Agenda item

11:30

The Director for Social and Community Services will give an update on current local and national issues followed by an opportunity for the Committee to ask questions.

This will include discussion of the actions in place to reduce the number of adult social care clients using care homes, and progress on proposals for the Oxfordshire Care Partnership.

The Cabinet Member for Adult Services will also attend for this item.

The director gave a verbal update on developments at national and local levels. The content is summarised below.

National

Commission on the Funding of Care and Support

On 4th July, the Commission published its proposals for the funding of adult social care.  They would involve a very radical change in the funding of adult social care.  The key recommendations are as follows:

·         Individuals’ lifetime contributions towards their social care costs – which are currently potentially unlimited – should be capped.  After the cap is reached, individuals would be eligible for full state support.  This cap should be between £25,000 and £50,000. The Commission considered that £35,000 is the most appropriate and fair figure;

·         The means-tested threshold, above which people are liable for their full care costs, should be increased from £23,250 to £100,000;

·         National eligibility criteria and portable assessments should be introduced to ensure greater consistency; and

·         All those who enter adulthood with a care and support need should be eligible for free state support immediately rather than being subjected to a means test.

The Commission estimate that the cost of its proposals - based on a cap of £35,000 - would cost about £1.7 billion.

There was widespread support for the proposals. It is understood that the Department of Health is planning to carry out widespread consultation on the proposals during the autumn.  The response will be reflected in a White Paper on Adult Social Care which will be published next spring.

Andrew Dilnot will be invited to address the committee on the proposals and their potential impact on Oxfordshire. A presentation on the proposals is attached (AS7)

NHS Changes

·        The NHS has announced that SHAs would be clustered with one SHA covering the whole of southern England (from Cornwall to Kent).  Sir Ian Carruthers (current Chief Executive of the South West SHA) has been appointed as Chief Executive.  Geoff Harris, currently Chairman of South Central, has been appointed as Chairman.

·        Locally, Sonia Mills has announced that she is to step down from her role as Chief Executive of the Oxfordshire and Buckinghamshire Cluster PCT.  This will take place on 7^th November.  The PCT are in the process of finding a successor.

Local Developments

Southern Cross

·        The announcement was made on July 11^th 2011 that landlords were withdrawing from the Southern Cross group. Therefore the operation of Southern Cross homes will transfer to other care providers.

·        The County Council has been monitoring the situation through ADASS information, contact with other local authorities and regular meetings and telephone contact with Southern Cross managers.

·        The County Council is currently purchasing 105 beds out of the 225 beds in the 6 Southern Cross homes in Oxfordshire.  We understand that the landlord for two of the homes is NHP, that 3 are owned by PHF(Four Seasons) and the sixth by London & Oxford Estates. 

·        The latest information from Southern Cross is that transfer of its 752 care homes is underway and is expected to be complete by the end of October.

·        Staff consultation under TUPE regulations is underway and the management, staffing and operation of the homes is intended to remain unchanged during the transfer. 

·        Contracts already in place between Local Authorities and Southern Cross will be transferred on existing terms and conditions 

·        CQC registration is being sought by the new operators.

·        Four Seasons will operate the 3 Oxfordshire homes they own.  Methodist homes will operate another.  Four Seasons and Methodist Homes are both established care home operators and already run one home each in Oxfordshire.

·        It has been uncertain for some time who would run the two NHP homes given that they are a property investment group .  We are now hearing that their two homes in Oxfordshire will be run by Four Seasons (as well as the three homes that they are taking over from Southern Cross and the one home that they run currently).

·        This means that we anticipate the operation of 5 of the Southern Cross care homes to transfer to Four Seasons and the other to transfer to Methodist Homes.

·        Whilst in the short term it appears that the homes will transfer smoothly, in the medium term the County Council will monitor these companies with appropriate levels of contingency planning both locally and through ADASS. 

·        We continue to have concerns about standards at the Albany – a home which we stopped making new placements to at the end of last year.  We shall not change this position until we are satisfied that all of our concerns have been addressed.

·        Oxfordshire are funding 11 people in Southern Cross homes outside of Oxfordshire. The Contracts Unit has made contact with these local authorities and is monitoring progress with these homes

Committee members expressed concerns regarding the long term financial health of care providers given efforts to reduce county council reliance on care homes, and the consequent reduction in revenue for providers.

The Director outlined the systems in place to monitor the financial status of providers and emphasised the importance of spreading risk across different providers. Four Seasons has been identified as a medium term financial risk and is being monitored closely. The Cabinet Member pointed out that the Department for Health is in the process of seeking financial guarantees from providers.

Castlebeck

·        Winterbourne View closed on 24^th June

·        CQC has carried out inspection of all Castlebeck services. Following this they have closed Arden Vale hospital where Oxfordshire had one patient. He has moved to a community placement which is being closely monitored.

·        Oxfordshire has 2 patients at another Castlebeck hospital and one person in a registered care home run by Castlebeck. The learning disability team is closely involved with all 3 placements.  CQC has not raised any serious concerns in relation to these 2 services. Plans for discharge to community placements are being made for the 2 patients in the hospital service, as soon as they are able to be discharged from section. The person in the residential care home is happily settled and does not want to move. A care manager and a quality monitoring officer carried out a joint 4 hour visit in August and are satisfied with the quality of his care.

·        A national review of learning disability models of care and pathways is underway and will be informed by the CQC inspections, an NHS serious incident and commissioning review, South Gloucestershire’s safeguarding review, and Castlebeck’s internal review. Oxfordshire has contributed to the NHS review and the safeguarding review.

·        CQC are shortly embarking on a targeted programme of inspections of other health funded provision for people with learning disabilities who have challenging behaviour and mental health needs. Following this the programme will sample a broader range of learning disability provision.

·        In Oxfordshire we have carried out a review and root cause analysis of the arrangements for placement and monitoring of the 3 patients at Winterbourne View. An action plan has been drafted which will increase the robustness of commissioning arrangements and management of individual cases.

·        The action plan includes two key actions: to introduce a formal system of pre-placement quality checks on specialist health providers, and to formalise and document the decision making process when a specialist health placement is made.  Other actions include strengthening monitoring arrangements, training service users and carers to play a greater role in monitoring, ensuring independent advocacy is in place, and reinforcing recording practices.

Members asked whether the action plan to increase pre-placement quality checks suggested that we no longer need or value CQC assessment.

The Director stressed that whilst this issue is likely to be debated in Parliament in the near future, the need to place people out of county requires some level of oversight and common standards. At the local level efforts are being made to resolve concerns before they escalate to complaints through reducing bureaucratic and perceptual barriers. This will require an increased role for the Safeguarding Board. Improvements were evidenced by the increased number of concerns now being received.

Continuing Health Care

A note was circulated to members setting out what is happening in Oxfordshire with what is happening elsewhere in England and the rest of South Central SHA region. Oxfordshire has recently seen a fall in the number of people receiving payments and is now the 6^th lowest in the county out of 151 PCTs.

Members felt that further discussion of this issue was required at the next meeting of the committee.