All Wales Adult Services Heads

12th and 13th October 2006

Venue

Sue Cooper(Chair)BridgendDay 1 and 2

Mike ThomasWLGADay 1

Richard WarrilowMerthyrDay 1 and 2

Sheila WentworthWrexhamDay 1 and 2

BarbaraYnys MonDay 1 and 2

Ruth DerrickTorfaenDay 1 and 2

Tony ClementsNeath Port TalbotDay 1 and 2

David HarrisCeredigionDay 1 and 2

Bob GatisRhondda Cynon TafDay 1

Bill CollinsCarmarthenDay 1 and 2

Simon BurchMonmouthshireDay 1 and 2

Gordon JonesBridgendDay 1 and 2

Chris MaggsSwanseaDay 2

Liz MajerBlaenau GwentDay 2

Nygaire BevanPowysDay 2

Colin CribbPembrokeshireDay 2

Minutes of the last Meeting

The Minutes of the last meeting held on 7th July 2006 were agreed as a correct record.

Updates

Adult Protection

ADSS have agreed to take forward the AWASH paper outlining the need to undertake a piece of research regarding additional resources due to increased activity. Mike Thomas to work on the original paper to strengthen the brief.

Direct Payments

Sheila Wentworth explained that Wrexham have been having problems with Direct Payments and the CRB checks. No communication between WAG and CRB. There is a difficulty in reaching requirements due to budget issues. It was noted that they need to reach people who have a legitimate right to Direct Payments.

Sue Cooper noted that there are issues when moving from Children with Disabilities into Adult Services due to capacity and the need for re-assessment.

Learning Disability

The recent consultation process for the proposed Policy and Practice Statement has now been reviewed by the Learning Disability Implementation Advisory Group. There was considerable support expressed for the document but suggestions were also made about changes to the document. It is now the case that the position is to be explained to the Minister and if he approves the document then it will be for Welsh Assembly Government officials to conclude any necessary work.

Finance linked to the Service Principles and Responses Guidance will now be included as part of the Revenue Support Grant for next year and this is certainly to be welcomed.

As far as theDirected Enhanced Service is concerned for health checks each locality is trying to progress the necessary work. It is recognised that the speed of this work has varied across Wales but it is hoped that matters will be progressed as quickly as possible.

Increasing concern has been expressed that various health tasks are not addressed on a consistent basis across Wales. One such example concerns support for those adults with a learning disability with a Percutaneous Endoscopic Gastrostomy (PEG). The fact that different approaches are taken will be highlighted for the Minister by the Learning Disability Implementation Advisory Group.

Bill Collins, given his new role as Head of Mental Health and Learning Disability Services, will become a member of the Learning Disability Implementation Advisory Group.

Mental Health

Liz Majer has spoken to Ted Unsworth regarding the Secure Mental Health Review. As Liz was not in attendance today this matter was deferred until tomorrow.

Care Fees Model

Mike Thomas reported that there have been a series of meetings held regarding this. Some authorities find the model useful and others don’t, patchy about who is using this and who isn’t. Lang & Buisson are still being used. Independent sector are using this to generate figures. It was noted that the figures were not out of date. A few people in the group expressed concern about dealing with Care Forum. Mike has done an internal report for the WLGA regarding this and will report back to the group in future.

It was agreed that it would be helpful to get a position statement across all authorities regarding the percentage of in-house and external provision. Mike to put together a questionnaire and for this exercise to be completed by the next AWASH meeting.

It was agreed to raise this issue with Pat Vogt on 13th October 2006 session.

Fairer Charging

There is a working group ongoing. Big issues regarding Disability related expenditure. Marie Thomas from Finance, WLGA involved in the technical and financial aspects.

As Neil Ayling was not in attendance it was agreed to seek further clarification from him at tomorrow’s session.

Older People

Bob updated the group about NSF Older People. This is a big piece of work and there are targets around age discrimination. To be completed by March 2007.

Sue noted that there should be an update at future meetings about what other authorities are doing.

ADSS / HOS Meeting 19th July Follow Up

It was noted that the feedback from the groups was very similar with particular anxieties expressed from Children’s Services. AWASH members recognised that the links between AWASH and ADSS could be strengthened and in general would welcome this. Members also felt strongly that AWASH also needed to maintain its own identity.

It was discussed that the group want to feed back to ADSS.

To summarise:

  • Embrace ADSS
  • Be positive
  • AWASH links with ADSS
  • Standardisation
  • Learning lessons
  • Relationship with SSIW
  • Health communities
  • Lead officer to continue

Sue to put these points together and send to ADSS Joint Chairs, Sue Lewis and Jo Howsam.

Sue, as Chair of AWASH has been invited on to the SSIA Reference Group and would feedback to AWASH.

It was noted to take up this issue with Moyna Wilkinson in tomorrow’s session.

Fulfilled Lives: Supportive Communities

Two events have been held, one in the north and one in the south. Members agreed it was a disappointing document. Sheila and Gordon agreed to put together a response to the consultation on behalf of AWASH. Any contributions to this to be sent directly to Gordon or Sheila.

Telecare – Integrated Equipment Funding

  • Spend is for capital only
  • Overall there are significant revenue implications
  • Timescales are very tight
  • There are economies of scale issues, needs to be targeted widely – existing community alarm plus
  • Best to start at the lower needs end
  • Technological support needed
  • May be possible and sensible to look for cross border collaboration
  • Newport is planning a presentation on call centre/telecare progress
  • Wrexham and Flintshire are hoping to build a new store
  • Ceredigion – the Trust may out in some funding
  • NPT has a jointly funded Project Worker with health
  • RCT have identified lots of equipment in schools – it’s helpful therefore to involve education
  • There are a range of partnerships in place across boundaries
  • Use of S31 by March 2008 via pooled budgets is a challenging timetable
  • The S31 template sent round by Steve Vaughan has been useful
  • Would be useful to share experience and good practice in the use of S31 agreements

Independent Complaints Panel

Complaints Officers are pooling experiences. Emerging issues are:

  • Lack of consistency
  • Very/over formal
  • Time consuming
  • Lack of flexibility about times/dates
  • Tone and attitude
  • Is there a quality assurance system? There needs to be
  • Concern that panels are reinvestigating the complaint
  • Need to consider in conjunction with Ombudsman’s new role

Action – Agreed to raise with Pat Vogt in SSIW session and Mike Thomas to make WLGA/SSIA (Beverlea Frowen and Martyn Palfreman) aware of emerging issues.

13th October 2006

Ray Jones – Chair of BASW

Presentation attached.

Sue welcomed Moyna Wilkinson to the meeting to lead the discussion on Continuing Health Care. Moyna introduced paper that condenses the legal opinion.

Issues about how guidance has kept up (Coughlan & Grogan)

Issue about differential responses of application across in Wales.

The bill for CHC continuing to rise, which is tied in with growth of older population. Normally case law would sort it out.

ADSS have charged Moyna and Cardiff Director with taking this issue forward.

On the matter of quantity and quality threshold rather than look at “complexity of need” we should look at what is it appropriate for SS to provide.

Cardiff have sought an independent judgement which stated that 4 out of 5 were CHC. Cardiff LHB then said they did not agree with the assessment.

Luke Clements has done some calculations based on pro rata 20,000 cases in England @ £600 per 1000 people per week (5% of cases) - £30 million across Wales. (These are over and above those being currently funded) Therefore £30 million is what we as LAs are currently funding that we shouldn’t be. Chris Maggs thought this may be an underestimate.

Neil Ayling queried that if we follow the legal guidance then how do we deal with disputes. There is an agreement in Denbighshire that there is a 50/50 split until decision has been made (this is legal as there is no final judgement on the matter).

Moyna felt that action not as helpful to community based provision as to institutional care provision.

ADSS promised a toolkit on decision making. Simon Burch felt we needed to continue as 22 Authorities and to be assertive but sensible. There is a risk about ‘our bit’ and ‘their bit’ and the gap in the middle. WAG have concerns about this.

Moyna ‘issue is not enough money in the system, which means we are being caught up in these arguments’.

Is the next step challenging the guidance? No it is establishing our position first as what we will or will not provide.

Moyna: Exsiting guidance is not Grogan proofed. So we need to define our position – the limits of provision.

It was agreed that it would be useful to have some further advice from Counsel on key principles to flesh things out and it was agreed that Simon would co-ordinate on behalf of AWASH.

We should now share this information with the LHBs locally and our own legal advisers.

Health interface group to follow up. Now to include Neal Ayling to replace Brian. Simon Burch agreed to co-ordinate a meeting for the group.

Ruth Derrick commented that David Williams from Torfaen had conducted a data collection exercise but there had been a poor response. It was agreed that this needed to be re-circulated.

ADSS Cymru

Sue shared with Moyna the views of AWASH regarding the link up between AWASH and ADSS. As an ex-member of AWASH, Moyna recognised the value of the group and felt that AWASH could act as a powerful voice. She was pleased for AWASH to respond to the ADSS Chairs as was outlined.

Pat Vogt and Phil Evans

Reference was made to the Week In Week Out television programme that had been recently screened. Ministerial issues highlighted regarding Cardiff/Specific authorities and Pat was keen to explore the commonality of these issues. Her view is one of increasing funding problems and the more that we can collectively do to get word in the right place, the better.

Pat made reference to preparing a paper for the Minister. Pat was also interested to learn of any changes to joint funding and the impact of this.

Sue briefly outlined some of the common themes to joint funding – group demographics, increased transition child to adult; expectation of users/carers; loss of Supporting People Grant; developing Exit Strategies before developing the bid. It was suggested that we open discussion out to all members to share their own authority’s perspective and experience.

There was consistency in the issues being highlighted and overspends were varying from approximately 300k to 2 million but consistent inexistence. Examples given across the board were: huge amounts ascribed to just four individual transition cases, (5000k); LHB reconfiguration – bed closures, focus on acute setting, capacity reduction raised eligibility cycle; planned cuts for next year are a concern; 28a agreements in question – lack of clarity; much concern around learning disability and again big impact of transition; POVA has had a huge impact on capacity. Mental Health and the need to reshape the services. Acknowledged that this would cost. New guidance on sensory impairment. Vulnerable adults coming through the system because of POVA. These cases would not normally meet the eligibility criteria and yet were creating high cost placements as part of a protection plan.

Some authorities felt that there were many things current that were diverting energies away from frontline services. Some areas had a huge waiting list for domiciliary care but that there was a lack of providers. Again remodelling in the Trust was having an impact. Some homes with low occupancy because homes not meeting Care Standards spec. Huge community care packages to maintain independence was also raised. SKEPS; Direct payments pressure and decommissioning services in order to free up funds. Lifelong Learning Assessment and lack of communication from DELLS (previously ELWA) Wanless grant reduction. Recruitment and retention; fee levels and the independent sector able to sell beds to highest payer. Third party payments a concern – providers could impact severely on local authorities. In some areas Trust have changed criteria around Respite criteria in EMI. Transport cost increases.

Some areas reported big overspend in Children’s Services and some reported same in Community Care (Adults). Only one authority reported pressures that were not critical. Concerns were raised around next year.

Pat will feedback to the Minister on overall issues but not identify individual authorities. Unlikely that this report could be shared directly.

Sue raised concerns about the new Stage 3 Complaints Process and shared some examples with Pat. Pat will take this feedback to Jonathan Corbett who is leading on this in SSIW.

Hearing impairment benchmarking exercise starts next week – Nigel Bone holding meeting with special social workers.

On November 3rd Steve Vaughan has invited Social Services departments to send managers to a meeting to get management perspective – only received a couple of replies – don’t mind if people feel issues will be addressed at first meeting but needs to know numbers.

Possibility of arranging a conference next year on extra care housing and dementia. Would like to know what training on dementia presently provided to frontline care workers plus assessors. Could people forward training course outline to me. Not a competition – no prizes – just helpful to know.

Community Equipment Conference 22nd November – English teams plus other speakers sharing experience. Thanks for co-ordinating delegations – important health plus education engaged.

Joint Review discussion led by Phil Evans.

Not unmindful of the burden placed on local authorities. A reminder of the purpose of Joint Reviews. Feedback on where the process is currently.

Powys /Torfaen– Monitoring Stage

Cardiff/Rhondda Cynon Taf– Action Planning

Vale of Glamorgan /Anglesey – Draft Response

Ceridigion /Merthyr – Review started

Gwynedd /Neath Port Talbot – Notification December

Discussions around methodology – stock take after six reviews November 7th publishing evaluation (Eskridge)

Not trying to create a judgement that bears no link to local picture

Point made and acknowledged by Phil and Pat that WAG need to be better linked to whole systems.

Any Other Business

Liz Majer – Expert Patient Programme – Pilot with LHBs by end of year. To be put on next AWASH Agenda.

Sue to represent AWASH/MH on the secure MH Review.

Neil – Fairer Charging issue will be sizing individual local authorities for share of 17 mill. Discussion relating to buffer of 35%

Next meetings:

Provisional date – 2nd March 2007

Next Agenda:

Gordon and Sheila agreed to lead a debate on “To externalise or not to externalise, that is the question!”

CHC

Section 31

Expert Patient

Externalisation data base

Small interest groups - leads to be agreed.

Mike will send out proposed date.

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