Transcript

meeting of the Adult Health and Social Care Policy Committee. My name is Councillor Arderncio and I chair this committee. The meeting today is open to the public and there are no items that contain exempt information. The meeting will be webcast and the recording will also be available for people to view latest through the Council website. It is also possible that Sheffield Live TV will record and rebroadcast this meeting. Please can I request that mobile telephones and other such equipment are switched to silent mode so as to not to disturb the conduct of the meeting. There is no fire test planned for today, there was one just before the meeting so if there is an emergency evacuation please take instruction from the Town Hall staff and the assembly point is to the square. I would like to remind everyone attending and speaking today that we are in the pre-election restriction period. This means that the Council has to be especially aware of its legal duty not to publish any material that might be seen to favour a candidate or party in the election. There is also a requirement to ensure government policy is presented in a balanced and even handed way. Publicity is given a wide meaning and includes matters said in Council hosted meetings. I therefore require everyone speaking today to confine their questions and comments to those strictly necessary to conduct the business on the agenda and not to stray to incidental or related matters that might breach the publicity restrictions. In addition, public questions and petition and member questions are not permitted during the pre-election period. Please could I ask each member of the committee to introduce themselves but before I do that actually can I pass on to Robert who's our legal person today to just add to that and just to explain. Thank you Chair and good morning committee I'm Robert Parkin, Assistant Director for Legal Services. I just wanted to resonate and amplify the points made about the heightened sensitivity period in which we are meeting today. Chair has run through the importance of the need to be objective even-handed and also to be reflective in the points made. The watchword is to avoid making points comments that are designed to influence voters specifically so naturally by examining the papers and considering them on the merits and on the officers points made one would hope that doesn't arise but but if members could be conscious of the need to reflect on when giving speeches to avoid saying things with which which could be interpreted as seeking to influence the voters. Thank you Chair. Thanks Robert. Could I ask colleagues to introduce themselves and I'll start on my left here. Thank you Chair. Councillor Ruth Nelson, I represent Crooks and Crossport Ward. Hello I'm Councillor Laura McLean, I'm a spokesperson for this committee and I represent Walkley Ward. Councillor Matt Dwyer, I represent Burley Ward. Good morning Councillor Julie Greco, I represent Stocks Beach and Upper Don Ward. Good morning apologies for being late I've been stuck in a bit of traffic. I'm Councillor Sophie Thornton for Beechiff and Greenhill Ward and Deputy Chair of the Policy Committee. Sherry Grant, Assistant Director of Legal Services. And you've already heard from me what we talk about in legal services. Alexis, do you want to introduce yourself again? Apologies to all, Alexis Chapel, Strategic Director for Adult Care and Well-Being. Rachel Marshall, and I'm Principal Democratic Services Officer. And we have Alan that does all the tech for us, very important. So our next item on the agenda is apologies for absence. I've received apologies from Councillor William Sapwell and Councillor Mick Rooney. Are there any other apologies? There should be apologies from Councillor Steve Ayres if he's not from them. Yeah. There are, as I said before, there are no public questions or petitions allowed in this meeting and item 6 members questions also. Those are not on. So item 6 on the agenda, sorry, item 4 on the, item 3 on the agenda is declarations of interest. This is different, my thing. It's confusing me. Item 3, declarations of interest. Are there any members that wish to declare an interest? Thank you, Chair. Can I declare an interest please on agenda item 13, emulation to home care. I'm in the process of going through that procedure with the family member. Thank you. Thanks Councillor Grawcutt. Those are noted. Minutes of previous meetings, these are on page 11 of the pack. There are two sets of minutes. One set is from our March meeting. So do members agree that these are a correct record of the meeting? I'm going to go page by page because I need to initial them. So on page, I assume it's 11 on the pack, sorry. So on the first page of that one and the second page and then page 13, 14. Councillor. When we go to page 13 in our pack, it goes on to the work programme. So we've just got the minutes from the meeting on the 15th of May. We haven't got any other minutes in our pack. Oh, okay. Sorry. Can we put these back to next meeting then if members haven't had them? Apologies, I have like three sets of things in front of me. So let's just do the minutes of the 15th of May, which was the AGM. So on page 11. So do we agree that these are the correct version? So page 11 and page 12, I assume. So, Rachel, will you make a note about the fact that we've not approved those minutes yet? Thank you. Thank you so much. Item five on the agenda is the appointments to subcommittees. So we just need to note this. So to note that on the 13th of May 2024, the Monitoring Officer, in consultation with the relevant political group WIP, has authorised the appointment of Councillor Mary Lee as a substitute member for the Health Scrutiny Subcommittee. And on the 7th of June 2024, the Monitoring Officer, in consultation with the relevant political group WIP, has authorised the appointment of Councillor Julie Brookard to the member vacancy of the Health Scrutiny Subcommittee. Members are happy to note and agree to those. Thank you. Work programme. This is on page 13 of your pack. As usual, the work programme is a work in progress because things get added and moved about during the year. And I'm just going to ask for members to kind of note it in a way. So the recommendations are on page 12, 14, sorry. The committee work programme as set in Appendix 1 be agreed, including any additions and amendments identified in part 1. The consideration be given to further additional adjustment to the work programme presented in part 2 of Appendix 1. The consideration to any further issue to be explored by officers for inclusion in part 2 of Appendix 1 of the next work programme report for potential addition to the work programme. And if items are referred from LACS, this should be highlighted to the Principal Democratic Service Officer to ensure they are dealt with appropriately. Members happy to approve those. Brilliant. And then I suggest that in next meeting, maybe we go a bit more in depth with the work programme. If people want to make any comments on it, we can do that then. Thank you. So we move on to the reports in the, you know, the more formal reports in the pack. So we go on to item 7, which is on page 27 of the pack is the Hospital Discharge and Urgent Care Delivery Plan update report. And we have Alexis, Ian, and someone else is going to introduce, and Sarah, if you could introduce yourselves when you start, and thank you. My name is Alexis, Strategic Director for Adult Care and Wellbeing. Good morning, everybody. My name is Sarah and I am the System Discharge Lead for Sheffield, which is a partnership post working across both health and social care. Good morning, colleagues. Ian Atkinson, Deputy Place Director within the Sheffield Place team of NHS South Yorkshire ICB. My role within the system is a joint Senior Responsible Officer for discharge from an NHS perspective. So I'm going to open and then I'm going to hand over to my colleagues. So we are delighted to present the discharge report today. This represents an update to committee on our progress in meeting our local ambitions. And before I hand over to Sarah and to Ian, I just want to actually do two things. Number one is to note a thanks to all the team across social care health and care providers and VCSE who on a day-to-day basis have been involved in supporting people to be discharged home from well, when they are well. And the combined efforts of our collective team to realise our ambitions. And I think I just want to note that first of all, because I know there's a huge amount of effort that goes on between our teams and really good joint work and locally to do that. And then the second thing is I want to draw out the report is actually our support to unpaid carers. We have made a commitment to make discharge personal locally in Sheffield. And I think this is particularly important because actually last week was Carers Week. And we have, as part of our ambitions, have very much tried to support unpaid carers. And I just want to draw that out for members also. And I think that's particularly important within this agenda because often it's unpaid carers or other ones who are very much supporting people through what can be quite difficult times. So that's it. So I'm going to hand it over to colleagues. Can I just comment before Sarah comes in, if that's okay, Chair. So just briefly to remind to members that this time last year, it's exactly 12 months since we came to present and gain support from members for our discharge improvement strategy across the Sheffield place. I think it's going through a second challenge in winter on discharge. I think it's really important, as Alexis say, just to acknowledge the thanks to all staff and partners across the system. Hopefully we're going to demonstrate through this discussion today and take questions in terms of that improvement journey we are on. We are absolutely keen to stress that this was a journey that we described over a two to three year program, not just a six to 12 month one, Chair. So thank you for just allowing me to say that. Okay, so it's over to me. Thank you, everybody. So in terms of this paper that you've got, there's obviously some of it's for update and we'll go through some of the detail of that. But it does also have a request around extension of what we call somewhere to assess beds. So they are beds that are made available, residential and nursing home beds that are made available for people when they're discharged from hospital for a temporary period of time. So there's a formal request within that. Obviously, the program has been running now for 12 months. I've been here since the middle of March. So the first thing to tell you is you now have a system lead in place, which is in line with the National Hospital discharge policy. And my role is to do that strategic approach across health and social care in order to make sure that we are doing things together more formally and actually alongside Ian and Alexis and Michael from the hospital. Just to make sure that there's some capacity in there to make sure the discharge is a priority. So we've now recruited that post is the first thing. In terms of where we'd like to try and get to improvements. Currently, people who are in hospital when they don't need to be there, and it's called the national languages discharge ready. Generally, that's about 17% for us in Sheffield, which is higher than we'd like. And we're aiming on a trajectory to get that down to 13% by the end of March in terms of some of the things we do. We're making good progress against that. So the last figures we had got us down to just under 15%. So it's already starting to come down significantly. It will go up in winter, because there will be that fluctuation, but we will try and do it. And in terms of the steps that we're putting in place to manage that through the program. They are the right steps to make sure they are happening. They are the ones that are nationally recognised as being best practice. So we'll just run through some of those. Just to give members a flavour, if we wanted to be sort of the best in the country, we'd be looking at around about 10%. Because there's always going to be some people. It does take a while to plan it, particularly when people have had a period of being unwell. The other thing that's really important to put out for hospital discharge, because it's really difficult for people to understand sometimes, is that criteria to reside means that you need an acute hospital bed. Just because you're discharge ready, it doesn't mean you're very well. And that's a very difficult message sometimes to have with people and particularly with carers. Your loved one may look unwell still, but they do not need to be in hospital. They can recover at home. And that's obviously a very difficult message to have and discussion to have with people. But it's just to remember that discharge ready doesn't mean you're better. Unfortunately you don't come out of hospital feeling better. In fact you often don't feel better until you're out of hospital. So just in terms of the things that we're doing, so in Sheffield we do really really well at getting people straight home from hospital. There's nationally a big fix on people are better off in residential nursing care than they are in hospital. And yes they are, but they're actually far better off if they can get them home with the right support. And in Sheffield we do really well against that. So the national target for that is 91% of people going straight home. So that's people that just go home because they've had an operation or an intervention and they don't need any support. But also people that go home with care and support. And in Sheffield if you look at the trajectory, we're traditionally and consistently above 95%. So we're getting 95% of people straight home from hospital. That's a really good thing to do and we are ahead of where actually people think we should be. We are also doing better on getting people home with what we call 'reablement'. So when people leave hospital they often need a bit of time to recover. And we say people often need an opportunity to have rehabilitation, recovery or reablement. That idea of getting better and we're doing better in terms of our approach on that. In terms of how we're actually going to make the difference, in terms of the steps we're taking. We are currently working on and it will be delivered by the beginning of July our first version of a single version of the Truth Digital System. And what that will do is bring together a place that pulls NHS acute hospital data to start with into a place that everyone can see it and enter into it. We will then expand that to think about how we bring in local and community health data and eventually mental health data. So we've actually started that journey. The tool is being built. It's going out for testing with the team this week to socialise it. So we've made that up pretty quickly in terms of we started this work about the middle of March. So actually we've got something very quick stood up in terms of supporting the work that we're doing. So that's a big step forward for us in terms of understanding our data and understanding what we're doing together. We are also implementing a care transfer hub. This is again something that's recognised as national best practice. We already have teams in the system that are working really hard to get people out of hospital. We have hospital social work teams, we have community health teams and we have internal teaching hospital teams. But they kind of rub along together. What a care transfer hub does is bring those people together to have a conversation around the person. So it puts the person back in the centre of that. It's a slightly different way of doing things rather than people doing things differently. So there's a change to do that we need to do in a steady way so that it works for people and so they feel comfortable with the journey. So we're starting with a few wards. We started that in the middle of May. We're already seeing that people are getting home more quickly than they were in those wards beforehand. And that's as a result of things like replying with people while they're still in their acute phase, so before they're discharge ready. So where we need to do things to make sure they can go home, we're doing those before they're ready to go home. We're having early conversations with families, earlier conversations with care providers and early conversations with obviously people themselves around what those discharge patterns might look like. And we're changing some of the structures of how we get people out of hospital to try and help people get home in a more timely manner. Obviously for some people they do need a bit longer, but people shouldn't be waiting as long because we are not as organised I guess in terms of how we do things. So we're starting to see some inroads and we need to think about how we make that the main scale model, ideally for winter. It might be still in progress in winter, but that's what we'd like to get to. When we are getting people out of hospital, we want to get people home. The language around hospital discharge is sometimes very complex, but we say if people just get up and go home with a family member, it's called pathway zero. If they just go out, same as they went in, we call it pathway zero. If we think someone needs support to go home, we call it pathway one and for our pathway one we have some good services in place which are delivered by health and social care. And we fund those to be free at the point of delivery for people leaving hospital under what's called discharge to assess. But we still do an awful lot of assessment in hospital which means people don't get home as quickly as we'd like. So what we're doing is tweaking that model and changing it and saying we want to go to something called describe not prescribe. So rather than looking at a person who's in a hospital bed and saying they're going to need four care calls a day to go home and then thinking we need to wait four care calls before we can get them home. We say actually we're not quite sure what you're going to need, we're going to take you home, assess you there and then if you need four calls, we'll put them in. If you need two calls, we'll put them in. So it means we're not waiting for care capacity to get people home. There's a safety netting around that in terms of what you do if somebody needs more care than you've got. But actually generally we've got a reasonable amount of care capacity we could pull on in an emergency if somebody does need more than is available. So we're just trying that out and do something different by reducing those assessments in hospital. You can get two or three days of assessment in hospital and then you can have however long it takes to get out. It might be three or four days before the capacity is available and then you get the person home and they didn't need any of that because they're used to furniture walking and tripping over their own carpet because it's their environment. They're really comfortable with it and they're not in an unfamiliar environment, you know, in their nightgown. So they're much more confident in their own environment and they manage very differently. So we're changing the way we assess people to try and help more people get home more quickly. But also if you take a person home to understand their needs, you'll put the right support in for them. If a person or potentially their family member hears from a doctor or a nurse that this person is going to need four calls a day, if they don't need that, it's very difficult to say when you get a person home they don't need that. Which means we're potentially prescribing care which causes us problems in terms of our overall care capacity. So it allows us to right size care in a better way. In terms of people who do need to go into a bed, and for us that is a small number of people. And we should, you know, we're on track for sort of 5% of people going into beds in terms of numbers. But the split of that you should be looking at, and it should be over 65s only, so it shouldn't be 5% of everybody. So there is a little bit of work we could do with that. 4% of those people should be going to something called a pathway to a bed. And what that means is they should have an active support within that bed to help them to recover to a stage where ideally they could go home. Or if they can't go home at that stage, they would go on to long term residential care. Only 1% of people should be going into what is potentially long term residential nursing care for the first time from the hospital. We don't quite have that balance right, although we have beds that we buy in nursing residential care under somewhere to assess. Actually the person goes there, they will have a follow up care act assessment at the right point or a continuing health care assessment if they need. But in the meantime there is nobody actively saying what is it you need at home, can you get out of bed, can you make yourself a cup of tea. Those things that you can do for yourself that would help you to get home. So most of those people will by default end up in long term residential care. So we need to just change our modelling slightly so that what we do is offer more of that enabling pathway to provision and less of that pathway to provision. Within the same probably number of beds, possibly slightly less, because we might get more through put. Which means we need to do something slightly different about how we wrap around. We need to think about intermediate care, supportive service to wrap around those people. And we do have some of that, we have some pathway to beds, they are delivered by Sheffield teaching hospital. They are quite traditional in terms of physical health and rehabilitation. So actually where somebody has broken their hip or had a mild stroke, they are focusing very much on that physical intervention. But actually if you think about the needs of people, we often have people where they have the start of dementia. They need to think about how they are orientating themselves in their home. They need to think about what their mental health is post Covid and how we can support carers to carry on and deliver that service. And actually it's a different type of intervention that they need, it's not necessarily actually we need to get you walking five steps. Actually what we need to do is think about do you need more technology in your home? What do we do if you do wander off in the middle of the night? Have we got things like the Herbert Protocol and other protocols around keeping you safe? And actually what can we do to support your son or daughter who is working full time and is also a grandparent themselves and trying to look after you and has been doing everything on their own. And how do you wrap around? So it's a different type of intervention that we need in those two beds to help those people actually be able to return home. Sorry I'll move on, I'm going on a bit. And then the final thing is just about pulling into mental health. So there is a separate mental health discharge programme, it's part of the same work but it's all set separately. And actually what we want to do is try and bring those together. We have had a peer challenge from the local government association on 7th June. What we want to do is have a look at not just hospital discharge mental health but look at wider mental health but the recommendations on discharge are things like actually you would benefit from offering discharge to assess out of mental health hospitals. Because actually that's what you do at physical health hospitals. But we need to do earlier planning for people in hospital around some of the complexities of the mental health act. And actually to do that if you use the care transfer model there's lots of really good model of doing it. So some of the stuff that's coming out particularly around hospital discharge from that review say you should be doing the same thing. And what we know is that a lot of people who are struggling to get out of our acute hospitals have mental health issues. And some of our people who are in mental health hospitals have physical health issues. So if we have the same set of services with a shared workforce that has the right companies and skills to support people across the board then actually what we'll do is be doing a better delivery for our system. And Alexis already talked about carers so I think that's it from me unless there's anything else that members would like to ask. Are there any questions? Councillor Crockett. Thanks for the report and I think it all sounds really positive and it's really good and we're moving in the right direction. And so thank you for that and thank you for all the hard work that you're doing. Just a couple of points from me when we're talking about people being discharged ready to go home. And it's just understanding how long those people are waiting before we actually get them out. Is it only a few days? Is it a few weeks? How long are they waiting? And what's the cause of that? Is it just capacity in terms of staff? Is it about training? What's the issue that's holding that up and how are we trying to sort of unpick that? So that we can then get on with all the planning of all the other stuff that you've talked about and also just a comment I suppose it's about trying to understand then. I think you mentioned it quite eloquently about the patients being discharged ready and then I like the idea of people having the assessment at home because I think that's the best and most suitable place for them to have that. How do you balance the making sure that they are discharged ready at that point while getting the assessment done in the home. I suppose that's just a bit. Just have some clarity about how you make sure you've got those bits right. Thank you. Okay I'll start with that last one because I think it's one of the biggest issues that people have of how would you take somebody home without knowing what they want and know they're going to be safe and it is a real worry for people. And what we have done as part of that is we've put with ring fence an intermediate care bed so if we get somebody home and they're really not safe we will be stepping up to that intermediate care bed. If for some reason that is full we would bring them back to hospital that person wouldn't have gone home on that day anyway so you know we don't see that necessarily as a failed discharge it's not what we want to do but we wouldn't leave somebody in an unsafe position. That being said we've been doing this now for about four weeks so it's still early doors and a very small cohort of people nobody's used that intermediate care bed yet. Because what we have is very good community services who actually do an awful lot of work to keep people out of hospital who are very good at keeping people at home and very creative around how they do it. And actually it's often even if you've got there and a person couldn't manage because they need a bed downstairs or they couldn't get in and out the back. Because there are often times you can bridge that with some things sometimes you might have to set people off for a couple of days but if it's a case of actually we think this person's going to need four calls a day and we can only put in three. But we know that actually at the end of this week we can put the fourth in. Families will often say yeah don't take them back to hospital we'll cover that a little bit because they know there's an end date they know there's something coming and actually that's okay. As we start to get more ambitious because it meant we're sending people home in that way and we've got a load of capacity still. We're not a load of capacity but we have enough capacity. The services haven't stopped for increasing capacity they've just made sure because we've got these slots it's there so we haven't had enough capacity. Where I've done this in other areas we did it because there wasn't capacity but we will start to move to what else can we do. There's a lot of work we can do as we come into winter about wrapping down differently and thinking about what we can do around things like our SGP services, what we can do around our voluntary sector in terms of some things that they might be able to do and how we can wrap around those things. So as we get more confident with doing it we can start to think about doing things differently. So that's that one. In terms of why people are in hospital and how long they're in hospital for after they're are discharge ready. Some of our data isn't as good as it could be on that so I think we just need to be upfront about that and part of the reason we want the digital discharge tool is it will help us plan together. Some people get home really really quickly. If all you need is to go home with a family member or all you need is a package of care restarting you'll generally go home the same day or next day depending on some of the internal processes like making sure you discharge letters ready and your medications there and everyone that's been through a hospital system. This is the Sheffield thing, knows every way you spend all day waiting for medication, you just don't. And that's not unique to Sheffield. If what you need is a more, you need some support at home we do have some capacity gaps in our services which is less about the service capacity that we've got. It's more about getting people off the other end. It's about how we get into all term care and some of that's been affected by the fact we've been re-tending our care at home contract. So we're hoping that will settle. The things that really challenge people are where they need something outside of the ordinary. So we get a lot of people who come into hospital where their houses have been neglected so things have been going wrong for a while and actually we need to make sure that we need to help them get their house into a fit state before they go home. Now if we know that, when they're admitted we can arrange that. If we don't know that's on the day they discharge ready they could be waiting a week, ten days, two weeks for that to happen. So this is where the early discharge plan will start to help with some of that. And there's also something to think about, not necessarily about hospital discharge but about preventative work. How do we get in earlier and help people so they don't get themselves into that situation and how do we make sure that we can support people with that. The other thing is where people actually haven't got houses so where things have been breaking down for a while for them at home. Again this comes after prevention so actually people potentially could be in a homeless route and if they've got care and support needs or if not necessarily got long term care and support needs but they're not very well it's very difficult to see presented homeless and we don't have sufficient supported accommodation that's not residential nursing care for people and particularly for younger people. And again that's not a Sheffield situation and one of the things coming into Sheffield compared to areas where it's a separate housing and adult social care function it's more challenging. At least in Sheffield we've got those things together and we're a city council. And then the final thing is mental health so there's lots of increase in mental health in the system particularly post Covid and actually how you support a person who doesn't need care and support in terms of washing, dressing, meal prep, in and out of bed. What they actually need is somebody to stop them from feeling anxious to help around things like drinking, making sure that they're taking medication. And then also to other social care perspective low level stuff but actually really quite complex so they're the things that really stirs down and then we do have a delay getting people into beds because actually you need a trusted assessment and then you need a care home for example. So actually beds is not a great option for people because actually that's the longest pathway out of the supported pathways anyway. Thank you Sarah. I have Councillor Nelson and then Councillor Dwyer. Thank you chair. About your role Sarah, I feel kind of I'm speaking from a place of ignorance but I feel kind of instinctively glad that the role is hosted by the council rather than by the NHS and because you know the continuing care of the person is kind of more than half the story it seems to me. I wonder how the relationship for you with our NHS partners feels at the moment and whether there's any challenges or particular successes already in that for you. And then I also wanted to ask about unpaid carers because I mean this whole committee has long recognised how important unpaid carers are in the system and it's you know it's been a priority for us to support unpaid carers more. And I just wondered about the Sheffield Carers Centre whether capacity is sufficient there or whether that's something that is going to need looking at sooner rather than later. Can I ask Councillor Dwyer to also ask his question and then we can answer it. Thank you for the work on this. I had a question on the quality impact assessment highlighting unpaid carers but Councillor Nelson has already covered. The report notes that there was issues recruiting the transfer care hub manager. Can you go into a bit more by that and then also the wards that were selected for the pilot scheme. Is there a chance that those would impact the kinds of wards those were would impact scaling this up further? OK. I'll try. I might hand some of the carers stuff over to her to submit. But just in terms of my role. So this is a nationally recognised role. It has it's quite an odd one. It was one I've done before. You have I have the joyous responsibility of being accountable to health and social care and holding health and social care accountable for discharge. So it's a dual role. So I have equal equal part challenge and accountability in that role. And it is interesting. It shouldn't matter and it doesn't matter which partner holds that post. It is about that. You are separate. You do sit out. I don't have the transfer of care. I don't have line. I don't have operational teams. I don't attend. I don't attend DLT. I don't attend whatever the equipment is in the trust unless I'm invited to. I'm not part of the operational management of each service. I sit in the management structures. In terms of the particular question. This is the second time since I started on in the middle of March. I'm on site of the council. I am at the hospital twice a week. I only do three days. So I'm at the hospital twice a week for most weeks. So I spend most of my time on site. But then it just I have an adult social care background. And therefore it's incredibly important that I have credibility in the health space. I think I have. I guess you'd have to ask the partners. But nobody's told me I haven't. And nobody's said back that anybody else I haven't yet in terms of that space. Just to add to that, Councillor Milson, I think there's a couple of things for members just to note. When we brought the plan through last year with all the kind of we want to move to discharge to assess, we think people should be in their own home. We were really committed, myself, Alexis and colleagues, that this was a joint plan for the Sheffield place that we all sign up to. And in order to do that, through my lens, it's alright putting it on a piece of paper, but actually there's a culture change. There's a commitment to joint working. And actually some of the, well, Sarah's role being one example, but when we're talking about the Transurf Care Hub Manager and other things that we're now doing in that space, to me it gives me assurance that we are still driving down that one plan and we'll continue to review it and we will kind of make adjustments to that plan over the period. And that's a different position to what we were in 18 months ago as a place, so I just wanted to kind of furnish it in the wider context of the fact that we've got this post. It should be hugely beneficial and should break down barriers across organisations and it's the culture that we're collectively trying to nurture across this pathway of dialogue, across all elements of the urgent care. We'll start from the front to end, thank you. Just to answer a couple of questions here in terms of both the post and also unpaid carers. What's been really important to us locally at Sheffield is the good relationships that we've got between ourselves and the Trust and the ICB. And actually we've really worked hard to go and develop these really good relationships between us at an executive level and also at an operational level. And actually what's really quite helpful about Sarah's post is actually the joint leadership between ourselves and Sheffield teaching hospitals, which I think is really helpful. Because actually what this also does is consolidates that joint work in, particularly between us as organisations. And already I think within the first few months of Sarah being in post, but also actually really implementing the plan, what we've actually seen is the momentum for change and actually driving forward the local ambitions that we are taking forward. I've always been ambitious for Sheffield and for the residents of Sheffield and I think this helps us to really very much deliver upon our ambitions. And fundamentally I think this from a people point of view is, I think it's a year ago actually, Ian and I were here actually, probably about a year ago actually now when I think about it. Ian and I came to committee a year ago to set our ambitions for discharge and we actually ended up using the media around that, which was quite good. And one of the things that was really important at that time we said we would do is very much focus on enabling people to return home when they were well. And thinking about that from a point of view of not only individuals but also family members and unpaid carers. And our commitment was to make the investments in the infrastructure and the support to go and do that and that's exactly what we've done. It's nice to see a year on from that that we're delivering upon that and this is where the cultural shift but also the strategic approach that we're taking as a city is really important. And recently we were nationally recognised for actually some of our good work which I'm pleased to say and I'm saying that in a repositive way around Sheffield. A bit around unpaid carers came up is we made a commitment as part of making discharge personal as our support to unpaid carers because for me what's been really important, and I'm going to say this as somebody who's actually supported a person coming out of the hospital himself, is actually that could be sometimes some of the most difficult time actually if you're a family member and unpaid carer because you're worried about what's going on and how's things going and so what we've done is in parallel to our work, what we've also done is said actually how do we work alongside the carer centre and also colleagues across the Sheffield teaching hospital to actually think about how do we support unpaid carers. And actually what we've done is actually worked with the carer centre and also health watch to look at patient experience and that patient experience programme is helping us to continue to go and improve how we support particularly unpaid carers. And last week actually we did, we actually had some lunch events in the carers week and we actually talked about very much is actually the passport that we're developing to help identify more carers, but actually also think about what supports we could also give to carers upon discharge and particularly in some ways it's that language, making the language very much more accessible for people, particularly in a time of sometimes quite a lot of stress that's going on. So I think that's been really important and alongside that, you know, for us I think we've got our carers delivery plan that we've committed and we bring six months of the updates to committee and that very much is reflected upon that so it's good and I'm really pleased to see that actually what we've done in the last year, we've actually had about a 50% increase now in referrals and in the identification of carers which shows that again we're moving in the right trajectory and the right focus around that so hopefully that's helpful. Thank you. Can we have the answer to Councillor Dwight and then we need to wrap up? Yes, absolutely. So on the Care Transfer Hub we were unsuccessful in appointments to that post which is also a system post, so that particular post is being hosted by the teaching hospital but with a view that actually it could be hosted by the council if there's no person. We have gone out for a secondment till the end of March to see if we can get some internal interest and I am leaving straight after this to go and do those interviews and we have applicants from both the council and the trust to visit this afternoon so hopefully by the end of the day we'll have somebody in post at the end of March. In terms of the wards that were selected, they were selected by the trust. I'm not sure what the rationale was but that was the wards that I was handed with but we're actually starting to look at what we need to do to think about scaling it up. We need to be a bit careful because there's lots of people doing discharge who are very anxious about what this might mean for me. We still need lots of people to do discharge. It's about conversations and culture and those things we need to change. So we will be thinking about how we scale that up but we just need to be mindful of those people in that space. In terms of the particular conversation on care responsible for discharge, the Health and Care Act 2022 put a legal obligation on trust to talk to people about their discharge plans and talk to carers about their discharge plans. It's not rocket science but hospitals up and down the country aren't very good at doing that and they have an obligation to do it. From the care transfer hub perspective, one of the things I've put on the proposal for what we might want to do when we start to think about it more generally is actually some specialist support on carers and some of those areas that we identify with. So we're looking at how we can build in some of that support for carers as part of that process and get the news from the carers in terms of what we're trying to capture of the discharge plan. Thank you. I am going to move us to the recommendations which are on page 28. So there are three. The first one is the committee notes the current performance in relation to discharge and progress in delivering phase one of the hospital discharge and urgent care delivery plan. Number two agrees a six month extension to the somewhere to access temporary care home beds and number three requested the strategic director of adult health and wellbeing provides the community with update on progress against the delivery plan in six months time. Are members happy with that? Brilliant. Thank you all so much and we look forward to having you back telling us more and having more time maybe next time. Brilliant. Yeah. And we go on to item eight on the agenda which is on page 45 of the pack is the shared care record. I think Dominic is here to present. Thank you. Good morning. Dominic Sleeth head of service digital innovation and ICT. This proposal is about the Yorkshire and Humber shared care record proposal is that we participate as a local authority. This is a national initiative and a regional project responsibility for delivering the shared care record is with the South Yorkshire integrated care board and Sheffield is a key participant. At the moment we know individuals data isn't shared consistently between the NHS and other organisations that play a role in health and social care. The Yorkshire and Humber care record is being developed to address that in order to share information in near real time. So that's information about health and care. The data that's shared will help us to improve individual care speed up diagnoses and plan local services. It's important to note that we're committed as a local authority to keeping people's data safe sharing it lawfully and securely and protect protecting confidentiality and that's part of this project. We'll be working with a wide range of partners across South Yorkshire. This includes all four local authorities all NHS trusts GPs across the region and the Yorkshire Ambulance Service. The data that's shared is defined by the public record standards body individuals data practitioners data locations and organisations involved in care. The care record is underpinned by interweave technology which is something which as a local authority we don't have experience of. It's an NHS owned version of an open platform set of technologies. So therefore we will require support and consultancy in order to implement this. The information that we share will come from the social care system liquid logic and for our practitioners working with individuals the shared care record will be accessed directly through liquid logic. The way that works is that a practitioner will be in a care record they click through directly into the interweave portal. It's launched with single sign on so there's no further authentication required and it pulls up the individuals data from the shared care record. This includes efficiency and also data security. The initial set up costs are estimated at 92,000 or up to 92,500 pounds and it's anticipated that that will be covered by the ICB. We're undertaking work to confirm that and the governance around that. As I said before we will require technical consultancy in order to set that up. The cost to the council is likely to be around 10,000 pounds. There will be ongoing costs of up to 35,000 pounds to support and maintain the virtual server and also for licensing. That will need to be covered under business planning. Once in place the shared care record will help us to meet our care act responsibilities to promote health and care integration. It also supports our adult social care outcomes. It helps us to understand the needs of patients and people receiving service and it also helps them to make the best decisions for their own wellbeing. An equality impact assessment is in place and that will be reviewed throughout the project. In terms of the legal implications, under the care act and the children's act we have a legal justification for assembling and processing data in order to enable the delivery of services. As well as that, as well as the technical and practice work streams to the project there will be an information governance work stream which will make sure that we are compliant with all the relevant regulations. For the summary, this decision enables the council to participate in a regional and national program that will benefit people receiving care and treatment in Sheffield, across South Yorkshire, across the region and eventually nationally. Thanks Dominic. And it fits in with what's happening regionally as well and nationally obviously is a real kind of key to need the data sharing. Are there any questions from colleagues? Councillor Doyne. Thank you, this feels like a really good piece of work. You said that the cost for set up would be anticipated to be covered by the ICB and so this brings on the question of if the program costs go over, who is liable to pick up those costs? So the costs which are included there are the maximum threshold for those costs. So I understand that if it was to go over that then I'd need to come back for a further decision. There'd be consultation with the ICB. All the indications are that the ICB would be likely to pick up those extra costs but I don't anticipate that it will go up to that. We're looking at the ways in which we use the technology. I would expect it to come below that cost. Thank you. Can I go on to the recommendations? They are on page 46. There's only one that states that the Health and Social Care Policy Committee approves the Sheffield City Council's participation in the share care record at an estimated initial cost to the council of £10,000 and a cost of £35,000 per annum. Thank you. Thanks Dominic. Thank you very much. And we move on to item 9 which is the adult future options commissioning program. This is on page 61 of the pack and we have Christine and Andrew presenting. Good morning everybody. Morning. Thanks Jo. So I'm going to present this report to the committee this morning. Thank you for the invitation to meet you again. Just to give an introduction, my intention is just to summarise and give the headlines because I think the report is reflective of a lot of work that's going on and evolving in this particular space in terms of meeting the support needs of people with a learning disability in Sheffield. So the report is seeking our approval for a commissioning strategy for an overarching enhanced care framework which would include lots for emergency overnight short breaks, enhanced care and accommodation and shared lives. It's fair to say that this is a changing picture and since we last came to the committee last year to talk specifically about emergency overnight short breaks, we've continued to learn and gather more evidence and data about how we need to best meet the need of the learning disability population in Sheffield. I'm going to just give a summary of where we are in terms of the adult future options framework for adults with disabilities in Sheffield and the enhanced living framework. The proposal is underpinned by our Learn Disability Strategy, Hear Our Voice, which was approved at committee in November 2023 and was developed, as you'll remember, based on a very successful engagement project and co-produced with individuals, carers and stakeholders. It's also set this proposal in the context of our legal duty under the section 5 of the Care Act to ensure that we've got sufficiency and diversity in the market and a choice of high quality services, particularly for this group of individuals who often have very complex support needs, which is from cradle to grave. So our key next step is to further develop our offer in terms of emergency overnight short breaks, our shared lives offering placements and specialist accommodation, which will include enhanced supported living and residential care, which is of a specialist nature. So currently we've got two commissioning frameworks in place supporting people with a learning disability and/or autism, either in their home or other settings and in the community. The adults with disabilities framework has now been live for just over a year and the contract term is for seven years and that covers supported living, activities outside the home, which includes daytime services and overnight short breaks. We've also got an enhanced supported living framework, which went live last January and is due to expire in 2027 and that replaced a regional enhanced supported living framework, which was jointly commissioned with South Yorkshire ICB and on the expiry of that we decided to set up a local framework. So that's for people that are over 16 with a learning disability and/or autism with behaviours of distress that may significantly challenge themselves and the environment that they live in. The enhanced supported living framework has enabled 18 Sheffield citizens with complex support needs to actually remain in Sheffield and to move away from looking at out of area placements, so there has been some degree of success, but as I mentioned we now want to take those next steps and expand on these successes. We have an enhanced supported living scheme in Sheffield, which was funded with NHS Capital funding, which is, as we speak, this month will be full and that is achieving great outcomes for people with more enhanced supported living needs. We also have a very successful scheme for five young people with very complex autism behaviours of distress, which again with NHS Capital funding has now been up and running for a year and we're already seeing amazing progress for some of those young people who are now looking at moving on to more independent living. These frameworks, as I say, as they've been implemented and we're working with them and they're evolving, we've identified that there is still a need for an enhanced care framework, so to enable us to develop emergency overnight short breaks, shared lives and more enhanced care with accommodation and include residential care as well as supported living. Underpinning this, we have got a South Yorkshire Regional Market Position Statement, which has identified that on average Sheffield requires 21 new supported living units each year over the next 10 years. We also, what we're factoring in, is the number of Sheffield people that we still know are out of area. We have 195 people currently placed out of the city of Sheffield, although it has to be said that a number of those are, the vast majority are still in the South Yorkshire region. But we want to enable people to have that choice to be able to move back to their home town and we recognise that we need to expand on the offer that we currently have. People are placed out of area for several reasons. That would include emergency placements where we haven't got vacancies in the city, but sometimes it has been because we haven't had the expertise currently in the city and we want to bridge that gap. We're currently doing a deep dive on the data that we have and we're updating that data in real time in terms of the out of area placements and that will inform our commissioning strategy moving forward. I just wanted to mention as well in terms of regional initiatives that are in train, we are currently out tender for a safe space provision in the South Yorkshire region and that will provide three units for people with very specialist support needs to have an intensive period of work in a safe space. And work with people in their support and a clinical team to enable them to move on after the period of crisis has ended, that is out tender currently. We also have plans in place for developing accommodation in city. We have an accommodation with care pipeline which we're looking at over the next two year period and again it's a rapidly changing picture which is looking very positive. We've developed an analysis tool to look at developers proposals in line with CQC recommendations of right support and with some success. So we have quite a healthy looking pipeline which again will hopefully enable us to meet our targets that have been set in South Yorkshire market position statements of 21 units per year. I don't know if you wanted to add something about Shared Lives, Andrew there as well. Thank you. Shared Lives has been one of our successful services that we offer and we've offered for a long time. I think I've sent reports or spoken to yourself Andrew and other cabinet members recently about where we've changed things considerably and enhanced quality of life for people. In particular there were plenty of young children with a disability that were in foster placements and had a learning disability or a physical disability and in previous years those people have come into adulthood and probably have gone into residential care settings or supportive living schemes. Over the last four or five years we've taken a lead in preventing that wherever we possibly can. It's a very person-centred approach. I wouldn't like to give the exact number because it's consistently changing but there are tens and tens of people who no longer have to go into residential care or supportive living and stay within the family where they've grown up. So that foster placement has now become a Shared Lives placement and we've probably got some of the best approaches to Shared Lives in the entire country. This is not just a local regionalised thing, Shared Lives is a national service obviously, but we've been looked at about how we've done that and where we're getting to. And it's encouraged complex needs to be able to stay into one place by support from health colleagues and the community learning disability team etc. Shared Lives is an extremely difficult area to grow. As in children's services with foster placements it's a strong challenge. Sometimes it's extremely hard work and no rewards, other times it's quite rewarding and quite supportive. But we are taking a lot more complexity of need and I think there's the challenge. We've got a continual recruitment drive with South Yorkshire at the moment about Shared Lives. We're not standing alone in this, we're standing across South Yorkshire and it's starting to show some really, really good results. We have services that we can be very proud of as a council that you've supported in the past and I think Shared Lives is one of those. For any of you who don't know, we're more than happy to put some display on. I think we've done so previously down the road, we've put some events on. And if you can get the capture of the feel here, it is an extremely well run service that gives the alternative to an improving supported living and residential offer, that's absolutely clear. But we're also using TechCare and they're pausing a building at the moment. We're using TechCare to support those placements with a much more enhanced approach and positive outcomes. But before people would have definitely gone into residential placements, that's not the case any longer. So it's a big challenge to us to keep that going but it's heading in the right direction at a good speed. Thank you. Thank you. I just wanted to continue by touching on emergency overnight short breaks. As I mentioned, we did come to committee last December and just as a further update, since then we have done a soft market test with our short breaks providers and our enhanced supported living providers. It's fair to say that there is little appetite for further development but as we mentioned before, this needs to be a multifaceted approach in terms of improving the emergency overnight short breaks offer. We know that the greatest unmet need is in the 18 to 25 year old age group, so working with our colleagues in the transitions team, social work colleagues, to be able to project and predict the needs of people in the future. Given the unmet need, we have developed our in-house provision with success shared lives is another option that we are considering. There are further developments due to launch this year working with two of our framework providers. Although they won't be offering emergency overnight short breaks, it is further developing our overall offer so that it hopefully free up some capacity for the in-house provision. We are also negotiating to residential care providers to potentially look at block funding some beds for emergency overnight short breaks. It comes with its own complexities because the people that we are talking about here have very enhanced level of support needs. So it's not just a local issue but regionally and nationally it poses its own challenges, not so much in terms of the support but the accommodation that is available to support people in a safe setting. So in terms of the commissioning strategy, the proposal is to establish an enhanced care framework which would include lots in a similar model to what we have got with the adults with disabilities framework for shared lives care as emergency overnight short breaks. And what we are calling accommodation with care because that would include specialist accommodation either in a supported living or residential setting. In terms of engagement and co-production, we have got a working group which has been run very successfully and that's reporting back and accountable to the Learn Disability Partnership Board and they are looking at developing a specialist accommodation plan. The plan is for the specialist accommodation plan to come to approval by committee in September this year. So that's the headlines that I wanted to really go through today. So it's to seek approval for our commissioning strategy. Thank you. Are there any questions? Thank you for a really comprehensive presentation. So we go to the recommendations that are on page 62 of the PAC and the recommendations are as follows. The committee knows the progress in implementing the adult future option working age framework. I post the proposal to develop an enhanced care and accommodation framework to ensure sufficiency of provision for emergency overnight short breaks, supporting living and shared lives in the city. And request that the strategic director of adult care and wellbeing provides the committee with an update on progress against the future option delivery program in six months. My colleagues are happy to approve those. Brilliant, thank you so much. Can I just thank everybody again. I know we've been here several times but it's really pleasant to see that you're supporting where we're trying to get to and I know that a lot of you have got personal interest in this area. So it's really valuable to us that we feed this back and we do, so thank you. Thanks, Andrew. We're going on to item 10, care governance and performance framework update and I believe Liam is presenting on this. Thank you. Morning everybody. Liam Duggan, Assistant Director, Care Governance and Financial Inclusion. So we're here with the update to the care governance strategy, performance management framework and the cycle of assurance. So the care governance strategy, all three documents have been reviewed and updated for 2024. Firstly the care governance strategy which is overarching and strategy for adult care and wellbeing care governance was approved by committee in June two years ago. Its purpose is to provide a comprehensive framework of assurance and accountability for all aspects of adult care and wellbeing. We made some changes to the framework this year, making the framework more robust and more consistent across each of its five domains by bringing in the cycle of improvement into each domain and describing how each of those parts of the improvement cycle will operate in those different contexts. What we'll see in future iterations of the strategy is that cycle develop out, so we'll be getting more and more prescriptive about how we expect the governance process to operate in each of those five domains. We've made a significant update to the statutory regulatory compliance domain so that it describes in more detail how we will give oversight to the directorate's care act responsibilities through alignment with the new local authority information return which has emerged over the last 12 months and the ADAS getting ready for assurance checklist which we've also been working to. The updated care governance strategy is at appendix one. The performance management framework sits within the care governance strategy framework and it aligns with our adult social care strategy and our local and national outcome measures. The performance framework has been redrafted. We've tried to reduce and simplify it so that it more clearly articulates the process of improvement through each of the parts of the improvement cycle. Some of the changes are to incorporate and reference the council's performance framework and new council plan and we're also going to do a little bit more information about the performance dashboards and outcome indicators. We've also updated the cycle of assurance with some very minor changes so that it remains current for 2024/25 and that's it. Are there any questions? I just want to make a very brief comment because I'm a bit parroting myself but just to say how very glad I am to see, I'm sure everyone is, to see the emphasis on the whole workforce involvement in continuous improvement. I've said it before, we've all said it before, I just wanted to underline that for the record. I think it's really vital, it's so good to see it running throughout the whole government system. Thank you and I think we had a really long conversation in one of the briefings. Lots of the tweaks to the reports before they come to here and they happen cross party so thank you for all the work on this. The recommendations for members are on page 77. So the Adult Health and Social Care Committee approved, we are asked to approve the updated care governance strategy, approve the updated performance management framework and approve the updated cycle of assurance. Are members happy with that? Brilliant, thanks Liam. And we can go on to item 11, which is the Adult Care and Wellbeing Budget Risk Management and Financial Governance and Jonathan is presenting this one. Good morning everyone. I'm Jonathan McKenna-Moore, I'm the Service Manager for Business Planning and Governance and I'm here today with the quarterly update on the budget but this is also an annual report that we do every June. That is to explain the constituent parts of the Adult Social Care Budget. So that's both the income, which you'll see broken down in table 1 and then how that spend is distributed, which is in tables 3 and 4. There's some additional explanation of how that spend on services is reduced by income and how that varies across the different service types and that's explained in table 5. Our last report was at the end of the last financial year. So there's an update on the final out turn for Adult Social Care, which was a 3.1 million overspend, which is the best out turn we've had for a number of years. A history there of the last few years since COVID and the increased costs we saw as the impact on that. So it's returning to a stronger financial position there. As we've described to committee in previous reports, a lot of the new income that made that out turn possible has now been absorbed by inflationary costs and demand pressures. That has an impact on this financial year. So table 6 summarises the plan savings that were all approved through council for this year. As you can see, this mainly relates to that income transferring into the permanent budget. Alongside that, we have a recovery plan to address the 17 million pound pressure that's been carried forward. And there's a summary of the activity that's underway across our services in order to deliver that by the end of March next year. Section 1.5 gives some more detail on the better care fund that is referenced as one of the lines in the income and table 7 sets out the different parts of the BCF. And you'll notice the majority of that is actually a nominal amount from both the council and the NHS. So while things like the disabled facilities grant and discharge grant are specific sums of money that come into the council. The majority of the better care fund is actually nominal amounts that are monies that we both spend that meet the requirements of the better care fund. So it's not additional income. It's just describing how that money is spent under that remit. And then finally, there's a recap on our plans for governance improvements that links to the plans that we brought previously to committee and the items that are due for delivery this month. Most of which are contained within the paper itself. The last item is scheduled reporting for the year ahead. Any questions? Thanks Jonathan. Are there any questions from members? Thank you. It's a really, really clear report. I think we all kind of got used to the reports. It's very interesting and obviously we have challenges ahead but it's like we are preparing for the challenges. I look forward to seeing the schedule when we're looking at the recovery plans. Alexis, do you want to come in? I just want to say thank you to Jonathan and the team for all the work around budgets. I think it's been a miraculous work over the last few years. I also just want to note for committees that we will also rescind the recommendation that has any other recommendations as well at the end. Yes, on the recommendations which are on page 114, the last bullet point I suggested in pre-meeting that we take out because it just slipped in from notes. I think it's a vague recommendation. We can't really agree to that. But it's one of those that nobody knows how it's got on there. The recommendations on page 114 are as follows. The committee notes the update to the financial forecast for the delivery of savings into 2024/25. Note the upturned position for 2023/24. Note the overview of adult care budget and current user resources. Note the user resources delivery plan update. Note the schedule of reporting 2024/25 aligned to financial regulations. Request updates on progress with implementation throughout budget delivery reports for future committees. Are we all happy with those? Thank you. So Rachel will take in the last one. Thank you. Thanks Jonathan and the team. We move on to item 12, the DASIN strategy delivery update. And we have Rebecca and Andrew. So I'm Rebecca Dixon. I'm the service manager for Care Governance and Improvement and this report is the DASIN strategy delivery update. So I'm just going to run through and give you the key highlights from that. This report is scheduled as part of our performance and governance framework. We last presented this in March. This one will provide an update on our preparation for CQC and our self-assessment. And also demonstrate how impact is being measured in enabling citizens to live the life they want to live. Our focus continues to be on the delivery of outcomes and working in genuine partnership and very much underpinning this as a culture of proactive performance management and assurance. Our improvement journey is evidence-based and informed by the voices of people who use services, their families and those who need experience alongside our workforce and partners. The highlights for the last quarter include a quality assurance process for adults with a disability and a refreshed joint health and care quality assurance framework residential care. A co-designed programme for Carers Week which is a number of events for citizens and professionals to learn more about the support available and network etc. Transition to the new care and wellbeing service which will improve our home care provision and help to provide flexible care based on people's individual needs. We had a health adult care and wellbeing conference in May which was city-wide for colleagues and partners which focused on safeguarding including domestic and financial abuse. In terms of the partnership and strategy delivery programme to embed our commitment to partnership and collaboration with further developing the partnership board. And as part of the last quarter we had two system-wide workshops in April reflecting on what works well already and where we can strengthen our approaches to collaboration. Over the next 12 months there will be more workshops to harness opportunities for collaboration focused on disability friendly city, our climate goals, quality of care, early health and prevention, living and ageing well and safeguarding. In terms of CQC, CQC are now publishing the local authorities, they're due to assess. We're still on standby so we're not on that list just yet. So same timeframe, we'll receive the notification and have three weeks to return the local area information return and the self-assessment and then a six to eight week timeframe after that three weeks to prepare for the assessment visit. So we're looking post summer which is good I think because logistically trying to organise lots of interviews and visits and things over the summer when there's obviously more annual leave and things would have been a bit of a nightmare. In terms of the self-assessment, that's been out for consultation and we've been doing lots of work with the workforce and teams to really get people's views and input on the self-assessment. It's currently being refreshed, fundamentally it's the same in terms of the strengths and challenges identified but obviously it's updated with the data and there's a much bigger focus on the I statements because we really want to embed that commitment that people are at the heart of what we do. Over the next few months we'll submit the self-assessment to committee, the council's leadership team and other partnerships for agreement as part of demonstrating our local commitment to its content and delivery focus. In terms of horizon scanning, the Department of Health and Social Care are planning to publish waiting times for adult social care assessments and services broken down into service types, so community, residential, nursing. This comes after ADAS surveys recording 400,000 to 500,000 people waiting for an assessment review of direct payment care package at any one time and also showed a doubling in waiting six months for assessments from 41,000 to 85,000. In terms of our approach, we've presented previously to committee around waiting times and we're really focused on developing and building our understanding of why people are waiting and social care's role within that and how we can enable those waiting times to reduce. Just a quick overview of performance highlights, we have new measures now as part of our dashboard for SCAS, the Social Care Account Service, to measure the impact on access to support alongside transparency and fairness in adult social care charging. Our individual carers satisfaction engagement user survey results are back in, so we sent 1,861 and received 500 responses, which is a good response rate to actually have tangible measures from that. Six measures have improved, two remain the same and combined with our recent carers survey and I statements, that really shows a continued improvement and bringing us closer to our comparators, which is positive in terms of satisfaction and engagement. In adult performance, the target operating model has been successful in restructuring social work teams into specialisms and a number of highlights there, safeguarding contact screen within one day are up to 72% in May this year compared to 51% in March this year. In some areas there's been a change in directory and that includes median days to complete S42 safeguarding, number of dolls awaiting allocation and median number of days to put support in place. We've got clear improvement plans around those, we have comprehensive and evidence based understanding for changes, why things have changed and we've completed that work. It's largely around things like increased demand and recruitment and retention of staff, increased acuity of individual's needs and the number of people presenting at front doors such as A&E, GPs and first contact. And also the impact of the timeliness of our case management system which does actually skew some of these figures sometimes so people can appear when they're not actually waiting. As I said we've got clear improvement plans in place to address these challenges alongside increasing our resilience. Obviously we have the hospital discharge paper earlier in this committee and there will be further committee papers on safeguarding and dolls coming forward. I'm going to pass to Andrew to talk about complaints. Thank you. So I'm Andrew Drummond, Service Manager for Safeguarding Quality Assurance. I'm just going to give an overview on complaints and update. So with complaints we continue to have a really proactive approach, learning from complaints and embedding that into our improvements. We're at the lowest level of open complaints in several years which I think really evidences where we're resolving things early on, speaking to the person or their representative which shows a clear improvement. One of the things that we've done since we last came to committee to discuss complaints in January earlier this year is we've built a complaints delivery plan which we'll be bringing later in the year to really evidence that journey and to evidence CQC where we learn from learning from what we need to improve on in relation to complaints. We're awaiting the corporate report on complaints and that will be embedded into the next time we come and talk about complaints which will be later into the year, early next year for six months time and we'll be able to give wider information at that point. Excellent. Thank you so much for the report. Are there any questions in terms of any of the items? Thank you. Brilliant. So the recommendations are on page 126. It is recommended that the Adult Health and Social Care Policy Committee notes the progress in delivering upon the adult care strategy living the life you want to live. Notes the strategy delivery programme at Appendix 1, notes the adult care and wellbeing performance, notes adult care and wellbeing update in relation to complaints and complements and notes the progress in consultation and engagement on the CQC self-assessment and our preparations. Are members happy with those? Brilliant. Thank you. And we move on to item 13, which is on page 143 of your pack and Catherine and Paul presenting. Hi, I'm Catherine Bunton and I'm the Assistant Director for Commissioning and Partnerships. And I'm Paul Hinkingbottom, the strategic commissioning manager. Thanks for having us here today. The report provides a committee with an update on the care and wellbeing service for the provision of home care in the city. And that's summarised in sections one to three. It also seeks approval from committee for our commissioning intentions for the provision of home care alongside this contract and the rationale for that is set out in section four. Within section three and at three point six, the report notes how the development of technology enabled care is critical and central to our vision for home care in the city. So we're seeking committee's approval to commission a tech call monitoring system as part of this report also. In brief summary, the care and wellbeing service contract is a significant change in the way that the council provides and delivers home care for people. We'll be working with 14 providers across 16 contract areas in a collaborative way to improve the quality and the consistency of care. And that's about moving from a framework arrangement where providers can be in competition and the process and our capacity is focused on process and brokerage. And we're moving that to spending our time and providers' time working in partnership to improve people's experiences of care and their outcomes. In the first month of June, first week of June, just a couple of weeks ago, we saw about 2,000 people see their care provider change. And that was managed through hard work and commitment of our commissioning teams, our social work teams and the providers themselves. We took a really person-centred approach to having lots of conversations with people and their carers and their families and providers to make sure that they knew what was happening. And where we're making decisions based on their needs and their preferences. There's lots of detail in the report, but we're happy to take any questions. Are there any questions? Obviously, we've had updates regularly of the whole process and I assume that after the period, people will be more kind of at ease asking specific questions. So probably we'll have an update later, maybe in September, like to do like a quarterly report on this. Oh, sorry. I was just not so much a question, but just a comment, because obviously, like you say, we're under purpose at the moment. But I think it's important to acknowledge the amount of work that our office of talent has gone into this in the last few months to make sure this is a smoother transition for people in our city. And we can acknowledge that today and say thank you, really. Yes, thank you very much. But we'll do more formally with the details later when we have a bit more data. But I just wanted to comment on the fact that the providers have changed. It doesn't mean that the staff have changed because the staff have all been chipped over. So it means people are not actually necessarily changing who's providing the care for them. It's just that the provider is different. So I just wanted to clarify that. There were approximately 900 to 1000 staff transferred into 2PIC. So we're in a bed-and-down phase with the new contracts. But there were an awful lot of new recruits as well. There's been some very helpful recruitment pipelines, more people on foot. So I think that's a really positive change for Sheffield as well. Thank you. The recommendations are on page 143 and 144. Sorry, they are on page 144. It is recommended that the Adult Health and Social Care Committee knows the outcome of the tender for the Sheffield's care and wellbeing service contracts and mobilisation transition to the service, which went live on the 3rd of June, 2024. I propose the commissioning of a home care provision to run alongside the care and wellbeing service contract and to know that a tender process will follow. This will enable the council to procure individual packages of home care and people living in Sheffield and in case our provider exits tender for a case and wellbeing patch in a timely way. I propose the commissioning of a 12-month contract with the option to extend for an additional 12 months for the provision of 24/7 tech monitoring services and to note that the tender process will follow. And to further note that this will allow the necessary time to commission our tech service delivery model, which will be implemented, subject to approval, on Monday 8th of September, 2025. Are we all happy with those? Brilliant. Thank you. Thank you so much for the report and we're moving on to item 14, which is providing support to market sustainability and commissioning plan update, which is still Catherine and Paul. Yeah, thanks. It's still me. So this report is part of the regular updates that the commissioning and partnership service brings to committee. There's seven recommendations within the report that sort of fall into the categories of noting the progress we made, asking for committee's approval of our priorities for 2024 to 2026, and one approval for a PA sleeping rate. Section 2.2 notes the work that's ongoing to provide an update on market position statements so that we're clear with current and potential providers of social care in the city, what needs we have, what our values are, and how we think the next five to ten years will look in terms of commissioning. Section 2.3 and Appendix 1 provides assurance to committee that previous decisions made over the course of the last two years have been implemented, and that provides assurance to the public as well, so it summarises what we've done following all of your approvals. Thank you for those. Section 2.4 and Appendix 2 is updated commissioning priorities. We did bring that last time, but since then we've had some workshops and further engagement, so we keep those reviewed and as up to date as possible. Section 2.5 is a summary of our adult future options commissioning programme, which Christine and Andrew already presented, and 2.6 is an update of our living and ageing well commissioning programme, and that's due to come in September with more details and specific recommendations there. And then finally, Section 3 notes our wider approach to ensuring that our provision of care in the city is of a high quality, and that includes the request to approve a sleeping rate for PAs connected to our personalisation agenda. And then just a note really to apologise that there is no Section 4, and the report jumps straight to Question 5, which is just a numbering issue during report writing. Thank you. Catherine, would you just mind explaining why we are suggesting the sleeping rate for personalisation, just for people out there who don't know, so we make a lot of assumptions, but it's just to clarify why we're doing that. Yes, certainly. So this aligns actually with the sleeping rate that we have around supported living as well, so people who are employed by people with personal budgets provide care aligned to their own support plans, and some people will have care that requires their PAs to be awake at night, and that has a rate attached to it, and other people just need somebody in the house, but they're able to sleep. So there's a court ruling that allows us to set a specific rate around that, and that's what we're asking for, and it also helps to empower people actually who have personal budgets to act as employers, and to use their budgets to their best outcomes. Thank you. Are there any questions? Okay, so there's seven recommendations. Sorry, Councillor Doyne. Sorry, can you just explain, so is the sleeping rate paid, is that the amount we're paying for a service to providers or to the PAs directly, or is it to the... Sorry, apologies. This is the rate that a personal assistant who would be employed by somebody who receives a personal budget would get for providing a sleeping service, so it's down to £77.95, and they would get that through their employment with the person that has a personal budget. I may have just, because it noted that one of the risks is that reputational damage, but does this mirror what other local authorities are doing, particularly close by ones, because obviously it's not too far if you were a PA to move to rather than for work? Yeah, absolutely, but it does mirror a pattern across lots of local authorities. I would have to go back and double check, which I will do, and I'll come back to Committee on exactly what our neighbouring authorities would do, but it is as well, it aligns with, as I said, what we're doing with our adult future options commissioning strategy and the rates for supported living as well, so it brings equity there. Thank you. So the recommendations are on page 190, and there are seven. So the first one is note the outcome of the commissioning strategy decisions made at committee and with delivery of commissioning priority in Appendice 1. Approve adult commissioning priorities for 2024-26 at Appendice 2. Approve the sleeping rate for personal assistance of £77.95. Note the development of a living and ageing well market position statement and programme to bring together all commissioning and delivery programmes relating to living and ageing well into one programme, inclusive of the care and wellbeing services, service development. Note the work and the way as part of the adult market position statement to market shape and to stimulate a diverse range of highly quality services, both in terms of the types of volumes and qualities of services and the types of provider organisation to ensure the market remains vibrant and sustainable. Six, note how quality assurance will be assured in commissioned and in-house provision and priorities for 2024-25, including review and design of brokerage services and contracts to ensure quality outcomes and safeguarding outcomes are met. And finally, request that the strategic director of adult care and wellbeing continues to bring regular updates to the adult health and social care policy committee and can I suggest that we have the first one in six months time and then we decide that could we, can we say in six months time for number seven? Are people happy? Yeah. Are people happy with that? And then if it's too often, we can then change. But at least if we have a six, because if we've got the new providers in, it would be good to see how it's going in six months time. Members happy to approve those? Brilliant. Thank you so much. And we move on to the final item, which is item 15 at 2023-24 final upturn position. This is on page 213. And we have Jane presenting this item. This is the same item that will go to all policy committees. So it's from the finance people. Thank you, Chair. I'm Jane Wheelby, Assistant Director of Finance and Accounting. So the purpose of the paper is to give the final upturn position for 23-24. As the Chair quite rightly says, the full position is presented to the finance committee, which is later this afternoon. It's also worth noting that the position is included in the annual statement of accounts for 23-24 and a draft of which was submitted in line with statutory deadlines for the 31st of May and is published on the Council's website. This is the primary part of the 41% of Council's nationally to hit the deadline for a consecutive year, noting that for my former Audit Committee members, which I can see a few of around the room. So overall, the Council did spend 15.6 million over against a net revenue budget of 497 million, which was a variance of 3.1%. So between the quarters, the early Quarter 1 forecast indicated a 17.6 million overspend, which improved by 2 million throughout the year. The relative stability in the forecast, which is shown in Chart 1.3, shows a good commitment of Council officers to financial management and some realistic estimates of service costs. Improvement was largely due to corporate underspends through sustained improvements on our interest income from Treasury investments, and this did provide £6 million of mitigations for our increasing unfunded overspends. The challenging underlying budget issues remain for the Council in children's services, SCN transport, adults' care and wellbeing, and homelessness services. Children's services have been faced with increasing costs of external residential placements and persistent demand for SCN home to school transport. The homelessness situation arisen due to the hotel and bed and breakfast accommodation being used to support our homelessness duties, where a shortage of affordable housing in the city has pushed families and single people to crisis point. Government legislation around housing benefit rules means that the Council is subsidising the cost of the provision without funding or available budget, leading to an overspend of 8.4 million between temporary and supported accommodation last year. The Adults' Health and Social Care Committee overspent by 2.7 million against a net revenue budget of 155 million, which is less than a 2% variance, and whilst is still an overspend position, is better than we have seen for recent years as noticed earlier. Throughout the year, the service budgets have been continued to be challenged by the high cost packages of care, and fundamentally an underlying issue in learning disabilities, purchasing budgets, and overspends in staffing across the service. As Jonathan mentioned in his earlier update, the position has been somewhat offset through one-off funding in the year. There was over 6 million from the adult social care grant, additional funding from discharge and market sustainability fund. The table in 1.8.1 breaks down the overspend into one-off items, budget implementation plans that are not delivering, and underlying trend issues. And it highlights the underlying issue of a 10.5 million overspend in committee budgets, mitigated by 11.3 one-off funding received in the year that mitigated that position. It's also worth noting that the out-of-term position assumes a carry-forward of 23/24 budgets of almost 900,000 in respect of commitments made to care providers in the city for workforce funding and support as part of the market sustainability investment funding grant. The process of agreeing those carry-forwards is via the Finance Committee and will happen this afternoon. The biggest risk and challenge to the committee budgets is the 17 million recovery plan. Without the certainty on the funding to offset these underlying issues, the service is carrying a significant budget overspend into 24/25. The Council did put in place 47 million pounds of budget savings last year, of which 78% were delivered within the year. The 6.5 million were deemed 'undeliverable' and will present a risk to budgets in 24/25, alongside underlying budget challenges of 26.7 million, of which the adults are carrying quite a large amount of that. One-off grant income has mitigated, as we've said, but in order to be sustainable going forward, the majority of the issues do span the three overspending areas – adults, children and homelessness. The issues that we face are not unique to Sheffield and councils across the country are experiencing similar challenges and the financial context of uncertainty over future funding streams. We've been able to manage our overspends by drawing from reserves for the past three years, and Table 1.5 shows you the £70 million worth of reserves that we've drawn from to manage our budget contingency risk, which leaves us 27.6 to manage our overspends into 24/25. We are currently in the process of refreshing our medium-term financial analysis and will begin to set a balanced budget for 25/26. Pressures on services from increased demand, inflating cost basis and reductions on funding on top of undelivered savings with underlying budget gaps will make the process even more difficult this year as that gap continues to widen. So the paper is just to note the financial position for the Committee. Thank you. Thank you. Any comments? Remember, we're in perp. I think we would have plenty of comments, but we are going to do it later on. And thank you for all the hard work on this. I know that it's not easy. So the recommendations are on page 2013. The Committee is recommended to note the update information and management actions on the 23/24 revenue budget upturn as described in this report. Are we all happy with that? Brilliant. And this concludes the meeting for today. Next meeting of our Health and Social Care Policy Committee will be held on Wednesday, 18th of September at 10am. Thank you, everybody. [BLANK_AUDIO]