(Democratic Services Manager) To consider the attached report.
The Democratic Services Manager introduced Ms A Green, Director for Local Delivery in West Essex, and Ms M McGrath, Director of Commissioning, from Essex County Council to the Committee.
Ms A Green informed the Committee that Essex County Council had spent £590million on Adult Social Care in 2018/19; they had supported over 17,000 adults but had also received 33,500 new requests for support. In Epping Forest alone, 1,182 people were being supported, of which the majority were elderly, across a range of support needs. The Service had been implementing a Transformation Strategy over the previous 18 months, working with other health bodies and District Councils to move towards a preventative and early intervention model, as it was felt that the level of dependency could be minimised if intervention occurred earlier. This should lead to more people being supported in their homes, but it was acknowledged that there would always be some vulnerable people who would require 24-hour care.
Ms M McGrath reported that the Service was currently working on a number of programmes. One of these programmes was working with people who were suffering from learning difficulties and autism. One challenge for people with learning difficulties was that they tended to acquire dementia at an earlier age, so the programme was focusing on trying to get such people back into employment. The Service was also developing a programme to work more closely with Carers, who were critical in providing ongoing support. The focus of this programme was keeping people in their own homes and supporting them in their own homes. Other programmes concentrated on the use of technology to support people, and some interesting pilot projects were in place, as well as supporting people with mental illness to live more fulfilled lives. The overarching aim of the Service was how to work with people on a more personal basis, and give them a degree of choice over their care.
Cllr S Neville enquired about the inter-agency work that the Service undertook, particularly in relation to people with mental health issues to support and improve their lives. Ms M McGrath explained that the Service was involved in many partnerships across Essex; the National Health Service (NHS) in particular was a key partner as they accounted for 80% of the Service’s referrals. District Councils were also a key partner in respect of the provision of housing needs. Physical activity was of huge benefit to people suffering from depression and a significant grant in excess of £1million had recently been received to increase people’s physical activity. Ms A Green added that the Service was determined to shift its focus from a medical model to a more social model for supporting people with mental health issues. This shift in mental health support was being supported by using the available resources in local communities.
Cllr S Murray enquired about a recent article in the Epping Forest Guardian newspaper, which stated that the proposed budget for Essex County Council in 2020/21 was looking to save £24million from activities associated with Adult Social Care, including £17.7million from services for people with learning disabilities, £1million from mental health services, and £1.2million from services for the elderly. The Councillor asked what would these budgetary savings mean in reality for service delivery?
Ms M McGrath stated that she was aware of the proposed budgetary savings, but also highlighted that the Service spent over £400million per annum to give some context. The Service was looking at how it could improve outcomes for people and, as mentioned earlier, the Service had concentrated on the latter stages in the past whereas now it was looking to intervene earlier. Similar issues were also being studied for people with mental health problems, and supporting users at home was generally less expensive for the Service to provide. It should also be noted that there were also investment opportunities for the Service alongside the budgetary savings. Ms A Green added that partnership working also helped to improve services and therefore make savings. Traditionally, the Service waited for a crisis to happen but now it could intervene earlier by working with other agencies, which was less costly and freed up resources for other users. This approach also gave a higher quality of life for users of the Service.
Cllr R Baldwin stated that he was aware of the escalating costs for Adult Social Care, as well as the increasing demand, and was pleased to see the measures being taken to reduce costs through partnership working. However, the Councillor wanted to know to what extent were the voluntary and charity sectors involved in Adult Social Care?
Ms A Green stated that there was a good track record of partnership working with the voluntary sector in the District, with a single point of access for a number of agencies in West Essex. The Service was also linked via Frontline – a voluntary sector portal for accessing services. The voluntary sector could help people to help themselves, and there would be more opportunity for involvement in the future, plus the Service could also assist with the funding of voluntary sector organisations. The Service was also working closely with Princess Alexandra Hospital in Harlow to form an integrated partnership with voluntary sector organisations.
Cllr S Rackham asked about the use of technology to contact hard-to-reach groups, and for some information on the replacement for Careline. Ms M McGrath reminded the Committee that the Service was moving towards an early intervention model which, with people living longer, would see them staying at home for longer. It was noticeable that the elderly was prepared to use technology, especially ‘Alexa’-type devices and technology that was intuitive to use, which had the potential to be hugely transformative for people’s lives. In respect of Careline, new providers were in the process of being procured to provide the service. Ms A Green added that many elderly people now had iPads and smart mobile phones. There were concerns that technology could replace human contact, but the Service was looking at technology to enhance the services that could be provided and used in the right circumstances.
Cllr D Wixley highlighted a case that he had been made aware of by a resident at a County Council-owned Care Home, which was being run by a third party. There were issues at the Care Home with the plumbing and heating, as well as problems with running the Care Home itself. This particular person now felt that she had made a mistake by going into a Care Home as other residents had dementia, and she felt that she could have stayed in her own home with suitable help. The Councillor enquired whether the County Council did its own inspections of Care Homes, and added that this Council ran a number of sheltered home schemes which he hoped had no duplication with County Council facilities.
Ms A Green explained that the Care Quality Commission regulated Care Home providers, and inspection routines were published. The County Council also had its own Safeguarding & Quality Team, who worked with Care Home Providers; the County Council kept a risk profile on those providers and worked closely with them to stabilise their provision. The Service was aware that people in the past had moved into residential care too early, and more solutions were now provided to allow people to remain in their own homes for longer.
Ms M McGrath added that most provision in the future would be for people suffering from dementia, and they would make up the majority of the people residing in care facilities. The Service was keen to further develop accommodation pathways, providing care support in sheltered schemes for a number of people together. This was also an opportunity for the Service to work more closely with District Councils over sheltered housing, although it was acknowledged that sheltered housing was not as popular as it had been in the past. The Service intended to talk to District Councils about their plans for their sheltered housing schemes.
Cllr Y Knight highlighted an issue with social housing, whereby vulnerable adults were being housed in social housing with other people who had drink or drug dependencies. The Councillor wanted to know what preventative models were being put in place to prevent this happening in the future. The Leader of the Council, Cllr C Whitbread, added that he was actively engaged in this issue and had recently discussed similar concerns with a number of London Borough Councils. Cllr H Whitbread, the Housing Portfolio Holder, stated that she met regularly with other Essex Councils and knew that this was a widespread problem – especially in Harlow. Often, London Borough Councils would move their residents out of London to cheaper accommodation, without informing the host authority. Ms A Green explained that the Service was aware of this issue, and had also tried to map the level of need for social housing for vulnerable adults across the County.
Cllr R Jennings commented that the Local Government Association was currently examining the relationship between County and District Councils. Adult Social Care was traditionally a County Council responsibility, but this and other areas could be investigated for joint working. Ms M McGrath agreed, and a number of partnership working initiatives were already under way. As part of this, the Service was looking at issues being faced by both types of Council together, rather than in isolation. Ms A Green agreed that there was a huge scope for partnership working between different Councils and added that the Service was actively working with this District Council on a number of issues, including the usage of green spaces and local leisure centres.
Cllr A Patel, the Portfolio Holder for Commercial & Regulatory Services, stated that he was always looking for ways for this Council to become more involved in Adult Social Care, and welcomed any opportunity to support the County Council in caring for the District’s vulnerable residents. Ms A Green stated that it was a pleasure to work with this Council, and there had been heavy joint investment at a place based level; there was a need now to shift the focus to how great our local communities were. Cllr H Whitbread, Portfolio Holder for Housing Services, reminded the Committee that a review of the Council’s elderly housing was being undertaken, as there was a lower level of interest in sheltered housing schemes now than in the past.
Cllr A Lion, Portfolio Holder for Strategic Projects, informed the Committee that technology issues had been discussed by the organisations involved in the Digital Innovation Zone, and it was found that older people were using technology and using it very well. Careline was now utilising old technology, and would be replaced by better technology which would allow people to live at home whilst also being monitored.
The Chairman thanked Ms A Green and Ms M McGrath for their presentation, and for answering the many questions from the Committee.
(1) That the external scrutiny of Essex County Council regarding the current provision, planning, management and performance of local Adult Social Care services by the Committee be noted.