1.         To review the effectiveness of the Adult Social Care Improvement Plan to ensure that the changes underway are being delivered as proposed and are meeting the needs of Torbay’s residents.

2.         To track patients from discharge from hospital to the care they receive in the community to ensure that it is fit for purpose.

(Note:  Director of Adults Services, Jo Williams, Torbay Council Head of Commissioning, Steve Honeywill, the Chief Executive of Torbay and South Devon NHS Foundation Trust (TSDFT), Liz Davenport and Steve Holman, TSDFT Associate Director of Operations for Torbay have been invited to attend the meeting for this item.)

Torbay Council Head of Adult Commissioning, Steve Honeywill, and the Torbay and South Devon NHS Foundation Trust Associate Director of Operations for Torbay, Steve Holman, outlined the submitted presentation in respect of the Adult Social Care Improvement Plan and responded to Members’ questions in relation to the following points:

·                     concern about the shortage of domiciliary care workers and the amazing job they do which did not seem to be recognised, what could be done to raise the profile of the role, improve training and potential recognition from the Royal College of Nursing that the role was similar to that of a nurse – meetings have been held with domiciliary care providers to explore this issue further, it was not all about the money, although there were many jobs in hospitality and other trades that pay higher wages, it was also about how employees feel about the job and the status that it was given, looking with wider NHS Devon to see how we could market the job at a higher level and using Torbay News to promote it as a career, also looking at training and development opportunities;

·                     the number of readmissions following discharge and how discharges were being planned and managed when Torbay Hospital had 40 people in the Emergency Department waiting for beds – they had to match people with the solution that provides the best outcome and due to shortages of some provision it could be necessary to accommodate people outside of Torbay.  They were working with the NHS to try to recruit more staff but this was a national issue and some of our provision was taken by people from outside Torbay, there were also plans to increase capacity and make more use of community support;

·                     why Direct Payments was going out to procurement and if people had problems procuring services for themselves – it was being procured as this is normal practice;

·                     query on how the savings had been made over three years and if this had resulted in any care packages being compromised – savings had been made through a number of ways including those under 65 with no mental health issues being placed in supported living rather than residential homes, restructuring of staff and savings through Direct Payments as a result of some people not wanting to access services during the pandemic;

·                     how people would pay for their care if they needed to go into a nursing home etc. – there were a number of options depending on circumstances which included deferring payment until their property was sold once the person had passed away, day care being assessed based on available cash and income and what the person could afford to pay;

·                     how people could access befriending services and get help with gardening, collection of medication etc. through the voluntary sector – there were many organisations that could provide this with people being directed to contact the Community Helpline and they would be signposted to the most appropriate support;

·                     difficulty discharging patients with additional needs e.g. dementia – they try to ensure that people were placed with providers that could meet their needs, there was limited capacity for acute nursing care, support for people with dementia, learning difficulties and autism which could result in people being placed out of area to ensure that their needs were adequately met, the pathways for these people was closely monitored;

·                     suitability of key worker accommodation for nurses and domiciliary care workers to encourage them to come to work and live in Torbay – access to affordable housing was key to filling our local vacancies, some providers also offer accommodation on site;

·                     importance of place shaping to ensure Torbay can meet the needs of our workers – they were working with the Planning Department to explain what their needs were and building relationships with community partnerships and ward Councillors early on in the planning stages for new accommodation.  Housing was a key issue and the Housing Team were helping people to move on from large social housing to free up capacity for larger families when occupation had reduced;

·                     impact of staff not receiving the Covid-19 vaccination – 10% of care workers had not received the vaccination and work was being done to support those individuals, including peer support to try to encourage them to get vaccinated.  This was also happening across the whole system to reduce the number of people who would not be able to carry out their full role after the deadlines imposed by the Government;

·                     loss of residential beds – four providers had closed for a number of reasons and work was being done to help support the remaining providers as well as building more extra care housing to help people live at home with appropriate support; and

·                     how people with severe mental health conditions were supported – most people were able to live safely within the community and had regular intensive support to help them settle into the community, they were closely monitored, normally under the management of the Devon Partnership NHS Trust.  Often they were relying on carers they live with which could be difficult for many family members.

The Board requested the following information be provided:

·                     a breakdown of how the £6m would be saved;

·                     data on how many people we support in nursing care, residential placements, domiciliary care, day care etc; and

·                     an estimate of the number of key worker’s accommodation required to meet the needs and help fill our care worker vacancies.

Resolved (unanimously):

1          that the Board recognise the work being carried out in Torbay to deliver the Adult Social Care Improvement Plan and the hard and professional work of our care workers.  The Board encourage the Council’s Head of Adult Commissioning and the Torbay and South Devon NHS Foundation Trust’s Associate Director of Operations for Torbay to continue to recognise our care workers, by raising their profile, exploring ways to enhance their career opportunities in care and investigate ways of providing sufficient additional key worker accommodation, to encourage more staff to come to work in Torbay and fill our vacancies in the care sector; and

2.         that the Devon Partnership NHS Trust and Torbay and South Devon NHS Foundation Trust be invited to a future meeting of the Overview and Scrutiny Board to outline the Community Mental Health Framework on how people are supported with severe mental health needs.

(Note:  Councillor Brooks arrived during discussion of this item and Councillor Stockman left the meeting during discussion of this item.)