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Apologies for absence were received from County Councillors G Ratcliffe, E Roderick, G Morgan and J Ewing.
There were no Declarations of Interest from Members relating to items to be considered on the agenda.
The Committee did not receive any disclosures of prohibited party whips which a Member had been given in relation to the meeting in accordance with Section 78(3) of the Local Government Measure 2011.
The Chair was authorised to sign the minutes of the following previous meetings as a correct record: 25-07-2022 07-10-2022
Documents Considered: Quarter 2 Performance 2023-23 together with the Pro-Forma. Issues Discussed: Children’s Services. · Many strengths in the Service’s performance and some complicating factors around elements. Numbers of Children Looked After have remained stable and the Service is aiming to reduce those numbers. Child protection numbers increased towards the end of quarter 1 into quarter 2. The Service has started looking at ways of how to start reducing these numbers and these should start decreasing into quarter 3. · High level issues include the budget due to the overspend. This is mainly due to an increase in the costs of placements around residential provision and the lack of affordable placements in-county. · The Service has refocussed on its closer to home strategy which includes the recruitment of foster carers, residential provision and bringing children closer to home. The Service has realigned the strategy and developed a Board to the actions and aims. · In terms of staffing there is still a high reliance on agency staff. During the Autumn the Service has acquired 5 fully qualified social workers through the Council’s grow your own programme who started work in quarter 3. · Pressures remain around high cost placements which has had an impact on budget, but overall with regard to performance on child protection and children looked after, there are plans in place to reduce these numbers going forward. Questions: Question Response In Section 1.2 of the Performance Report, there are three objectives identified which seem to have a red Brag status. It is difficult to see the thread between sections in the report. Officer Response: The Directors agreed to take those comments back to the team who compiles the report to see whether it could be improved. Closer to home work. Last year £1.5m was identified as savings for closer to home placements. Those savings have not been achieved as yet and it is becoming clear that this is difficult. What is being done to locate a property and could a county farm be considered as an option. Officer Response: The closer to home Board has tried to focus on what are the aims and objectives and what is trying to be achieved. One of those areas is around increase the numbers of in house foster carers, and the Service is working with Foster Care Wales in terms of developing a strategy alongside them to recruit new foster carers within Powys. The Service recognises that the Council has not built its grow your own foster carers in as much depth as would have been liked so the focus is around building the in house foster carer provision. There has also been a national campaign around fostering. The Council also has responsibility for unaccompanied asylum seeker children as part of children looked after and the Service is looking at ways to support those young people with provision in Powys rather than elsewhere. A provision has been developed in North Powys with an organisation called Llamau who have secured properties in North Powys and in Brecon. Llamau provides support to the young people who live in those properties in those placements and some of the unaccompanied children have been placed together in one of those properties. It was hoped that this would have an impact on the projected savings and costs. With regard to the residential provision, there is a residential provision strategy. The development of residential provision in Powys is being undertaken with people placed in the homes currently available. The Council has Bannau in South Powys for children with complex needs which remains full. Some of the complication about developing residential provision is that it does not automatically create a saving at the start. The Service is reliant on staffing being drawn from agencies to provide support to those young people. The Service is trying to recruit staff for all of the homes as well as holding job fairs trying to encourage the grow our own residential staff. Have secured a number of buildings it is now essential to develop the quality of support for those settings. Therefore, there are a number of strands being undertaken by the Service. It was uncertain whether Powys farms had been considered previously, but it would be considered as an option. Have the numbers of children placed outside the county reduced over the last year Officer Response: The number has not reduced to the target set, but there is a need to develop provision and numbers of foster families in the county before children can be brought back into the county. Foster carers complete an annual review on how they found the support provided to them. This was considered at the Foster Panel. If they do not feel supported or have ideas for improvements how is this picked up through a management level and fed through and actioned. Officer Response: That information would go to Service Manager. The Head of Children’s Services also holds monthly meetings with foster carers and feed back would be made directly to the Head of Service which is logged and is part of a rolling log of actions. Has something been done to make the interview process more convenient for applicants as foster carers. Officer Response: Yes the Council is now using technology to interview people. In terms of performance items which are off target such as children’s placements for 16+ due to an issue with fire doors. Why has this become such an issue and who is supposed to make this happen at pace. Officer Response: This is a complicated issue. The Service is working in collaboration with the Housing Service regarding the installation of fire doors. There is a backlog in the distribution of fire doors and also fitting. There is an eight week turnaround in obtaining the product before fitting. The fire doors are now fitted in the properties that the Council has as they are required as a legal requirement for that facility. Is the Director of Social Services aware of this as something where we should prioritise Officer Response: Everyone is aware, and it is a case of a national shortage of these doors. 90% of children, young people and their and families report that they achieve their goal through accessing early help. The performance is currently 80% against the target of over 90%. Why are we not on target and what are we doing about this. Officer Response: This is around the Council’s early help provision. The early help service uses a distance travelled tool which tracks progress from the start of the intervention until the end. However, not all staff are using this tool in the way that was intended so further training has been undertaken with the team. This is not around interventions not happening but staff not filling in the information appropriately so this can be measured. Comments: · The Chair asked whether when there was a meeting of Council or a Member development day that Members could hear from one or two foster carers about the work that they undertook or could the Council have a foster carer day. The Director of Education and Children’s Services advised the Committee that Foster Care Wales had been in attendance at County Hall for a Council meeting which had generated some interest. Providing information about the support provided to foster carers is also important. Outcomes: · That Children’s Services consider the use of a vacant County farm as a potential for respite or for the development of residential provision for children. · That prospective Foster Carers do not incur excessive travel costs as part of the application process. Adult Services. · It has been reported in the press that there are ongoing challenges across the Health and Social Care system with sustained levels of demand and increased levels of complexity. · There are also ongoing issues with recruitment and retention which are national as well as Powys issues. · It has been another challenging quarter for Adult Services with ongoing internal recruitment and retention issues, sustainability issues within the provider market, and a sustained high level of demand. · The Service has focussed on providing effective information and advice, managing demand effectively for care and support in the community, supporting people to move out of hospital in a timely manner, reviewing packages for those that have long term care needs as regularly as possible and doing everything possible to sustain the workforce. · The Service is continuing to make progress on its extra care ambitions. Work is underway in Welshpool and Ystradgynlais as a key part of the accommodation strategy long term which is to change the profile of demand away from residential care to supporting people to live independently. · With regard to self directed and more personalised forms of support it was noted that the numbers of people receiving a direct payment was continuing to increase. · Social Care had a corporate recruitment and retention working group which was working at pace, for example working with digital services to make it as easy as possible for people to apply for jobs in Adult Services. A new recruitment campaign was to be undertaken in the new year as well as a market comparison exercise to assess how pay and conditions compared with other authorities. Questions: Question Response Direct Payments. How do we as an authority monitor the use of those direct payments funds. Officer Response: The default method of administering direct payments are by means of a virtual wallet (an online bank account) to make it as easy as possible for the recipient of a direct payment to pay their providers. In terms of monitoring, the Service reviews care and support plans funded through direct payments to ensure that the amount of funding provided is proportionate to the care and support needs. Sustainability of the workforce. There was a plan to commission people to undertake the backlog of reviews which did not work. Then there was a plan to pay staff overtime to do this. The highest level of sickness is the Council is in Children and Adult Services and Highways which is not unsurprising. Do the Directors or Heads of Service have any concerns about sickness levels. Will doing overtime work impact on the level of sickness. Officer Response: From an Adult Services perspective there is a delicate balance to be found. As a Head of Service you do not want to increase demand on fatigued staff. This is why the Service looked to commission two managed services for the backlog of care and support reviews and for assessments. However, the organisation undertaking the reviews could not meet the terms and conditions of the contract so the Service is looking to use the money differently and bring in short term agency support as opposed to asking staff to work additional hours which is not sustainable. The Service is also looking to use some of that funding to bolster the in house domiciliary care service. In terms of Children’s Services the Head of Service was most worried about resilience, with staff continuing to work in challenging circumstances. There have been two managed teams in Children’s Services. The initial managed team did not have the desired outcomes in terms of practice and the contract was ended early as it did not fit what was wanted. The experience with the second managed team practice was much more positive. This team was ended earlier than planned which provided a saving and some of those social workers were recruited by the Service as agency staff but managed by the Council. There has been a difference in the recruitment of agency workers over the past few months. There are some national standards which have been agreed by the ADSS (Association of Directors of Social Services) in Wales with authorities signing up to an agreement on pay rates and not employing agency staff who recently worked in another Welsh authority, to stop people jumping between authorities. Is there capacity in the agency market to do this work. Officer Response: There was a problem recruiting agency social workers but that situation may have changed. Officers are currently liaising with agencies to see if that capacity is available. In the past few months it has been less difficult to recruit short term agency resources. What are the sickness levels in Childrens and Adults Services currently and what is being done to ameliorate this. Officer Response: In Children’s Services sickness is monitored monthly. The figures are not increasing. The Service is focussing on the reasons for sickness especially if it is stress or work related and how staff can be supported. Part of the support is around supervision, appraisals and reflective practice as well as bringing practitioners back into offices to provide peer to peer support. The Service is also looking at what can be done differently to support the well-being of staff. Can we expect supervision numbers to be improving in November’s performance report Yes Are staff being encouraged to go back into the office and what is the Authority’s policy about bringing staff back into offices. Officer Response: In Children’s Services the Head of Service indicated that the Service wanted staff to be back in the office two to three days a week to provide the peer support for staff. The Council’s approach is a hybrid approach. In relation to the pressures on the Domiciliary Care market are officers working with other authorities to raise these issues with Welsh Government in terms of any support that is forthcoming to Councils being ring fenced. Also is there sharing of information on a national basis. Officer Response: The Director of Social Services attends ADSS meetings across Wales on at least a monthly basis. As a group ADSS also meets with Welsh Government monthly as well. The ADSS group discusses challenges, issues, concerns and these are fed back to Welsh Government and Ministers. The recruitment of agency staff in children’s services was an example of discussions held, as well as the agreement on not competing with each other. Heads of Service will also be meeting with counterparts across Wales. The Committee was advised that Powys had volunteered to be part of an ADSS working group recognising the pressures that all authorities are facing around the domiciliary care market. One of the outcomes of that group is to explore a range of different models such as a franchise model. Adaptations. The target of getting adaptations in place is 130 days, but current performance is 170 days. What is holding this up and what is being done to mitigate it. Officer Response: There has been a recent restructuring in Housing Services and a recent change of supplier for the community equipment service. The Occupational Therapy Team are working with colleagues to ensure that seamless processes are in place to reduce the timescale. The Council could also be affected by supply chain issues. Could officers provide an indication of how services are performing against the 11 or 12 red measures in the report for quarter 3. Officer Response: This information is not available at present. Quarter 3 internal reporting will be started shortly. Then this will be considered by portfolio holders so an update can be provided after that. Outcome: · Noted. Outcomes - General: · That officers consider the structure of the performance report to ensure there is a clear thread between each section with improved cross referencing between the sections to improve the navigation for the reader. · That the recommendations in the performance report are appropriate and robust and reflect the issues raised.
Documents Considered: Report of the Cabinet Member for Finance and Corporate Transformation. Issues Discussed: Children’s Services: · There are a number of complicating factors within the report in terms of placements and the costs of placements and residential provision to meet the needs of children. The costs in that marketplace are increasing, with placements becoming fewer which is an increased budget pressure. · In terms of resilience within the workforce and the ability to recruit and retain staff the Service has had to rely on agency workers and there is an impact of those costs on the Council, so the work done by ADSS to cap costs is welcomed as the need for agency staff has continued. · There is a national problem in terms of placements for profit which is part of the national agenda around eliminating profit. However, we currently have exceptionally high cost placements and we are in a position that we have to find placements for children, sometimes quickly and they can be far away and expensive which is why the closer to home strategy is so important moving forwards. Recruitment and retention and the number of vacancies across Wales are national issues as well which is why the grow your own strategy is also so important. Questions: Question Response Could give quick view on some of those children with complex needs, why are those children costing so much in terms of placements, what are the themes behind the complex needs, and what are we doing at the preventative level to address that through collaborative working or early help. Officer Response: In terms of placements the position is that providers can charge for profit and they name their price. This is the position nationally and what we are trying to stop. Some of the placements that we need currently for children with complex needs are not available in Powys Sometimes there is also an overlap with Education and ALN and it can affect both the Children’s Services and ALN budgets. The Service tracks all children looked after and there has been greater focus on those placements which have a higher cost and the reasons behind this. Some of these may have been historic placements with children and young people who experienced environmental themes. The preventative services through collaborative working with education, health and early intervention are in a much stronger position, with emphasis on community based working and a focus on early intervention. In addition the Flying Start programme is picking up on early themes for children and bringing these to our attention. Whilst the Children Looked After figures have risen in quarter 3 but there are specific reasons for that and they will reduce, those themes have continued and become apparent during the pandemic but this has not led to the expected increase in numbers. Early intervention and a multi -agency approach is working in the ways which is intended. Welsh Government’s aim of care without profit is to bring those young people back into Powys and possibly stepped down from residential care into a foster family which fits with the Grow our Own Foster Carers strategy or placed back at home. Even with the intervention work being undertaken, there always be a number of children with complex needs in future but it was hoped that numbers would be diminished. Unachieved efficiencies – continuing care. In relation to the £800K savings projected within the budget for the costs of children looked after, and the savings were due to attributing costs across other agencies. Is the £800k saving achievable, working with ADSS Cymru to achieve that. Officer Response: With Continuing Care there is a set eligibility criteria for meeting continuing care. There is a checklist devised by Health Boards which has been legislated in terms of Welsh Government. The Service works with Health professionals to identify if a child has continuing care needs. There is no pooled budgets in respect of continuing care. The individual’s needs are assessed by both Health and Social Care with each agency picking up the costs for their relevant elements based on assessed need. This efficiency saving had a red BRAG rating last year. Therefore, was this a realistic efficiency and now that a process has been determined for which cases might be applicable, will next year’s budget be more realistic in terms of continuing care. Are the thresholds correct in terms of what constitutes health by comparison to social care. Officer Response: We have been required to reassess every child to determine the level of need and what the package of care would look like and the cost implication. It has been acknowledged that the figure is not realistic going forwards and there is not the volume of children with those high level needs to meet the criteria. With continuing care there is legislation which determined the criteria to be met. Children’s Services have developed a working relationships with the Health Board in terms of those children and their identified needs. Special Guardianship Orders (SGO) and cost reductions not met. The project plan is being implemented but there does not appear to be a team in place. Could you remind Members what the project was and why the team is not in place and what is currently happening. Officer Response: The Special Guardianship Orders (SGO) project looks at special guardianship orders which are a different way of legally looking after a child. Where a child is subject to a care order the local authority would share parental responsibility. With an SGO the child may live in the same placement but under a different legal order, not sharing parental responsibility with the local authority. The Special Guardian has the parental responsibility and they share that with the parents. Savings are attached to this in a different way as the child is not looked after, does not have children looked after reviews or visits. There have been delays but the Service is recruiting staff currently to develop the team and have it in place before the end of the financial year. There are two costs pressures of £353k for Bannau and £516k for children and residential loans which relate to the use of agency workers. Taking Bannau as an example what is the set budget for staffing costs to understand the percentage differential by comparison with the total budget. Officer Response: The staffing and on cost budget is set at £848k in total for 2022/23. The £353k agency overspend is additional over and above to date assuming vacancies are filled from period 7 to the end of the financial year. Staffing remains a real pressure, despite the number of agency workers within the Service at present. The numbers of permanent staff are increasing in part through the Grow our Own programme Adult Services: · The Service was projecting an overspend of £5k currently by the end of the financial year. · That is based on achieving a savings target of £3.4m and the Service was on target to achieve that. £1.73m had already been achieved and there was an assurance regarding a further £1.699m by the end of financial year. · The Committee’s attention was drawn to future pressures in the main relating to increasing pressures on demand over the winter period. The Service is also pre-empting potential increased requests from providers for contractual uplifts due to the wider costs of running a business. There is uncertainty in this but it regularly monitored in terms of potential additional pressures. Questions: Question Response For the year 2023 / 2024 the budget includes the use of £2.4m either from specific reserves or the Covid underfunded pressures. Is this one off funding depending on how the service intends to cope with this pressure. Officer Response: Those reserves are one off monies. As the Service has developed its Finance Resource Model (FRM) into 2023 / 24 we have accounted for additional pressures within that year. The mitigating actions are an extension of the efficiency themes such as looking at strength based reviews, promoting the use of Direct Payments as an alternative to the traditionally commissioned Domiciliary Care, and utilising as far as possible technology enabled care. The Service has been working closely with providers over the past few years to ensure value for money from contracts which is becoming increasingly difficult as there is a difficult balance between achieving value for money and encouraging providers to remain in the market. The Commissioning Team is continuing to work with providers to achieve fair costs of care and ensure contracts are financially viable for providers. The Commissioning Team has good working relationships with providers. The Commissioning Service has robust contract management processes in place which allows the Council to scrutinise costs and ensure that costs are evidence based. The tea is seeing increased pressures similar to those being faced by the Council such as recruitment and retention, and that partners are reliant on using agency staff which contributes to the additional cost, including increased utility costs and the tea works with providers to ensure that they remain viable. In terms of the investment made in the Delayed Transfer of Care (D-ToC) team, can we have an overview on how this impacts the budget going forward whilst ensuring that individuals are discharged with the right sized care packages and the potential financial implications of that. Officer Response: The Service has invested approximately £150k into this service to provide a dedicated hospital social work team funded through the base line budget. This allows the targeting of the resource at District General Hospitals out of county, supporting Powys patients to come back into county as soon as possible. This has allowed the facilitation of hospital transfers quicker than before. Moving into the winter pressures period it is crucial that this targeted resource is in place to remove as far as possible blockages in the wider care system. Outcome: · That any efficiencies identified as a result of collaborative arrangements in 2023 / 24 are realistic and achievable.
Documents Considered: Report of the Cabinet Member for Finance and Corporate Transformation. Issues Discussed: · The Chair noted that the items raised in the risk register have already been considered in the Children’s Services budget, the domiciliary care pressures in the workforce. · The only other issue was the WCCIS system which was not considered to be fit for purpose. Questions: Question Response Could the Committee receive and update on digital transformation, how are systems working and is the risk starting to de-escalate. Officer Response: The Director of Social Services indicated that WCCIS is not fit for purpose which impact on the Service areas in carrying out operational duties. Following updates the current feedback from officers is there is a general improvement, with the platform being more stable. In the summer a digital transformation of Social Services project was commenced led by ICT in collaboration with staff from across Social Care. As part of this review, early next year, will be the consideration of options for a data management system including remaining or update the current system or moving to a new platform. The feedback from practitioners is that WCCIS remains slow with outages, and it is still not as intuitive as it could be, so there is a level of dissatisfaction amongst practitioners. Staff are very reliant on the system to make evidenced based practice decisions. In relation to the digital transformation project the group is in the process of arranging four demonstrations for alternative or updated systems to soft test the market. Then there will be a procurement exercise if that is deemed to be the next step. What are other Local Authorities in Wales doing in terms of their use of WCCIS. Are they looking at the same options as Powys. Officer Response: Other local authorities are aware of Powys’ intentions and watching what we are doing. Not all Welsh Local Authorities signed up to WCCIS initially so there is mixed provision in relation to these data management systems. Some local authorities have moved onto WCCIS and others have remained with their bespoke platforms. Due to the historic WCCIS issues, the Chair had asked Heads of Service whether any service users been put at risk due to the system. The previous Head of Children’s Services suggested that this may have been the case whilst it was not the case for the Head of Adult Services. Are service users being put at risk due to the issues with the platform. Officer Response: In relation to Adult Services the Head of Service was not aware of any individuals placed at risk. However, when the system does not work it has a significant effect on staff morale. However, whilst no residents have been put at risk it is a serious enough problem that needs to be rectified. In relation to Children’s Services no child has been placed at risk due to WCCIS issues. It is around staff morale and the ability to record information in a timely manner. The system does cause frustration which has a direct impact on staff. Are the risks on this register only those which are Red or above. Are there other risks being managed rated as green and amber? Officer Response: In both Adult Services and Children’s Services there are a range of risks which have not reached the threshold in terms of probability or impact score to move them onto the strategic risk register. The Service Risk Registers are reviewed on a quarterly basis. Outcomes: · Noted. · That a link to Service risk registers be made available to the Committee through the Teams area.
Documents Considered: None. Issues Discussed: · A Working Group had been held to discuss Delayed Transfers of Care and the timely return of Powys patients from District General Hospitals outside Powys with appropriate care packages. · The Working Group noted the positive work undertaken by the team as well as the positive relationship with the Health Board and that the investment made was delivering the necessary improvements. · Some of the issues being reviewed included two brokerage system being in place for care home placements with work being undertaken to realign those systems. · There was also work to be done to incentivise short term care in Care Homes. · The Service works to Welsh Government’s Discharge to Recovery and Assess framework, not assessing people in hospital and moving people onto short term pathways to give people a chance to recover and then they can be assessed for any longer term care needs. Ideally what should happen is to move people straight from hospital to home. Where this is not possible the Service relies on step down provision and it wants to work with care homes as a strategic partner to provide that step down provision. · Joint commissioning work needs to be undertaken between the Service and the Health Board to work with care homes in providing that short term provision. · The Commissioning Team is working with the Health Board, and have arranged a workshop with Care Home providers and Domiciliary Care providers to understand their pressures and to work together to understand collectively what can be done to support the sector. Questions: Question Response What are the outcomes of the workshop. Will it lead to an action plan or is there one already in place. Officer Response: The aim is to have an honest conversation with the sector as the Council is already aware of many of the issues but to identify what else the Council and Health Board can do to support the sector and to explore all possible options. Outcomes: · Noted · Add to scrutiny work programme about the prevention of falls work and what difference this is making.
The Committee noted the schedule of future meetings.
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