Minutes of the meeting held on Thursday 17 December 2020 at 2.00pm at County Hall, Northallerton.
County Councillor Karin Sedgwick in the Chair.
County Councillors: Philip Broadbank, Eric Broadbent, Mike Chambers MBE, John Ennis, Caroline Goodrick, Helen Grant, Andrew Jenkinson, David Jeffels, Stanley Lumley, John Mann and Cliff Trotter
Mike Padgham (Independent Care Group) and Jill Quinn (Dementia Forward).
In attendance:
County Councillors Caroline Dickinson (Executive Member for Adult Social Care)
Officers: Ray Busby (Principal Scrutiny Support Officer), Richard Webb (Corporate Director for Health and Adult Services), Dale Owens (Assistant Director of Commissioning & Quality, Health and Adult Services), Louise Wallace (Director of Public Health, Commissioning (HAS))
Apologies:
County Councillor Stuart Martin MBE
Copies of all documents considered are in the Minute Book
230. Minutes
That the Minutes of the meeting held on 25 September 2020 having been printed and circulated, be taken as read and be confirmed and signed by the Chairman as a correct record.
231. Declarations of Interest
There were no declarations of interest to note.
232. Public Questions or Statements
The committee was advised that no notice had been received of any public questions or statements to be made at the meeting.
233. Chairman’s Remarks
The Chairman updated members on changes to the work programme she had agreed to.
She highlighted some of the adjustments made in order that the committee not only met at the right time, but also accommodated officer priorities in these challenging times. Hence, the decision to re-arrange the meeting form the 3rd December to the 17th.
As Chair, she would be observing the upcoming meeting of the Outbreak Management Board, which intended to review how Covid 19 had affected suicide rates in North Yorkshire. This topic has been a key concern for the committee. In this context, she had recently suggested that aspects of the mental health first aider training feature as a future members seminar agenda topic.
234. Care Market Update
Presentation by Dale Owens Assistant Director of Commissioning & Quality, Health and Adult Services on how the Health and Adult Services directorate has responded to the challenges of the pandemic. This presentation focused on the impact of Covid 19 on the Care Market.
Care settings, whether they are nursing homes, residential homes or extra care, have been at the heart of the council’s response. There are 235 of these settings in NY – more than any other area of Yorkshire, with high concentrations in Harrogate and Scarborough. This reflects the high number of people coming to retire to the County, as well as people being referred from West Yorkshire and Teesside.
The headlines:
· Residential and nursing occupancy dropped from an average of 94% in November 2019 to an average of 80%. This equates to an overall increase of available beds of 17.5%.
· Increase in mortality due to Covid-19 has seen higher than average excess deaths.
· Financial Sustainability survey has resulted in 32 providers expecting to face significant financial challenges in the next 12-18 months.
· Non-regulated Day Care Service providers continue to be paid based on planned activity with a blended model of support in place consisting of virtual sessions, small group based activities and one to one support. We are working with 23 providers who are reporting challenges with reopening services. In response to a members question, Dale confirmed that this situation was a level of risk that was a county we could not live with. Efforts were in place top address this.
Dale explained that a strategic Market Development Board had been established with the participation of key partners. Its priority being strategic level action to support the care sector in the future, with the aim of helping the market to become more sustainable.
The Adult Social Care Winter Plan includes a commitment to deliver a designation scheme with the Care Quality Commission. Premises have been designated for people leaving hospital who have tested positive for COVID-19 and are transferring to a care home. Anyone with Covid-19 positive test result being discharged into, or back into a registered care home setting must be discharged into an appropriate designated setting. These approved settings have been signed off by CQC and have policies, procedures, equipment and training in place to maintain infection prevention and control and they support the care needs of residents.
Members were reassured that the market has been supported financially by a range of measures, including:
· Compensatory Payments to residential, nursing, domiciliary care and non-regulated providers.
· Payments in advance in line with annual uplift agreement.
· Block purchasing of bed capacity to support hospital discharge and admission avoidance where appropriate.
· Infection Prevention Control Fund National Personal Protective Equipment Portal.
· Supplier relief and Hardship processes in place.
Dale advised on the latest 7 Day Infection rates across the county, including prevalence in Care Homes and Extra Care Housing.
Members noted that the overall capacity for testing and turnaround times for the polymerase chain reaction (PCR) testing and for lateral flow testing (LFT) continues to improve.
Dale replied to a question about transmission rates amongst care staff, highlighting the response of providers trying to minimise the effects of transmission by adhering to good practice guidelines and regulation, especially where PPE was concerned. More latterly, increased reliability of supply of PPE was helping the situation. The incidences of asymptomatic transmission would always be a challenge for providers.
Mike Padgham stated the care providers, because of fixed costs, needed to operate at high levels of occupancy.
Mike added that the county council’s support offered to providers had been exemplary. Some providers were struggling to manage the increased burdens and lower occupancy levels. A number of homes were having to recruit additional staff to ensure the required testing in homes could be properly undertaken.
Against the background, It was inevitable that some providers would be lost to the market. Continued financial support was no doubt needed, but he acknowledged the county council faced financial challenges of its own.
Anecdotally, a member reported knowledge of some individuals being reluctant to accept the move into a residential setting – known as “Covid fear”. Dale advised that the service would always support individuals who decided not to go into residential care even when a needs assessment had determined that this was an appropriate response.
Mike Padgham agreed that some relatives had struggled to persuade individuals to enter residential care because of national publicity around care homes repeatedly reporting that homes were centres of high transmission of the virus. Indeed some concerned relatives had sought to move loved ones out of existing care settings. He believed the government could do more, in terms of messaging, to highlight that care homes were a safe environment.
In response to a member’s question, Dale advised that the council was monitoring very closely the additional cost to the authority in relation to extra services - purchase of bed space, additional staffing and so on – so that the underlying cost could be accurately evaluated and the longer term risks properly identified.
A member commented on the demands upon staff. Fatigue was becoming an issue, Dale responded, and we may yet see that reflected for example in stress levels, absenteeism and future sickness rates, The county council had a number of initiatives in place, as did CCG’s, to support staff’s mental health and well-being during this period.
a) That the report be noted.
b) The committee was pleased at the comprehensive and professional nature of the action taken and the support offered.
c) The committee agreed to revisit this issue at the next meeting.
235. Local Account: Consideration prior to publication
The Local Account for North Yorkshire Health and Adult Services for 2019/2020 - the directorate’s own statement on how services have supported people across the county, how public money has been invested, and what the aims are in 2020/2021.
The Chairman congratulated Louise Wallace on her recent appointment as Director of Public Health.
Louise advised that preparing and publishing a Local Account was not a statutory requirement, but it was a good practice requirement. The document whilst an Adult Social Care document, also included, quite appropriately, references to Public Health.
Members liked the revamped document - especially its accessible format. The description of how the service has worked with our partners, including care providers, the NHS, District and Borough Councils, Police, Fire Service, community and voluntary sector organisations was found to be clear.
That the report be noted.
Richard Webb advised that contact with care providers had been maintained through daily calls and online options that was providing critical data.
Richard updated members on the very latest infection rates and the picture across the county – district by district. He contrasted the experiences between the first and the second wave; outbreaks in care homes - at the time of addressing the meeting - had not been as numerous as faced in the first wave. Preparations were now being made for the onset of the anticipated third wave and the consequences of increased household mixing.
Generally, the authority in conjunction with providers had collaborated effectively with all partners to stay ahead of issues - for example in relation to testing, safe visiting procedures, and PPE.
The Chairman asked about priorities for our prevention and intervention services as we come out of Covid. It was clear that some vulnerable adults have been hit harder than others - learning disabilities, autism the whole transitions agenda. Richard highlighted the implications for certain groups of people being more susceptible to Covid, notably younger people with disabilities. That had influenced the shape of the local response with local discretion was being sensibly applied terms of access to rapid testing for example.
Work was underway looking at the longer-term impact on day services – most of which had been unable to take place - and what those services might look like in the future.
In reality, however, the pace and volume of challenges faced had made it difficult to plan for the longer-term future to any substantial degree.
The mental health condition of staff had been a priority concern. Richard covered the corporate and directorate responses for supporting staff – both formal and informal, information around this was available on the website.
Ways and methods of working had changed dramatically over recent months. We have seen the move away from traditional office based to home working, accompanied with the increasing confidence in digital communication and solutions. As a Director, he recognised that assessing the impact of changing work patterns would need proper and full consideration; part of this would be about how best to prepare staff for inevitable shifts and adjustments to the work environment.
Richard agreed with members’ comments about the need to tackle the longer term funding of social care. He believed that at national level there was a clear recognition of the needs for longer-term reform of social care, including particularly the evident current fragmentation in funding arrangements.
That the report be noted
237. Work Programme
The report of the Scrutiny Team Leader on the Work Programme.
A member believed that the committee should consider looking beyond the current experience to what the future of council social care services might look like and what might be the key considerations of a recovery strategy.
A member suggested that the respective chairs of the Scrutiny of Health and Care and Independence Scrutiny Committees might want to explore the feasibility of some time-limited joint work on what many observers believe is an impending crisis: the backlog of undiagnosed conditions, missed operations and GP appointments and so on. The Chairman agreed to explore this suggestion furher.
That the work programme be agreed.
The meeting finished at 2.30pm