Agenda and minutes

          The Minutes of the meeting held on 26 November 2024 were signed as a correct record.

The following question was received:

Question:

Appendix 1 - the Quality Assurance Framework was approved and published in October 2024 to meet the Council’s obligations under the Care Act 2014. Although the obligations under the care Act has been in place since April 2015.

What Quality Assurance Framework did the Council’s quality assurance team use to mitigate risks that led to the Council’s (the providers) failure to protect its residents across its own internal care homes prior to October 2024 (specifically from 2022-2024)? No Audits performed from 2022.

The Quality Assurance Team employs 2 part time quality assurance officers - one of which has been off long term sick since 2021. The nominated person over all of the Council care homes had overall responsibility to protect services users from avoidable harm, and overall governance of the services owned by the Council.

I’d really appreciate if my response to my question, was in the public domain in the next minutes of the PBB. I feel it’s in the public interest to know the failings that are occurring in our care Homes in Halton.

Response:

The question was received the day before the meeting at 1141 hours, so a response would be prepared following the meeting and sent to the member of the public.

The minutes from the Health and Wellbeing Board meeting held on 9 October 2024, were submitted to the Board for information.

The Board received a report which presented the results from the Employer Standards Health Check Survey 2024.   The survey was conducted at a national level between 16 February and 22 March 2024.  The summary report was attached at appendix 1.

It was noted that the health check was conducted on an annual basis and this was the fourth year that it had been run nationally by the LGA, where Halton had taken part each time.  Some key points were outlined for Members in the officers report, taken from the summary.

Members welcomed the results of the survey and that required standards were being met.  It was noted that staff employed by the Council were preferred over agency staff, as this offered clients consistency and reassurance.

RESOLVED:   That the report and appendix be noted.

The Board considered a report from the Executive Director – Adult Social Care, which provided an annual progress report from the Adults Principal Social Worker (APSW) showing how the role of social work supported the Council to meeting its priorities and objectives.

It was reported that the APSW was a statutory requirement under the Care Act 2014.  The national guidance on the role and responsibilities had evolved and been updated and clarified over recent years.  It was noted that the Principal Social Worker played a key role in representing and promoting the social work profession; the report listed some of the responsibilities that came with the role. 

The report also outlined details of the strengths based approaches and practice training, which had been carried out over the past 12 months.  Included were details of specialist training such as e-learning for all staff and webinars, in conjunction with the Learning Disability and Autism Programme.  

Information on: present and future workforce development; the mental health ‘Think Ahead’ Programme; the LGA’s Standards for Employers of Social Workers; the organisational health check and quality assurance, was also presented in the report.

In response to Councillor Fry’s question on apprenticeships, it was announced that updated guidance had been issued in relation to apprenticeships eligibility criteria, which is encouraging for the Social Worker profession.

RESOLVED:  That the report is noted.

The Board received a report from the Executive Director – Adult Social Care, which presented the Principal Occupational Therapist’s (POT) Annual Report.

Although the Adults Principal Social Worker (APSW) role was a statutory requirement under the Care Act 2014, at present there was no requirement in place for local authorities to have a POT, however Halton had one in post since January 2024.  It was acknowledged by the ADASS (Association of Directors of Adult Social Services) that having a POT to work alongside the APSW added diverse leadership within adult social care and had a positive impact on local populations. 

The report outlined the role of occupational therapy, referral numbers, challenges faced, and culture and practice of the service and the current workforce.  Members were referred to the appendix, which presented an anonymised case study for information.

Members agreed that the addition of the POT’s post was a benefit to the service and welcomed the appointment. 

The consensus of the Board was that the adaptation of homes, where possible, was preferable to people being admitted to hospital.  It was commented that the Occupational Therapy Team was a stable workforce, and staff members had been employed at Halton for a long time.  Although a challenging area to work in, they were creative and motivated and had the support of a good leadership team. 

RESOLVED: That the report and appendix be noted.

The Board was presented with the Quality Assurance Framework that is used by the Quality Assurance Team; this was appended to the report.

This document brought together the process, methods and tools that the Quality Assurance Team (QAT) used to gather evidence and intelligence about Adult Social Care services that were commissioned for Halton.  It was noted that these quality assurance activities supported the delivery of social care commissioned services, in meeting and exceeding contractual, regulatory and quality standards.

A summary of the purpose of the Framework and the services supported were provided.  This included the role of Elected Members in the quality assurance process, through Councillor visits to care homes (Section 4.27).

RESOLVED:  That the report is noted.

The Board received a report from the Executive Director of Adult Services, which presented the Home Adaptations for Disable People Policy and the Home Assistance Policy.

The Board was advised that the Home Adaptations for Disabled People Policy was the internal policy for staff for determining eligibility, approval and management of both minor and major housing adaptions requests.  The Home Assistance Policy was the corresponding public facing document, required to be in place as per the Regulatory Reform (Housing Assistance) Order (RRO) 2002.

The report provided Members with details of a recent review of the policies, using Government guidance published in March 2022 – Disabled Facilities Grant (DFG) Delivery: Guidance for Local Authorities in England.

Following Members discussion and scrutiny of the policies, the following additional information was provided:

·       It was disappointing that the review had not included proposals for an increase on the £30k maximum DFG (Disabilities Facilities Grant) award for housing adaptations – a review was supposed to have taken place last year, but this was cancelled by Government;

·       Concerns were raised that £30k does not go as far as it did when it was set years ago, so for some people this may not be enough to cover required adaptions and therefore push them into care homes;

·       The fast track process for a DFG application took approximately 6 months from when the grant application is made;

·       It was noted that only the Motor Neurone Disease (MND) Association had responded to the consultation, despite two reminders being sent.  Members were curious as to why other charities had not responded;

·       Top up loans were available to clients in certain circumstances;

·       Discretionary support loans may be available for owner occupiers to cover contributions to adaptations or to cover a shortfall in funding.  These charges were then placed against the property and recouped if the property was sold or transferred within 10 years; 

·       Housing associations do fund housing adaptations and were signed up to fund 50% of costs; and

·       In the case of a private landlord not agreeing to adaptations to their property, the client would be supported to consider a house move.

RESOLVED:  That the report is noted.

The Board considered a report from the Integrated Care Board (ICB) Place Director for Halton, which informed of the proposals to commence consultation on the cessation of NHS Funded Gluten Free Prescribing across Cheshire and Merseyside.

It was noted that the ICB had a duty to engage with Local Authority Health and Overview Scrutiny Boards, so that confirmation could be sought as to whether the Scrutiny Boards believed that the proposal was a substantial development or variation (SDV) to NHS services.  If this was confirmed by the Board, then the requirement for the ICB to formally consult with the Board would be triggered.

Members were referred to Appendices one and two – Gluten Free prescribing paper to the Board of NHS Cheshire and Merseyside ICS (28 November 2024); and Cheshire and Merseyside Protocol for the establishment of Joint Health Scrutiny Arrangements in Cheshire and Merseyside. 

Members discussed the proposals and after taking into consideration the fact that Halton was a deprived Borough; 141 patients were accessing the prescriptions; the demographics of this group of patients was unknown; and coeliac disease was a medical condition; it was agreed that the proposal to cease NHS funded gluten free prescribing represented a substantial variation.

The Healthwatch Co-optee requested the consultation to be available in other formats other than online, this would be addressed.  It was also noted that all stakeholders that wished to be included in the consultation would be.

RESOLVED:  That the Board confirms that the proposal to cease NHS funded gluten free prescribing represents a substantial development or variation.

The Board received the summary of evidence, Member conclusions and recommendations, relating to the Scrutiny Committee Review of NHS (Non GP) Community Services.

This topic was agreed by the Board in June 2024 and between July and December, a scrutiny group met monthly to receive evidence from several contributors.  Details of the membership, contributions and summary evidence was presented in appendix 1 – Scrutiny Recommendations Report.  The recommendations proposed were also outlined in the report in paragraph 3.5.

The Board agreed that the findings and recommendations of the Scrutiny Review of NHS (Non GP) Community Services be approved.

Members had proposed two options for potential areas for security in 2025, as follows:

Mental Health Support – looking at how existing provision was meeting current demand and responding to predicted demand, and equality of access to services for marginalised or minority groups, covering both Adults and Children and Young People’s services; and

Access to Health Care – looking at equality of access, experience and outcomes across specific health care provisions for marginalised or minority groups (specific provisions to be identified, but including mental health and dentistry).

After discussion and consideration of a further suggested topic, oral health and dentistry, Members voted for the Mental Health Support topic group.  A full topic brief would be developed and shared with Members at the next meeting.  It was noted that an update on dentistry in the Borough would be requested for the next meeting.

RESOLVED:  That

1)    the findings and recommendations of the Scrutiny Review of NHS (Non GP) Community Services be approved; and

2)    the Board agrees that Mental Health Support is the scrutiny topic for 2025.

The Board received a report from the Director of Finance, which gave the Council’s overall revenue and capital spending position as at 30 November 2024, together with the latest 2024-25 outturn forecast.

On 16 January 2025, Executive Board received the attached report and appendices, which presented details of Councilwide revenue and capital spending by each department and outlined the reasons for key variances from budget.

Executive Board has requested that a copy of the report be shared with each Policy and Performance Board for information.  This was to ensure that all Members had a full appreciation of the Councilwide financial position, in addition to their specific areas of responsibility.

RESOLVED:  That the Councilwide financial position as outlined in the report be noted.