Meeting documents

Communities Scrutiny Sub-Committee (DCC)
Monday 5 September 2005

            Meeting: Communities Scrutiny Sub-Committee (County Hall, Durham - Committee Room 1a - 05/09/2005 10:00:00 AM)

                  Item: A6 Aids and Adaptations and Domicillary Care Issues


Scrutiny-Sub-Committee for Strong Healthy and Safe Communities
5 September 2005

Aids and Adaptations and Domiciliary Care Issues

Report of Acting Director of Social Care and Health

Purpose of Report

1. To provide information to Members about Aids and Adaptations and Domiciliary Care issues.


2. Representations have been received from the County Durham Service Users and Carers about the operation of Aids and Adaptations and Domiciliary Care Services.

Aids and Adaptations

3. Some of the comments received have concerned the role of different agencies in relation to certain aspects of service provision which inhibit a whole service approach for users. These include issues such as out of hours repairs to hoisting equipment, accessing bed extensions and wheelchair servicing. For instance, the Health Service continues to be responsible for wheelchairs and the County Council and District Councils have discrete responsibilities for some aspects of adaptations, but there is no effective single assessment process in place which enables one agency to undertake work on behalf of another.

4. Considerable progress has, however, been made over the past two years to improve the range and quality of services available. This includes the establishment of a multi-agency Community Equipment Board which includes service user and carer representation to address on-going concerns. There is a common approach to eligibility criteria, joint training and a new range of home independence shops to increase responsiveness to the public.

5. There are some outstanding issues that are still to be resolved. The Aids and Adaptations Scrutiny Working Group continues to monitor progress in this area and the next meeting of the working group will be held on 7 th October 2005. This will be a joint meeting with Darlington Borough Council. Of the outstanding issues that are still to be resolved, the following are noteworthy:-

  • How to increase capacity within Services to deal with the rising demands associated with an ageing population and more rapid hospital discharges.
  • Seeking multi-agency support for a fully integrated service which is based upon a pooled budget, lead commissioning and integrated providers with a single assessment service.
  • Agreeing joint performance measures with partner agencies which are undergoing significant organisational change.
6. The situation is exacerbated by the current complex administrative arrangements within the County in terms of provision and responsibility for delivery. Although performance has improved, there have been concerns about backlogs in referrals for assessment and delivery of services. The question of resourcing and future pressures upon budgets will need to be considered at some point given the profile in County Durham of an ageing population and increasing numbers of people being cared for at home.

Domiciliary Care

7. Many of the issues highlighted above apply equally to domiciliary care services. Concern has been expressed about continuity of care, particularly over weekends and holidays and during times of staff sickness/staff annual leave. The natural preference of service users would be for one, or a small number of carers, attending to an individual’s personal care needs, as opposed to many carers carrying out ‘tasks’ done for them.

8. Many service providers are struggling to recruit and retain staff to provide basic services and the opportunities to achieve the quality of service demanded by service users as outlined above are limited in the current situation. Agencies do try to offer consistent inputs but the tasks have to be undertaken by the staff available to them. There is also an impact arising from the working time directive and the very nature of domiciliary care, where large numbers of services are required at specific times, stretches the availability of staff. Many of the staff from agencies who provide care at home now have to deal with very complex cases, including personal as well as domestic care, which requires a higher level of personal accountability and training. However, many of the staff providing these services receive low levels of remuneration and are becoming increasingly difficult to recruit and retain.

9. Work has been undertaken to improve overall capacity within a domiciliary care market and ensure that we monitor public satisfaction. Most surveys continue to remain positive, but we are aware that some older people are fearful that critical comments about services may result in their withdrawal and this might influence their responses in some instances. This may not be the case in the future as an increasing number of service users are now expressing their higher expectations about service provision to us. Current standards may not, therefore, be acceptable in the future.

10. The question of performance of domiciliary care services is not simply a local issue. There have been a number of national investigations which have highlighted issues such as lack of regulation, poor standards of personal hygiene, diminishing time allocations and a lack of flexibility in service provision. A number of improvements have been made to our services in the past three years including setting clear standards for providers, establishing a preferred provider system so we can better manage the market and develop quality standards, routinely surveying customer views and engaging service users in key planning groups so as to better shape service provision.


11. This report is for the information of members.
Contact: John Thornberry Tel: 0191 383 4619


 Aids and Adaptations pdf.pdf