Minutes - Health and Social Care Overview and Scrutiny Committee - 21 September 2010

BOROUGH OF POOLE – HEALTH AND SOCIAL CARE OVERVIEW AND SCRUTINY COMMITTEE – 21 SEPTEMBER 2010

BOROUGH OF POOLE

HEALTH AND SOCIAL CARE OVERVIEW AND SCRUTINY COMMITTEE

21 SEPTEMBER 2010

The Meeting commenced at 7:05pm and concluded at 10:20pm

Members present:

Councillor Bulteel (Chairman)

Councillors Mrs Evans, Mrs Lavender, Mrs Long, Meachin, Montrose, Mrs Moore, Rampton, Wilson and Woodcock

Non-voting LINks Co-opted Members present:

Barbara Plumbridge – Chair of Poole LINk Stewardship Group

Also in attendance:

Councillor Ms Atkinson, Portfolio Holder for Social Care, Health, Housing and Equalities, Elected Member, Borough of Poole

Liz Baron, Legal and Democratic Services, Borough of Poole

Carol Burgess, Community Development Officer, Bournemouth, Poole and Dorset Mencap

Sarah Elliott, Director of Patient Safety and Quality, NHS Bournemouth and Poole

Lisa Harding, Deputy Director of Primary Care Commissioning, NHS Bournemouth and Poole

Liz Kite, Deputy Director of Corporate Affairs, NHS Bournemouth and Poole

Sue Lee, Principal Officer, Contracts and Service Improvement, Borough of Poole

Jo O’Connell, Programme Manager, Personalisation and Efficiency, Borough of Poole

Councillor Mrs Rampton, Elected Member, Borough of Poole / Manager Poole Forum

Jan Thurgood, Strategic Director (Adult Social Care), Borough of Poole

David Vitty, Head of Adult Social Care (Commissioning and Improvement), Borough of Poole

Members of the public present: 0

The Chairman advised that following the sad recent death of Councillor Brian Leverett, a minute’s silence would be held prior to the commencement of the Meeting.

All present stood in silent tribute to the late Councillor Dr. Brian Leverett, Leader of the Council, Ward Member for Poole Town, who had died suddenly on 17th September 2010.

HSC29.10 APOLOGIES FOR ABSENCE

Apologies for absence were received from Councillor Mrs Deas, Councillor Matthews (substituted by Councillor Mrs Moore), Judy Birch (substituted by Barbara Plumbridge) and Bob Grant-Kensley.

HSC30.10 DECLARATIONS OF INTEREST

Councillor Mrs Long declared a personal interest in a number of Agenda Items as she was a Service User in receipt of Adult Social Care Services.

HSC31.10 MINUTES

RESOLVED that the Minutes of the Meetings held on 25th May 2010 and 1 July 2010, having been previously circulated, be taken as read, confirmed as a correct record and signed by the Chairman, subject to the following amendment:

M.HSC14.10 – Councillor Mrs Long declared a personal interest in a number of Agenda Items as she was an outpatient of Poole Hospital NHS Foundation Trust and a service User in receipt of Adult Social Care Services.

HSC32.10 UPDATE ON GP SERVICES – WEST CANFORD HEATH

The Chairman welcomed Lisa Harding, Deputy Director of Primary Care commissioning and Sarah Elliott, Director of Patient Safety and Quality, NHS Bournemouth and Poole, who updated Members on GP Services in West Canford Heath following the closure of West Canford Heath Surgery. Prior to commencing the Report, the Chairman wished to put on record the Committee’s thanks and appreciation for Sarah Elliott’s long-standing support and guidance to the Committee and wished her well in her new role.

Members received an update on primary medical services in the West Canford Heath area as follows:

·  Following the closure of the Practice Surgery, NHS Bournemouth and Poole had surveyed 1,100 patients on the Practice list in order to gauge their levels of satisfaction with their new surgeries and establish any issues of concern as a result of the closure of the site.

·  205 responses had been received with feedback detailed in the Report Appendix for Members’ information.

·  94% of patients had been able to register with their first choice GP.

·  Issues raised by patients to be addressed by the PCT included new patient checks; people wanting to see their ‘own’ GP; attitudes of reception staff; access to practices by telephone and opening hours.

·  A Ward Councillor had queried the future use of the site and the lack of choice of surgery on Canford Heath.

The PCT had concluded that overall here was general satisfaction amongst patients with their new providers of primary care and that no significant issues had been raised by the transfer following the closure of West Canford Heath Surgery. In addition, the PCT had put in place measures to ensure that any future service changes had clear objectives, processes and feedback mechanisms which could be clearly communicated to Committee Members.

Questions and comments were received from Members as follows:

·  Councillor Rampton commented that he would have liked to have received further information on the effect on the new GP Practices of absorbing patients previously registered at the West Canford Heath Surgery.

·  Councillor Mrs Moore commented that residents were generally of the view that an additional surgery serving West Canford Heath would be helpful.

·  The PCT was developing mechanisms to increase the capacity of individual nursing staff offering specialist diabetes care.

·  Members were assured that new providers would offer support for carers.

·  The PCT would welcome the opportunity to discuss with Ward Members any aspect of GP provision on Canford Heath in the future.

RESOLVED that the update Report on Primary Medical Services in the West Canford Heath area be noted.

HSC33.10 FAIR ACCESS TO CARE AND FAIRER CONTRIBUTIONS POLICY

The Chairman welcomed Barbara Plumbridge, Chair of the Poole LINk Stewardship Group, who was invited to comment on the borough’s public consultation into the implementation of a new Fairer Contributions Policy and a review of the Fair Access to Care (FACS) Policy. A copy of the Poole LINk response to the proposed changes was circulated for information, which outlined concerns over (i) the consultation document, (ii) proposals to conduct client ‘follow up’ interviews via telephone and (iii) concerns that removing the ‘moderate’ category of support for clients could lead to an increase in ‘substantial / critical’ categories. In addition, Poole LINk had specific concerns regarding the costs of re-assessment, extending the re-enablement programme and the financial implications of supporting service users, who might, due to lack of ‘moderate’ support, in future require a higher level of support.

Members received a brief presentation from Carol Burgess, Community Development Manager, Mencap (Bournemouth, Poole and Dorset) which outlined a case study demonstrating the effect of the proposed service level criteria cuts on client ‘K’, an independently living client with learning disabilities assessed as ‘moderate’ under the current criteria. It was outlined that the few hours of personal support to which clients assessed as ‘moderate’ such as ‘K’ were entitled were essential in order to enable them to move their lives forward and maintain independent living.

Concerns expressed by Poole LINk had been reported to the Borough of Poole as part of the consultation process.

Members received a PowerPoint Presentation from Jan Thurgood, Strategic Director (Social Services) and David Vitty, Head of Adult Social Care (Commissioning and Improvement) which outlined:

·  The future role of Adult Social Services

·  The financial context in 2010 / 11 and future years

·  The Medium Term Financial Plan

·  Consultation methodology and outcomes

·  Case studies

·  The Fairer Contributions Policy

·  The Fair Access to Care Policy

The Council had agreed to raise eligibility for Adult Social Care to ‘Substantial’ in February 2011 and raise more income through Service User contributions. Financial pressures and the need to deliver significant savings over the next three years meant that the Council was no longer able to maintain its current budget to support ‘moderate’ users. It was emphasised that only ‘vital’ services were considered ‘critical’ and that Service Users assessed as ‘critical’ would not be adversely affected by the changes. Approximately 40% of clients assessed under the new criteria would be re-assessed as ‘critical’ or ‘substantial’ and all would continue to receive services under the new criteria.

A summary of the proposals was given as follows:

Fairer Contributions Policy Changes

·  The Policy name would become ‘Fairer Contributions’

·  The maximum charge would remain, but would be set at 85% of the cost of residential care

·  Contributions would be a single service user contribution towards the overall cost of care

·  The lower threshold to protect individuals on low income from paying any charge would remain.

Fair Access to Care (FACS) Policy Changes

·  The threshold for eligibility would be raised from ‘Moderate’ to ‘Substantial’ and ‘Critical’

·  Services which supported volunteering and preparation for employment would not be subject to FACS

·  Specialist equipment provided as part of a re-ablement or intermediate care service would not be subject to FACS

·  Carers’ needs would be subject to Fair Access to Care eligibility at the same threshold as Service Users.

Comments received from Members are summarised as follows:

·  Concerns were expressed over the likely effect of the proposed changes on Service Users occupying the same households with differently assessed needs; in response, it was clarified that carers were indirectly cove red by the eligibility criteria and that carers were frequently assessed as part of the Service User assessment. In addition, Carers would continue to be assessed in their own right.

·  Learning Disability Groups had expressed their unease about the proposed changes and felt that they would lose support as many Service Users would be assessed with ‘Moderate’ needs.

·  Concern was expressed that as part of the consultation process one of the focus groups had invited Bournemouth rather than Poole residents to take part. In addition, of the 158 professional bodies included in the consultation process, on 18 had submitted responses. Officers shared Members’ concerns at the low level of responses received. The decision to invite Bournemouth residents to participate in the consultation was taken by an independent focus group and was regrettable.

·  Concern was expressed that Service Users with very limited funds could now be required under the new criteria to pay for their own equipment. A Member felt that this was wrong. In response, the Head of Adult Social Care (Commissioning and Improvement) stated that only equipment currently provided by the Community Team would be affected, however, under the new criteria, some people would be expected to cover the cost of simple pieces of equipment for themselves.

·  A Member commented that learning disability groups had struggled with the Consultation Questionnaire, a fact reflected in large parts of the Questionnaire being returned ‘blank’. In response, the Strategic Director confirmed she had met with the Manager of Poole Forum and Ruth Crook in order to discuss these concerns and from this, Officers had developed learning for future consultation exercises.

·  A Member commented that timely re-assessment of Service Users was vital; Officers agreed that this was a key issue and that staff time needed to be used effectively to mitigate any risks to Service Users.

·  The Citizens Advice Bureau had been consulted as part of the Consultation exercise.

·  Service Users requiring moderate levels of support would be signposted to other agencies and organisations.

The Committee invited the Portfolio Holder for Social Care, Health, Housing and Equalities to comment and she underlined the need for Social Services to focus on (i) re-ablement and (ii) encouraging Poole residents to do what they could to support themselves.

In light of the financial pressures faced by the Borough, particularly within health and Social Care, she stated that the Borough had to focus on providing only those essential services to keep Poole residents safe and healthy. Whilst the Borough was committed to supporting its residents, in future it would need to do everything it could to encourage Service Users to support themselves, including helping them to access third sector organisations by signposting these services to them.

RECOMMENDED that

(i)  Cabinet, at its Meeting on 5 October 2010, approves the proposals in relation to the Fairer Contributions Policy and refers the proposals to Council for final decision; and

(ii)  Cabinet, at its Meeting on 5 October 2010, approves the proposal that eligibility for Adult Social Care is set at ‘substantial’ and ‘critical’ and refers the proposal to Council for final decision.

FOR: Councillors Bulteel, Mrs Evans, Mrs Lavender, Montrose, Rampton and Woodcock

AGAINST: Councillors Meachin, Mrs Moore and Wilson

ABSTAINED: Councillor Mrs Long

The Meeting adjourned at 9:25pm and was reconvened at 9:30pm

(Councillor Meachin and Barbara Plumbridge left the Meeting at 9:25pm)

With the consent of the Committee, the Chairman agreed to vary the order of the Agenda in order to consider the item on Hot Meal Provision before the remaining items.

HSC34.10 HOT MEAL PROVISION

The Committee considered the Report of the Head of Adult Social Care (Commissioning and Improvement) on proposed alternative arrangements for Social Care hot meal provision provided by the Borough of Poole.

Members received a PowerPoint Presentation which detailed:

·  Current provision – 199 individuals (mainly older people) in receipt of a delivered hot meal from Agincare, at a cost of £177,000

·  The Government’s focus on promoting ‘Social Capital’ – i.e., greater involvement of the community in supporting fellow residents and helping them to become independent

·  The necessity of achieving cost savings whilst retaining services and support for those in greatest need; and

·  The overall unit costs for current hot meal provision.

It was proposed that the Agincare Hot Meal Service be decommissioned from January 2011 with the introduction of a new service for each recipient thereafter, either via a continued Community Care Service which supported meal provision (e.g., domiciliary care) or by assisting the recipient in finding a suitable hot meal alternative in the local community.

Examples of alternative hot meal provision included:

·  Hot meal delivery funded by the Service User

·  Frozen meal delivery funded by the Service User

·  Local lunch clubs or day services

·  Local commercial meal providers, such as cafes, bakers, pubs or take-aways

·  Local voluntary organisations

·  Volunteers, friends, neighbours and family

Current project activity was focused on mapping the current community meal delivery options and costs by locality; identification of any gaps in provision; stimulation of community-based meal provision; and support for Service Users who currently receive a meal delivery to source suitable alternatives. The net annual saving anticipated from the proposed alternative arrangements for hot meal provision was anticipated to be £137,000.