Doncaster Metripolitan Council Health and Adults Social Care Overview and Scrutiny Panel Meeting

Apologies for absence were received from Councillor Kearsley. 

There were no declarations of interest made.

That the minutes of the meetings held on the 24^th November 2022 be agreed as a correct record and signed by the Chair.

There were no public statements made.

The Panel was presented with an overview of ‘Your Care and Support Doncaster: Adults, Health and Wellbeing Local Account 2023’.  It was reported that ‘Your Care and Support Doncaster’, had been coproduced by the Making it Real Board (MIRB) and provided strategic oversight to Adults, Health and Wellbeing, influencing and challenging decisions and agreeing priorities for improvements and developments.

Martin Walker from Making It Real Board, spoke about his role as an unpaid carer to an elderly parent and about what was helping them live a good life.  Martin also spoke about the honest and open conversations that had taken place through the development of the local account.

Glyn Butcher from Making It Real Board, spoke about the various roles he undertakes for a number of different people.  Glyn spoke about what he felt about Doncaster and what had been achieved as a Council and through working together.

It was noted that significant progress had been made around Social Work Assessment times.  It was recognised that there was a great deal of bureaucracy and that efforts would be made to reduce that.  It was questioned how people could begin to feel more connected and how existing barriers could be removed. It was noted that there had been a great deal of partnership working and changes made in the culture and the way we talk to each other.

Members were informed that a decision was being taken to Cabinet in March 2023.  It was explained that there was now a focused about people being able to remain in their own home, although it was seen that there was a need for more domiciliary support which could be achieved  within communities.

A discussion took place that included the following areas;

Feedback on Local Account – A Member questioned why the ‘voice’ had not featured more prominently in the report.  It was also felt that context was missing from areas that contained statistical information and may prove challenging for those it was targeted at.

It was explained that this was the first Local Account produced since 2015, and was not just about presenting statistics and plans but about how we felt we was doing against our South Yorkshire comparators.  Regarding statistical information, it was commented that some areas were not easy to understand and further clarification was sought.  Officers welcomed Members comments and noted that they would be considered as part of future Local Accounts.

Payment Policy (to those with Lived Experience) – In terms of how this worked, it was explained that the Council looked to reduce bureaucracy when making payments as part of the Adult Social Care payment policy.  Glyn Butcher explained that his involvement was paid through non-financial contributions to the People Focused Group (PFG), for example, through the provision of craft items and rooms.  Martin Walker supported how it was important for the Council to offer payments and recognise the work of those with lived experience that provided their time.  It was also commented that financial payments could impact benefits received by individuals and that there was uncertainty around how often such payment was applied.  It was noted that it could also be about supporting individuals to be involved and therefore needed a flexible approach.

Occupational Therapy (OT) Assessments – It was felt that Occupational Therapy assessments continued to take too long although it was recognised that significant progress had been made.  Members were informed that waiting list times had reduced by 44% since September 2022, although it was still considered as being too high.  It was noted that there had been a high number of referrals and requests for support being made through other areas.  Members were told that significant investment had been made in additional staff, there had been a recruitment campaign for Assessment Officers to support OTs and apprenticeships in this area were now available.  It was commented that it was also about communicating effectively with those on the waiting list.  Finally, Members were informed that a new model of working had just been launched and that there was confidence that further reductions would be seen in Quarter 4 2023/24 and Quarter 1 2024/25.

Members were informed of positive stories that demonstrated how communities were successfully working with OTs.  The Panel was informed that an update could be provided on what was happening around OTs as part of scrutiny’s future workplan.

Active and Supportive Communities – Concern was raised that Doncaster was ranked last place in the country and locally for this measure and it was asked how this could be improved.  It was felt that there were good examples taking place and Members felt that it was important to continue them across other parts of Doncaster.

It was responded that this was covered as part of the ‘openness and honesty’ element, which featured within the report.  Reference was made to social economic issues experienced within Doncaster and across South Yorkshire.  It was explained that the current model mainly processed people through some narrow considerations instead of looking at prevention and creating a better quality of life. 

Martin Walker spoke about how his parent used a befriender who had made the decision to bring others together who were identified as lonely, and this provided a new network as part of a broader community response.  Martin said he would welcome seeing such measures joined up more through working with the Council.  Glyn told the group about his own experiences and where he had benefited from support, he also spoke about how communities could benefit each other through having an understanding and providing the right help.

It was explained that it was about changing the narrative by looking at how we practice and the way we work to allow people to remain in their own homes and within their communities. 

Involvement with those with Lived Experiences - It was supported that Officers would like to work alongside a greater number of people at a strategic level in addition to what was currently in place.  It was also felt that it was about respecting those willing to be involved and appreciate that the voice element would broaden in time.

It was recognised that accessible information, communication and advice was also an area that needed to be considered.  Reference was made to work undertaken around access to care and support with the Sensory Social Team Workers and looking at how improvements could be made.  It was hoped that more work could be done to connect with the deaf community.  Glyn Butcher informed the Panel about the different groups that were being engaged with and the importance of how the community can continue to take this forward. There was a brief discussion about what else was available in the community

Parish Councils – In terms of Parish Councils, a Member commented how a community hall in their ward had been well utilised and felt that there was value in having a direct link with the Parish Council and Adult Social Care.  The Director of Health and Wellbeing commented on the role of the Joint Consultative Council for Parish Councils (JCCPC) and reference was made to the conversations that have taken place with Parish Councils around localities and how they can build on that going forward.   

Hospital Discharges – A Member welcomed the update that medical discharges would be speeded up although it could be quite complex.   Concern was also raised around language used and the term “medically fit for discharge”, which did not actually mean that the individual no longer required treatment in an acute bed. 

Views were shared around the term “medically fit for discharge” as it was not understood properly and was not encouraged to be used by social care staff.  Clarification was provided on the meaning and that nationally the term had been replaced it with ‘no right to reside’, which was also a term being challenged.  It was noted that there was good partnership working which was being used to push back on language around policy, and influencing and challenging where appropriate.  Glyn Butcher noted that this term was not used within SafeSpace.

Members heard that the MIRB had themselves risen the point that more needed to be heard about the experience of individuals going through a hospital discharge.  The Director of Health and Wellbeing commented that he would take that view back to NHS partners to find out more about peoples experiences.

Members were informed that for out of area issues, partners would come together as part of the Integrated Care Board (ICB), which was making a difference in how we were talking to each other.

Mid-Year Update for Scrutiny – The Panel welcomed a mid-year update and to be involved where Officers felt appropriate to ensure the report was as accessible and included as many resident voices as possible.

RESOLVED that the Panel;

•         Note the “Your Care and Support” priorities for 2023;

•         The Panel receive a mid-year update as part of the Overview and Scrutiny workplan.

The report provided an overview and update on the approach being taken around housing for people who may need care and support in Doncaster.  Members were informed that work had been ongoing for a number of years and there was now a focus to bring this work together into a more structured approach and to build on the existing provision.  It was recognised that this was an area of work that needed further work.

A discussion took place that included the following areas;

Quality of Data Used – It was explained that there were around 24,000 social housing properties and more than 100,000 private ones.  It was noted that it was important to make best use of the existing housing stock. Members were informed of a private sector housing condition survey undertaken by the Building Research Establishment, which would provide the Council with an evidence base on property condition.  It was explained that social housing landlords had better information about their properties (in comparison to the private sector) due to the service they provided and the standards they adhere to.  It was explained that they had blended together some national sets of data about housing conditions to create a picture which would provide an assessment of property condition cast against a framework known as the Housing Health and Safety Rating System.  It was explained that the survey would help form the Health Impact Assessment of the data, which would in turn provide useful information.

Regarding the quality of data, it was outlined that teams within the Council looked at both data and projections through POPPI (for older people) and PANSI (for working age population).  It was noted that CENSUS data was used to help when looking at the longer-term projections.  In addition, Needs Assessments were used as well as 3-year rolling data to look at those populations groups and what future housing needs were likely to be. 

Housed Outside of Doncaster – Members heard that work was being undertaken to repatriate those individuals with specialist needs that had been housed outside of Doncaster, and that numbers were reducing.  It was outlined that part of the Specialist Housing and Support Steering Group’s role was to provide information on what was needed and where there were commissioning gaps to ensure that the right offer was in the right place.  Members were also told about work being undertaken with Directors of Adult Social Services to look at those very specific areas of commissioning and what could be achieved regionally.  It was also noted that Outside Area Reviews were considered a priority to ensure that there was an oversight when individuals were moved outside of Doncaster.  It was commented that there were links with what was trying to be achieved through Adult Social Care work.

It was felt that there was an inadequate provision for homeowners to downsize when their current home was no longer the best option.  It was believed that the Housing Development industry had failed to respond to this demographic shift.  It was noted that this was a complicated issue that the Local Plan has tried to balance through the allocation of land and the needs of different households.  It was recognised that it was important to build family houses as household numbers continued to grow (due to societal changes such as marriage breakdowns).

It was noted that there were issues around the lack of available land to build houses and the housing sector building what was needed.  Members were informed that efforts were being made where possible to secure houses suitable for downsizing as part of the planning process. It was explained that the Council was entering the next phase of bungalow developments as part of its housing offer, through building them on small infill plots, although this also presented its own challenges.  A different route would be to support people to remain in their home through the provisions of aids and adaptions.

Proposed Governance Model -– It was explained that the membership of the group was partly made up of those who wished to be on the group and ensuring that they were appropriately represented.  It was noted that we needed to improve or correct the way things are undertaken here before feeding in the voice of those with lived experience in a meaningful way.

Homelessness and Rough Sleeping Strategy 2019–2024 – A Member questioned what progress had been made around the numbers of people who were homeless and rough sleepers during the time of the strategy.  Members were informed that numbers of rough sleepers tended to fluctuate between low 10 teens to low 20s although this was higher during periods of the pandemic.  Members heard that SLHD worked alongside people who have experienced homelessness or were facing homelessness.  Reference was made to positive developments that had taken place since 2019 such as the Housing 1st approach, helping people to access a home and build the support they needed around the home.  Members were also informed about homes modelling with SLHD, helping more people straight away resulting in fewer people staying in Bed and Breakfast accommodation (especially families with children).

Mosaic – Concern was raised about issues with the Mosaic system for Adult Services following reporting problems that had occurred in Children’s Services.  Members were assured that the system used for Adult Services was a different version and although there would be some challenges, the same reporting difficulties were not being experienced.  Members were assured that this would be monitored closely.   

Present and Future Challenges – Concern was raised around issues arising across households such as damp and mould due to increased cost of living and fuel poverty.   Members were told that St Leger Housing Doncaster (SLHD) had started to respond to potential damp and mould issues through an internal working group.  An outline was provided of what was in place to address this issue including a small new team of surveyors who have been moved onto damp and mould work and a review of options for better ventilation was currently underway.  It was explained that SLHD undertakes any repairs required at the property to remedy damp and mould issues.  It was acknowledged that in some cases, there were no physical property issues to address and the fundamental problem was an inability by tenants to be able to afford to heat their home due to the very high cost of fuel bills and other cost of living pressures.  Members were assured that cost of living was being looked at through Public Health’s Wellbeing Essential group and was being considered through other poverty related work.  Reference was made to what was taking place and what was available to support residents facing such challenges.

The Panel welcomed a future update on the Health Impact Assessment of the Stock Condition report and consultation around the next Housing Strategy, to ensure that Adult Social Care issues and health inequalities (being addressed by housing) will be accounted for and embedded.

RESOLVED that the Panel;

·         Note the contents of the presentation and provide their feedback;

·         Receive an update on the health impact assessment work.

The Senior Governance Officer presented the Scrutiny Work Plan that had recently been agreed by the Overview and Scrutiny Management Committee and the Council’s Forward Plan of Key Decisions.

RESOLVED: That the update be noted.