Agenda item

The Committee received a report of the Interim Corporate Director of Adult and Health Services which provided an update on developments in Adult Social Care; including the Care Quality Commission (CQC) assessment of Adult Social Care in County Durham, a new service delivery model for Adult Mental Health Services, Unpaid Carers Service in relation to hospital discharge, and the Breakthrough Service.

The report also provided an update on developments in relation to health and social care integration, particularly the advances made through the County Durham Care Partnership (CDCP) on the Transfer of Care Hub (ToCH), the Therapies Project and extended work on the Children and Young People’s Integrated Services.

On 14 September 2022 Cabinet noted the potential changes to health and care integration set out in the Health and Care act 2022 and the Integration White Paper (February 2022). Cabinet agreed that the preferred option for future health and social care integration would be a Joint Committee co-produced with the North East and North Cumbria Integrated Care Board (ICB). Cabinet also noted that detailed discussions were needed with partners and Government guidance may be published which would have an impact on the preferred option. The report gave an update on the discussions with partners, the impact of Government guidance and the likelihood of the preferred option to deliver significantly better outcomes (for copy of report, see file of minutes).

Lee Alexander, Head of Adult Services was in attendance to present the report and advised Members that Durham’s ‘Good’ CQC assessment rating carried the joint third highest assessment score among the local authorities currently with published CGC reports.

The Chair congratulated the team on the outcome of the CQC Assessment of Adult Social Care in County Durham.

Councillor Early referred to the issue of hospital discharges; transfers of patients and care pathways and asked if there were other opportunities to better integrate decision making and access to services to facilitate safe and prompt discharges.

The Head of Adult Services responded that despite some of the restrictions that had been embedded within the Social Care Act and the associated White Paper the Council was ahead of the curve and one of the strengths of Durham was their partnerships approach to integrated service delivery. The Council and partners take a measured approach to this in identifying new opportunities; they regularly get together strategically to address joint issues. An example of this was joint work pertaining to hospital discharges where they have implemented a trusted assessment model whereby NHS professionals can undertake baseline assessments for patients who require social care services coming out of hospital. In doing so, this reduces hand offs and delay. He stated that they were challenged by budgetary constraints, but they continually are looking at how they can develop social care service delivery.

Councillor Hovvels referred to discharges from hospitals and the use of external organisations and stated that an understanding of the local area and locations was useful and asked if some of these organisations were outside of the County. She continued in relation to the caseloads of social workers and asked for details of the caseloads and how often were the cases reviewed. She then asked if the Housing Board still had their own occupational therapists and how they linked into the Council and partner agencies. She stated that the work carried out for the children’s social care casework that herself and Councillor Gunn had undertaken in bringing that together was important and asked if this would continue to be a priority.

The Head of Adult Services responded that in terms of caseload management he looked at a dashboard on a weekly basis of all of his team’s workloads. He stressed that caseloads varied between teams due to having different remits as well as the varying nature of the work. Regarding hospital discharges they had relatively low caseloads but managed high volume and quick turnover, but the learning disabilities team have larger caseloads but manage people over a longer period of time; often over many years. He stated that there was no benchmarking data to define an optimal caseload within adult social care, but caseloads had remained stable and manageable, the greatest challenge was the complexity of cases. He referred to the legislative changes that had taken place and years of resource pressures which had led to more challenges because case management had become more complex in nature. The service continued to monitor workloads and service standards and have systems in place to monitor these. Improvements in new technology had contributed to developments in service standards. An example of this was the investment in tablets with 4G technology to enable staff to make case notes and update records out in the field. In relation to occupational therapists, the service worked with housing partners and had set up a partnership board. An early focus of this board was to better understand occupational therapy interfaces between housing and social care activity. Within housing providers occupational therapy provision had reduced over the years and the Councils’ occupational therapists had become more of a referral agent to respond to as a consequence of that. In relation to work with children they had the navigation service (overseeing the transition of children with disabilities from children to adult services) that was robust and there was no intention to remove that; reflecting that this service was continually developing in close working across the board on how they could improve and develop their service offer to young people.

Councillor Higgins asked if they were up to date with the twelve-monthly reviews of care packages.

The Head of Adult Services indicated that during COVID the reviews had suffered, and performance had reduced. They had undertaken a review of their systems and processes and carried out a re-structure 18 months ago and invested in additional staff to recreate a countywide review team. They had seen the performance increase and was now up to almost 80% of reviews undertaken within the twelve-month period. They had a target of 80% and he wanted to increase this to 90% and in doing so would be in a really strong performance position and was confident this was achievable in the next 6 to 12 months.

In response to a question from Councillor Heaviside on the breakthrough service, the Head of Adult Services responded that the service had been up and running for 18 months, he would get back to Councillor Heaviside with the data in relation to the number of referrals and the number of service users seen. He continued that a successful business case for the initiative had allowed for investment to be made to deliver the service which works in line with statutory duties under the Care Act. They received referrals from social workers and integrated teams. There are operational restrictions as they are a consensual service which requires people to fully engaged. The Head of Adult Services referenced lots of case examples where they had made a significant and lasting difference to service users wellbeing. The new breakthrough service was specifically designed to enable this.

Some of the historical challenges experienced with this type of service was the wide range of agencies who were in a position to identify, and report concerns around hoarding but might not be able to address the issues holistically.

Resolved: (i)That the outcome of the CQC Assessment report which, with a service improvement action plan, will be presented to Cabinet on 16 October 2024 be noted.

(ii) That the progress on the developments across Adult Social Care be noted.

(iii) That the continued commitment of partners to further health and care integration through the County Durham Care Partnership (CDCP) be noted.

(iv) That the impact of the Statutory Guidance (March 2024) on the likelihood of the previously preferred option of a Joint Committee to deliver significantly better outcomes for the residents of County Durham be noted.

(v) That the Council should continue to promote and participate in health and care integration through the CDCP, but the option of a Joint committee should not be pursued in the current circumstances be agreed.

(vi) That if there are changes to Statutory Guidance or ICB proposed delegations to place based arrangements further reports will be made to Cabinet.

(vii) That the developments in relation to health and social care integration to improve outcomes for the people of County Durham be noted.

(viii) That the extension of the integration programme to include Children and Young People’s Service be noted.

(ix) That the committee receive future updates on Adult Social Care and progress on health and social care integration.