Agenda and minutes

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To approve the minutes of the meeting of October 25^th 2011 (AS3), and to note for information any matters arising on them.

The minutes of the meeting of October 25^th were approved.

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10:00

John Jackson, Director of Social and Community Services, will deliver an update on Local and National issues in Adult Services.

John Jackson, Director of Social and Community Services, updated the committee on national and local developments in Adult Social Care.

On the national level, the passage of the Government White Paper on social care was discussed. The paper is due to be released in April of this year, and, assuming a smooth passage, would pass into statue by the end of the year.

At the local level, the director confirmed that all Southern Cross homes have now transferred to Four Seasons. The financial position of the care group was discussed, and it was pointed out that the group are in a stable financial position. Different tenancy arrangements to those which precipitated the collapse of Southern Cross, make a similar scenario unlikely.

Concerns were raised about the capacity of CQC to provide a sufficiently in depth level of monitoring. The director accepted that the remit of CQC in very broad and is growing. These issues are currently being debated in government committees and members were encouraged to raise concerns through these channels.

Sara Livadeas AGREED to bring a report to the committee on current and proposed arrangements for contract monitoring and raising safeguarding concerns.

A paper on the Oxfordshire Care Partnership will go to cabinet on December 20^th. This will be scrutinised by the committee at a meeting in early January.

Recent changes in the procurement process for Tier 2 Day Services were discussed. In summary, there will be less direct member involvement in the decision making process than originally proposed, with the director making the final procurement decision. Members will have the chance to input into the process through face to face meetings with relevant Officers in December. The reasons for the changes were the tight time constraints and the lack of training.

Members expressed some frustration at the lack of guidance and the late changes to the process.

11:00

John Jackson will brief the committee on plans to move towards a fully operational pooled budget for Older People with the NHS.

A cover report is attached at AS6a, with a substantive report at AS6b. An annex showing the national outcomes for Older People is attached at AS6c.

John Jackson outlined the work taking place alongside NHS colleagues towards creating a genuine pooled budget for older people. A summary of this work is attached (AS6a, b, c).

Members were broadly supportive of the direction of travelled and questioned why this had not already been achieved. The director stated that the recent strengthening of partnerships has created a better position to achieve these goals. The debate around Delayed Transfers of Care brought senior personnel together and was helpful in drawing attention to the importance of joint budgeting.

Cllr Stevens supported the general aspiration but wished to explore the implications for governance and accountability further. He AGREED to share his findings with members of the committee at a later date.

11:30

John Jackson will brief the committee on the proposed Budget for Adult Services for 2011/12.

The directorate business strategy paper will be tabled at the meeting.

Lorna Baxter, Acting Head of Corporate Finance, outlined the major developments for the council as a whole, as detailed in the tabled papers (See agenda for December 15th 2011).

John Jackson discussed the papers as they relate to Adult Social Care. In summary there will be more money for Adult Services than in the previous year but a number of unforeseen pressures mean that there is little room for manoeuvre.

The committee were invited to consider the papers and return with comments at the meeting on December 15^th.

12:15

John Jackson will address the committee’s questions on the outsourcing of independent living services for people with a learning disability, with particular reference to the proposed social enterprise delivery model.

Councillor Richard Stevens posed a number of questions to Ann Nursey, Head of LD Commissioning, on the proposed changes to the learning disability service.

1.      What is the reasoning behind the phased approach to the savings?

2.      The proposals appeared to suggest that providers would be non-profit making. Why hasn’t this been the case?

3.      What is the scope for bringing in mutuals/micro-mutuals on a cooperative basis?

In response to the first question, Ann Nursey, Assistant Head of Adult Social Care (Learning Disabilities), suggested that a number of things had impacted on the original phasing. Firstly a serious staff incident in a centre led meant that the transition was stalled. Secondly TUPE protections meant that savings could only be realised through the natural turnover of staff. It was asserted that staff savings would be passed on to the council rather than remain with the provider.

Regarding the question of profit making providers, the officer highlighted the fact that this applied to one provider but that most providers were non-profit organisations. The use of framework contracts and the open procurement process mean that the directorate unable to discriminate on the basis of the profit making intentions of any organisation.

Similarly, the question of mutual ownership was presented as one of practice rather than principle. The directorate is not opposed to the principles of mutual ownership but would need to be satisfied that the organisation was sustainable. This option was explored by a group of staff who subsequently encountered difficulties in the complexity of setting up.

ArashFatemian, Cabinet member for Adult Services, AGREED to send a statement on the monitoring and provision of the service.

12:45

John Dixon, Deputy Director for Adult Services, will brief the committee on Continuing Healthcare. Fenella Trevillion, Head of Joint Commissioning at Oxfordshire PCT, and Paul Cann, Chief Executive of Age UK Oxfordshire, will field questions from the committee.

A report outlining operations, auditing, and performance benchmarking is attached (AS9).

John Dixon, Deputy Director for Adult Social Care, Sara Walters, Area Service Manager for the SCS City team, Fernella Trevillion,  Head of Partnerships at NHS Oxfordshire, and Dan Harbour, Continuing Care Advice Team Age UK, explained the complexities in the application of government guidelines for Continuing Healthcare. Current and historic performance was discussed with particular reference to the relatively low numbers receiving continuing care in Oxfordshire. Further detail is provided in the attached report (AS9).

FernellaTrevillion stated that although the numbers in Oxfordshire are low relative to other counties, the process is applied fairly across the county. Other counties are at different stages and it is likely that they will see numbers fall following reviews.

Dan Harbour stated that there had been improvements in the processes and that guidelines were being followed more closely. He also emphasised the role of Age UK in helping people to understand the assessment process and to provide independent challenge to drive improvement across the health and social care spectrum.

Members pointed out that many of the problems inherent in delivering services at the interface of Health and Social Care would be solved by genuine pooled budgeting and by implementing the recommendations of the Dilnot Commission.

13:15

Adrian Chant and Sue Butterworth will deliver an update from the Local Involvement Network and field questions from the committee on recent developments. Rosamund Southgate will update the committee and field questions on Oxfordshire HealthWatch.

A copy of the update is attached (AS10).

Sue Butterworth, LINk Chair, and Adrian Chant, LINk Host Manager, discussed the attached update on the Local Involvement Network (AS10).

Anita Higham, LINk Deputy Chair, gave a detailed account of the complexities of the health and social care system as they relate to the function and remit of Local Healthwatch Organisations.  Anita AGREED to distribute a copy of the statement.

Lisa Gregory AGREED to send a link to the Healthwatch consultation.

13:25

Committee members are invited to propose items for future meetings of the committee.

Members proposed that the former TASC workgroup reconvene in January to outline an approach for future workgroup activity.

It was proposed that the issues of waiting lists and reviews should be brought to the committee in the future.

It was AGREED that a report on Day Services and Community Transport would come to the committee in March.

13:30