Agenda item

To present the finding of the Adult Services Inspection.

Jenny Jenkins presented the adult services inspection report, noting it followed up on 2022 findings around people, prevention, well-being, and partnership. Of 23 areas for improvement, 20 have been completed; work continues on risk management, contingency planning, and carers' co-production. Ongoing efforts include quality assurance, training, and revising carers' assessments. Inspectors gave positive feedback on transformation plans, service expansion, technology use, and safeguarding. The service is satisfied with progress but remains committed to further improvement and ongoing engagement with Care Inspectorate Wales. 

Together with Cabinet Member Councillor Ian Chandler and Jane Rodgers, Jenny answered Members’ questions.  

Key Questions from Members: 

• Are statutory reviews that are not ‘being undertaken in a timely manner’, due to staff shortages or other reasons? 

Jenny Jenkins advised that the main reason is the volume of work, which impacts the ability to conduct reviews on time. She added that improvements are being made through better recording and additional resources, resulting in above-average performance in review completion. The Welsh average for completed reviews is 60%, while Monmouthshire achieved 70% at the end of the year, indicating substantial improvement.  

• The 64% staff recommendation rate for working at Monmouthshire seems a low figure which is concerning.  

Jane explained that 64% is not as high as desired, reflecting the challenging environment in adult social care, especially post-COVID and during ongoing changes. She stated that efforts are being made to improve staff engagement and communication.  

• In terms of the progress of the domiciliary care change, there are concerns about the transfers from providers and new carers and whether the planned changeover date is still achievable.  

Jane advised that in terms of the timescale, the three lot areas are in different positions, with one ready to go and two requiring more attention, but overall, the plan is broadly on track and the main priority is ensuring continuity of care. She encouraged anyone with concerns to contact the council directly.  

• Section 2.8 of the report refers to people who are paying privately not being offered assessments, and from my own experience, I know that lacking access to assessment reports when holding power of attorney can make people feel vulnerable. It’s important to address this concern as it has also been highlighted by Care Inspectorate Wales.  

Jane explained that while many people arrange care without council involvement, if someone comes to the council with care and support needs, they will be offered an assessment and support. Jenny added that the process includes discussing how care is to be provided, but acknowledged the process can be complex.  

• Are there many elderly people living alone who "fall through the net", who do not receive help, because no one realizes they need it or they are unsure who to ask? 

Jane advised that this is always a concern and efforts to strengthen early help approaches in communities are very important, relying on partnerships with third sector organizations, community groups, and health partners to identify those in need. She emphasized the importance of community networks, neighbours and friends in alerting the council to people in need and mentioned plans to strengthen the council's response at the "front door" with additional posts and training.  

• The report states that demand is outstripping supply in domiciliary care and that some people require care to remain independent, but it is not always available, leading to increased burden on carers and frustration for staff. It also mentions delays in processing direct payment requests. How does the assessment process work? How does the council ensure timely progression for those needing direct payments and how does the process link for those already arranging their own care? What is the sequence and timing of assessments for direct payments? 

Jane clarified that the situation with domiciliary care has improved, with waiting numbers and hours now significantly reduced compared to previous years, though some areas remain harder to provide for. The brokerage process has been shifted to the commissioning team to reduce frustration for social workers.  

In terms of direct payments, social care assessment is required first to determine eligible needs, followed by a technical assessment by the direct payments team to ensure suitability. The process is prioritized based on urgency, and the direct payments team has streamlined their process to minimize delays. Once someone is assessed as eligible and expresses interest in a direct payment, the follow-up assessment and setup are handled quickly, though exact timescales depend on prioritization and demand.  

Jane and Jenny both acknowledged that delays and complexity in the system can add stress for carers, especially those supporting people with dementia or Alzheimer's, and emphasized ongoing efforts to improve responsiveness.  

• Are issues with data collection and statutory reviews due to outdated systems, and are there plans for investment in more robust data systems?  

Some issues are due to how reviews are recorded, and improvements are being made through staff training and better recording practices. Jane explained that a new cloud-based social care case management system is being implemented in partnership with Gwent authorities, which will significantly improve system capability and address data issues over the longer term.  She noted the implementation is a long process due to data migration but will support future needs.  Whilst a lot of data is collected and used for planning and reporting, there is room for improvement in data capture and recording accuracy, and efforts are ongoing to ensure staff have the right information and support. Sometimes data is not recorded accurately, leading to underreporting of completed work.  

• Is the new system (Mosaic) is compatible with health staff systems? How are personal stories captured in the new system?  

The health sector is procuring its own systems, but interoperability is a key requirement for all, aiming for integration between services. More clarity on compatibility will be available once health completes procurement. The inspection has highlighted the importance of capturing biographies of people and that Monmouthshire does this well as part of the assessment process. There will be ongoing work to standardize data capture processes across the region, including how assessment documentation is formulated, to ensure personal stories continue to be included, as this is an intrinsic part of the assessment process.  

• The chair advised the Committee that she would suggest a visit to Chepstow Hospital to see the assistive technology rooms, highlighting the value of technology in supporting independent living. 

Jane agreed that the development of assistive technology had had a transformational impact and suggested Members may like to visit either or both of the two sites (Chepstow and Monmouth) to see the close partnership between social care and housing.  

• Can you advise us on the progress us on growing the number of micro carers in the area? 

Jane advised that the number of micro carers has grown to at least 50, the approach being part of a preventative offer, in conjunction with other local authorities and Welsh Government.  

• The chair noted that the gaps in carer assessments are being addressed and emphasized the importance of capturing carer needs in assessments.  

Jenny explained that there is ongoing work to better integrate carer assessments with those for the cared-for person, aiming to avoid missing carers and to clarify co-produced outcomes, with improvements planned for assessment pathways.  

Chair’s Conclusion:    

The chair thanked officers and the Cabinet Member for attending and providing an interesting and reassuring report, noting that it had clarified some of members’ concerns.