Agenda item

The Committee to consider the perspective of the Cabinet Member for Adult Care, Wellbeing and Health Integration on West Northamptonshire Council’s current performance against KPIs, challenges faced and responses.

The Cabinet Member for Adult Care, Wellbeing and Health Integration introduced the agenda item and commented that a scorecard on adult social care performance was reported to Cabinet quarterly. There was recent activity in the directorate to review and enhance the key performance indicators (KPIs) in line with Care Quality Commission (CQC) guidance ahead of inspections. As part of his role as Cabinet Member he monitored the performance of adult social care and sought assurance from the Executive Director People Services where necessary. The high number of safeguarding referrals had been an area of significant attention that should start to have an impact. 

The Cabinet Member highlighted the WNC Self-Assessment report and explained that it was a working document, produced by the Assistant Director Commissioning and Performance, and demonstrated the journey of the Council and helped it prepare for future CQC inspections. The report set out the challenges and strengths of the Council and explained the history and direction of services. WNC was experiencing many similar issues to other authorities. Its Self-Assessment had been identified as an exemplar within the region.

The Executive Director People Services went on to present the report and explained the corporate dashboard was the basis for performance reporting. There were changes made last year to refresh the dashboard in line with the upcoming CQC inspections and to give a more meaningful depiction of areas for improvement and areas to celebrate. The KPIs included were all nationally reported indicators and when CQC inspected it would want to see that WNC had a good understanding of its situation. The dashboard also reflected a drive to reduce the number of residents going into care homes and a commitment to keeping people independent for longer.

The Executive Director People Services highlighted the following points relating to the KPI report:

·         In terms of care assessments, the main statutory assessment that WNC was responsible for, members should expect to see an increase due to the level of demand for the service.

·         One of the current challenges for WNC was carers assessments as previously this function was commissioned and although a good service was delivered, the separate service caused issues for WNC in relation to understanding users’ needs and data collection.

·         One of the main changes was a move towards client level data (CLD) across all adult social care data sets. This would mean that there would be 28 data fields relating to an individual’s personal circumstances and would document their journey and show what support has been provided to them which would be shared with the NHS. WNC had begun collecting CLD for 6 months ago and would be able to review the impact of this in the short-term future.

·         Reviews of support packages and placements were on an improvement trajectory as shown in the report.

·         The KPI relating to reablement was one of the most significant indicators being monitored on how well the service was doing at keeping people at home following a discharge from hospital.

·         The corporate indicators would be a starting point for conversations with CQC following an inspection.

·         The speech and language therapy service (SALT) which was responsible for short term interventions, getting equipment and assisting with reablement work was concluding and a long term care package solution would replace this.

·         The report included a selection of KPIs derived from the corporate dashboard, which encapsulated all performance management which covered public health, adult’s, and children’s social care.  Each month at the Assurance Board the team would pick out and rate, areas to celebrate and areas of concern that were not on target.

·         The WNC Self-assessment had been recognised as good practice and demonstrated an honest depiction of where WNC was on its journey as well as a financial backdrop, an improvement plan, data set and explanatory narrative. This would further demonstrate to CQC that WNC knew its position well, its current priorities and had plans in place for further improvements.

The Committee considered the report, asked questions and had discussion as follows:

·         Members felt it would be useful to receive the items of concern and dialogue that went with the KPIs for the Committee’s agenda planning meeting. This would signpost to areas where scrutiny might be able to assist or look at in more detail. The Executive Director People Services suggested that 5 priorities could be brought to each meeting for oversight and assurance and evidence provided.

·         Members sought further understanding of the position regarding carers assessments. The Committee was advised that WNC had a statutory responsibility to undertake carers assessments. Northamptonshire County Council (NCC) had previously commissioned Northamptonshire Carers to carry out this function, which reduced the ability for WNC to work holistically and to develop good data. WNC was now moving towards taking more direct responsibility and a new Carers Strategy was also being developed. The Support for Unpaid Carers Task and Finish Panel would contribute to work in this area.

·         The 10 KPIs in the areas of concern were highlighted and it was asked how many KPIs in the dashboard had a red RAG rating. The Committee was advised that 35%-40% were currently rated red. Members asked if this could be included at future meetings so scrutiny could monitor the improvement of this.

·         Members questioned what an outstanding rating from the CQC would involve and the Executive Director People Services advised that it required an authority to be in the upper quartile for all nationally reported KPIs, although this was only part of the CQC’s focus. The pilot authorities for the new inspection process had reported that it was based on going through case records, speaking to service users, partners and those working in the service area. This would be used to see whether the dialogue from those CQC engaged with matched the position documented by the authority. CQC expected authorities to have a comprehensive understanding of how they performed and areas that required improvement. The Executive Director People Services had applied for WNC to be part of the pilot period and the next group of authorities to be part of the pilot sites had been identified. He was encouraging CQC to come to inspect WNC as soon as possible so that it had a clear understanding of areas it needed to address. He expected that WNC’s rating would be between requires improvement and good. 

·         Members welcomed the move to CLD and asked when the Executive Director People Services anticipated that scrutiny could be able to review the progress. The Committee was advised that the Executive Director People Services would approach the performance lead. The current position was that 98% data matched and it was exciting that this would be overlayed with NHS data in the future to strengthen adult social care as they moved towards a partnership working approach.

·         Members welcomed the safeguarding referral response rate and discussed a personal experience of using the service on behalf of a resident.

·         Members discussed discharges from hospitals and how this was communicated with GPs. The Committee was advised that there would be a shared care record and GPs would be more informed about a person’s entire medical and care history going forward.

·         Members expressed concern at funding being cut in the voluntary sector and the impact of this on local area partnerships (LAPs). The Executive Director People Services responded that he was not aware of a reduction in funding for the voluntary sector in the Medium Term Financial Plan and the People Services directorate had not taken any action to this effect. The Committee was further advised that there was an aspiration to have devolved budgets for LAPs but this was not possible within the WNC constitution at this point.

·         Members sought reassurance about performance on respite care. The Executive Director People Services advised that much of the respite capacity formerly used by NCC was in North Northamptonshire. WNC did have plans to convert Eleanor house but CQC had not agreed to changing its use.WNC was currently looking at cost exercise to procure a number of respite care beds within homes to give allocation to people on an annual basis or to use for those in crisis.

·         Members asked if there was a triage process in place for care plans that had not been finalised. The Committee was advised that there were triggers that alerted officers if plans had not been signed off and for ongoing social involvement there was a handover process in place. However, this was dependent on resourcing and social workers in place to take over the care provision.

The Chair thanked the Executive Director People Services for presenting the report and agreed with the suggestion for 5 priorities to come to future agenda planning meetings and if necessary be brought to the Committee for further scrutiny input. The Chair thanked members for the important points raised and suggested that respite care could be considered as part of the scrutiny review of support for unpaid carers. The Chair also reminded the Executive Director People Services that the Committee were awaiting a date for a briefing session on the adult social care, public health and wellbeing operating environment.   

RESOLVED: That the Adult Social Care and Health Overview and Scrutiny Committee considered the reports, KPIs and information relating to the performance of adult social care and requested that:

·         The Executive Director People Services highlight 5 key priority areas to the agenda planning meeting for Adult Social Care and Health Overview and Scrutiny for oversight and scrutiny to consider potential areas for further scrutiny input.

·         The KPI performance RAG ratings be monitored and brought to future agenda planning meetings so that scrutiny could monitor the percentage of red ratings.

·         A review of client level data and the impact of this be brought to scrutiny in the next 6 months.

·         Respite care be considered by the Support for Unpaid Carers Task and Finish Panel as part of its work.

[The Executive Director People Services left the meeting at this point].