Agenda item

The Committee received a presentation on the Scrutiny Review of Adult Social Care Transformation. It was highlighted that the topic had been chosen within the context of a new legislative framework of risks and opportunities linked in particular to the Health and Care Act 2022, a new operating model based on prevention and early intervention and the changing needs of the population. The experience of service users and how to work with partners to optimise service delivery was also important.

It was highlighted that the Care Act 2014 streamlined legislation for Adult Social Care. The aim of the Care Act was to give people and their carer’s more choice and control, and the opportunity to live independent and fulfilled lives, keeping people at the heart of all assessments and support. The focus was on a strength-based approach, what mattered to people, ensuring people were connected to their communities and ensuring the different types of support available were taken into consideration.

Other key legislation included the Mental Capacity Act; Mental Health Act; Human Rights Act and the Equalities Act. There were imminent changes to the Mental Health Act and the Deprivation of Liberty Safeguards within the Mental Capacity Act expected.

Adult social care reform had made a commitment to ensuring people were well looked after; the social care system would work better for people and carers; would meet the increasingly complex needs of an aging population and the needs of younger adults who needed support. The aim was for social care to be more joined up; for there to be a simpler and more consistent approach that linked national and local provision of care and support; a focus on prevention and early intervention; choice, control and support for people to live independent lives; good quality care and support specific to people’s needs and circumstances; fair and easy to access adult social care and a limit on how much people should pay for care over their lifetime.

The Health and Care Act 2022 turned the above intentions into law and introduced Integrated Care Systems (ICS’s); powers for the Secretary of State to intervene in the healthcare system and changes to public health. It also removed the delayed discharge regime and confirmed ‘discharge to assess’ and improved the oversight of quality and safety by the introduction of a new assurance/inspection programme. 

It was highlighted that adult social care was operating in a challenging environment, with high levels of change, uncertainty, financial pressure, increasing and complex demand and workforce shortages. This made it necessary to reconsider social care services to meet needs differently, problem solve for people earlier, stop needs from escalating and help keep people in their homes for longer. Key to this was working collaboratively and sharing resources.

The Integrated Care Programme would include a single integrated front door to receive and screen urgent health and all social care referrals. There were a number of different referral forms being used that would be replaced by a single form, whilst recognising that there would be other entry points through partners that should remain accessible. An integrated urgent response triage team would be implemented to prevent hospital admissions and manage hospital discharge. The call handling team would be upskilled and there would be a multi-disciplinary team of healthcare professionals helping them make the right decision at the right time. Funding had also been awarded for a housing post within hospital discharge. A new reablement service would include community referrals. The work underway was explained and the next steps, including the launch of the revised reablement offer, details of which would return to the next Health and Care Overview and Scrutiny Committee.

A member highlighted that Councillors should highlight the views of residents and this could help reshape the service, for example the amount of time social care could take to move an elderly resident between care homes, the lack of clarity around the charging policy and the need for a system to monitor the progress of individual cases.

A member asked whether there were any unintended benefits or learning that had come from making changes. It was explained that considering the issue and looking at where they would like to be, then starting small and getting some quick wins had built trust and taken staff with them. Additionally, hybrid working had allowed for more integrated partnership working.

A member asked whether there was a vision within health and social care reform for more self-service, e.g people getting information for themselves or viewing and tracking records online. This was part of the plan.

A member asked whether there would be Key Performance Indicators (KPI’s) and whether the Committee could view them. The Committee were informed there would be different KPI’s for different projects and they would change depending on the stage of the project.

A member felt that people were not getting help for their long-term conditions and support was falling onto others when it should be covered by social care. It was explained that bringing health and social care together should help and they could be contacting regarding any individual cases.

The Committee considered recruitment. It was highlighted that there was a recruitment drive underway and twelve agency staff had been transferred to permanent contracts. Although it was a competitive market early indications showed there had been a positive response.

The committee considered loneliness and isolation and the importance of ensuring people remained part of the community and had enough contact with people and organisations. It was explained that the reform sought to ensure people in the community were connected and there would be closer partnership working with the voluntary and health sector to ensure people could live fulfilling lives and remain in their own homes. Additionally, new hubs such as fairer together and the family hub would provide connections and social workers were being encouraged to consider the whole person. A member raised the issue of homebuilding for an aging population, so older people could be part of a community. This was something the Council was working on.

A member asked that information on how the committee could monitor targets and scrutinise the models; where the distinction between scrutiny responsibilities would be e.g if the issue is housing when does it go to housing scrutiny; details of the charging policy and the plans for facilities that catered for cultural needs or preferences could be shared with or bought to the next committee meeting.