Transcript

Morning morning everybody and Welcome to this morning's adults and community well-being scrutiny committee Before we begin there is no fire drill plan this morning So in vent of a fire alarm sounding we need to leave the council chamber through the rear doors through reception Assembling the car park at the front of the building and wait further instructions I Would like to welcome Kellam cook welcome Kellam new vice chairman for this meeting and for the committee, so welcome also, Councillor Wendy bo kit, nice to see you here and Colin Matthews as well and Martin Samuels our executive director of adult care and community well-being and We've also got Justin Hackney and Pam Clipsen for to join us along the way Okay, we'll start off. Well, I suppose also we'll welcome Thomas who's taken out from Emily. So Welcome Thomas So we'll start with apologies, please Thomas. Thank you chairman. We have apologies from Councillors Cameron Lee Mrs. Nicola Clark and Trevor young today Brilliant. Thank you Declarations and members interests if any members find an interest along the way Hasn't been already noted. Let us know Minutes will go to the minutes of the 24th of April 2024 To confirm the correct record the minutes of the meeting found on pages 5 to 10 Are we all happy and can I have a purposer and a seconder propose Rob Kendrick second Mark Whittington? all those in favor Excellent, thank you any abstentions. Yeah Thank you Announcements I've got no announcements and Martin no, so All quiet while I near election process So we'll move on then to the first in effect item which is the financial position so adult care and community well-being's financial positions So I welcome Pam Clipsen head of finance to Just give a summary Thank you morning everybody So report obviously is in the pack In the contents of the increasing demand and the inflationary pressures that we talked about as we set the budget for 23 24 It is really pleasing and a sign of the level of financial control that we've got within adult care and community well-being To be able to confirm a year-end position of just 70,000 pound overspent on what is a gross? 300 million pound budget for the year for the directorate So a really healthy position particularly when you look across all the local authorities for their adult care and community well-being areas There are pressures that are detailed in the report particularly on page 12 We have seen an increase in our adult frailty and long-term conditions area in the number of previous self funders that are approaching the local authority for support and You can see the increase Forecast there that we've that we've seen We have factored that level of increase into our 24 25 budget So as we monitored that throughout the year, we did build that term anticipated impact on 24 25 within our budget set in process That will be an area of high risk that will continue to monitor throughout 24/5 to see how those look going forward We've also had impact in our specialist adult services area from the Worcestershire ruling Which for those who may not be aware of that? That's the challenge from our section 1 1 7 aftercare and that ruling confirms the local authority where the person was already Ordinarily resident when sections should incur those costs and we received one of those cases in February 2024 Which you they can back date and I was back dated to 2019 and that has a cost of four hundred and fifty four thousand That is not a cost that is in our control That is as a result now of that new ruling because it was and came about in the latter part of 23 24 That was after we've set the budget So that is an area where the operational teams are working through see if we have any more risk exposure to to that If there is any further risk exposure, we haven't got any financial allocation for that one We have been some or the bottom line is supported by the maximization of the public health grant So you can see from the table on the first page We continue to get an increase in our public health grant in 23 4 and that has enabled that one to spend to support our adult social care costs We have also received in three for the continuation of the discharge fund which has supported the increase in activity We have seen as a result of increased discharge and we've put that predominantly to our active recovery service Which you've received papers on in the past on on the outcome of that And more towards our packages of care that have been required as people have been discharged from hospital promptly Also on page 12 we have seen the continuation of the market sustainability and improvement fund and we saw an increase in year of that funding For five million pound that has both of those discharge and MSI have continued into 24 25 So the work that we've done that has enabled our four-tier home care rate our two-tier community supported living rate and the increases that we made to support the workforce across adult social care has Continued into 24/5. So again, no pressures coming off those actions that we've taken because those grants have continued So all in all a very positive financial position for 23 24 We are forecasting balance for 24 25 or where we'll caveat. We're only on month 2 So an awful lot of time still to go through for 24 5 But we will keep the committee abreast of any changes as we go through 4 5 and that will be a lady called Manhattan who starts with us on Monday Any questions happy to take? Thank you. Okay. Thank you I've got Councillor Wendy Bo kit. Thank you. And I just like to thank Pam for her excellent work it's not easy to keep a balanced budget in adult care and you know, we have our ups and downs and Bills come in we have to be paid but she's done an excellent job over the years and I for one will be sorry to lose Her because she's she has held us together. She's been our glue in adult care So thank you for all your hard work and you know, the figures here just goes to show you know That what what good work you are doing and the team it's not you know, we have a team behind you obviously but yeah, it is it's a really good budget and thank you very much and Please come back soon Thank you mark Yeah, I think I like to just just echo the comments that Councillor focus just made I mean we know this is you know, the adult social care is the biggest single elements of our expenditure And in terms of the sheer size of the budget to just come in. I mean 70,000 overspent I mean in percentage terms is Minute and I mentioned I think it's great testament, you know to everybody in the team and also the level of financial planning that goes on and I know because I've I Saw the fan. I've seen the financial model that they actually use, you know, and it's proof time and time again year-on-year 30 works you know, so No real questions other than a great huge. Thank you, and it makes the accountants hard happy to see such a big budget coming in Well, as I say to all to all intents and purposes breaking even is fantastic Thank you Callum, thank you chairman, and I think I echo the comments that have already been made in terms of the the finances You know, it is incredibly difficult in adult, you know social care and in terms of funding I suppose if we are looking at the year ahead and I know we're obviously only two months in do you see any sort of? significant challenges that might impact on our Sort of financial record going forwards or anything that you're predicting that might happen over the next 12 months Yeah, yes, I mean we always have continuous challenges and the increasing demand across our services for mental health specialties in particular We are continuing to forecast as pressures We have got close workings obviously through the directorate leadership team with plans in place And maybe I don't Martin if you want to pick up on some of those Yeah, thank you. If that's okay. It's a couple of things. I wanted to note one is that Yeah, Pam has already commented about the size of the budget. It's it's When you look at the numbers, it's it's a large budget from a from a net perspective a net budget 185 million pounds Pam noted correctly that of course that we spend a significantly larger amount of money than that that we you know, we note the that the income we get through the Public health grant and through the better care fund which comes largely through the NHS, but of course, we also Adult social care is a means-tested service. So there's also Within that there's a significant amount of funding that we we charge people for so it's important to recognize here We are a in effect a 300 million pound budget Spend and to come within 70,000 pounds of that is I think Real credit to the to the team and of course I you know, I was only around for the last couple of months of that so I can't take much of that credit at all It was the team. I mean you asked about pressures ahead The classic pressures that we along with everywhere else are experiencing. The first is demography. We know there are More and more older people and people people are living to a much Greater age and they are living with many more health conditions. Now, that's that's You know that's sometimes presented as being a bad thing all these old people around well You know for me That's a sign of enormous success That people are living to up to a ripe old age and more people are living to a healthier old age than they were before nonetheless we are seeing a rapid increase in the number of Older people and of older people with long-term health conditions that has a significant pressure on the adult social care system in particular we're seeing a particularly rapid increase in Number of people over the age of 85 a very substantial proportion of people in that age cohort are in the social care system And indeed of a significant a very significant proportion of them are in residential care. So the fast of that particular cohort grows we see a real pressure on our Our services and Lincoln sure is seeing one of the fastest increases in the country For that we start from a from a an older population on average than most of the country We are seeing that population growing faster and aging faster than just about anywhere in the country We're also on the working-age adult side And again, it's a it's a sign of massive success that It used to be that for example, someone who was was born with Down syndrome They probably lived through to their mid to late 20s often not much longer than that We now are seeing people with Down syndrome who are reaching retirement age And again, yeah, that's that's a huge success that people are able to live a long and fulfilled life But it means they're with us for a much greater period of time and therefore the implications in terms of the pressures on the budget we're also seeing increases from The the national living wage and again, it's quite right that people who are providing care Which is you know, our system relies on people providing care that they should be appropriately enumerated for that but of course that's a significant increase the national living wage has been rising much faster than inflation to try to to Reach a reasonable level. But of course we have to we have to pay that and I think The the the amount you know, if each pound on the national living wage is several million pounds Cost to the to the budget. So it's really important that we get that right And then what we're also seeing is a general increase in security of the level of need that people have and and some of that is as a result of the Challenges that the NHS is finding in catching up from the backlogs from from kovat that there are people who are waiting longer for treatment And are therefore in the community more unwell than they than they would have been But also the success of the NHS that people are living longer with with more with more condition So I think those are the key Challenges that we're that we're facing So we're really having to focus on having a different way of working We can't carry on working in the way that we that we really have been So they're really sort of three three aspects that I think I would I'd want to highlight today to the committee about the ways We're changing a real focus on prevention It we we often say that the the fastest hospital admission Sorry The heart the fastest hospital discharge is the admission that never happened and in the same way the best Experience for someone of social care is if they never have experience of it at all because they actually were able to live a life That kept them well and healthy and independent and so we're really focusing on what I've recently been hearing I'm not I have to say I really dislike the term prevention because it's by definition a negative term I've been hearing people recently talking about health creation, which feels a much more positive time. I'm not sure it's quite catch-on but but the idea of Making it easier for people to live a healthy life that allows them to retain good health and independence for Much longer. We're also working to be much more person-centered and strength-based in our approach is rather than saying what's wrong with you What what what help do you need? It's what what can you do and how could some support enable you to carry on doing that for longer? and we're finding that that there's a very clear correlation that the longer people are able to maintain their independence and they have choice and control of their lives the healthier they stay and actually the more able to We're doing some some very interesting work at the moment with people with a learning disability just to see Do we really come can we use this different approach to really understand? Where people are and what their needs are and what their strengths are so that they can have a more independent life Which does tend to be cheaper as well as being a better outcome for them And then finally we're looking to work very closely with the NHS The prevention agenda means we have to be more effective working with community services There's been one of the real issues over the last several years that the NHS has increasingly been focusing on hospital services the vast majority of the NHS budget is spent on hospital services actually the vast majority of Interventions with people that keep them well happen in the community So we need to be working there But then we're also working very closely with hospital system so that when people have been in hospital We can get them out to the moment that they no longer need hospital care and get them back home back into the community People recover much more quickly. So not only do we reduce the pressure on the NHS system We're actually getting people a better quality of life and a better experience and actually a better a better You know that they will recover more more rapidly. So we're we're very much focusing therefore in terms of The workforce, can we get the right workforce with the right skills and the right the right philosophy in the right approach? We're looking at informal unpaid carers because they make a tremendous difference to people's lives And we're looking to see where we can make better use of technology so that we can Draw on all of the latest latest advances so that people can use technology to maintain themselves Independently at home rather than needing someone to come in to provide personal care So it's a slightly long-winded answer to your to your question, but hopefully it's given some some pointers as to where we're focusing Thank you for that well Councillor Mike Clark Oh Rob right, so Rob's first then Mike. Do you actually want to speak or Just highlighting that Rob's bit wants to speak Yeah, thanks, thanks chairman I was just interested I have a bit more information about the section 117 aftercare issue I'm assuming right that this is for people who are older adults who are being sectioned or is this everyone Wow Because that's obviously a regular current I take it the modeling for this for the figure that you've come up with is based on data from LPFT In terms of the the number of people having section two or new resident No, so the modeling that we've got is for all our clients within Our adult social care area the financial cost that we've incurred in 23/24 is actually on other local authorities being able to apply the ruling and for one of a better phrase billows So that that's what the four hundred and fifty four thousand is. That's just one person And so what we're going through is just working client by client with our heads of service across all of our areas to see where The risks are that we know about But obviously, I mean this person particular left us a long long time ago. So yeah We will do our best to mitigate where we can but it applies to everybody wherever they may be in the country Just on that One do we have many that are coming in from outside Lincolnshire that in effect We're swallowing up their Health costs on that then or not. We don't have many incomers for that service the other thing is on the S17 Is the agreement our sort of contract with the LPFT in effect aligned enough to address this issue Yeah Yeah, so at the moment we're working through what the risks are that we face because it is a brand-new ruling that we need To go through there isn't anything that you can align because it is a ruling So what we basically need to work through is who are the people that we've got in receipt of our care that it's sort of applicable under this new ruling likewise That's what every other local authorities doing and then the outcome of that work which will be concluding with our ad's and their heads of service in the coming weeks will then Have to have an impact analysis on the obviously from the clinical perspective, but also from the financial perspective So just to be clear because if somebody is sectioned Technically, then they would go into an LPFT Or not they would be at home No, not necessarily they they would if sectioned then they would go into a mental health inpatient care That might not necessarily be LPFT could be an out-of-area placement as well so There's a lot of people from outside link coming in to use our services being referred in do we have additional? Costs there or or they could be at home. I mean I if they went into let's say they went in-house to whether it was Scunthorpe or whether it was at Lincoln on LPFT and They've got a social care element now, which we're expected to pay Correct. Would they therefore in in theory? LPFTs got them in-house and paying so are they then recharging us? So the section one one seven is aftercare so it relates to when people are discharged from Mental health inpatient care and then receiving ongoing support in the community. So it's the ICB So are they sectioned before or is the section actually The sectioned then they go in-house and then we're looking at the bit when they are coming out of that service so section one one seven is section one one seven of the Mental Health Act which entitles people to aftercare on discharge and we have to share the cost of that between LCC and LPFT Depending on which section of the mental health the person was detained on so it's not necessarily all sections. It's particular sections of the Mental Health Act I think it's predominantly section Three in section two, I think in terms of the aftercare entitlement, but I'd need to double-check on that Coming out Just just to pick up one thing and I think the the the ordinary residence point is is a key thing here so If so, so if I'm if I'm understanding correctly what you're suggesting so if a if there were a person living in another part of the country who was sectioned and they were moved for their care into the county and then having Completed their care. They were then Discharged and and had an entitlement to care under section one one seven They wouldn't be the responsibility of Lincolnshire because they were only in Lincolnshire because the system had moved them there so if they were, you know, if you said from from Scunthorpe then then That that would still be their home local authority and they would be responsible however, if there's a Lincolnshire person who gets sectioned and the NHS move them to North amptonshire for that for their treatment at the point where they're discharged then it's still Lincolnshire that responsible for them Even if they're in North amptonshire because it was the care system that put them in North amptonshire They didn't choose to go there. So it's based on where they were living at the point where they were sectioned and there's no means testing No It's a statutory entitlement to free care free aftercare Paid for by the public bus and how long does that carry on for? as long as the care is required as long as they need care and Generally, how long we got any? Pretty much For entirety. Yeah, I mean there are reviews but very few of the reviews end up with No longer care being needed So yeah, so in effect it's about one of the only services that really has no endgame and no means test But it does help to prevent readmission so therefore in terms of the overall public purse, you know it is It does help to prevent, you know escalation of need but also really high cost mental health inpatient provision And I think realistically To a large extent the people who are subject to this if they if if they were subject to a means test I don't think we'd be getting very much income from them anyway, so so then the net effect may not be that great it's it's a question of which which Organization is responsible for funding it. But yes, my instinct would be That if we were to means test people that wouldn't there wouldn't be a great deal of income and therefore that you know The the net financial implication isn't very great. It's a question of who pays so that does make a difference An LPFT would still have an input in that patient's well-being or not Technically, they'd discharge at that point from LPFT Back into our hands. Well, it's I mean section 1 1 7 after care is in the care in the community So but we split that care Obligation with the ICB. Yeah, so Yeah, LPFT won't be the deliverer of services. It's more likely to be you know, adult social care providers and so more community-based health providers but we do have a Section 1 1 7 policy that we've developed jointly with the ICB and LPFT and that sort of sets out our respective obligations as organizations and who pays what Okay, it's clear I think it just makes it Yeah just I think sometimes you read into it and it just Unravels it better so makes it clearer and the only other thing would be well The the long-term self funders that is quite a high number that are coming off being self funders Where they actually are now requiring LCC support Have we got a predicted tool on that going forward then because that's quite a high number now that are coming What's the future can we do do we have a lack of predictive model for like five ten years? Knowing what's coming or the potential we we did do a model when the adult social care reforms Were being discussed and it was the national modeling that we used that showed us potentially how much How many sorry for self funders we have compared to local authority funders? And if you remember when we went through the kovat 19 grant funding which covered all People in receipt of adult social care. We also checked that modeling against the work We did as part of the kovat 19 funding which confirmed the modeling for us. It was pretty accurate That will need updating So I think for me that the one of the focus is for 24 25 as we go into the new round for setting fee rates and what we need to do to support and shape the market going forward for the next round of Commercial contracts and service requirements will be a review of the self funders because obviously we've had that cost of living crisis We've had the national living wage increase We've got our rates set. It's that delicate balance that we go through every year at the moment, which says are we setting our rates? Accordingly that means actually the way that the self funders are paying it Excessively an increase isn't seen as excessive in that area. It's a delicate balance We've got to to work with our market on year in year out and I would suggest that next focus is in Readiness for the work that we'll be doing for the next 25 26 That's quite important feeding into the medium long-term plan because that'll be really where we're gonna get quite high Budget cost pressures. I suppose going forward And you've got your better care fund submission ready then Yes, yeah, we're on target for that it's not a full submission so it's just an update so we already submitted the 24 to 26 last year The submission which is due on Monday is an update to that plan For finance for capacity and the quality matrix based on from a financial perspective any of the changes So for example for us the confirmation of the discharge funding that was received as part of the settlement will be within that For a cross link and share the update on the capacity Expectations versus the demand and then the performance metrics. So yeah, that's in draft Thank you In some sense I agree with all your preventions and the Maintaining independence and NHS Community Service In fact, a lot of that is what we're looking at which should all come together quite nicely over the next period and the next Our next committee meeting actually we've got coming back The public health in effect annual report, which is what it's all about Technically like you said Martin prevention in effect getting the residents of Lincoln sure in shape for retirement Which is crucial to reduce the issues coming forward. So Brilliant thank you very much for that. I think yeah credit you all in order all good financial accounting and Being realistic and getting the budget and making sure on target Mike Thank You chairman I Was interested in reading the section on grand funding on page 13 where we mentioned the Ukraine system I Note that we've had 227 guests arrive It says in the UK How many of those actually come into the county and how many have left is there been a a balance? through the period and I know we have sometimes had adverse press about the added work that it gives to The system in accommodating Ukraine families have we experienced any of that was in the county. Thank you So sorry, that should be 227 in Lincoln sure UK Coming you guys. So it's 270 227 that have come into Lincoln sure very few leavers, but I can come I could check those I think it's less than 10, but We've had very few leavers and any costs incurred regardless of where those costs are So for example, it's district councils if it's support we've put in through charities and voluntary organizations That is from a financial perspective fully funded through the grant income that we that we have received. So there is no financial Implication to any individual any family or provider as a result as a result of that Okay Thank you very much. Thank you for your kind words and it's been a joy. Thank you Thank you So we'll move on to the care quality Commission improvement plan and in effect the reports from the CQC inspection so I Think you're taking on this one Martin Okay, thank you so is members of the committee will be well aware Link to County Council was the first council in the country to go through the CQC assurance process We went through that process Near enough a year ago now with the final report being published in November Worth noting that CQC has only very recently published the first three reports from the substantive Assurance process so they did five pilots. They've now published three of the of the sort of the proper reports of the eight that have been published so far seven or Receive a good rating only one has received requires improvement rating it's worth noting that although Lincoln sure came out with the the best if you add all the Sub elements together Lincoln sure came out with the best results from the pilots I'm afraid that Hertfordshire has now come out with a better report from the From the substantive process and they got one outstanding. All of the other areas were good. So the we The report that CQC gave us identified a number of areas for improvement We previously brought to you a sort of set of Appendices which I'd identify, you know Each of those areas for improvement and what we are Doing now what they are and what we're doing about them or what we're seeking to achieve What we've provided this time is an update on each of those and then appendix H We've set out the various actions that we're taking and we've we've set that out in a in a table to just make it a Little bit easier for you to see what we're doing and just worth noting that as part of that work We've been looking again at the adult social care vision It's become clear that there's there's been quite a few sort of different different approaches different visions different Perspectives and we're doing some work to try to bring things together So we have a really a simple and memorable but meaningful Statement about what it is that we're that we're seeking to achieve and that's set out at the bottom of page 16 So I think the key point is that the work to address the areas for improvement that were identified by the CQC Proceed is you know, that work is is proceeding and we're making you know, making good good progress We're also now starting to get ready for when they come back CQC have been Instructed by government that they should do the entire country over a period of two years So they did us about a year ago. So in principle They should come back in a year to 18 months or so So what I'm doing with the team is making sure that we are ready so that we have the material we have the the self-awareness the That sense of where we are as an organization that's already So that rather than there being a mad rush at the point where the phone call comes that we are ready to go When it went whenever time that call might come Because I've been saying well we would expect them to come in a year to 18 months or so when they've done everyone else It is entirely possible that CQC might take the view that the five organized the five local authorities that were the pilots Because the process that they're doing now is really quite significantly different from the process They used with us because they've learned from the pilots It is it is entirely possible that CQC might say well actually we're going to go back To one or more of the pilots and try the substantive process with them now On the basis that it's different from the pilot process So we need to be ready and so we're making sure that we are we are organized for that and then one one last thing just that just the point that has come up and and it's sort of opportune given that we've we've just had the discussion about the the financial position the first page of the CQC report itself. So appendix D. So appendix G that starts on page 31 That sets out some demographic figures and some financial facts From from CQC and I should note that these figures are figures presented by the CQC not figures that were given to us and They are I think you would note that Actually, though those figures are somewhat different from the figures that We were presenting to you earlier or that you will you will recognize and indeed the figure for the population of the county is different And just to provide a little bit of explanation These figures the CQC was instructed by DHSC and DLUC that they should present this Data to provide some context it's taken from a national data set that is calculated in a particular way It's not the way that I think any local authority in the country actually presents its own its own data One one thing that I think is particularly important to highlight that could very easily be misinterpreted so if you look at the the second Well, the first and second bullet points. So it says that in 2023 We estimated that our total budget for the council would be 895 million and we actually spent 917 as a as a whole council 22 million more than estimated and that we would spend 230 million on adult social care and we actually spent 234 million. So 4 million more than estimated It would be very easy when looking at those figures to to interpret that as meaning that the council overspent That would be an incorrect assumption In many cases what what happened was that the government gave us additional funding during the course of the year and asked us to spend it Some of that on social care some of it on other things and clearly we couldn't Build that into our budgets at the start of the year because we didn't know the government was going to give it to us So they're they're saying this is what you said you were going to spend. This is what you actually spent the Giving an implication that that's poor financial management. In fact, it was that the government gave us significant amounts of additional funding asked us to spend it and we did and Therefore we spent significantly more than we had thought we were going to spend but that wasn't an overspend So just for that for that clarification, but thank you Excellent, thank you very much Wendy Thank you, and thank you for that Martin and CQC I still get very upset about it because we were the first obviously on the list of people they visited and I quite frankly and quite openly stay to whoever asked me they weren't up to the job They didn't know they hadn't gelled. They didn't know what they were doing really now They are and as Martin said, you know We are getting ready for them to come back and I welcome them to come back Because the score of good is not what we do We are an excellent council and to be rated good alongside the other five that was well There was one that was inadequate, but we we had the highest score and we did deserve a better than good But we have to go with what we've got So I welcome them to come back and we will be ready for them and we will be getting an excellent Else heads will roll Thank you Colin Probably be outstanding That's all right. Sorry, you can't help can't take the inspector out the job the I'm interested in the adult safeguarding And I'm interested in the story behind the adult safeguarding report Because it sounds as though we're doing our job in adult safeguarding correctly, but we're being criticized for partner organizations and using different criteria to us and Then we've written to them and told them this is what we mean by this. I just don't quite understand this story there If I start and then Justin may pick up some of the some of the details so we we are in a position where Safeguarding is everyone's business. So by law The police and the NHS and the local authority. We all have equal responsibility for safeguarding It just happens that the the safeguarding inquiries are undertaken by the local authority but it but all organizations have a responsibility to identify safeguarding issues and to Make referrals. What we're finding is that a very substantial proportion of the referrals that are made to us Do not meet the standard for a for a further inquiry to be to be undertaken And of course, it takes quite a lot of time and effort to go through Large numbers of referrals that then don't meet that don't meet the standard. So we've been working with partners to say well Can can we ensure that all of our staff because of course we have to be just as careful that that the council's own staff Are judging these things correctly that we are really clear about When a safeguarding referral is appropriate and that we're not using it when actually we've got a request for service or if we think there's an issue with quality of service because quality of service is different from Safeguarding that we are using these systems appropriately. So we've been working with the partners And so I did write to the the chief executives of our various partner organizations about well, we've got this issue We need to work together Let's work together on this and it was very encouraging that most of the organizations that I wrote to I then got a very polite letter back saying oh, you know, we really This is clearly an important issue can we Look at more detail of the data for referrals from our organization so that we can see our you know, where are we? How are we performing? Are we getting things are we getting the thresholds wrong? Is there a training need for our staff and a real sort of positive view about you know, we need to get this, right? we need to get the different organizations doing doing the right thing because When I say safeguarding is everyone's business It's not just looking out for it and then getting somebody else to do something about it It is the responsibility of the organization that spots it often They have a responsibility to to it to seek to address the safeguarding issue themselves So I've had a very positive reaction from almost all of the partners We have there is one organization that has been less positive and they work on a regional basis and I've been engaging with with colleagues in councils across the region and they all have the same issue with this this particular Organization and they've essentially taken the stance Partly based on feedback they had from the from from a CQC inspection That more is better And so they've been working on the basis that they've been training their staff that if you have any any thought whatsoever that this might possibly be related to safeguarding putting a safeguarding referral because you can't possibly be wrong in that situation and We are having on a regional basis conversations with that organization to say well Actually, that's not terribly helpful. I'm reminded of a colleague I worked with some years ago when he was talking about safeguarding issues He said when you're looking for a needle in a haystack Generally, the first thing you do is you don't make the haystack bigger and that's the do that's the risk that we're doing that We're making the haystack bigger, but there's still only one needle in it And so the risk is that we'll actually miss some of the the genuine safeguarding issues So we are working with partners and we are so working with partners locally And I think we're getting a very positive response and working regionally with this this other organization and seeking to Make progress with them, but it's it's a more complex situation with them because they are a regional regional organization So I hope that that gives some clarity Justin. I don't know if there's anything you wanted to add to that Thanks Martin, yeah, so I think the other thing that we we're going to be doing this year is actually revisiting the front-end Referral process. So I think a lot of partners send us things because they think it's it would be helpful And you know if we can actually separate that out into intelligence and actually then progress Legitimate concerns through to the safeguarding team so that we're not overwhelming them through triage and they can focus on that work Then that's going to be helpful so we have got some support from the County Council's corporate transformation team that are going to help us revisit how Concerns and referrals are made To us and then how we can actually manage those in a different way. So that should help To some extent be able to you know separate intelligence from true safeguarding concerns going forward We will of course with the LSA be continue to do the wider work around making Safeguarding personal because as Martin says, you know, it's it's an obligation on all partners to to keep people safe So we'll be doing that at the same time Yeah In the document it says that between April and October there were 1,400 additional concerns so if we extrapolate that to a year, that means nearly 3,000 additional concerns in the year Hey, is that continuing and B is our? triaging of those concerns where we push some back putting anybody at risk because the organization that's made the Recommendation believes they've transferred the problem So the answer is yes can the number of concerns that being raised Continues to increase and that that does cause some operational problems for us because we're having to triage every single one so, you know, but we're we're having to look at this the Resources in the team, but we see the review of the from the front door Processes being the the solution but in terms of risk the fact that we triage every single one in a timely way That actually people aren't being put at risk and I think the other thing I'll say is is that you know in terms of our wider performance indicator for our Safeguarding function they're still all on target So the team are soaking up all this additional work, but still keeping people safe. So I need to reassure on that So, but yeah that the volume the volume issue is a challenge for us So we need to continue to work with partners to to resolve that that's the bit that really it's this making sure that what's coming through is Tied it up and tightened up, isn't it? it's certainly a piece of work there to stop that high numbers coming through just because people are basically pinging them on to us and not actually doing a bit further research and I think What some of that is you know what sometimes actually just make a quick chat about it all I think it's you know If don't watch it you're panicking and blocking the whole system up and then we don't really get to the people that we want to be Getting to because we're blocking the system Sorry, I absolutely get all of that and I Can see that we're doing very well here what I'm concerned about is if 3,000 have been put forward a Thousand have been accepted as genuine safeguarding issues two thousand been pushed back to these organizations are any of those two thousand at risk They're not directly on our responsibility. But is there a vacuum that they're being pushed back into the organization will then pick it up and deal with it as It's a flat tire or it's a leaking roof or it's a they will know what it is and deal with it. Yeah, so The concerns they're sent to is that don't meet the criteria for section 42 That they can but the majority are really really low-level issues. So it might be Mr. Megan's bumps into mrs. Smith in a care home and knocks a biscuit out of hand and the care home reported to us as a Safeguarding incident. So in those sort of it those sort of concerns there is no need for any follow-up action Yeah, it you know, if someone's at significant risk of harm, then it will meet the criteria and we do it in inquiry Make sure people are safe. So and we do Periodically do quality audits of the triaging and of the no further action Concerns we closed down and that that that audit work is always reassuring that the right decisions being made Okay, I mean I think When you sort of look at this whole report and the actions in in some sense I think it summarizes up pretty well at the very beginning Which talks that the CQC? Method method of inspecting us is changing. It's already changed We need to keep in contact with the changes Because when they next come back, it will not be like it was the first time that they came to inspectors Their focus will change but in essence we still need to take on board what they have raised And resolve some of these issues so that when they come back we can say we have listened and we have adapted and Things like financial assessments. I can't stress enough how quick that process needs to be I think the quicker people know where they are and what they're entitled to the better and so You know, I fully support that and I think we've mentioned home care surveys before that you know if we provide a service we shouldn't one of the criteria is you give us feedback instantly at the end of it and So that that process of volt helps us to keep evolving because you know, remember we are commissioning council So it does mean we get flexibility to adapt and change to what people's needs are Most of all the other bits actually are already in well, in fact, most things are in the system to be fine-tuned and made better and improved on so all in all We're going in the right direction and I think We'll see what happens when they next come back and change The other thing just to note in here is the new vision of adult social care Which I will make reference to that. We we all want to live in the place We call home with the people and things that we love in communities where we look out for one another Doing what matters to us? So that is that now implant is that actually official now that that's on you or is that still being? Thinked I think we're still going through the process right, I Would slip one word in there cause we all want to live. Well, I Think that's the half of the priority of what we're really after and and the only thing I would perhaps put in There is a bit about prevention because we know that is absolutely crucial The nation has to get itself fitter and healthier And there's no need to sort of be putting up with a lot of sort of some of the issues when we can in a Fact get ourselves take responsibility and get ourselves sort of geared up for retirement really or the best shape we can Mike Thank You chairman It was quite an eye-opener reading all the information has been given to us in this report A couple of observations if I may It would be I think be useful for fellow Councillors and any member of the public that would read this report To have some idea of the numbers that we're dealing with because obviously we're spending a large amount of public money and I think it would be wrong not to sit were blow our own trumpet as the number of people that we're dealing with and caring for because I think that's a big item and In annex C. I was wondering it mentions new digital technologies I wondered how far down the line we were going with that idea In order to help us run a bit more enthusiastically or more better for the clients and similarly in Annex G. I was wondering we have been told before about apprenticeships and how useful that's been But have we any idea at the moment how many are under training that will help us in the future. Thank you very much If I if I pick up and then I may Get asked Justin to come on a couple of things And so very much take your point about it beep the value of the sort of context the wider context some years ago they there was a Tradition that local authorities and adult social care departments would publish a local account About what that what had been done over the past year and which would give a sense of the numbers of people supported That that's a rather fallen out of fashion of in recent years We're looking at whether we could do something like that again something something short and accessible, but it's just just gives you an overview of You know, as you say we're spending a very large amount of money What who are we spending it on and what are we what are they what are we getting from that? So we're we're working on that in terms of digital we are we've just been just in the process of completing some work with a Consultancy called channel 3 to help us to work through where where we can get most benefit from The the the digital revolution that's been that's been happening and and really that their guidance has been particularly that There's an awful lot more that could be done when people are first starting to find it a bit difficult to manage at home That actually at that stage Pointing people towards the technology that is available and there's that there's a huge amount of consumer electronics that is valuable to people That giving people a bit of guidance as to how they can access that what might be Appropriate what might be available that can make a big difference to people's lives people's ability to maintain their independence So they're advising that we go down that route They're also advising that we make much more use of remote sensing. So you'll be aware. You know, lots of people now have those Those front doorbells that have a camera and a link to your phone and that kind of technology is readily available And these quite easily and fairly cheaply Installable in people's houses so you can have cameras and motion sensors and the like in someone's home Which can all be wired up both to connect to family members phones So we don't need to we don't need to go through a formal service process People's friends and families can keep a keep an eye on them the latest development which I think particularly exciting is that? through AI The system can learn what someone's habits are and can and so rather than having to have someone Monitoring and saying well have to have they switched the kettle on have they gone to the loo have they have they moved The system can do that and then it can send an alert if someone's behavior is well out of the out of after the norm And the the parallel that I came across I came across a few years ago was in care homes quite often They will do checks during the night and often your every every couple of hours I'll go round each of the rooms and I just poked this member of staff poke their head through the door just to check That the person in bed is is is sleeping fine and is okay Apart from the fact that that's really disturbing for the individual I don't think I'm not sure how many of us would like to have someone poking their head around the door every couple of hours During the night while we were trying to sleep It's quite so it's disturbing for the individual It's also expensive because you've got to have staff awake walking around the building doing this Technology is available and I've seen it installed in a number of homes, which is Sound activated recording so that if there is a sudden noise in the room it records it and sends a audio file by email to the reception desk and it pings up and the person sat on reception can can listen to what's the noise that's just happened in that room and They can then make a judgment as to whether whether something has happened or it was just you know Mrs. Miggins was turning over a bit noisily in in bed and is fine And that gives you a huge advantage that you can respond much more quickly because your response, you know there and then Whereas, you know, they might have fallen out of bed and you not do the round for another hour or so But it also means that you're not disturbing the individual and you're not having to employ member staff to walk around That kind of AI that kind of technology is much more readily available now through consumer electronics That the people can can use that at home quite cheaply That can give that level of reassurance that that they never they don't actually need to call on adult social care at all But they might just get some help from us in the first place about working out what it is to buy So so that's the kind of thing that we can do with the technology I mean there's an awful lot more but it's that the the consultant saying that that would be an area where we could make a big Difference to people's lives and it would save the council a significant amount of money It's quite interesting really the digital isn't it because there will become a point when it becomes invasive into your own private life How far do we go with the point if you've got cameras and everything else what in your house keeping an eye on you then in? effect it's Quite interesting concept, but I think one of the things when I travel about is If we don't watch it We're coming so reliant on digital But actually we're losing all form of social contact and the only thing that you'll ever do is you'll go into your home and you'll be digitally looked after and actually no one will visit you but anyway, Mike I Can see the digital being very useful in rural areas We're obviously getting to people would be a concern and very timely and costly that way Could I have an answer to the question about apprenticeships? Thank you You're right. I forgot that one and I don't know the answer. I don't know if Justin Justin. Do you know the answer? Sorry in terms of do how many apprentices do we have was the question? Sorry? I Noticed it said that there was apprenticeships and I was wondering how many we've now got it in the system Because we were told a few months or few or even last year How well the system was working and the fact that we'd managed to get I think it was 11 nurses Into this into working at the hospital and I'm wondering what sort of progress we were now making through the medical school. Thank you Yeah, so I'm sorry. I don't have numbers. We can't follow that up and get some for you though But yeah, we have got apprentices opportunities in a number of different areas including day opportunities We're progressing them within social work services as well. So yeah, we yeah Yeah, we can get we can get some intelligence on that for you. Just remember though the council in itself is the commissioner so we do have a number of Apprenticeships within the cat heart and I have a feeling something like 12 or something that we've just taken on last year but I mean don't quote me on that but across the board that is But actually and I suppose the workforce There will be an agenda item at some point coming up soon Maybe on the workforce which actually would be where that wants reflecting back to as an industry wide for Lincoln Sure, what is the apprenticeship? Recruitment process because obviously workforce is such a key element to making sure we've got good services Wendy yeah, I was talking to Chris Erskine yesterday our head of Social worker and they've just had a few Apprenticeships qualify again and certainly with Andrea's team Andrea Kingdom's team in the hospitals again. They've just had a number of apprentice OTs Qualify and just taken on again. So yeah, it would be interesting to get the numbers of before the departments of what Apprenticeships have just qualified and how many we've taken on again because it is I think it's quite a substantial number Just on that is the medical the university's medical School or department whatever it it's called is that must be in full flow now and are we seeing any? What's that should actually be feeding through and into the system as well So the medical school is is fully up and running I suppose the issue is the course they're training people for the NHS rather than for adult social care. Is there any sort of Way we can capitalize on anything in that area or not Well, we're certainly working closely with the university to to identify the scope for Developments in the social care field, but but yes that their area is more medical and health care than social care But we do have links with them Okay any other questions All right, well, it's nice to see I think the end of the report really summarized everything kept in the actions so I think it'd be one of those that be worth just coming back at some point just to Make sure that we're all ready for the next time that they come and just sort of just see where we are in terms of An update on the progress because most of it should be signed off soon in some form or another Over time, but we can slot that in or just have an update at some point with the work program going forward Which then takes us on to the work program I think got enough comments noted on that previous item. So Simon Thank you. Thank you chairman. Just referring members of the committee to pages 58 and 59 Just to say that there are no confirmed changes to the list of items from 24th of July onwards I do note the Chairman's comment though because there is an item on the sort of to be program list in relation to Workforce development recruitment and retention. So that is something we can look at and maybe I can in terms of the previous item on the CQC Improvement we can look at perhaps. I don't know whether Martin wants to suggest whether that would be another six months or nine months or a year perhaps nine months perhaps in March 25 thank Thank You chairman Their party conferences and all discuss what they're going to do for adult social care to feed into that because workforce will be a big part Right. Well, that's done that's finished in record time for adults So thank you all for coming. Thank you You You You You You [BLANK_AUDIO]