Agenda item

The Committee will receive an update on the Councils Adult Social Care key performance indicators which is to follow.

The Chairman welcomed Emma Legg (Director – Adult Social Care) and Emma Townsend (Head of Service - Living and Aging Well) who were in attendance to provide an update on the Council’s Adult Social Care key performance indicators. 

Summarising the more detailed presentation shared within the agenda supplement pack, the following was highlighted:

·            From the graphs showing the demand and activity data it was to be noted that there had been an increase in demand for adult social care (ASC) since April 2023 and that the number of new contacts had increased by 41% and the percentage of work requests to be allocated at risen by 26%.  Another graph showed that there was a rise in productivity rates whilst the ASC demand continues to rise;

·            Placements of adults of working age and 65 and over were detailed as to whether they were in permanent residential care, in permanent nursing care or receiving care in their own homes.   It was noted that there was growth in the number of adults of working age ASC were supporting but that more of them were in their own home and there was a steady increase in demand for residential placements for those aged 65 and above;

·            Details of how long people wait for a Care Act Assessment showed that more were waiting longer in the winter months but that the trajectory is reviewed by Performance and Outcomes Board and the wait continues to reduce;

·            At April 2023, there were 67 adults with a learning disability in paid employment who had also had an annual review in the last 12 months.  At October 2024 this was the case for 85 adults.  At April 2023, there were 637 adults with a learning disability living in their own home or with family who had also had an annual review in the last 12 months.  At October 2024 this was the case for 784 adults.  Both graphs showed improvement but the service remains ambitious and they would strive for improvements to continue;

·            ASCOF was the Adult Social Care Outcomes Framework which is designed to measure how well care and support services achieve the outcomes that matter most to people.  The ASCOF 2023-24 results were due to be published in mid December 2024 and so the Wiltshire 2023-24 data is provided alongside the last national survey data and the ASCO’s previous years data was being used as a benchmark;

·            Some of the statutory return data was provided and showed how Wiltshire is positioned out of the 14 local authorities in the Southwest area and the England average in relation to a number of different indicators.  Wiltshire were top for the % of carers who receive direct payments but low in the rankings for the % of service users who receive direct payments.  This was a priority project in the transformation programme work and it was hoped this would improve to reach the England average of - 26% by April 2026;

·            The last slide was information drawn from surveys which are self-reports from individuals themselves – in addition, a number of factors impact on how people view their circumstances, not just related to adult social care. Wiltshire ranked towards the bottom in the Southwest for the % of people who reported that they spend their time doing things they value or enjoy and the % of people who say help and support helps them to think and feel better about themselves - for an individual these indicators could be impacted by transport, availability of opportunities and by the disposable income they have; despite this, the service wants to be ambitious with their partners to see those numbers increase

·            The Council performs well on the % of people satisfied with their care and support and the bottom 3 indicators which show people feel they have choice which is a real positive because that provides people with more control over their lives and that the services they receive make them feel safe. 

The Committee asked the following questions which included but were not

limited to:

·            The waiting list for the Care Act Assessment shows remarkable improvement – what were the reasons behind that?  There had been wider workforce development with the service’s recruitment and retention to make use of market supplements and apprenticeships to make sure that the workforce is as full as possible and that staff are well trained and supported.  There was also a range of performance management tools to ensure that they are responsive to demand and show where some of the pressure is.  They were also making use of preventative services and had introduced their performance and outcomes groups to look at the work waiting and that is report to the board to review the challenges and look at how the wait list numbers can continue to come down.

·            Why do the cumulative outcomes for residents with a disability reset at April?  It was noted that these figures were based on when a person has an annual review – when the review has happened they can then be counted in the cumulative total.  This was the way it had to be reported nationally; however, they could look at how else that could be presented in a future report.

·            How are the reviews done for those with a learning disability – is it the Social Worker or is it an independent review?  It was noted that these were statutory reviews and the Care Act states that they should be checking that everything is working and their outcomes are still being met on a regular basis.  They aim to do them annually but there is some flexibility due to people’s circumstances.  They are usually done by the Social Worker or a Social Care practitioner depending on the complexity they would be flexible in meeting with the individual and their family and the methods that they use so they can really hear the voice of the person and ensure that the support plan is continuing to meet their needs. 

·            Looking at the graph of the outcome at 91 days after discharge with the % of people at home – does that mean only 35 people are at home – what group of people does that relate to?  It was noted that this graph was focused on Wiltshire Council activity and would add up through the year.  This was the number of people taken into the Home First service and then they are people they can measure but agree numbers look slightly low so would check on the figures.  The % figure was the one to focus on and they were achieving around the 90% of people still at home 91 days after discharge. 

·            Is there a mechanism for looking at financial indicators such as comparing day rates for example for domiciliary care with other counties so that it could give a sense of whether it was value for money?  It was noted that there was a lot of data around finances and spend and that could be shared in terms of where they are focused and where they were prioritising.  It may be worth having a discussion with the Chair and Vice Chair to bring the information that the committee would find helpful.

·            Whilst noting that there was a steady increase in demand for residential placements for those over 65, the number staying at home was flat lining – was there a change in cohort, more complexity, why is it that more are opting for residential and nursing homes rather than staying at home?  It was noted that there was a degree of complexity in the graphs but that they would expect those in residential homes to decrease or remain the same.  A few years ago there was a potential lack of capacity in domiciliary care in the community and that may have meant that some did move into placements because for some rural areas it was difficult to source care, but that position has improved significantly where there is the right amount of high quality community capacity to be able to keep people at home more effectively. 

·            When you talk about outcomes for those with learning disabilities – are those with autism included or have you done something separate for those that have autism not learning disabilities?  It was noted that the graphs shown did relate to those who had a learning disability, but that information could be provided for those that have autism or were neuro diverse.

·            Has the implementation of Caring Steps helped with the discharge of people to home?  It was noted that it had been implemented and that there was further embedding as it is an excellent scheme in terms of giving people information at the right time and allowing them to plan and make decisions for themselves.  Keen to ensure that all staff and whole range of organisations know how to access and help people understand what the offer might be and how we can support our own loved ones.  Raising awareness of this scheme is really valuable. 

·            What is this data telling us in terms of top priorities for actions over next few months and do we have the capacity to carry out those actions?  It was noted that the improvement that has been seen in terms of activity and productivity, the number of reviews completed, the number of people waiting for a Care Act assessment is hugely improved and the focus over the next few months is going to be maintaining and improving that position because we know that working with people in a timely way delivers the best outcomes for them.  That would continue to be prioritised.  As they go into winter will ensure that they are working effectively with system partners around likely increased pressure in acute hospital and community issues whilst keeping a focus on key transformational priorities.  Longer term they would be focusing on technology enabled care and other digital solutions.  There was a huge amount of activity underway and glad to be able to say that the majority of indicators going in the right direction.  

The Chairman commented that it would be useful to have some context in first slide to give details of how many people are in those two age ranges and also an idea of what the budgets are perhaps for last few years and then current budget.  He also asked if the graphs showing the age cohorts could be split further to show the numbers of those who are aged 64 who are about to drop into the 65+ age range.  Emma Legg reported that a key area of focus is around transitions and working with young people who are coming into adulthood and making sure there is a strong offer and the right solutions at that point.  It was felt that information on transition would be helpful to share with the committee. 

The Chairman also asked if it would be possible to have the yearly data going back 3 years to help understand the trends.

Resolved:

That the Health Select Committee:

1.          Take into account the ASCOF publication pattern (mid-December) and receive an annual report on Adult Social Care KPIs at the January / February committee meeting, which shall include:

a)         The first page of the report showing budget for Adult Social Care for the last 3 to 5 years (depending on data included) and overall population in Wiltshire split by the same age groups as used in the report (if data available)

b)         The data being split a little more with regards to age to understand “trend” and predictable demand (currently 18-64 then 65+ years)

c)         Yearly data for at least last 3 or 5 years for demand, activity and place/placement.

Noting that the next annual report on KPIs would then be on 14 January 2026.