Agenda and minutes

Apologies were received from Councillor Liz Leffmen (Councillor Richard Webber substituting), Councillor Mike Fox-Davies (Councillor Nick Field-Johnson was scheduled to be substitute but also had to send apologies) and Councillor Charles Mathew.

Councillor Jeannette Matelot was a Temporary Replacement for the vacancy created by Councillor Liam Walker’s appointment to Cabinet.

There were no declarations of interest.

To approve the minutes of the meeting held on 9 January 2020 and to receive information arising from them.

The minutes of the meeting held on 9 January 2020 were approved and signed with one amendment:

Item 4/20: add a bullet point under the heading “Officers responded to issues raised by Members as follows:”

·         There is funding committed to undertake a study into the feasibility of civil parking enforcement in the districts.

Oxfordshire’s Health Overview Scrutiny Committee and Oxfordshire County Council Performance Scrutiny have asked that matters relating to the delivery of mental health support to people in Oxfordshire are brought before them for scrutiny. This item includes two reports.

S75 Adult Mental Health Social Work report

They have asked to be presented detail on the Section 75 Partnership agreement between OHFT and OCC covering the delivery of social work and the outcome of the transfer of the Older Adult Mental Health Team back into the council. It also includes team performance, the number of people supported and an overview of s. 117 funding.

The Committee is RECOMMENDED to note the report.

Mental Health Outcomes Based Contract

They have also asked to examine Mental Health Outcomes Based Contract between OHFT and OCCG (OCC contribute funding to this contract) covering the delivery of all mental health support to people with particular conditions, including inpatient care, community support, wellbeing and employment support, and housing.

This paper provides the Centre for Mental Health Review of Oxfordshire Mental Health Outcomes Based Commissioning Contract Summary Report and the next steps being taken by OCCG in relation to the contract. 

The report recognises the way Oxfordshire commissioners and providers have pioneered the model of outcomes based commissioning, and whilst the system has ongoing challenges to address, the integrated way of working across the partners is positive and beneficial for service users and carers.

The Committee is RECOMMENDED to note the report.

Stephen Chandler introduced the report on S75 Adult Mental Health Social Work.  This is a partnership agreement between Oxford Health Foundation Trust and the County Council.  The report also references the Council decision to take back mental health social work services for older adults.  He was accompanied by Karen Fuller who is on the Joint Management Group.

Officers responded to Members’ points as follows:

·         Forensic social workers work with people who have come in contact with the criminal justice system who are identified as having a mental health need.  Their needs tend to be highly complex.

·         When the older adults service was taken back the same budget came over to the Council.  There are no particular delays in relation to assessments.  There were only a few people awaiting assessment last week.

·         S117 aftercare cases are being reviewed and cross examined to see if they are still appropriate for aftercare. Continuing Health Care (CHC) is also being considered.  It’s a misconception that you can get either S117 or CHC, it’s not a question of only one or the other.

·         A doctor has to discharge individuals from a S117. 

·         Care Act assessments have to be recorded on the LAS system.  This means they must be input twice but both organisations can see each other’s system. This is double entry.

·         The only delay between an assessment and it becoming visible on the system is the time taken to enter – usually when back in the office.

·         The ‘clusters’ refer to eligibility.  OHFT deliver support for clusters 4 to 17.  Care Act eligibility is statutory for the local authority.

·         The proposed budget for next year reflects increased demand for housing support in the Outcomes Based Contract.  The Council wants to examine how it is met – if not residential care, then how to support alternative accommodation.  Some are in a grey area but may just need some signposting to services. This will be a joint piece of work

·         The reasons for eligibility or non-eligibility are not always clear in the records.  The Council is working with OHFT to ensure that recording is clear.

·         The Principal Social Worker is working closely with the Social Care lead in the Trust to share learning and development.  There will be updated guidance from NHS England soon in relation to mental health social work.

·         There are two new people in key positions with the Trust and they are clearly committed to the partnership.

·         All residents in Oxfordshire are the County Council’s responsibility even if they live in border areas and receive services from neighbouring counties.  The Trust covers Oxfordshire and Buckinghamshire.

RESOLVED: to note the report.

Stephen Chandler introduced the report on the Mental Health Outcomes Based Contract (OBC).  The Council controls the finances but is not a signatory – OBC is a contract between the CCG and OHFT.  It was innovative five years ago but parts need to be reviewed.  There are aspects that the Council would do differently, particularly where people fall between eligibilities – for example  ...  view the full minutes text for item 10/20

This report provides an overview of Delayed Transfers of Care (DToC) in Oxfordshire. It includes recent performance compared nationally and locally as well as a summary of the challenges facing the Health & Social Care System that have on impact on DToC performance.

Oxfordshire is one of the worst performing systems in the country in terms of DToC consistently ranking in the bottom quartile nationally, and for the current financial year is ranked 147th out of 149 authorities . It is recognised that being delayed in hospital has a detrimental impact on a person’s health and wellbeing. It is therefore critical that Oxfordshire’s health & social care system partners work together to improve on recent poor performance in this area.

There are a number of challenges which impact on this performance, some of these challenges are being experienced by systems across the country, whilst others are specific to Oxfordshire. These are described in this paper as well as work that is underway to mitigate these challenges. As requested by the Performance Scrutiny Committee there is a specific focus on Reablement.

The Committee is RECOMMENDED to note the report.

Stephen Chandler introduced the report and gave a short presentation on some of the related statistics.  There are over 100 contracts for home care.  Progress has been made – the number of delays per month was double the current figure – but Oxfordshire still has the third poorest record in the country.  The number of “joint” delays is the worst England – that is, those attributable jointly to the NHS and Adult Social Care.

Officers responded to Members’ questions as follows:

·         There can be differences in recording delays and disputes about this between the Council and hospital in some cases, but better relationships will ensure more accurate recording.

·         The Home Assessment Reablement Team (HART) has become a bottleneck in the system.  There is a range of support for which people need to be assessed.  The Council is proposing changes to the contract to tackle this.

·         The £23 per hour that the Council pays for home care goes to the care provider.  There is nothing in the contract to require disclosure of the amounts paid to workers.  The Council would prefer this to be transparent.

·         The Council is exploring options to re-tender for home care with a standardised more transparent agreement.  Providers have asked that the required activity be defined and the Council has agreed to this.

·         The HART contract ends September 2020. What happens following this is currently being reviewed.  The Council is recommending more hospital-based reablement with contracts linked to home care.

·         In the meantime, the Urgent Care Working Group is looking at the whole system.  There was significant improvement in the December and January figures despite it being winter.

·         HART was reportedly only 80% staffed but more have been recruited recently.  Staff there are doing their best, the challenge is with the contract.

·         While there is a lot of focus on the hourly rate, the quality of care is monitored too.

·         There is a window of opportunity now to improve reablement.  Daily contact gives the best outcomes.

·         At one point the Council and NHS were competing for care home beds.  Now all go through the Council so it is simplified with agreement on who gets beds.

·         It is important not to be too prescriptive.  Some people do not want carers in.  The Council also considers community networks and technological solutions.

·         Age UK do a lot of good work – in particular in supporting people in the difficult first few days back at home.

The Committee supported the principle that there should be transparency in contracts to ensure that the Council is aware of the rates that workers are paid by providers.

Councillor Richard Webber asked if a scatter graph could be provided showing home care costs against cost of living in the various areas.

The Chairman paid tribute to care workers who are often low-paid but still go out of their way to help.  She asked that workers from other EU countries be assured that they are still welcome.  Stephen Chandler agreed that the work being done should  ...  view the full minutes text for item 11/20

To review the Committee’s Work Programme.

The following was agreed:

·         to move the May meeting from the 7^th to the 14^th to avoid clashing with the local elections.

·         to leave discussion of S106 until the partnership work is done.

·         the Turning Point Contract has been re-let so can come out of the work programme.

·         Lauren Rushen will look at the various strands on housing and make a proposal on how to address.