Agenda item

The Committee received a report of the Corporate Director of Adult and Health Services that provided an update following the report presented in July 2023, on the Care Quality Commission (CQC’s) timeline to commence the assessment of the way local authorities discharged their Adult Social Care duties under Part one of The Care Act (2014); including information relating to pilot assessments and Assurance Peer Challenges (for copy see file of Minutes).

L Alexander, Head of Adult Care provided a further update following the initial report that was presented to the committee in July 2023.  There was to be an assessment of the Local Authority on social care and how they discharged their duties under part one of The Care Act 2014.  The Care Quality Commission (CQC) was a single assessment framework that looked at all services with a health and care setting.  The processes had not changed apart from the quality statement. Guidance had been issued to reinforce best practice with reviews carried out on published evidence and data from all 153 Local Authorities to establish a baseline.  The baseline review focussed on themes on care provision, integration, continuity and assessing needs.  Workforce capacity was a real challenge and it had been reported nationally within Local Authorities that there was an under provision of specialist care, domiciliary care and day care.  The self-assessment for Durham County Council was almost complete which had been prepared alongside an independent assessment by an ADASS associate with external peer reviews as a learning process.  He agreed once completed the self-assessment would be brought to the Committee’s meeting scheduled in March.

Councillor K Earley asked if it was thought there were any major risk areas that were cause for concern. 

The Head of Adult Care responded that he did not think there were any major risk areas to be concerned about as Durham was in a strong position.  CQC were looking into waiting lists.  He confirmed that Durham County Council had no waiting lists for domiciliary care but there was a small waiting list for people to have assessment of needs carried out but that was not down to Durham County Council and not a significant factor.  There was a waiting list for Deprivation of Liberty Safeguards (DoLS) but this was tolerated due to emergency cases. The annual review was not as good as it used to be therefore countywide review teams were introduced to improve completion times.  Direct payments were focussed on.  Although Durham County Council provided direct payments it was of a low prevalence compared to other local authorities who promoted them.

Councillor K Earley queried if direct payment issues were comparative to similar authorities outlying or if they were linked to community areas with levels of deprivation or multifaceted reasons.

The Head of Adult Care stated that this was not the case as direct payment were not classed as benefits and was used for people to employ personal assistants to help them to live independently irrespective of where they lived.  There were other models people used of pre-existing domiciliary care facilities if they did not want to employ a personal assistant. 

Councillor S Quinn felt that the way forward was through intermediate care that enabled rehabilitation following a hospital visit prior to going home.  Care assessments promoted their wellbeing for life so they could take charge of their own destiny. 

The Head of Adult Care confirmed that Durham County Council offered intermediate care but it needed to be reviewed to identify gaps in the market to expand the offer.

Councillor S Quinn thought people gained a good quality of life even if they did present again as it was different to a nursing home.

Councillor D Haney queried if direct payment were paid in advance to use domiciliary care which could potentially build up in an account if visits for care were cancelled. 

The Head of Adult Care stated that direct payment for care was a further way in which service users could have control of their care needs.

Councillor D Haney felt that people did not want to manage direct payments to try to sort out spreadsheets and pay bills.

Councillor P Jopling endorsed Councillor S Quinn’s comments as intermediate care was important to release patients from hospital beds.  She stated as people grew older they could be taken over by services but most people wanted to stay in their own homes to make own decisions and look after their own wellbeing and health.  This service was very important to take the strain off the NHS.  She trusted Councillor S Quinn’s judgement as she worked in this field.

The Head of Adult Care commented that there was a legal framework to adhere to with intermediate care that had strengths.

Councillor S Quinn gave an example of people not being able to get out of bed when they came into her setting and left being able get up and sit in a chair.  She felt that little things led to people becoming victims but they needed to accept they were old, their way of life and take responsible for their own body to give themselves the dignity they deserved.

Councillor J Higgins stated that he was a former social services employee and knew that some people did not want to be responsible for accounts and were concerned about employing someone.  This added a barrier for people to explore this option but the list for DCC to provide carers was once very high.

The Head of Adult Services confirmed that historically there were delays with OT assessments that delayed care provision.  However there had been intensive work carried out on the service and currently there were not significant waiting lists.

Councillor J Higgins acknowledged that there were review teams established to carry out assessments but with redundancies this fell to social work assistant to do their own assessment.  He queried if this issue had been evaluated.

The Head of Adult Services confirmed that there was a wide review team in place 10 years ago that had been disbanded that was linked to the Medium Term Financial Plan pressures at that time and that work had been absorbed into locality teams.  This had increased the amount of pressure on adult care staff and performance had suffered.  The service was now different as investment had been made in staff to re-establish the review teams.

Councillor L Hovvels referred to page 20 in the report that care plan assessments took too long to complete and queried what had been done to improve the service.

The Head of Adult Care agreed to provide with response.

Mrs R Gott questioned how the recent legislation fit in if assessments were unable to be completed. The Head of Adult Care replied that CQC focused to engage to co-produce a strategy plan based on peer review comments on good areas.  There was a need for more work on co-production that was challenging and taking longer to do now.  He stated that Durham was the only authority that did not advertise about direct payments.

Mrs R Gott asked how the needs of clients with dual diagnoses were met both physically and mentally. The Head of Adult Care responded that the social care assessment provided a holistic multi-faceted care plan for that catered to people’s needs.  This incorporate work with colleagues across agencies that were adept working in mental health expertise.

Councillor V Andrews felt that this was the way forward with reviews that needed to remain current.

Resolved

i)        That the report be noted.

ii)       That the finalised self-assessment be presented to Adults,

          Wellbeing and Health Overview and Scrutiny Committee on 18  

          March 2024.