Agenda item

For Committee Members to scrutinise performance matters within the Department.

1.     To accept the report and note the comments

 

 

The report was presented by the Cabinet Member for Adults, Health and Well-being.

 

It was highlighted that the Department was working on the Cyngor Gwynedd Plan 2023-2028, and that the report included an overview of these six main projects. It was mentioned that the report also discussed the day-to-day work of the Department, and the financial situation. There was pride in the department's major achievements, listing some of them:

·       An increase in care provision within the county.

·       Two new houses for individuals with ALN had opened in Harlech and Penrhyndeudraeth, with work progressing in Penyberth.

·       Increasing use of technology and telecare to enable people to live independently.

·       An increase in the number of social assessments and a reduction in the occupational therapy list.

·       Dementia Actif was very successful, with carers also involved.

·       The bed occupancy rate in internal homes had increased back to 87%.

·       The Deprivation of Liberty Safeguards (DoLS) waiting list was falling, with new officers having qualified.

·       Original budget deficit projections had improved by the end of the financial year, but pressure on the Department's services remained.

 

The discussion then moved on to some of the concerns, specifically referring to the high demand for domiciliary care, with recruitment challenges continuing. The desire for work to improve support for unpaid carers was noted, recognising their valuable contributions.

 

It was identified that the Department's budget deficit for the year was £1.4million, and that cuts of £1.5million were included in the budget. The pressure on delivery services was reported to account for £1m of the departmental pressure, which was mainly on staff overspend and use of agency staff within residential care. It was emphasised that the Department had to provide for the people who needed the services, and therefore these services were not driven by money. Concerns were raised about the waiting lists from a financial point of view, and the increase in need. Reference was made to the uncertainty surrounding the RIF funding that was key to how these services were funded, and the risk in terms of the savings yet to be achieved was also mentioned.

 

The Department's successes were welcomed, confirming that there was an awareness of the underfunding they were facing. It was clarified that it was not possible to say whether the additional funding received this year would improve the Department's position, as it was not possible to predict what additional pressures or complex cases would reach the Department.

 

It was detailed that around £6 million of RIF funding was coming to Gwynedd, noting that this funding was for Adults and Children as well.

 

Although domiciliary care was being restructured, it was observed that the figures were still increasing. In response to this, it was explained that the complexity of cases was increasing, and while the extra care homes would assist with this, it would take time to be able to see the change. It was reported that the Department was dealing with ongoing changes, and that review work was underway to look at the options going forward. It was proposed that this field could be pre-scrutinised when the report was published. It was added that it was an area where problems were dynamic and moved from area to area, such as staffing challenges or provider failure.

 

Staffing challenges were mentioned in relation to these waiting lists. It was confirmed that the Department had been working with the Community Catalyst organisation to support people who wanted to develop small care initiatives themselves, to help with the pressure. Although this agreement had now expired, it was stated that the work was now being done in-house, with a leader appointed in relation to the work. 

 

The percentage of residential beds being used in the county's care homes was discussed, noting that it was a low percentage. In response, it was explained that there was a desire to increase the figure again, but the numerous factors affecting this use were mentioned, such as upgrading and re-registration, and staffing proportions. There was concern that the upgrade was taking a long time to complete, and it was asked whether it could be better prioritised so that the beds could be used. There was agreement with this concern, assuring that steps would be taken to try to make the system faster and more effective. Reference was made to the findings of the Llechen Lân report - that there was an increase in demand for the service but not enough manpower to respond to that. It was reiterated that these staffing challenges were a combination of a number of extensive factors. It went on to note that Gwynedd was more likely to put people in homes for the elderly or nursing homes than other counties, so it should be questioned whether this was a good thing or took away people's independence prematurely, taking up several placements unnecessarily.

 

It was recognised that change within the system was needed to promote independence and to enable better and faster implementation.

 

Questions were asked about the job vacancies situation within the service, and it was suggested that councillors should be promoting these positions through their social media platforms. It was noted that a number of jobs were being advertised at the moment, but in order to be able to address the waiting lists and the increasing demand, much more recruitment would be required. It was identified that a high number of vacant beds in some homes was due to a lack of adequate staffing levels. To address that, a larger budget would be needed to be able to recruit more staff.

 

Concerns were raised about the lack of nursing beds in Pen Llŷn and the lack of beds in hospitals, also mentioning the strain placed on unpaid carers.

 

It was hoped for assurance regarding the timescale of work for the Penrhos site as soon as possible. A Member highlighted that low wages within the care sector was one of the reasons why these positions could not be filled. It was noted that things were progressing well in relation to the nursing home in Penrhos, and it was confirmed by the Cabinet Member that he was part of regional discussions in relation to unpaid carers, and fair pay and working conditions for staff in the care field.

 

In response to a question about measuring the quality of care provided, it was confirmed that the Department frequently discussed with those receiving the service and asked residents about what was important to them in terms of provision. This was elaborated upon, stating that a Quality Assurance Team monitored the quality of care supplied by providers and asked people about that service.

 

It was observed that there was diversity in the needs of those on the waiting list for domiciliary care, with a number of individuals on the list but not ready for care for reasons such as their property being unsuitable. It was mentioned that these figures would be subjected to a more detailed analysis in order to better understand them. It was noted that around half of the individuals on the waiting list were currently ready for care, so the figures were rather misleading.

 

It was asked how the people waiting for these care packages were supported in the meantime. In response, it was explained that there was a specific technology that offered support to those individuals, but that a package needed to be developed to offer it while they waited for care. The priority was the safety of the individuals as they waited, adding that more should be done to tackle the waiting list. In addition, it was highlighted that some of those on the waiting list were individuals who were already receiving care but were keen to change the time of care, but the company providing the care perhaps was not able to provide during that time.

 

Pride was expressed that an increasing number were taking advantage of the Dementia Actif service, enquiring about the provision available and the nature of the activities carried out at the sessions. It was confirmed that the sessions were delivered in various locations across the county, and the numerous entertaining activities and mobility work carried out at these sessions were described. It was revealed that a men's group had recently started, with many of those attending being young men who were starting to show symptoms of dementia. The work done by the team of five was praised, but it was reported that discussions were underway about the way forward as the funding for the team's work ceased next year. It was hoped that the team's work could also be developed into a preventative measure for people who were starting to show symptoms.

 

It was assured that the Committee would be involved in implementation following the Housing LIN report, which would outline the demand for care accommodation. It was noted that the findings were likely to be challenging and would suggest that there was a need for a number of specialist properties for older people across the county.

 

 

DECISION

 

1.    To accept the report and note the observations.