Agenda and minutes

The Chair welcomed all Members to the first Board meeting of the 2022-23 municipal year and introduced Mr Ed DeVane, the new Co-opted Healthwatch Member, who was welcomed to his first meeting of the Board as a co-opted member.

Co-opted Member, Ed DeVane declared he was employed as an Advisor for the Department of Health, however he attended in his role as representative of Healthwatch and as such his employment did not preclude him from fully participating in the meeting on all agenda items.  

(a)  The minutes of the meeting held on 23 March 2022 were signed as a true record.

(b)  Matters Arising: Minute 33 (Report back from the Autism Task and Finish Group)

The Board noted that the recommendations in the report had been accepted by Cabinet and an update would come to the Board in due course.  The Chair reported that she and Cllr J Innes had met and would be establishing a Task and Finish Group to look at autism from an education perspective and invited those Members who would like to participate to let her, or the Scrutiny Co-ordinator know.

Briefing note

The Board considered a briefing note and presentation which introduced the series of adult social care reforms which were to be implemented over 2022 and 2023 (based on current published timescales) as a result of the introduction of new government policy and legislation.  The engagement and involvement of SB5 in supporting the preparation for this raft of reforms could have a significant contribution to the success of their implementation.

The presentation included information on the range of reforms to Adult Social Care which are to be implemented over 2022/23 which included:

• Moving towards a Fair Cost of Care (FCoC)
• Introduction of the care cap
• Changing contribution thresholds
• Liberty Protection Safeguards (LPS)
• Care Quality Commission (CQC) oversight of Adult Social Care

Alongside the above areas of reforms there was other work ongoing including the transformation of Mental health, improvements to Urgent Care and Frailty and revised Discharge processes alongside revisions to the Mental Health Act.

The Briefing Note indicated that the input of Scrutiny Board 5 could play an important role in supporting Adult Social Care to prepare for these reforms over the next two years.  A particular area recommended to the Board which would have an immediate contribution was in respect of preparation for CQC oversight and the review of i) how we oversee quality within commissioned support, ii) how risk was managed when people approach the city council for support iii) how effective our safeguarding procedures were, and iv) how we monitored the customer experience and take feedback from this to improve. 

Members of the Board were invited to consider their input in preparing for the incoming reforms with a particular focus on preparation for CQC oversight.

Following the presentation, Members asked questions and were given answers on a number of matters including:

• Co-operation with providers in moving towards a Fair Cost of Care and the impact on waiting times.
• With technology enabling users, what plans were in place for training.
• Impact on those who were self-funded and how they would be notified of the incoming changes.
• Key challenges for an integrated care system.

Arising from discussion, the Board agreed that it would be useful to their understanding to have Member workshops arranged in respect of ‘Transformation of Mental Health services’ and ‘Revised discharge processes’

RESOLVED that the Board note the content of the Briefing Note and presentation and agreed:

(a)  That the Scrutiny Board 5 Chair work with the Cabinet Member for Adult Services and Officers to consider the Board’s input in preparation for reforms with a particular focus on preparation for CQC oversight.

(b)  That Member Workshops be arranged for:

(i)  Transformation of Mental Health Services

(ii)  Revised discharge processes

Briefing note

The Board received a briefing note and presentation which informed them of the Council’s refreshed approach to quality assurance of adult social care provision and management of market failure in adult social care and sought support for both new approaches.

The Council’s Adult Social Care Service remained committed to ensuring best value in its commissioning and procurement and required on-going assurance that the quality standards for care and support outlined in its service specifications and contracts continue to be met. This included requirements for individual outcomes to be delivered by providers working with service users and their representatives with dignity and respect being central to the quality of services.

As at June 2022, the Council had around 130 services (including some in house services) that required monitoring including 73 care homes (of which 48 cater for older people, 15 for younger adults with learning disabilities/autism and 10 for younger adults with mental ill health) 17 home support providers (providing both short-term promoting independence support and longer-term care) 18 housing with care schemes for older people and 14 supported living facilities catering for people with learning disabilities/autism or mental ill health. Other services include day opportunities, community meals and a range of voluntary sector preventative support.

The work to monitor and oversee the quality of these services is led by the City Council as contractor. This was undertaken collaboratively by our Adult Commissioning Team, working with nurses employed through Coventry and Warwickshire Clinical Commissioning Group (CWCCG) who provided clinical input to the Quality Assurance function and worked closely with colleagues at the Care Quality Commission (CQC) whose role as regulator was distinct and separate to our role as contractor of services for people with care and support needs.  The collective approach with CWCCG colleagues and the CQC ensured we were better able to identify issues and take remedial steps to improve the delivery and quality of care locally.

The service had applied a risk-based approach to quality assurance for many years with more focus on those services considered to be most at risk due to indications of poor quality gathered from local intelligence. This process had been reviewed and on the basis of this, a refreshed approach based on 4 levels of risk, (detailed in the report) was proposed and endorsement sought.

The enhancements to the approach were:

·  Introduction of an improved risk-based approach with greater clarity on levels of concern and appropriate oversight and action.

·  Improved processes and management of providers where there are quality concerns with clear escalation process. 

The Board considered the matter in particular whether there was sufficient capacity in both number and skills to undertake the market shaping activity.

RESOLVED that the Board note the proposals and agree that comments be formally conveyed to the Cabinet Member in a briefing note to be considered alongside the Public Report on this matter at the meeting to be held on 13 July 2022.

Report of the Scrutiny Co-ordinator

The Board noted the work programme for the 2022-23 municipal year with the inclusion of:

·  Adult Social Care Reforms/CQC oversight (referred to in Minute 4 above)

·  Health Protection

·  Director of Public Health and Wellbeing Annual Report

Agreed the Board would further consider the items below for possible inclusion in the Work Programme:

·West Midlands Ambulance Service:

ØWas it too large an organisation to provide a good local service?

ØWhat work was being done with NHS partners to ease waiting times?

·  Pet therapy – explore benefits and consider developing a strategy

·  Covid – as a standard item on the agenda

·  FGM

Any other items of public business which the Chair decides to take as matters of urgency because of the special circumstances involved

(a)  The Board conveyed their wholehearted thanks to Councillor J Clifford who had been Chair of the Health and Social Care Scrutiny Board since 2019.

(b)  The Board asked that an updated list of widely used acronyms be circulated to Members.