Agenda item

11:00

 

Contact Officer: Steve Thomas, Performance Information Manager, (01865) 323609

 

The 2008/09 report for Oxfordshire is attached at Annex 1 to report AS6.

 

The Cabinet considered this report on 19 January where it agreed to:

 

a)                 Receive the report;

 

b)                 Review progress on the areas for development through the quarterly monitoring of the directorate balanced scorecard.

 

The Committee will have the opportunity to question the Cabinet Member for Adult Services, together with the Director for Social & Community Services and Mr Thomas (Performance Information Manager - Social & Community Services).

 

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

(Agenda No. 6)

 

The 2008/09 report for Oxfordshire was before the Committee (Annex 1 to reportAS6).

 

The Directorate had been judged as ‘performing well’, as had 108 of the 148 authorities nationally and 18 of the 19 authorities in the South East. One third of all local authorities had been given a rating of ‘adequate’ in relation to maintaining personal dignity and respect, as had Oxfordshire.

 

Eleven areas for improvement had been identified, which was a similar number of areas to those flagged up in previous years.

 

The Cabinet had considered this report on 19 January and had agreed to review progress on the areas for development through the quarterly monitoring of the directorate balanced scorecard.

 

The Cabinet Member for Adult Services, together with the Director for Social & Community Services, Mr Paul Purnell (Head of Social Care for Adults), Mr Steve Thomas (Performance Information Manager - Social & Community Services) and Mr Hugh Ellis (Safeguarding Adults Manager) attended before the Committee in order to answer Members’ questions.

 

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

 

·          The Care Quality Commission (CQC) had stated ‘the report acknowledges an improving picture of performance in safeguarding adults in Oxfordshire, with some areas of positive performance and a clear commitment to further raising of standards’. Was this a fair summary? Had the Inspectors been looking at the possibility of things going wrong or things that had gone wrong?

 

The Inspectors had been given a hundred referrals from the previous year. From this, they had chosen eight cases to read in detail and had interviewed staff and clients and had held group interviews. The Inspectors had wanted to look at how well the cases had been dealt with and to assess whether they thought that the situation would improve. Their judgement had been that the arrangements were adequate, but that there were promising prospects for improvement. Standards were understandably very high in this category and only one local authority had been given a rating of ‘excellent’.

 

 

 

 

 

·          Why wasn’t a rating of ‘adequate’ ok for safeguarding, given the County Council’s financial situation?

 

This was a question to put to the regulator. A rating of ‘adequate’ was a reasonable benchmark. A rating of ‘performing well’ meant that an authority had added value and done extra work. Pursuing a score of ‘performing excellently’ was not that relevant to service users. Service users needed to know that the Directorate was doing well and therefore the Directorate was aiming for a future score of ‘performing well’ in terms of safeguarding.

 

·          How much would it cost to get from ‘performing adequately’ to ‘performing well’? Was money being spent wisely?  Would the Directorate be spending money to get a better performance rating when money would be best spent elsewhere?

 

Safeguarding was a national priority and was much higher on the agenda than it had been in previous years. Officers had looked for strengths and weaknesses in their existing services and had found both strengths and weaknesses. The CQC took safeguarding very seriously and was awarding harsh scores in this area. Processes that had been put in place before the Inspection had been viewed by the Inspectors as not having been in place for a sufficient amount of time. 

 

The difference between both ratings was not about money. The Dignity in Care report by Sir Michael Parkinson ‘My Year as National Dignity Ambassador’, which had been recently circulated to members of this Committee had made the point that improving dignity, respect and quality life was related to how people were treated. For example, staff not addressing older people by their first name could make a big difference to their wellbeing. It was important to share best practice in this area. 

 

·          What was meant by a safeguarding referral?

 

A referral would take place the moment that officers knew that a person might be at risk of harm in terms of abuse or neglect.

 

·          Was there any evidence of under-reporting in terms of safeguarding?

 

Yes, and this was a national problem. There had been under-referrals the previous year, but this year the number of referrals had doubled.

 

·          Under-referrals were not in the Directorate’s hands. Did officers try to promote referrals?

 

Officers trained staff to spot safeguarding issues including the Council’s partners, for example, Oxfordshire PCT and Thames Valley Police. Literature was routinely sent to all services and service users to raise awareness of what to do if there were issues.

 

·          Who should any referrals be sent to?

 

Any referrals should be sent to the Access Team who were the first point of contact and would then immediately forward them to the appropriate team. This information was on the internet and the intranet. The Access Team was also the first point of contact for children’s safeguarding issues.

 

·          Did GPs know what to do?

 

Officers were currently working with Oxfordshire PCT to ensure that this was the case. An increasing number of referrals did come from PCTs and GPs.

 

·          In relation to Outcome 1 (Improved health and emotional wellbeing) the inspection report had stated ‘the effectiveness of Oxfordshire and its NHS partners’ combined performance in achieving independence for older people through rehabilitation and intermediate care was below that of the average of similar council areas. This indicates that the council and the NHS in partnership need to be more effective in helping people achieve independence through rehabilitation and intermediate care’. What progress had been made in relation to this?

 

Officers had not agreed with all of the inspection findings and had strongly disagreed with this statement. There were more intermediate beds in Oxfordshire than in many other counties. A new indicator had been used by the Inspectorate. It was clear that the Directorate had submitted its figures on a different basis and had therefore resubmitted its figures, but they had not been permitted to resubmit. In reality, performance in achieving independence for older people through rehabilitation and intermediate care was above average. Officers wanted enablement to be the prime focus of any referral, although it would take some time to achieve this.

 

·          What were the gaps in arrangements to ensure that people who wished to die at home were effectively enabled to do so?

 

This was a very important priority for the PCT and the County Council and was being worked on. However, on average, more people were able to die at home in Oxfordshire than elsewhere. This and all of the other issues raised were in the Directorate’s action plan.

 

·          The report stated that the council had not delivered on its plan for additional extra care housing in the last year due to delays in construction and this had impacted on the number of people helped to live independently and in a better environment. What was the current situation?

 

Most of the delay had not been within the Council’s control as it had been dependent on the availability of land and work with registered social landlords and the District Councils. The Council was still intending to open 140 units by the end of this financial year.  If there was any delay it would only be by a few weeks. Builders were on site in Banbury and Bicester and officers were looking very hard at Wychwood and Chipping Norton. There was likely to be an exchange on the Chipping Norton site. The programme had been slow to get off the ground and was to some extent due to planning permission not having been agreed at the Shotover Site but was now well underway.

 

·          Why was it the case that the percentage of care management assessments leading to service provision for people was higher in 2007/08 but lower than the average for similar councils?

 

Officers’ view was that this was an indicator that assessed poor performance and was therefore not a useful indicator. The Directorate was trying to avoid giving services following an assessment, as the focus was on enabling people to remain independent in their own homes and therefore only directly intervened if people were in need of those services. Local authorities had also been asked to report how many service users received a service without needing an assessment (for example, attended a day centre) and the Council was in the top quartile for that indicator. This was even after taking into account that services that were not viewed as Council services had not been counted and the Council often signposted people to other services.

 

·         The service inspection had found that the Council’s arrangements for managing complaints and compliments needed to be strengthened. What was being done about this?

 

Work was underway in relation to this area. The main issue was the need to learn from any complaints and to record compliments. For example, comment books were available at the county’s day centres and most of the comments had been compliments but these had not been logged.

 

·        The report stated that more people who use drugs were benefitting from being in effective treatment programmes as a result of increased engagement. What were the current waiting times for drug and alcohol treatment programmes and the reasons for this?

 

Mr Thomas undertook to obtain this information from Jo Melling (Oxfordshire Drug and Alcohol Action Team (DAAT)) for circulation to the Committee.

 

·         Why were there waiting lists for people who were unable to get a place at the county’s day centres?

 

The Director for Social & Community Services undertook to look into this issue, commenting that one of the issues regarding day centres was that people had not been turning up and that the day centres were not being fully utilised.   Therefore the Directorate was looking to make savings in this area.

 

It was AGREED that the Committee would consider a report on day services for older people, together with the strategy, at its June meeting.

 

·        In terms of increased choice and control the Directorate had been awarded a rating of ‘excellent’ in 07/08 but this had dropped to ‘well’ in 08/09. How much was this a wording issue and if this wasn’t was it of concern?

 

The difference between ‘well’ and ‘excellent’ seemed quite borderline and subjective, which was why there was no point in striving for a rating of ‘excellent’. The directorate’s performance had not declined in this area. The Inspectors had said that the directorate was not at the forefront in terms of TASC. However, as stated earlier, there was no point rushing TASC, as it had to be rolled out properly.

 

Following the question and answer session, the Committee AGREED to request that a report on the rationale behind and eligibility criteria for Adult Social Care services and NHS services be circulated to all members of the Committee, as background information for future discussion on NHS Continuing Health Care.

 

Members noted that the action plan to address the areas for improvement from both the June inspection and the annual performance assessment for 2008/09 would be circulated to the Committee prior to Cabinet consideration.