Agenda item

10.10

Report by the Corporate Director for Customers and Organisational Development and Director for Finance

This report sets out Oxfordshire County Council's (OCC's) progress towards Corporate Plan priorities and provides an update on the delivery of the Medium Term Financial Plan, at 31 January 2020. A summary of overall performance and description of change is contained within the report. The report contains three annexes:

·         Annex A shows our current performance against targets and summarises progress towards overall outcomes set out in our Corporate Plan.

·         Annex B sets out the Leadership Risk Register which has been developed as part of the Council’s work to strengthen risk and opportunities management.

·         Annex C sets out the current financial position, providing detailed explanations of significant budget variations and an update on the Medium-Term Financial Plan including the delivery of savings agreed by Council in February 2019.

The Committee is RECOMMENDED to note the report and consider any matters for future attention by the Committee.

Robin Rogers introduced the report.  The Chairman asked that the recommendation for this report, and future reports, be amended to include reference to the Committee’s role in bringing issues to the attention of the Cabinet.

Delayed Transfers of Care

Stephen Chandler described three main reasons for the lack of improvement in the situation.  He believed there was an over-reliance on bed-based support.  Oxfordshire has more people in hospital and care home beds than would be expected given the demographics.  The Council is working with clinical staff and social workers to ensure that the risks of hospital care as against home care are properly assessed, taking into account the negative impact that can result from long stays in hospital.

The second issue is that the HART reablement system has lower outcomes than are seen nationally.  A very high number of people are sent there for reablement and in some cases it may be inappropriate, for example those who really need end-of-life care.

The HART contract ends in September and work has started on recommissioning including visits to other parts of the country to study systems with good outcomes.  In the meantime, the Council is challenging the procedures surrounding discharges.

The availability of home care is the third issue.  Although the rate of pay is good, the workforce is simply not there with almost 100% employment in Oxfordshire.  The Council is switching to a strengths-based approach to ask people what they think they need themselves.  The hope is to avoid people receiving more support than they actually need.

The figures will not improve quickly.  Some improvement should be seen in six months or so but the new contract will not have a big impact until this time next year.

Stephen Chandler responded to Members’ questions as follows:

·         Not every care home will be capable of providing end-of-life care but the Council is willing to discuss this.

·         Even though the current system is not improving, the Council will continue to work with the trusts as it cannot afford to lose the skills and expertise that they have.

·         While there may be problems in the counting of cases and assigning responsibility, that does not change the overall picture.  The goal is to have people in the right place with the right care.  The Council will challenge every discharge plan to ensure that anyone who can go home with the right level of support can do so.

·         Improvements that should be seen in the next six months would be: getting people home quicker, fewer going through HART and more support from Age Concern to help people at home.

·         The new contract will insist on transparency in regard to the pay rates paid by providers.

·         The draft contract will be brought to the Committee for Members’ input.

Councillor Glynis Phillips urged that the new money coming into the NHS be invested in increasing clinical staff in the community to support the shift away from hospital beds to better care at home.

Covid-19

Stephen Chandler gave an update on the situation.  It is not known when the number of cases will spike but it is likely to be in the next two to four weeks. Discussions are taking place with providers to ensure staffing and equipment are available.  Government and Public Health England advice is being followed.  Guidance has been provided to care workers.  No payments will be stopped – any adjustments necessary will be made afterwards.

Children’s Services

Vince Clark gave apologies from Lucy Butler, Corporate Director for Children’s Services, and provided an update on issues in that directorate.

Family Safeguarding Plus is on target to go live towards the end of June.  This is a major service change and the impact will be seen within 8 to 12 months.

The increase in the numbers of Looked After Children has levelled off but the complexity of needs remains high.  Foster home placements are used where possible.  In-house residential placements are being used to capacity with additional private capacity being used.  Crisis beds are not registered children’s homes but are only used as a last resort.

Vince Clark responded to issues raised by Members as follows:

·         While some private providers may give better value, all services are regulated and monitored by Ofsted.  The Council prefers to place with providers rated ‘good’ or ‘better’.  However, a provider could be downgraded in which case the Council works with them to make improvements.

·         Unregistered placements are monitored by senior managers on a daily basis.  Unregistered placements require ‘pop up’ provision (e.g. a hotel) that require 2:1 staffing arrangements around the clock. Unregistered placements occur when the young person’s behaviour mitigates against an appropriate placement being found (for example they present a significant risk to other young people placed with them).

·         Fostering provision has declined since 2014 but payments have recently been enhanced and we anticipate an increase in applications to become a foster carer.

·         Some children and young people are unable to be placed in a substitute family placement (e.g. fostering) and therefore have to be placed in a residential placement or other suitable provision. The reasons for young people being placed in residential vary but they include violent or aggressive behaviour, breakdown in foster placements, managing extreme harm to self or others, managing the risks related to sexually exploitation, requirement for specialist therapeutic placement (e.g. managing sexually predatory behaviour), criminal behaviour and fire setting.

·         Independent providers can mean that the child is placed out-of-county. 

The Chairman asked for a briefing on the breakdown of placements with reasons and costs.  Vince Clark agreed to provide this.

Education Health and Care Plans

Jayne Howarth provided an update.  There was a 30% increase in applications for EHCPs in 2019 – way above the prediction.  This created a timeliness issue.  The Educational Psychologist service was only able to report on 26% of cases within the 6 week target which delayed the completion of EHCPs.  An action plan was implemented and the figures for March have improved dramatically.

This February there has been a large increase with 95 applications received.  The peak is usually in June/July so this has caused concern about this summer.  Cabinet has given additional money and recruitment has started.

Members raised a number of points and Jayne Howarth responded as follows:

·         The schools with high rates of requests for EHCPs are being challenged.  About 50% relate to Year 5 students looking for special schools when transferring to secondary.

·         A Cabinet proposal for more early intervention was agreed.  The Council is working with Hampshire and Norfolk on this and benchmarking against them.

·         There is concern that those attending independent out of county special schools can lack basic independence skills when they leave – such as using public transport.

·         The proportion of children in Oxfordshire with EHCPs is 2.5% while the national average is 3.1% and the South East Region average is 3.3%.  Oxfordshire still has a high number of children on SEN Support.

Councillor Michael Waine expressed disappointment that there has been no update to wording in the corporate plan with respect to the council’s relationship with schools, as discussed in the Committee.  He asked Robin Rogers to take this up.

The Chairman and Councillor Michael Waine, Chairman of the Education Scrutiny Committee, agreed to meet and see what information is needed for the committees to scrutinise this issue.  They will then work with officers on a prospectus for a joint working group and ask Members who is interested in participating.

Other issues

The Chairman noted that the Growth Deal had the highest risk rating.  She asked for the figures behind the commentary.  Councillor Liz Leffman asked that figures for social and affordable houses be provided.

Councillor Charles Mathew asked for more information on the 80% target versus the 20% rate under “rate of delivery against the Growth Deal infrastructure programme”.  Stephen Fairhurst Jones agreed to get answers on that.

Councillor Nick Carter asked about a number of areas of overspend and underperformance such as Community Operations, the Parking Account and Debt and Loan Write-offs.  It was agreed to take these issues at the next Committee meeting and to focus on Environment and Economy.

RESOLVED: to note the report and consider any matters for future attention by the Committee or by the Cabinet.