The Committee received a report which updated members on the current issues impacting on the Adult and Social Care Service in County Durham (for copy see file of minutes).
There were a number of significant changes ahead for the service which included:
· Social Care Charging Reforms
· Introduction of a national quality assurance framework for local authority Adult Care services by The Care Quality Commission (CQC)
· Amendments to the Mental Capacity Act (2005) which would replace Deprivation of Liberty Safeguards with Liberty Protection Safeguards
· A refreshed national Adult Social Care Outcomes Framework
K Barnes, Principal Social Worker for Adults provided a detailed presentation explaining that the refreshed vision for Adult Social Care was to “Ensure adults with care and support needs and their carers receive the care and support they need, when they need it, to support them to live the lives they want.” She explained that the Service supported over 22,500 adults in County Durham with a wide range of social care needs and advised that the service had seen an increase in self-neglect and hoarding. She explained the current workforce challenges for the service and advised that the introduction of a new assurance framework would include an independent assessment of local authorities’ delivery of adult care functions by the CQC.
Councillor Kellett highlighted that out of 8,504 open cases in integrated mental health services, only 482 adults had care & support provisions and questioned if there should be more. The Principal Social Worker for Adults explained that the mental health service was an integrated team and included various professionals who were able to provide targeted support for adults. She advised that the integrated team focussed on a support and recovery model and that this helped adults to overcome an episode of mental health. As a result, they benefited from a clinical oversight, which meant that bought in care and support provision was not always required.
In response to a question from Councillor Sutton-Lloyd regarding increased hoarding, the Principal Social Worker for Adults noted that whilst there was no research to indicate the reasons why hoarding had increased, she believed that there were a range of factors that had contributed to the increased numbers, including the Covid-19 pandemic.
Councillor Quinn did not believe that increased hoarding was linked to the Covid-19 pandemic, from her experience it was more cultural and often affected people that had never had anything. Councillor Quinn stated that she worked in a private nursing home which helped to rehabilitate people who were discharged from hospital so that they could return to their own homes. She emphasised the importance of the work to allow adults to live the lives they want.
Further to the comments raised regarding hoarding, Councillor Hovvels stated that a lot of services were required to address this issue, not just health alone, and hoped that services were working well together to address this issue. The Principal Social Worker for Adults confirmed that there were strong partnership arrangements with the fire service to address hoarding and explained that training had been introduced to help identify the cause of the behaviour and to try and prevent hoarding from reoccurring but advised that this required a larger resource.
With regards to the changing profile of the workforce, Councillor Earley, the Chair, expressed his concern and asked if there was anything further that could be done to address this problem in the short and mid-term. Further to this, Councillor Quinn noted that NHS staff who had retired in their fifties were going to be encouraged to return to work.
M Laing, Director of Integrated Community Services, County Durham Care Partnership explained that in the short term, a new generic role, similar to the previous nursing auxiliary role, was currently being considered to combine the many visits currently undertaken from various professionals. He advised that salaries were often a barrier in recruiting new staff noting that salaries in the independent sector were significantly higher. The Director of Integrated Community Services explained that another plan was to encourage those that had retired to continue to work and that this would help to address some of the problems with workforce challenges and maintain expertise within the service.
Councillor Kay commented that it was costly to re-employ a person following retirement and suggested that encouraging reduced hours as an alternative to retirement could be more cost effective. The Director of Integrated Community Services stated that to appeal to people’s public service ethic, it was better to persuade people of their right to retire and receive their pension and then encourage them, where possible, to return to work at a normal hourly rate, but he highlighted that negotiations around this were dependent on the relationship the person had with their manager. The Director of Integrated Community Services stressed that highly skilled nursing staff were key and their return to the NHS was important.
Councillor Andrews highlighted that if nursers reduced their hours towards the end of their career, it impacted on their pension and therefore could be a contributing reason why people retired and then returned to the workplace.
Councillor Andrews went on to ask about the hybrid programme for social services and mental health and whether this programme had progressed. The Principal Social Worker for Adults explained that dual registered nurses and social workers had existed, and that further consideration was to be given to this approach as there was value in hybrid roles.
M Laing, Director of Integrated Community Services referred to the independent assessment of local authorities’ delivery of adult care functions by the CQC and advised that the Local Authority could be inspected in 2023. He explained that the inspection would involve the whole Council and would include a review of minutes of the meetings of the Adults, Wellbeing and Health Overview and Scrutiny Committee (AWH OSC), interviews with the Chair and Members of the Committee. He noted that the previous inspections had stopped in 2011 and it was therefore important to make staff aware of the inspection process and what was required of them.
Councillor Earley emphasised that it was vital to support staff through the CQC inspection.
S Gwillym, the Principal Overview and Scrutiny Officer highlighted that there had been a robust relationship between the Children and Young People’s Overview and Scrutiny Committee (CYP OSC) and the Children’s Services Inspection. He stated that the Adult and Health Service Team would seek support from Children and Young People’s Services in terms of experience from their Ofsted inspection, and Members of the AWH OSC Committee should likewise seek support from Members of the CYP OSC to help them to feed into the CQC inspection.
That the report and presentation be noted.