Agenda item

Purpose of the item: To provide a progress update on the programmes which make up the ASC transformation programme and to share the ambition for 2022/23.

Witnesses:

• Sinead Mooney – Cabinet Member for Adults and Health
• Liz Uliasz – Deputy Director of Adult Social Care
• Kathryn Pyper – Senior Programme Manager, Adult Social Care
• Sue Murphy – CEO, Catalyst
• Immy Markwick – Mental Health Lead, Independent Mental Health Network

Key points raised during the discussion:

1. The Senior Programme Manager introduced the report and highlighted the scale of the Transformation Programmes, which covered seven areas of Adult Social Care (ASC). An overview of each of the Transformation Programmes was provided to the Select Committee Members. The Transformation Programmes were designed to deliver savings of £8.7 million in the 2021/22 financial year and it was expected that just over £5 million of those would be achieved. This was largely a consequence of the impacts of the COVID-19 pandemic on care packages. ASC had bid for £3.3 million of funding which would be used to invest in achieving financial benefits of £13.8 million. The progress of each Transformation Programme was robustly monitored by the ASC Leadership Team.  

2. A Member asked whether other areas in ASC would receive reduced funding, in attempt to achieve the efficiencies which the Transformation Programmes were unlikely to fulfil. The Member also questioned whether the assumption of investment to produce financial benefits had been factored into the plans from the start. The Deputy Director of ASC explained that the focus was on remodelling delivery of services, rather than delivering financial cuts. The most appropriate outcomes for service users were the priority. The Cabinet Member for Adults and Health highlighted that the Transformation Programmes were about developing the Council’s offer through improving the quality of care and developing options for service users.

3. A Member enquired about how realistic the expected benefits were, given the continuing impact of the pandemic and high level of inflation, and what mitigations were in place to respond to those pressures. The Deputy Director responded that the savings were about purchasing care in the most efficient way. Fee uplifts had been factored in to ensure that the Council’s fees were sustainable. The ASC team worked closely with the NHS to support them and to plan for future impacts of the pandemic.

4. With reference to the table included on page eight of the report, a Member asked how the level of efficiencies would be achieved through the market management process. The Deputy Director emphasised that this was about the establishment of a different relationship with the provider market and having a dynamic purchasing framework. The Cabinet Member explained that the commissioning team had developed a consistent, and more digitally streamlined, approach. The commissioning team were to provide a more detailed written response to the Member in due course. The Deputy Director added that ASC now had a centralised brokerage team, which ensured that all care packages were sourced through one team.

5. A Member asked whether ASC was on track to deliver all 500 Supported Independent Living units by 2025. The Deputy Director reassured the Member that they were on track to deliver this target, whilst acknowledging the challenges caused by the pandemic and the work force. The Cabinet Member added that over 100 Supported Independent Living units had already been delivered and that she personally monitored the progress very closely.

6. A Member questioned how carers and users had been engaged so far and what the plans were for future engagement. The Deputy Director explained that ASC was committed to carer and user engagement and highlighted how crucial this feedback was in the process. Stakeholder engagement sessions would continue to be held, as well as stakeholder input in the Mental Health Group.

7. A Member enquired about the progress made with the motivational interview training and the timeline for this. The Member also asked about the purpose of the training and how it would benefit residents. The Deputy Director responded that good progress had been made and the training was being rolled out to more teams. The Senior Programme Manager explained that the target was for training to be completed by the end of the 2021-22 financial year, but some training was likely to fall into the next year. Transformation funding had been allocated to ensure the training was provided to all front-line staff. The Deputy Director explained that the training was about staff using their strength-based practice to talk to residents in a different way. The Chairman asked whether the training was voluntary; whether attendance was recorded; and how agency staff access the training. The Deputy Director clarified that staff were expected to attend the training and attendance was recorded. Where relevant, agency staff would be included in the training.

8. With reference to supporting those with additional needs to access and maintain employment, the Chairman asked how the Service reached employers and what support was in place to help individuals maintain employment. The Chairman also sought clarification about whether this was paid or voluntary employment. The Deputy Director explained that it can be paid or voluntary employment, and ASC engaged with a variety of organisations to help support these individuals to access, and maintain, employment.

9. A Member asked about ASC’s confidence in receiving the £500,000 which had been bid for to help support those with additional needs to access and maintain employment, and whether this funding was considered adequate. The Member also asked about any sustainable solutions ASC was planning to deliver. The Deputy Director clarified that the funding had been secured. The Senior Programme Manager added that this funding was from the Government’s Contain Outbreak Management Fund. Through co-design and co-production, sustainability remained a key focus.

10. A Member sought assurance that residents with learning disabilities and autism (LD&A), who may experience technophobia, would still be able to access the Digital Front Door services. The Deputy Director assured the Member that those residents would still be able to access all of the services. Most of the digital strategy around LD&A was about harnessing technology to support those in their home and to maximise their independence. ASC would always seek to ensure contact with residents used the most suitable method for their needs and preferences.

11. A Member asked for more information on ‘maximising social value as a new funding stream’, as referenced on page 26 of the report. The Senior Programme Manager explained that ASC had been working with procurement colleagues to ensure maximisation of the social value of contracts with the Council. A number of ‘We Run Surrey’ events had been run with this aim in mind. Work was being undertaken with Unit Four where they had committed £500,000 for social value funding.

12. A Member sought assurance about how motivational interview training worked when interacting with residents with mental health issues. The Deputy Director explained that the staff who had undergone this training were mental health staff, therefore, they understood the conditions of the residents they were working with. The principle surrounded being person-centred. ASC was in the process of establishing a mental health reablement service and were to employ five occupational therapists for mental health for the first time, which was a positive step. The Chairman asked whether other partners and stakeholders had experienced a similar cultural change. The Deputy Director shared that ASC had newly recruited team managers whose job was about constantly embedding with staff the new ways of working. There was a lot of work being done around the Mental Health Improvement Plan which was system-wide and focussed on cultural change. The CEO of Catalyst added that this work was an ongoing programme around the cultural change of all organisations through actions such as simplifying the language used.

13. Responding to a question on motivational interview training, the Deputy Director explained that a Mental Health Reference Group existed which included service users and carers who helped to develop a lot of the training. It was noted that more could be done to disseminate information, and the Deputy Director said they would look into this.

14. A Member enquired about a reference in the report to staff leaving ASC and their roles not being replaced. The Deputy Director responded that it was about getting rid of posts that historically existed but were not funded, so that it was clearer for managers to understand what staff they had and the budget for those positions.

15. The Chairman asked about plans in place to help increase the number of people using the HandiCalendar app. The Deputy Director shared that there was a senior occupational therapist working with that team to increase the numbers of users.

16. A Member enquired about whether the dates for the Enabling You With Technology programme were on time and meeting the targets. The Deputy Director responded that they were as far as she was aware, but this would be checked with the Head of Resources (ASC). A Member asked about the rollout of the programme for specific Districts and Boroughs, andthe Cabinet Member explained that the majority of Districts and Boroughs had their own tech offer. When this programme was launched, the Council linked up with some Districts and Boroughs to work collaboratively on the pilot programmes and intend to roll it out on a wider scale. The intention was for this to become a county-wide, universal (including self-funders) offer.

17. In response to a question on the evaluation of in-house services, the Deputy Director shared that ASC was updating the strategy in relation to services for older people and how different care choices could be provided for these residents. The consultation on in-house care homes had recently ended, and this formed part of the strategy.

18. A Member asked about families who had experience of LD&A who may be self-funders and living at home but could benefit from some of the services on offer. The Deputy Director explained that quite often the first ASC would hear of someone may be when their carer passes away. For a lot of young people, even if the parents could be self-funders, they would not be considered a self-funder in their own right. The Transition Team engaged regularly with families and schools regarding this.

19. Responding to a question on the feedback received thus far on the transformation of the day services model, the Deputy Director highlighted that Surrey Choices had commissioned the National Development Team for Inclusion to evaluate the progress and hear from the residents. There would be more information on this when available.

20. The Chairman asked about the 80% strength-based reviews target in LD&A. The Deputy Director shared that the Mental Health Team was well above the target. There had been challenges with staff vacancies and absences with the LD&A Team, but they were continuing to work towards their target and significant improvement had already been made.

21. A Member queried the expectations laid on the market management insight tool which was yet to be developed but was required for delivery. The Deputy Director explained that there had been considerations about whether the tool could be developed internally and a workshop was taking place to consider the options. It was unlikely to be rolled out in quarter one, and possibly not quarter two either.

22. With reference to the changes to National Insurance (NI) rates and the Government’s ASC reforms and the potential impacts, the Deputy Director shared that the NI changes would increase the cost for ASC’s providers. There was Government workforce funding distributed to support providers with this. The consequential fee uplifts for ASC were to be considered in the budget negotiations. The potential impacts had been discussed at leadership meetings as well, including ideas around modelling and piloting. The Cabinet Member added there would be challenges around meeting the requirements that the Government had set out around self-funders. It was suggested by the Cabinet Member to bring this area to the Select Committee for scrutiny in the future, which was agreed by the Chairman.

23. The Chairman asked about the level of confidence surrounding the commitment with other partners involved in the Transformation Programmes. The Deputy Director responded that within the remit of mental health, this would come under the Mental Health Improvement Plan. One of the streams included in the Adults Mental Health Alliance focussed on workforce. The CEO of Catalyst added that the Alliance included a core group who mobilised the plans, and then a wider group of organisations who are part of the Alliance. The voluntary and third sector were leading on a lot of this work.

24. A Member enquired about the rollout of the mental health training referenced in the report. The Deputy Director responded that all the mental health staff had been through the motivational interview training and Mental Capacity Act training was being rolled out, which all staff were expected to attend. Section 117 training had also been commissioned and was to be rolled out. Attendance of training was monitored through one-to-ones and by team managers and it would be known if staff members did not turn up to training. The CEO of Catalyst assured the Member that the training went further than the ASC teams.

25. Responding to a question on rising demand for Section 117 provision, the Deputy Director explained that there had been an agreement with health colleagues that the funding would be split evenly between the two. Each case was presented to a Joint Assurance Panel where the funding would be agreed and split. It was a statutory requirement to ensure Section 117 provision for those who required it and thus, those residents would always receive the care required.

26. The Mental Health Lead of the Independent Mental Health Network asked about whether the reablement service would be working with private mental health wards due to a closure of a hospital. The Deputy Director shared that the reablement service was due to go live in March 2022, which was a similar time to the closure. If a patient was a Surrey resident then ASC would work with them, regardless of what hospital they had been placed in.

Robert Evans left the meeting at 11.53am.

Actions/requests for further information:

i.              The Assistant Director of Commissioning (ASC) to provide a written response about market management efficiencies and how these would be achieved, including granular detail on the information included in the efficiencies table (page 20).

ii.            A motivational interview training taster session to be organised for Members of the Select Committee.

iii.           Further information on how Adult Social Care provided support to people with additional needs to access and maintain employment.

iv.           The Head of Resources (ASC) to provide an update on the timeframes for the Enabling You With Technology programme and if these were being met.

v.            An update on the Older People’s Commissioning Strategy to be shared with the Select Committee.

vi.           Results and feedback of the Transformation of Day Services Consultation to be shared once available.

vii.          Inclusion of Learning Disability and Autism targets regarding strength-based review to be included in the next report.

viii.         A report on the Government’s National Insurance and Adult Social Care changes and the impact on the Council to come to the Select Committee at the appropriate time