Agenda item

To consider a report by the Social Services: Adults and Health Cabinet Member on the above.

(a)     The Cabinet Member for Social Services, Adults and Health presented a draft report on the End to End review of older people’s services.  

 

(b)     A presentation was received from the Head of Adults, Health and Wellbeing Services in a slide format and he noted that the direction set for the review was not new with much of it based on existing arrangements and the Council’s resolutions over the last few years.   Attention was drawn to the vision, nature of the vision and a series of service principles. It was further noted that specific requirements had been set under the Social Services and Well-being Act (2014) and attention had to be drawn that the percentage of the older population was increasing.   In the future the budget would be significantly less than in the past and it would be necessary to keep an eye on the impact of this.   

 

(c)     He referred to the review’s methodology and noted the following fundamental steps:

1.     Good Practice – to learn lessons from others on pioneering methods of operation accepting there is no one best method in every case or field.  There are several methods that may work and it will be necessary to be wise and choose what would be appropriate and best for Gwynedd.

2.    Comparison – mainly with the ‘family’ of comparative authorities to measure progress / Gwynedd’s performance.

3.    Look at the progress not only with hard data but also in terms of gathering information and response at a local level.

 

Regarding well-being and managing the demand, it was noted:

 

1.    That well-being was a responsibility across the Council, not a matter for Care Services / Social Services only and well-being needed to be considered before profound problems occurred. 

2.    The need to use intervention and prevention as early steps on their own but these could also make an important contribution towards managing the demand for formal care services. 

3.     There was no one general ideal answer to shape frontline services. Also integrated methods could be included such as Ffordd Gwynedd work at Ysbyty Alltwen and the third sector contribution.

4.    That the relationship with communities received specific attention in the Council’s Strategic Plan.  Resources will have to be directed to achieve this and it had to be accepted that neither Gwynedd nor any other local authority would succeed without strengthening this element of the Service.

5.    That restructuring the Department was key to the provision of services in a new way and to meet with the expectations of the Act and those of service users.

 

In the context of the development of social work practice, it was explained

 

1.             That it was inevitable that social work practice would change in order to respond   to the requirements of the Act and the need to transform services

2.             Evidence indicated that culture and standard of the work practice were key to       find appropriate and better methods to meet the needs of individuals.

3.             It was necessary to try and support individuals to live at home with appropriate      support and over time in order the dependency on residential care could be    reduced.   

4.             That offering and promoting direct payments placed the focus on the outcomes to the individual were two important aspects when developing social work practice.

5.             That the Care Workforce Development Team had a key role to develop the Council’s ability to achieve the changes.

 

In order to achieve the aims and requirements of the Act, it was noted that it was required to strengthen the support to live at home and focus on the following specific aspects:

1.             Dementia and vulnerability

2.             Day Care in Gwynedd

3.             Role of the third sector, especially in terms of providing support in the home and               in the community

4.             Home Care – it was recognised that it was necessary to look at the correct balance in terms of internal / external provision in Gwynedd as approximately    50% / 50% currently had an internal and external provision and this was a cause of concern in terms of recruitment in Meirionnydd.

 

Regarding accommodation provision, it was noted that an alternative option had to be ensured for older people such as extra care housing.  It was noted that clarity regarding the role of local hospitals was important in terms of planning for nursing and residential care in the future and as a context to prioritise options over the next few years.   The priorities will have to reflect the requirements that will be highlighted as a result of the needs assessments.  

 

Integration with NHS services may achieve positive results, however, this may vary from area to area. It was noted that the Intermediate Care Fund programme leads us towards better commissioning and facilitating movement in the correct direction.     

 

To conclude, it was noted that the methodology was dynamic with decision to be made over the next 18 months, some of these were strategic and operational decisions that would shape the future and would entail huge and inevitable changes. 

 

(ch)      Members were given an opportunity to express their comments and the following points were highlighted:

(i)            It had to be ensured that the third sector operated across the whole of Gwynedd

(ii)           There was praise in the Bangor area for the additional care housing provision

(iii)          The importance of including respite care provision within the strategy to support carers

(iv)          The importance of forging a relationship with other partners e.g. Môn / Menai the north of the County and Ceredigion / Powys for the south.

(v)            The good practice undertaken in Dolgellau Hospital was mentioned. 

(vi)          The importance that elected members supported the Social Services         Department and that early intervention and preventative work was vitally                       important.     

(vii)         Would the arrangements of implementing the pool budget be suitable and work for the changes in this field?  

(viii)        Why cannot the Council operate dual registration in order that community nurses can give them a service in residential care homes? 

(ix)           That home care worked successfully if the facilities were available, however it was known that individuals had to move from their home area to get residential        care provision and this caused difficulties for families to visit and to travel etc.,  

(x)           Concern regarding the lack of recruitment of carers in competition with the better wages offered by supermarkets.   

(xi)          Can lessons be learnt from other authorities that perform better within the family, and was it possible to make more use of private residential homes?

 

(d)       The officers responded to the above observations as follows:

·         Perhaps it would be possible to give consideration to experiment with the implementation of the pool fund in certain pockets of the County, but certainly this would have to be considered step by step.

·         In terms of comparing performance with other authorities, it was assured that this had been considered and incorporated in the report’s recommendation.

·         That the scenario regarding the living wage might possibly close the gap in the future in terms of residential and private care.    

·         Although respite care had not received specific attention within the report, it was recognised that there was room to make use of respite care by considering other methods to reduce the dependency on respite care.    

 

Resolved:       To accept the contents of the draft report and to request that the Cabinet Member for Social Services:  Adults and Health and the Head of Social Services give consideration to the relevant comments outlined by members in (i) – (x) above as part of the final report.