This meeting of the Care and Independence Overview and Scrutiny Committee included a presentation on substance misuse, and considered the annual reports of the North Yorkshire Safeguarding Adults Board, the Director of Public Health, and the Health and Adult Services Department. The committee also reviewed the Health and Adult Services Department's 2024/25 work programme, and received an update on the use of direct payments for adult social care.

Substance Use

The committee was scheduled to receive a presentation on substance use in North Yorkshire.

The presentation described the national context for substance use policy in the UK, including the 2012 national alcohol strategy and the 2021 national drug strategy, which committed the government to attack harmful alcohol use, and to move from harm to hope in drug policy. It then discussed substance use in North Yorkshire, outlining the key challenges facing the council.

The presentation went on to discuss the council's strategy for dealing with substance use, which it described as putting people, health and communities at the centre. The strategy has three priorities: disrupting drug supply chains and promoting responsible retailing of alcohol, providing effective support for people who are experiencing harmful substance use, and working to achieve a generational shift in demand for substances.

The presentation described the services that are available to people in North Yorkshire who are experiencing problems with substance use. These included North Yorkshire Horizons, which provides support to around 2,500 people from four hubs, as well as in GP surgeries, pharmacies, and other community locations, North Yorkshire RISE, which provides support to around 120 young people in schools, homes and community venues, and North Yorkshire Connected Spaces, a lived experience recovery organisation.

The presentation went on to describe the North Yorkshire Treatment Plan, which the council is using to invest a £992,000 grant from the Department of Health and Social Care to improve substance use treatment services. The council intends to use the grant to create a system where no one falls through the gaps, where there is no stigma attached to addiction and where people who need it are provided with long-term support. The plan has three objectives: to increase the number of people engaged in drug and alcohol treatment, to increase the number of young people engaged in drug and alcohol treatment, and to increase the proportion of people who are able to remain in treatment.

The presentation described the progress that has been made towards achieving these objectives, and provided examples of other work that the council is undertaking to engage more people in treatment.

Safeguarding Adults Annual Report

The committee was scheduled to consider the 2023/24 annual report of the North Yorkshire Safeguarding Adults Board.¹

The report was introduced by Adrian Green, the independent chair of the board. It set out the board's strategic vision and outcomes, and described its work over the past year.

The report highlighted the board's four strategic priorities for 2023/24: reconnecting with communities in North Yorkshire to raise awareness of safeguarding and develop strategies to reduce the risk of abuse, ensuring that safeguarding policies and procedures are in line with best practice and meet the needs of older people and younger vulnerable people, strengthening partnerships and accountability for the prevention of abuse, and ensuring that the board is able to adapt and respond to wider changes that are affecting adult safeguarding.

The report described the work of the board's local safeguarding partnerships (LSPs), which are local safeguarding meetings where partners come together to raise awareness of safeguarding in the local area and respond to local needs.

The report also described the board's work on learning and reviewing safeguarding practice and standards. This includes considering new safeguarding adult review (SAR) referrals, overseeing ongoing SARs, and ensuring that any learning from reviews is considered by partners and taken forward in their organisations.

The report provided an overview of the board's financial record for 2023/24. The board's budget is made up of contributions from the three statutory partners: the council, North Yorkshire Police, and the NHS. As well as direct funding, the board is also provided with services in kind by a number of agencies.

Public Health Annual Report 2024

The committee was scheduled to consider the Director of Public Health's Annual Report for 2023/24.

The report was introduced by Louise Wallace, the Director of Public Health. It was titled 'Live, Age, Engage: healthy ageing in North Yorkshire', and focused on healthy ageing in the county.

The report argued that the fact that people are living longer is an achievement to be celebrated, but that it also presents challenges and opportunities for the council and its partners.

The report was structured around four healthy ageing priorities for North Yorkshire that have been developed in collaboration with stakeholders, including older people and support organisations: health and reducing inequalities, housing, financial security and employment, and making North Yorkshire an age-friendly place.

The report argued that not everyone has the same opportunity to age well, and that there are inequalities in how many years we live and how long we live in good health. The report called for more to be done to understand the diversity of our older population and tackle inequalities in later life.

The report made a series of recommendations for each of the four priorities, and some overarching ones. It also provided an update on the recommendations from the 2022/23 DPHAR, which focused on children's health in North Yorkshire.

Health and Adult Services Local Account 2023/24

The committee was scheduled to consider the Health and Adult Services Department's Local Account for 2023/24.

The Local Account described the department's work over the past year, its investment of public money, and its plans for the year ahead.

The report opened with an introduction from Councillor Michael Harrison, the Executive Member for Health and Adult Services, and Richard Webb, the Corporate Director for Health and Adult Services. They described the challenges facing the social care sector nationally and in North Yorkshire, as well as the department's vision for people living longer, healthier, independent lives.

The report then described the department's 3 public health and 7 adult social care improvement priorities, which were identified based on feedback from local people and data. These priorities are: providing the best start in life, getting people moving more, supporting healthy ageing, ensuring that people can wait well while they wait for an assessment or care package, making sure that people receive reviews of their care at the right time, supporting more people to use direct payments, providing a clear and consistent support offer for unpaid carers, continuing to recover the reablement offer, helping people to return home after a stay in hospital, and providing a clear and consistent support offer for people with complex needs.

The report went on to describe the department's work on involvement, including the development of a new involvement framework, and its work on workforce development. The report also provided details of the department's budget and its complaints process.

Health and Adult Services Work Programme 2024/25

The committee was scheduled to consider the Health and Adult Services Department's work programme for 2024/25.

The work programme outlined the key issues that the department will be focusing on over the next year. These include adult social care assurance, market transformation, hospital activity and discharges, substance use, direct payments, support for carers, young adults complex care, and the Living Well review.

The work programme also included possible future items for discussion, such as an overview of the 'Waiting Well' action plan, an update on the move to adult social care specialist teams, a review of hospital discharges, a discussion of the budget for high-cost complex care, a review of the extra care programme, a review of the care provider services, a discussion of the care market, a discussion of dementia services, a discussion of the smoking bill, and a discussion of the Royal Commission on the Long Term Care of Older People.

Direct Payments

The committee was scheduled to receive an update on the use of direct payments.

The presentation began with an overview of some key data about direct payments, including the fact that the number of people receiving a direct payment has increased in recent years.

The presentation went on to provide examples of how direct payments have been used to support people. For example, Mrs S from Scarborough has advanced dementia and lives in her own home with support from 35 hours of care that is funded through a direct payment. The direct payment allows Mrs S to employ personal assistants, use a care agency, and attend day care. The total cost of Mrs S's care is £483.92 per week, which is significantly less than the average cost of residential care in Scarborough, which is £1,132.36 per week.

The presentation went on to describe the key improvement areas for direct payments, including the introduction of a new database to monitor activity, the streamlining of systems and processes, and the development of new training materials.

The presentation also provided an update on the use of Individual Service Funds (ISFs). An ISF is one way of managing a personal budget, where the person chooses an organisation to manage the budget on their behalf. The organisation works with the person to plan care and support services. The presentation noted that the council is working with Self-Directed Futures to explore the use of ISFs in a range of service areas.

Finally, the presentation provided an overview of how the council works to ensure the safety and quality of personal assistants. The presentation noted that personal assistants are exempt from registering with the Care Quality Commission because they are employed directly by individuals. This arrangement allows the individual or their family to have full control over the care provided. However, the council has a statutory duty to ensure that people have access to the right information and support when making decisions about their care, and to ensure that PAs have the necessary skills to perform their roles.