Meeting Details

Health and Adult Social Services Standing Scrutiny Panel
3 Dec 2019 - 19:00 to 21:00

Documents

Agenda

Standard Items
1 Substitute
Councillor Young replaces Councillor Morrissey for this meeting only.
2 Apologies for Absence

Apologies were received from Councillor Steed, Raza and Morrissey and from co-opted member Anna Whitty.

Cllr Young substituted for Councillor Morrissey.

3 Urgent Matters

There were no urgent items to consider.

4 Declarations of Interest

Alan Cook declared a non-pecuniary interest as a member of Healthwatch Ealing.

Jaime Walsh declared a non-pecuniary interest as a member of Healthwatch Ealing.

5 Matters to be Considered in Private

There were no matters to be considered in private.

6 Minutes
To approve as a correct record the minutes of the meeting held on 25th September 2019

RESOLVED:

The minutes of the meeting held on 25 September 2019 were agreed as a true and accurate record of proceedings.

Kerry Stevens, Director of Adult’s Services, introduced the report and explained that the social care Market Position Statement was an annually produced document in line with guidelines laid out in the Care Act (2014). It was explained that this document encompassed Adults and Children’s Services and examined the quality and capacity of the local offer. A report on the quality of social care in Ealing was scheduled to come before the Panel in March 2020.

 

Kerry Stevens explained that the authority commissioned £70 million per annum on a range of services; including domiciliary care and nursing care provision. It was explained by the Director that the majority of services delivered were procured through private providers, and that there was some provision undertaken by the Voluntary and Community Sector (VCS), particularly in disabled care provision. It was also noted that internal providers provided reablement services.

 

The Director noted that in terms of numbers of people supported the majority were over 65, but that, in terms of the spend, there is similar spend on younger adults as in the older cohort.

 

The Panel questioned whether there had been any work undertaken to develop a system-wide approach to falls prevention and management. Officers stated that a falls prevention group, which the CCG and Council officers participated in, was working on this approach, and that the Director would provide the Panel with further information on progress

 

Members of the Panel queried the training offer. Gordon Crighton, Operations Manager explained that there was a substantial training offer available to ensure that statutory training was undertaken by all care providers. It was noted that this was supplemented by the providers own training programmes. Officers explained that Ealing was one of the few authorities which offered a free training offer to providers, and that they would like to maintain this level of service. It was explained that the training offer was key to the service driving quality.

 

The Chair of the Panel questioned how the service managed performance of providers. Kerry Stevens noted that the Care Quality Commission (CQC) was the regulator for service quality, and that they ensured that providers met quality standards. However, it was explained by officers that the authority, Healthwatch, the NHS and CQC had regular meetings to discuss the local market quality and how to encourage improvement. It was also noted that there were regular discussions regarding safeguarding and major issues, and that engagement with regulators and providers was good in this regard.

 

The Chair of the Panel questioned how the service was integrating the Accommodation Strategy and implications for the care market. Officers explained that the service was looking to move away from long term accommodation and care, and that they would look to support independence wherever appropriate. Officers also explained that they were looking to encourage development of the market and use more local care placements. It was stressed that this would improve outcomes for services users, being closer to home, but also reduce spend. It was noted that this tranche of work was in early development, but that a preliminary explanation of progress could be reported to the Panel in late 2020. Kerry Stevens also noted that he had a statutory duty to have influence over the care market in the borough. However, it was explained that the authority only purchased one third of services offered by private providers, which reduced the influence that the authority had over the market but stressed that there were significant mitigating factors to this, such as the training offer.

 

Kerry Stevens explained that that the Council was developing a commercial programme with Housing and Property Services to create an improved housing offer for extra care service users, but that this would be a long-term solution. Officers highlighted that there was evidence of good practice in this area that had been undertaken by Children’s Services, and that the service would be using the lessons learnt to develop their own housing priorities. The Panel questioned whether there was an opportunity to work with Planning officers to incorporate affordable housing and extra planning conditions in new developments. Officers noted this and explained that the service would be looking at opportunities where this was possible. Officers also explained that they had undertaken workshop activities with providers and housing officers to develop this idea, and that there would be future workshops to investigate this issue further.

 

Members questioned the development of the Carer’s Strategy with regard to the Care Market, and whether carers were sufficiently considered by the authority. Kerry Stevens noted that a new Carer’s Strategy was in development, and that Carers were key to the delivery of services. Members highlighted the need for signposting for carers of children with special needs, particularly when moving from primary to secondary education. It was also explained by officers that there were efforts to look at signposting support for carers in an improved way, including using technology where appropriate It was noted that there was a capacity issue in the Voluntary and Community Sector regarding carers which needed to be addressed. Officers highlighted that there was support available for Young Carers in Children’s Services.

 

Members asked about transition, and the support available for children in need of support transitioning into Adult Social Care. Kerry Stevens noted that there was significant work underway with Children’s Social Care, to provide a joined-up approach to supporting children in transition.

 

Members of the Panel questioned Falls Prevention care provision and how the service was working to develop a new system-wide approach to falls prevention and management. Kerry Stevens explained that there had been a Falls Prevention Group established, which included officers of the Council, Clinical Commissioning Group (CCG) and other partners which was developing this new system-wide approach. Officers offered to provide more detail on this to the panel.

 

The Panel questioned the effectiveness of adult transport commissioning, noting that . work was also being undertaken to support people to make use of public transport. Gordon Crighton stated that there was an improved integrated Children’s and Adult’s Dynamic Purchasing System (DPS) to allow for competition between providers and ensure best practice and value for money from market providers. Members asked whether further information on the effectiveness of the DPS could be provided in late 2020.

 

In response to a question from a member of the public on the authority’s performance in regard to delayed transfers of care (DTOC), Kerry Stevens stated that the service worked closely with the NHS to monitor performance on length of stay and DTOC indicators and that, as a result, performance in Ealing had improved significantly over the last 12 months. It was stressed however, that there was more work to be undertaken in this area. Officers assured the Panel that, during the winter period, they spoke to health partners on a daily basis and the service was on high alert.

 

 

RESOLVED:

 

  1. That officers provide the panel with information on the progress of the work being undertaken to develop a system-wide approach to falls prevention and management.

  2. That officers will provide further information to the Panel on the effectiveness of the Dynamic Purchasing System for adults transport in late 2020.

  3. That the service provides a report which:
    1. Showcases outcomes of work with Planning and Housing teams to provide Extra Care provision in current and future housing developments; and
    2. Arranges a Panel site visit to the Borough’s extra care schemes to support members in having a better understanding of the service.

  4. That work is undertaken to improve signposting of support available for carers by officers, with an emphasis on the technological offer.

  5. That officers provide a report in in March 2020 on the quality of social care in Ealing.

 

Note: Councillors Burke and Murtagh arrived at the meeting following the Officer introduction of this item.

Jaime Walsh, the Chair of Healthwatch Ealing, noted that the report highlighted the user feedback from a year long study of the NHS Falls Clinic and Local Authority Strength and Balance Classes. It was explained that there had been 668 respondents to the questionnaire. Of these 75% had attended Strength and Balance classes only, 12% attended the NHS Falls Clinic only, and the remaining 13% attended both.

Jaime Walsh noted that there had been positive feedback overall, but that one-to-one therapy and home visits from physiotherapy had received less positive feedback. It was explained that these services were provided by the NHS. It was also noted that there was significant negative feedback regarding waiting times for accessing the NHS Falls Clinic, which at the time of this study had an 8 week wait. Healthwatch stressed that they were working with the NHS and providers to look at the potential of providing some meanwhile and mitigation support in-between appointments to alleviate this issue.

 

Healthwatch noted that their datasets had seen a trend in patients receiving the most benefit from continued, low levels of support and education about trip hazards was most helpful. It was also noted that those who attended both the Falls Clinic Services and the Strength and Balance classes reported the greatest improvements in fear of falling and confidence The Panel noted other less tangible social benefits, such as reduced social isolation. It was noted that awareness of services amongst patients and practitioners was low.

 

Healthwatch also explained that the service landscape had changed significantly since the falls report was written, with both services being commissioned from new providers. Healthwatch stressed that they were in discussion with the new NHS provider regarding the findings of the report, to ensure that good practice outlined is continued and to raise concerns that the 2 way referral between the NHS Falls Services and the Strength and Balance classes was not working.

 

In response to questions about the current provision of strength and balance classes, Healthwatch advised that these had previously been commissioned from ‘Stay Active 4 Life’ but were now being provided by the voluntary sector, which had significantly lower capacity. It was important that the momentum created from the previously commissioned service was not lost.

 

One of the recommendations arising from the survey was that the cost of the Strength and Balance classes be reviewed, Healthwatch highlighted that after the 10 weeks of free classes there was a nominal fee to cover hire of the venue, which differed according to location. It was explained that this had reduced accessibility in some instances.

 

The Panel expressed support for the Strength and Balance service, noting its previously reported popularity. It also noted that it was important to understand the need, cost and benefits of providing the current service and requested that a report on the outcomes from the current provision be provided.

 

The Panel noted the specific reference to pavement and street cleaning in the recommendations of the Healthwatch report, and the Chair commented that, along with the Vice Chair, he had met with the Ealing Older People’s Forum, where similar concerns had been aired. It was explained that there may be scope to look into improvements in streets on the conclusion of the current street cleaning contract, when the service would be provided in-house.

 

Members questioned the fairness of access and quality of equipment. Jaime Walsh noted that the provider may have changed some of the equipment and that procurement methods may be different for each area.

 

Jaime Walsh noted with concern that there was an issue relating to accessibility, explaining that the survey was sent those who had access to the service, and not those who could not. It was explained that this may have left a gap in the results. It was noted that the service was accessed through GP referrals, and that GP referrals were becoming the good practice method of engaging with the service.

 

 

RESOLVED:

 

  1. That the Panel receive a report from officers on the progress and outcomes from the current provision of Strength and Balance classes and an update on referral and waiting times for the NHS Falls Services.

  2. That the recommendations of Healthwatch Ealing’s Review of Falls Prevention Services be considered for inclusion in the Panel’s final report on Falls Prevention.
  1. pdf Appendix 1 (3878Kb)

Jaime Walsh, Chair of Healthwatch Ealing, introduced the report which cover the period January - March 2019 and explained that there had been 1200 respondents to the patient survey. It was explained that this contained predominantly positive feedback of services provided in the borough.

 

Jaime Walsh reported back on the request of the Panel to provide a breakdown of white ethnicities in the borough, particularly of Eastern European descent. It was noted that, due to reporting structures in Healthwatch, this would not be possible to implement, but that Healthwatch would be undertaking outreach in Eastern European communities to gather viewpoints. Healthwatch asked Members of the Panel to provide information, if available, on communities within this ethnic bracket.

 

Jaime Walsh reported that feedback received from patients on the quality of General Practitioner (GP) contact and calls had been poor, citing numerous patient sources. Healthwatch was planning to investigate this issue with the aim of making recommendations to improve the service.

 

In response to a question about GP home visits, members were informed that a service was provided by Ealing Community Transport to help patients travel between their homes and GP surgeries, which aimed to reduce the number of GP house calls and missed appointments.

 

Members questioned why there were some omitted datasets. Jaime Walsh explained that datasets would only be presented if they had a statistically relevant sample, and that there was not enough data for that quarter. However, it was explained that annual reports would have statistically relevant samples to report on, and that full data would be provided there.

 

The Panel asked how Healthwatch use the data to help improve practice in providers. Jaime Walsh explained that data, recommendations for improvements and patient feedback were provided by Healthwatch to the NHS and providers on a regular basis. The NHS used feedback from this as part of their overall performance indicators.

 

RESOLVED: That the report be noted,

The Panel considered the items that had been deferred by NHS partners due to this meeting occurring during the pre-election period. It was noted that at the next meeting the Panel would receive reports on the Ealing Primary Care Standards and Ealing Community Partners Community Services.  

RESOLVED: 

That the Panel work programme was noted and approved.

11 Date of Next Meeting
The next meeting will be held on 12th February 2020

It was noted that the next meeting would be held on 12th February 2020

 

The meeting of the panel concluded at 8.55pm

- 25th November 2019

Meeting Documents

There are no separate meeting documents but there may be meeting documents assigned to the Agenda.

Attendance

NameReason for Sending ApologySubstituted By
Councillor Joy Morrissey  
Councillor Aysha Raza Councillor Anthony Kelly
Councillor Andrew Steed Councillor Anthony Young
Ms Anna Whitty  
NameReason for AbsenceSubstituted By
Councillor Anna Tomlinson  

Declarations of Interests

Visitors

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