Apologies were received from Mr W Cross.

To confirm the records of the meetings of the Adults and Health Scrutiny Committee held on 21 March and 20 June 2019 (previously circulated).

The minutes of the meetings of the Adults and Health Scrutiny Committee held on 21 March and 20 June 2019, copies of which had been previously circulated, were confirmed.

In accordance with the Regulations, Members are invited to declare any personal or prejudicial interests they may have and the nature of those interests in respect of items on this Agenda and/or indicate if Section 106 of the Local Government Finance Act 1992 applies to them.

No declarations of interest were received.

To receive any petitions, deputations and questions received from Members of the Public in accordance with the provisions of Procedure Rule 216.

The total time allowed for this item shall be 30 minutes.  Petitions, declarations and questions shall be dealt with in the order in which they are received.  Questions may also be submitted at short notice by giving a written copy to the Committee Administrator 15 minutes before the start of the meeting.

The total time allowed for questions at short notice is 15 minutes out of the total time of 30 minutes.  Any petitions, deputations and questions that have been submitted with prior formal notice will take precedence over questions submitted at short notice.  Any questions that are not considered within the time limit shall receive a written response after the meeting and be the subject of a report to the next meeting.

No petitions, deputations or questions were received.

To consider any questions with notice from Members received in accordance with the provisions of Procedure Rule No 218 and No 218A.

No questions with notice had been received from Members.

To consider any Notices of Motion from Members submitted in accordance with the provisions of Procedure Rule No 219.

No notices of motion had been received from Members.

To consider any matter referred to the Committee for a decision in relation to call in of a decision in accordance with Procedure Rule 206.

No matter had been referred to the Committee for a decision in relation to a call-in of a decision in accordance with procedure Rule 206.

To appoint a vice-chairman of the Committee.

Mrs Harvey was nominated for the position of Vice-Chairman by Mr Ainsley and seconded by Mrs Fox. There being no other nominations, a vote was taken and a unanimous vote for Mrs Harvey was given.

RESOLVED

That Mrs S Harvey be APPOINTED as the Vice-Chairman of the Adults and Health Scrutiny Committee.

To receive a presentation from Andy Donoghue, Assistant Director for Estates, Leicestershire Partnership NHS Trust, updating Members on the Inpatient Mental Health Services Feasibility Study.

A presentation on the Inpatient Mental Health Services Feasibility Study (appended to the minutes) was given by Andy Donoghue, Assistant Director for Estates, Leicestershire Partnership NHS Trust.

During discussion the following points were noted:

·         The feasibility study was following the NHS strategic business case process with a master planning exercise which would eventually take the shortlisted option down to one preferred option.

·         There was a need for a new site where all mental health services eg, psychiatric wards, learning disabilities, dementia and eating disorders could all be in one place rather than spread across the patch as they were currently.

·         Existing sites were not fit for purpose and no amount of remodelling or refurbishing would address this.

·         New premises would give better co-efficiency, reduce the length of stay and improve the privacy and dignity of patients.

·         Of the 20 original sites, 11 were immediately dismissed because the sites did not have room for further expansion and could not be future proofed.

·         A outline business case (OBC) was now being made for three of the sites.

RESOLVED

The Committee NOTED the update on the Inpatient Mental Health Services Feasibility Study

To receive Report No.141/2019 from the Strategic Director for People.

Report No.141/2019 was received from the Strategic Director for People.

John Morley, Deputy Director Adult Services introduced the report the purpose of which was to provide the Adults and Health Scrutiny Committee with an overview of performance against the key performance indicators (KPIs) for Adult Services. The purpose of the report was to provide a narrative summary to accompany the data (which has its own commentary) provided in Appendix A.

During discussion the following points were noted:

·         Members wanted to have more understanding and context of the KPIs provided and what the levels meant for staff and for service users.

·         The Strategic Director for People suggested that, in order to put the targets into context, the adults services directorate could report to the Committee giving an overview of the whole system, covering what services people were looking for and what happened to Rutland residents when they needed that care.

·         Residents who phoned into the services were often referred on to lots of different routes. The service was making efforts to capture the outcomes of these referrals.

·         KPI number 14 in the report could be interpreted in differing ways. On one hand it was positive to have people who had previously received a service calling in as it could be seen as preventative and could be acted upon quickly. On the other hand people could be calling in for changing needs because their original service had been mis-commissioned and therefore resources were being wasted. It was for this reason that an audit of services offered was welcomed.

·         There were KPIs that looked at the transitional services from children’s to adult services but the numbers were so small that they were sometimes misleading and unhelpful.

RESOLVED:

The Committee

1.    NOTED and COMMENTED on the performance figures for Adult Services for Quarter 1 (April-June).

2.    REQUESTED that an overview of the Adult Social Services process be given at the next meeting of the Committee in order that the performance figures could be put in context.

To receive Report No.144/2019 from the Strategic Director for People.

Report No.144/2019 was received from the Strategic Director for People.

John Morley, Deputy Director for Adult Services, introduced the report the purpose of which was to provide the Adults and Health Scrutiny Committee with an overview of the Rutland Adult Services Strategic Plan 2019-2022 and the development of its key priorities for 2019 and the intended outcomes.

During discussion the following points were noted:

·         Adult Social Services had integrated very successfully with health services to allow residents to have healthy independent lives. Rutland performed very well in this area compared with other Councils and had less people as a percentage having to enter a residential home.

·         Appendix A outlined the vision for the service which would be more focused on how it worked rather than implementing ever new changes to the model. Because the model was already efficient, Officers now wanted to try and spend more time with service users and build up trust to enable users to direct their care rather than having things prescribed for them.

·         The Plan was about more than just gaining independence for people but also as part of that independence, getting people to have a ‘good life’

·         Members felt that the Plan needed to have some context to it, for example what other strategies fed into it, and that it also needed to state how long it was for.

·         There was concern that the goal of ‘safe, valued and heard’ could be setting the Council up to fail as this did not cover providing the services that resident needed and that the Council had a statutory duty to provide.

·         Members asked whether the aim of keeping residents living independently in their own homes for as long as possible could sometimes conflict with the aim of reducing levels of loneliness for the elderly.

·         Officers felt that the majority of users preferred to stay in their own homes for as long as possible and that services provided could enable many people to die in their own homes with all the comfort that that brought rather than having to go into a care home. It was not simply a matter of cost as it was not always cheaper to keep people in their own home.

·         The report was an early outline of the sorts of aims and visions the service wanted to include in their strategic plan.

RESOLVED:

The Committee NOTED and COMMENTED on the development of the Adult Services Strategic Plan 2019-2022.

To receive a presentation on care homes from the Strategic Director for People.

A presentation on Care Homes (appended to the minutes) was given by Mark Andrews, Strategic Director for People.

During discussion the following points were made:

·         The length of stay in a care home had reduced over the last 5 years and was now on average less than 3 years.

·         Rutland had a much lower than average percentage of residential placements compared to community based support.

·         Because of the low numbers involved, Rutland did not have the same weight in the market as other authorities did.

·         Reviews of care homes within 12 months was at 95% of its target in Rutland compared to 50% at most other authorities where reviews had been cut in order to save money. At Rutland they had found the opposite to be true and that regular reviews helped Officers to respond to need thereby reducing higher cost care plans.

·         The review process used to be seen as a ‘stick’ but had now turned into a supportive process with joint information sharing.

·         Members felt that there were a multitude of agencies involved with end of life care and that signposting to services was still sometimes unclear.

·         A relatively significant percentage of the overall care budget was spent on taking over the care and associated costs of residents who had originally entered their care home as self-funders.

·         Members questioned whether the building of ever more care homes in Rutland would cause a serious future funding issue if they had to take on more of those who had originally been self-funded.

·         Officers confirmed that any self-funder who moved into the area automatically became a Rutland resident and as such if their funds became depleted RCC would have a duty to take on their care. From a moral standpoint, case workers would try and keep them where they were but this was not always achievable.

·         Many smaller care homes relied on a business model that involved self-funders subsidising Council placements. Officers were concerned that a shift in the market may cause these homes to go out of business. 

·         It would be preferable to have adaptable and affordable housing in the first place rather than building more supported housing. There were many assistive technology options that could help with adapting a person’s home and enabling them to remain there.

·         The CCG assessed a individual’s health needs and if they had a 100% health need their care would be paid for by the NHS regardless of their financial means.

·         There were sometimes disputes between the Council and the NHS over what was healthcare and nursing needs rather than social needs but this was not a significant issue for Rutland when compared to other Councils.  In general the Council did well and received a higher proportion of health funding.

RESOLVED:

The Committee NOTED and COMMENTED on the presentation.

To consider the current Forward Plan and to identify any relevant items for inclusion in the Adults and Health Scrutiny Committee Annual Work Plan (attached), or to request further information.

The Forward Plan can be found on the website using the following link:

https://rutlandcounty.moderngov.co.uk/mgListPlans.aspx?RPId=133&RD=0

During discussion of the Annual Work Plan and review of the current Forward Plan the following comments were noted:

During discussion of the Annual Work Plan and review of the current Forward Plan the following comments were noted:

·         Members requested that a report on the Community Wellbeing Service be added to the work plan.

·         The Adult and Health Scrutiny Committee details shown on the website did not align with the terms of reference for the Committee as outlined in the Constitution. The Governance Officer would amend the website to correct this.

To note Report No.146/2019 from the Chairman of the Leicestershire and Rutland Safeguarding Adults Board

The report was taken without debate.

To note Report No.114/2019 from the Strategic Director for Resources.

The report was taken without debate.

To receive any other items of urgent business which have been previously notified to the person presiding.

No items of urgent business had been previously notified to the Chairman.

Thursday 21 November at 7pm.

The next meeting of the Adults and Health Scrutiny Committee would be held on Thursday 21 November at 7pm.