The Chair welcomed everyone to the meeting as well as those watching the webcast.

Apologies for absence were received from Councillor Baldwin. Councillor Bennett was in attendance as substitute.

Members are asked to consider whether they have any disclosable pecuniary interests and/or any other relevant interest in connection with any item(s) on this agenda and, if so, to declare them and state the nature of the interest.

Councillor Gail Jenkinson declared in interest in agenda item 8 ‘Direct Payment Support Services’ due to a client being in receipt of direct payments.

Councillor Keiran Murphy declared a personal interest in agenda item item 8 ‘Direct Payment Support Services’.

To approve the accuracy of the minutes of the meeting held on 6 March 2023.

Resolved – That the minutes of the meetings held on 6 March 2023 be approved as a correct record.

The Chair reported that there were no public questions, statements, petitions or questions by members.

The Assistant Director – All Age Independence presented the report of the Director of Adult Care and Health.

The purpose of this report was to seek the Committee’s approval of the Adult Social Care Community Reablement Model.

This was designed to add value to a person’s experience with the reablement system.

The report Community Reablement Model contained within the comprehensive Target Operating Model attached in Appendix 1.

This was split into six sections: -

1. Context

2. Design model

3. People

4. Financial

5. Governance & Reporting

6. Appendix

Adult Social Care and Public Health Committee on 11 October 2022, approved in principle the establishment of an Adult Social Care reablement service delivered by the Council. The Council had a hybrid model of reablement. The assessment element was provided by the Wirral Community Health and Care NHS Foundation Trust, as part of Wirral Social Work contract, this returns to the Council on 1 July 2023.

The delivery element was provided by independent sector community domiciliary care providers as part of a full Care and Support at Home offer which covers reablement, domiciliary care and Continuing NHS Health Care.

The model would enable greater alignment and joining up of services to improve outcomes for people accessing or in need for reablement to live well in their communities, and to aspire to more active, fulfilling, and independent lives as possible.

The model will focus on providing high quality community reablement services that would enable greater opportunity to direct resources to those who would benefit the most, and was designed to enable people to maximise their independent living skills in order that they can continue to live their lives as independently as possible and to reduce their need for long term social care support.

The approach to supporting people who require reablement services in Wirral will benefit from learning from other areas. This ensures that best practice in personalised care and support is offered to people to meet their goals and aspirations, and to achieve better outcomes.

Members noted the value of support of carers and queried the level of training required. They also discussed the line between rehabilitation and reablement. Members requested the an annual review and reporting be brought back to Committee and were informed that this would form part of the performance monitoring report brought to committee on an quarterly basis.  

Resolved – that the Adult Social Care Community Reablement Target Operating Model as set out in Appendix 1 of this report be approved.

The Assistant Director – All Age Disability presented the report of The Director of Care and Health.

The report requested approval to recommission the Wirral Independence Service (WIS) within quarter 2 of financial year 2023/2024. The current contract ends in June 2024 and there are no further contract extensions available. This is a joint commission with NHS Cheshire and Merseyside Integrated Care Board (Wirral Place) (NHSCMICB) and is managed via the Better Care Fund. The WIS is inclusive of:

· The provision of Community Equipment.

· Technology Enabled Care and Response service.

· Carers emergency card.

· Falls Pick up service.

· Falls prevention service.

· Provision of Paediatric equipment.

· Education equipment for schools.

Members were informed that; the Wirral Health and Care system must ensure that it had a fully operational and responsive community equipment and technology enabled care (TEC) service to meet local needs to meet its statutory duties. That the use of TEC formed a key part of the Councils approach to digital care and early intervention and prevention services. That the Council had a duty to ensure value for money and to tender will ensure that best value is sought. And a longer contract length of up to 10 years, would support the successful tenderer to invest in local infrastructure and support social value

Members queried the social value of the tender and were informed that there was a 15% weighting for social value. Members noted that this was not especially high and asked for Real Living Wage and Union Representation to be considered as well. Members were informed that any tender would be subject of an Officer decision Notice.

Resolved – that,

1.  The re-commission of the Wirral Independence Service on a 5-year contract (with options for a 3-year, plus a 2-year contract extension) with a total contract value of £4.2m annually, up to £42m over 10-years be approved.

2.  The director of Adult Social Care and Health be authorised to award the contract to the most economically advantageous tenderer.

The Assistant Director – All Age Disability presented the report of The Director of Care and Health.

It was a statutory duty as defined by the Care Act 2014, to offer a person a Direct Payment as a cash alternative to a directly commissioned care and support service where a person has been assessed as having eligible needs. This applies both to carers and people in need of care and support.

The regulations of the Children Act 1989 also placed a duty on Local Authorities to offer a Direct Payment to disabled children.

The review of Direct Payments was presented to the Adult Social Care and Public Health Committee on 29 November 2022 and approval was given to explore how a Personal Assistant (PA) register could best be delivered with the intention of increasing the numbers of people, carers and families choosing to use a Direct Payment. The report set out the options as they related to the Personal Assistant (PA) register as identified by the Direct Payments working group.

The review had been a collaborative exercise and included, as equal partners, officers of the Council, people with lived experience, and representatives from Cheshire and Wirral Partnership NHS Foundation Trust (CWP) and the Wirral Community Health and Care NHS Foundation Trust (WCHCFT).

Members queried the financial targets, and whether the approach of direct payments over commissioned services and were informed that it was a matter of choice and allows for empowerment and choice, especially when moving into further education and employment. It was noted that direct payments had been reviewed by the Committee over a five-year period.

Resolved – that,

1. The proposed service model (Appendix 1) and implementation plan (Appendix 2) be endorsed

2. The Director of Adult Social Care and Health be authorised to progress with implementation of phase 2 of the proposed service model as detailed in Appendix 1 , commence the proposed procurement exercise and award the contract.

3. A further report be brought to a future Committee with proposals for implementation of the remaining phases of the model.

The Director of Public Health presented the report, which sought approval of the Wirral Drugs Strategy which set out a vision for uplifting communities and enabling all people in Wirral to live healthier lives free from the harmful impacts of drugs.

There was to be a focus on improving the health of people who use drugs, and preventing the early deaths that are seen too often. Prevention will be key, as will a vision for a positive narrative for recovery, combatting the stigma associated with drug use, and strengthening the voice of people with lived experience. The report enabled Committee to adopt the 4-year Wirral Drugs Strategy which placed collective responsibility for local system partners to align policy, strategy, and resources wherever possible to protect and improve the health of residents. Strategic planning helps local system partners work together to establish a clear vision, prioritise resources, determine a clear direction of travel, and to set goals and outcome targets. One option could be to not develop a local Strategy; however, the absence of a local strategic plan could exacerbate the burden of ill health, impacting negatively on health outcomes, inequalities, system pressures and the local economy.

Members queried Mental Health support and trauma therapy as well is the impact of organised crime on individuals. Also discussed was the support services in place for addiction to prescription drugs and other sources of addiction such as gambling. It was noted that officers were developing a response for gambling, counselling, harm prevention. There was a separate service for tobacco, smoking prevention services.

Also discussed was primary care, family engagement, support for young people as well as joined up services with the police and probation services. Members requested that a annual report be brought back to committee to update Members on progress and implementation.

Resolved – that the Wirral Drugs Strategy 2023-2027 as set out as Appendix 1 to this report be approved and that the Director of Public Health submit a report on an annual basis to enable the Committee to monitor progress.

The Director of Public Health presented the report, which updated Committee on the report presented on the 6th of March 2023 regarding the recommissioning of sexual and reproductive health services in Wirral. The Director of Public Health had been authorised by the Committee to commence the re-commissioning of Sexual and Reproductive Health Services for an initial five-year period from the 1st of April 2024 with the option for two one-year extensions to a value of £20,300,000 over the seven-year term and award a contract to the successful party/ies following this process. However, additional financial pressures likely to be experienced by providers had since been identified, and the report asked Committee for approval to increase the maximum financial value of the contract.

Members noted the increased value of £809,078 over the seven-year term. and queried the 15% social value element and increased weighting.

Resolved - that the Director of Public Health be authorised to commence the recommissioning of the Sexual and Reproductive Health Services, as otherwise agreed at the Adult Social Care and Public Health Committee of 6th of March 2023 at an increased value of £21,109,078 from £20,300,000. An increased value of £809,078 over the seven-year term.

The Assistant Director – All Age Disability presented the report of The Director of Care and Health which informed Committee of the findings and recommendations for greater alignment of All Age Disability Service. The scoping, initiation, planning and engagement phase is complete.

There was a greater reliance in Wirral on more traditional care services, which lead to Wirral being a higher spend Council on disability services. This also meant that outcomes achieved for people with disabilities did not always help them to achieve aspirational targets or to be as independent as they could be. This was be improved through better alignment, joining up planning, and collaboration between services. The experiences of people supported across the life course was greatly improved by focussing upon their aspirations and life goals in a more effective and clear manner.

Wirral was a high spend Council on adults with a disability and there are opportunities to optimise outcomes for people. Effectively supporting young people and their families through transition from Children’s to Adult’s Services means reduced reliance on more traditional and intensive accommodation-based services. It would enable effective planning to meet housing and employment needs alongside education and training opportunities. This should contribute to improving outcomes for individuals and families.

Four main themes have emerged from engagement with those who have lived experience either as people supported, carers or practitioners of the system. A summary of these engagements and graphic visualisations of engagement sessions can be found in Appendix 1 of this report. The four emerging themes were:

a. Starting Earlier from 14 and better joined up planning;

b. Housing Options;

c. Training, Volunteering and Employment; and

d. Better, Accessible & Relevant Information for people, parents and carers.

The deliverables and milestone plan set out in this report were aligned with these themes in appendix 4.

Members were pleased to note that lived experiences had formed part of the review, and discussed the fact that many types of disability were included but noted that it was difficult to name them all individually. All discussed were housing options, day services and shared lives.

Resolved – that the priorities and indicative timeframe for the All Age Disability Review, as listed in Appendix 4 to this report be approved.

The Assistant Director – All Age Disability presented the report of The Director of Care and Health which sought to seeks to provide a comprehensive update on the progress and impact of Care Quality Improvement interventions undertaken by the Quality Improvement Team in relation to the Adult Social Care commissioned care services.

Members were informed that the report focussed on;

· Current Care Quality Commission (CQC) rating position and movement

·Provider Assessment Market Management System (PAMMS) implementation, progress, and improvement/feedback journey

· Publication of placement suspensions and CQC ratings

· Quality Improvement Team Plan 2023

· Enhanced Health in Care Homes Quality Improvement strategy

Members raised concerns that there was no published deadline for safeguarding referrals and were informed that there was a strict deadline for investigations and that this would be addressed. Members queried funding and wages, but noted that there were distinct signs of progress within the report.

Resolved – that, the positive feedback from providers who have received a PAMMS assessment to date be acknowledged and the report be noted.

The Director of Care and Health introduced the 2022/23 Revenue and Capital Budget Monitoring which set out the financial monitoring information for the Committee as at Quarter 4 (1 Apr – 31 Mar) 2022/23. The report provided Members with an overview of budget performance for this area of activity, including delivery of the 2022/23 saving programme and a summary of reserves to enable the Committee to take ownership of the budgets and provide robust challenge and scrutiny to Officers on the performance of those budgets.

Members noted that at the end of Quarter 4, there was a reported favourable position of £0.345m on the Committees net revenue budget of £114.962m. The outturn reflects full achievement of the £3.89m 2022/23 savings target.

Resolved – that,

1. the favourable revenue outturn at Quarter 4 be noted.

2. the delivery of the 2022/23 savings programme at Quarter 4 be noted.

3. the reserves allocated to the Committee for future one-off commitments be noted.

4. the level of reserves at Quarter 4 be noted

The Director of Care and Health introduced the report which set out how the 2023/24 budget will be monitored through the Committee system, which will facilitate the Policy and Services Committees (the Committees) to take ownership of their specific budgets and present appropriate challenge and scrutiny of Officers on the management and performance of those budgets.

Members were informed that the 2023/24 Council budget was agreed at Full Council on 27 February 2023. This budget was made up of savings proposals, pressures/growth items and funding that were based on actual known figures or best estimates available at the time. At any point during the year, these estimated figures could change and need to be monitored closely to ensure, if adverse, mitigating actions can be taken immediately to ensure a balanced budget can be reported to the end of the year.

The Council has a legal responsibility to set an annual balanced budget, which sets out how financial resources are to be allocated and utilised. In order to successfully do so, engagement with members, staff and residents is undertaken. The recommendations in this report informed that approach.  Managing and setting a budget will require difficult decisions to ensure that a balanced position can be presented. Regular Member engagement, which this report forms part of, is considered essential in delivering effective governance and financial oversight.

Members queried the tables set out in the appendices and discussed suicide prevention and domiciliary care services.

Resolved – that,

1.  the process for in-year monitoring of the 2023/24 budget be noted

2. the establishment and appointment a Budget Monitoring Panel to comprise of the Committee Chair and Spokespersons, with sessions to be led by the relevant Director/Assistant Directorbe agreed.

The Assistant Director – Adults Care and Health presented the Adult Social Care and Public Health Performance Report. The report was designed based on discussion with Members through working group activity in December 2022. Members’ requests have been incorporated into the report presented at this Committee meeting.

Members discussed the Quality Care Commission total for people in residential care as well as the inspection ratings and queried how many of these were transitional. It was agreed this detail could be added to future report.  

Resolved – that the report be noted.

The Head of Legal Services presented the report which enabled the Adult Social Care and Public Health Committee to review the continuing need for various panels, statutory / advisory committees and working parties, and to appoint members and named deputies to serve on those (including the statutory committees and panels) that are to be retained in 2023/2024, as well as appoint a Member Champion for Domestic Abuse.

In relation to the appointment of a Member Champion for Domestic Abuse, it was moved by Councillor Phil Gilchrist seconded by Councillor Onwuemene that Councillor Onwuemene be appointed.

It was moved by Councillor Williamson, seconded by Julie McManus that Councillor Williamson be appointed.

A vote was had on the appointment of Councillor Onwuemene as Member Champion for Domestic Abuse. The vote was lost (2:8).

A vote was then held on the appointment of Councillor Williamson as Member Champion for Domestic Abuse. The vote was won (7:0 with 3 abstentions). It was therefore,

Resolved – that,

1.  the Monitoring Officer be authorised as proper officer to carry out the wishes of the Group Leaders in allocating Members to membership of the Statutory and Advisory Committees, Sub-Committees and Panels detailed within the report and to appoint those Members with effect from the date at which the proper officer is advised of the names of such Members.

2.  Councillor Janette Williamson be appointed a Member Champion for Domestic Abuse.

The Head of Legal Services presented the work programme update report. Following the whole-Council elections, the newly composited Committee was invited to review the 2023-24 work programme moving into the 202324 municipal year. It was proposed that issues on the existing work programme that are for information purposes only can be considered via other means, such as briefing notes or workshops.

Members requested a joint Committee workshop in relation to supporting dementia services, as well as a report on extra care housing be brought to a further committee.