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:
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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