Agenda item

14:15

Contact Officer: 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 each meeting of this Committee and will include detail on self directed support.

A progress report on Transforming Adult Social Care is attached (AS7(a)). The new National Progress Measures and Draft Terms of Reference for the Programme Assurance Group are appended to the report (Annex 1 and Annex 2).

As part of the work on Transforming Adult Social Care, the Directorate is looking to set up a working group to help ensure that the programme is delivering against its expected outcomes and timescales. This function is called programme assurance and acts as an insurance policy for the programme board. A wide range of stakeholders are sought to join this group, including Councillor representation.

The details of how the group will operate, including initial terms of reference and the time commitment required will be agreed by the group when it first meets.

Existing Members of the Self Directed Support Task Group who sit on this Committee may wish to put themselves forward as may any other members of this Committee.

The Self Directed Support Learning Exercise Evaluation is attached at AS7(b) – comprising a short summary, executive summary and full report.

Mr Sinclair will attend to provide the update and to answer the Committee’s questions, accompanied by the Cabinet Member for Adult Services. 

Mr Sinclair will begin this item by summarising progress on Transforming Adult Social Care and will then focus on the officer evaluation of the self directed support learning exercise.

The Committee is invited to:

·                    track progress on the whole of Transforming Adult Social Care;

·                    conduct a question and answer session on the Officer Evaluation of the Self Directed Support Learning Exercise;

·                    offer comment to the Directorate on both of the above, if necessary; and

·                    nominate one Member to join the Transforming Adult Social Care Programme Assurance Working Group.

The Committee had before it:

·        a progress report on Transforming Adult Social Care (TASC) (AS7(a));

·        the new National Progress Measures and Draft Terms of Reference for the Programme Assurance Group (Annexes 1 and 2 to AS7(a));

·        the Self Directed Support Learning Exercise Evaluation Report (AS7(b)), (short summary, executive summary and full report).

Mr Alan Sinclair (Programme Director – Transforming Adult Social Care), Mr Martin Bradshaw (Assistant Head of Service – Reshaping the Supply Market), Mr Nick Horn (Assistant Project Manager – TASC Programme) and Mr Jon Ray (Senior Project Manager – Strategy and Transformation) attended before the Committee in order to answer Member’s questions on the evaluation of the Self Directed Support Learning Exercise.

Mr Sinclair summarised progress in relation to the Transformation of Adult Social Care.  In response to a question from the Committee, Mr Sinclair stated that although progress was slower overall than originally intended, it was important not to rush many of the activities and it had been difficult to align numerous different tasks throughout the Council. However, as the overall budget for Adult Social Care was dependent on the successful delivery of TASC, it would be necessary to continually monitor adherence to the timescale for the delivery of the project milestones.

The Committee also noted that as part of the work on Transforming Adult Social Care, the Directorate was also looking to set up a working group to help to ensure that the programme was delivering against its expected outcomes and timescales. This function (programme assurance) would act as an insurance policy for the programme board. A wide range of stakeholders were sought to join this group, including Councillor representation.

Mr Sinclair then drew the Committee’s attention to the evaluation highlights from the Self Directed Support Learning Exercise, notable successes and areas for improvement, as detailed in the report.

Support brokerage had worked well, clients had spent 9% less of their personal allocation than anticipated (the national pilot figure was 8%) and the cost of external home support was lower than that of internal home support. Eleven out of the thirty three people who had chosen a direct payment had used it to purchase a personal assistant rather than to arrange care through an agency, which had worked out at approximately £12 - £15 per hour, as compared to £20 per hour for Council services. Although questionnaires and interviews had been based on a low number of people (those 55 people who at the end of August had support plans in place), the findings were in line with the national pilots and results from other local authorities.

Areas where improvement was needed were also detailed in the report, including an acknowledgement that the interim IT arrangements that were in place were sufficient to manage the current level of clients, but that once the project was implemented, would not be able to cope with the increased numbers and data. The emphasis in the systems review would be to ensure that IT systems and processes were fit for purpose to deliver self directed support. However, it had been necessary to specify the processes that would need to be put in place before this could be done and officers needed to see if the new SWIFT model could deliver what was needed. Overall the areas for improvement were slower and less than expected, largely as a result of having imposed a new business model onto an existing system and it was the structure of the organisation and the systems that were now being reviewed.

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

·        Could detail please be provided in relation to the fast track assessments?

The accelerated review programme for older people was in response to both the major overspend on the older people’s pooled budget and government directive.Priority service users would be reviewed between now and the end of the financial year, with the aim of reducing the amount of support given to them based on the Fair Access criteria.A number of people were receiving more support than they needed and as they were being reviewed and re-assessed would be moved onto self directed support, at the same time offering people more choice and control on how their needs could be met. It was timely to get people onto self directed support now in light of the reviews rather than to wait another six months before this was done. This would bring forward the introduction of self directed support county wide six months earlier than originally anticipated.

·        What training would be delivered to personal assistants (PAs) and how would this be funded?

PAs mostly work for themselves and are not subject to regulation. This was a risk.

However, the Council had introduced the ‘Support with Confidence’ Scheme to give service users and their families an assurance when purchasing non-regulated support services that PAs registered with the scheme had been vetted, including CRB checks, independent safeguarding processes, references and nearly all of the processes that County Council employees and contracted providers of services were subject to. Any complaints would be investigated and the PA would be removed from the scheme if necessary.

This scheme was being strongly encouraged and promoted, especially with the registered brokers.

The Council was paying for the CRB checks and the training and PAs would be hosted by local authorities and other organisations until work was available for them. It wasn’t known whether there would be job transfers from existing home support workers, as although PA work was more lucrative it was less stable at the moment.

Given the cost of training a PA (£1000 for each PA to go through the system), officers were keen not to recruit them until demand for self directed support had picked up. To do so before then would run the risk of losing them to other employers. Eight PAs were currently going through the application process.

• How could the Council ensure that PAs not on the scheme were sufficiently trained?

It was not a mandatory scheme. Family members, friends and neighbours would not be required to undergo training. If an agency provided a PA then they would have to be registered. However, there is no current obligation for PAs to be registered. The Council is keen to ensure that the Support with Confidence PA scheme is promoted and that people use this service.

• Would money for training be added to personal budgets?

Over time training costs would come out of personal budgets. If a PA had not already been trained then the resource allocation would need to take this into account.

·        How could an elderly and possibly confused person be expected to employ a PA?

Officers recognised that they were less likely to be a direct employer especially if mentally incapacitated and they would receive contracted or directly provided home support or a trusted person could employ on their behalf.

·        How could the Council avoid being “unfair” when reassessing people when it already had an outcome in mind?

Colleagues undertaking the reviews would be targeting those people whom they believed to be in receipt of more services than necessary or who had not been identified as high risk. For example, some conditions changed over time. There was also the possibility that some people would be found in need of additional support. People had already been identified in terms of risk as a result of flu pandemic planning assessments.

Following the question and answer session the Committee AGREED:

• that it was generally satisfied with the findings of the Self Directed Support Learning Exercise;

• that the Self Directed Support Task Group should continue, in order to monitor the rollout and operation of Self Directed Support, including the robustness of IT systems, the internal restructure and the accelerated review programme;
• to continue to monitor the Transformation of Adult Social Care at each meeting; and
• to nominate Councillor Don Seale as the Councillor representative on the Transforming Adult Social Care Programme Assurance Working Group and Councillor Larry Sanders as his Deputy/Substitute.