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Apologies for absence were received from Members County Councillors A Williams and J Ewing Officer Nina Davies (Director of Social Services & Wellbeing).
There were no declarations of interest by Members relating to items to be considered at the meeting.
The Committee did not receive any disclosures of prohibited party whips which a Member had been given in relation to the meeting in accordance with Section 78(3) of the Local Government Measure 2011.
It was agreed that the minutes of the previous meeting held on the 20th of September 2024 would be brought to the next meeting of the Health & Care Scrutiny Committee.
Background: • The Head of Children’s Services presented the paper which highlighted the discussions held at the last meeting of the Corporate Safeguarding Board in September 2024. • A recent audit had reviewed the role and functions of the Safeguarding Board. This report would come to the Health & Care Scrutiny Committee once it was available. • It was noted that the regulatory tracker was on track. • The Director of Social Services Annual Report was discussed and had been through the Health and Care Scrutiny Committee in August 2024. It was being investigated whether an ‘easy read’ version of this report could be produced for the 2024-25 Annual Report. • Terms of Reference were being reviewed to ensure that the Board’s purpose and function were held to account. A draft version would go to the Safeguarding Board for approval in December 2024. • The Regional Safeguarding Board had regional responsibilities for Powys, Ceredigion, Pembrokeshire and Carmarthenshire. The Board met regularly, and the Head of Children’s Services and Adults Services for Powys were members of the Board. It looked at cross cutting themes across all local authorities through a regional lens. • The Board looked at the Child Exploitation Strategy in Powys to understand what it meant for Powys as a whole and what areas within the council could have accountability as part of the wider thinking and learning around Child Exploitation as a whole. • The Board looked at Community Practice Sessions, outreach events and the development of the Ambassador Programme. Conversations were held regarding learning from the regional safeguarding board back into operational groups. • Safeguarding in housing: • There was an update regarding care leavers and homelessness in Powys. • A significant reduction in the number of children in bed and breakfasts had been seen, reducing from 46 households in October 2023 to 26 households on the 9th of September 2024. • Safeguarding in Education • The Board looked at safeguarding and education with particular attention to elective home education and fixed term exclusions. • There was discussion around the importance of safeguarding for learners during exclusions and ensuring that exclusions were not a consequence of safeguarding issues at home. • CE Strategy and Implementation Plan • The Board looked at roles, responsibilities and accountability for different service areas and the Council regarding its strategy and implementation plan. Especially regarding licensing, visibility in community settings, and online learning. • Learning from CPR and APR • Learning was always taken from the Regional Safeguarding Board to the Local Safeguarding Board. • Learning opportunities were taken from Child and Adult Practice Reviews, where themes were taken from Practice Review summaries into the organisation. • Future Board meetings were scheduled for 12th December and13th March. • The Portfolio Holder for a Safer Powys added that the Committee should see the revised terms of reference once presented to the Corporate Safeguarding Board. • The report reflected the way that corporate safeguarding cut across the whole Council. Issues Raised by the Committee: Responses Received: The Committee requested that the presentations presented to the Board be embedded in the activity report going forward. The Committee requested examples to demonstrate how the Corporate Safeguarding Board was on track with actions against the Safeguarding Regulatory Tracker. The Head of Children’s Services answered that all services had to demonstrate that safeguarding was a priority and complete a safeguarding element of their self-assessment. That information was used to understand the overall placement of the Council. This meant the requirements of safeguarding were embedded across the whole Council’s agenda and any problems identified would be fed back up to Board level where an action plan could be performed. The Committee asked for more information regarding savings achieved by using AI for translation and how it was used for the Welsh Language. What was the current spending on translation, the savings achieved and how had savings been reutilised to improve service provision and role efficiency going forward? AI was used for language translation and had the potential to support communication between Children’s Services and Unaccompanied Asylum-Seeking children amongst other things. It was anticipated that savings would be achieved due to AI decreasing reliance upon paid translators. The Portfolio Holder for Future Generations added that everything translated by AI still had to be proofread to ensure that it was accurate but there was great opportunity in the use of AI. The Head of Children’s Services added that AI was part of the Social Care Digital Transformation Agenda. The Service was working with other local authorities on the use of AI and offered to bring a report to Committee to pick up on the financial part of the question. The Head for Adults Services added that the Service had been working with Torfaen Borough Council to review how AI could assist with minute taking for safeguarding meetings. Were other Services looking at incorporating AI and could a Members Development session be available on this? The Head of Children’s Services answered that many services were looking at incorporating AI into their work and the idea of a Members Development Session could be taken back as a comment. The Committee welcomed the reduced use of Bed & Breakfast accommodation and asked what further actions were needed to ensure this change was sustainable. This was an ongoing challenge for the Housing Service in terms of having enough provision to manage homelessness in Powys. If the Committee required more specific information, then the Housing Service would need to prepare a report for the Committee. The Committee felt assured of this item only after it was accompanied by the presenting officer’s supporting narrative. It was recommended that the Cabinet receive more comprehensive reports to ensure confidence. Cabinet Member for Future Generations answered that Cabinet Members sat on many Board meetings and had access to many reports, thus, knew a lot of background information, which resulted in reports being narrowed down when presented at Cabinet meetings. It was noted that due to this, Cabinet documents could give the impression of being insufficient. The Committee commented that the use of acronyms and lack of table headings made the report difficult to read. It was asked that the report was made more reader friendly and incorporated further details for members of the public. These points were taken by the Head of Children’s Services and would be reported to the Director of Social Services. Cabinet member and portfolio holder for Future Generations thanked the committee for bringing this to their attention and offered assurance that this would be looked into. What were the associated cost savings around the reduced use of Bed & Breakfasts? Could a narrative be provided explaining how this reduction resulted in increased safeguarding for young people? The Committee requested further details around excluded learners, including why this had an impact on safeguarding. The narrative provided for item 2.6 The CE strategy and implementation plan did not answer why it had an impact on safeguarding. What was the impact of implementing that plan? Would Cabinet members receive the embedded papers for the Cabinet Meeting? Cabinet Member and Portfolio Holder for a Safer Powys answered that each member of the Cabinet was a member of the Safeguarding Board, so would receive the embedded papers with Safeguarding Board papers. The Committee asked about the formality of procedures at Board Meetings. The Head of Children’s Services answered that it was a formal Board with opportunity to stop, reflect and ask questions. Cabinet Member and Portfolio Holder for a Caring Powys added that detailed reports were received before the board meeting. Cabinet Member and Portfolio Holder for a Safer Powys added that this question was also posed by the Auditing Commissioner, and the report would be ready soon. The Committee reiterated the importance of the ability to seek assurance from papers presented and that assurance of this paper was only received following the supporting presentation from the officer. This could not be achieved by members of the public by looking at the agenda. The Committee asked Board members to consider how the robustness of meetings could be demonstrated to assure effectiveness to the public.
Background: • Item presented by the Head of Adults Services. • The Falls Prevention work carried out in Powys was a collaborative approach with Powys County Council’s Social Services, Housing Services and Community Equipment Store and Powys Teaching Health Board and the Third Sector. • Falls were the second leading cause of accidental injury or death worldwide. Each year in Wales 1 in 3 people over the age of 65 would fall and 1 in 2 people over the age of 80 would fall. The demography of Powys meant that this was a significant issue for the Service. • Routine enquiries and Assistive Technology would go through to the ASSIST team who would ask about falls and organise assistive technology such as careline alarms and falls alarms to prevent long lies on the floor. 361 people were signposted to Falls Service. • If people were reporting to be at risk, self-referral was encouraged or support to refer would be given by the call handlers to Powys Teaching Health Board’s Fall Service. • Out of the 720 individuals receiving technology, 361 were provided with technology-enabled care to help manage the risks associated with falls. Mobility Assessment and Rehabilitation: • The process of support would begin with a Multifactorial Falls Risk Assessment by Powys Teaching Health Boards Falls Service. • Tailored interventions were then provided based on the results and necessary referrals to the relevant professionals made. This was a preventative approach which addressed possible causes of falls. Strength & Balance Training • Powys Teaching Health Board were currently setting up new specialist training sessions. An example of this would be the ‘Confident Strides’ Group in North Powys. Home Hazard Adaptations • Making modifications in the home was essential. Work with the sensory impairment team, housing services and care and repair work collaboratively to understand the needs of the resident to provide small, medium and large adaptations that could improve the accessibility of homes and significantly reduce the risk of falls. • Examples included the provision of grab rails, ramps, level access showers, lighting on stairs, stair lifts. • Enabled residents to stay in their homes significantly reduced the risk of lost independence and care costs for the Council. • According to a report from the UK Government, installing home adaptations could save Councils £4 for every £1 invested. • Home adaptations allowed quicker hospital discharges and support to domiciliary care providers to provide support in a safe environment. Community Equipment Provision • The service worked with the Community Therapy Team, Occupational Therapy Team, Sensory Impairment Team and District Nurses to provide adaptations and reduce falls. All these teams accessed Millbrook; the Community Equipment Store so that mobility aid chair raises, toilet frames, community beds and other equipment was available to meet needs and reduce falls in the community. • In 2023-24 the Community Equipment Service visited 5,760 individuals in Powys. • The Service had their own domiciliary care providers and Sensory Impairment Team who worked with older people with visual impairments to improve mobility and reduce falls risk. • Mobility rehabilitation and encouragement of community participation were also methods for reducing falls. • Reablement Teams and the Social Worker Teams work with individuals, carers and care agencies to ensure that the right level of care and support was provided so that risks due to inadequate nutrition and hydration were reduced whenever possible. • Most people who receive a reablement intervention see a decrease in the package of support, so it was a priority service for the Council. • The teams also worked with GPs and District Nurses to provide help in a timely manner. Exercise • Exercise could significantly reduce the risk of injuries and falls. Therefore, access to leisure facilities and activities could reduce the number of older people at risk of falls and reduce the cost of higher levels of support from Health and Social Care. • The National Exercise Referral Scheme and Access to Fitness Scheme ran in Leisure Centres throughout Powys and it was being looked at how this could be expanded to other community venues in Powys. Issues Raised by the Committee: Responses Received: What adaptations to properties were offered following a fall, who would complete the work and what would the budget be? How long would it take to install these adaptations from knowledge of the fall to completion of installation? A large variety of adaptations were offered by Powys were described in the presentation. Larger adaptations would be sourced through the disabled facilities grant. The service was waiting for translation for an ‘aids and adaptations’ page for the website where residents could see the range of adaptations available for them to purchase themselves. Length of time was dependent on the work that needed to be done. Immediate requests could be received, with a turnaround time of 24 hours. Regarding the budget, there were several different budget sources from several grants, further details could be provided outside of the meeting. The Committee requested a deep dive on this topic to analyse the costs of adaptations, budget streams and to receive an analysis on the relevant cost efficiencies. The Committee asked if the timeframes were a challenge and if there were enough resources to meet time frames. How efficient was the system? On the whole feedback was positive. Marketplace availability of equipment could cause issues at times. The Community Equipment Store Board oversaw the efficiency and effectiveness of the store, measuring timeliness by tracking from referral to the point of delivery. Led by officers from Powys County Council, Powys Teaching Health Board, Millbrook, Care and Repair. Was support offered to residents who used the wrist and neck fall detectors to ensure confidence and competence in use? Yes, each resident would have a review, and an officer would go through equipment with them. Feedback would be sought from family and canary systems could be in place to monitor movement to provide reassurance for families. How did falls work harmonise with hospital discharge teams and how quickly could adaptations be implemented for further preventions? 24-hour requests usually came from hospital discharges. Teams were completely linked across the Occupational Therapists and the Reablement Teams. The Committee requested assurance that the 24-hour requests were met and did not hold up hospital discharges. Assurance was given. The Head of Adults Services sat on the Discharge Meetings twice per week and the Patient Flow Meetings on a weekly basis. Only once had a concern been raised regarding the provision of equipment over the last 18 months. Were there other home adaptations which were not covered under ‘slips, trips and falls’ and so would be more complex and timelier due to being under a different income stream? Yes, the Disabled Facility Grant would cover larger pieces of work where there were significant adaptations within the structure of the home and could take longer. Would equipment be collected once it was no longer needed? Was there an infection control process in place if equipment was to be brought back? Collection of used equipment was carried out, but further information would be sourced regarding which equipment. - ACTION Was there assurance that Care Line Alarm systems were working? The Care Line Alarm Systems were being reviewed constantly. Concerns were raised in the performance report regarding issues with sensory impairment equipment, so the service was working with the manufacturer to reduce impact. The Committee requested further understanding of the arrangements between Powys County Council and Powys Teaching Health Board. Including the financial arrangements and the number of people who had gone on to fall following intervention of the Falls Prevention Service. The Service could access central grants but there was a combined budget from Powys County Council and Powys Teaching Health Board that went into the equipment store for different levels of equipment. Details regarding the budget were not to hand. A Falls Group monitored and researched the number of people who went on to fall following support from the service. Officer to provide more information in writing - ACTION The Committee requested an update on the Care and Repair Budget following concerns that there was a gap in the budget. The demand for this service was increasing year on year and work was currently being carried out to understand what funding stream could cover this gap in funding. A meeting had been held last week and the Head of Adults Services was confident that this gap in funding could be covered. Had Adults Services been involved in discussions around the review of the leisure services? Yes, regular conversations were held around the Leisure Review. It fed into the work being done in Day Opportunities and Place Based Planning; making use of community assets across the county for ensuring the activities were connected to provide adequate information for members of the public to access. The Committee requested an annual report containing the monthly data of equipment availability, stock on order, collection of used equipment and data demonstrating budget and availability. The data was available and could be shared easily. ACTION How much money did the service save by completing adaptations in a timely way? Often cost reductions were seen elsewhere in the system, e.g. The Welsh Ambulance Service. There was a lot of data and modelling regarding this which could be shared with the Committee. The main highlight was that for every £1 spent, £4 was saved. The Committee sought assistance from the Service during the deep dive to identify trends in the monthly performance reports that highlighted savings achieved through preventive measures. This was looking to be developed in the new revised data which would be shown in future monthly performance reports. It was noted that savings were increasingly difficult to see due to increased demand on services. The Committee asked whether the savings could be better demonstrated if data was presented as a population percentage. Yes, there was modelling that could be used, it just needed to be applied. It was noted that there had been an increase in nursing home and residential beds commissioned this year and the service had supported 50% of residents who had fallen to return home due to reablement work, growth of the domiciliary marketplace and resources. This was a 40% increase from the previous year. The Committee asked for guidance around how it could support the service during Deep Dives. What role could Community and Town Councils have in sign posting? The Service shared a lot of information with town and community councils and having Link Officers would mean that information could be shared more easily going forward.
Background: • The Committee planned to review the Monthly Performance Reports in advance of future meetings to prepare questions for officers to be provided at the relevant scrutiny meetings. • The Committee requested training on reading the reports to help scrutinise. Issues Raised by the Committee: Responses Received: What level reduction of supervision would cause concern? What actions would be taken following a concern in supervision rates? It would be worrying if the level had fallen well below 70%. The aim was to get as close to 100% as possible, however the summer months often shown a dip due to annual leave. Assurance was given that weekly performance meetings were held with supervision being brought up as a key performance indicator, so changes would be noted quickly. Supervision was just one format of conversation between practitioner and manager. There were multiple other methods for communication taking place. It was noted that there was a 100% appraisal rate in the summer. The data showed that 50 SP Statutory Visits were carried out ‘out of time’ in September 2024. Was this a worry? What was the risk? At what point would supervisors be expected to highlight this? The target was above 90%. It would be worrying if a significant downward trend was seen. It would be a concern if the number of days was increasing between children being seen. But this was monitored regularly on a weekly and monthly basis and assurance was given that problems would be picked up quickly. The WICCIS Service had been down during September, which prevented the timely recording of information. It was not that the Children were not seen, but that the information from the visits could not be uploaded onto the system. The Committee requested the identification of the top 5 to 10 most critical service metrics to streamline evaluation of the monthly performance reports. The Head of Children’s Services suggested the following: • Increase in Child Protection Registrations • High-Cost Placements • The Front Door Data The Head of Adults Services suggested the following: • Number of assessments completed needed to be added to the Performance Report to allow for qualitative data in understanding outcomes. • Could focus on a theme every month rather than provide all information at once. The Cabinet Member and Portfolio Holder for a Caring Powys noted that the monthly report had the potential to provide a holistic view of the work being done by demonstrating the whole system. The committee requested an update regarding WICCIS and sought assurance of the new system. The Head of Children’s Services answered that the WICCIS system was on a phased decommissioning process. The tendering process had been completed. The service was now in the testing phase of possible suppliers. The Director of Social Services could provide a more detailed report to the Committee - ACTION Would the new system only be available in Powys? Yes, Powys had independently sourced its own system, but it would still be attached to the National Board. Concern was shared regarding the potential risk of using un-unified systems when keeping track of at-risk children who had moved to different areas. How could a smooth transition and reduction in risk be ensured? Assurance was provided that tracking of dangerous or at-risk individuals would continue to take place through multiple data bases throughout the UK. And it was offered that the Director of Social Services and Wellbeing could provide a more detailed report to the Committee.
Background: • It was requested that the Scrutiny officer provide new member, Cllr A Evans with information and resources regarding scrutiny committee membership. • Forward Work Plan Meeting to be rescheduled. • Informal Financial Position meetings to be rescheduled. • Scrutiny Officer to provide timeline to Chair and Vice-Chair regarding the Q2 Capital Forecast Report.
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