Agenda item

6.1

The Committee received a report and presentation by Sara Storey, Interim Director of Adult Social Care, Sheffield City Council, providing an update on how the changes that have been implemented through the Collaborative Service Development, are impacting on the people in receipt of ongoing long term care and their representatives. 

6.2

She said that the Council’s Ongoing Care Service was committed to working to improve services by looking at barriers, challenges and difficulties faced by families and how the Service can be improved.  The Service had agreed to sign up to the values and principles and was working in partnership with the Clinical Commissioning Group (CCG) to deliver helpful, responsive and timely support to those in need. 

6.3

She referred to the “How did we do” questionnaire which gave people in receipt of care services, the opportunity to share their experience of the services they received.  Gathering feedback from the questionnaire was still in the development stage, however Sara Storey felt that the questions that had been asked were the right ones, and had been supported by Healthwatch, in terms of setting up focus groups as to ascertain what type of questions were the right ones to ask of those people who had previously been in receipt of care from the Council and those currently receiving care and what was their experience and support received in terms of their long term needs.  Data had shown that not everyone was able to get their views across for a number of different reasons, i.e. not everyone was able to fill in a form; some people do not answer their phones; some are not able to answer questions online or are uncomfortable at answering questions about themselves in any format and that the offer of help was there to those people who need support in accessing advocacy.  It was important to engage with people using the service, as well as the frontline staff, voluntary sector organisations and carers delivering the service and that a clear process needed to be put in place, particularly when a complaint had been received regarding the level of care someone was receiving.

6.4

She said that a process was in place to resolve issues when the City Council’s Social Workers disagreed with Continuing Care Nurses about the level of care and support someone was receiving, there needed to be a clear process in place to identify someone’s needs by talking to each other, by working better together, although there was more work to be done to resolve these disputes.  If managers were unable to find an amicable solution, the dispute was then escalated to a higher level, but this had only happened in a small number of cases.

6.5

Sara Storey said that the number of complaints relating to continuing care had reduced and that responsibility for managing appeals had recently transferred to NHS Doncaster CCG to ensure that the process was independent.  She believed that a more integrated approach to workforce development would deliver a consistently high quality service experience.

6.6

Lucy Davies, Healthwatch representative, stated that with regard to the questionnaire shewelcomed the fact that the Sheffield Clinical Commissioning Group (CCG) had taken steps to gain feedback from service users, however she felt that feedback scores only related to specific parts of the process.  She referred to a case study and said that his version of the level of care he had received differed vastly from that of the CCG and his experience doesn’t reflect the care outlined by the CCG.  She had two questions to ask, firstly, how was the CCG measuring the impact of the new set of values and behaviours put in place when they hear stories similar to the one she had outlined and what are they doing to unpick how to do things differently.  Secondly, does the Social Care Service feel assured that when someone is moved from Social Care to Continuing Health Care (CHC), is the Service assured that the person has adequate care management and also that their social care needs are going to be met.

6.7

In response to the comments made by Lucy Davies, Sara Storey stated that each person was individually case managed. There are on average up to 11,500 adults in social care and that for every complaint received by the City Council, the correct procedure was put in place to deal with it. Ms. Storey stated that what was working well was the care at night service, which were formally undertaken by two separate services, one commissioned by the City Council and the other by the CCG.  If someone was identified, via the district nurse or social worker, as having care needs during the night, they would have to go through a lengthy process, and if change to that care was required, they would be passed from one provider to another.  Through joint commissioning, a more efficient and effective service was being provided.

6.8

Members made various comments and asked a number of questions, to which responses were provided as follows:-

·                     Adult Social Care (ASC) in the past was extremely process driven with targets and tick boxes and constraints caused by austerity. There used to be a 24 page assessment form and this has been reduced, by working with people, listening to them and finding out what was happening to them, we feel we are now in the position where we have a vision and strategy how to deal with people. It was accepted that the Service was not getting it right all the time, but now have more of an understanding of what was needed to be done and what the staff and workforce need to get it right.

·                     The decision to move the Continuing Health Care (CHC) appeals service to Doncaster CCG was taken by the Sheffield CCG and was not a Council decision.

·                     With regard to digital capacity, one of the problems experienced was that the Council and the CCG have completely different information and data capturing systems, so there was no method or way of capturing and holding information on people who go through a full process, in a way that enabled the Service to compare year-on-year the care being provided, but information from previous years to compare with was unavailable.  The ASC Service was looking at how the current case management system can be changed to incorporate all documents and information into the same system.  The aspiration was to have one system so that City Council and the CCG can look collectively and staff don’t use two systems to log, store and move information around. The current system the City Council uses was Liquid Logic, and a module was being developed around continuing health care, but it was felt that an interim system should be put in place to reduce duplication and capture information across the board, so work for this was going out to tender, but there was still a lot of work to be done in that area.

·                     With regard to reassessments, it was felt that this had definitely improved. More social workers were given more notice to attend meetings, the problem in the past being that they were given short notice that a meeting was going ahead and therefore the Service would be struggling to release Social Workers to attend meetings to support people or they would be struggling to find someone who knew the person well enough to provide the personal element required. It was not known, at present, what timescale would be considered appropriate, whether it was days or weeks. The Service would be interested in people’s views on the process to express what they would consider to be timely for them.

·                     In response to questions about Members not being confident that the appeals process was independent, it was felt that there should be a level of knowledge and understanding about nursing care needs, health care, social care needs etc. and that a level of professional experience on the Appeal Panel when making those decisions was necessary.

·                     When asked whether people are being signposted appropriately, it was noted that the Council has been looking at benchmarking data in other areas to try and get an idea of whether the staff that normally fill in the initial healthcare checklist, are filling it in properly and talking to people to direct them to the best care available.  Looking at Sheffield numbers, its good to know whether we’re doing enough or not enough and reminding staff on a regular basis wherever possible, to always bear in mind is this person eligible for continuing healthcare.

·                     The Service would like to raise expectations. It is, to a certain extent and more particularly the CHC, tied to the NHS national set of guidance, criteria and  casework assessments  etc. and has limited ability to influence  what they look like and how they are set up. The Service is looking at introducing an initial “Welcome to the CHC Service” contact with people, for those who are able to communicate initially over the phone, looking at rolling out the customer satisfaction feedback reviews, looking at how to get in touch with people early on and supporting and managing their expectations and to be clear with people as early as possible of what they can expect in adult care.

·                     The figures regarding the value for money of the night care service were not to hand at the meeting, but the figures will be made available to Members of the Scrutiny Committee.

·                     There hasn’t been any difficulties recently in recruiting social workers into adult social care, although children’s services have not always had the same issues as adults. There had recently been a round of recruitment of Social Work Prevention Officers and Care Managers on a similar grade and 150 applications for the post of Social Work Prevention Officer had been received.  The Service had changed its approach to recruitment.  In the past, it had always recruited newly qualified workers to a lower grade, however there had been an increased number of Social Work Apprenticeships and Occupational Therapy Apprenticeships  and the Council were recruiting at higher grades to encourage more experienced Social Workers and thereby creating a good mix of skills. There had been a good response from people prepared to work across the board. The City Council was very clear about what was expected from its workforce and was working with HR colleagues to make sure job descriptions were up to date.

6.9

The Chair stated that a number of questions had been asked at the meeting and she was preparing to submit them to the CCG to provide answers, and she would request that the CCG attend a meeting of the Scrutiny Committee in February, 2020, the focus to be on the person centred approach to CHC and the appeals process.

6.10

RESOLVED: That the Committee:-

(a)       thanks Sara Storey for her contribution to the meeting; and

(b)       notes the contents of the report and presentation and the responses to the questions raised.