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Apologies and Introductions
Apologies had been received by the Chair, Councillor Jim Dickson.
Declarations of Conflict of Interest
None were declared.
That the minutes of the meetings held on 28 November 2018 and 30 January 2019 be approved as an accurate record of the proceedings. ?
In response to queries regarding receiving updates on Occupational Therapy (OT) and potential cuts to social workers:
• The Committee needed to decide how it would present risk registers and how frequently the Committee felt it was appropriate to report back on issues relating to staffing and waiting lists.
• Further discussions had been held with regard to OT and records of these could be circulated to the Committee.
• Those with lower level concerns were being dealt with by trusted assessors. OT were largely only dealing with staff. More OTs had been recruited to deal with specialist issues.
• It was understood that there were still 422 OT assessments waiting to be started, 192 of which were awaiting adaptations.
• Although the effort to recruit more staff was having an impact on long waiters, it was not having an impact on reducing the waiting list because more service users were using the service. Examinations were underway to identify the new users using the services.
• Signposting information should be going to referrers and most of this would be generated from acute hospitals. This would be checked but it was understood that there were people already in receipt of some services.
• Most of the people waiting for OT assessments considered to be at risk were those still waiting for adaptations. Checks needed to be made to see if those people were at risk of harm. If this was the case, then it would affect the safeguarding risks.
• The meeting agreed that a letter should be sent to GPs to inform them of any long waiting lists.
The Committee felt that the processes being deployed to minimize waiting lists and to categorize the risks as well as escalation processes needed to be identified.
The Committee heard that further work was being undertaken as part of the Living Well Network and was examining staffing in general. There were no staffing changes for 19/20 but staffing issues could be further risk assessed. Generally, there were staff savings expectations in the long term.
Ms Moira McGrath, Director of Integrated Commissioning (Adults) presented the report.
• There was a requirement to update the register every two months and formally go through it every other month for the CCG.
• The risks were being reviewed through each organisation and were being reviewed by teams through standard processes.
• More detailed information was noted at the CCG Integrated Governance meeting.
• An extract of the records from the most recent GSTT Contract Monitoring Board would be circulated to the Committee showing district nurse vacancies by locality.
• DTOC risks had reduced since the start of the year.
1) That the report be noted.
Ms Moira McGrath, Director of Integrated Commissioning (Adults) presented the report and stated that the new DOLs regulations were due to go through Parliament in the coming week and there would be new way in which authorisations would be made.
The Committee heard:
· The increase in double handed care as indicated on page 24 of the agenda papers did not take into account some of the work being done. The increase had been observed and there has been work done on double handed projects to help the issue and take a different approach.
· Consideration also needed to be given regarding supporting the cost of high care packages.
· Some staff savings had already been achieved via changes made to day services. In the older adults area, the focused offer of day services concentrated on people with moderate to increasing issues of dementia. This reduced staffing and some took voluntary redundancy. Some staff members had gone to other offices and some had continued to work in in-house services.
· The process for additional staffing would be an internal discussion in management teams. Some areas had been agreed in relation to non-recurrent staff.The agreements would be reviewed by the Committee in general but also by other bodies.
· There was a risk that in order to generate savings, core staffing would have to be reconsidered.There was a challenge in covering expenditure with non-recurrent resource and this would therefore deplete the resource for recruiting non-recurrent staff.
· Additional social care funding would be allocated in 2020/21 and Lambeth would have to manage with grants unless additional recurrent resources were allocated. It was difficult to predict when the financial issues would become even more serious than it already was because Lambeth would receive non-recurrent funding intermittently.
· The BCF policy Framework was expected to be submitted in late February 2019.
1) That the report be noted.
Mr Brent Withers and Ms Moira McGrath, Director of Integrated Commissioning (Adults) presented the report.
The Committee commented that:
· Having a vocational strategy for the employment of people with mental illness was partly a question for Lambeth Together.
· Further information would be provided to the Committee on the proposed models of employment at a future meeting.
· Some observation needed to be made on what contribution employers were making. Processes needed to be monitored as it would help with data gathering on wider issues such as discrimination.
· Further information was required on the workforce recruitment challenges in mental health as part of next stage developments.
The meeting heard that:
· The work being done in Health In All Policies may have some debate on how the Council and LWNA offers around employment would operate.
· There was a broader question regarding challenge to the wider population on influencing workforce strategies.
· The Committee would be updated further on any progress.
· The decision was technically a CCG decision delegated to CCG members of the Committees.
1) That the CCG members of the Committee approve the 12 month contract extension for NHS Lambeth CCG and Lambeth Council’s vocational, information, advocacy and support related contracts as detailed in appendix one and two of the report.
Ms Sabera Ebrahim and Mr Pete Hesketh, Head of Finance, Integrated Support presented the report.
The meeting heard that:
· There were local authorities which had overspent despite having been allocated additional funds, but Lambeth had not done this. Lambeth was managing using the resources that it had.
· There was a significant financial risk on uncertainty on recurrent financial resources for social care for the health and care sector generally.
· There are cost pressures due to the increase in numbers of older people and people with physical disability, the length of time people were living, increase in unit cost and the general cost of living.
· Employers are required to pay at least the national Living Wage but this was increasing the cost.
· The House of Commons library had issued a issued ‘thinking so far’ document regarding the green paper. This would be circulated to the Committee.
· The government had said that said that it would be issued at the earliest opportunity.
· There was still dispute in central government regarding how much should be allocated to health care services; caps on expenditure were still being discussed.
· At the MADE event, a closer examination was made of the 12 super stranded individuals. Some themes included an individual need for more intense personalised support. There was one cohort that had a need for more forensic input. This needed escalation because the interaction between forensic teams and ward teams was not as good as it could be. This had been escalated to the South London Partnership. There was a small number of women with complex needs, some with drug taking issues or sexual exploitation issues.
· Patients reconnecting with the community could find themselves in unintended or unhelpful circumstances or environments.
· There were a number of other people who would discharged and readmitted hospital. Attempts had been made to manage risks for individuals.
· More work may need to be done to help find theright solutions. This may mean trailing an idea or process for 3 months.
· Some patients were fearful of being discharged and would exhibit behaviours to delay their discharge.
· At times, patients had been partially institutionalised and support had been given to patients to become more confident of being discharged.
· Taking the DoLs or Court of Protection route often took months. However, if patients refused to leave, then they would have to go through Court of Protection process.
· There were groups of people entrenched within the system who were all known to professionals working within it. Consideration needed to be given on how to interact with them with respect to their personal circumstances. Some had supportive families.
· In the field of Learning Disability and Homelessness, the cohort across the trust had 70/80 people who took up 60% of the bed occupancy. Some people would be admitted for 200 days or more.
· There had been some difficulty in finding the right person who could engage with a particular individual. There have been some workers who had been able to establish a relationship ... view the full minutes text for item 7.