Agenda item

Chief Officer for Social Care and Health: Annual Report - To conduct pre-decision scrutiny on the report and scrutinise the performance of the service area.


Jane Rodgers presented the report and answered the members’ questions.


·         Some of the language that used objectively is somewhat alarming and may need further consideration, an example being of a system that is “broken” and ‘”in crisis” which links to a statement of “expectations of services that are shifting” and “change being the only constant”.  Please can you explain what is changing significantly, that is not predictable, accepting that the pandemic wasn’t.

We have a system that does feel at times in crisis, for all the reasons we are aware of such as demography and the pandemic. We have thought hard about how to solve those challenges, but the change required is to think about how we can organise ourselves from a whole system approach, re-engaging with our partners to understand practice and to determine risk in our communities. This is happening slowly, neighbourhood care networks being a new development that has been positive in developing an understanding of our communities and repurposing ourselves to do things differently. We know things are shifting but we don’t know exactly how it will develop.

Cabinet Member Councillor Tudor Thomas:  It’s a challenging question, because the demographic in Monmouthshire is aging and that means people will need more support. The health service is under such strain and the pressure on hospitals is immense. We also have practical challenges such as recruitment, which we’ve spoken about.  

·           What is predictable change versus unexpected change?

Our demographic and our workforce issues are predictable to a degree, but the pandemic has brought about changes that were less predictable and we are in a different territory, trying to determine how to respond.

·           Looked after children numbers have declined whilst the number of children on the child protection register have doubled. Please can you explain potential reasons for this?

We have had a strategy of changing the culture and practice, becoming more effective at care planning, which builds on the preventative approach, so children are staying on the register longer to seamlessly integrate them back into the community with family support services, so that’s the reason for the decline in the numbers of LAC together with those higher numbers on the child protection register.

·           In terms of the future challenge, we’ve seen examples such as the very successful Raglan Project, where the situation required us to be creative in solving our challenges, so given that we are in a similarly difficult situation, is there a prospect doing something similarly creative?

The question is whether we go alone or with others. I think we need to do both, working with the health board and other Gwent partners, accepting we have different challenges to our Gwent partner authorities, but we need to do it in partnership with health. I agree that we often have to find our own solutions, our Community Night Sitting Service and the Micro Carers project being key examples. We are starting to think of different ways of procuring care at home by taking a place-based approach, to put options in place that suit the community. This will require us to have a different relationship with the care provider, commissioning a different service where there is more flexibility and autonomy in the care offered, whilst providing greater security than a spot purchase contract. This direction will require us to upskill our micro carers, our direct payments, our in-house care and our procured care, but this where we are heading in trying to address the issue.

·         In terms of the data, if we are to adequately scrutinise the performance of services, we need more data, for example, rather than solely the number of children on the child protection register, we need to know how long they have been on the register and their status on the register, so I’d like to request that.

We do collate this information so we can provide you with this following the meeting (Action: Jane Rodgers). In terms of what happens to children on the register, they are reviewed frequently on a multi-agency basis with the children sometimes involved in this and every 3-6 months, there is an independent review, so the review process is continuous and is robust.

·         The report refers to 89% of adults in receipt of social care being satisfied with the services they receive, however, I’m concerned that responses can be overly positive where people are reluctant to say anything negative, so how was the survey conducted? 

The adult services questionnaire is sent automatically to service users via the Council’s Policy and Performance Team, so it’s not a case of a service provider going through the questions with the service user. The template is a national one, but I accept your points around needing to see numbers not just percentages and I will convey that. I will provide further information on this following the meeting (Action: Jane Rodgers). 

The report indicates a low score in terms of the participation of service users in the design of their care packages, so what are we doing to rectify that?

Unfortunately, the figure is lower, which is very disappointing. The reason for this is that there is so little choice currently, so people do not have a lot of choice in their care plan and are not able to make decisions about coming home or going into care, because of the challenges these services are facing.

·         I note in the report that there are 2000 weekly hours of unmet care which is highly alarming. The Care Inspectorate Wales has also highlighted this. It is also very concerning that people are not being able to choose their own care plan, given the Social Services and Well-being Act champions this.  What are your thoughts about the financial impact of people going into residential care as opposed to receiving care at home?  Has thought been given to the social price of a person losing their independence and connection with the local community? Conversely, if a person needs residential care and cannot obtain it, there would be significant pressure placed on carers to deliver care at home.

I agree with many of your sentiments – I feel this daily and so staff. The challenges are impacting on the choice. All we can do at the moment is continuously assess and prioritise, try to broker the right care for the person and to support carers, working with people and their families to deliver the best outcomes for them. We know people are in hospital waiting to come home, rather than going into residential care and we know it has a negative effect on people and on their carers. Our staff feel very strongly about this every single day, but the circumstances are so strained. As the chief officer, this is something I carry with me every day.  I want to work preventatively with partners to change the situation and to avoid people going into hospital, to increase our options around direct care, our micro carers, doing more work to support direct payment carers to support people to live the lives they want to live in the best way we can.

Cabinet Member Councillor Tudor Thomas: It concerns me greatly, but it’s a very difficult situation and there are clear fundamental issues in the care system that we cannot solve ourselves. 

·         Is there an opportunity to capitalise on some of the wonderful work that was undertaken in communities during the pandemic to support people in tasks such as shopping, collecting medication, running errands and cleaning.

Yes, there is. We have new community teams that work alongside our social care colleagues, and they work closely with the Gwent Association of Voluntary Organisations and Bridges Community Project to provide lower level support, such as shopping, making telephone contact and home calls and running errands. We have a new point of contact system, whereby people are redirected to that service rather than front line social care if appropriate.

·         I have personal experience of the difficulty in recruiting direct care by out of county providers, following a lengthy assessment process, with services since being cancelled, due to the increased fuel costs. Do you have any solutions for this? 

We do face particular challenges that are different to our colleagues in Gwent, particularly our rurality, the higher cost of living and our demographic, which makes it difficult to recruit carers who live in Monmouthshire, so many do come from Torfaen and Blaenau Gwent and the increased fuel costs, and the cost of living means they choose to take up work closer to home. There is no easy solution to this. As an authority, we do pay above living wage and we make sure any additional payment to carers from Welsh Government flow directly to carers, but this is a problem that we cannot dog ourselves out of financially, it needs a multi-faceted solution. The ‘place-based’ approach tries to reduce costs and time for carers in terms of travelling, by basing them in the community in which they live.

·           Recognising that the current economic challenges may mean some people may not occupy the same roles in coming months, is there potentially an opportunity to recruit people into social care?

Yes, you are correct we look at any and every opportunity to attract and recruit staff.

What are the contingency plans within the services to ensure we don’t lose essential skills and experience through people retiring?

I accept your concerns; we are very aware of this and note your point.

·           In terms of workforce development, you refer to a 10% staff turnover in adult services and a 12% in children’s social care. Is that directly within the council? I’m not sure what grades or roles that refers to, but is there a similar percentage within the external sector?  You talk about recruitment in the report, but I don’t see much about retention.

We put a lot of effort into retaining our staff with a significant well-being offer for staff, put in place during the pandemic and continued afterwards.  Our Workforce Development Team look carefully at our training offer for all different types of practitioners who are building a career in social care. There are several aspects: supporting professional development, then listening to staff on their terms and conditions and then also supporting them day to day in their work. We take this very seriously, meeting senior leaders every week for 2 hours to talk about their staff, so we know the individuals and their needs for coaching or mentoring and we look at caseloads. Also, wider than this, we think about how we can support home carers, foster carers and social guardians, because it’s a highly stressful field in which to work and we know we are in direct competition with other fields where you can earn similar wages without the stress and responsibility.

Chair’s Summary:

Thank you so much for bringing this report, which we have scrutinised in detail and we support. I’m aware there are staff vacancies across the council, so workforce retention is not an issue isolated to social services. One point I would like to raise, is the timeliness of reviews into need. The report indicates that 54% are completed on time, so my concern is that if 46% of reviews are delayed, people may be in receipt of services they may not need, against a backdrop of increased need. I would urge the Chief Officer to explore this further to ensure this isn’t affecting the availability of services for those who need them (Action: Jane Rodgers).


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