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AGENDA ITEM NO 4

SOCIAL AFFAIRS, HEALTH & HOUSING SCRUTINY COMMITTEE

21ST NOVEMBER 2007

REPORT FROM THE CHIEF SOCIAL CARE OFFICER

ADULT SOCIAL CARE – PERFORMANCE MANAGEMENT UPDATE 2007/08

PURPOSE OF THE REPORT

To provide Scrutiny Members with:

1. A status report on 2007/08 performance; 2. Comparative 2006/07 Welsh performance management information; 3. Draft details of 2008/09 business planning priorities.

BACKGROUND INFORMATION

1. Members will be aware that a report titled ‘Adult Social Care / Monitoring and Review of Performance was circulated for information to SAHHSC in June 2007. A report titled ‘Adult Social Care – Business Plan 2007/2008’ was also presented to SAHHSC in March 2007.

PERFORMANCE MANAGEMENT UPDATE 2007/08

1. Members will remember that a recent Adult Social Care performance management reports was modelled on a ‘Balanced Scorecard’ approach. Recent collaborative work with other north Wales authorities, however, suggest that basing performance management reports and business plans on the Joint Review / Performance Evaluation model might be more effective in highlighting areas of good performance and areas requiring further attention. The Joint Review / Performance Evaluation process evaluates performance across 14 domains, which essentially cover all aspects of the Balanced Scorecard model, with the added advantage of perhaps presenting performance and planning information in a more user- friendly format to those working in Adult Social Care.

The first set of seven domains’ ask ‘How Good are the Services’?

 The first three of these seven domains – Access, Assessment, Care Management and Review – are fundamentally about fieldwork services, including in the latter two much about social work practice.  The next two domains – Range and Quality of Services provided – consider what are known as “provider services” which are the services provided by internal and external providers as the result of a care plan. 2  The last two of the seven domains – Protecting Vulnerable People and Promoting Independence and Social Inclusion – should as far as possible be about outcomes and ask how successful is the authority’s social services in achieving their key aims? The next set of seven domains ask ‘how well placed is the authority to sustain and improve services?’ They concern themselves with capacity, infrastructure and corporate governance and ask if the authority has the means at its disposal to deliver good services both now and in the future.

 Workforce and Resources cover the human and material resources available to the authority, what it is doing to develop them and how it uses them.  Planning and Partnerships and Commissioning and Contracting consider how the authority reshapes and improves its services to meet assessed and anticipated needs.  Performance management covers how the authority gets the best from its staff and services.  Leadership and Culture and Corporate and Political Support and Scrutiny cover overall direction and governance.

Some performance information may refer to more than one domain as can be seen in several places within the following report.

Domain 1 ‘Access to Services’

This first domain asks about the provision of appropriate access to services. This domain overlaps in part with Domain 2 –Assessments.

1.1 Service User / Carer Engagement Strategy The Service User / Carer Engagement Strategy is currently being updated to ensure policies and procedures for involving service users and carers are robust. The updated strategy will detail:

1. How we involve service users and carers in evaluating and reshaping services; 2. How we use evidence from care management and service provision to reshape services; 3. How we publish information to the public, service users, carers and partner agencies;

The strategy will be in place by March 2008 with the draft document being presented to Senior Managers in December 2007.

The Planning and Commissioning team also have a programme in place for ensuring stakeholders are engaged as required, including the use of a number of programme groups for progressing the Health, Social Care and Well-being Strategy.

1.2 Published Information Work continues on updating our range of published information leaflets. The Adult Social Care pages of the Internet and Intranet are currently being updated to ensure citizens, service users, carers, staff and partners are able to download information and leaflets upon demand thus increasing access and minimising waste.

1.3 Access to Services / Delays or Gaps in Service Processes to manage allocation and waiting lists are now well embedded and are considered to be working well.

Version 1a 08/04/2018 3 1. Unallocated Cases are reported monthly to senior managers. During the second quarter the number of unallocated cases remained steady at around 90 across the 10 care management teams. This figure excludes OT and DSO assessment which are detailed in sections 2.2 and 2.3 below. 2. Delayed Transfers of Care performance for those aged 75 plus continued to improve during quarter 2 confirming the effectiveness of weekly DToC management meetings and increased Domiciliary Care resources. Wrexham’s performance in the first half of 2007/08 has improved considerably with the final DToC rate for the year expected to be approx 3 per 1000 (for social care reasons). This should equate to top quartile performance based on all Wales 2006/07 data. In 2006/07 Wrexham’s rate was 9.04 per 1000 population which was slightly better than the Welsh average of 9.49. 3. Domiciliary Care waiting lists continue to reduce. At the end of September the average waiting time was 3 weeks compared with 5 weeks over the last two quarters. Incidentally, the Welsh Assembly Government are considering introducing a new core performance indicator for 2008/09 which will measure the time taken from completion of the care plan to provision of domiciliary care. This will usefully allow our performance to be compared with that of other similar Welsh authorities. 4. Time taken from completion of care plan to provision and/or installation of aids/equipment. This is a WAG core performance measure. In 2006/07, Wrexham reported an average of 5.7 days against the Welsh average of 9.1 days. 2007/08 performance is currently 6 days (on-track) with process audits currently taking place in an attempt to further improve performance. The current development of the joint community equipment stores with Flintshire County Council is being carefully managed to ensure it does not disaffect performance in this area.

Domain 2: Assessment

This domain considers the application of eligibility criteria and the provision of appropriate assessments.

2.1 Eligibility Criteria / Personal information A report on eligibility criteria was presented by the Chief Social Care Officer to SAHHSC on 14th November 2007.

At present officers are working to improve the consistency and completeness of recording information such as eligibility criteria and equalities on the IT system RAISE. This action will ensure we can report more accurately on the background of people we are providing services to and at what level.

2.2 Occupational Therapy (OT) Assessment OT waiting times for assessment lengthened to 5 months in Q2 from 4 months in Q1 as a result of an increase in the number of referrals received and an increase in ‘high priority assessments’. Waiting times for Disability Services Officer assessments remain on track with no client waiting longer than 3 months at the end of Q2. See Appendix C for up to date position and actions being taken.

During quarter 3, the Performance Management Unit (PMU) are to audit the work of the OT team to confirm the effectiveness of processes and use of IT systems within their work.

Domain 3 – Care Management and Review

Version 1a 08/04/2018 4 This domain considers the rate the provision of appropriate care management and review and takes into account:

3.1 Capacity to Appropriately Allocate all Current Cases. This is linked to the information on allocation mentioned in Domains 1 and 2 above. Caseload information and unallocated case information is discussed by senior managers each month. Senior managers have not identified any major concerns with allocation at present.

3.2 Care Management Work is currently taking place on reviewing care management quality standards, covering case files, assessments, care plans and reviews. This information will be entered into an updated Care Management Manual.

The PMU have put in place an audit programme and new audit tools to confirm with greater accuracy the quality, timeliness and performance of care management in general. Efforts are currently being made to increase capacity within the Performance Management Unit to ensure audit programmes are completed to sufficient depth.

3.3 Timeliness- Reviews within Timescales This is also a WAG core performance measure and in 2006/07 Wrexham completed 75% of reviews within timescale (top quartile performance). 2007/08 quarter one performance was 72%. Q2 performance has not been reported as officers have been dedicating their time to developing the new audit tools and audit programme mentioned in 3.2 above.

Domain 4 – Range of Services Provided.

This Domain considers the range, cost and timeliness of services provided by the department and supplements Domain 1 – Access to Services.

4.2 Domiciliary Care Nearly 70% of Domiciliary Care hours are now provided through independent providers. The in- house unit cost continues to reduce and now stands at £21.92 (In March 2006 it was over £27). This reduction reflects the increased efficiency of the Homecare team and lower staff sickness levels.

4.3 Reablement Service The Reablement service started its pilot study from August 1st. The aim of the service is to reduce acute hospital admissions and residential / nursing placements through the provision of intense and dynamic Domiciliary Care services that focus on fostering independence.

Reablement is a national priority at present and will be closely scrutinised by CSSIW inspectors during future visits. LHB performance officers, the Service Manager for Direct Services and the PMU are working with the Reablement Team and the Local Health Board to capture performance information in this area including unit costs and outcomes achieved.

Leaflets on Reablement have recently been produced and are being circulated to partner agencies in addition to being made available to the public and clients.

4.4 Assistive Technology Systems are still being developed to report accurately upon Assistive Technology including ‘Telecare’.

Version 1a 08/04/2018 5 4.5 Self Directed Support A report on Self Directed Support was presented by the Chief Social Care Officer to SAHHSC on 14th November 2007.

Self Directed Support is an important venture and represents current thinking across England and Wales on how services should be delivered in the future to provide more control to service users and carers whilst potentially reducing overall costs. Adult Social Care officers will carry out a quarterly audit to confirm the effectiveness of the initiative from both an outcome and cost perspective.

4.6 Direct Payments The number of service users in receipt of Direct Payments continues to increase with Wrexham’s performance for 2006/07 being second quartile compared with other Welsh authorities.

4.7 Unmet Need Progress is being made in collating and using unmet need information. Work is also taking place to provide users and carers with feedback on how services are being reshaped as a result of unmet need information.

Domain 5 – Quality of Services Provided

This domain considers the quality of services we provide.

5.1 Gauging Customer Feedback A working group now meets monthly to coordinate better the feedback we receive from service users and carers on the quality of service provision. The intention is to discuss holistically the feedback we receive from sources such as customer complaints, customer surveys, monitoring and reviewing of independent providers, care management, domiciliary care standards compliance, service delivery, staff training and POVA referrals. Information from these meetings is helping to confirm, with more clarity, which services are performing well and which are not.

5.2 Complaints, Representations and Compliments The Customer Services Manager is currently producing a half-year report that will detail trends and developments for complaints and complements. Some key points are detailed below:

1. Seven complaints were received about the proposals to close Caia Park family centre. 2. Over the first six months - 10 complaints have been received from people whose invoices have been incorrect. Remedial action is taking place to improve performance in this area.

5.3 Customer Satisfaction Surveys A customer satisfaction survey is currently taking place with some 750 questionnaires being sent out to service users and carers. The survey questionnaire is based on a format used within the Joint Review process and will allow us to ask the same questions that inspectors are likely to ask at our next Joint Review in 2009. The draft findings of the survey should be available early 2008 and will be circulated to Members.

The results of the last survey held on March 2007 are shown below. The response rate was good with over 22% of service users and clients returning their questionnaires. The Customer Service Manager also telephoned a small sample of service users and carers to discuss in detail particular comments received.

Version 1a 08/04/2018 6 Overall, the feedback from the survey was encouraging and indicated that Adult Social Care continues to meet the need of Service Users and their Carers. Some headline messages are detailed below: 1. 84% of respondents confirmed that they were involved to some degree in deciding what help they needed from Adult Social Care; 2. 88% confirmed that they were also involved in deciding what services they were provided with (The same figure as in the survey carried out by the SSIW in 2005); 3. 91% of respondents rated the quality of the services they received from Adult Social Care as being either “excellent” or “good” (SSIW questionnaire in 2005 =85%).

Domain 6 - Arrangements to Protect Vulnerable People

6.1 Protection of Vulnerable Adults (POVA)Monitoring information. Evidence suggests that Wrexham continues to manage POVA processes appropriately. The number of POVA referrals is now comparable with similar Welsh authorities as is the number proceeding to investigation stage (which indicates if care managers are confident in screening out inappropriate POVA referrals and in managing risk effectively).

6.2 Quality Standards and POVA Recording A key improvement action from the CSSIW inspection in 2005 was the need to improve consistency across POVA case management and recording. A POVA quality audit tool has been developed but needs to be implemented fully to ensure the required standard is achieved consistently.

Domain 7- Success in Promoting Independence and Social Inclusion

Essentially, this Domain tends to summarise performance over Domains 1 to 6.

7.1 Older People Supported to Live at Home Supporting older people to live at home is both a Corporate priority and a National Strategic performance indicator. In 2007/08 Wrexham continued to increase the number of older people supported to live at home. Reductions in DToC, reductions on OT/DSO assessment waiting lists and increased Domiciliary Care provision have all positively impacted upon this performance indicator over the last twelve months or so.

The development of the Reablement service will also be a key contributor to fostering independence but perversely positive outcomes for clients might lead to a reduction in ‘performance’ against this indicator because older people might not become long term clients.

At the end of September 2007, we were supporting 1363 older people to live at home. This compares to 1317 in March ’07 and 1120 in March ’06.

Version 1a 08/04/2018 7 On an all-Wales basis, however, Wrexham’s performance appears low. The Chief Social Care Officer is in open dialogue with the Care and Social Services Inspectorate Wales (CSSIW) and the Wales Audit Office (WAO) questioning the accuracy of counting against this indicator by some authorities whose performance appears to have increased exponentially over recent years. Members will be briefed with the outcome of these discussions in future reports.

7.2 Clients aged 18-64 supported in the community This indicator is expected to be on-track by quarter 4. Better performance is achieved by lowering the number of clients supported in care homes whilst supporting more in the community. In 2006/07, Wrexham’s performance compared with the rest of Wales was second quartile.

7.3 Clients Aged 65 and over Supported in the Community This indicator is expected to be on track by the year end. On an all-Wales basis Wrexham’s performance for 2006/07 was bottom quartile, however, the comments above in section 7.1 apply here placing doubt on the accuracy of ‘comparative’ performance.

7.4 The percentage of clients supported in care homes Wrexham’s 2007/08 performance continues to improve in this area with less older people being supported in care homes although a rise in the number of basic residential placements has been noted over recent months. Wrexham’s performance in 2006/07 (26.68 per 1000) was slightly higher than the Welsh average of 26.63 per 1000. The half-year figure was 25.81 per 1000 and is on-track to hit the year-end target.

How Well Placed is the Authority to Sustain and Improve Services

The next set of seven domains ask ‘How well placed is the authority to sustain and improve services?’ They concern themselves with capacity, infrastructure and corporate governance and ask if the Council has the means at its disposal to deliver good services both now and in the future.

 Workforce and Resources cover the human and material resources available to the authority, what it is doing to develop them and how it uses them.  Planning and Partnerships and Commissioning and Contracting consider how the authority reshapes and improves its services to meet assessed and anticipated needs.  Performance management covers how the authority gets the best from its staff and services.  Leadership and Culture and Corporate and Political Support and Scrutiny cover the overall direction and governance.

Domain 8 – workforce.

This domain essentially considers Wrexham’s ability to recruit and retain sufficient staff with suitable qualifications and experience. It also considers staff development and workforce strategy. Human Resources have recently produced their annual workforce report. The potential impact of the pay review in terms of recruiting and retaining staff is a major consideration in this area as noted at the recently held Member/Chief Officer strategic risk workshop.

Domain 9 - Performance Management

This domain considers the following aspects of performance management:

9.1 Staff Management / Aligning Objectives of Staff with Business Planning Objectives.

Version 1a 08/04/2018 8 A staff supervision and PRD audit is currently taking place to confirm the standard of staff supervision and will also consider how supervision is used to quality assure care management work. The audit is also checking that the PRD process is being used to ensure the objectives of the Business Plan are aligned with the objectives of the team member. The results of this audit should be available in December 2007.

9.2 Quality Assurance of Case Recording and Care Management Processes As stated previously in this report, the PMU are currently reviewing audit programmes and audit tools to provide more confidence in the quality of case recording and care management compliance.

9.3 Performance monitoring – ‘Dashboard’ This is a continually developing area of work with a monthly ‘Dashboard’ report being presented to senior managers that lists key performance and management information such as allocation, assessment, DToC etc…

9.4 Contract specification, monitoring and compliance The PMU regularly audit the Contracts Team to establish the status of contract specification, monitoring and compliance. A concern at present is the limited monitoring and reviewing capacity within the team, which has been reduced through vacancies.

9.5 Complaints and representation procedures Amended procedures were issued in April/May to reflect new national guidelines in this area. Quarterly and annual reporting is well established and a training programme is in place (Fully supported by Human Resources) to ensure staff and independent providers are aware of the complaint agenda. Recent changes were made to the funding of independent investigators for second/third stage complaints with costs now being borne by the service manager rather than by the PMU.

9.6 Business Processes The Wales Audit Office recently completed a ‘walk through’ exercise to confirm the effectiveness of business processes. The results of this exercise were positive in confirming that business processes are generally in place but need to be ‘meshed’ together more closely. An action plan is being drawn up to make several improvements, for instance linking together financial and performance reporting.

Domain 10 - Planning and Partnerships

This domain essentially considers the department’s approach to planning and towards partnership working.

10.1 Business Planning The Department’s business planning process is well established and is considered to be effectively managed. Business plans down to service manager level are reviewed and updated quarterly and progress reported to senior managers. Service risk registers are also routinely updated.

A draft business plan for 2008/09 is currently being drawn up with the Chief Social Care Officer and the Strategic Director currently confirming priorities.

Priority areas for improvement in 2008/09 are: 1. Fully Implement the service users /care engagement strategy; 2. Complete update to care management manual; 3. Embed outcome focused care management; Version 1a 08/04/2018 9 4. Embed care management QA systems; 5. Collate and use unmet need information for commissioning purposes; 6. Develop joint commissioning strategy for older people (2008/2011); 7. Fully implement ‘Reablement’; 8. Implement ‘Self Directed Support’; 9. Implement the commissioning plan for accommodation & support services for people with learning disabilities; 10. Develop and implement Intermediate Care Strategy; 11. Expand use of assistive technology; 12. Develop combined performance and budget reports; 13. Work with Health partners to ensure Unified Assessment is implemented across all agencies; 14. Full integration of Mental Health and Learning Disability services; 15. Implementation of older people’s mental health review.

10.2 Partnership working.

The 2007/08 business plan details a number of initiatives around partnership working. These include 1. Contributing towards the development of the 2008/11 Health, Social Care and Well Being strategy; 2. Continuing to work with health partners on developing the Intermediate Care Strategy; 3. Developing the integrated community equipment service with Flintshire County Council; 4. Joint commissioning of EMH nursing beds; 5. Integrating health and adult social care occupational therapy services; 6. Working with the independent sector to confirm future capacity and improve governance.

Work is also continuing on embedding joint working across Mental Health and Learning Disability services following the signing of S31 agreements in 2006/07.

Domain 11- Commissioning and Contracting

This domain considers the following aspects of Commissioning and Contracting:

11.1 Analysis of need and service demands This is a developing area of work and a number of initiatives are featured within the 2007/08 business plan. Progress is being made in collating unmet need information and in consulting with service users on reshaping services. Work is also taking place to ensure information is readily available on the current pattern and use of services (places, capacity, throughput etc…) and how this may, or may not, match patterns of demand.

11.2 Service-wide strategic commissioning that matches needs and resources to deliver best value services The employment of joint commissioning and contract officers and S31 agreements are both evidence of progress in this area. A concern, however, is the cessation of the ‘Joint Working Special Grant’ at the end of 2007/08 which will result in the loss of a number of key joint officer positions.

The Commissioning and Planning team, the Contracts Team and the PMU have developed procedures and systems based on an ‘Institute of Public Care’ model to provide more rigour around commissioning and contracting. The procedures reflect the Corporate Project Management Guidelines and will include equalities considerations such as impact assessments. This is an

Version 1a 08/04/2018 10 important piece of work that will improve internal governance across commissioning and contracting.

Domain 12 - Resources

This domain covers:

12.1 Resource allocation Appendix A provides comparative Social Services spend per head information for Welsh Councils. At the time of the last Joint Review, it was confirmed that whilst Wrexham County Borough Council received a relatively lower level of settlement compared with some other Welsh Authorities, the Council actually spent a greater proportion of the council’s budget on Social Services. Senior managers are currently working with Corporate officers to update these figures.

12.2 Ability to meet commitments and keep to agreed budgets There is an inevitable tension within all social service departments to balance demand with available resources. In 2007/08 Members were very supportive of Adult Social Care in terms of an increase in budget allocation. Demand, especially amongst Older People and Learning Disability services, however, continues to outstrip resources. For instance in 2006/07, PSNI and Learning Disability services saw a 15% increase in the number of service users provided with a service.

Domain 13 - Leadership and Culture

This domain covers:

13.1 Agreeing and communicating the key principles, aims and objectives of the department The current Staff Engagement Plan also makes a considerable contribution in this area in developing better two-way communication with staff at all levels.

13.2 Adequate leadership capacity incorporating both professional and business management Over recent years, capacity at senior management level has increased overall.

13.3 Effective implementation of plans Insufficient project management capacity continues to be an area of concern in terms of managing the change process. Another key consideration is the requirement to adhere to Corporate project management guidance which again increases pressure on project management capacity.

Domain 14 - Corporate and Political Support and Scrutiny

The 2005 CSSIW inspection of Adult Social Care commented positively on Corporate and Political Support and Scrutiny.

14.1 Linking service aims and corporate aims The recent CSSIW also confirmed arrangements are well developed in linking the Department’s business plan with the Corporate planning process. 14.2 Effect of corporate management arrangements on the management of social services Again, arrangements in this area were acknowledged as working well. Corporate Finance and Performance are particularly supportive of Adult Social Care.

14.3 Effectiveness of political leadership in valuing, representing and setting a direction for social services Version 1a 08/04/2018 11 Communication with Members continues to be enhanced through regular meetings such as the Adult Strategic Improvement Group and Members’ workshops such as the recent workshop concerning the Learning Disability service. Visits by Members to Adult Social Care offices are also appreciated and present an opportunity for staff teams to update Members on their work.

14.4 Effectiveness of political arrangements in scrutinising performance and securing public accountability The SAHHSC and Lead Member role in terms of scrutinising performance is well established as acknowledged by CSSIW.

SUMMARY

It is appreciated that this is a lengthy report. The range of information contained within this report, however, reflects the intensity of the inspection regime employed by the CSSIW within their Joint Review / Performance Evaluation process. The structure of the report has, hopefully, allowed Members to ascertain how Adult Social Care are progressing towards the aim of being considered a ‘top quartile’ department following the next Joint Review (which is scheduled to take place in 2009).

The CSSIW inspectors are visiting Wrexham on 27th November 2007 to provide feedback on the performance of Adult Social Care during 2006/07. Members will be presented with a report by CSSIW at Executive Board in February 2008 (Actual date to be confirmed).

RECOMMENDATIONS Scrutiny Committee is asked to note and consider the contents of this report and the attached appendices.

BACKGROUND PAPERS

Appendix A – spend per head.

Appendix B - 2007/08 Performance indicator update.

Appendix C – Occupational Health Update

ADULT SOCIAL CARE / MONITORING AND REVIEW OF PERFORMANCE 2007/08 (CSCO/15/07)

ADULT SOCIAL CARE - BUSINESS PLAN 2007/2008 (CSCO/11/07)

SOCIAL SERVICES FOR ADULTS – PERFORMANCE MANAGEMENT UPDATE (CSSO/45/06) Report Ref: CSCO/27/07S

Version 1a 08/04/2018 12 Appendix A – Spend Per Head SPEND PER HEAD - WELSH SOCIAL SERVICES 2002/03 TO 2005/06 (Combined Adult and Children's Services) 2002-03 2003-04 2004-05 2005-06 Per £k Per £k Per head £ks Per £ks head head head Neath Port Talbot £360 £48,393 Merthyr Tydfil £403 £22,296 Merthyr Tydfil £438 £24,135 Rhondda CT £464 £107,529 Blaenau Gwent £344 £24,090 Blaenau Gwent £391 £26,965 Conwy £426 £47,619 Merthyr Tydfil £458 £25,139 Merthyr Tydfil £340 £19,143 Neath PT £384 £52,022 Denbighshire £425 £40,611 Blaenau Gwent £453 £30,989 Rhondda CT £328 £76,039 Conwy £381 £42,216 Rhondda CT £416 £96,490 Conwy £448 £49,933 Newport £321 £44,152 Denbighshire £380 £36,067 Blaenau Gwent £412 £28,378 Neath PT £442 £59,867 Bridgend £313 £40,262 Rhondda CT £379 £87,701 Neath PT £395 £53,603 Denbighshire £439 £42,097 Swansea £308 £68,869 Newport £367 £51,115 Newport £385 £53,632 Caerphilly £416 £70,815 Gwynedd £307 £35,886 Bridgend £346 £44,899 Caerphilly £384 £65,489 Newport £414 £57,830 Torfaen £300 £27,314 Isle of Anglesey £341 £23,311 Bridgend £369 £48,114 Torfaen £409 £36,937 Cardiff £298 £91,717 Swansea £339 £76,061 Isle of Anglesey £367 £25,214 Isle of Anglesey £402 £27,723 Conwy £297 £32,564 Caerphilly £336 £57,113 Gwynedd £361 £42,585 Bridgend £397 £51,898 Vale of Glamorgan £294 £35,073 Torfaen £334 £30,270 Swansea £355 £80,039 Gwynedd £389 £45,877 Denbighshire £290 £26,992 Gwynedd £331 £38,913 Cardiff £347 £109,860 Cardiff £384 £122,826 Isle of Anglesey £286 £19,348 Cardiff £323 £101,727 Torfaen £345 £31,191 Ceredigion £377 £29,542 Caerphilly £284 £48,198 Wrexham £323 £41,844 Vale of Glam £344 £42,049 Vale of Glam £377 £46,402 Carmarthenshire £274 £47,504 Vale of Glam £322 £39,052 Wrexham £343 £44,697 Swansea £369 £83,586 Monmouthshire £271 £23,057 Ceredigion £315 £24,277 Ceredigion £340 £26,550 Carmarthenshire £367 £65,339 Wrexham £264 £33,989 Carmarthenshire £305 £53,753 Carmarthenshire £332 £58,961 Wrexham £357 £46,527 Powys £257 £32,504 Monmouthshire £293 £25,259 Powys £316 £41,283 Powys £354 £46,584 Ceredigion £253 £19,041 Powys £291 £37,597 Flintshire £308 £46,249 Monmouthshire £335 £29,340 Pembrokeshire £245 £27,695 Flintshire £283 £42,232 Monmouthshire £306 £26,679 Flintshire £333 £49,966 Flintshire £234 £34,731 Pembrokeshire £280 £32,614 Pembrokeshire £305 £35,772 Pembrokeshire £323 £37,946 Total UA £295 £856,562 Total UA £336 £987,304 Total UA £362 £1,069,199 Total UA £394 £1,164,691 Comparator group Newport £321 £44,152 Conwy £381 £42,216 Conwy £426 £47,619 Conwy £448 £49,933 Gwynedd £307 £35,886 Newport £367 £51,115 Newport £385 £53,632 Newport £414 £57,830 Conwy £297 £32,564 Gwynedd £331 £38,913 Gwynedd £361 £42,585 Gwynedd £389 £45,877 Vale of Glamorgan £294 £35,073 Wrexham £323 £41,844 Vale of Glam £344 £42,049 Vale of Glam £377 £46,402 Wrexham £264 £33,989 Vale of Glam £322 £39,052 Wrexham £343 £44,697 Wrexham £357 £46,527 Pembrokeshire £245 £27,695 Flintshire £283 £42,232 Flintshire £308 £46,249 Flintshire £333 £49,966 Version 1a 08/04/2018 13 Flintshire £234 £34,731 Pembrokeshire £280 £32,614 Pembrokeshire £305 £35,772 Pembrokeshire £323 £37,946

Version 1a 08/04/2018 14 Appendix A (cont) OLDER PEOPLE - SPEND PER HEAD OF POPULATION (aged 65 plus). 2002/03 Per head 2003/04 Per head 2004/05 Per head 2005/06 Per head Rhondda Cynon Taf £938 Merthyr Tydfil £1,046 Rhondda Cynon Taf £1,101 Rhondda Cynon Taf £1,177 Merthyr Tydfil £921 Rhondda Cynon Taf £1,015 Merthyr Tydfil £986 Neath Port Talbot £1,028 Neath Port Talbot £888 Neath Port Talbot £998 Neath Port Talbot £979 Merthyr Tydfil £1,025 Blaenau Gwent £848 Blaenau Gwent £885 Caerphilly £895 Caerphilly £962 Carmarthenshire £772 Cardiff £833 Blaenau Gwent £880 Blaenau Gwent £939 Bridgend £770 Denbighshire £815 Denbighshire £877 Denbighshire £922 Gwynedd £732 Newport £813 Carmarthenshire £855 Cardiff £920 Flintshire £724 Flintshire £810 Cardiff £844 Carmarthenshire £883 Swansea £722 Carmarthenshire £810 Swansea £831 Newport £844 Newport £719 Swansea £799 Flintshire £830 Flintshire £828 Torfaen £718 Caerphilly £797 Gwynedd £797 Gwynedd £820 Cardiff £681 Gwynedd £795 Newport £788 Swansea £810 Caerphilly £678 Bridgend £794 Wrexham £787 Monmouthshire £806 Monmouthshire £649 Torfaen £791 Bridgend £783 Torfaen £773 Wrexham £649 Ceredigion £746 Torfaen £743 Bridgend £767 Denbighshire £641 Monmouthshire £730 Monmouthshire £738 Isle of Anglesey £764 Ceredigion £638 Wrexham £696 Conwy £713 Wrexham £758 Pembrokeshire £610 Conwy £691 The Vale of Glamorgan £695 Ceredigion £742 The Vale of Glamorgan £608 The Vale of Glamorgan £689 Isle of Anglesey £690 Conwy £720 Isle of Anglesey £607 Isle of Anglesey £688 Pembrokeshire £671 The Vale of Glamorgan £711 Conwy £562 Pembrokeshire £679 Ceredigion £668 Pembrokeshire £683 Powys £552 Powys £595 Powys £630 Powys £679 Wales Wales Wales Wales £854 Comparator group Gwynedd £732 Newport £813 Flintshire £830 Newport £844 Flintshire £724 Flintshire £810 Gwynedd £797 Flintshire £828 Newport £719 Gwynedd £795 Newport £788 Gwynedd £820 Wrexham £649 Wrexham £696 Wrexham £787 Wrexham £758 Pembrokeshire £610 Conwy £691 Conwy £713 Conwy £720 The Vale of Glamorgan £608 The Vale of Glamorgan £689 The Vale of Glamorgan £695 The Vale of Glamorgan £711 Conwy £562 Pembrokeshire £679 Pembrokeshire £671 Pembrokeshire £683 Appendix A (Cont) Version 1a 08/04/2018 15 LEARNING DISABILITIES - SPEND PER HEAD OF POPULATION (aged 18-64). 2002/03 Per head 2003/04 Per head 2004/05 Per head 2005/06 Per head Newport £128 Rhondda Cynon Taf £143 Conwy £188 Conwy £191 Gwynedd £124 Conwy £141 Isle of Anglesey £153 Isle of Anglesey £163 Bridgend £122 Isle of Anglesey £140 Rhondda Cynon Taf £149 Neath Port Talbot £156 Powys £121 Newport £134 Neath Port Talbot £137 Rhondda Cynon Taf £154 Neath Port Talbot £118 Bridgend £132 Newport £136 Newport £151 Cardiff £113 Neath Port Talbot £126 Denbighshire £133 Powys £150 Blaenau Gwent £110 Powys £124 Bridgend £133 Caerphilly £146 Torfaen £108 Denbighshire £124 Powys £131 Bridgend £142 Rhondda Cynon Taf £105 Caerphilly £119 Caerphilly £130 Gwynedd £142 Monmouthshire £105 Flintshire £113 Gwynedd £126 Vale of Glam £132 Conwy £102 Blaenau Gwent £113 Flintshire £123 Cardiff £131 Swansea £100 Cardiff £112 Merthyr Tydfil £122 Ceredigion £131 Caerphilly £100 Gwynedd £110 Blaenau Gwent £120 Blaenau Gwent £128 Isle of Anglesey £96 Merthyr Tydfil £104 Cardiff £118 Denbighshire £126 Merthyr Tydfil £94 Ceredigion £103 The Vale of Glam £115 Torfaen £123 The Vale of Glam £92 Monmouthshire £103 Wrexham £112 Merthyr Tydfil £122 Flintshire £84 Carmarthenshire £102 Monmouthshire £111 Wrexham £122 Denbighshire £80 Swansea £102 Ceredigion £108 Carmarthenshire £121 Carmarthenshire £76 Wrexham £101 Swansea £108 Monmouthshire £120 Ceredigion £69 The Vale of Glam £100 Carmarthenshire £107 Flintshire £112 Wrexham £67 Torfaen £98 Torfaen £95 Swansea £106 Pembrokeshire £66 Pembrokeshire £70 Pembrokeshire £79 Pembrokeshire £82 Wales Wales Wales Wales Comparator group Newport £128 Conwy £141 Conwy £188 Conwy £191 Gwynedd £124 Newport £134 Newport £136 Newport £151 Conwy £102 Flintshire £113 Gwynedd £126 Gwynedd £142 The Vale of Glam £92 Gwynedd £110 Flintshire £123 Vale of Glam £132 Flintshire £84 Wrexham £101 The Vale of Glam £115 Wrexham £122 Wrexham £67 The Vale of Glam £100 Wrexham £112 Flintshire £112 Pembrokeshire £66 Pembrokeshire £70 Pembrokeshire £79 Pembrokeshire £82

Appendix A (cont) Version 1a 08/04/2018 16 MENTAL HEALTH - SPEND PER HEAD OF POPULATION (aged 18-64). 2002/03 Per head 2003/04 Per head 2004/05 Per head 2005/06 Per head Denbighshire £42 Conwy £60 Merthyr Tydfil £63 Conwy £57 Merthyr Tydfil £37 Denbighshire £52 Conwy £58 Ceredigion £52 Conwy £34 Merthyr Tydfil £44 Ceredigion £53 Denbighshire £47 Isle of Anglesey £32 Wrexham £39 Denbighshire £51 Wrexham £46 Wrexham £31 Ceredigion £36 Isle of Anglesey £41 Isle of Anglesey £43 Gwynedd £26 Isle of Anglesey £36 Wrexham £37 Merthyr Tydfil £41 Swansea £26 Monmouthshire £31 Pembrokeshire £32 Torfaen £37 Ceredigion £26 Torfaen £30 Gwynedd £30 Gwynedd £36 Torfaen £25 Swansea £29 Caerphilly £29 Pembrokeshire £33 Blaenau Gwent £25 Pembrokeshire £28 Swansea £29 Swansea £30 Pembrokeshire £25 Gwynedd £28 Torfaen £28 Caerphilly £29 Monmouthshire £23 Caerphilly £26 Neath Port Talbot £25 Neath Port Talbot £28 Neath Port Talbot £22 Blaenau Gwent £23 Flintshire £24 Blaenau Gwent £26 Rhondda Cynon Taf £20 Newport £23 Newport £23 Carmarthenshire £26 Cardiff £20 Neath Port Talbot £21 Cardiff £23 Newport £26 Caerphilly £17 Cardiff £20 Carmarthenshire £22 Rhondda Cynon Taf £26 Carmarthenshire £17 Flintshire £20 Rhondda Cynon Taf £21 Flintshire £24 Powys £17 Rhondda Cynon Taf £20 Blaenau Gwent £20 Cardiff £24 Newport £17 Carmarthenshire £19 Monmouthshire £20 Powys £23 The Vale of Glamorgan £16 Powys £17 The Vale of Glam £19 The Vale of Glam £21 Bridgend £15 Bridgend £17 Bridgend £19 Bridgend £16 Flintshire £13 The Vale of Glamorgan £16 Powys £17 Monmouthshire £15 Wales Wales Wales Wales Comparator group Conwy £34 Conwy £60 Conwy £58 Conwy £57 Wrexham £31 Wrexham £39 Wrexham £37 Wrexham £46 Gwynedd £26 Pembrokeshire £28 Pembrokeshire £32 Gwynedd £36 Pembrokeshire £25 Gwynedd £28 Gwynedd £30 Pembrokeshire £33 Newport £17 Cardiff £20 Flintshire £24 Newport £26 The Vale of Glamorgan £16 Flintshire £20 Newport £23 Flintshire £24 Flintshire £13 The Vale of Glamorgan £16 The Vale of Glam £19 The Vale of Glam £21 Appendix A (cont) PNSI - SPEND PER HEAD OF POPULATION (aged 18-64). Version 1a 08/04/2018 17 2002/03 Per head 2003/04 Per head 2004/05 Per head 2005/06 Per head Monmouthshire £53 The Vale of Glamorgan £56 The Vale of Glamorgan £60 Torfaen £70 The Vale of Glamorgan £49 Isle of Anglesey £49 Merthyr Tydfil £51 The Vale of Glamorgan £65 Isle of Anglesey £46 Torfaen £49 Isle of Anglesey £51 Conwy £54 Swansea £39 Conwy £44 Conwy £49 Isle of Anglesey £51 Torfaen £38 Monmouthshire £43 Monmouthshire £48 Monmouthshire £48 Merthyr Tydfil £34 Swansea £42 Torfaen £46 Merthyr Tydfil £46 Bridgend £34 Merthyr Tydfil £40 Wrexham £43 Bridgend £46 Conwy £34 Bridgend £38 Bridgend £41 Caerphilly £45 Gwynedd £32 Wrexham £36 Cardiff £40 Wrexham £45 Cardiff £32 Caerphilly £35 Swansea £40 Swansea £43 Caerphilly £29 Gwynedd £34 Caerphilly £39 Ceredigion £43 Neath Port Talbot £28 Denbighshire £34 Gwynedd £37 Carmarthenshire £41 Blaenau Gwent £28 Cardiff £33 Ceredigion £36 Neath Port Talbot £40 Rhondda Cynon Taf £27 Neath Port Talbot £32 Denbighshire £35 Gwynedd £39 Denbighshire £26 Rhondda Cynon Taf £30 Neath Port Talbot £35 Blaenau Gwent £37 Wrexham £26 Flintshire £28 Rhondda Cynon Taf £32 Denbighshire £36 Newport £24 Newport £26 Newport £30 Cardiff £35 Ceredigion £23 Ceredigion £25 Carmarthenshire £30 Flintshire £34 Carmarthenshire £20 Blaenau Gwent £24 Flintshire £29 Rhondda Cynon Taf £34 Flintshire £14 Carmarthenshire £23 Blaenau Gwent £28 Newport £34 Powys £12 Powys £22 Powys £23 Powys £23 Pembrokeshire £9 Pembrokeshire £19 Pembrokeshire £17 Pembrokeshire £20 Comparator group The Vale of Glamorgan £49 The Vale of Glamorgan £56 The Vale of Glamorgan £60 The Vale of Glamorgan £65 Conwy £34 Conwy £44 Conwy £49 Conwy £54 Gwynedd £32 Wrexham £36 Wrexham £43 Wrexham £45 Wrexham £26 Gwynedd £34 Gwynedd £37 Gwynedd £39 Newport £24 Flintshire £28 Newport £30 Flintshire £34 Flintshire £14 Newport £26 Flintshire £29 Newport £34 Pembrokeshire £9 Pembrokeshire £19 Pembrokeshire £17 Pembrokeshire £20

Appendix B - 2007/08 Performance indicator update. Service User Satisfaction Status Increase % service users satisfied with being involved in deciding their services to 90% by Mar 08(88% Survey currently in progress and scheduled to report by March ‘08 Version 1a 08/04/2018 18 @ March ’07) Increase % service users satisfied with quality of services to 88% by Mar. 08 (85% @ March 07) Survey currently in progress and scheduled to report by March ‘08 Increase % service users satisfied with range of services to 80% by Mar. 08 (77% @ March 07); Survey currently in progress and scheduled to report by March ‘08 Corporate Priority Status Increasing the rate of older people helped to live at home per 1000 pop to 64 by March 08 (March 07= On-track – 63.85 per 1000 at Q2 62.4); Maintaining the rate of older people supported in care homes per 1000 pop to less than 28 throughout On-track - 25.81 per 1000 at Q2 2007/08; Reducing DToC for those over 75 years old to less than 7 per 1000 by March 08 (March 07= 9 per 1000); On-track - 1.18 per 1000 at Q2 Increase the % of clients aged 65 and over supported in the community to 78% (76.02 @ March 07) Slightly off-track – 74.86 at Q2 Reduce the rate of clients supported in care homes per 1000 to 28 or less (26.81 @ March 07) On-track – 25.81 at Q2 Increase % of Domiciliary Care budget delivered externally to 54% by March 08 (43% @ March 07) On-track - 53% at Q2 Increasing domiciliary care hours delivered per week to 7230 by Mar. 08 (3% increase); On-track – 7570 hours at Q2 Reduce in-house Home Care Service unit cost to £21.50 by March 2008 (March 07= £22.28). On-track - £21.92 at Q2 Timeliness of service delivery Status Maintaining waiting times for OT assessment to 4 months throughout 2007/08; Slightly off-track – 5 months at Q2 Reducing waiting times for DSO assessment to 2.5 months by Mar. 08 (March 07= 3); On-track – 3 months at Q2 Reducing waiting lists for Domiciliary Care to 40 by March 2008 (March 07= 59); On-track – 46 waiting average of 3.08 weeks at Q2 Reducing average working days taken from completion of the care plan to provision and/or installation of On track – 6 days at Q2 aids/equipment to 6 by March 08 (March 07= 6.8 days); Care Management /Risk Status Increasing the % reviews completed within timescales to 80% by Mar. 08 (March 07= 75%); Not reporting this quarter Maintain the rate of POVA referrals per 1000 pop to between 1.3 and 1.6 (1.72 @ March 07) On-track – 0.85 at Q2 Maintain rate of POVA referrals that progress to investigation stage to between 75-80% (90% @ March On-track – 77% at Q2 07) Staff satisfaction Status Increasing the % of staff who perceive their work as being valued within social services to 70% (Last Survey scheduled for January 08 survey = 45%);

Increasing the % of staff who perceive that they receive good support and guidance in their work to 82% Survey scheduled for January 08 (Last survey = 71%);

Version 1a 08/04/2018 19

Appendix C Occupational Therapy Update

Purpose of Report

To report on the current performance of Occupational Therapy Service with particular emphasis on the waiting list and the adaptations review actions of April 08

BACKGROUND INFORMATION

1) There remain no waiting lists for service users in Priority 1, 2, and 3. The waiting list therefore relates only to priority 4 referrals. A large number of referrals on this list are assessments where there are difficulties with getting in/out of the bath have been highlighted as the main need.

DSO OT June 2007 96 on the waiting list none more 63 on the waiting list- none than 2.5 months waiting more than 5 months November 2007 202 on the waiting list none 47 on the waiting list- none more than 3 months more than 5 months.

2) The small deterioration in waiting lists for DSO’s has occurred as a result of an increased number of Priority 2 & 3 referrals which has therefore reduced the DSO’s capacity to address the priority 4 referrals. The OT waiting list has increased slightly due to an increase in the number of high priority referrals received, and short term reductions in staffing due to maternity and staff turnover.

3) To address the DSO waiting list steps are being taken from the 1st of December to implement an increased number of telephone assessments. This has proven to be successful in many english authorities, and the model adopted locally will be in keeping with these.

4) Appointments to posts in OT have been made which will allow the deterioration to be overcome in the coming months.

5) Actions are being agreed with housing to overcome the minor difficulties being experienced in closing cases due to delays in agreeing some adaptations.

6) Paediatrics

Version 1a 08/04/2018 20 There remains a eighteen month waiting time for an O.T. assessment for disabled children. This issue has been highlighted to childrens services who are considering opportunities to invest in this service.

7) Delivery of Equipment

Target is 7 days – current Performance is 93% within 7 days. 8) Housing & Adaptations

A review of adaptations has been completed in conjunction with scrutiny. Main recommendations are:-

Recommendation 1 – The previous limit for minor adaptations be replaced by an agreed list that would not be considered for DFG.

Fully in place.

Recommendation 2- There should be flexibility of the budgets of Public Minor adaptations and Public DFG and the budget of private minor adaptations and private DFG’s.

Fully in place.

Recommendation 3 – The existing Adaptation Working sub-group investigate ways of streamlining the DFG process as far as practicable.

Actions being implemented in 2008.

Recommendation 4 – Form a Strategic Adaptations Group to include key partners

To date this has not been formed, further discussion with partner groups regarding the purpose and membership of this group will occur in 2007 with a view to implementing it in 2008.

Summary

Although there has been a slight deterioration in the achievement of targets for OT and DSO assessments, actions are in place to recover both positions and will be implemented in full.

The changes to the adaptations process will continue to support achievement of these targets.

Version 1a 08/04/2018

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