Agenda item

Purpose of the Report:

This report describes the Adult Social Care Transformation Programme, the expected changes and transformation of Adult Social Care in Surrey and the anticipated impact and challenges.

Witnesses:

Sinead Mooney, Cabinet Member for Adults

Simon White, Interim Director of Adult Social Care

Mike Boyle, Interim Director of Commissioning and Transformation (Adult Social Care)

Will House, Head of Finance (Adult Social Care)

Sonya Sellar, Area Director (Adult Social Care)

Peter Tempest, Interim Assistant Director for Learning Disabilities

Liz Uliasz, Deputy Director (Adult Social Care)

Key points raised during the discussion:

1. An introduction to the Transformation Programme report was provided by officers, who stated that it aimed to make sure the Council delivered its statutory care responsibilities without tightening its eligibility criteria or adversely affecting those who rely on its services.
2. Members heard about the financial implications of the Transformation Programme, with the Interim Director of Adult Social Care highlighting the progress made by the department. The Committee were told that Adult Social Care (ASC) was set the task of saving £10.7m and are currently forecast a £16.8m underspend, with that underspend likely to be larger come the end of the year.
3. A Member of the Committee asked whether any elements of what is being proposed have been proven to work elsewhere, or whether ASC are starting with a completely new model. The Interim Director of Adult Social Care explained that much of the work was already underway in the department before he arrived, and that it was based significantly on two sources. The first was the work that John Bolton, Visiting Professor at Oxford Brookes University’s Institute of Public Care, had presented through a publication called Six Steps to Managing Demand in Adult Social Care, while the second was concerned with the ‘In Control’ work that the Council had previously done with younger age adults. The Interim Director of Adult Social Care went on to talk about the ‘person-centred’ philosophy behind the Transformation Programme, which was concerned with investing in people’s independence while simultaneously dealing with demographic growth and financial pressures.
4. As a follow-up question, a Member of the Committee questioned the role of the Social Care Institute for Excellence (SCIE) and asked how they would be working with the Council. The Interim Executive Director of Adult Social Care replied that working with SCIE would allow the Council to take an active part in networks that would let them work with other authorities that were implementing similar proposals.
5. The Interim Executive Director told the Committee about the activities being undertaken to shape the market for preventative services, discussing how Adult Social Care meet regularly with a range of providers.
6. Regarding the quoted 5% reduction in the number of people using adult social care services, a Member of the Committee questioned ongoing demographic challenges and what impact these may have on this forecast target. The Interim Executive Director discussed the difficulties concerning demographics. The greatest pressure came from adults with learning difficulties – for example, the number of people cared for by their parents for years before presenting themselves to social care services. With life expectancy also increasing, this represented a challenge that the Transformation Programme was seeking to solve by promoting ‘anti-institutional bias’, as the chances were such that in Surrey these people would spend time in residential care.
7. The Interim Assistant Director for Learning Difficulties went on to discuss areas where the Council had failed in providing the means for people with such needs to live independently, highlighting that, compared to other local authorities, the Council was second bottom only to Northamptonshire while spending significantly more money than many of those ahead of them. The officer went on to say that ASC’s aims, as laid out in the Transformation Programme, were to improve performance, reduce its heavy dependence on residential care, and focus on better using the expertise of the people at their disposal.
8. Responding to a question from the Vice-Chairman about the support given to individuals after they have gone into employment, the Interim Assistant Director for Learning Difficulties emphasised to the Committee that the support they give does not stop at that stage and continues throughout their lives. The officer went on to talk about the discussions had with Surrey Choices regarding a move away from the ‘day centre’ model of providing support, as well as making sure that the level of intervention and support offered was tailored to the individual’s specific needs.
9. A Member of the Committee noted their support for the aims set out in the Transformation Programme but expressed concern about whether they can be achieved if the Council are unable to exert enough influence in the care home marketplace. In response, the Interim Director of Commissioning and Transformation (Adult Social Care) said that the Council spends around £340m a year on buying care from the market and, as such, has a degree of influence that can be used to its advantage. He went on to tell the Committee that the Council was paying significantly more than its neighbouring local authorities on residential care and nursing, and that the conversation with the market needed to be about what was reasonable. Members were then informed that ASC are looking to pilot an approach where they go out to the marketplace in advance and start block purchasing beds in order to bring down costs.
10. The Interim Director was questioned about the Council’s capacity to deliver extra care units. The Committee were advised that there was an ambitious programme to provide more sites across the county and that an options paper would be presented to the Cabinet in the summer.
11. A discussion was had regarding the assessment process for those people in the adult social care system and the level of care package. The Deputy Director told the Committee that there would not be less time spent on assessments but that the aim was for a more personalised approach to be undertaken earlier in the process, with a ‘home first’ policy being implemented to make sure that people with special needs are able to increase their independence.
12. Officers also responded to questions from the Committee about the sustainability of care markets and the challenges in managing prices within affordable levels in the context of the current economic climate. The Head of Finance ensured the Committee that ASC worked collaboratively with providers to shape future services and assess market sustainability and were currently in the process of reviewing the market and planning for the year ahead. The Interim Executive Director then discussed the challenges facing ASC but told the Committee that, in the current year, 10 out of the department’s 11 teams were paying less for residential and nursing care than they were at the start of 2019.
13. A follow-up question was asked about the reviewing process concerning care packages, and the Deputy Director told the Committee that the Council had a statutory responsibility to review annually. If circumstances changed, a review would be taken at the start of the process and assessed after six weeks, while a review was undertaken four weeks after an individual was discharged from hospital.
14. Discussing the conversations that took place between the Council and borough and district councils, the Interim Executive Director spoke about the importance of building relationships at a county-wide level in order to increase the strength of these partnerships. The Committee also heard about the meetings that took place regarding the Surrey Community 2030 vision, and the Cabinet Member for Adults spoke further about the role borough and district councils could play in county-wide conversations about adult social care.
15. The Chairman noted that reducing demand, changing the pattern of care and reducing costs were the three drivers behind the Transformation Programme but questioned the absence of any risk management planning. In reply, the Interim Executive Director spoke about a set of performance measures that had been formulated, with examples being included in Annex 1 of the Transformation Programme. The Committee were also told about the creation of a new specialist team to help manage social care for adults with learning difficulties, which would go live in April 2019 and cost an additional £1m per year in salaries.
16. Following on from this, the Chairman and Interim Director of Adult Social Care agreed to meet outside of the meeting to discuss the formulation of a performance dashboard so that the Committee could better track the Transformation Programme’s progress.
17. Responding to a question about supported living for individuals with learning difficulties and/or autism, the Interim Assistant Director for Learning Disabilities told the Committee about the difficulties facing those people who are looking after children late in life and the need for the Transformation Programme to support them. He also spoke about the services currently offered by Surrey Choices and suggested improvements around accessibility (such as increased opening hours and flexible sessions) that could help give individuals more choice.
18. The Chairman invited the Area Director to discuss the developments in ASC workforce with the Committee as this was considered to be relevant to the topic of transformation and practice improvement.
19. The Area Director delivered a presentation (included as Annex 1 in these minutes) and spoke about a national recruitment campaign for ASC developed by the Department of Health and Social Care that had recently gone live. The Area Director explained that the national campaign was being advertised through social media, radio and posters – in partnership with the Surrey Care Association and using the campaign tools that had been created – but was not able to reach into television or wider channels due to financial constraints. The Committee also heard about an apprenticeship recruitment campaign and ASC’s plans for another to be launched in April 2019.
20. The Area Director told the Committee that the recently targeted ASC campaign for the new learning disability service had been oversubscribed with job applications and that she was confident that places would be filled by April 2019. The officer then went on to discuss the Register Your Interest recruitment offer, which allowed qualified social workers interested in working in adult social care to be contacted by a representative within 48 hours, and how these conversations had resulted in job positions being filled. The Committee also heard about ASC’s plans to further develop the recruitment campaign and work closer with the Surrey Care Association in the future.
21. Responding to a question about the work undertaken with Surrey’s hard to reach communities, the Area Director informed the Committee about the Chance to Care Project, which had targeted potential recruits from all hard to reach communities, including the Gypsy/Romani community, and those with learning difficulties. Information had been circulated to let adult social care services know that they were looking for teams to offer placement spaces.
22. A Member of the Committee questioned whether or not ASC were offering remuneration levels appropriate for the county’s living costs and was told that the lower-grade roles being advertised are above the national minimum wage. The Area Director also discussed the department’s positive retention rates – which are around eight to nine percent – and told the Committee that, compared to national and regional colleagues, ASC was performing well.
23. A discussion was had about ASC’s use of technology, which the Area Director said linked to the aims set out in the Transformation Programme. The Committee was told that ASC’s key aim was to improve the productivity of its workforce, and this was being achieved through the rollout of hybrid computer devices and the trialling of automated systems that free up staff from doing administrative tasks.
24. The Area Director was asked a question about the integration of roles between health and social care and told the Committee that the process was in its early days, with an example of the steps being taken evident in the apprenticeship roles in the Frimley system. The Area Director went on to say that ASC would continue to explore the opportunities presented by new and joint roles, and these would be achieved by undertaking work with the Surrey Integrated Care Systems and the development of joint workforce plans.

Actions to be taken/recommendations:

1.    The Committee is supportive of the transformation plans as outlined today.

2.    The Committee recognises the importance of developing new relationships with private providers in the care home market in order to deliver services in new ways. The Committee will follow-up on the health of this relationship at a future meeting.

3.    The Chairman and Vice-Chairman will seek to identify key performance information with the Cabinet Member for Adults and Senior Officers to monitor the progress of Adult Social Care through its Transformation Programme and review the Directorate’s risk register. This information will then be shared routinely with the Committee.