Agenda and minutes

Health and Care Scrutiny Committee - Thursday, 15th December, 2022 10.00 am

Venue: By Zoom. View directions

Contact: Wyn Richards Scrutiny Manager and Head of Democratic Services

Media

Items

No.

Item

Apologies

To receive apologies for absence.

Minutes:

Apologies for absence were received from County Councillors G Ratcliffe, E Roderick, G Morgan and J Ewing.

Declarations of Interest

To receive declarations of interest from Members.

Minutes:

There were no Declarations of Interest from Members relating to items to be considered on the agenda.

Disclosure of Party Whips

To receive disclosures of prohibited party whips which a Member has been given in relation to the meeting in accordance with Section 78(3) of the Local Government Measure 2011.

(NB: Members are reminded that, under Section 78, Members having been given a prohibited party whip cannot vote on a matter before the Committee.)

Minutes:

The Committee did not receive any disclosures of prohibited party whips which a Member had been given in relation to the meeting in accordance with Section 78(3) of the Local Government Measure 2011.

Minutes PDF 127 KB

To authorise the Chair to sign the minutes of the last meeting(s) as a correct record.

25-07-2022

07-10-2022

Additional documents:

Minutes Public Pack, 07/10/2022 Health and Care Scrutiny Committee , item 4. PDF 152 KB

Minutes:

The Chair was authorised to sign the minutes of the following previous meetings as a correct record:

25-07-2022

07-10-2022

Quarter 2 - 2022-23 Performance, Finance and Risk

5.1

Q2 Performance Report PDF 73 KB

The Scrutiny Pro-Forma is attached.

Below is the link to the Performance Report:

Performance Report

Minutes:

Documents Considered:

Quarter 2 Performance 2023-23 together with the Pro-Forma.

Issues Discussed:

Children’s Services.

· Many strengths in the Service’s performance and some complicating factors around elements. Numbers of Children Looked After have remained stable and the Service is aiming to reduce those numbers. Child protection numbers increased towards the end of quarter 1 into quarter 2. The Service has started looking at ways of how to start reducing these numbers and these should start decreasing into quarter 3.

· High level issues include the budget due to the overspend. This is mainly due to an increase in the costs of placements around residential provision and the lack of affordable placements in-county.

· The Service has refocussed on its closer to home strategy which includes the recruitment of foster carers, residential provision and bringing children closer to home. The Service has realigned the strategy and developed a Board to the actions and aims.

· In terms of staffing there is still a high reliance on agency staff. During the Autumn the Service has acquired 5 fully qualified social workers through the Council’s grow your own programme who started work in quarter 3.

· Pressures remain around high cost placements which has had an impact on budget, but overall with regard to performance on child protection and children looked after, there are plans in place to reduce these numbers going forward.

Questions:

Question

Response

In Section 1.2 of the Performance Report, there are three objectives identified which seem to have a red Brag status. It is difficult to see the thread between sections in the report.

Officer Response:

The Directors agreed to take those comments back to the team who compiles the report to see whether it could be improved.

Closer to home work. Last year £1.5m was identified as savings for closer to home placements. Those savings have not been achieved as yet and it is becoming clear that this is difficult. What is being done to locate a property and could a county farm be considered as an option.

Officer Response:

The closer to home Board has tried to focus on what are the aims and objectives and what is trying to be achieved. One of those areas is around increase the numbers of in house foster carers, and the Service is working with Foster Care Wales in terms of developing a strategy alongside them to recruit new foster carers within Powys. The Service recognises that the Council has not built its grow your own foster carers in as much depth as would have been liked so the focus is around building the in house foster carer provision. There has also been a national campaign around fostering.

The Council also has responsibility for unaccompanied asylum seeker children as part of children looked after and the Service is looking at ways to support those young people with provision in Powys rather than elsewhere. A provision has been developed in North Powys with an organisation called Llamau who have secured properties in North Powys and in ... view the full minutes text for item 5.1

5.2

Q2 Finance Report PDF 448 KB

To receive and consider the report of the Cabinet Member for Finance and Corporate Finance.

Additional documents:

Scrutiny Report - Q2 202223 questions , item 5.2 PDF 83 KB

Minutes:

Documents Considered:

Report of the Cabinet Member for Finance and Corporate Transformation.

Issues Discussed:

Children’s Services:

· There are a number of complicating factors within the report in terms of placements and the costs of placements and residential provision to meet the needs of children. The costs in that marketplace are increasing, with placements becoming fewer which is an increased budget pressure.

· In terms of resilience within the workforce and the ability to recruit and retain staff the Service has had to rely on agency workers and there is an impact of those costs on the Council, so the work done by ADSS to cap costs is welcomed as the need for agency staff has continued.

· There is a national problem in terms of placements for profit which is part of the national agenda around eliminating profit. However, we currently have exceptionally high cost placements and we are in a position that we have to find placements for children, sometimes quickly and they can be far away and expensive which is why the closer to home strategy is so important moving forwards. Recruitment and retention and the number of vacancies across Wales are national issues as well which is why the grow your own strategy is also so important.

Questions:

Question

Response

Could give quick view on some of those children with complex needs, why are those children costing so much in terms of placements, what are the themes behind the complex needs, and what are we doing at the preventative level to address that through collaborative working or early help.

Officer Response:

In terms of placements the position is that providers can charge for profit and they name their price. This is the position nationally and what we are trying to stop. Some of the placements that we need currently for children with complex needs are not available in Powys Sometimes there is also an overlap with Education and ALN and it can affect both the Children’s Services and ALN budgets.

The Service tracks all children looked after and there has been greater focus on those placements which have a higher cost and the reasons behind this. Some of these may have been historic placements with children and young people who experienced environmental themes. The preventative services through collaborative working with education, health and early intervention are in a much stronger position, with emphasis on community based working and a focus on early intervention. In addition the Flying Start programme is picking up on early themes for children and bringing these to our attention.

Whilst the Children Looked After figures have risen in quarter 3 but there are specific reasons for that and they will reduce, those themes have continued and become apparent during the pandemic but this has not led to the expected increase in numbers. Early intervention and a multi -agency approach is working in the ways which is intended. Welsh Government’s aim of care without profit is to bring those young people back into Powys and possibly ... view the full minutes text for item 5.2

5.3

Q2 Risk Report PDF 74 KB

To receive and consider the report of the Cabinet Member for Finance and Corporate Transformation.

Additional documents:

Minutes:

Documents Considered:

Report of the Cabinet Member for Finance and Corporate Transformation.

Issues Discussed:

· The Chair noted that the items raised in the risk register have already been considered in the Children’s Services budget, the domiciliary care pressures in the workforce.

· The only other issue was the WCCIS system which was not considered to be fit for purpose.

Questions:

Question	Response
Could the Committee receive and update on digital transformation, how are systems working and is the risk starting to de-escalate.	Officer Response: The Director of Social Services indicated that WCCIS is not fit for purpose which impact on the Service areas in carrying out operational duties. Following updates the current feedback from officers is there is a general improvement, with the platform being more stable. In the summer a digital transformation of Social Services project was commenced led by ICT in collaboration with staff from across Social Care. As part of this review, early next year, will be the consideration of options for a data management system including remaining or update the current system or moving to a new platform. The feedback from practitioners is that WCCIS remains slow with outages, and it is still not as intuitive as it could be, so there is a level of dissatisfaction amongst practitioners. Staff are very reliant on the system to make evidenced based practice decisions. In relation to the digital transformation project the group is in the process of arranging four demonstrations for alternative or updated systems to soft test the market. Then there will be a procurement exercise if that is deemed to be the next step.
What are other Local Authorities in Wales doing in terms of their use of WCCIS. Are they looking at the same options as Powys.	Officer Response: Other local authorities are aware of Powys’ intentions and watching what we are doing. Not all Welsh Local Authorities signed up to WCCIS initially so there is mixed provision in relation to these data management systems. Some local authorities have moved onto WCCIS and others have remained with their bespoke platforms.
Due to the historic WCCIS issues, the Chair had asked Heads of Service whether any service users been put at risk due to the system. The previous Head of Children’s Services suggested that this may have been the case whilst it was not the case for the Head of Adult Services. Are service users being put at risk due to the issues with the platform.	Officer Response: In relation to Adult Services the Head of Service was not aware of any individuals placed at risk. However, when the system does not work it has a significant effect on staff morale. However, whilst no residents have been put at risk it is a serious enough problem that needs to be rectified. In relation to Children’s Services no child has been placed at risk due to WCCIS issues. It is around staff morale and the ability to record information in a timely manner. The system does cause ... view the full minutes text for item 5.3

Working Group Reports

To receive and consider the feedback from the Hospital Discharges Working Group which met on 9^th December, 2022.

Minutes:

Documents Considered:

None.

Issues Discussed:

· A Working Group had been held to discuss Delayed Transfers of Care and the timely return of Powys patients from District General Hospitals outside Powys with appropriate care packages.

· The Working Group noted the positive work undertaken by the team as well as the positive relationship with the Health Board and that the investment made was delivering the necessary improvements.

· Some of the issues being reviewed included two brokerage system being in place for care home placements with work being undertaken to realign those systems.

· There was also work to be done to incentivise short term care in Care Homes.

· The Service works to Welsh Government’s Discharge to Recovery and Assess framework, not assessing people in hospital and moving people onto short term pathways to give people a chance to recover and then they can be assessed for any longer term care needs. Ideally what should happen is to move people straight from hospital to home. Where this is not possible the Service relies on step down provision and it wants to work with care homes as a strategic partner to provide that step down provision.

· Joint commissioning work needs to be undertaken between the Service and the Health Board to work with care homes in providing that short term provision.

· The Commissioning Team is working with the Health Board, and have arranged a workshop with Care Home providers and Domiciliary Care providers to understand their pressures and to work together to understand collectively what can be done to support the sector.

Questions:

Question

Response

What are the outcomes of the workshop. Will it lead to an action plan or is there one already in place.

Officer Response:

The aim is to have an honest conversation with the sector as the Council is already aware of many of the issues but to identify what else the Council and Health Board can do to support the sector and to explore all possible options.

Outcomes:

· Noted

· Add to scrutiny work programme about the prevention of falls work and what difference this is making.

Work Programme PDF 53 KB

To note the Committee’s Forward Work Programme.

Minutes:

The Committee noted the schedule of future meetings.