To consider the submitted report which provides an overview of the adult social care market.

The Sub?Board noted the Overview of the Adult Social Care Market report, which provided an update on the quality, capacity and sustainability of Adult Social Care provision in Torbay, including workforce issues across residential, nursing, supported living and domiciliary care.

Members discussed provision for people living with dementia. It was noted that a significant number of care homes continued to support people with dementia. The Divisional Director of Adult Social Care advised that earlier awareness and diagnosis were important in supporting prevention, enabling family support and facilitating alternative community?based or home support options before admission to residential care became necessary.

The Sub?Board queried whether training for care staff was regulated. Officers advised that training should be accredited and that the Care Quality Commission (CQC) was responsible for the registration and regulation of care homes, including compliance with training requirements. The Divisional Director of Adult Social Care confirmed that while care providers were not regulated directly by the Council, they were required to be registered with the CQC as part of the Council’s contracting and quality assurance processes, and the Council became involved where safeguarding concerns arose.

Members sought clarification on the Living Well at Home domiciliary care arrangements and whether these operated under a contract. Officers explained that the Living Well at Home offer operated through a Framework, which providers could join. When care was required, the brokerage team identified needs through assessment and issued requirements to providers on the Framework to secure appropriate care.

Members were reminded that assessments were undertaken in line with the Care Act 2014, and that where an individual was assessed as having eligible needs under the Act, they would receive services to meet those needs in line with statutory duties.

The Sub?Board discussed the Jack Sears House model and queried whether it was being sufficiently promoted. Members expressed the view that the approach was strong and should be more actively championed. Officers acknowledged that greater emphasis was required to ensure people were supported to return to their own homes where appropriate. It was noted that the CQC report reinforced the importance of this approach and that, regardless of the future of the Section 75 arrangements, the core principle of protecting and promoting independence remained central. Officers also referenced the NHS 10?Year Plan, which reinforced the need to equip people with the tools to maintain independence.

Members queried how the Council assured itself that care homes were following their own procedures and meeting wider health needs, such as dental care. The Divisional Director of Adult Social Care advised that where a person was at risk of harm or abuse, this would be addressed through safeguarding processes. Where concerns related to failure to provide routine care, this might constitute a CQC regulatory matter. Where issues related to access to services, such as dentistry, responsibility could sit with the Integrated Care Board (ICB). It was noted that Healthwatch received significant feedback regarding access to dentistry generally, though not specifically from care home residents, and Members were encouraged to direct relevant concerns to Healthwatch to support wider monitoring.

The Sub?Board discussed nutrition, particularly in the context of dementia and Alzheimer’s disease. The Divisional Director of Adult Social Care advised that under the Care Act the Council’s responsibility related to ensuring individuals were supported to eat and drink, rather than determining the nutritional content of their diet. It was acknowledged that there was no specific system wide focus on nutrition in relation to dementia. Officers confirmed that individuals retained choice and control over what food they purchased and consumed.

Workforce challenges were discussed, including staff turnover. Officers advised that turnover often reflected staff moving between providers rather than leaving the sector entirely. Members were informed that reliance on overseas workers presented a risk to workforce stability, particularly given recent changes to immigration arrangements.

Actions:

1) that the Chair of the Adult Social Care and Health Overview and Scrutiny Sub-Board write to the Integrated Care Board to request that they attend to discuss dentistry access for care home residents and those in supported living.  In addition, the Divisional Director for Adult Social Care identify the responsible bodies for other services such as opticians and chiropody in order for the Chair of the Adult Social Care and Health Overview and Scrutiny Sub-Board to write to them seeking details as to how care home residents access these services; and

2) that the Director of Public Health attend a future meeting of the Adult Social Care and Health Overview and Scrutiny Board to present to Members Public Health activities regarding healthy weight/nutrition with a focus on older people.