The Health Care and Overview and Scrutiny Committee met to discuss a new choice policy for adult care, and to receive an update on the Freedom to Speak Up guardian scheme. Councillors recommended that the consultation period for the choice policy be extended by four weeks.

Adult Social Care Choice Policy

The committee reviewed a report ¹ regarding a draft choice policy for adult social care, designed to ensure adults are offered choice and control of how their needs are met, while balancing the council’s resources. The policy intends to make people's entitlement to a choice clear, ensure consistency and fairness, and assist the council in balancing the interests of each individual with the interests of the whole population.

The policy differs from existing council guidance in two main ways:

• The council will source a placement that meets the assessed identified care needs within a 25-mile radius of the adult's usual place of residence.
• The personal budget will be determined by the cost-effective placement that can meet the needs of the person.

Councillor Jill Hood raised concerns that the 25-mile radius was too far, especially in rural areas with poor public transport. She also stated that the policy restricts choice based on cost, and that top-up payments² are not always feasible for residents.

Dr Richard Harling MBE, explained that the policy is in line with the requirements of the Care Act 2014³, which obliges the council to fund care homes that meet the needs of individuals who cannot pay for their own care. He noted that care homes set their own prices, and the council must make fair decisions based on its duty to taxpayers. He also clarified that the ability to top up is allowed under the Care Act 2014.

Councillor Tracey Dougherty echoed Councillor Jill Hood's concerns about the 25-mile radius, citing the difficulties faced by families on low incomes in visiting their loved ones. She asked if the radius could be changed. Dr Richard Harling MBE responded that the tighter the radius, the less likely it is that there will be a range of care homes at a similar price to the average across the county.

Helen Trousdale, Lead Commissioner for Older People and People with a Physical Disability or Sensory Impairment, added that assessments consider a person's wider social needs, including contact with family. She stated that the council can offer carer's grants and is exploring ways to support people with transport costs.

Councillor Catherine Brown stated that the 25-mile radius needed looking at, and asked how the consultation was being publicised to residents in Staffordshire. She also felt that the briefing for the general public did not accurately reflect the policy.

Helen Trousdale said that the consultation was being run through the Let's Talk Staffordshire platform, with information distributed via social media and the citizens panel. She also mentioned that there was an easy-read version of the draft choice policy Appendix 2 - Easy Read Choice Policy.

Councillor Colin Greatorex suggested that a combination of mileage and time should be considered, referencing the blocked bed policy's 30-minute travel time. He also raised concerns about the level at which the personal budget is set, and the need for transition planning to mitigate the impact of the policy.

Councillor Steven Norman questioned whether the focus should be on investing in local supervision rather than moving people far away. He also asked whether the policy was effectively creating a two-tier system for those who can and cannot afford to pay top-up payments.

Councillor John Jones supported the 25-mile argument, stating that even 10 miles is too much in rural areas with limited transport. He asked for clarification on the cut-off costs for council funding and how top-ups are defined.

Councillor Wayne Luca argued that the focus should be on the quality of care and opening up the correct bed for the person's needs, rather than the relatives' travel. He asked how many more beds would be opened up within the 25-mile radius and what measures would be in place to keep people as close to home as possible.

Councillor Ann Edgeller asked if checks are made to ensure that the money being paid to care homes is being spent correctly and that residents are receiving the services they should be. She also questioned how the council would cope with the increasing number of people over 65 and the associated budget pressures.

Councillor Gary Bentley suggested building care room villages and supporting planning applications for granny flats to keep people at home.

Councillor Tracey Dougherty highlighted the inadequacy of NHS home care and the need for people to use their own money to pay for private care.

Councillor Jill Hood stated that the 25-mile radius was a massive problem for isolated elderly residents who cannot afford or have the capacity to travel that far. She also criticised the practice of giving care homes a courtesy call before assessment teams visit.

Councillor Matthew Wallens asked if transport links are taken into account when assessing people for care homes.

Councillor Catherine Brown requested that district councils and parishes be informed about the consultation and asked what issues were specifically faced by rural homes.

The committee recommended that the consultation period be extended by four weeks, although it was noted that there may be legal issues with this.

Freedom to Speak Up Update

Tracy Shewan, Director of Corporate Governance, presented an update on the Freedom to Speak Up (FTSU) processes in place at NHS providers, following a request from the previous committee. The FTSU initiative aims to ensure that staff can raise concerns without fear of reprisal.

Tracy Shewan reported that guardians and champions are in place in each organisation, and there are several things that they do to encourage staff to speak up. The main issues raised by staff relate to how they have been treated by other staff, patients, or visitors, with a notable increase in concerns from overseas colleagues.

Councillor Steven Norman asked about encouraging staff to speak up about inefficiencies and good ideas. Tracy Shewan responded that there are separate processes in place for people to make suggestions, including a suggestions page on the ICB website and intranet.

Councillor Ann Edgeller suggested that the committee write to the organisations that have been recognised for their good work in this area.

Councillor Matthew Wallens questioned the cost-effectiveness of the FTSU scheme and asked for an example of where speaking up had led to real change. Tracy Shewan cited a case involving medicines management where a change in policy execution was implemented.

Councillor Colin Greatorex asked how feedback is given when good practice is taking place and whether people understand what protected disclosure is. Tracy Shewan responded that every FTSU action is reported to the national guardians office, and feedback is given to the individual. She also acknowledged that not all staff may be aware of protected disclosure and that this could be included in induction training.

Councillor Catherine Brown stated that the FTSU scheme gives real change for individuals and is cost-effective because it allows people to be retained. She suggested that the next report focus on bullying and provide more detail on the numbers of cases, what happens, and how feedback is given to staff.

Councillor Wayne Luca expressed concern about racist attacks and asked what is being done to support overseas staff. Tracy Shewan responded that there are special programs in place to support overseas colleagues and that there is a zero tolerance policy towards discrimination, bullying, or harassment.

Councillor Tracey Dougherty asked if the FTSU scheme extends to care homes. Tracy Shewan clarified that it is currently only for NHS providers and general practice, but that care homes can raise issues through other channels such as complaints and PALS⁴.

Councillor Michael Carver questioned the cost of the guardianship aspect of the FTSU initiative. Tracy Shewan explained that it is part of existing roles for some staff and that the time commitment varies depending on the organisation and the number of cases.

Councillor Matthew Wallens asked why it is taking whistleblowing for management to do its job properly and whether senior management and HR will be held accountable if they fail to act when staff raise issues. Tracy Shewan responded that there are policies and consequences in place for those who fail to act appropriately.

Councillor Wayne Luca expressed concern that too many managers knowing the identities of the guardians could lead to the hiding of facts and information.

The committee requested that costing information be provided and that more information be included in next year's report.

Work Programme

The committee approved the work programme and agreed to add an additional meeting on 10 November to consider the operational plan and saviors delivery plan.