efficiency savings but would be focusing on prevention and early intervention to limit the need for social care and therefore save money, ensuring that there were still sufficient resources to deal with safeguarding and other crises and using the remaining resources on those with the greatest needs.

A member of the Committee expressed her concern regarding the drop in the amount of money the Directorate was contributing towards residential care home fees (reduced by £25 a week), and the possible impact on safety, adding that constituents had already told her that they would either have to pay the top up fee or take their relative(s) out of the home.

The Director responded that the Contracts Team carefully monitored safety and if a home received a poor rating from the Care Quality Commission the Directorate treated it as a safeguarding issue. However, there did not appear to be a correlation between the amount of money charged by a home and the quality of a home. Reducing fees for residential care for older people was a difficult issue as there were limits as to how far prices could be squeezed. Keeping people in their own homes or moving into a different  ...  view the full minutes text for item 84/10

15:10

Items logged for future meetings are listed below:

26 October 2010

• Dementia Strategy – progress update.

• Telecare – Q&A and report.

• Delayed Transfers of Care – Q&A

• Report on Transforming Adult Social Care including Task Group update

• LINk research report into personalised budgets

• LINk update

7 December 2010

• Services for Adults on the Autistic Spectrum – ongoing – including draft report to be used as the basis for the Outline Commissioning Strategy.

• Report on Transforming Adult Social Care including Task Group update

• LINk update

The Committee is asked to consider if there are any items they may wish to have presentations about in the future  or any items that they may wish to include in future agendas.

The Committee noted the following items logged for future meetings are listed below:

26 October 2010

• Delayed Transfers of Care– Q&A

• Report on Transforming Adult Social Care including Task Group update

• LINk research report into personalised budgets

• LINk update

7 December 2010

• Services for Adults on the Autistic Spectrum– ongoing – including draft report to be used as the basis for the Outline Commissioning Strategy.

• Dementia Strategy – progress update

• Report on Transforming Adult Social Care including Task Group update

• LINk update

Councillor L. Sanders undertook to provide a ½ page summary on case law surrounding the application of NHS Continuing Health Care to all members of the Committee.

Councillor Wilmshurst drew the Committee’s attention to uncollected income for fairer charging which was being addressed, and also monitored by a working group under the Audit Committee.

15:20

The Committee is asked to note any items in the current version of the Forward Plan which covers the time period September to December 2010.

No items were identified for consideration.