Agenda item
Health and Wellbeing
The Lead Member Health and Wellbeing, Councillor Anwara Ali, will attend to report on her portfolio.
(Time allocated – 45 minutes)
Minutes:
Councillor Anwara Ali, Lead Member Health and Wellbeing, gave a presentation on the key issues, achievements and challenges arising from her portfolio which focused on the points set out below.
The Chair informed members of the Overview and Scrutiny Committee that a
paper containing the main points of the Lead Member presentation had been Tabled, a copy of which would be interleaved with the minutes.
Key headlines of current service provision in response to demand for social care and homecare from residents:
Achievements
· Performance assessment: rated “Excellent” for 6th year, in annual performance assessment for adult social care, and improved customer satisfaction ratings which compared favourably with other authorities.
· Telecare now a free service with significantly improved uptake (76%) particularly amongst BME communities.
· Additional resources - £1 million from reserves identified to improve services supporting older people, allocated to expansion of lunch club provision and also aids/ adaptions which enabled older people to remain in their own home.
· Beacon Award for positive engagement of older people.
· Initial feedback from the Care Quality Commission Inspection of November 2009 was good.
· Linkage Plus: Increased emphasis on outreach and prevention, with the Council and PCT providing £640,000 joint funding for a successful pilot project.
· National pilots for Integrated Care, Health Needs Assessments of Carers and Home Improvement Agency - Tower Hamlets lead role.
· Transforming Adult Social Care Programme: successful pilot work following Cabinet approval, which increased choice and control for service users through a “Personal Budget”.
· Re-ablement service introduced: assessment of support needs for elderly on hospital discharge to enable them to come to terms with living alone
Challenges
· Improving safeguarding of vulnerable adults at risk of abuse. A much higher priority nationally in the context of Baby P and some high profile media cases. Tower Hamlets leading work in the field with a Safeguarding Adults Board established (and to be strengthened) to work closely with that for Children and jointly with partners eg PCT and Police. Attention to now focus on engaging other organisations such as RSL’s that dealt with older people.
· Full implementation of Transforming Adult Social Care Work – a lengthy process with huge service implications.
· Improving value for money. In the context of future public sector funding constraints an innovative approach to provision of social care and home care was needed to achieve savings without any significant impact on service delivery.
· Integration of Social Work teams and Community Nursing Teams. The Council must work to meet patient demands for all their needs to be assessed at one point, rather than having separate appointments with various health professionals. Much work done under Corporate Director guidance but would require information sharing and adoption of best practice. Performance was however lagging against LAA targets, and the implications for employees of the PCT and Council needed worked through, as did the future scrutinising role of the Council.
· Working Closely with NHS Tower Hamlets on moving care closer to home.
· Increasing employment of people with learning disabilities and mental health problems. An issue of concern which was under constant examination.
Members of Overview and Scrutiny Committee then posed a series of detailed questions to which Councillor Ali and Ms Helen Taylor, Acting Corporate Director Adults Health and Wellbeing, responded. The question and answer session was centred on the following points:
· Requested that Committee members be provided with an analysis of telecare and homecare service provision by ward.
· Complaints:
o Requested that Committee members be provided with an analysis of complaints received by stages reached in the complaints process. New national procedure for adult social care complaints to be circulated for information.
o Mechanisms in place to capture valuable learning from complaints/ mistakes particularly with reference to those relating to staff attitude.
· In the context of acknowledged health inequalities in Tower Hamlets (example: life expectancy compared to London or nationally) the direction given/ steps taken to address these, and in particular that relating to the prevalence of diabetes in BME communities.
· Lunch clubs:
o The rationale for closure of lunch clubs on the Isle of Dogs in 2009 as a result of the mainstream grants process and the future approach boroughwide.
o Response to complaints from older people regarding lunch club closures on basis of value for money assessment.
o Requested that Councillor Archer be provided with details of the geographic location of 11 additional lunch clubs
· Whether there was potential for budgetary constraints to impact on service provision and the various elements of the approach being taken to obviate this: savings generated through prevention, managing sickness absence, managing staff remuneration, integration of operational establishment, deletion of redundant posts.
· Clarification sought and given as to the numbers of older people from Tower Hamlets receiving care outside the borough rather than in residential homes within the borough, the reasons for this, and whether this distorted performance statistics. Councillor Archer to be provided with out of borough placement figures.
· Arrangements in place for smoothing the transition from childhood to adulthood for young people, particularly those with mental health issues, learning disabilities and autism. Also mechanisms for influencing service provision in this area by partner organisations (PCT, East London Foundation Trust). Further details to be provided to Councillor Jackson.
· Outcomes relating to referrals to AHWB for assessment of care needs: upheld/ not upheld, main problems identified. Also arrangements to ensure public awareness of care entitlements and understanding of the referral process. Councillor Jackson to be provided with data on the number of assessments that led to a service outcome.
· Given that assessment of mental health needs and support had been problematic in the past, what measures had been taken to address this and what was the current position.
· The reasons for the unexpectedly low numbers of those accessing the substance misuse service, indicated in the Lead Member presentation.
· With reference to the move to Personal Budgets, as part of the transformation of adult social care, the measures being taken to minimise financial abuse of older people.
· With reference to the challenge of reduced budgets and achieving value for money, the current level of dependence on agency staff in AHWB. Also the strategy for closer joint operational working with partners such as the PCT.
· In the context of acknowledged late diagnosis of cancer borough-wide, and the spread of related responsibilities across agencies, the steps being taken to mitigate this phenomenon, in particular those relating to a communications strategy.
· Joint working being undertaken with partners to control fast food businesses, particularly with reference to planning policy, and more general initiatives to mitigate the impact of fast food on health through promotion of health options.
· Concern expressed regarding the quality of homecare: lack of continuity in staff dealing with individual elders and visits being of insufficient duration to provide the service required, particularly with travel time being included within this, and how this should be addressed.
· Concern expressed regarding the quality of district nursing care and clarification given as to steps taken to influence the quality of provision by partners.
· In the context of the Government strategy to move towards healthcare delivery through polyclinics rather than hospitals, what approaches could be taken to build the confidence of residents regarding the quality of healthcare provided at polyclinics, particularly for children and older people, and so change behaviour patterns.
· Whether there were any challenges or concerns identified in the recent Care Quality Commission inspection.
· The need to ensure that a local focus was maintained in providing for the healthcare needs of residents, in the context of the major regional reconfiguration of PCT’s and the requirement for joint working/ integration where possible.