Agenda item

Cabinet Member for Health and Social Care Update


Councillor Jane Palmer, Cabinet Member for Health and Social Care, advised that early intervention to deal with social care issues that arose in childhood reduced the impact on their lives into adulthood. 


Councillor Palmer praised the social workers who had worked tirelessly during the pandemic to support residents during a very difficult period.  There had been a range of initiatives delivered and work undertaken over the last year included: Hillingdon Shared Lives Scheme, reablement and hospital discharge.  In addition, the Hillingdon Suicide Strategy had been developed with links to health, British Transport and Hayes station.  There had been no strategy in place to prevent to suicide in the Borough when Councillor Palmer had taken on her Cabinet portfolio so she was very proud of the partnership working that had resulted in this accomplishment. 


It was recognised that social care took up approximately 60% of the Council's entire budget and that this supported a relatively small number of residents.  However, it was also noted that social care was a statutory service that had never been sufficiently funded to enable preventative work to be undertaken which would ultimately reduce the overall costs of the service provision.  To ensure that the quality of service was maintained, proper procurement and monitoring measures had been put in place to ensure that poor performance in contracts was addressed and to ensure value for money.  However, inflation had meant that everything was now more expensive than it had been previously (including the workforce) but the Council continued to maintain its sound financial management. 


Ms Sandra Taylor, the Council's Executive Director of Adult Services and Health, advised that social care would always be a high spend area of the local authority and would therefore always be a talking point.  However, Hillingdon had demonstrated a good and effective use of resources based on early intervention.  A strong hospital discharge process had been put in place resulting in 70% of people coming out of the reablement process with no ongoing care needs.  It was important not to create dependencies and to keep people living in their own homes for as long as possible. 


Further work was needed to create resilience in young people and, to this end, Ms Taylor would be speaking to the Interim Director of Public Health to see what action could be taken to further develop good general health.  There were gaps that had emerged and it would be important to fill these with voluntary sector providers. 


Councillor Palmer noted that social care in Hillingdon was a good place to work, with dedicated staff.  The Council promoted social care apprenticeships to enable the authority to develop its own staff and allowed them to move between departments.  Supportive working relationships were in place with proper supervision and support for social workers and caseloads were well managed. 


Ms Taylor stated that staff retention in social care in Hillingdon was very good and that the leadership team had a breadth of experience to support the service area.  Social workers were well equipped and had a balanced caseload and the right support.  A range of workforce development schemes had also been put in place. 


Members were advised that the CQC had today published its new inspection framework but that Adult Social Care had been preparing for an overarching inspection for some time.  Ms Taylor noted that the CQC would be undertaking five inspections between April and October 2023, one of which would be in London.  Operationally, she had attended meetings to learn how local authorities could best present their evidence to the CQC and effort had been made to gain an understanding of difference and how residents were helped to live independently.  It was anticipated that Hillingdon would be inspected in 2023/24.  Insofar as local care provision was concerned, a new approach of having face-to-face meetings had been introduced (where appropriate) as well as a review of complaints and the remote monitoring of services. 


With regards to being dynamic in new ways of working, Councillor Palmer advised that she had initiated a review of the Hillingdon Health and Wellbeing Board when she became Cabinet Member for Health and Social Care.  The Board, which she now co-chaired with the Managing Director of Hillingdon Health and Care Partners (HHCP), was no longer a talking shop and had enabled frank and honest discussions to be held with all health and care partners.  In addition, Councillor Palmer raised issues such as health inequalities at meetings with her counterparts from the other seven North West London (NWL) boroughs (Brent, Ealing, Hammersmith & Fulham, Harrow, Hounslow, Kensington & Chelsea and Westminster). 


Councillor Palmer advised that she had recently been appointed as a representative on the NWL Integrated Care Board (ICB) for the eight NWL boroughs and had attended a meeting earlier in the day where there had been some discussion about the proposal to change the provision of orthopaedic services in NWL.  Concerns had previously been raised at the Health and Social Care Select Committee about transport in relation to these proposals and Councillor Palmer confirmed that she would be on a Transport Working Group to look at this issue. 


With regard to succession planning, Ms Taylor advised that there were three Registered Managers in Adult Services who had worked for the Borough for many years.  These managers were all very supportive of their teams in terms of personal development and providing training opportunities including registered manager training.  Experience and knowledge could also be shared through the Provider Forum and Registered Manager Forum. 


In the past there had been a disproportionate number of out-of-town placements which had been more costly than in-Borough placements.  Ms Taylor advised that extra care housing had been developed to try to meet this need and tip the balance back to being able to live in the community in supported living.  There were now more supported living places in Hillingdon than there were residential care places (there were 44 registered care homes in the Borough).  However, there were still some residents with niche needs that could not be met locally which would need to be reviewed and monitored.  In the future, the focus would need to continue to be on early intervention rather than care homes, as people had realised that the best care could be provided at home and that the least restrictive options needed to be implemented. 


Feedback in relation to the digitisation of social care applications had been positive.  However, it was recognised that some people would not be able to navigate their way through the technology and, in these circumstances, there would always need to be a human available to talk to.  The online assessment facility had been available for some time and an online referral system would soon also be available to try to reduce the waiting time for residents.  The online facility reduced the number of steps in the process which made dealing with safeguarding issues, etc, much more efficient.  More feedback on the system would need to be collected. 


The work of the Hillingdon Dementia Alliance had grown and the team were commended on their efforts.  Tovertafel sensory tables had been made available in libraries across the Borough.  Councillor Palmer noted that the dementia team had been phenomenal, providing a good service, developing good networks and resulting in good engagement with services.  Ms Taylor noted that engagement with residents had increased but that she would need to establish how much it had grown and report this information back to the Committee. 


The dementia work in Hillingdon had been aligned to the third sector work to help keep residents at home for longer.  Admiral nurses had provided a first-class service to support those with dementia and their carers at home and Dementia Friends had been trained inhouse. 


It was anticipated that the fair cost of care would cost around £4m but that Hillingdon would only be receiving £2.4m funding towards this in 2023/24.  All councils had been asked to undertake a fair cost of care assessment with providers in 2022 and Hillingdon had submitted its findings in October 2022.  It was actually estimated that the costs would be £4.5m to bring them to the right level so, as the Government funding was on an incremental level, it was hoped that the 2024/2025 settlement would be £2.1m.  However, inflation had risen which had put even more pressure on the Council in terms of the fair cost of care.  The Chairman asked that Ms Taylor advise the Democratic Services Manager when the 2024/25 settlement had been announced. 


It was noted that there had been a drop in formal safeguarding enquiries from 2,497 cases in the previous year to 1,694 cases this year.  In addition, there had been an increase in overall referrals from 8,848 in 2019/20 to 13,938 so far during 2022/23 (an increase of 58%).  Ms Taylor advised that, during the pandemic, fewer referrals had been made which meant that there had been an increase in the number of people experiencing mental ill health and more mental health referrals coming through.  However, consideration needed to be given to what it was that converted an enquiry into a s42 investigation.  The Council wanted people to raise safeguarding referrals and, if the conversion rate to s42 was low, this would be positive. 


The Cabinet Member thanked the Committee for inviting her to attend the meeting and advised that she would continue to work with partners to achieve good outcomes for Hillingdon's residents.  She would be happy to come back again on an annual basis to provide the Committee with an update. 


RESOLVED:  That the discussion be noted.