Agenda item

The Committee received a report and presentation from Jane Robinson, Corporate Director of Adult and Health Services and Lee Alexander, Head of Adult Services, on activity of the Adult Social Care Service in County Durham and the frameworks within which it operates (for copy of report and presentation see file of minutes). 

Presenting the report, the Corporate Director of Adult and Health Services referred to the request made by members at the July meeting, for further information with regard to adult social care and she introduced the Head of Adult Services to deliver the presentation. 

During the presentation, the Head of Adult Services highlighted information, presented in greater detail in the report, including the governance and legislative frameworks, the strong integrated partnership arrangements that exist, the structure of the service, and, the wide range of services and support provided.  He also outlined some case studies to illustrate day-to-day work of the service.

The Head of Adult Services referred to the rise in demand for services over recent years with an increase in those presenting with complex needs.  The time had also been one of transformation and service development, with the constant challenge of keeping pace with new technology and innovation.  He explained one of the key challenges for the future includes mental health, with a national increase in suicide rates, loneliness and social isolation, with these particular issues being more prevalent amongst adults with social care needs. More recently, during the pandemic, there has been a further demand on mental health services with an increase in the number of new patients presenting with mental health needs. 

The Chair thanked the officers for the comprehensive report and presentation.   The officers responded to questions and comments from the Committee as follows.

Councillor Tucker referred to those adults with complex needs and asked how quickly community health care assessments are being carried out, whether there is a back-log of assessments, and, how funding is provided, prior to assessments being carried out.  The Head of Adult Services explained, that as a result of the pandemic, hospital patients were being screened for community health care needs on discharge from hospital and would receive services which were fully funded through the NHS via the Clinical Commissioning Group. There is a back-log of cases which are being worked through, and, whilst this is taking place, those people will continue to receive funding through the NHS.  From a social care perspective, the work has continued effectively throughout the pandemic with some work being undertaken remotely, however risk processes are in place, and, where face to face assessments are appropriate, this has continued, using personal protective equipment.   Sarah Burns, Head of Integrated Commissioning, County Durham Integrated Community Care Partnership, added that integrated working enables a people-first approach to funding.  As many community health care staff had been redeployed to work in frontline clinical roles during the first wave of the pandemic, additional staff had been recruited to reduce the backlog, and, COVID-19 had led to various new ways of working being employed which had benefited patients and colleagues. 

Councillor Bell referred to the 955 adult social care staff mentioned in paragraph 19 of the report and asked for a breakdown of the spread of the staff.  The Head of Adult Services explained the two main areas of work. The first being frontline staff, for example social workers and occupational therapists, with locality teams including older persons, learning disabilities, mental health and hospital discharge, with each team having approximately 25 to 30 members of staff.  Secondly, in-house provider staff provide direct care and support in areas such as extra care, day services and respite.  Alongside this, administrative support staff carry out functions such as performance monitoring.

Councillor Bell welcomed the report and complimented officers for the comprehensive overview, he added, however, that he was of the opinion that the report had neglected to cover the point raised at the July meeting which was to investigate the social care system in the context of COVID-19, and, in particular, how discharges into care homes and the community will differ during the second wave of the pandemic. 

The Corporate Director of Adult and Health Services referred to the pace of change with regard to government guidance which reflects national learning, and, to which the service has continued to react and respond. 

Councillor Brown referred to the case study on the adult with learning disabilities, and, speaking from her own experience in this field, she said she had frequently observed similar scenarios.  She commented on much of the work being reactive and asked what proactive work is undertaken.  The Head of Adult Services explained that much of the work done on a daily basis is proactive, with the service response being informed through developing relationships with service users and their families, balancing risks, to maximise the independence of service users, whilst protecting and respecting the impact on families.  He added that he would be more than happy to discuss the matter further with Councillor Brown.

Councillor Temple commended the officers for the very wide-ranging and useful report which was brought to life by the case studies.  He echoed Councillor Bell’s comments adding he too was disappointed that the report had failed to address his request made at the meeting of the Committee in July, for a COVID-19 related report which was specific and dedicated to the approach as to how social care had fared during the first six months of the year.  He pointed out that in Scotland, a report had been produced on behalf of the Scottish Parliament in relation to hospital discharges and deaths from COVID-19 which included conclusions and recommendations based on statistics. He explained, the report discovered that hospital discharge is associated with an increased risk of an outbreak, when considered on its own, but, the estimated risk of outbreak was reduced and not statistically significant after accounting for care home size.  Furthermore, the report highlighted the importance of care home size in the number of deaths that had occurred.  He pointed out that the report looks at facts and statistics in order to learn lessons and he suggested that a similar approach should be used by the Committee.

The Chair and the Corporate Director of Adult and Health Services responded that they were not familiar with the report to which Councillor Temple referred and they respectfully requested Councillor Temple forward, to them, a copy of the report, to which Councillor Temple agreed.  The Chair commented that he could not recall a specific request from the Committee for an inquiry and stated his view that the issue of deaths from COVID-19 in care homes and hospitals is a national issue and, as such, should be looked at on a national basis, and, when complete, that would be the appropriate time for the Committee to investigate the issues from a local perspective.  He added the priority at this point in time should be to support professionals to undertake their duties in order to deal with the second wave of the pandemic. 

Councillor Crute, Chair of the Overview of Scrutiny Management Board added that he was not familiar with the Scottish report, however, he agreed with the Chair’s comments with regard to a call for a national report and he added he was aware that other that local authorities had also called for a national review to be undertaken, at the appropriate time, and, he would support this course of action.

Councillor Bell asked for an update on the current situation in terms of discharges from hospitals to care homes.  Providing a response, Sarah Burns, Head of Integrated Commissioning, referred to the government guidance received in September which outlined designated settings, which are units within care homes that must meet stringent physical requirements.  Patients who are fit to be discharged from hospital to a care home, must be discharged into these dedicated settings. Work has been done with care home providers to identify homes suitable to meet the physical and staffing requirements to become designated settings. The CQC must carry out an inspection to ensure the requirements are met and there is also a robust local assurance process, and, partnership working with the Council, the CCG, and providers, to ensure a safe service is delivered.

Michael Laing, Director of Integrated Community Services, County Durham Integrated Community Care Partnership, informed the Committee that new government guidance in respect of hospital discharges was received in July which set 6 weeks’ care for those being discharged from hospital which were not charged for.  The guidance included that no discharges should be delayed whilst waiting for an assessment and staff had been trained to carry out trusted assessments.  A working group was formed with partners from health and social care and the CCG to make process improvements which are built upon the existing clinical discharge processes.  The new guidance stretched targets for discharging patients from acute hospital settings within hours of being assessed as suitable for discharge, with an emphasis on discharge to safe, appropriate settings, including community hospitals. Longer term, the guidance requires the identification of single coordinators for the discharge process, to improve the transfer of patients between organisations to a safe setting as quickly as possible.

Councillor Temple thanked colleagues for the information which addressed his request for information as to what is being done now, he added that it is his view that, whilst he agrees there should be a national review, there remains a need for action locally, and, to look at regional anomalies.  The Corporate Director of Adult and Health Services acknowledged Councillor Temple had corresponded with her on this matter and she undertook to provide the information requested, to Councillor Temple, and, also to provide a copy of the information to the Chair.

The Chair thanked members of the Committee for the good-natured discussion.  He thanked the Corporate Director of Adult and Health Services and the Head of Adult Services and extended the best wishes of the Committee to all staff.  The Corporate Director of Adult and Health Services commented that she hoped the report provided the Committee with a greater overview of the work of the service and assured the Committee that the service continues to learn from local and national experiences, to do the best it can to safeguard local communities.

Resolved:

That the report be noted.