Agenda item

1.    Mr Gibbens, Cabinet Member for Adult Social Care introduced this item explaining that it was a serious issue affecting Adult Social Care.  Many other authorities were also suggesting similar stresses on their Adult Social Care services as the demand for services increased and the budgets decreased.  The difficulties experienced in Kent were mirrored throughout the country.

2.    Mr Gibbens discussed the discharge rates in hospitals, there had been a spike in admissions to Accident and Emergency (A&E) units in Kent during Dec ’14 - Jan ’15 and this was an ongoing pressure on the service, there was exceptional demand on A&E services.  Kent’s Adult Social Care Service had been very successful in keeping elderly people at home, there was a focus on independence particularly as people were living longer. 

3.    It was necessary to look at doing things differently, in September Mr Gibbens had written to the Chief Secretary to the Treasury setting out the challenges on health and social care and the need to move forward with integration, there was an ongoing and increased focus on care in the community.

4.    The Service had also looked at innovative models of working, particularly to support carers.  Officers were working with NHS colleagues to support the process of integration.  The information contained within the agenda dated back to June 2015 and was therefore slightly out of date but still worthy of discussion. 

5.    Mr Ireland referred Members to the two performance indicators which had originally been of concern to members.  These were ‘Number of Promoting Independence Reviews completed’ and ‘Percentage of Delayed Discharges from hospital with Adult Social Care responsible’.  Both these indicators had improved however they both remained significant issues.  There was significant pressure on hospitals which were working at  99% occupancy level in September 2015, this was no longer a winter issue, it was affecting hospitals all year round.  Two acute trusts in Kent were in special measures and all trusts were seeing an increase in demand along with pressure to control the flow of people through hospitals, there were admission issues as well as discharge issues. 

6.    There was also a market issue, and the ability to meet the demand with adequate staff, resources were stretched.  The process of developing enablement services played a critical part.  In relation to Health and Social Care there was a huge workforce issue, increased use of agency doctors, nurses and social care professionals added to the financial pressures.  A combination of increased demand and a decreasing workforce meant it was crucial to manage the demand, through-put and increasing enablement and discharge protocols. 

7.    Mrs Tidmarsh set out some different approaches adopted by the service, some additional funding had been received last winter and the services was working on integrating health social care.  It was necessary to move away from traditional solutions towards different ways of working, increased working with the voluntary sector such as ‘Crossroads’.  Care Navigators were not in almost all of the hospital sites, they helped people to understand what was available to them in the community.  Enablement support had increased decisions by patients being made at home which was positive.  North Kent had seen the implementation of an integrated discharge team in the hospital service.  The Kent Health and Wellbeing Board had also formed a task force to look at workforce issues. 

8.    Many nursing homes had had difficulties in recruiting; work was being done to increase the attractiveness of a career in nursing and domiciliary care, for example rotating posts and the development of career pathways.  The workforce group was also looking at the image of social care and attracting young people into social care, much of the promotional information was being updated.

9.    A Member quoted a personal example of the care his family had received within the last 9 months through the Adult Social Care Services and this had been first class care.  The pressures on the service were understood but what would the Council do if it continued to be unable to recruit was there any confidence for the future?  Mr Ireland explained that by working differently there was confidence for the future, if the service continued as it was it was very difficult to see how things could improve without significant additional funding.  It was necessary to change the pattern of demand with fewer people requiring the use of long term services.  There were opportunities for other organisations to be involved and promote people getting back to their own home.  There had been an increase in the number of people going through enablement which had produced good results however this was a longitudinal study which was ongoing.  The Local Govertnment Association had employed Newton Europe to review short term pathways in hospitals, there were savings to be made and the needs of those who need placements were growing.  There had been an increasing in requirements for nursing care and specialist services such as for dementia sufferers and a decrease in standard residential care. 

10. Mrs Tidmarsh explained that the housing sector was working with Local Authorities to look at alternatives for residential care.  Extra care sheltered housing was the answer to frail elderly people who did not yet need nursing care. 

11. Many Members commented on the excellent service their families had received from the Adult Social Care Service, KCC was doing an excellent job at supporting people in their own home and there was a need to continue to invest in care.  Mr Gibbens responded to a comment about the current consultations on care homes in the county – these consultations were due to run until 20 December and would be discussed at the relevant Cabinet Committee.

12. In response to a question about the funding received earlier in the year Mrs Tidmarsh explained that this was one off funding and there was not yet any indication of any similar funding this year.

13. There was a discussion around the role of voluntary organisations such as Age Concern which was considered an effective and economical way of extending support, there were some funding issues around the volunteer service but it was agreed that the use of the voluntary sector was increasing vital.  A question was raised about retaining Pins for nurses with limited use once they had retired for example.  This was currently prohibitively expensive.  Mrs Tidmarsh agreed to take this issue forward. 

14. Referring back to Mr Gibben’s letter to the Chief Secretary to the Treasury the Scrutiny Committee agreed to write a brief follow up letter to the Chief Secretary to the Treasury confirming that following the scrutiny by the Committee members were convinced about the severity of the situation. 

15. With the aging population and the increasing desire for elderly and vulnerable people to stay in their own homes family choice was fundamental to the process.  A member asked whether the Council should, or could, have invested earlier in the county’s care homes?  Mr Ireland explained that this was not a realistic option; the key issue was the availability of appropriate beds.  There was a need for more nursing home and more specialist beds.  Families had to be prepared to wait for particular beds and there was the added complication of the appropriateness of waiting in an acute hospital bed until the desired bed became available.  The Council was not able to run nursing homes, so it wasn’t possible to convert existing homes and run them.  If other businesses had a desire to run existing care homes as nursing homes this would alleviate some of the pressure, however this had not happened.  There was a need for more extra care sheltered housing and fewer residential care home beds.  Mr Gibbens explained that there was no option for continuing as things were, there was a need for different accommodation.  Mr Ireland confirmed that the Community Care Act 1993 put a duty on local authorities to ensure 85% of services were in the independent sector.  This statutory basis did not encourage investment in care homes, this was a direct response to the policy requirement. 

16. In response to a question about the budgetary pressures within other authorities in Kent and whether other authorities were coping with the difficulties Mr Gibbens confirmed that in discussions he had had with other authorities their budgets were stretched, and they were experiencing similar strains as seen in Kent.  It was considered that the coastal fringes attracted significant numbers of older people and there was a general concern across adult social care about the long term budget situation.

17. In response to a question Mrs Tidmarsh explained that the authority was looking at the impact of the enablement service, it was not the case that people who were assessed as needing care were not provided with care.  Increasing age and increasing fragility accompanied with dementia meant that the enablement service was working hard to ensure that people could live as independently as possible, however there would be regular reviews of the needs of individuals.  There had been an increase in the use of telecare and occupational therapy equipment people were also being helped by other services including the voluntary sector. 

18. A Member queried the Social Care budget, it was understood that there would be an additional significant savings target next year, would it be possible for the Council to deliver this target?  Would the thresholds for care change?  Mrs Tidmarsh confirmed that the thresholds were set out in the care act and these would not be changed.  Mr Ireland confirmed again that the threshold eligibility criteria had not changed. 

19.  A Member asked whether the discharge rates had improved; with an increasing number of people going through the re-ablement service were there deep seated problems within the service.  Mr Ireland confirmed that the September figures showed that for delayed discharges the percentage of delayed discharges from hospital figure was 38% (June 2015 was 44%) and the total delayed discharge figure was 80 (reduced from 140 in June 2015).  There had been an improvement since the June figures. 

20. There was also a query about the workforce, it was considered that the workforce was heavily dependent on immigrant labour, would the tightening of immigration requirements make the situation worse?  It was not thought that staff employed by care homes or agencies within social care in Kent was as affected by this issue as the NHS.  There were difficulties in recruiting social workers in some areas of the county, particularly Dartford and Gravesham, Officers would again review the position. 

21. In response to a query about housing standards for life, in the past building standards ensured that homes were suitable for life, did this still happen?  Mrs Tidmarsh explained that as far as she was aware housing standards for life was still a ‘standard’ but it would be useful to review this. 

22. Mr Gibbens concluded by stating the safeguarding was the top priority and with regarding to the budget safeguarding would not be jeopardised. He offered his sincere thanks to those people providing support to the most vulnerable people across the county.

23. The Chairman summed up the meeting, thanking the witnesses for the information they had provided and for answering the questions so fully.

RESOLVED that the Scrutiny Committee thank Mr Ireland, Mrs Tidmarsh and Mr Fitzgerald for attending the meeting and answering Members’ questions on this item.  A letter would be sent, from the Scrutiny Committee, to the Chief Secretary to the Treasury, referring to and supporting Mr Gibbens letter of 10 September, the focus on safeguarding would also be set out in the letter.