Adult Social Services Scrutiny Performance Panel...Mar 08, 2017 · Peter Black (Convener), Yvonne...

***This is an open meeting*** Members of the public are welcome to observe from the public gallery

Adult Social Services Scrutiny Performance Panel

Date:

Venue:

8 March 2017 Time: 2pm

GUILDHALL Committee Room 3B

Summary: This is an agenda pack for a meeting of the Adult Social Services Scrutiny Performance Panel taking place on the 8 March 2017. The main items are Objective Setting for Senior Officers and Adult Services Performance.

Members of the Panel: Uta Clay (CONVENER) Paxton Hood-Williams Yvonne Jardine Geraint Owens Paulette Smith Peter Black

Chris Holley Jeff Jones Sue Jones Gloria Tanner Tony Beddow

AGENDA No. Item 1. Apologies2. Meeting Notes

• 11 January• 8 February

3. Objective Setting for Senior Officers – Cabinet Member attending• Convener’s Letter 9 January• Cabinet Member Response 9 February

4. Adult Services Performance Management Report – Alex Williams, Head ofAdult Services

5. Timetable of work

05/04/17 1) Update of Western Bay Intermediate Care Services Model – Alex Williams, Head of Adult Services

6. For Information• AMBU Mental Health Services Presentation (8 February meeting)• Impact Report: Social Care at Home Inquiry (Convener’s letter)• Impact Report: Social Care at Home Inquiry (Cabinet Member Response)

Contact: Dave Mckenna, 01792 636090, [email protected]

mailto:[email protected]

1

Adult Services Panel Meeting January 11 2017 Notes

These are the notes and actions form the Adult Services Scrutiny Panel meeting held on 11 January at 4pm.

Attendance: Peter Black (Convener), Yvonne Jardine, Paulette Smith, Chris Holley, Jeff Jones, Sue Jones, Tony Beddow, Delyth Davies, Alex Williams, Mark Campisi

Summary – actions and what was agreed

ACTIONS • Contact Cabinet Member for Housing to request performance data on

disabled facilities grants and delays in transfers of care due to DFGs – DD to action

• Pathway map for Local Primary Mental Health Support Services – AlexWilliams to provide

• 400 referrals to primary care – panel wants more information on the detailbehind this figure - Alex Williams to provide

• The panel would like responses to the following questions – Mark Campisi toprovide responses

o Of the 400 monthly referrals how many of these are accepted and whatis this expressed as a percentage?

o How many of the “do not attend” figures are referrals?o What is the rate of “do not attend”?

• Invite Alex Williams to the additional panel meeting arranged for 6 Februaryto scrutinise the Adult Services draft budget and feed into the budgetconsultation.

WHAT THE PANEL AGREED • To hold an additional panel meeting on 6 February to scrutinise the Adult

Services draft budget and feed into the budget consultation. • The panel agreed a number of questions during the meeting that would be

relevant for the meeting in February with ABMU o in providing primary care interventions what information is used to

determine what a person needs o One to one interventions: What happens to the patient during the 2

year waiting time? o Group work – how effective is group work, what are the sizes of the

groups and has there been an increase in the size of the groups?

Item 2

2

FULL NOTES OF THE MEETING Pre-meeting

• Apologies Gloria Tanner• Letter approved• Additional budget meeting 6 Feb at 2pm – panel wants Alex present and/or

finance person

Meeting • Matters Arising: Letter – approved and the issue with DFG data in final

paragraph of letter needs to be actioned

Mental Health Presentation Mental health is complex area and it was a challenge in implementing legislation – the presentation will show how the health board and the local authority have worked together to deliver the measure and each of its 4 parts. It is to be noted that the local authority and the health board have joint responsibility to deliver the measure which is age blind

Comments on slides Slide 6 – Part 1 of the Measure – Local Primary Mental Health Support Services (LPMHSS) Function

• Accessing assessment and support – this is a health led service. The localauthority wouldn’t receive a referral for assessment via LPMHSS. Thisservice can refer onto services that are provided by the authority which are ata lower level.

• The assessment goes to a central point of access which sits within communitymental health service which is a combined team of health and social care (thisis secondary care).

• This pathway wouldn’t lead to managed care with a social worker. This is forlower level intevrentions.

• Only GPs can make a referral to this service

ACTION: Panel wants pathway map for LPMHSS

• The CAMHS service provides support services to children and young peopleup to the age of 18. If the young person continues with education they can besupported up to age of 25.

• The CAMHS transition process to adult servicesstarts at 17yrs9mths.• If a young person is statemented and the statement says the young person

needs some support for an apprenticeship for example, CAMHS would stilltransfer the person at 18 to adult services.

• There is a linkage team in education. If they are in school the schools shouldhave the contacts for the team in education.

3

• 5th bullet – this service provides support and guidance to GPs and primarycare practices.

• Benefit of measure: Dedicated resources and staffing to primary care to helpprevent people from escalating and to help step down.

• This is the same model across the health board area.

Slide 7 • LPMHSS sits between the local authority and GPs

Slide 8 • Interventions are structured and time limited• Question for ABMU: in providing primary care interventions what

information is used to determine what a person needs

Slide 9 • The targets within primary care are set by Welsh Government• ACTION: 400 referrals a month – The panel wants more detail on the this

figure• The 3922 patients receiving a service under Psychiatrusts Primary Care Clinic

are those who have been referred and accepted. This is just one service.• Secondary care is providing services for primary care.• Primary care doesn’t have any psychiatry support.• Did not attend (DNA) rates – GPs are going to say that service user has to

refer themselves to the service which will give the person the impetus toattend.

• ACTION:MARK TO PROVIDE THE FOLLOWING:o Q)Of the 400 monthly referrals how many of these are accepted

and what is this expressed as a percentage? o How many of the DNAs are refererrals?o How many referrals for those who DNAo What is rate of DNA?

• Q) ONE TO ONE INTERVENTIONS: Do you think the local authority should have any role in saying to the health board and/or Welsh Government that the authority is not happy with 2 year waiting time for one to one interventions? A) Officers do not think that this is the role of the Council/Cabinet. Individualwards councillors may wish to make representations on behalf of constituents but it’s not the role of Council/Cabinet.

• Question for ABMU:What happens to the patient during the 2 year waiting time? Group work – how effective is group work, what are the sizes of the groups and has there been an increase in the size of the groups?

Slide 10 – Part 2 of the Measure • Secondary care is the specialist care and includes out patients and health and

social care co-ordinate services provided to this group of individuals.

4

• Care plan is a legal document – one exists for every service user insecondary care the plan is reviewed annually.

• The statutory timescale for completion of a care plan is 28 days• The Care co-ordinator is any professional person and it normally rests with

social workers, psychiatric nurses, occupational therapists and psychologists• Substance misuse - where it is a factor it will be included in the care plan.

However, there is a range of substance misuse services in Swansea andthere is a single route for access into these support services.

Slide 11 – Secondary Care – Community Mental health Teams (CMHT) • Support services for older people with Alzheimers is not included in mental

health services its included in older peoples mental health team.• Q) How is risk to individuals managed? Risk management of the

individual is part of the care planning process. It’s a contingency plan set out in the care plan. CMHTs will have regular case conferences to discuss key individuals who present a risk at that time to ensure case managers can address issues. Part of the care plan is about monitoring the individual and identifying triggers for relapse and these are passed onto relevant agencies who ar ein contact with the service user.

• Q) Is there a professional who manages each case? Yes, service user will have a care co-ordinator who will be a registered professional.

• The CMHTs work to the “Recovery Model” – this takes service users view ofwhat their priorities are and how the service user and professional can workwith them to get to that position. It includes things like includes familysupport, social networks, education, it takes account of everything.

• Q) The panel asked what the optimum case load was? – officers said there was no accurate data on case loads at the moment.

Slide 12 – Referral Pathways into Secondary Mental Health Services • Anyone can refer into secondary mental health services, including the family

and self referrals. All go to a single point of access.• The different routes into these mental health can be confusing and this is

being addressed through a single point of access and triage system.

Slide 13 – Secondary Care • 24 hour provision to access support• Assertive Outreach Team – this was developed because some people were

very complex and risky and needed to be assertively dealt with. The teampro-actively engages the service users to prevent deterioration. This teamhas low case loads.

Slide 14 – Secondary Care – CMHT Volume • People needing secondary care numbers have been static.• Local primary Mental Health Service has kept the mental health population

stable• Suicide rates have remained static across the time period in the table on this

slide

5

Slide 15 – Assessments of former Users of Secondary Mental Health Services • This recognises that people have complex mental health issues and

recognises that people progress and get well. Service users are informed ofthis.

Slide 16 – Expanded Mental Health Advocacy • This is an independent Wales wide service Welsh Government funded and

completely independent of health and social care.• Changes as a result of the Social Services and Well Being Act and changes

surrounding advocacy - Swansea is mapping all advocacy arrangements andlooking at what the authority needs going forward which could lead toprocurement of services or changes to current services. This process willmaking sure that the advocacy arrangements are fit for purpose.

Workplan • Additional panel meeting – 6th February. This will be to examine the Adult

Services draft budget and form a view to feed into the consultation process.• Alex Williams has been invited to the meeting.• Panel meeting – 8th Feb - ABMU Mental Health presentation from Dai

Roberts. Alex Williams will attend this meeting.• 8th February meeting will also consider the Local Area Co-ordination

Evaluation report if its available • Panel meeting 8th March – Dave Howes will attend in place of Alex

Adult Services Scrutiny Performance Panel Meeting Notes 8 February 2017

Attendees Peter Black (Convener), Uta Clay, Paxton Hood-Williams, Yvonne Jardine, Chris Holley, Jeff Jones, Sue Jones, Tony Beddow (co-optee)

SUMMARY

Agreed • Add ‘Review of Social Services Charges (Community Alarm) to workplan

Actions • Actions from January meeting to be checked / delivered• Presentation slides to be circulated to Panel• Dai Roberts to provide a briefing note covering the work of the strategic

commissioning group• Dai Roberts to provide details of suicides following redundancies• Dai Roberts to provide information about Gwalia specialist unit in Tumble• Dai Roberts to provide breakdown of 2 year one to one intervention waiting

times figures• Dai Roberts to share performance scorecard with Panel• Objective setting (8 March Meeting) – need to check this item with Steve

Rees

AGENDA ITEMS

Apologies • None

Notes of Meeting 11 January 2017 • Actions from January meeting to be checked / delivered

Presentation: Mental Health – ABMU Health Board Attending: Dai Roberts (ABMU), Malcolm Jones (ABMU), Mark Campesi (CCS)

Discussion points (see presentation slides)

• Mental health service has £100m turnover – does not include CAMHS• Services for Mental health / learning disability services are locality based• Veteran services are a day service for trauma based in Orchard Street• ‘Part One service’ relates to Social Services Act – requires creation of primary

mental health services• Treatment (of MT??) is 88% currently (80% required)• Monthly fluctuation in demand probably linked to GP referrals• Performance reports are provided quarterly• Everyone in secondary care has a care plan – drawn up with service user,

supported by Mental Health team• There is an audit team that monitors the care plans

• There are a range of opportunities to access the teams – we offer follow upsfor those who don’t turn up

• 100% of service users receive care plans – this is not reflected in selfreporting by service users

• Unknown whether there is a higher prevalence of mental health issues amongpeople with learning difficulties (general population figure is one in four)

• A new mental health strategy is being produced next year with fullengagement of service users

• Mental health and community support teams are co-located in multidisciplinary teams

• Co-location benefits the public as information can be shared betweenprofessionals more rapidly

• Strategic commissioning group for western bay area helps us to manage themarket

• Six month pilot in Bridgend has been set up to help reduce waiting times• Urgent treatment is provided promptly• Costs of pathways are split between health and council• Dai Roberts to provide a briefing note covering the work of the strategic

commissioning group• Homelessness nurse only operates in Swansea – not NPT or Bridgend• In terms of dual diagnosis legal highs are a particular issue for the under 25s

and alcohol for the over 40s• Transition link to CAMHS is critical – we are working on a protocol to make

the transition more robust• The loss rate from CAMHS is not known• We are concerned about the quality of some CAMHS provison and looking at

the potential of different models• Some areas have higher incidences of mental health issues – poor housing,

education, family break up etc all linked• Care plans cover the transition from CAMHS• There are opportunities to modernise the service for older people• The level of learning difficulty in-patient beds is too high compared with other

areas – commissioning board is working on this• Demand for talking therapy is high and can mean long waiting times• Making links to employer occupational health services is a challenge• Dai Roberts to provide details of suicides following redundancies• Numbers of longer term hospital residents is significantly lower than used to

be• Dai Roberts to provide breakdown of 2 year one to one intervention waiting

times figures• Dai Roberts to provide information about Gwalia specialist unit in Tumble• The service has a scorecard with dozens of performance indicators• Dai Roberts to share performance scorecard with Panel

Workplan • Objective setting (8 March Meeting) – need to check this item with Steve

Rees• Add ‘Review of Social Services Charges (Community Alarm) to workplan

Overview & Scrutiny / Trosolwg a chraffu

City and County of Swansea / Dinas a Sir Abertawe Civic Centre, Swansea, SA1 3SN / Canolfan Ddinesig, Abertawe, SA1 3SN

C I T Y A N D C O U N T Y O F S W A N S E A———————————————————————————————————————————————

Dinas A Sir Abertawe

Dear Councillor Stewart and Councillor Lloyd,

As you may know the Scrutiny Panel overseeing Adult Social Care has spent considerable time seeking to understand the budgetary and performance information currently available to the Council, and to relate these to the corporate processes by which the objectives of key people are set and monitored in these areas. Good progress is being made and the Panel has arranged for its meeting on 8th March to explore in depth how performance management processes operate in both setting and then monitoring key objectives.

We seek your help to identify an officer or officers to invite to the March meeting to help us understand how the performance management / objectives setting processes in adult social care operate.

We think Panel members could gain a good insight into the performance linkages operating between the Cabinet / Council, the Chief Executive, the Director of People, senior Adult Social Care officers, and any other officers in other departments who might need to be involved if the following "givens" were taken as exemplary aims for the performance management process to take on board. I stress these hypothetical examples are chosen simply to help us understand how the different political and managerial levels would respond to the issues raised; they do not foreshadow any emerging proposals from the Panel.

Councillors R. Stewart, Leader of the Council and C. Lloyd, Cabinet Member, Transformation & Performance

Civic Centre Oystermouth Road SWANSEA SA1 3SN

Please ask for: Gofynnwch am:

Overview & Scrutiny

Direct Line: Llinell Uniongyrochol:

01792 637491

e-Mail e-Bost:

[email protected]

Our Ref Ein Cyf:

Adult Services/05

Your Ref Eich Cyf:

Date Dyddiad:

11/01/2017

Summary: This is a letter from the Adult Services Scrutiny Performance Panel to The Leader of the Council and Cabinet Member for Transformation and Performance. It is about the linkages between the budget and performance management objectives.

Item 3



Given 1. Cabinet decides that budgetary pressures and forecasting data, require activity levels in adult social care to be adjusted in the following ways during 17/18 when compared with 16/17 outturn: a) the numbers receiving domiciliary care from in house services shouldincrease by 15% b) the numbers getting domiciliary care from external providers shouldreduced by 10% c) the numbers supported by the local authority in residential care settingsshould be held at the level supported in 2015/16.

Given 2. Cabinet decides that it needs by September 2017, (for implementing in 18/19 if agreed) costed proposals setting out how the intake team and all hospital based social care staff could move to either a Wednesday to Sunday service or to a six day per week service including Saturday, in order to begin the process of providing a service covering the week end.

Given 3. In respect of delivering a) housing adaptations and b) re-housing hospitalised Swansea residents who are ready for discharge but cannot return to their own homes, Cabinet wishes to achieve a target time of four weeks from notification of the need for housing action to the actual provision of those services.

Yours sincerely

UTA CLAY CONVENERADULT SERVICES SCRUTINY PANEL

CLLR [email protected]

Item No. 4

Report of the Cabinet Member for Adults and Vulnerable People

Adult Services Scrutiny Performance Panel – 8th March 2017

ADULT SERVICES PERFORMANCE FRAMEWORK

Purpose • The purpose of this report is to present the AdultServices Performance Framework.

Content • The Performance Framework is designed to monitorperformance across Adult Services.

• This is the second time that such a report has beenpresented to the Adult Services ScrutinyPerformance Panel. The report has been developedon the basis of the feedback provided by the Paneland there is now a summary page towards thebeginning of the report which highlights key areasthat Members may be interested in within the report.

• However, monitoring performance in this way is stillvery much work in progress and there are severalareas for future development towards the end of thereport.

• The report demonstrates the areas of business thatare performing well and less well, and is designed tobe an operational tool to help continually improveservice quality and delivery.

• Similarly to the Performance Framework that Childand Family has developed over the years, it isanticipated that the Framework will be an evolvingdocument.

Councillors are being asked to

• Consider the Report

Lead Councillor(s)

Cabinet Member for Adults and Vulnerable People

Lead Officer(s) Alex Williams, Head of Adult Services

Report Author Alex Williams [email protected] 01792 636249

mailto:[email protected]

Final

Version Status: Final 1 Version Date: 1 March 2017

ADULT SERVICES SUMMARY MANAGEMENT INFORMATION REPORT

JANUARY 2017

Adult Services Challenge Session Reports Prepared by

Performance Coordinators:

Compiled by Performance and Information Manager

John Grenfell

Contents


Contents Summary of Expectations, Standards & Performance ........................................ 3

Common Access Point (CAP) ............................................................................... 5

Local Area Co-ordination .................................................................................. 10

Delayed Transfers of Care ................................................................................. 11

Waiting for Package of Care in Hospital ............................................................ 14

Assessment and Care Management ................................................................. 16

Integrated Social Care and Health Services ....................................................... 17

Assessment and Care Management: Mental Health ......................................... 24

Community Re-ablement .................................................................................. 26

Residential Reablement .................................................................................... 30

Residential / Nursing Care for Older People ..................................................... 33

Temporary Admissions to Residential / Nursing Care ....................................... 35

Long-Term Domiciliary Care ............................................................................. 39

Day Services for Older People ........................................................................... 43

Safeguarding Vulnerable Adults ....................................................................... 44

Deprivation of Liberty Safeguards (DoLS) ......................................................... 48

Planned Future Developments to this Report ................................................... 50

Appendix A: Performance Indicators ................................................................ 51

Appendix B: Performance Indicators: Numerators and Denominators ............. 53

Key Expectations, Standards & Performance


Summary of Expectations, Standards & Performance Throughout this report, each series of information is prefaced by a brief summary

of any national or local performance indicators and performance against those.

For subjects where there are no indicators or indicators that do not assist the

reader to evaluate performance, we have provided some commentary to assist the

reader.

Additional commentary is provided throughout the text.

Common Access Point (CAP) We continue to deal with a large volume of requests for support via the Common

Access Point (p.6). We have been successful in improving the number of people

being dealt with at the CAP by means of information, advice and assistance (p.7).

We have been trialling a Multi-Disciplinary Team (MDT) approach to triaging

incoming requests for support (p.8). We believe that the MDT approach is helping

to prevent unnecessary assessments and we would like to improve its coverage.

We will need to improve our recording arrangements for Third Sector Broker

activities to develop stronger intelligence on our use of the third sector to support

the population (p.8).

Local Area Co-ordination (LAC) Gaps in recent recordings mean that we will need to work with the LAC Team to

ensure that they are recording their activities accurately. Our performance team

will assist with this in the coming months (p.10).

Delayed Transfers of Care We have been able to support our NHS Hospital colleagues this winter by

continuing to focus on ensuring the pathway home from hospital is as speedy as

possible and social care related delays are minimised (p.11).

We continue to meet the performance target set for this financial year (p.11).

Assessment and Care Management We are aware that enquiry-handling, assessment and care management practice

across the department is in need of some refreshment and renewal. In particular,

we need to review our approach to assessment to ensure it fits with the Social

Services and Well-Being Act, and that we can ensure that we have effective

reviewing arrangements to help people to remain independent. We will be

developing a practice framework for social work during 2017/18 and we will be

carrying out a range of data cleansing and analysis activities at the same time.

Integrated Health and Social Care Services

Activity continues to be sustained (pp. 18-22)and most teams are achieving better

than an average of 30 days for completing assessments of need (p. 22)

Mental Health

The service continues to provide assessment for those requiring mental health

support (pp. 24-25)

Community Reablement: The service has met both locally –set targets against new national performance

indicators (p.26).

There have been some improvements in the effectiveness of the community

reablement service during the year (p. 28-29) but the evidence is incomplete.

More work is needed to ensure that all outcomes are recorded correctly by the

teams.

Residential Reablement There has been sustained improvement in the effectiveness of the residential

reablement service since it strengthened its acceptance criteria in Autumn 2015

(p.30, p.32)

Permanent Residential / Nursing Care While we have been able to reduce further the number of people who are

supported in residential care at a point in time (p.33), we continue to see

admissions running at a higher level than we would like (p.34). We have therefore

introduced a Panel to test and challenge decisions made about new and

temporary placements into residential and nursing care, and will need to monitor

whether these arrangements help to reduce admissions overall.

Temporary Placements to Residential / Nursing Care We have started to explore this area of work and an initial analysis is presented

here (pp. 35-38). Through the Panel arrangements, temporary placements can

now only be made for a maximum of two weeks.

Key Expectations, Standards & Performance


Domiciliary Care The numbers of people receiving a package of care has increased (p.39) and as a

result of marginal increases in the average package size (p.42), the total number of

hours provided each month has grown disproportionately (p.41). The number of

people starting to receive long-term domiciliary care to date during 2016/17

exceeds the number of starters for the same period in 2015/16 (p.40).

We are concerned about these metrics as they could indicate that there are issues

with our reablement strategy that need to be explored. We are therefore in the

process of mapping all of the routes into long-term domiciliary care to ensure that

effective decisions are made and that people are not over or under supported.

Day Services for Older People We have been able to maximise usage of day services for older people by means

of monitoring take-up and revisiting waiting lists (p. 43).

Safeguarding Adults This is an area of critical focus due to the need to ensure that people are

safeguarded. We continue to take great pains to ensure that our work is as

effective as possible, keeping people safe and reducing the risk of further abuse or

neglect.

In performance terms, the picture here is mixed.

We have been able to meet the target we were set to assist people to move away

from requiring ongoing care management support following safeguarding (p.44).

While performance lagged on timeliness of response to safeguarding enquiries

during the earlier part of 2016/17, performance is now back on track (p.44, p.46)

following close scrutiny of this by the Principal Officer and Head of Service.

Performance on the indicator relating to re-referrals of those in residential /

nursing care homes has been heavily-impacted by a specific situation in a single

large care home and could not have been foreseen (p.44). We are however

working with colleagues in the Health Board and CSSIW to manage this situation.

Deprivation of Liberty Safeguards (DoLS) DoLS has become a national adult social services issue due to the unprecedented

increase in statutory work created by a significant legal ruling. With typically a

hundred requests arriving monthly, the challenge continues (p.48).

It has been a testing year for DoLS work in Swansea but currently the situation has

become much better, with the current backlog almost cleared

While there are no national or local indicators relating to DoLS, Welsh Government

expects the core elements of the process to be completed in 21 days. During

2016/17 we were achieving this on average less than half the time (pp.48-49).

Close scrutiny however continues at both Head of Service and Principal Officer to

ensure that compliance to timescales improves.

Common Access Point (CAP)


Common Access Point (CAP) The Common Access Point continues to be reviewed for function and purpose. During 2016/17, the key expectations for the service and outcomes against those are set out

below. (This service may also be referred to as ‘Intake’ or ‘the front door’.)

Summary of Expectations / Standards Summary of Outcomes / Performance There is a new national performance measure. Measure 23: The percentage of

adults who have received support from the information, advice and assistance

service and have not contacted the service again during the year.

We have not been able to report data in-year to date. We continue to work on the

definition of our advice and assistance service and how we capture data from within

it.

We wish to increase the number and proportion of enquiries completed at the

Common Access Point rather than referral onwards, diverting to signposting or third

party organisations

The number of enquiries completed at Common Access Point has increased but the

proportion of the total closed down at the CAP could be improved further.

We wish to make effective us of the Third Sector Broker arrangements. We have identified problems with the recording process and the Performance &

Information Team is working with staff and managers to resolve this.We do however

now have an agreed set of performance metrics in place with the deliverer of this

service, so once the recording process is addressed we will have rich data to draw on

to monitor the effectiveness of the arrangements.

To pilot and develop use of a Multi-Disciplinary Team (MDT) approach in order to

triage enquiries received.

While some improvements have been made in more recent months and more cases

are being considered by the MDT function, it remains a key deliverable to improve

the range and effectiveness of the MDT function. If we get the MDT function right,

we should be able to manage demand more effectively into Adult Services.



1206,

11.2%

9526,

88.8%

Enquiries Processed Via Common

Access Point 2016-17

Complete at Common Access Point

Enquiries transferred from Common Access Point

Volume of Demand To date during 2016/17, 89% of enquiries were processed via the CAP are passed through to other teams. 11% of enquiries are completed at CAP.

989936 908

847939

992 997 983

826

1,109

138

119111

108

104

141 14399

120

123

500

600

700

800

900

1000

1100

1200

1300

Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17

Enquiries Processed Via Common Access Point 2016-17

Enquiries transferred from Common Access Point Complete at Common Access Point

What is working well? What are we worried about? What are we going to do? The number of enquiries appears to be relatively

constant, suggesting relative stability in the amount of

work coming through.

September and October saw larger numbers of

enquiries dealt with at CAP,

Over time we would like to see higher numbers dealt

with at CAP but this will be dependent on development

of effective universal and community services to

signpost to as well as development of the overall

information, advice and assistance offer across the

Council.

Continue to work with Team Manager to improve

recording of activity within CAP.

January 2017 saw considerably higher numbers of

enquiries processed.

Staff within CAP have identified a large number of

enquiries created at the request of members of staff

within the Hub Teams.

This is being investigated as a potential process issue: It

appears agreed rules for use of Paris are not being

followed.



820,

68.3%

380,

31.7%

Enquires Completed at Common

Access Point 2016-17

ADVICE/INFORMATION SIGNPOSTED

Apr-16May-

16Jun-16 Jul-16 Aug-16 Sep-16 Oct-16

Nov-

16Dec-16 Jan-17

SIGNPOSTED 36 31 21 29 32 51 44 44 23 40

ADVICE/INFORMATION 89 72 72 78 70 90 99 76 80 94

8972 72 78 70

90 9976 80

94

36

31 2129

32

5144

4423

40

0

20

40

60

80

100

120

140

160Enquiries Completed

at Common Access

Point 2016-17

Enquiries Completed at the Common Access Point To date during 2016/17, over two-thirds of enquiries completed at CAP were for information / advice only. 32% were signposted. There were an additional 6 enquiries

during the first few months of the year that are not reported as those function have since been relocated away from CAP.

What is working well? What are we worried about? What are we going to do? The number of enquiries completed at intake appears

to be relatively constant, suggesting relative stability in

the amount of work coming through.

We are aware of issues in recording the complexity of

working with preventative services (Local Area Co-

ordination, Independent Living). There is a need to

clarify what is ‘signposting’.

The Performance Team will be monitoring the

information being recorded and we will be making

recommendations to CAP Team Manager.

DFG requests are no longer completed in CAP and are

passed directly into the Integrated Community Hubs for

appropriate assessment.

Not applicable. No further action required.



Destination of Enquiries Initiated at the Common Access Point

Enquiries Processed Via Common

Access Point 2016-17Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 2016-17 % of total

Complete at Common Access Point 138 119 111 108 104 141 143 99 120 123 1,206 11.2%

Integrated community health teams 343 415 424 388 419 476 395 417 371 501 4,149 38.7%

Safeguarding 284 225 199 184 268 247 273 256 213 233 2,382 22.2%

Social Work teams 240 237 227 214 201 203 202 195 145 278 2,142 20.0%

MDT 110 46 52 54 50 58 125 111 89 89 784 7.3%

Third Sector Broker 12 13 6 4 - 5 2 4 6 7 59 0.5%

EDT - - - 2 - 1 - - 1 - 4 0.0%

Secure Estate - - - 1 1 2 - - 1 1 6 0.1%

Total Referrals Completed 1,127 1,055 1,019 955 1,043 1,133 1,140 1,082 946 1,232 10,732 100%

Note: we continue to work on ways of summarising this data and as such there is a lack of complete alignment with the later data provided on referrals. Note also that this

data refers to enquiries and not the number of individuals to whom an enquiry relates. In practice, the way we work can result in multiple enquiries for an individual.

‘Integrated community health teams’ refers to OTs, physios and

specialist NHS community health disciplines provided within the

Hubs. The 4,149 break down roughly as 1,500 OT enquiries, 800

physio enquiries, 1,800 specialist community health and the

remainder additional specialist referrals. During 2016/17 to

January 2017, they received 38.7% of enquiries received at CAP.

‘Social work teams’ refers to social work services provided

within the Hubs. They received 20% of enquiries received at the

CAP. A small number of learning disability referrals (dozens)

may also be included here.

22.2% of referrals related to safeguarding and were distributed

appropriately across all teams.

1,206

4,149

2,382 2,142

784

59 4 6 -

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

Complete at

Common

Access Point

Integrated

community

health teams

Safeguarding Social Work

teams

MDT Third Sector

Broker

EDT Secure Estate

Destination of Enquiry at Common Access Point

April 2016 - January 2017



What is working well? What are we worried about? What are we going to do? Increased referrals to the Multi-Disciplinary Team

(MDT) arrangement from October onwards. The MDT

carries out proportionate triage in order to divert or

establish need for further assessment

The MDT arrangements have taken some time to

develop and has not been staffed consistently.

New arrangements have been proposed to strengthen

the MDT approach.

Assistant Team Manager carrying out quality assurance

checks on a sample of referrals to establish whether

they were handled / recorded correctly.

The anticipated high number of safeguarding referrals

was processed due to the anniversary of the relevant

court judgment that drove up DOLS referrals.

There was an increased number of safeguarding

referrals in the period August – October but this did not

continue. This was due to specific issues relating to a

particular residential home; a pro-active plan is in place

with CSSIW and the Health Board to address these

issues.

No further action required.

We are able to record 3rd

sector broker referrals if the

relevant Paris process is followed.

Third sector broker referrals have resumed in

September 2016

Nil return for August reflects absence of 3rd

sector

broker.

Performance management staff are working with the

service to develop appropriate recording processes to

support Third Sector Broker activity.

Prevention & Early Intervention


Local Area Co-ordination (LAC)

Summary of Expectations / Standards Summary of Outcomes / Performance Local performance indicator SUSC5 sets a target of 35 new introductions to the

service each quarter

This target has been met for each quarter. The Performance & Information Team has

identified some recording issues in recent months which will be addressed.

Requests for Local Area Co-ordination and Main Presenting Issues

126

48

36

29

13

12

9

51

Isolation

Mental Health

Not known / required

Needs Advice

Older Age

Physical Difficulties

Financial Issues

Other

0 20 40 60 80 100 120 140

Main Presenting Issues - Local Area Co-ordination

(July 2015 - January 2017)

15

12

27

20

15

16

13

20 19

11

18

21

14

21

28

31

4

6

13

0

5

10

15

20

25

30

35

Jul 1

5

Au

g 1

5

Sep

15

Oct 1

5

No

v 15

De

c 15

Jan

16

Feb

16

Ma

r 16

Ap

r 16

Ma

y 16

Jun

16

Jul 1

6

Au

g 1

6

Sep

16

Oct 1

6

No

v 16

De

c 16

Jan

17

Introductions to Local Area Coordination July 2015 -

January 2017

‘Other’ includes categories of less than 10 introduction reasons in the period, including Child and Family, Housing, Carer, Community Tension, Drug and Alcohol, Learning

Difficulties, Benefits, Dementia, Social Contacts, Domestic Violence and Employment.

What is working well? What are we worried about? What are we going to do? There is a basic database in operation to capture

information about the people who come forward or are

referred to the team.

There is a need for further development of the

recording process and system. The reduced number of

recorded introductions in Q3 and beyond appears to be

a recording problem.

A plan will be prepared to make the necessary changes

to working practice and systems.

Delayed Transfers of Care



Summary of Expectations / Standards Summary of Outcomes / Performance National performance indicator SCA001 is now known as Measure 19 under the

Social Services and Well-Being Act performance arrangements. The target range for

the year 2016/17 has been set as between 4 and 6

Performance to Q3 2016/17 is 4.7. Year-end projection suggests a year-end figure of

5.6, both of which are within the target range.

The above data records the monthly Census of delays in

transfers of care. This refers to people who are delayed in

hospital for social care, health or other reasons. Typically

delays for social care reasons represent less than a third of all

delays. The most common reason for delay is usually delay in

start of package of home care.

.

1221 19 23

32 30 28 24 2721 19

28 2418 19

14 17 16 17 15 16 1521

10

4 77

10 12

46

814 21

16

7

712

1010 9

1413 10 9

122225 26

30

42 42

32 3035 35

4044

31

25

31

2427 25

3128 26 24

33

05

101520253035404550

Ap

ril

Ma

y

Jun

e

July

Au

gu

st

Se

pte

mb

er

Oct

ob

er

No

ve

mb

er

De

cem

be

r

Jan

ua

ry

Fe

bru

ary

Ma

rch

Ap

ril

Ma

y

Jun

e

July

Au

gu

st

Se

pte

mb

er

Oct

ob

er

No

ve

mb

er

De

cem

be

r

Jan

ua

ry

Fe

bru

ary

2015-16 2016-17

Spread of Delayed Transfers of Care April 2015 Present

Health & Other Reasons Social Care Reasons Total

Health &

Other

Reasons

476

67%

Social

Care

Reasons

232

33%

Reason for Delayed Transfers of Care

April 2015 - February 2017

53

6 6

9

6

3 45 5

11

4 3 46

42

5

97 6

4

7

Ap

ril

Ma

y

Jun

e

July

Au

gu

st

Sep

tem

be

r

Oct

ob

er

No

vem

be

r

De

cem

be

r

Jan

ua

ry

Feb

rua

ry

Ma

rch

Ap

ril

Ma

y

Jun

e

July

Au

gu

st

Sep

tem

be

r

Oct

ob

er

No

vem

be

r

De

cem

be

r

Jan

ua

ry

Feb

rua

ry

2015-16 2016-17

Delays Due to Start of Home Care April 2015 to February 2017



Reasons for Delay and Associated Monthly Averages

The above data shows that of the 232 delays for social care reasons recorded at

Census day since April 2015, the most common reason delays in arranging an

appropriate package of care to support a person in their own home with 132 (or 57%). There is an average of 5.7 delays a month for this reason. Around 12% of delays

relate to delays in arranging for residential / nursing placements to be made, with an average of 1.2 for this reason each month.

Delays due to incomplete assessment are infrequent, with only 5 recorded in 20 months. Typically an average of 1.2 people a month are delayed for reasons of incomplete

admissions to residential care and a further average 1 person delayed for social care funding reasons (not necessarily for residential care).

See also the section below ‘Waiting for Package of Care in Hospital’.

Awaiting

completion of

assessment

5

2%

Housing-related

16

7%

Home adaptation

/ equipment

24

10%

Home Care

Provision

132

57%

Residential /

Nursing Care

27

12%

Capacity issues

6

3%

Funding Issues

22

9%

Main Social Care Delay Reasons

(April 2015 - February 2017)

0.2

0.7

1.0

5.7

1.2

0.3

1.0

- 1.0 2.0 3.0 4.0 5.0 6.0 7.0

Awaiting completion of assessment

Housing-related

Home adaptation / equipment

Home Care Provision

Residential / Nursing Care

Capacity issues

Funding Issues

Average Social Care Delays per Month by Delay Reason

(April 2015 - February 2017)



What is working well? What are we worried about? What are we going to do? Delays have remained relatively stable over the last few

months and have been declining

Winter is not over and a cold snap often increases the

number of social care delays.

We will continue to maintain focus on facilitating early

discharge. We want to develop and use better evidence

about delays to address the issues that are identified

Delays for package of home care starting has been kept

to a reasonable number, with an overall average of 5.4

delays a months for this reason.

Delays for package of home care have been above

average in both September and October 2016.

Issues with capacity in the home care market may

continue to cause difficulties.

We are actively working with providers to ensure

capacity is available. Effective procedures are in place

to escalate cases where there is a social care delay for

whatever reason, and targeted activity is undertaken

by both the hospital and community teams to expedite

discharges. We recognise that we do have issues over

availability of packages of care in the external sector,

but wherever possible we put interim arrangements in

place to deliver this care using the internal service.

The arrangements for recording and reporting delayed

transfers are well-established

The established method focuses on a single census day

each month, which does not take account of the

broader flow of patients throughout the month. There

have also been issues with the validation process for

cases in Learning Disability and Mental Health hospital

settings.

Software and processes to support more real-time

reporting of delays during the month are in

development. We are working with colleagues in the

Health Board to ensure that good validation processes

are in place in relation to the Learning Disability and

Mental Health sites.



Waiting for Package of Care in Hospital The Team Leader of the Hospital Social Work service has been gathering

data throughout 2016 and we reproduce some of this data.

The reader should be aware of the following significant cautions in

reading this information:-

• It has been difficult to obtain all the data due to the need to create both

more effective systems and enhanced administrative capacity to

maintain the data collection in a fast-moving environment. As such

there is no complete record of all activity for the period.

• The data shown here therefore provides a sample of the data available

but it is not known how representative this sample is.

• The data is related to the delayed transfers of care information but is

not based on the same criteria because it includes preparations for

people not yet medically fit. As such the numbers of people awaiting a

POC in this data is larger and should not be directly cross-referenced

with DToC figures.

It should also be noted that the same person can be included in more than

one column while awaiting care (see next page for delay length data). The

graph to the left shows the numbers of people discharged in the same

week as the above delays were recorded.

The numbers of delays cancelled illustrate another issue that is not obvious

in the context of delayed transfers, which is that of relapse: considerable

work can be expended on arranging a package of care for a person who

then subsequently becomes more unwell and whose discharge is then

cancelled.

Together the graphs on these pages show some changes over time, such as

improvements to the flow through community reablement since late

Spring 2016, and improvements in numbers discharged per week since

Summer 2016.

1713 12 11

19 1721 19

13

23

138

1517

12

21 5

1

2 4

5

2

4

3

3230

24

32

24

18

23 24

18

25

17

11

0

5

10

15

20

25

30

35

Sampled Awaiting Package of Care (POC) in Hospital

Awaiting Long-term Package Awaiting Community Reablement

Total waiting POC

6

19

31

16 17

8 9 813

1915

1

1

2

3 3

6 3 0

1

0

0

0

5

10

15

20

25

30

35

Discharged Discharge Cancelled



How long are people waiting

in hospital for a package of

care? The chart opposite shows how long

people have been waiting for a

package of care to be arranged.

On most occasions, more than half of

those waiting have been waiting for

under two weeks.

In some months there have been

instances where people have been

waiting over four weeks. It is possible

that some of these have previously

had a discharge cancelled.

What is working well? What are we worried about? What are we going to do? Overall total number of delays appears to be dropping over time.

Improvements to flow into community reablement have taken place,

reducing delays for that reason. Significant work has also been undertaken

to put interim arrangements in place using internal services if support

from the external sector is not readily available.

Structural issues and provider failure

within the market have and can

continue to cause fluctuations in

response times.

Cabinet will be considering the outcome of the

Domiciliary Care Commissioning Review at its

meeting of 20th

April, which will include a

recommendation to recommission external

provision.

11

Dece

mber

2015

08

Janua

ry

2016

05

Febru

ary

2016

25

Marc

h

2016

21

April

2016

27

May

2016

02

June

2016

22

July

2016

09

Septe

mber

2016

07

Octo

ber

2016

17

Nove

mber

2016

24

Nove

mber

2016

Over 4 Weeks 4 6 2 2 5 7 5 8 1 6 5 2

3-4 Weeks 1 9 2 4 0 1 2 2 4 1 0 1

2-3 Weeks 6 5 8 2 2 3 1 1 2 5 1 0

1-2 Weeks 5 0 13 10 16 6 8 7 5 7 2 5

Waiting less than a Week 12 12 5 6 9 7 2 1 6 6 9 3

All Waiting 28 32 30 24 32 24 18 19 18 25 17 11

12 12

5 69

7

2 1

6 69

3

5

0 13 10

16

6

87

57 2

5

4

6 2

2

5

7

5 8

1

6

5

2

28

32

30

24

32

24

1819

18

25

17

11

0

5

10

15

20

25

30

35Over 4 Weeks

3-4 Weeks

2-3 Weeks

1-2 Weeks

Waiting less than a

Week

All Waiting

Assessment & Care Management


Assessment and Care Management All the data provided here comes from Paris and various elements of terminology have been translated in order to assist in explaining how the data is being represented.

Safeguarding referrals and assessments are dealt with in a later section of this document.

Summary of Expectations / Standards Summary of Outcomes / Performance There is a now-defunct national performance indicator (SCA007) relating to the

proportion of people who were due an assessment of social care need that

received an assessment. Historically a very ambitious target of 80% was set.The

final reported Wales average was 82.9%

Performance at the end of Q3 was 65% and the service has now embarked on a

process of development to create a practice framework for social work and to

cleanse a large quantity of records.

There are no formal standards for the completion of enquiries and assessments,

although 30 days would seem to be a reasonable expectation for many assessment

types.

Performance data has been refined (see below). Most teams are achieving an

average below 30 days for assessments of need.

We continue to implement the Social Services and Well-Being Act and to introduce

proportionate assessments.

Within Mental Health Services (only), there is a requirement under the Mental

Health Measure to ensure that anyone who had an active Care and Treatment Plan

in place should have that plan reviewed at least annually.

Performance in this area is known to be better than in other areas of the service

due to the impact of the MH Measure. We are working to bring this data to the

next edition of this report

Assessment & Care Management: Integrated Services


Integrated Social Care and Health Services Teams In order to make reporting of the data meaningful, we have grouped the 30 Paris

general and specialist teams together into specific groups for the purpose of

reporting. Principal Officers are provided with team-level data on a monthly basis.

Teams included in this section are:

• Central / North / West Hubs includes the three social work Hub teams with a

range of OT and physiotherapy staff, including both local authority and NHS

workers.

• Specialist Practitioners refers to community health specialist services e.g.

continence. They also work across the Central / North / West hubs.

• Sensory Services relates to specialist sensory and younger adults workers

• Hospital Team refers to the social work teams at Morriston and Singleton

Hospitals

• The Care Homes Quality Team is a social work team that works with those

living in residential and nursing care

• The Older People’s Mental Health Team is the social work team working

directly with those older people experiencing dementia and requiring

specialist social work support.

• Service Provision Teams groups referrals or requests for specific service(s) to

all areas of service provision, but notably brokerage for domiciliary care and

the community reablement service (aka DCAS).

• Sensory Services relates to specialist social work support for people with visual

or hearing impairment.

Types of Enquiries With over 50 enquiry types reflecting the range of support provided to the

community, we have classified the enquiry types to help make sense of the data

and to allow for meaningful comparison.

• MDT / Advice / Info are enquiries that are dealt with as part of the multi-

disciplinary screening process that has been piloted during the year. Note that

many of these are dealt with at the Common Access Point.

• Care Management Input enquiries relate to requests for initial, review or

specialist assessment by a social worker, including ‘proportional assessment’

under the new Act formerly known locally as ‘integrated assessment’. Also

included are enquiries requesting joint assessment or to support discharge

from hospital.

• OT Input and Physio Input refer respectively to requests for OT or

physiotherapy assessment, review or other input. The OT service includes staff

employed by both social services and the NHS. Physiotherapy is exclusively

provided by the NHS via the Hubs.

• Specialist NHS Input refers to enquiries to the community health specialisms

such as incontinence which are delivered area-wide.

• Service Requests refers most commonly to enquiries relating to domiciliary

care and community reablement but other services are also included e.g.

respite. These enquiries only rarely relate to brand new requests for support

and most enquiries relate to package adjustments etc.

• Other Enquiry Types includes specialist technical sensory impairment

enquiries, requests for AMHP assessments and a small number of enquiries

relating to more specialist services e.g. substance misuse.

Enquiries / Assessments and People The tables and charts below reflect counts and proportions of enquiries and

people. This is an important distinction since over time individual people

commonly accrue enquiry events of different types. For the period since April

2015, for example, the average number of referrals for each person who has been

referred is 2.

All references below distinguish between people and enquiries and assessments



2,131 2,265 1,896 1,778

1,410

391 141

1,039

497

-

500

1,000

1,500

2,000

2,500

Number of People by Enquiry Team


647

3,075

2,518

1,353

2,115

3,707

448

- 500

1,000 1,500 2,000 2,500 3,000 3,500 4,000

Number of People by Enquiry Type


People Subject of Enquiry by Team and by Type of Enquiry

Individuals who were subject of an enquiry April 2016 – January 2017

Enquries - Number of

People

Central

Hub

North

Hub

West

Hub

Specialist

Practitioners

Hospital

Team

Care Homes

Quality Tm

Older People's

MH Tm

Service

Provision Tms

Sensory

Services

All

Teams

MDT / Advice / Info 201 215 206 - 6 11 2 - 9 647

Care Management Input 555 731 535 4 1,302 104 115 5 4 3,075

OT Input 917 895 749 2 2 1 - - - 2,518

Physio Input 549 478 362 - 2 - - - - 1,353

Specialist NHS Input 126 118 186 1,773 1 1 - - 1 2,115

Service Requests 934 985 874 - 273 296 12 1,034 132 3,707

Other Enquiry Types - 24 1 1 10 - 26 - 392 448

All Referral Types 2,131 2,265 1,896 1,778 1,410 391 141 1,039 497 7,908

%ge of All Teams 26.9% 28.6% 24.0% 22.5% 17.8% 4.9% 1.8% 13.1% 6.3%

With 2,265 individuals subject of enquiry, the North Hub processes the highest number of individuals that come through to the Integrated Services.

(Detailed monthly listings appear at Appendix X.)



Number of Enquiries by Team and Type of Inquiry April 2016 – January 2017 Many service users receive more than one enquiry type in a period of time. Compared to the 7,908 individuals who were the subject of an enquiry in 2016/17 so far, 17,531

enquiries were logged, an average of 2.2 enquiries per person.

Enquiry Team Number of

Enquiries

%ge of all

Enquiries

Central Hub 3,748 21.4%

North Hub 4,005 22.8%

West Hub 3,345 19.1%

Specialist Practitioners 2,021 11.5%

Hospital Team 1,890 10.8%

Care Homes Quality Team 465 2.7%

Older People's Mental Health Team 165 0.9%

Service Provision Teams 1,279 7.3%

Sensory Services 613 3.5%

All Services 17,531 100%

The most common enquiry type (32%) relate to enquiries relate to service provision such as home care or community re-ablement. OT / Physio together account for 25½%

of enquiries, with enquiries about care management input represent 21% of enquiries.

What is working well? What are we worried about? What are we going to do? There continues to be a consistent number of

enquiries so population demand does not

seem to have increased significantly.

Continuing demographic pressure could

escalate the number of enquiries.

Work carried out on the Population Assessment will be used to model future

population need.

The distribution of enquiries across the hubs

is now relatively even.

At present we are working towards a

clearer picture of what typical activity

looks like.

Performance staff and managers are working together to look in more detail at

this topic. We need to revisit the configuration of the Hub teams following

integration to make sure we have allocated resources effectively. The

performance information will be vital to be able to help us do this.

The hospital team is now handling between

typically 150 and 170 referrals each month.

Periodically reduced numbers coming

through the hospital team with no

consistent pattern.

Continue to monitor and take action where necessary.

We believe there is a consistent level of

recording enquiries across the service.

Performance staff will work more closely with Paris staff in order to interpret

spikes or troughs in data.

Type of Enquiry Number of

Enquiries

%ge of all

Enquiries

MDT / Advice / Info 726 4.1%

Care Management Input 3,760 21.4%

OT Input 2,938 16.8%

Physio Input 1,520 8.7%

Specialist NHS Input 2,473 14.1%

Service Requests 5,589 31.9%

Other Enquiry Types 525 3.0%

All Enquiry Types 17,531 100%



Numbers of People Assessed and Assessments Completed by Assessment Type and by Assessment

Team

The above table shows the number of assessments by different types over the course of the first 10 months of 2016/17.

‘Assessment of Need’ principally comprises social work assessments but also includes some assessments carried out by some NHS staff based within the three Hubs.

The ‘CRS Specialist Assessment’ category relates to assessments carried out by specialist NHS practitioners who are out-with the Hubs and cover Swansea as a whole

instead.

‘Assessment Relates to Service Provision’ principally relate to assessment or review requests for changes to service user packages of domiciliary care.

The largest numbers of assessments are in the category ‘Assessment of Need’ and ‘OT Assessment’.

Number of Assessments and People

Assessed by Team and Assessment Type:


Ce

ntra

l Hu

b

No

rth H

ub

We

st Hu

b

Sp

ecia

list Pra

ctition

ers

Ho

spita

l Te

am

Ca

re H

om

es Q

ua

lity T

ea

m

Old

er P

eo

ple

's Me

nta

l

He

alth

Te

am

Se

nso

ry S

erv

ices

Ass'ts C

om

ple

ted

Pe

op

le A

ssesse

d

Assessment of Need 572 954 725 714 438 314 256 3,973 3,013

OT Assessment 850 836 703 2,389 2,330

Physiotherapy Assessment 285 331 199 1 816 796

CRS Specialist Assessment 137 186 132 441 896 606

Ass't Relates to Service Provision 314 346 262 1 923 855

Carers Assessment 77 148 128 9 26 1 389 379

Number of Assessments Completed 2,235 2,801 2,149 443 723 438 340 257 9,386

Number of People Assessed 1,589 1,898 1,439 255 626 413 204 238 5,854

3,0

13 2,3

30

79

6

60

6

85

5 37

9

Asse

ssm

en

t of N

ee

d

OT

Asse

ssm

en

t

Ph

ysio

the

rap

y A

sse

ssm

en

t

CR

S S

pe

cia

list A

sse

ssm

en

t

Ass't R

ela

tes to

Se

rvic

e P

rov

ision

Ca

rers

Asse

ssm

en

t

Number of People Received

Assessment by Type

April 2015 -January 2017



Disribution of Assessments by Type and Over Time

42% of completed assessments are for assessments of need, which mostly comprise Overview Assessments and Review Assessments. Assessments for Occupational

Therapy and Physiotherapy together account for 34% of all completed assessments. Assessments of need and OT / Physio assessments represent 3 out of 4 completed

assessments.

The dotted line in the graph above shows the total number of individuals who were assessed. The total number never exceeds the cumulative number of assessment types

due to the fact that some people may receive multiple assessment types during any given period of time.

Apr May Jun Jul Aug Sep Oct Nov Dec Jan

Carers Assessment 48 33 59 42 30 38 30 49 33 27

Ass't Relates to Service Provision 74 86 68 81 81 94 93 110 104 132

CRS Specialist Assessment 58 38 78 90 91 103 103 114 103 118

Physiotherapy Assessment 104 76 93 91 92 78 59 72 57 94

OT Assessment 226 231 238 256 234 232 248 307 208 209

Assessment of Need 328 386 443 425 373 360 439 436 378 408

Number of People Assessed 739 739 847 859 794 779 842 954 769 839

0

200

400

600

800

1000

1200Carers Assessment

Ass't Relates to Service

Provision

CRS Specialist

Assessment

Physiotherapy

Assessment

OT Assessment

Assessment of Need

Number of People

Assessed Ass essment

of Need,

3,973 , 42%

OT

Assessment,

2,389 , 25%

Phys iothera

py

Assessment,

816 , 9%

CRS

Specialist

As sessment,

896 , 10%

As s 't

Relates to

Service

Provis ion,

923 , 10%

Carers

Assessment,

389 , 4%

Other,

1,205 , 13%

Number & Percentage of Assessments by

Type




Average Time Taken to Complete Assessments by Type

Central Hub North Hub West Hub Hospital TeamCare Homes

Quality Team

Older People's

Mental Health

Team

Assessment of Need 22 27 25 19 42 28

OT Assessment 28 35 32

Physiotherapy Assessment 10 8 4

CRS Specialist Assessment 18 24 16

Ass't Relates to Service Provision 15 12 5

Carers Assessment 17 33 21 15 17

22

27

25

19

42

28

28

35

32

10

8

4

18

24

16

15

12

5

17

33

21

15

17

-

5

10

15

20

25

30

35

40

45

Average Days to Complete Selected Assessment Types by Selected Teams


Assessment of Need

OT Assessment

Physiotherapy Assessment

CRS Specialist Assessment

Ass't Relates to Service

Provision

Carers Assessment

Note: Empty cells indicate no assessments of this type completed by this team.



What is working well? What are we worried about? What are we going to do? A reasonably consistent amount of assessment activity

continues to take place.

We are aware of current difficulties with accurately

reporting numbers of new assessments/ re-

assessments and reviews.

Performance staff and managers are working together

to look in more detail at this topic.

The range of health and social care disciplines is now

fully integrated within the Hubs, as can be seen by the

range of assessments carried out.

The service will continue to work closely with the

Common Access point in order to improve the MDT

function (see earlier section).

Typically assessments of need are completed within 30

days by the Hubs

Assessments of need that are carried out in CHQT and

the sensory team are higher than 30 days.

Social work practice will be examined as part of the

development of a practice framework.

Physio assessments are carried out swiftly by the Hubs.

OT assessments take slightly longer than assessments

of need to complete.

Previous data had suggested OT / Physiotherapy

assessments were taking considerably longer than

assessments of need. This is now known to be false: the

error was caused by the incorrect inclusion of an

interaction type ‘OT Evaluation and Outcome’, which

are programmed to occur following an assessment

proper.

The shortage of OTs and Physiotherapists is not limited

to Swansea, and we will continue to seek to recruit

appropriately-qualified people.

Caseloads & Reviews At this stage, information on these subjects is not completely reliable across most work areas and as such we are working towards being able to present more reliable

information as it becomes available.

In the context of the introduction of the Social Services and Well-Being Act, there is a need for a substantial piece of work to establish the exact size of the client base and

the nature of the reviewing task. The Principal Officer leads are in the process of working on this area to ensure that we have the intelligence to understand caseloads and

therefore effectively deploy resources.

Assessment & Care Management: Mental Health


Assessment and Care Management: Mental Health Number of People Assessed by Assessment Type

Types of Assessment Recovery Plans are carried out for people who may have

a mental health problem that needs to be managed

under the terms of the Mental Health Measure passed

by the Welsh Assembly.

If a person is deemed to require care co-ordination

under the terms of the Measure, a Care and Treatment

Plan is carried out and reviewed at periodic intervals.

An Associate Mental Health Professional (AMHP)

assessment is carried out where a person with a mental

health problem may need to be admitted to hospital for

care and treatment.

The dotted line shows the total number of individuals

who were assessed. The total number never exceeds the

cumulative number of assessment types due to the fact

that some people may receive multiple assessment

types during any given period of time. This will be

particularly the case for those who receive a Recovery

Plan which identifies the need for care co-ordination and

a subsequent Care & Treatment Plan.

204177

226

158 163 173 182 171 156 160

93

98

169

10550

117121

111 141 139

1721

31

30

18

2620

3323 26

13

6

4

2 5 1 2

0

50

100

150

200

250

300

350

400

450

500

2016/17

Nu

mb

er

of

Pe

op

le A

sse

sse

d b

y A

sse

ssm

en

t T

yp

e

Mental Health Care & Treatment Plan Mental Health Recovery Assessment

MH AMPH Assessment Carers Assessment

Number of People assessed

Assessment & Care Management: Mental Health


People with Active Care & Treatment Plan

1,2

91

1,2

94

1,3

04

1,3

05

1,3

01

1,3

02

1,3

04

1,3

11

1,3

12

1,3

26

1100

1150

1200

1250

1300

1350

Ap

r

Ma

y

Jun

Jul

Au

g

Se

p

Oct

No

v

De

c

Jan

2016/17

Clients with Active Care & Treatment Plan

April 2016 to Present

The ‘caseload’ for the mental health service is relatively-well defined since the Mental Health Measure stipulates a mental health client should have an active Care and

Treatment Plan.

The overall caseload for the mental health service has remained relatively stable over the last year (up 2.7%), as has the number of individual workers who are carrying a

caseload (up 4.8%). As there are some workers who do not employed full-time, mathematically dividing the number of clients by the number of workers gives only a rough

estimate of average caseload. Although this method provided a steady average of roughly 21 -22,

What is working well? What are we worried about? What are we going to do? The Mental Health Measure has supported the routine

management of information to enable reporting of

caseloads

Sometimes resource issues arise when staff are

required to undertake training in order to carry out

AMHPS. The training is substantial and lasts for most of

a year.

We are going to look in more detail at issues that affect

available resource.

62 61 60 59

59

63 6

1

63

64

65

40

45

50

55

60

65

70

Ap

r

Ma

y

Jun

Jul

Au

g

Se

p

Oct

No

v

De

c

Jan

2016/17

Workers Care-Coordinating Clients with Active Care

& Treatment Plan

April 2016 to Present

Community Reablement


Community Re-ablement

Summary of Expectations / Standards Summary of Outcomes / Performance The purpose of the community reablement service is to improve the ability of people to remain

independent with less or no ongoing managed care, thereby reducing the overall total burden on

managed care services.

There is mixed evidence on how effective the service has been

in reducing the total burden on the managed care system.

There are two national performance indicators measuring the effectiveness of community reablement.

These are brand new indicators and there continue to be national debates as to the final national

definition of the indicator calculation method.

Staff are engaged in discussion with peers across Wales and

contributing positively to a meaningful definition.

Measure 20a: The percentage of adults who completed a period of reablement and have a reduced

package of care and support 6 months later. Locally a target of 50% was set.

Target has been met. Cumulative performance to the end of Q3

was 66.2%.

Measure 20b) The percentage of adults who completed a period of reablement and have no package of

care and support 6 months later. Locally a target of 25% was set.

Target has been met. Cumulative performance to the end of Q3

was 27.7%.

People Receiving Community Reablement

181

249

156

0

50

100

150

200

250

300

Dec 14 Dec 15 Dec 16

Number of People Receiving

Community Reablement at Month

End

18

3

18

1

18

7

17

8

16

4

19

9

19

2

19

0

18

1

18

7

21

3

25

9

28

7

29

3 26

4

25

4

28

7

27

7

27

8

26

5 24

9

24

3 22

3

24

8 22

1

21

1 18

4

18

7

18

3

20

7 17

5

18

1 15

6

0

50

100

150

200

250

300

350

Ap

r-1

4

Ma

y-1

4

Jun

-14

Jul-

14

Au

g-1

4

Se

p-1

4

Oct

-14

No

v-1

4

De

c-1

4

Jan

-15

Fe

b-1

5

Ma

r-1

5

Ap

r-1

5

Ma

y-1

5

Jun

-15

Jul-

15

Au

g-1

5

Se

p-1

5

Oct

-15

No

v-1

5

De

c-1

5

Jan

-16

Fe

b-1

6

Ma

r-1

6

Ap

r-1

6

Ma

y-1

6

Jun

-16

Jul-

16

Au

g-1

6

Se

p-1

6

Oct

-16

No

v-1

6

De

c-1

6

Number of People Receiving Community Reablement at Month End



721

784

674

600

650

700

750

800

Dec 14 Dec 15 Dec 16

Cumulative New Episodes of


New Community Reablement Episodes (formerly DCAS)

What is working well? What are we worried about? What are we going to do? People continue to access the service and around 180

are usually being supported at any given time and on

average 70 typically admitted each month.

As can be seen from the following slide, we still need to

develop the recording of outcomes following

reablement from the service so do not have sufficient

data to understand whether our criteria are correct.

We will continue to keep criteria for acceptance to the

service under review.

There has been a decline in the overall number

supported in DCAS at the end of each month. This was

achieved from Autumn 2015 by revising criteria for

acceptance by community reablement to avoid

inappropriate reablement packages.

As above.

We will continue to keep criteria for acceptance to the


New episodes of community reablement continue to

be stable following realignment of service to focus on

those most capable of successful reablement.

New episodes this year are lower than for the previous

2 financial years. We will continue to keep criteria for acceptance to the


85 7

9

79 7

3

86

96

79

85

59

81

97

10

9 10

3

10

8

11

0

92

10

1

74

78

62 5

6

64

69

74

63

74

58

69

81

85

73

93

78

0

20

40

60

80

100

120

Ap

r-1

4

Ma

y-1

4

Jun

-14

Jul-

14

Au

g-1

4

Se

p-1

4

Oct

-14

No

v-1

4

De

c-1

4

Jan

-15

Fe

b-1

5

Ma

r-1

5

Ap

r-1

5

Ma

y-1

5

Jun

-15

Jul-

15

Au

g-1

5

Se

p-1

5

Oct

-15

No

v-1

5

De

c-1

5

Jan

-16

Fe

b-1

6

Ma

r-1

6

Ap

r-1

6

Ma

y-1

6

Jun

-16

Jul-

16

Au

g-1

6

Se

p-1

6

Oct

-16

No

v-1

6

De

c-1

6

Ne

w C

om

mu

nit

y R

ea

ble

me

nt

Ep

iso

de

s

Number of New Community Reablement EpisodesNumber of New Community Reablement Episodes Average New Episodes for Period



Effectiveness of Community Reablement

Positive numbers in graph / table on the previous page reflect desired outcome of community reablement, which is to reduce or eliminate the amount of managed care

that people will require on an ongoing basis. The minus numbers reflect other outcomes, but these will of course be appropriate to the needs of the individual.

-40

-30

-20

-10

0

10

20

30

40

April

2015

May

2015

June

2015July 2015

August

2015

Septemb

er 2015

October

2015

Novembe

r 2015

Decembe

r 2015

January

2016

February

2016

March

2016

April

2016

May

2016

June

2016July 2016

August

2016

Septemb

er 2016

October

2016

Novembe

r 2016

Decembe

r 2016

Other -1 -1 -4 -3 -6 -5 -4 -5 -6 -4 -7 -2 -1 0 0 -1 0 -4 -1 -4 -3

Care Home or Hospital -5 -4 -8 -11 -3 -5 -11 -9 -5 -5 -1 -1 0 -6 -2 -5 -2 -1 0 -2 -2

Same or increased care -13 -23 -21 -16 -11 -10 -6 -14 -2 -3 -3 0 -11 -11 -3 -9 -5 -4 -6 -2 -1

Reduced Care 1 12 14 12 2 5 3 6 2 3 2 3 4 1 5 0 1 1 3 0 0

No care 7 12 16 8 10 12 13 14 16 13 18 11 10 12 24 21 21 14 22 20 15

Destination on Discharge from Community Re-ablement

No care Reduced Care Same or increased care Care Home or Hospital Other

53 59 64 65 64 70 71 73 7387

113

61

123

62

5869

6050 53

75

340

20

40

60

80

100

120

140

Ap

r-1

5

Ma

y-1

5

Jun

-15

Jul-

15

Au

g-1

5

Se

p-1

5

Oct

-15

No

v-1

5

De

c-1

5

Jan

-16

Fe

b-1

6

Ma

r-1

6

Ap

r-1

6

Ma

y-1

6

Jun

-16

Jul-

16

Au

g-1

6

Se

p-1

6

Oct

-16

No

v-1

6

De

c-1

6

Nu

mb

er

of

Da

ys

Average Number of Days Receiving Community Reablement for those

Leaving - 2015 to Present

No care,

309, 43%

Reduced

Care, 80,

11%

Same or

increased

care, -174, -

23%

Care Home

or Hospital,

-88, -12%

Other, -62,

-9%

Community Reablement Discharge

Destination

April 2015 - December 2016



What is working well? What are we worried about? What are we going to do? There has been an increase in the proportion of people

who are leaving service to reduced care package or no

care.

Data is not complete due to a variety of factors. We

have also detected a range of errors in recording.

We are working to an improvement plan to foster

improvement in recording accurately. This is essential

to monitor the effectiveness of the service.

There has been a reduction in the numbers of people

leaving community reablement and going into hospital

or residential / nursing care.

We will continue to divert people away from care in

care homes or hospital where appropriate in line with

people’s desired outcomes.

There has been a reduction in the average length of

stay, reflecting improvements in the through-flow of

service users into other services.

We know that stay lengths can increase due to

pressures within the service, in terms of securing long-

term care.

Maintain focus on effective commissioning

arrangements and workflow processes for domiciliary

care.

Residential Reablement



Summary of Expectations / Standards Summary of Outcomes / Performance The purpose of the residential reablement service is to avoid further escalation in a person’s care needs

and to avoid their admission to hospital or to a care home. Where successful, the ability of people to

remain independent with less or no ongoing managed care reduces the overall total burden on managed

care services.

There is good evidence the service has become effective in

preventing admissions over the last 2 years.

There is a local PI relating the the service: AS4 - Percentage of clients returning home following

residential reablement. For 2016/17, the target was set at 58% returning home.

This target has been met. Cumulative performance is 67%



Numbers in Residential Reablement

1614

11

6

97

1112

15

10

1413

1516

1516

18

13

9

1214

12 1211 11

1011 11

1011 11 11

910

98 8 8

11

86

7

0

5

10

15

20

Ap

r 15

Jun

15

Au

g 1

5

Oct 1

5

De

c 15

Fe

b 1

6

Ap

r 16

Jun

16

Au

g 1

6

Oct 1

6

De

c 16

People in Residential Reablement at End of Month

April 2015 - December 2016

Bonymaen House

Ty Waunarlwydd

Admissions to /Discharges from Residential Reablement

13 11

13 9

13 9

13 11

13

16 14

14 12

13 11 7

11 8

11

17 1

3

-14 -16

-14

-10

-11

-9

-10

-10

-10

-20

-10 -1

4

-7 -11

-10 -12

-8 -13

-13

-14

-11

-30

-20

-10

0

10

20

Ap

r-15

Ma

y-1

5

Jun

-15

Jul-1

5

Au

g-1

5

Se

p-1

5

Oct-1

5

No

v-1

5

De

c-15

Jan

-16

Fe

b-1

6

Ma

r-16

Ap

r-16

Ma

y-1

6

Jun

-16

Jul-1

6

Au

g-1

6

Se

p-1

6

Oct-1

6

No

v-1

6

De

c-16

Bonymaen House Reablement Admissions and Discharges April

2015 to October 2016

Admissions Discharges

7 8 8

5 7 5 6 5 4 4 3

6 7

3 4 6 4 5 5 4 5

-6 -8 -10

-5 -7

-4 -6 -7

-3 -4

-3

-8

-6

-4 -5 -6

-4

-2

-8

-5

-3

-15

-10

-5

0

5

10

Ap

r-15

Ma

y-1

5

Jun

-15

Jul-1

5

Au

g-1

5

Se

p-1

5

Oct-1

5

No

v-1

5

De

c-15

Jan

-16

Fe

b-1

6

Ma

r-16

Ap

r-16

Ma

y-1

6

Jun

-16

Jul-1

6

Au

g-1

6

Se

p-1

6

Oct-1

6

No

v-1

6

De

c-16

Ty Waunarlwydd House Reablement Admissions and Discharges

April 2015 to October 2016




Effectiveness of Residential Reablement

Positive numbers reflect desired outcome of residential reablement, which is to

avoid admission to a care home or hospital. The minus numbers reflect other outcomes, but these will of course be appropriate to the needs of the individual.

What is working well? What are we worried about? What are we going to do? Most people return home following residential

reablement, with Bonymaen house achieving a higher

success rate since Ty Waunarlwydd deals with people

with dementia whose care needs are often greater

We want to do some work looking in more detail at

what ‘returning home’ looks like in terms of ongoing

care plan and care packages.

We will prepare a plan to examine this issue.

5 5

9

8

7 7 7

5

7

14

5

10

7

9

5

9

6

9

12

7

16

2

-6 - 6

-4 -6

-2 -2 -3 -3

-1 -3

-1

0

-2

-1 -1 -1

-10

-5

0

5

10

15

Ap

ril

20

15

Ma

y 2

01

5

Jun

e 2

01

5

July

20

15

Au

gu

st 2

01

5

Se

pte

mb

er

20

15

Oct

ob

er

20

15

No

ve

mb

er

20

15

De

cem

be

r 2

01

5

Jan

ua

ry 2

01

6

Fe

bru

ary

20

16

Ma

rch

20

16

Ap

ril

20

16

Ma

y 2

01

6

Jun

e 2

01

6

July

20

16

Au

gu

st 2

01

6

Se

pte

mb

er

20

16

Oct

ob

er

20

16

No

ve

mb

er

20

16

De

cem

be

r 2

01

6

Nu

mb

er

of

Dis

cha

rge

s

Bonymaen House Reablement Destination on Discharge April 2015 to December 2016

Returned Home Own Home - No care Own Home - With care

Residential Care Hospital Deceased

3 4 3 4

1 1

4

1 1

4 5

2 3 2 3 2 3 2

-3 -3

-7

-2 -2 -3 -4

-2

-1 -3 -3 -4

-2

-1

-4

-3

-1 -1

-10

-5

0

5

10

15

Ap

ril

20

15

Ma

y 2

01

5

Jun

e 2

01

5

July

20

15

Au

gu

st 2

01

5

Se

pte

mb

er

20

15

Oct

ob

er

20

15

No

ve

mb

er

20

15

De

cem

be

r 2

01

5

Jan

ua

ry 2

01

6

Fe

bru

ary

20

16

Ma

rch

20

16

Ap

ril

20

16

Ma

y 2

01

6

Jun

e 2

01

6

July

20

16

Au

gu

st 2

01

6

Se

pte

mb

er

20

16

Oct

ob

er

20

16

No

ve

mb

er

20

16

De

cem

be

r 2

01

6

Nu

mb

er

of

Dis

cha

rge

s

Ty Waunarlwydd Reablement Destination on Discharge April 2015 to December 2016

Returned Home Own Home - No care Own Home - With care

Residential Care Hospital Deceased



Residential / Nursing Care for Older People

Summary of Expectations / Standards Summary of Outcomes / Performance Wherever possible we seek to ensure people can remain at home, living independently, with support

where necessary, before residential / nursing care can be contemplated. This service is intended only for

those whose needs cannot be met at home. As such our intention is to keep numbers low.

There have been reduction in the numbers of people support

over the last three years but the decreases have slowed down

over that period.

There was a performance indicator (SCA002b) that related to the rate per 1,000 older people supported

in residential care. Target for 2016/17 was set at 9.5

Performance at the end of Q3 was marginally short of the

target at 9.54

New national Measure 21: the length of stay (days) in residential care and new national Measure 22 the

average age (years) on admission to residential care (Measure 22). Both indicators exclude people in

nursing care. These indicators are not ostensibly measures of performance but contextual in nature.

Recorded results at the end of Quarter 3 were 1.027 days for

Measure 21 and Measure 22 was 83.5 years of age. No targets

were set and indicators not reported corporately.

Older People Aged 65+ Supported in Residential / Nursing Care by the Local Authority at the end of the Period

15

8

15

7

15

6

15

6

15

7

15

8

15

4

14

8

14

9

15

0

14

3

14

2

14

0

14

4

14

5

14

1

13

9

14

0

14

0

14

0

14

2

14

1

14

4

13

9

13

7

13

2

13

4

13

6

13

4

13

7

13

9

13

6

13

8

50

0

50

3

50

6

49

9

49

8

50

8

50

3

49

5

49

3

49

8

51

0

51

0

50

9

49

5

48

8

49

7

49

8

49

9

49

4

50

0

50

2

49

4

49

6

48

9

48

2

49

6

49

1

49

4

49

4

48

7

48

7

48

3

47

9

32

2

32

3

32

3

32

9

33

0

32

1

31

7

30

9

29

4

28

3

27

9

27

9

28

3

28

3

28

5

29

2

29

3

28

9

28

9

28

9

29

0

29

1

28

8

28

8

29

2

29

9

29

4

29

0

29

5

29

4

28

6

29

2

28

7

98

1

98

4

98

6

98

5

98

6

98

8

97

5

95

3

93

7

93

2

93

3

93

2

93

3

92

3

91

9

93

1

93

1

92

9

92

4

93

0

93

5

92

7

93

0

91

8

91

4

93

4

92

7

93

0

93

3

92

7

91

2

91

1

90

4

0

200

400

600

800

1000

1200

Nu

mb

er

of

Pe

op

le

Local Authority Residential Nursing Total



293

312 313

280

300

320

2014 2015 2016

Nu

mb

er

of

Dis

char

ges Cumulative Discharges from


Admissions to and Discharges from Residential / Nursing Care

The number of older people aged 65+ supported

in residential / nursing care by social services

has declined in the last two years (previous page). Maintaining the reduced figures is dependent on effective control over admissions and a consistent flow of discharges.

What is working well? What are we worried about? What are we going to do? The number supported has decreased from higher

levels prior to October 2014.

We have not reduced numbers to the level anticipated

in the Western Bay business case for intermediate

care and we are still making above-average use of

residential care compared to other Welsh councils.

We have re-established processes to strengthen the

rigour of acceptance of potential residents to care

homes. There is a Panel now in place which challenges

decisions surrounding new and temporary placements.

We will need to monitor whether these arrangements

help reduce the propensity to use of long-term

placements.

Discharges have been high this calendar year helping to

maintain downwards pressure on the overall number of

people supported in residential / nursing care.

For 6 of the 9 months of the calendar year so far

admissions have been higher than the average of 30

for the entire period. Ultimately this will push the

average admission number upwards.

We have re-established processes to strengthen the

rigour of acceptance of potential residents to care

homes, as outlined above.

223289 292

0

200

400

2014 2015 2016Nu

mb

er

of

Ad

mis

sio

ns

Cumulative New Admissions to


30 2

4

15

31 2

5

26

27 2

1

24

32

40 37 3

3 26

34 32

24

36 33

33

38

27

35

41 3

5

45

28

37 3

2

36

28

32

19

-31

-26

-21

-32

-25

-31

-42

-44

-41

-37

-39

-40

-36

-37

-41

-21

-28

-44

-40

-30

-35

-37

-35

-51

-44

-31

-34

-41

-33

-40

-37

-34

-19

-60

-40

-20

0

20

40

60

Ap

r 1

4

Ma

y 1

4

Jun

14

Jul

14

Au

g 1

4

Se

p 1

4

Oct

14

No

v 1

4

De

c 1

4

Jan

15

Fe

b 1

5

Ma

r 1

5

Ap

r 1

5

Ma

y 1

5

Jun

15

Jul

15

Au

g 1

5

Se

p 1

5

Oct

15

No

v 1

5

De

c 1

5

Jan

16

Fe

b 1

6

Ma

r 1

6

Ap

r 1

6

Ma

y 1

6

Jun

16

Jul

16

Au

g 1

6

Se

p 1

6

Oct

16

No

v 1

6

De

c 1

6

Nu

mb

er

of

Ad

mis

sio

n /

Dis

cha

rge

s

Number of Admissions and Discharges - Residential and Nursing Care April 2014 onwards




Temporary Admissions to Residential / Nursing Care A temporary admission can be for a variety of reasons, the most common being trial periods to allow a person to establish whether they would like to consider a permanent

placement and where the authority will need to carry out a financial assessment to determine whether the law requires that the person should pay for their care. Such

stays tend to be relatively brief, typically between 40 and 60 days.

We have recently started to examine this information in the context of understanding overall levels of demand for residential / nursing care.

Summary of Expectations / Standards Summary of Outcomes / Performance Given the risk of a temporary placements becoming permanent placements, we think

that the number of such placements should be kept as low as possible.

Cumulative admissions to temporary care in 2016/17 have been lower than in the

previous financial year but look set to increase.

We will keep this area under review in order to define reasonable expectations. No additional outcomes defined as yet.

Number of People in Temporary Residential / Nursing Placements at the end of the Month

19

27

25

28

26

28

21

15

17

18

22 2

1

22

27 2

6 25

25

26

23

23

31

34

25 2

4

26

18

31

29 2

8

18

22

19

21

0

5

10

15

20

25

30

35

40

Numbers in Temporary Placement At Month End



5

20

6

15

12

18

12

8

12

17 1

6

12

17 1

6

18

9

14

15

15

15

21

17

11

15

17

12

19

11

16

10

15

16

6

-6

-12

-8

-11

-15 -1

6

-19

-14

-9

-15

-14

-13

-16

-11

-17

-12 -1

3 -14

-19

-14

-14

-14

-20

-15 -1

6

-19

-7

-13

-17 -1

9

-11

-20

-4

-25

-20

-15

-10

-5

0

5

10

15

20

25

Ap

r-1

4

Ma

y-1

4

Jun

-14

Jul-

14

Au

g-1

4

Sep

-14

Oct

-14

No

v-1

4

De

c-1

4

Jan

-15

Feb

-15

Ma

r-1

5

Ap

r-1

5

Ma

y-1

5

Jun

-15

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

No

v-1

5

De

c-1

5

Jan

-16

Feb

-16

Ma

r-1

6

Ap

r-1

6

Ma

y-1

6

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

No

v-1

6

De

c-1

6

Temporary Placements - Admissions and Discharges

Number Admitted to Temporary Placement Number Exit From Temporary Placement

Admissions to and Discharges from

Temporary Residential / Nursing Care

What is working well? What are we worried about? What are we going to do? Admissions and discharges are keeping pace with each

other and numbers are remaining relatively stable

We do not yet understand the dynamics of this aspect

of service delivery.

We are going to monitor this area of work and seek to

understand it better. Under the new Panel

arrangements, temporary placements are now only

agreed for a two week period. Following the two weeks,

care managements have to come back to Panel

explaining the long-term care arrangements or why the

temporary placement should be extended.

108

140122

0

50

100

150

Dec-14 Dec-15 Dec-16

Cumulative Admissions to Temporary

Res / Nurs Care

110130 126

0

50

100

150

Dec-14 Dec-15 Dec-16

Cumulative Discharges from

Temporary Res / Nurs Care



Destination on Discharge from Temporary Residential / Nursing

Placements The chart opposite shows the destination of people who have ceased to be in a

temporary placement.

The largest group representing 39½% of discharges since April 2016 is into a

permanent placement. A further 5.4% are ‘pending FACS approval’ and are likely to

turn into a permanent placement. Just 1.6% of discharges are to self-funded care.

This means that just under 45% of those who are admitted to temporary

placements are likely to represent an ongoing cost to the local authority.

Of the discharges to the community, accounting for 29.5% of discharges, many are

likely to require ongoing care and we will examine the relevant records to test this.

8½% of people sadly die whilst in the temporary placement. Work is needed to

establish whether temporary placements were appropriate, particularly where the

length of stay is very short, as many are.

Only 3 people (2.3%) were discharged to hospital from a temporary placement,

compared to 11 (9.7%) in the same period to December during 2015/16. Nobody

has been discharged to a CHC placement in 2016/17.

Discharge to

Health / CHC, 3,

2.3%

Discharges

(community), 38,

29.5%

Deceased, 11,

8.5%

Pending FACS

Approval, 7, 5.4%

Placed, 51, 39.5%

Self-funding, 2,

1.6%

Misc, 17, 13.2%

Oth

er,

23

, 1

7.8

%

Temporary Placements: Discharge Destination April - December

2016



What is working well? What are we worried about? What are we going to do? We have good quality

information about the

destination of people who

leave a temporary placement.

Inappropriate use of temporary placements can result in increased

local authority expenditure should not be undertaken lightly. This is

particularly following the change in charging arrangements as a result

of the Social Services and Wellbeing Act whereby temporary

placements can now only be charged at a maximum of £60 per week

for the first 8 weeks.

We need to ensure that admissions to temporary placements

are only made when necessary due to the escalating risk to

local authority budgets that they represent.

We have good quality

information about the start and

end of a period of temporary

placement

We will develop better length of stay profiles for those in

temporary placements.

The very low level of discharges to Continuing Health Care (CHC)

funded placements is illustrative of wider issues of whether the

Health Board is appropriately funding Swansea citizens. This pattern is

echoed across Western Bay.

We will continue to engage with the LHB on achieving equitable

distribution of CHC funding across Western Bay. We are also

relooking at our strategy in relation to how we negotiate the

funding of new placements to make sure that the Health Board

funds legitimate health needs.

Domiciliary Care


Long-Term Domiciliary Care

Summary of Expectations / Standards Summary of Outcomes / Performance There are no national or local performance indicators relating to this service. N/A

Wherever possible we seek to ensure people can remain at home, living independently, with support

where necessary. Long-term provision of home care should be limited to those who need it to remain

independent. As such our intention is to keep numbers low.

There has been no reduction in the numbers of people

supported over the last three years. There have been notable

increases in numbers during 2016/17.

People receiving a domiciliary care package

1,0

95

1,1

07

1,0

95

1,1

24

1,1

35

1,1

55

1,1

60

1,1

50

1,1

36

1,1

37

1,1

32

1,1

19

1,1

26

1,1

05

1,1

36

1,1

67

1,1

46

1,1

68

1,1

55

1,1

21

1,1

03

1,0

71

1,0

87

1,0

99

1,1

35

1,1

15

1,1

10

1,1

04

1,1

34

1,1

23

1,1

91

1,2

27

1,2

45

16

9

17

4

17

4 17

0

17

6

17

5

17

3

16

9

15

9

15

6

15

1

14

5

15

9

14

5 13

6 12

9

13

1

11

4

12

2

12

0

11

7

11

2

11

7

13

9 13

6

14

4

13

9

14

4 14

7

16

1

17

6 16

2

17

3

12

64

12

81

12

69

12

94

13

11

13

30

13

33

13

19

12

95

12

93

12

83

12

64

12

85

12

50

12

72

12

96

12

77

12

82

12

77

12

41

12

20

11

83

12

04

12

38

12

71

12

59

12

49

12

48

12

81

12

84 1

36

7

13

89

14

18

700

800

900

1,000

1,100

1,200

1,300

1,400

1,500

Nu

mb

er

of

Pe

op

le

Number of People Receiving Domiciliary Care at Month End

Purchased Service Receiving Service - In-house Total

Domiciliary Care


60

55

46

51

61

44

48

62

38

53

44

56

35

36

68

65

41

53

38

39

26

33

59

47

68

41

62

42

63

36

51

51

24

7 13

9

10

12

9 3

6

6

11

7

10

22

8

9

5

13

9

22 15

11

6

25

27

24

33

12

19

21

36

30 2

3

26

0

10

20

30

40

50

60

70

80

90

100

Ap

r-1

4

Ma

y-1

4

Jun

-14

Jul-

14

Au

g-1

4

Se

p-1

4

Oct

-14

No

v-1

4

De

c-1

4

Jan

-15

Fe

b-1

5

Ma

r-1

5

Ap

r-1

5

Ma

y-1

5

Jun

-15

Jul-

15

Au

g-1

5

Se

p-1

5

Oct

-15

No

v-1

5

De

c-1

5

Jan

-16

Fe

b-1

6

Ma

r-1

6

Ap

r-1

6

Ma

y-1

6

Jun

-16

Jul-

16

Au

g-1

6

Se

p-1

6

Oct

-16

No

v-1

6

De

c-1

6

Nu

mb

er

of

Pe

op

le

Number of People Starting to Receive Domiciliary Care

Starters in-house Starters Purchased Service

540 515 662

-

200

400

600

800

2014 2015 2016

Nu

mb

er

of

Sta

rts

Cumulative Starts - In House and Purchased

Domiciliary Care

People starting to receive a domiciliary

care package

What is working well? What are we worried about? What are we going to do? Some reductions in overall number of service users

have been achieved from time to time but have not

been sustained.

Anecdotally, there have been some improvements in

the flow of service users into the service, although data

needs to be sought to confirm this.

The number of people receiving a long-term home care package

from either an independent provider or the council’s own

service has continued to remain at high levels and the overall

number of hours delivered is continuing to increase month on

month. We are supporting higher levels of domiciliary care in

the community than we have ever supported before.

Conversely, numbers were projected to reduce within the

Western Bay business model for intermediate care.

We need to scrutinise the routes into long-

term domiciliary care to ensure that

appropriate decisions are put in place before

agreeing new or increased packages of care.

Work is commencing to map this and then

ensure appropriate test and challenge

arrangements are in place.

Domiciliary Care


What is working well? What are we worried about? What are we going to do? Anecdotally, there have been some improvements in

the flow of service users into the service, although data

needs to be sought to confirm this.

The overall number of new starters has gone up during the

course of 2016 and new starts exceed new starts in the previous

2 financial years. Historically, there were panel arrangements in

place to agree all new and reviewed packages of care. These

arrangements were removed on moving to the Integrated Hubs

to improve flow through the system as they were perceived as

bureaucratic. However, it would appear that removing this layer

of decision making has led to more people being supported

than ever before.

As above.

Anecdotally, there have been some improvements in

the flow of service users into the service. Data should

be sought to confirm this.

The overall number of new starters has gone up during the

course of 2016 and new starts exceed new starts in the previous

2 financial years.

A Commissioning Review is underway within

this area of service.

The number of new starters for the in-house service since

February 2016 has increased

We will look into this issue more closely.

Monthly Home Care Hours Provided

56

,11

3

57

,98

3

56

,62

5

58

,97

7

59

,52

7

58

,40

0

60

,59

4

58

,50

7

59

,92

8

60

,07

8

54

,72

5

60

,57

0

58

,57

8

58

,91

2

58

,84

9

62

,62

7

62

,31

7

60

,59

6

62

,39

8

59

,80

6

59

,79

3

58

,06

3

56

,05

3

60

,32

9

59

,25

2

60

,49

9

57

,49

5

58

,83

0

60

,76

4

61

,70

1

64

,87

8

65

,44

3

62

,89

5

5,7

31

5,7

82

5,5

96

5,5

83

5,7

17

5,5

92

5,5

83

5,3

17

5,3

73

5,2

97

4,6

75

5,0

92

5,7

68

5,9

72

5,6

32

5,5

63

5,5

06

5,2

21

6,0

90

6,8

11

7,3

11

7,3

14 6,3

17

7,1

61

8,4

22

9,1

13 7

,98

0

7,9

28

7,8

01

7,4

11

8,1

34

7,8

40 8,0

63

61

,84

3

63

,76

5

62

,22

1

64

,56

0

65

,24

4

63

,99

2

66

,17

7

63

,82

4

65

,30

2

65

,37

5 5

9,4

00

65

,66

2

64

,34

6

64

,88

5

64

,48

1

68

,19

0

67

,82

3

65

,81

7

68

,48

8

66

,61

7

67

,10

4

65

,37

7

62

,37

0

67

,49

0

67

,67

5

69

,61

2

65

,47

5

66

,75

8

68

,56

6

69

,11

2

73

,01

2

73

,28

3

70

,95

9

40,000

45,000

50,000

55,000

60,000

65,000

70,000

75,000

Ap

r 1

4

May

14

Jun

14

Jul 14

Au

g 1

4

Se

p 1

4

Oct

14

No

v 14

Dec

14

Jan 1

5

Fe

b 1

5

Mar

15

Ap

r 1

5

May

15

Jun

15

Jul 15

Au

g 1

5

Se

p 1

5

Oct

15

No

v 15

Dec

15

Jan 1

6

Fe

b 1

6

Mar

16

Ap

r 1

6

May

16

Jun

16

Jul 16

Au

g 1

6

Se

p 1

6

Oct

16

No

v 16

Dec

16

Nu

mb

er

of

Ho

urs

Total Hours of Care Provided to All Clients

Hours - Purchased Service Hours - In-house Total Monthly Home Care Hours Provided

Domiciliary Care


51 52 51 52 52 51 52 51 53 53 48

54 52 53 52 54 54 52 54 53 54 54 51 55 52 54 52 53 53 51 52 50 51

34 33 32 33 32 32 32 31 34 34 31 35 36

41 41 43 42 46

50 57

62 65

54 52

62 63 57 55 53

46 46 48 47

-

20

40

60

80

Average Monthly Hours of Home Care Provided by Provider Type

Average Monthly Hours -Purchased Average Monthly Hours - In-house

Average Monthly Carer Hours Provided per Client

What is working well? What are we worried about? What are we going to do? A large number of hours of home care are being

provided independently or from the local authority,

which means that delayed transfers of care are at a

minimum and people are actively being supported to

remain independent at home.

Number of hours delivered has resumed the high levels

seen last autumn and subsequently the number of

hours delivered has continued to increase.

Work is underway to review all long-term packages of

care to ensure they continue to meet need. We also

need to scrutinise the routes into long-term domiciliary

care to ensure that appropriate decisions are put in

place before agreeing new or increased packages of

care. Work is commencing to map this and then ensure

appropriate test and challenge arrangements are in

place.

Sustainability of independent providers can result in

the local authority needing to absorb additional care

hours

A Commissioning Review is underway within this area

of service, and the outcome of the consultation will go

to Cabinet on 20th

April. This will include a

recommendation to recommission the external service

on a patch based approach which will help to

strengthen the sustainability of the external sector.

Work is also underway to support the external sector

with recruitment and retention of staff to help

strengthen the sector.

Purchased service has maintained a steady average

care package size.

There appears to be some considerable growth in the

size of the average in-house package.

We will look more closely at the data for hours of care

provided by the in-house service.

Day Services – Older People


Day Services for Older People Resource Utilisation of Day Services for Older People

The charts show that there has been some variation in the

take-up and usage of day services for older people. Abergelli

(which focuses on older people with a learning disability) and

Norton Lodge are achieving high percentages of attendance.

The Hollies and Rose Cross have significant capacity which had

been unallocated. St John’s and Ty Waunarlwydd show a more typical profile with around 80% of capacity allocated and around 65% of capacity attended over the period,

improving on p .

What is working well? What are we worried about? What are we going to do? We have newly-established consistent recording and

reporting methods across these services.

There is some variation between services in terms of

resource utilisation.

Work is underway to look at various issues of capacity

and allocation. There have been improvements since

the last report.

Abergelli Norton Lodge St Johns

Ty

Waunarlwyd

d

The Hollies Rose Cross

Not allocated 372 178 392 500 540 1250

Allocated Unattended 433 297 502 366 235 257

Allocated Attended 3325 1977 1793 1594 405 973

Total Capacity 4134 2500 2670 2460 1180 2480

4,134

2,5002,670

2,460

1,180

2,480

0

500

1000

1500

2000

2500

3000

3500

4000

4500

Att

en

da

nce

Da

ys

Day Services Older People: July to December 2016

Allocated Attended Allocated Unattended Not allocated Total Capacity

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Att

en

da

nce

Da

ys

Allocated Attended Allocated Unattended

Not allocated

Safeguarding & Deprivation of Liberty Safeguards (DoLS)


Safeguarding Vulnerable Adults There are a number of national and local performance indicators relating to safeguarding. All of these are new and therefore baselines are still being set for targets and, in

some cases, definitions. The performance measures focus on issues of the timeliness of response to safeguarding referrals and the most vulnerable people in residential /

nursing care.

Summary of Expectations / Standards Summary of Outcomes / Performance Effective safeguarding procedures are dependent on effective enquiries being made.

Local Indicator AS5: The percentage of individuals for whom an adult protection referral has been

completed where the subject has an active care and support plan at the end of period. A local

target has been set to achieve lower than 85% reflecting a desire to allow former safeguarding

clients to maintain independence without ongoing managed care.

Slightly lower performance in quarter 1 will affect the whole-year

performance on this indicator. Nonetheless, to end of January the

target is being met at 84.1%.

Local Indicator AS6: Number of adult clients receiving residential / nursing care where the service

provider is subject to escalating concerns protocol. It is preferable for this number to be as low as

possible at any time but no target has been set since 0 would be the preferred result.

At the end of December 2016, there was one home under the

Escalating Concerns protocol, with 12 adult social services clients

resident at that time. At the end of January 2017, there were no

homes under the Escalating Concerns protocol.

Local Indicator AS7: The percentage of safeguarding referrals relating to people in residential /

nursing care homes where the individual had been the subject of a previous safeguarding referral.

A local target has been set to achieve lower than 20% reflecting a desire to ensure that once

issues have been dealt with by providers, future safeguarding concerns would be reduced.

Currently to the end of Q3, performance was 34.8%. We have thus far

not met this in any quarter. The target and it may in fact need to be

adjusted because it may not be possible to achieve it.

Local Indicator AS8: Percentage of adult protection referrals to Adult Services where decision is

taken within 24 hours. A local target has been set to achieve higher than 80% reflecting a desire to

ensure that matters are dealt with promptly but recognising that there will once always be

occasions where decisions cannot be taken within a day.

Currently performance on this indicator is below target at 61.4%.

Staff are being reminded to ensure they respond as promptly as is

prompt and safe for the circumstances. Performance improved

considerably after Q2.

National Indicator: Measure 18: The percentage of adult protection enquiries completed within 7

days. . A local target has been set to achieve higher than 95% reflecting a desire to ensure that

matters are dealt with as promptly as possible but recognising that there will once always be

occasions where decisions cannot be taken even within a week.

Currently performance on this indicator is below target at 86%. Staff

are being reminded to ensure they respond as promptly as is prompt

and safe for the circumstances. Performance was poor in Q1 but for

Q2 and Q3 combined, performance was 94%.



Safeguarding Enquiries and Outcomes

The graphs show that of the 1,032 safeguarding

enquires completed since April 2016, 43% met the

threshold for investigation and 45% did not meet the

threshold.

are those enquiries that were ‘Awaiting Highlighted

Outcome’ at the end of each month. These do not

accumulate. At the end of January 2017, 4 were

outstanding

What is working well? What are we worried about? What are we going to do? Numbers are remaining relatively constant, with

typically 110 (plus or minus 10) safeguarding enquiries

received each month.

Some recording and compliance issues remain amongst

some staff

Information has been passed by the Performance Team

to the relevant Business Support Managers to highlight

these issues.

Threshold

Met, 444,

43%

Threshold

Not Met,

462, 45% Inapp. To

POVA, 85,

8%

Clos ed at

Intake, 41,

4%

Outcomes of Safeguarding

Enquiries:


Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17

Awaiting Outcome 1 11 6 3 7 2 3 2 0 4

Closed at Intake 3 12 4 1 7 4 4 1 1 4

Inapp. To POVA 7 8 6 6 7 6 10 23 7 5

Threshold Not Met 40 35 41 38 54 45 66 56 40 47

Threshold Met 44 52 30 42 44 63 42 37 39 51

All Safeguarding Referrals 95 118 87 90 119 120 125 119 87 111

44

52

30

42

44

63

42 37

39

51

40

35

41

38

54

45

66

56 4

0

47

7

8

6

6

7

6

10

23

7

5

1

11

6

3

7

2

3

2

0

4

95

118

87 90

119 120125

119

87

111

20

30

40

50

60

70

80

90

100

110

120

130

140

Outcomes of Safeguarding Enquiries: April 2016-January 2017 Threshold Met

Threshold Not

Met

Inapp. To POVA

Closed at Intake

Awaiting Outcome

All Safeguarding

Referrals



Within 24

Hours,

520, 79%

2 - 7 Days,

98, 15%

8 days and

over, 27,

4%

Awaiting

Decisions,

15, 2%

Safeguarding Thresholds Completed

Within Timescales: April 2016 - January

2017

Timeliness of Completion of Safeguarding

Enquires

We have been reporting internally in detail on time taken

to complete thresholding of safeguarding enquires since

August 2016.

In terms of reporting this data, a referral is completed when the threshold decision is taken. The preferred timescale is set by Welsh Government within its practice

guidance, which is 24 hours.

What is working well? What are we worried about? What are we going to do? Typically 4 out of 5 safeguarding referrals are being

completed within the Welsh Government specified

timescale.

The proportion of cases not being completed within a

timely fashion has increased in October.

This situation is being closely monitored and staff will

be reminded of the statutory practice requirements. It

is pleasing to note that the majority of cases are being

thresholded within 7 days.

98 106

7384 80 79

55

3528

421

112116

121 118

86

107

40

50

60

70

80

90

100

110

120

130

Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17

Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17

Awaiting Decisions 7 2 3 2 0 1

8 days and over 2 3 10 4 2 6

2 - 7 Days 5 5 35 28 4 21

Within 24 Hours 98 106 73 84 80 79

All Enquiries 112 116 121 118 86 107

Safeguarding Thresholds Completed within Timescales August 2016 - January 2017

Within 24 Hours 2 - 7 Days 8 days and over

Safeguarding


Categories of Vulnerability and of Alleged Abuse

4 7 12 1545

109

161

225

407

0

50

100

150

200

250

300

350

400

450

Main Category of Vulnerability


This information is largely contextual and would not normally be considered to represent performance. However we mo nitor these monthly to provide early warning of

any emerging issues.

Patterns of vulnerability and of abuse categories have remained relatively constant throughout 2016-17.

The most commonly-reported types of abuse are Neglect and Physical Abuse, which together account for 59% of the types of abuse reported. Emotional and psychological

abuse (22%) is twice as often reported as financial abuse. Sexual abuse is relatively unusual representing around 5% of abuse types reported.

In terms of the ‘vulnerability; of the person who is reported to be experiencing abuse or neglect, the two categories ‘physical’ and ‘organic mental health’ largely refer to

older people over the age of 65 and typically represent 45-60% of vulnerability reported each month. With learning disability, these 3 categories account for over 60% of

vulnerability categories recorded each month.

OTHER, 41, 3%

SEXUAL, 68, 5%

FINANCIAL, 149,

11%

EMOT. & PSY., 286,

22%

PHYSICAL, 340, 26%

NEGLECT, 429, 33%

Other, 109, 8%

Types of Abuse Reported in VA1 April 2016 - January 2017

Safeguarding


50

71 5

7 52

11

1

36 28

47 3

7

51

90

57

68

4

8

1 10

8

1

1

12

17

20

12

7

12

20

40

60

80

100

120

Nu

mb

er

Gra

nte

d/R

efu

sed

DoLS Authorisations Granted / Refused

Granted Refused

Deprivation of Liberty Safeguards (DoLS) Since 2015/16, DoLS has become a large area of work as a result of Court judgements, impacting every local authority in England and Wales. In Swansea we experience a

17-fold increase in workload in this area. Since timely processing of applications is an important aspect of ensuring individuals are not deprived of their liberty without due

process, handling the volume of demand in a timely fashion is critical. Completion requires a range of documentation to be completed in order for the decision on whether

to authorise the deprivation of liberty can proceed.

Summary of Expectations / Standards Summary of Outcomes / Performance There are no local or national performance indicators. The accepted

national standard for completion of process is 21 days.

In terms of average performance, we have met the standard of 21 days in 4 out of 10 months of

2016/17. Additional specialist capacity has helped to improve this in recent months.

Dealing with the volume of requests that come in is especially

challenging, particularly as there are spikes in activity during the year

reflecting the annual and half–year anniversary of the court judgment.

We have been working with staff to improve their ability to complete in a timely fashion. Senior

management continue to closely monitoring the situation.

Applications for and Disposals of Requests for DOLS Authorisations

The average monthly number of applications has increased from 93 in 2015/16 to 104 in 2016/17. On average for 2016/17, 87% of applications are granted.

79

86

98

85 84

99

12

6

81

71

59 5

3

72

15

0

94

11

0

67

12

0

11

6

11

3

97 9

2 84

40

60

80

100

120

140

160

Ap

r-1

5

Ma

y-1

5

Jun

-15

Jul-

15

Au

g-1

5

Se

p-1

5

Oct

-15

No

v-1

5

De

c-1

5

Jan

-16

Fe

b-1

6

Ma

r-1

6

Ap

r-1

6

Ma

y-1

6

Jun

-16

Jul-

16

Au

g-1

6

Se

p-1

6

Oct

-16

No

v-1

6

De

c-1

6

Jan

-17

DoLS Applications Received per Month

Safeguarding


Processing DoLS Applications

76

10687

75

10191

83102

130

4440

90

140

Outstanding BIA Assessments At Month End

4

11 12 1316

3

8 73

7

1

0

5

10

15

20

Outstanding Doctors' Assessments At Month End

4 6 104

11 8

21 2331

4738

58

47

2130 26

35 35

2012 15

25

0

20

40

60

Nu

mb

er

of

da

ys

Average Time Taken In Days From Allocation To Signatory To Awarding DoLS

What is working well? What are we worried about? What are we going to do? Applications have been fairly constant since August

2016

The number of authorisations has not kept pace with

the number of applications.

Dedicated resource has been introduced to deal with

the number of authorisations that need to be

completed.

Following senior management intervention,

outstanding Best Interests and Doctor’s Assessments

have been brought under control.

We will want to seek to avoid further bottlenecks in the

process leading to a backlog accruing.

There are some additional issues relating to case

allocation which are being dealt with. A longer term

plan is also being developed to look at how we can

effectively manage normal flow.

Introduction of dedicated resource to deal with the

number of authorisations has improved timeliness.

There is continued pressure from existing

authorisations requiring review

Continue to monitor the situation very closely.

Planned Future Developments to this Report


Planned Future Developments to this Report The following have been identified as subject matter that we wish to develop

capability of providing accurate, reliable and meaningful information.

Assessment & Care Management Caseloads & reviews is a topic that we will be working on throughout 2017, across

mental health, learning disability and integrated services.

Mental Health referrals will be added to the next report, as well as performance

on reviewing those with an active Care and Treatment Plan..

Learning Disability referrals and assessments will be delivered before the Summer

2017.

Well-Being and Prevention Services The Local Area Co-ordination (LAC) service will be developing additional metrics

during 2017.

We will be developing appropriate metrics for other related services.

Service provision Older People:

• Utilisation of local authority residential care – capacity and occupancy

Learning Disability:

• Numbers in residential / nursing plus supported living

• Utilisation of day services: allocation / attendance

• Respite Services

Mental Health

• Numbers in residential / nursing plus supported living

• Numbers in day services

Direct Payments

• Specific data items to be confirmed

Carers

• Specific data items to be confirmed

Safeguarding POVA:

• Outstanding work

• Provider issues summary

DoLS:

• We will continue to consider further metrics

Human Resources This section of the report will be developed over time to incorporate material on

human resources issues. Topics currently being considered include:-

• Sickness

• Agency Staff



Appendix A: Performance Indicators The following pages list the most recent recorded performance on each of the performance indicators that are currently used within social services.

New Social Services and Well-Being Act Statutory Measures

Performance Results for 2016-17

Q3 Data as at 8 February 2017Period Numerator*

Denomina

tor *

Swansea

2016/17

Wales

Average

2015/16

Swansea

Target

2016/17**

Desired

direction

of travel

StatusDistance

from Target

Measure 18: The percentage of adult protection enquiries

completed within 7 days Q1-3 2016/17 811 943 86.00 95 ↑ R -9.5%

Measure 19: Delayed transfers per 1,000 people aged 75+ (Was

SCA001)Q1-3 2016/17 92 21,619 4.26 4.87 6 ↓ G -29.1%

Measure 20a: The percentage of adults who completed a period

of reablement and have a reduced package of care and support 6

months later

Q1-3 2016/17 315 476 66.18 50 ↑ G 32.4%

Measure 20b: The percentage of adults who completed a period

of reablement and have no package of care and support 6 months

later

Q1-3 2016/17 132 476 27.73 25 ↑ G 10.9%

Measure 21: The average length of time older people (aged 65 or

over) are supported in residential care homes Q1-3 2016/17 1,404,360 1,368 1,026.58 1000 ↓ A 2.7%

Measure 22: Average age of adults entering residential care

homes Q1-3 2016/17 15,438 185 83.45 84 ↑ A -0.7%

Existing Non-Statutory Local Measures


Q3 Data as at 8 February 2017Period Numerator*

Denomina

tor*

Swansea

2016/17

Wales

Average

2015/16

Swansea

Target

2016/17 †

Desired

direction

of travel

StatusDistance

from Target

SSA1 - The MEDIAN number of working days between initial

enquiry and completion of the care plan, including specialist

assessments

Q1-3 2016/17 16 1 15.98 — 18.50 Down G -13.6%

AS4 - Percentage of clients returning home following RESIDENTIAL

reablementQ1-3 2016/17 89 132 67.42 — 58.00 Down G 16.2%



Former Statutory Measures no longer required for formal reporting


Q3 Data as at 8 February 2017Period Numerator* Denomina

tor*

Swansea

2016/17

Wales

Average

2015/16

Swansea

Target

2016/17 †

Desired

direction

of travel

StatusDistance

from Target

SCA002b: Rate per 1,000 older people supported in care homes

at end of periodAt Q3 2016/17 904 46,266 19.54 18.02 19.5 ↓ A 0.2%

SCA007: % of reviews carried out At Q3 2016/17 3,997 6,248 63.97 82.9% 80.00 ↑ R -20.0%

SCA018a: % of identified carers offered assessment Q1-3 2016/17 945 1,019 92.74 91.4% 97.50 ↑ A -4.9%

SCA018b: % of identified carers who received a specific carers

assessmentQ1-3 2016/17 408 1,019 40.04 28.9% 40.00 ↑ G 0.1%

SCA018c: % of carers who received an assessment who received

carers services as a resultQ1-3 2016/17 199 408 48.77 72.4% 70.00 ↑ R -30.3%

New Non-Statutory Indicators


Q3 Data as at 8 February 2017Period Numerator* Denomina

tor*

Swansea

2016/17

Wales

Average

2015/16

Swansea

Target

2016/17 **

Desired

direction

of travel

StatusDistance

from Target

AS5: The percentage of individuals for whom an adult protection

referral has been completed where the subject has an active care

and support plan at the end of period

Q1-3 2016/17 717 853 84.06 85.00 Down G -1.1%

AS6: Number of adult cl ients receiving residential / nursing care

where the service provider is subject to escalating concerns

protocol

Dec 2016 12 1 12 - Down #DIV/0! #DIV/0!

AS7: The percentage of safeguarding referrals relating to people

in residential / nursing care homes where the individual had

been the subject of a previous safeguarding referral

Q1-3 2016/17 121 348 34.77 20.00 Down R 73.9%

AS8: Percentage of adult protection referrals to Adult Services

where decision is taken within 24 hours Q1-3 2016/17 579 943 61.40 80.00 Up R -23.3%

SUSC5: Number of new requests for local area co-ordination for

individiualsQ1-3 2016/17 121 3 121 105 Up G 15.2%



Appendix B: Performance Indicators: Numerators and Denominators The following table sets out the numerators and denominators for each of the performance indicators referenced within this document.

Type of

Measure Performance Indicator Definitions Numerator* Denominator*

SSWBA Measure 18: The percentage of adult protection enquiries

completed within 7 days Adult protection enquiries completed within 7 days

Adult protection enquiries

completed

SSWBA Measure 19: Delayed transfers (SCA001) Number of people delayed in hospital for social services reasons on

Census day each month throughout the year Population aged 75+

SSWBA

Measure 20a: The percentage of adults who completed a

period of reablement and have a reduced package of care and

support 6 months later

People who have less care than when they completed reablement 6

months previously

People who completed a period of

reablement 6 months previously

SSWBA

Measure 20b: The percentage of adults who completed a

period of reablement and have no package of care and

support 6 months later People who have no care 6 months after completing reablement

People who completed a period of

reablement 6 months previously

SSWBA Measure 21: The average length of time older people (aged 65

or over) are supported in residential care homes

Total number of days spent in residential care by all those presently

in residential care aged 65+

Total number aged 65+ currently

in residential care

SSWBA Measure 22: Average age of adults entering residential care

homes Total age at entry for all those aged 65+ admitted to residential care

Total number aged 65+ admitted

to residential care

SSWBA

Measure 23: The percentage of adults who have received

support from the information, advice and assistance service

and have not contacted the service again during the year TBC TBC

Local AS4 - Percentage of clients returning home following

RESIDENTIAL reablement Number of people discharged from residential reablement to their

own homne, family or deceased Number of people discharged

Local

Safeguarding

AS5: The percentage of individuals for whom an adult

protection referral has been completed where the subject has

an active care and support plan at the end of period

Number of people who had a completed adult protection referral

during the period who were still listed in Paris as a client

Number of people who had a

completed adult protection referral

during the period

Local

Safeguarding

AS6: Number of adult clients receiving residential / nursing

care where the service provider is subject to escalating

concerns protocol

Number of adult clients receiving residential / nursing care where

the service provider is subject to escalating concerns protocol No denominator



Type of

Measure Performance Indicator Definitions Numerator* Denominator*

Local

Safeguarding

AS7: The percentage of safeguarding referrals relating to

people in residential / nursing care homes where the

individual had been the subject of a previous safeguarding

referral

Number of individuals subject of safeguarding referrals where place

of residence is a residential / nursing care home who had been the

subject of a previous safeguarding referral

Number of individuals subject of

safeguarding referrals where place

of residence is a residential /

nursing care home

Local

Safeguarding

AS8: Percentage of adult protection referrals to Adult Services

where decision is taken within 24 hours Adult protection enquiries completed within 24 hours

Adult protection enquiries

completed

Local SUSC5: Number of new requests for local area co-ordination

for individiuals Number of new requests for local area co-ordination for individiuals No denominator

WLGA SCA002b: Older people supported in care homes at end of

period Total # of people aged 65+ supported to live in their own homes in

the community at the end of ther period Population aged 65+

Ex-Statutory SCA007: % of reviews carried out Number of reviews carried out within the last year Number of people who should

have been reviewed

Ex-Statutory SCA018a: Carers offered assessment Number of carers offered a carers assessment Number of carers identified

Ex-Statutory SCA018b: Carers received assessment Number of carers who received a carers assessment in their own

right Number of carers identified

Ex-Statutory SCA018c: Carers received services Number of carers who received a carers service following a carers

assessment in their own right

Number of carers who received a

carers assessment in their own

right

Possibly

redundant

SSA1 - The MEDIAN number of working days between enquiry

and completion of all assessments Middle value for all times to complete assessments No denominator

01/03/2017

1

Presentation to

Adult Social Services

Scrutiny & Performance Panel

ABMU HEALTH BOARD

Dai Roberts, Service Director MH & LD

Malcolm Jones, Locality Manager - Swansea

ABMU Health Board

� Mental Health & Learning Disabilities Delivery Unit set up in August 2015

� Comprises x 4 Localities, x 3 based in Local Authority areas, and SpecialistServices.

� Swansea Locality comprises :-

� Older People’s wards Cefn Coed Hospital

� Adult Wards Cefn Coed

� X 3 CMHT’s Adult

� X 4 CMHT’s Older People

� X 1 Crisis Team

� Recovery Unit Adult

� LPMHSS

� Learning Disabilities Community Teams

� CDAT

� Veterans

� Perinatal Services

� Eating Disorders

Item 6

01/03/2017

2

ABMU Health Board

What has been the impact of the Measure on Primary Mental Health Support Services?

� The implementation of Part 1 of Mental Health Measure, in partnership with LA’s

and the creation of Local Primary Mental Health Support Services.

� The services work alongside primary and has been seen to improve access to Part 1

service.

� Referrals to Local Primary Mental Health Support Services

0

200

400

600

800

1000

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

2015/16

2016/17

ABMU Health Board

Satisfaction Surveys

Care and Treatment Planning Questionnaire

LPMHSS Experience of Service Questionnaire

.

61%

39%

0

0

I think the help I received will help me

cope better

Stronglyagree

Agree65%

30%

5%0

Overall I think I benefited from receiving this

service Stronglyagree

Agree

Neitheragree ordisagree

78%

17%

4% 0

I would recommend this service to other people

Stronglyagree

Agree

100%

Do you have a CTP?

Yes

No

Don't know83%

17%

Have you received copy of CTP?

Yes

No 67%

16%

17%

Did you feel Involved in CTP development?

Yes

No

01/03/2017

3

ABMU Health Board

The interface between Mental Health Primary Care Services and Social

Services.

� There is already integration of services

� Well established pathways support between Mental Health & Social

Services

� Can integration be improved further?

� Strategic commissioning group is an opportunity

� Work ongoing to align strategies

ABMU Health Board

Have there been any shifts in mental health in the Locality and the

causes of mental ill health?

� Increased incidences of dual diagnosis

� Dual diagnosis plan been adapted and implemented

� Homelessness nurse funded to support homeless community

� Veteran’s services, funding provided from WG

� “Legal” highs are a growing issue

01/03/2017

4

ABMU Health Board

� How do service users access and receive treatment for mental ill

health?

� Access to services has previously has been complicated

� Single point of access being developed; based on mental health

triage model

� Swansea SPOA pilot commenced in October 2016

� Initial findings are positive, ease of access and ownership of

referrals.

ABMU Health Board

How has the provision of primary mental health services expanded since the introduction of the Measure?

� LPMHSS introduced in 2012, from WG funding

� LPMHSS provides the following type of services

� Assessment

� 1:1 intervention

� Range of group interventions

� Further funding from WG expanding the team, providing moretherapy, expanding Tier O services



C I T Y A N D C O U N T Y O F S W A N S E A———————————————————————————————————————————————

Dinas A Sir Abertawe

Dear Councillor Harris,

Impact Report: Scrutiny Inquiry – Social Care at Home

The panel would like to thank you and your officers for attending the panel meeting, presenting the impact report and answering our questions. Overall the panel was pleased with the progress that has been made in implementing the recommendations of the scrutiny inquiry.

Implementation of the recommendations We felt that the inquiry’s recommendations have had a real impact on the delivery of social care at home. We were pleased to see that of the 21 recommendations that were agreed by Cabinet, all have been completed.

What has changed since the inquiry The panel was pleased to see that the following things have changed since the report was presented to Cabinet

• Re-design of the Adult Services Model• A commissioning review of domiciliary care services for older people• Re-structure of the adult Services Intake Team• Introduction and expansion of Local Area Co-ordination• A better understanding of the underlying issues contributing to delays

in sourcing packages of care

Councillor Jane Harris Cabinet Member, Adults & Vulnerable People

Civic Centre Oystermouth Road SWANSEA SA1 3SN

Please ask for: Gofynnwch am:

Overview & Scrutiny

Direct Line: Llinell Uniongyrochol:

01792 637491

e-Mail e-Bost:

[email protected]

Our Ref Ein Cyf:

Adult Services/04

Your Ref Eich Cyf:

Date Dyddiad:

10/01/2017

Summary: This is a letter from the Adult Services Scrutiny Performance Panel to The Cabinet Member for Services for Adults and Vulnerable People following the meeting of the Panel on 14 December 2016. The panel examined the impact of the social care at home scrutiny inquiry which concluded in September 2014

ITEM 2A



Impact of the inquiry The panel was pleased to learn that the inquiry had provided useful research and evidence which helped inform the service design for the adult services model and delivery options for the 3 commissioning reviews.

Finally, we were pleased that the inquiry had improved awareness and understanding of a complex topics amongst officers and councillors and had helped to promote constructive debate within the commissioning review process.

The panel considers the monitoring on this inquiry to be completed.

We have highlighted a number of issues in this letter which we agreed we would like to bring to your attention.

1. We would like you to consider providing an end date for thecommissioning reviews for day services and residential services whichwere highlighted as action already being undertaken inrecommendation 4.

2. Recommendation 10 – the panel was pleased that invitations forstakeholder workshops were sent to chairs of the relevant scrutinypanels and to all relevant scrutiny councillors

3. Recommendation 12 – the panel welcomed the development of aworking group with unions to develop a Swansea version of the Unisonethical charter.

4. Recommendation 13 – this was not agreed and did concern the panelhowever officers explained that rates were set on a provider byprovider basis and that the authority ensures it pays the minimum wageto providers. We did express our concerns regarding market failureespecially in the domiciliary care market and were informed about the“provider performance protocol” that providers operate under if theauthority is not satisfied with performance of the provider.

5. Recommendation 14 - the panel would like to request that you andyour officers consider the exclusivity of zero hour contracts as part ofthe ethical charter development work.

6. Recommendation 18 – the panel would like to request thatperformance information regarding the provision of basic items by thehealth board (eg, incontinence items) be added to the Adult ServicesPerformance Monitoring Report.

7. Recommendation 20 – the panel would like to request that data on thedelays in care pathways is added to the monthly performance report,specifically information on what type of cases are delayed and thereasons for the delay.

For your information the panel agreed to contact Fiona Broxton to thank her for all the work that had gone into the action plan and implementing the recommendations.



The panel also agreed that it would contact the head of Housing and cabinet member for housing to request performance data on DFGs and delays in transfers of care as a result of delays in the DFG process.

Your Response We welcome your comments on any matter raised in this letter but we would specifically welcome your comments on points 1, 5, 8 and 7 above. The panel would be grateful for your response by 1 February 2017.

Yours sincerely

UTA CLAY CONVENERADULT SERVICES SCRUTINY PANEL

CLLR [email protected]

Adult Social Services Scrutiny Performance Panel...Mar 08, 2017 · Peter Black (Convener), Yvonne...

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