Agenda item

To select appropriate items from the Cabinet Board agenda for Pre-Decision Scrutiny (Cabinet Board reports included for Scrutiny Members)

The Committee scrutinised the following Cabinet Board items:

Quarter 1 Performance Monitoring Report 2021

Members were provided with the Performance Information, and the Complaints and Compliments Data for Children and Young People Services, and Adult Services for the 1st Quarter Period (April 2021 – June 2021).

Members highlighted a number of the positive performance indicators, and congratulated Officers on their hard work in achieving targets; especially given the circumstances of the pandemic.

Reference was made to the graph contained within the circulated report which detailed the number of social worker vacancies, disciplinary investigations and grievances across Adult Services. It was asked why the social worker vacancies and the long term sickness levels were so high.

Officers explained that some elements of the report was misleading due to the way in which the data was presented; Members were assured that there were no current issues with vacancies or long term sickness levels within Adult Services. It was stated that the vacancies detailed in the graph related to vacancies across the whole of Adult Social Care, and were not specific to Social Workers. Officers confirmed that 20 of the vacancies were linked to the in-house domiciliary care service; these posts originally weren’t filled as they were being retained to support the budget issue, however over the last two years there had been an external recruitment campaign for those posts. It was noted that the Council had unfortunately not been able to fill them; not being able to recruit people into domiciliary care was a national issue. Members were informed that a further 20 of those posts were new posts which had been established on a temporary basis from different funding streams over the last two years; they were not vacancies within the Council, instead they were posts that had not been established permanently into the base budget. It was mentioned that the only vacancies within quarter 1 were 4.8 full time equivalent (FTE) posts.

Following this, Officers provided information on the sickness levels that were presenting high levels on the graph (39.5 FTE). It was noted that 21.5 FTE were staff from the in-house domiciliary care service; this was not unexpected due to the demand of this particular service throughout the pandemic. Members were informed that the Adult Service workforce was in the best position that it had been in for many years in terms of sickness levels; the sickness rates were currently in single figures.

It was stated that the Heads of Adult Services was working with Human Resources Officers to change how the data was presented; the data will be split into Principle Officer Remits to try and ensure that the figures were more meaningful and reflected a more accurate picture of Adult Services.

A discussion took place in regards to vacancies for Occupational Therapists. Officers confirmed that there were vacancies within this service, and that it was an ongoing, national problem with recruitment; there had been many occasions where individuals had opted to work for the National Health Service (NHS) instead of Local Authorities. However, it was mentioned that Officers had recently put out a joint advert on the NHS website in relation to vacancies, and following this had received 50 applicants across the region. It was highlighted that Officers were looking to provide Occupational Therapist Assistants employed by the Council, with a similar opportunity to the Social Worker degree funding; they would undertake a three year course at degree level, before they would be able to work in-house as a fully qualified Occupational Therapist.

Members queried who the Neath Port Talbot’s Children and Adult’s Quality Assurance and Learning Framework was issued to and used by. Officers confirmed that the document was designed for internal use. It was noted that the Customer Service Standards detailed in the framework was developed internally with Practitioners, Managers and Senior Mangers; however it was realised that it was also important to reach out to the wider community such as parents, children, carers, care homes and other groups. Members were informed that Officers carried out this work to find out what was important to them; this helped set the outcome focused framework, to detail what the Council was seeking to achieve and identify what difference was being made. It was stated that the Customer Service Standards were essentially what the service users expects of the Council; when Officers carry out their quality assurance work, they use the questions/statements included in the standards to ensure that they achieve what was expected of them.

It was recognised that Neath Port Talbot’s Children and Adult’s Quality Assurance and Learning Framework included an element which stated that key decision-making meetings will be observed through a programme led by Senior Managers within the service; Members asked that with the significant amount of intense work that was currently being carried out, would Senior Managers be able to cope with observing the numerous meetings that take place. It was noted that the quality assurance group met on a fortnightly basis; representatives from both Children and Adult Services attended these meetings. Members were informed that the group had a forward work plan which listed various meetings that needed to be observed over time; the expectation was that Senior Managers would not observe all of the meetings at one point in time, and that it would be a phased approach. It was highlighted that the various pressures across the service were acknowledged.

Following scrutiny, the report was noted.

Fee Uplifts to Support the Sustainability of Domiciliary Care and Supported Living Services 

The Committee received a report regarding a proposed implementation of a 10% uplift to the fees paid to providers contracted by Neath Port Talbot County Borough Council for the delivery of Domiciliary Care and Supported Living services.

Members welcomed the initiative and highlighted that the Members of the Valleys Wards were pleased to see the recognition that the Valley areas were disproportionately affected by this problem; however, the figures were extremely worrying.

It was asked if Officers could provide information regarding what the Council was currently doing to ensure that those who have had their care packages removed, were safe, well cared for and were managing to live independently. It was explained that in the past week, the service had found itself in the most difficult position that it had ever been in; for the first time ever, staff found themselves having to offer individuals a place in a care home as opposed to staying in their own home with a package of care. It was noted that there were currently 41 people in the community, who had been assessed as requiring a package of care, being supported by family and friends; this was supported by a visit from the Social Worker every month, weekly telephone calls, welfare checks, and the use of the Local Area Coordinators to ensure that the families were coping. Since September, the service had received 50 handbacks from external providers, due to staff walking away from the job; there will be a further eight handbacks in the next two weeks. Officers assured Members that they were doing everything they possibly could, and offering someone a place in a care home, instead of providing them with their care package, was the last resort. It was mentioned that the recruitment process was active, and 10 people were being interviewed in the coming weeks.

Officers were asked if they were confident that the uplift was going to work in attracting staff, and if it would be enough. It was noted that the 10% uplift was a risk to take, and it was unknown if it would work in terms of attracting staff and/or keeping staff in the service. Officers had spoken to every provider and suggested a number of options to them; all of the providers stated that they wanted some form of continuity, and they were happy to accept 10% on the hourly rate. Members were informed that the contracted highlighted that the money will be passed onto the front line workers; Officers will be monitoring this via the Contracting Team.

The Director of Social Services, Health and Housing highlighted the various risks associated with the uplift. However, it was stated that the risk of not doing anything was much worse; currently a lot of staff in the external market were leaving in numbers that were affecting the ability to provide care, therefore it was essential to try and retain the current staff. Some of the risks mentioned included:

·        The uplift was proposed for the external market, and not the internal market; it also did not cover residential care workers. These were risks as staff may choose to leave the service or migrate from one area to domiciliary care;

·        The uplift was affordable for the rest of the civic year and the next civic year, however the ongoing funding for it was far from clear; without additional monies from Welsh Government to support this, a pressure will be applied on the Councils budget.

Officers explained that they had been speaking to Welsh Government regarding sustainable funding; this would allow the Council to uplift the living wage for all of the care sector staff, and provide awareness and recognition of the huge benefits that caring staff make to those people who were most vulnerable.

It was queried whether the lack of European Union (EU) Nationals was a contributing factor to the issues with staffing. The Committee was informed that Officers had conducted research relating to this prior to leaving the European Union; this exercise was completed to gain an understanding of the impact that Brexit would have on the sector. It was confirmed that there were very low numbers of EU Nationals working in the care sector within Neath Port Talbot; and those that did, had applied for the EU Settlement Scheme. In regards to the staffing issues within the sector, it was highlighted that there were a number of factors contributing to this; including competition within the workforce, other companies/organisations offering very strong rates of pay and employment opportunities, and the impact that the pandemic has had on the care workforce which has resulted in individuals becoming exhausted. 

Detailed in the circulated report it stated that there was a risk that not implementing the same level of uplift to the Older People Care Home sector could result in Care Home staff leaving their current employment to work in Domiciliary Care or Supported Living due to the higher rates of pay. Members asked what controls, if any, were in place to prevent this from happening. It was stated that at this stage, the Council was not in a position to replicate the uplift across the Residential Care Sector, however Officers had completed the necessary research and had taken a view that there was more of a need in the Domiciliary Care provision currently. The Director explained that there will be a re-distribution exercise in the near future that will occur across the residential care market, as the Welsh Government support funding comes to a conclusion; the 10% uplift was a calculated risk, however the Managers in the service were very knowledgeable for the market. Members were assured that despite what was trying to be achieved with the external market, the Council was taking a Council wide approach; and were utilising groups of Officers to look at targeting various groups and bodies, such as the universities and colleges. 

Following scrutiny, the Committee was supportive of the proposal to be considered by the Cabinet Board.

Future of Trem Y Glyn Residential Care Home

Members were informed of the outcome from discussions with the Pobl Group, in relation to the continued operation of Trem Y Glyn Residential Care Home until 31 March 2025.

The circulated report detailed the two different funding arrangements for Members consideration, if they were minded to approve Option 2 or Option 3; funding arrangement A stated that Pobl would maintain repairs and maintenance liabilities. Members asked if Pobl would be in agreement with undertaking these arrangements. It was confirmed that Officers had been undertaking negotiations with Pobl for quite some time; they had been made aware of the report and were in agreement with it.

In the event of choosing to support Option 2 or Option 3, the circulated report highlighted that Pobl would require the Council to pay full cost recovery; Members requested further clarification on what this implies. Officers explained that this was the reason why the rates for contracting this service going forward were different to the previous rates that were paid; the detail behind this was included in the appendices of the circulated report. Members were informed that it was agreed that if an extension to the contract was going to be made, a separate contract would need to be developed which would take all of the costs of running Trem Y Glyn into consideration; this would be a standalone contract with Pobl in which they would charge the Council full rate of the 27 beds.

The Local Member for Blaengwrach and the two Local Members for Glynneath, who were in attendance at the meeting, shared their concerns in regards to the decision made in 2016 to close Trem Y Glyn, and the impacts the closure would have on the residents, staff and the wider community; highlighting in particular that there weren’t any other community care homes in the Neath Valley or Dulais Valley. The Members shared their views on the various options contained within the circulated report and queried elements of the process leading up to the report being presented to Committee.  

Members made queries relating to the exit strategy that Pobl were required to develop. Officers confirmed that Pobl were told to hold off on producing an exit strategy due to this report being brought for consideration on various options; if a decision was made to go with Option 1, continue with the planned closure of Trem Y Glyn by 31st March 2022, then Pobl will need to create the exit strategy over the next few months.

The Committee raised their concerns regarding the transport issues associated with the closure of Trem Y Glyn. The circulated report stated that the Council would fund specific time-limited transport provision in proven cases of hardship; however, it was noted that the traffic survey that was intended to be carried out to identify potential traffic and transport issues, was not completed. Officers mentioned that the issue surrounding travel costs would be imbedded into an exit strategy; it was acknowledged that this will need to be looked into, however there currently wasn’t a significant level of detail available.

A discussion took place regarding the current residents and staff working at Trem Y Glyn, and how this would impact on them. It was noted that the residents and staff were at the forefront of thinking, and Officers had been working to try and find ways of making sure they were supported when it closes.

Officers recommended that the Committee consider Option 3, which was a temporary situation in which the care home provision at Trem Y Glyn would be extended for a further year, with an option to continue to extend up to 2025. Members were informed that the residential market place was currently very different to when Officers last reported to Committee on Trem Y Glyn; the pandemic has had a marked impact on the uptake of residential care, on staffing and the ability to safely move residents from one home to another, and make assessments in a timely manner. It was noted that the market was currently very volatile, and Officers weren’t able to judge what the market will look like in coming months; Option 3 provided an interim position in order for Officers to better understand the market next year, once the impacts from Welsh Government and their reduction of funding had been identified.

Members mentioned that they had previously asked Officers if a new build will be in place before Trem Y Gyn was closed; there had been no further report on this. The Director explained that when the decision was taken in 2016 to close the care home, it was also decided that a new care home would not be built in the Glynneath area; however, there was a proposal in place from Pobl to build some form of supported living. It was explained that although this proposal might provide for the needs of some residents, it could not be described as a residential care home or a replacement for Trem Y Glyn. It was noted that Pobl had asked if the Council was interested in being involved in this development from a social care point of view for meeting the needs of older people; the Council had agreed to this, however Officers had yet to take part in detailed negotiations with Pobl in regards to what this arrangement will look like.

Following this, a discussion took place in regards to the future provision of care homes in the County Borough. It was noted that currently, there was over 150 empty residential care home beds across the County Borough; this was a significant number of beds. Officers added that some care homes in the area had occupancy levels of less than 70%; if this continued, these care homes would not be viable in the future.

The Committee highlighted that Trem Y Glyn still had a significant demand, compared to some other care homes across the County Borough which had a lower demand; and raised concerns with the volatility and uncertainly of care homes in the private sector. It was noted that Trem Y Glyn currently had around 3 or 4 bed vacancies; however, it was clarified that the number of vacancies will be affected across all care homes due to the upcoming dramatic changes in the market place over the next 6-8 months. Officers explained that there was a whole spectrum of care that people will need as they get older, and some of that need was with supported living; there were other options of care that needed to be explored and an overall strategy needed to be produced for the whole County Borough.

Discussions took place regarding the initial decision taken in 2016 to close Trem Y Glyn, and the decision taken after this to build two care homes instead of the original proposal of four; following legal advice, it was reiterated that the options for consideration in the meeting, were those contained with the circulated report. Members were informed that the Care Inspectorate Wales (CIW) would not allow Trem Y Glyn to be continued in the long term, in its current form, as it did not have the facilities expected in modern day care homes. It was noted that discussions regarding potential replacements would take place in the future. The Director highlighted that going forward with this matter, Members would need all of the relevant information regarding the strategy that was going to be taken into the future; this strategy would capture the needs of the County Borough, however this was not set to be developed just yet.

Following consideration of the various Options contained within the report, it was explained that Option 2 (enter into a new contract with Pobl to retain Trem Y Glyn for a period up to 31st March 2025) had significant costs associated with it.

The circulated report referenced the timely discharge of medically optimised patients, who will need care homes as a pathway; Members asked if discussions had taken place with the Health Board regarding their opinion on whether Trem Y Glyn would be required in the short or long term. Officers explained that specific discussions on the status of Trem Y Glyn had not taken place with the Health Board, however Officers were having weekly conversations with them in regards to the position of care homes across the County Borough; it was hoped that after the next 6-9 months, there would be more clarity around this.

The Chair summed up the discussions that had taken place; and a vote was undertaken to determine which of the three options, contained within the circulated report, Members were in favour of recommending to Cabinet Board. The results of the vote were as follows:

Option 1 – 0

Option 2 – 1

Option 3 – 10

Following the vote, Option 3 was proposed and seconded to be considered by Cabinet Board.