Adult Social Care Update Report 2023-24
Renfrewshire Council · 21 February 2024
Back to Leadership Board — 21 February 2024 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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___________________________________________________________________ To: Leadership Board On: 21 February 2024 ___________________________________________________________________ Report by: Chief Officer, Renfrewshire Health and Social Care Partnership ___________________________________________________________________ Heading: Adult Social Care Update Report 2023/24 ___________________________________________________________________ 1. Summary 1.1 Adult Social Work Services were delegated to Renfrewshire Integration Joint Board (IJB) on 1 April 2016. These services are managed through the Health and Social Care Partnership (HSCP). 1.2 This report, together with Renfrewshire’s Integration Joint Board Performance Management Mid-Year Report 2023/24 provides an overview of adult social care activity and performance. ___________________________________________________________________ 2. Recommendations 2.1 It is recommended that members: • Note the contents of this report updating activity and performance of adult social work services delegated to the IJB; • Approve the revised suite of adult social care performance indicators included in Appendix 1; and • Note that the 2023/24 Annual Adult Social Care update report will be presented to the Leadership Board on 18 September 2024. _________________________________________________________ 3. Background 3.1 The list of functions that must be delegated by the Local Authority to the IJB is set out in the Public Bodies (Joint Working) (Prescribed Local Authority Functions, etc) (Scotland) Regulations 2014, and is noted in Annex 2, part 1 of Renfrewshire’s Integration Scheme. These include:
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• Social work services for adults and older people; • Services and support for adults with physical disabilities and learning disabilities; • Mental health services; • Drug and alcohol services; • Adult protection and domestic abuse; • Carers’ support services; • Community care assessment teams; • Support services; • Care home services; • Adult placement services; • Health improvement services; • Aspects of housing support; • Day services; • Respite provision; • Occupational therapy services; and • Reablement services, equipment, and telecare. 3.2 Whilst regular reporting in relation to these services is provided to the Integration Joint Board (IJB), it was previously agreed that regular updates would also be presented to the Leadership Board. This ensures oversight of the key activities and wider context relating to the delivery of these services. 3.3 Integration Schemes are required by statute to be reviewed within five years from initial approval. Renfrewshire’s Scheme was laid before Parliament on 27 June 2015, however, the review was interrupted by the COVID-19 pandemic and was therefore delayed, with the approval of the Scottish Government. A draft updated Integration Scheme has been developed and is included as a separate report to this Leadership Board. 4. Renfrewshire IJB’s Performance Report 4.1 Renfrewshire IJB’s Performance Management Mid-Year Report 2023-24 provides a comprehensive reflection on the HSCP’s performance against local and national performance indicators. A summary of the mid-year status of the IJB’s performance indicators are provided in the table below. Performance Indicator Status 2023/24 (as at 30/09/2023) Target achieved 13 Warning (less than 10% variance of target) 10 Alert (more than 10% variance of target) 5 Data only (no target) 20
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4.2 Of the five indicators that are red alerts, one relates to adult services - Sickness absence rate for HSCP Adult Social Work staff (work-days lost per FTE). This remains a challenge and work continues across the Partnership and is monitored regularly by the Senior Management Team. During November 2023, approximately 40 HSCP managers and team leads attended absence management coaching, and a range of health and wellbeing resources are available to support staff. 4.3 As part of the IJB’s wider commitment to performance monitoring and evaluation, on 29 September 2023, the IJB approved changes to its 2023/24 performance Scorecard. A full review of all performance indicators was undertaken, with a particular focus on ensuring that social care indicators were more reflective of the breadth of activity across the Partnership. 4.4 The revised Scorecard utilises accurate and robust data, routinely reviewed by services, therefore it is recommended that the suite of adult social care indicators included in Appendix 1 is adopted by the Leadership Board. The existing indicators that will be replaced or removed from the existing Scorecard are included in Appendix 2. 5. Adult Social Work Performance Overview 5.1 Adult Social Work Services are managed and monitored via regular internal HSCP professional governance and operational management arrangements, including meetings, case management, and regular service and case reviews. These meetings involving Heads of Service and Service Managers cover a variety of local and national strategic and operational indicators. They allow Managers to scrutinise and discuss performance data, agree remedial action, timescales for improvement, and consider future challenges which may affect services, to allow planned actions and mitigation where appropriate. 5.2 In addition to internal scrutiny, performance is reported at all IJB meetings, with the Scorecard presented twice-yearly providing a detailed picture of what is working well, current challenges and intended remedial action where necessary. 5.3 The Scorecard includes adult social care indicators alongside a variety of both local and national health service indicators. As detailed in Section 4, the suite of adult social care indicators has been reviewed and the revised Scorecard for this Board is attached for approval. The service has significant ongoing challenges with increasing demand for services as an ageing population places greater pressure on the Partnership’s available budgets and the recruitment and retention of staff. 5.4 There are 19 adult social care indicators, details of the performance are provided in Appendix 3, however a summary is included in the table below. Performance Indicator Status No. Target achieved 2 Warning (less than 10% variance of target) 1 Alert (more than 10% variance of target) 0 Data only (no target) 15
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6. Key Activities 6.1 A summary of the key activities undertaken during the last six months related to the delegated services is detailed in the section below. Winter Pressures 6.2 Each year, Renfrewshire HSCP develops plans to ensure the resilience of critical services over the winter period. The planning process for winter 2023/24 was undertaken across all HSCP internal and hosted services. The key priorities over the winter were as follows: • Vaccination programmes - protect our staff and the public by delivering the required seasonal vaccination programmes; Flu and COVID Booster. • Operational resilience - embed our frameworks, policies and plans to support service resilience and the prioritisation of emergency and critical services, whilst maintaining the delivery of other essential services. This includes a focus this winter on the HSCP’s ‘Data Resilience’ plans and specifically how each service would respond when faced with a loss of systems, network, or power. • Surveillance and response [monitoring and control (governance)] - survey our environment and stay abreast of how our services are performing for our service users, taking note of any lessons learned and amending our policy and practice as required to sustain service levels. • Supporting the public - continue to access required services, addressing their critical and essential needs and supporting residents to remain safe and well. • Supporting our partner organisations – take steps to prepare for winter and collaborate on necessary solutions for the benefit of residents. • Enable and optimise existing infrastructure - deliver, champion, and optimise the use of appropriate infrastructure across the Partnership, with our partners, to underpin the successful delivery of our plans. • Festive period planning - adequately understand the needs of services during the festive period and plan appropriately to maintain and manage service levels and any potential disruption. • Workforce planning / staffing - ensure we deliver the right balance of annual leave and staffing across services to maintain service levels throughout the winter period. Ensure we support the health and wellbeing of our staff so they remain well and are able to undertake their roles during potentially challenging winter conditions. Sustainable Futures Programme 6.3 The Sustainable Future Programme aims to identify and develop options, subject to the IJB’s agreement, to address a projected financial gap of £14.7m in 2024/25. The options were agreed by the IJB on 30 June 2023 to progress to a process of engagement and more detailed impact assessment: 6.4 The final proposals relating to these options will be presented to the IJB for further consideration in March 2024.The HSCP has commenced a process of engagement with staff, service users, residents, families, and carers to gather
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feedback on the options above and this will be reflected in equality impact assessments and options appraisals. 6.5 Aligned to the Sustainable Futures Programme, on 26 January 2024 the IJB approved a suite of recommendations to be considered by Renfrewshire Council in relation to its Non-Residential Charging Policy. 6.6 A separate detailed report will be presented to the Leadership Board following completion of appropriate Equality Impact Assessments for the proposals. Adult Support and Protection (ASP) 6.6 Some people may find it more difficult to keep themselves safe and might need help and support to look after themselves. Renfrewshire Adult Protection Committee (RAPC) continues to oversee the effectiveness of our adult protection practice. 6.7 In September 2023, the new Independent Chair for both the Adult and Child Protection Committees, Tam Baillie was appointed. He has over 40 years’ experience working across many areas of social care: children and young people, including youth homelessness, street-work and throughcare and aftercare; as well as child and adult protection. During the period May 2009 to May 2017, Mr Baillie was Scotland’s Commissioner for Children and Young People. 6.8 The ASP Biennial Conference took place on 5 October 2023, as a hybrid event, the theme of which was a Trauma Informed Approach to ASP. The keynote speakers for the event were Dr Karen Treisman MBE and Joanna Macdonald, Depute Chief Social Work Adviser, Scottish Government. The remainder of the programme showcased work already underway in Renfrewshire around trauma informed approaches to ASP. The event was well attended both online (156 people) and in person (92 people) and evaluated very positively with only one improvement - provide more time for networking. 6.9 The ASP minimum data set is regularly monitored by the Adult Protection Committee and the Practice, Policy and Performance subgroup, the analysis from the Quarter 2 period July to September 2023, highlighted the following: • Physical harm is the well-established primary type of harm reported. Worthy of note that psychological, self-harm and financial harm all have significant numbers confirming the range of issues. • Physical, psychological, and financial harm invariably involve close relatives, friends, and carers. • Significant majority of harm takes place in people’s own home thus reinforcing the data indicating that people suffer harm from relatives, carers, and friends. In contrast, very little harm is reported while people are in hospital. • Although all client groups are at risk of harm, those at a higher risk are individuals with dementia, poor mental health and those with a learning disability.
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Care Home Inspection 6.10 An unannounced inspection of Hunterhill care home (HSCP operated) took place between 12 and 14 September 2023. The Inspection Team looked at a selection of the quality indicators which are based on the intelligence they hold about the service, and any risk factors that they may have identified. The evaluation provided to the care home is as follows: How well do we support people's wellbeing? 4 - Good People experience compassion, dignity and respect 4 - Good People get the most out of life 5 - Very Good People's health and wellbeing benefits from their care and support 4 - Good How good is our leadership? 4 - Good Quality assurance and improvement is led well 4 - Good 7. National Care Service 7.1 Between June and August 2023, various regional and online forums have taken place as part of the ongoing National Care Service co-design process. The engagement programme focused on 5 themes: (1) local care support; (2) information sharing; (3) complaints/independent advocacy; (4) rights and responsibilities; and (5) workforce. 7.2 In October 2023, the engagement summary reports were published. The reports outline the key findings and next steps in the co-design process which will take place over the next 18 months. 7.3 On 6 December 2023, the Scottish Government updated the Scottish Parliament’s Health Social Care and Sports Committee on proposed changes to the plans for the creation and delivery of the NCS following the Scottish Government’s tripartite negotiations with local government and NHS on the shared accountability agreement in summer 2023. This includes prioritised agreement on matters requiring primary legislation and further work that will be required, including the detail to be included in secondary legislation and what will be involved to implement agreed legislation. 7.4 On 17 January 2024, the Scottish Parliament agreed that Stage 1 consideration of the Bill would be extended to 1 March 2024. 8. Scottish COVID-19 Inquiry 8.1 The Scottish COVID-19 Inquiry has been launched to investigate the devolved strategic response to the Covid pandemic in Scotland between 1 January 2020 and 31 December 2022. The Inquiry will resume its health and social care
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impact hearings on 12 March 2024, to allow time for the Chair to have and recover from surgery, continuing through to 28 March before a short pause over the Easter break. They are then scheduled to resume the week beginning 15 April and continue until 31 May 2024. 8.2 The Inquiry began its health and social care impact hearings in October 2023 before pausing them for January 2024 while the UK Covid-19 Inquiry holds its Scotland hearings in Edinburgh. 9. Next Steps 9.1 The 2023/24 Annual Report on delegated Adult Social Care functions will be reported to the Leadership Board on 18 September 2024. ___________________________________________________________________ Implications of the Report 1. Financial – Although there are no direct costs associated with this report, the IJB is operating in an increasingly challenging environment with increases in both the level of demand and service delivery costs. The Sustainable Futures Programme has been established and will aim to deliver best value by modernising services as well as identifying savings to reduce the financial gap in a sustainable way and where feasible with the least possible impact. 2. HR & Organisational Development – The Sustainable Futures Programme is currently underway and could potentially have an impact following its conclusion. 3. Community/Council Planning – none 4. Legal – none. 5. Property/Assets – none 6. Information Technology – none 7. Equality & Human Rights The Recommendations contained within this report have been assessed in relation to their impact on equalities and human rights. No negative impacts on equality groups or potential for infringement of individuals’ human rights have been identified arising from the recommendations contained in the report because it is for noting only. If required following implementation, the actual impact of the recommendations and the mitigating actions will be reviewed and monitored, and the results of the assessment will be published on the Council’s website. 8. Health & Safety – none 9. Procurement – none 10. Risk – none 11. Privacy Impact – none
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12. Cosla Policy Position – none. 13. Climate Risk – The HSCP is committed to tackling the climate emergency and actively participates in Renfrewshire’s Plan for Net Zero. _________________________________________________________ List of Background Papers None ___________________________________________________________________ Author: Yvonne Farquhar, Policy Manager, Chief Executive’s Service yvonne.farquhar@renfrewshire.gov.uk
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Appendix 1 Proposed New Suite of Adult Social Care Indicators (Targets to be set for indicators unless otherwise stated) Performance Indicator 21/22 Value 22/23 Value Context Population of clients receiving Telecare (75+) - Rate per 1,000 58 140 Existing indicator to be retained, however, the methodology for the indicator has changed and this will be taken into consideration when developing a target for 2024-25. Population of clients receiving Telecare (all ages) Rate per 1,000 4.4 4.2 Critical to supporting people at home and would anticipate an upward trajectory for these indicators. Number of people accessing Community Alarms (all ages) 2,503 2,791 Number of people accessing Community Alarms (75+) 1,969 2,121 Balance of Care: Home Care - Total number of open community placements versus open residential placements for 65+ - CP: 1,554 (61.5%) RP: 971 (38.5%) To provide context around resource management required for community and all building based residential and nursing care. Balance of Care: Home Care - total number of hours per week provided for clients receiving personal care versus non-personal care - PC: 14,699.25 NPC: 317.75 To provide more context around resource management. Number of adult support plans completed with carers by the HSCP (age 18+) 40 25 This indicator will capture HSCP activity in addition to the Carers’ Centre indicator. Work is underway to align information systems with the aim of achieving a total HSCP figure for 2024-25. Number of adult carer support plans completed for carers (age 18+) (Renfrewshire Carers Centre) 148 203 Existing indicator to be retained
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Performance Indicator 21/22 Value 22/23 Value Context Number of Adult Support and Protection referrals (by source) Mental Welfare Commission for Scotland Care Inspectorate Healthcare Improvement Scotland Office of the Public Guardian Police Scotland NHS 24 NHS Primary Care NHS Acute Services NHS Specialist Drug and Alcohol Services Community Health Services Mental Health Services – Hospital and Community Other Health (Public, Private and Prison) Social Work Adults (inc Mental Health Officers) Social Work Children and Families Scottish Ambulance Service Scottish Fire and Rescue Scottish Prison Service Care Home Care at Home Provider Housing Education Other Child Protection Service Self (Adult at Risk) Unpaid Carer Friend, Relative, Neighbour (not an unpaid carer) Other Member of the Public Third Sector Organisation Financial Institution Anonymous Other 1.068 1,314 Enhance indicator will now track volume of referrals by source to give context and allow additional trend and analysis. Data only indicator, therefore no target will be established Percentage of Adult Support and Protection referrals where investigatory powers are used - - Data will be collated during 2023/24, this will allow additional breakdown of activity to inform resource allocation.
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Performance Indicator 21/22 Value 22/23 Value Context Data only indicator, therefore no target will be established Number of Chief Social Worker Guardianships (as at position) 125 132 Existing indicator to be retained Number of Private Guardianship Applications 47 158 To enhance our understanding of the number of overall guardianship applications in comparison to the number of CSWO guardianship. This is in line with guidance from the Mental Welfare Commission Scotland. Data only indicator, therefore no target will be established Total Mental Health Officer service activity 1,222 1,362 Existing indicator to be retained Percentage of Children registered in this period who have previously been on the Child Protection Register in the last two years 30.4% 9.52% Existing indicator amended from Percentage of children registered in this period who have previously been on the Child Protection Register Sickness absence rate for HSCP Adult Social Work staff (work days lost per FTE) 17.79 21.86 Existing indicator to be retained Appendix 2 Proposed Indicators to be Replaced/Removed from Scorecard
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Performance Indicator 21/22 Value 22/23 Value Reason Percentage of long-term care clients receiving intensive Homecare 65+ 29% 28% Replaced by more meaningful and relevant indicators reflecting the balance of care. Percentage of clients accessing out of hours home care services (65+) 93% 80% Homecare hours provided – rate per 1,000 population aged 65+ 411 444 Percentage of homecare clients aged 65+ receiving personal care 99% 99% Percentage of routine Adult Social Work Occupational Therapy referrals allocated within 9 weeks 68% 92% This Indicator currently reflects only one area of work within the HSCP. During 2023-24, the Rehabilitation and Enablement Service (RES) Improvement Group and Locality Services will develop new indicators for inclusion in the 2024-25 Scorecard, which will be reflective of all OT activity. This process will take some time due to the complexity of the data collection process. No. of SW employees, in the MTIPD process, with a completed IDP 1,000 - People, Performance and Talent Policy is currently reviewing the MTIPD and therefore any new indicators will be monitored through this process. Number of adult carer support plans declined by carers (age 18+) 36 226 This indicator only includes the number of declined adult carer support plans from the Carers Centre. Number of young carers' statements completed 27 49 Renfrewshire Children’s Services Partnership monitor the progress of the Young Carers’ Strategy and work closely with Renfrewshire Carers Centre who provide support to young people to complete their statement. Appendix 3 Existing Performance Indicators The 19 adult social care services’ indicators are as follows:
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Performance Indicator Status No. Target achieved 2 Warning (less than 10% variance of target) 1 Alert (more than 10% variance of target) - N/A Not applicable require year end figure 1 Data only 15 Status Direction of Travel Performance Indicator 20/21 Value 21/22 Value 22/23 Value 23/24 Value (Q3) Target Percentage of clients accessing out of hours home care services (65+) 90% 90% 92% 91% 85% Average number of clients on the Occupational Therapy waiting list 159 143 226 326 350 Percentage of long-term care clients receiving intensive home care 29% 29% 28% 27% 30% N/A N/A Sickness absence rate for HSCP Adult Social Work staff (work days lost per FTE) 13.50 17.79 21.86 9.86p (Apr-Sep) 15.3 days Data Only Indicators Performance Indicator 20/21 Value 21/22 Value 22/23 Value 23/24 Value Homecare hours provided - rate per 1,000 population aged 65+ 390 411 444 451 Direction of Travel Improvement Deterioration Same as previous reporting period
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Performance Indicator 20/21 Value 21/22 Value 22/23 Value 23/24 Value Percentage of homecare clients aged 65+ receiving personal care 99% 99% 99% 99% Population of clients receiving telecare (75+) - Rate per 1,000 (2022/23 includes all telecare, previous years included enhanced alarms only) 46 58 140 162 Percentage of routine OT referrals allocated within 9 weeks 41% 68% 92% 92% Number of adult carer support plans completed for carers (age 18+) (Renfrewshire Carers Centre only, does not include the number for HSCP) 86 148 203 87 Number of adult carer support plans declined by carers (age 18+) (Renfrewshire Carers Centre only, does not include the number for HSCP) 51 36 223 Carers centre to provide Number of young carers' statements completed 49 27 49 Carers centre to provide Number of Adult Protection contacts (including AWC) received 3,487 4,263 4,123 2,597 Total Mental Health Officer service activity 627 1,222 1,362 550 Number of Chief Social Worker Guardianships (as at position) 115 125 132 119 Percentage of children registered in this period who have previously been on the Child Protection Register 29% 30.4% 9.52% 2.7% No. of SW employees, in the MTIPD process, with a completed IDP 909 1,000 People, Performance and Talent Policy is currently being reviewed and a new indicator will be developed. Local Government Benchmarking Framework
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Performance Indicator 19/20 Value 20/21 Value 21/22 Value 22/23 Value Care at Home costs per hour (65 and over) £26.40 £23.05 £25.67 Information from LGBF available 2024 and report to Audit Risk and Scrutiny Policy Board Direct payment spend on adults 18+ as a % of total social work spend on adults 18+ 5.88% 4.05% 4.8% Net residential costs per week for older persons (over 65) £298 £277 £633