To approve the accuracy of the minutes of the meeting held on 19 November 2020.

Resolved – That the accuracy of the minutes of the meeting held on 19 November 2020 be agreed.

No apologies for absence were received.

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.

Members were asked to consider whether they had 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 what they were.

The following declarations were made:

The Head of Legal Services informed the Adult Social Care and Health Committee that no public questions, or requests to make a statement had been received.

Simon Banks, Chief Officer, NHS Wirral CCG and Wirral Health and Care Commissioning, introduced the report which summarised the proposals set out in the recently published NHS England/Improvement document ‘Integrating Care: Next steps to building strong and effective integrated care systems across England.’ The report also set out the work in progress to respond to these proposals for Wirral as a ‘place’ within the Cheshire and Merseyside Integrated Care System.

The Committee was informed that the key practical changes would include the devolution of national functions to a North West level and likewise the devolution of functions from a North West level down to a Cheshire and Merseyside footprint. The idea was that the future health and care systems would be built on local authority areas, and it was felt that Wirral was in a good position to enable this. Further proposals included ensuring providers worked together collaboratively and that clinical leadership within the NHS was maintained.

It was reported that the Joint Health and Care Commissioning Executive Group was looking at what function should be retained on a ‘place’ level and that committee such as the Health and Wellbeing Board and Adult Social Care and Health Committees would be at the heart of the new system.

Members welcomed the emphasis on local commissioning of services and sought clarification on the footprint that different services would be delivered on.

Resolved – That

(1)  the work to define what a commissioning offer at ‘place’ level should look like, setting out what commissioning functions should be delivered in place and what would best sit with provider partnerships be noted and supported.

(2)  the work in the creation of a provider collaborative/alliance in Wirral be noted.

(3)  a further update report on progress be presented at a future meeting of the Adult Social Care and Health Committee.

Simon Banks, Chief Officer, NHS Wirral CCG and Wirral Health and Care Commissioning presented the report which provided the Committee with a summary of the implementation to date of the national “Think 111 First” project in Wirral, as well as an overview of the anticipated next steps.

It was reported that the project intended to transform the way that patients accessed urgent and emergency care by offering a single point of access. It was hoped that the project would:

·  Reduce the risk of nosocomial infection through overcrowding in the Emergency Department;

·  Increase the number of patients who got to the right service first time; and

·  Increase staff and patient satisfaction with the 111 First service.

The Committee was advised that the project went live on 24 November and within the first ten days, 70% of all urgent referrals into the Clinical Advisory Service had been managed without referring people to the Emergency Department, in addition to fewer unheralded arrivals to the Emergency Department and shorter waiting times.

Members welcomed the project and sought further information on the targets outlined within the report and the data that these were being measured against.

Resolved – That

(1)  the report be noted and the implementation of phase two of NHS 111 be supported.

(2)  a further report be submitted to a future meeting of the Adult Social Care and Health Committee, including a performance data set.

Graham Hodkinson, Director of Adult Care and Health introduced the report which sought the continuation of delivery of adult care services within the Borough through the current provider, Wirral Evolutions.

The report outlined that Wirral Evolutions was set up as a limited company by Wirral Council in 2015 to enable the service to extend and modernise its activities and generate income in additional to the social care contract. However costs associated with day services had increased beyond the contract value leading to a review of the service as requested by Adult Care and Health Overview and Scrutiny Committee in February 2020, which included the potential for bringing services back ‘in-house’ to address the financial challenges currently facing the service.

It was reported that the Council had formally commenced consultation on the budget in relation to the Contract for Day Services for people with a Learning Disability, with the intention of removing the over contract spend amounting to £0.5m to bring the contract value in line with the social care budget allocation of £5.015m for 2021/22. Wirral Evolutions had discussed a range of options to modernise the current operating model, and the recommendation was that they would present these proposals to a future meeting of the Adult Social Care and Health Committee.

Members acknowledged that the quality of the service was not an issue and emphasised the need to provide reassurances and a sense of continuity to service users.

Resolved – That

(1)  the Council should continue to deliver Day Services through the current contract with Wirral Evolutions.

(2)  Wirral Evolutions be invited to the Adult Social Care and Health Committee to present the company’s proposals to modernise the current operating model and reduce the operating costs to ensure delivery of the service within the existing contract at the current contract price of £5.015m for 2021 to 2022.

(3)  Wirral Evolutions be invited to the Adult Social Care and Health Committee to present quarterly reports to update the Committee on its progress, with a six-month formal review of progress against allocated spend under the contract.

Jason Oxley, Assistant Director of Care and Health introduced the report which outlined the proposal to step down the Merseyside Safeguarding Adults Board and establish a Local Safeguarding Adults Board in Wirral.

The report detailed how Wirral Council was currently a member of the Merseyside Safeguarding Adults Board alongside Liverpool, Sefton and Knowsley, but that following a peer review by the Local Government Association it had been decided by the existing Board members to change the arrangements to a local level, where it was felt that there was more opportunity to strengthen links with the domestic abuse strategy and services.

Members were supportive of the introduction of a local Safeguarding Board and felt it would complement the local health and social care integration agenda. It was noted that the Children’s Safeguarding Board had undergone similar rearrangements and there was an opportunity for learning from those experiences.

Resolved – That

(1)  the establishment of a Wirral Local Safeguarding Adults Board to fulfil the statutory requirements that are currently being met and managed by the Merseyside Safeguarding Adults Board be agreed in principled.

(2)  a further report outlining the plans to establish a Wirral Local Safeguarding Adults Board be received at a future meeting of the Adult Social Care and Health Committee.

Simon Garner, Health and Care Commissioning Lead, introduced the report of the Director of Care and Health which outlined the funding requirements for the development of an Extra Care Housing scheme on Moreton Road, Upton.

It was reported that there were a number of these schemes across the borough, that provided 24 hour on-site care whilst also supporting independent living, which in turn reduced the need for residential and nursing care.

The previous Wirral Plan set out a target of developing 300 additional units by 2020, but national policy had resulted in delays to this. 101 additional units had been achieved, and the proposed development before the Committee alongside a further development in Rock Ferry would help to fulfil that target.

The Committee noted the considerable time required to identify and develop sites for developments such as this, and it was suggested that more regular consultation exercises could take place to identify need and to ensure that need could always be met.

Resolved – That

1)  payment of a grant of up to £3,685,400 to Housing 21 (H21) from the Council Extra Care Capital Programme to enable the delivery of 80 Extra Care Housing units by Housing 21 be approved.

2)  it be noted that the council holds nomination rights and that appropriate legal agreements will be put in place to ensure that the Council’s financial contribution and nomination rights are protected.

Graham Hodkinson, Director of Care and Health introduced the report of the Director of Resources and outlined that the report formed part of the Council’s formal budget setting process and gave the Adult Social Care and Health Committee opportunity to comment on the proposals that fall within its remit, which would enable those comments to be presented for consideration by Policy and Resources Committee at its meeting in February 2021.

The report included a savings proposal through a service review of the day services for people with Learning Disabilities provided by Wirral Evolutions. The review’s aim was to manage the cost of current provision through service changes with potential savings of £500,000.

Members felt that there was no need to further comment on the proposals whilst the public consultation was ongoing, and the comments the Committee made on the budget options at the previous meeting were still pertinent and should still be considered.

Resolved – That

the resolutions agreed under Minute Item 19 at the previous meeting of the Adult Social Care and Health Committee on the budget options be considered by the Policy and Resources Committee as part of the budget consultation.

Graham Hodkinson, Director of Care and Health presented the standing revenue budget monitoring report for quarter two of 2020-21 which provided members with an overview of budget performance for adult social care and health.

The Committee was informed that the projected year-end revenue forecast position was a favourable position of £0.06m which it was felt was a positive in the context of the ongoing challenges being faced. It was explained that the favourable forecast was due to several factors including a reduction in demand for social care services in the early stages of the pandemic, alongside hospital discharges being funded by the Clinical Commissioning Group. Members were advised that the demand for services had returned but would be partially offset by further NHS and Government funding.

Members acknowledged that the Revenue Budget Monitoring report was in line with corporate reporting timetable, but felt that a budget monitoring panel should be set up to enable more timely budget monitoring.

Resolved – That

1)  the projected year-end revenue forecast position of £0.06m favourable, as reported at quarter 2 (Apr-Sep) of 2020-21 be noted.

2)  a Budget Monitoring Panel be established with the Chair and Group Spokespersons to meet monthly to monitor the up-to-date financial data.

Jason Oxley, Assistant Director of Care and Health introduced the report, which provided a regular update on the performance of Adult Social Care and Health as requested at the meeting on 13 October 2020.

The report provided statistics relating to residential and nursing care in the borough and it was reported that there was currently a significant vacancy rate of around 15%, partly as a result of temporary closures for new admissions due to Covid-19 outbreaks or contractual issues.

The Committee discussed the care homes that had been rated inadequate by the Care Quality Commission (CQC) and the Council’s ability to continue to carry out inspections during the pandemic. It was reported that there were ongoing issues with the quality improvement team accessing care settings, but that quality surveillance was still taking place through the observations of district nurses, GPs and specialist health staff alongside regular surveillance meeting.

Members discussed the reasons why care homes moved into the ‘requires improvement’ and ‘inadequate’ CQC category and how the performance of care homes could be monitored pre and post Covid-19.

Resolved – That

(1)  the report be noted.

(2)  case analysis of care homes moving into the ‘requires improvement’ or ‘inadequate’ Care Quality Commission categories be included in future performance reports.

(3)  the Assistant Director of Care and Health be requested to undertake a review of the reasons for ending reablement that were currently categorised as “other” and include the findings in future performance reports.

(4)  the Assistant Director of Care and Health be requested to consider the use of notifiable incidents within care homes as a way of measuring their performance before and during the pandemic and report the findings back to the Adult Social Care and Health Committee.

Julie Webster, Director of Public Health, introduced the report which provided the Committee with an update on the Council’s Covid-19 response and the delivery of the Outbreak Prevention and Control Plan.

The report detailed the key progress made since the last update on the seven priority areas of the Covid-19 Outbreak Prevention and Control Plan which had been the main focus during lockdown, these included:

·  Effective Surveillance;

·  Governance and Accountability;

·  Engagement and Communication;

·  High Risk Settings and Communities;

·  Local Testing;

·  Local Contact Tracing; and

·  Supporting Vulnerable People and Communities

Members were advised that the weekly infection data was still available on the Council’s website, and the data showed that there was widespread community transmission in Wirral, particularly in the 20-29 year old age group. The number of cases per day was approximately 30 in December but had increased to 537 on 4^th January resulting in an infection rate of 800 per 100,000 residents. The Director of Public Health outlined that whilst cases had started to reduce, the number of cases remained extremely high and the pressure on NHS and social care services remained significant.

It was reported that work was ongoing to ensure that once the national restrictions ended there was a smooth transmission into local arrangements, including robust contact tracing and the continued work of the outbreak management hub. Asymptomatic testing had been launched across the borough following the previous meeting, and members were advised that an appointment system had since been introduced to prioritise people going into work.

Members welcomed the current communications strategy and work of the Community Champions and expressed their gratitude to the Public Health team for their ongoing work.

RESOLVED – That

the report and progress made to date be noted and the ongoing Covid-19 response be supported.

Simon Garner, Lead Health and Care Commissioner, introduced the report of the Director of Care and Health setting out the important context of the work of the Deprivations of Liberty (DoLS) safeguards, the issues and challenges faced during Covid-19 and providing further information on the forthcoming changes to the legislation relating to Deprivations of Liberty.

The report set out that under schedule A1 of the Mental Capacity Act 2005, the Council had powers to deprive a person in a care home or hospital of their liberty if certain statutory criteria were met such as the person being unable to consent to their treatment. The ethos of the Act was to assume the person could make their own decision and would be supported to make the relevant decision where required.

The Committee was advised of the challenges in continuing this work during the pandemic. Following the first lockdown in March 2020, all DoLS assessments were conducted remotely, other than those in exceptional circumstances where remote assessments were not able to be conducted, for reasons such as communication issues. It was reported that there had been issues whereby remote assessments had been deemed too distressing for the person being assessed.

A further update was provided on the Mental Capacity (Amendment) Act 2019 which would introduce Liberty Protection Safeguards to replace DoLS resulting in significant changes to the those who the Council had responsibility for as well as the assessment process. The introduction of the legislation had been delayed until April 2022 but the Council was still engaged in planning for its introduction.

The Committee discussed the end-of-life arrangements under DoLS and the requirement for more regular reviews under the incoming Liberty Protection Safeguards.

RESOLVED – That

the report and the ongoing work to support vulnerable people within the borough be noted.

Jason Oxley, Assistant Director of Care and Health presented the report which set out the Council and the NHS approach to working with Care Homes to meet required national and local standards and regulations, particularly during the pandemic. The report outlined the approach that the quality improvement team undertook to improve performance to homes rated ‘inadequate’ or ‘requires improvement’ by the Care Quality Commission (CQC).

Members noted that the Committee had already held an in-depth discussion on care homes with an ‘inadequate’ or ‘requires improvement’ CQC rating when considering the Adult Social Care and Health Performance Report.

RESOLVED – That

the report and the ongoing work to support vulnerable people within the Borough be noted.

Members considered a report of the Director of Care and Health outlining the Committee’s work programme and seeking members’ contributions.

The Chair outlined to the Committee that in order to enable officers to focus on the Covid-19 response, it had been agreed amongst political group leaders to have reduced agenda content for committees moving forward. Therefore only items relating to budget, Covid-19 response and Local Plan/regeneration matters would be considered by Committee.

Members acknowledged the need to reprioritise officer resource and felt it was not appropriate to propose further items for consideration.

RESOLVED – That

the proposed Adult Social Care and Health Committee work programme for the remainder of the 2020/21 municipal year be noted.

Jayne Marshall, Lead Community Care Commissioner, introduced the report of the Director of Care and Health which sought the Committee’s approval of the Care and Support contract for Poppyfields Extra Care Housing Scheme to the provider outlined in Appendix D to the report.

The Committee were provided with the details of the scheme in Saughall Massie, which contained 78 self-contained flats. The care provider was to ensure 24-hour background support was available in the scheme to all residents. The report set out the procurement timescales following the tender process, and pending approval of the Committee the contract would commence on 15 March 2021.

The Chair outlined that Appendix D was exempt by virtue of paragraph 3 of the Local Government Act 1972 and the Committee would need to agree the exclusion of the Press and Public to discuss it.

RESOLVED – That

(1)  under section 100 (A) (4) of the Local Government Act 1972, the public be excluded from the meeting during consideration of Appendix D to the report on the grounds that it involves the likely disclosure of exempt information as defined by paragraph 3 ‘Information relating to the financial or business affairs of any particular person (including the authority holding the information) of Part I of Schedule 12A (as amended) to that Act. The Public Interest test has been applied and favours exclusion.

(2)  the award of the Care and Support contract for Poppyfields Extra Care Housing Scheme to the Provider to in Appendix D to the report be approved.