Agenda and minutes

Apologies were received on behalf of Councillor Peter Skolar

Councillor Richards Stevens has now formally replaced Councillor Sarah Hutchinson on the Committee.

None

To approve the minutes of the meetings held on 7 December 2010 (AS3a) and 20 December 2010 (AS3b) to note for information any matters arising on them.

The minutes of the meetings held on 7 December 2010 and on 20 December 2010 were agreed and signed.

10:15

The Director for Social & Community Services will give a verbal update on key issues.

The Director for Social & Community Services gave an update on:

National developments:

The Dilnott Commission on Long Term Care, originally due to report in July this year is now likely to be reporting earlier in May and so likely be available for discussion for at the June Adult Services Scrutiny Committee meeting.

The Health & Social Care Bill – Oxfordshire is an early implementer for GPs Consortia and for the Health & Wellbeing Board.  It was pointed out that there is an existing health and wellbeing body chaired by Cllr Arash Fatemian but that this will need to be modified to meet with the requirements of the new legislation.  The new Board will be across all partners although is formally the responsibility of Oxfordshire County Council to set up. The focus of the board will to be develop a local health and wellbeing strategy for Oxfordshire.

It has been confirmed that Health Overview and Scrutiny Committees are to be retained.

Clustering arrangements are now being implemented to manage the transition phase for the removal of Primary Care Trusts – for Oxfordshire this means Oxfordshire and Buckinghamshire PCTs will be combined including a single Chief Executive and management team.

And on the following:

Local issues

Proposals on Day Opportunities for Older People were positively received by Cabinet when it met in November and the strategy is currently being implemented.  It should be noted that there has been a change to tier 3 which had originally proposed that the health and wellbeing resource centres would be reduced from 8 to 7.  However, in response to feedback during consultation, this proposal has now been reversed and the Centre in Wallingford will be retained.

Transport - service and resource planning assumes that Adult Social Care will cease to fund elements of the community transport service. This is as a result of the move towards personal budgets causing uncertainty over how people will want to spend their budgets.  Further consultation is now being undertaken, and plans could involve investing in voluntary arrangements. Cabinet will be asked to make a final decision in September with proposals coming to Adult Services Scrutiny before that in June and it was agreed that the full consultation document would be available and alongside this an overview report that would be produced to give the main principles.

Carers – the new contract has been awarded to Age UK.  The County Council will be working closely with provider organisations to ensure a smooth transition for both organisations and carers.

Oxfordshire Care Partnerships – the strategy is focused on ways to circumvent people from residential care by increased reliance on domiciliary care.  The strategy also includes the development of extra care housing.  There is a Cabinet decision tabled for April and so may be brought to either the June or September meeting of Adult Services Scrutiny Committee.

Formal proposals on Internal Home Support will also be brought to the Cabinet Committee in April.

Continuing health care – a briefing on the responsibilities of the  ...  view the full minutes text for item 116/11

11:00

Contact Officer: John Jackson Director for Social & Community Services

The 2009/10 report for Oxfordshire is attached as (AS6b) along with a covering report which draws out the highlights of the CQC attached as at (AS6a). Oxfordshire is rated as performing well which means that Oxfordshire is ‘consistently delivering above the minimum standard required for people.' Both reports went to Cabinet on 25 January 2011.

These results show a significant improvement on the previous report (2008/9) where the council was assessed as performing well on 6 outcomes and as performing adequately on one outcome.

The report’s overall summary says ‘Oxfordshire County Council has had a very productive year and has achieved well on the key outcome areas. It has strong leadership and tight financial controls in place that have enabled it to deliver significant efficiency savings and a slight budget under-spend.’

As well as providing reports on individual councils, CQC provide a national report, which highlights areas of good practice. Several examples of developments in Oxfordshire are included in the national report.

This is the last year that CQC will provide an annual assessment of performance.

The Cabinet member for Adult Services and the Director of Social & Community Services will be there to answer any questions.

The Report was welcomed by the committee and in particular the improvement to the target of maintaining dignity was noted.  It was also noted that this will be the last such annual report from the CQC.  John Jackson referred to the Government view that accountability in future will be more focused around local and sector-led improvements, and in Oxfordshire local services, users and carers should be in a position to drive improvements for example through the Hearsay events, the next being due to take place later this week on 11 March.

11:15

Contact Officer – Alan Sinclair, Assistant Head of Adult Social Care (Older People and Physical Disability Services)

A report to update Scrutiny Committee on the performance, remedial action and strategy in respect of delayed transfers of care (AS7). The report provides an update to the report presented on 26 October 2010. The minute of the meeting on 26 October 2010 is attached as an annex.

The Director for Social & Community Services will present the report and Mr Sinclair and the Cabinet Member for Adult Services will also be present to answer any questions raised. 

The report was presented and attention was drawn to two graphs contained in the report which showed that delayed transfers of care had been reduced.  It was also pointed out that delayed transfers of care fall into three key groups, those due to people waiting for:

• Health care or a community hospital placement
• Social care, care home or carer package
• Both health and social care support

John Jackson explained that less than half of delays are due to social care delays and that these have been brought down from 100 to the current figure of just under 40 and the plan is to reduce these to under 20.  But also pointed out, due to the complexity of the issue, this will never be completely eradicated.

The following questions were posed by the Chairman and answers were provided by Steve Thomas [Answers in italics]:

a.   Can it be confirmed and made clear that only those who "pass" the eligibility criteria are counted.   Do people become eligible during or immediately after, their hospital treatment while still in the acute hospital.

Answer: No, the delayed transfers of care figures include those who may not have a need for onward care as it is not known at this point and also includes people who are self-funding.

b.   From when, after the doctors pronounce a person as ready for discharge, does the clock start ticking to be included as a DTOC .

Answer:  To be counted as a delay a person must be:

(i)                 medically fit to leave

(ii)               clinically stable with an agreed place to go

(iii)             safe to discharge

c.   If a patient is moved to a "holding " ward in the acute hospital, does this show as a DTOC.

Answer:  There are no holding wards in acute hospitals in Oxfordshire.

d.   Do we have a record showing how long the patients recorded as DTOC actually remain in the acute hospital.

Answer:  We do not record this information at present although could collect it in the future.

e.   Are we sure that the reporting and recording system in Oxfordshire conforms to the practices in other UK Counties.

Answer:  It is difficult to say whether the reporting and recording system are the same in Oxfordshire as elsewhere because the guidance is both convoluted and lacks detail.  There are anomalies between areas, for example delays for community hospitals are only counted for areas that have them so the figure describes the configuration of services in your area.  It is perhaps more useful to look at trends in your area over time.

f.    Do other Authorities accept a patient's refusal to move out of the acute hospital

Answer:  There are very few options in this situation save for going down a legal path which is not the policy in Oxfordshire.

There followed a discussion about the appropriate approach and focus for efforts to reduce delays.  It was AGREED that progress on the medium term strategy set out at paragraph 13 of the report should be  ...  view the full minutes text for item 118/11

11:45

Contact: Jon Ray, Acting Programme Director – Transforming Adult Social Care

This is the final report from the Transforming Adult Social Care programme (AS8).

The attached report covers the progress that has been made in achieving the agreed deliverables, the impact on clients and carers and the Council as well as the progress being made on handover of the key deliverables to business as usual.

The Cabinet Member for Adult Services and Mr Ray 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, R. Stevens, L. Sanders, L Stratford and D. Seale].

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

The report was presented by Jon Ray and summarised as looking at: where the programme is currently; what’s next, and; what is being delivered.  The Programme has delivered well against the milestones and with the Programme formally closing on 31 March it was acknowledged that there is a need to continue to work on embedding the work delivered under the Transforming Adult Social Care Programme.  Two key areas of focus were highlighted:

(i)                 IT systems need further work to ensure all processes are automated, and;

(ii)               The workforce need further support to be able to enable clients and help create choice

Although work will be done as part of business as usual there will be specific funding which is carried forward to enable the continued embedding of developments within the day to day business.

The TASC Taskforce group will continue and Martin Bradshaw will lead on this from April 2011.

Alan Sinclair confirmed that the 30% target for those people being given an opportunity to receive a personal budget by the end of March 2011 has been reached.

Adult Scrutiny Committee may decide to undertake a Review of  the Transforming Adult Social Care Programme in the future.

…

12:00

Contact Officers: Fenella Trevillion (01865) 334626, Juliet Long (01865) 334606 and Ann Nursey (01865) 323669

Ms Fenella Trevillion (Head of Joint Commissioning, Oxfordshire PCT), Ms Juliet Long (Service Development Manager – Mental Health, Oxfordshire PCT) and Ms Ann Nursey (Assistant Head of Adult Social Care – Learning Disabilities) have been invited to attend for this item to answer Members’ questions. Ms Sarah Ainsworth (Area Service Manager – Disability Lead – Children, Young People & Families) will also attend in order to answer any questions on transition issues.

The attached report provides details on the needs analysis, consultation and proposed service developments to meet the needs of people who have Asperger’s Syndrome or High Functioning Autism, and also gives an update on the implementation of the Autism Act in Oxfordshire.

Ms Kathy Erangey, the parent of a young man who has Asperger’s Syndrome, who is assisting Oxfordshire County Council and NHS Oxfordshire with the work they are doing on Asperger’s Syndrome specific service development will also attend for this item to contribute to the discussion as both a Consultant and an expert by qualification and experience.

Ms Lindsay Smith and Mr Paul Isaacs, both of whom have Asperger’s Syndrome and who are now members of the working group have also been invited to attend and comment on the report.

The report is attached at (AS9a).

The service developments for people with AS, and the broader strategy which will cover all autistic spectrum conditions, will continue to be shaped through consultation and overseen by an Autism Partnership Board that will be established by summer 2011. The first service developments resulting from the work undertaken will be in place by March 2011.

The minute of the Committee’s discussion at its April meeting is attached at (AS9b).

The Committee is invited discuss the report (AS9a), conduct a question and answer session and offer any comment.

The item was introduced by Kathy Erangey.  Nationally, the Guidance on the National Strategy for Autism was published in December 2010. Locally, a needs assessment was completed and published in autumn 2010 and that there was good engagement with the consultation process that informed this.  Key issues around low awareness within the community and the public sector were highlighted.  In particular there is a need for improved understanding on the part of GPs and the police service. 

An example of poor awareness within the police service was given by Paul Isaacs.  Recounting an experience of another service user, Paul explained how a person he was aware of who has aspergers syndrome had been picked up by the police.  The reason he was picked up was because it was thought he was out late at night acting suspiciously.  Paul told the committee that the person in question was more comfortable going out at night when there were less people about and that his behaviour was harmless and stemmed from his condition.

Plans to take things forward include autism awareness training, an Autism Partnership Board being set up that will encompass the full autism spectrum and age range, and establishing a working group to look at the care pathway and diagnosis.

Transition from school to adulthood for a person with autism and especially Aspergers Syndrome was noted as being particularly difficult and there is evidence to suggest that there is often very little support in place once a person leaves the education system.

The Committee expressed concerns about the serious nature of the issues presented particularly the lack of awareness and lack of services for people with autism and acknowledged that there is a very significant amount of work required to make the changes needed with relatively very little money.  Therefore, it was AGREED by the Adult Services Scrutiny Committee to RECOMMEND to Cabinet that they consider whether further resources and support are required to enable the successful delivery of this work.

12.45

Representatives from the Oxfordshire LINk, Adrian Chant and Dermot Roaf presented the report giving an update on recent work and news.

It was suggested that it would be good for the LINk to collaborate with the TASC Taskforce to improve opportunities to hear service user views and  take account of these in and feedback to scrutiny committee.

It was noted that plans to reduce funding for this service have been altered so that the reduction is from £200k to £150k (rather than the £100k reduction previously planned).  It was noted that the new contract for this service will have a different specification although will address mainly the same issues.

13.00

The Committee is asked to suggest items from the current Forward Plan on which it may wish to have an opportunity to offer advice to the Cabinet before any decision is taken, together with details of what it thinks could be achieved by looking at any items.

The Committee noted the information listed on the face of the agenda.

The Committee AGREED to add a review of the Transforming Adult Social Care programme to the forward plan.

The Committee will consider adding a Review of Carers Services at a later date.

It was AGREED that the implications of service and resource planning in respect of learning disability services should be brought to either the April or June meeting.

The Committee noted the information listed on the face of the agenda.

13.15