Adult Services and Health Scrutiny Panel

ADULT SERVICES AND HEALTH SCRUTINY PANEL

Venue: Town Hall, Moorgate Date: Thursday, 2 March 2006 Street, Rotherham. Time: 9.30 a.m.

A G E N D A

1. To determine if the following matters are to be considered under the categories suggested in accordance with the Local Government Act 1972.

2. To determine any item which the Chairman is of the opinion should be considered as a matter of urgency.

3. Apologies for Absence.

4. Declarations of Interest.

5. Questions from members of the public and the press.

FOR DECISION

6. Consultation on the Configuration of Strategic Health Authorities in Yorkshire and the Humber, South Yorkshire Ambulance Service and PCT's in Yorkshire and Humber (report herewith) (Pages 1 - 4)

7. Review of NHS Dental Services - To consider the draft report and recommendations (herewith) (Pages 5 - 14)

8. Suggested Items for inclusion in Panel Work Programme 2006 / 07 (report herewith) (Pages 15 - 17)

9. Co-option onto Adult Services and Health Scrutiny Panel 2006 / 07 (report herewith) (Pages 18 - 20)

10. Nomination onto Transport Review Group

At its meeting on 9th December 2005, PSOC agreed to undertake a cross panel review of Transportation in the Borough. A nomination of up to two members from each Scrutiny Panel, at least one being an elected member, is required for the review group.The terms of reference and scope of the review will be agreed by the group when it is established. FOR MONITORING

11. Adult Social Services Revenue Budget Monitoring Report (herewith) (Pages 21 - 33)

Mark Scarrott

12. Half Yearly Complaints Report (herewith) (Pages 34 - 40)

Adam Hurst / Ian Bradbury

13. Intermediate Care Strategy - Action Plan (herewith) (Pages 41 - 45)

John Harding

14. Direct Payments - Progress Report (herewith) (Pages 46 - 49)

Susan Sumpner

15. Forward Plan of Key Decisions - Adult Social Services (herewith) (Pages 50 - 51)

FOR INFORMATION

16. Annual Health Check - Responses to Health Trusts (report herewith) (Pages 52 - 64)

17. Minutes of a meeting of the Adult Services and Health Scrutiny Panel held on 5th January, 2nd and 8th February, 2006 (copies herewith). (Pages 65 - 92)

18. Minutes of a meeting of the Performance and Scrutiny Overview Committee held on 21st December, 2005 and 20th January, 2006 (copies herewith). (Pages 93 - 101)

Date of Next Meeting:- Thursday, 13 April 2006

Membership:- Chairman – Councillor Doyle Vice-Chairman – The Mayor (Councillor Jack) Councillors:- Burke, Burton, Clarke, Darby, Havenhand, Jackson, St.John, Turner and Wootton Co-opted Members Sandra Bann (PPI Forum Rotherham PCT), Mrs. A. Clough (ROPES), Victoria Farnsworth (Speak Up), Mr. G. Hewitt (Rotherham Carers' Forum), Val Lindsay (Patient Public Involvement Forum), Ms. J. Mullins (Disability Network), Mr. R. H. Noble (Rotherham Hard of Hearing Soc.), Parveen Qureshi (R.E.M.A.), Gladys Sherratt (Patient Public Involvement Forum) and Lizzie Williams (S.Y. Ambulance Service PPI)

Page 1 Agenda Item 6

ROTHERHAM BOROUGH COUNCIL – REPORT TO MEMBERS

1. Meeting: Adult Social Care and Health Scrutiny Panel

2. Date: 2nd March 2006

3. Title: Consultation on the configuration of Strategic Health Authority for Yorkshire and Humber; Ambulance Trust for Yorkshire and Humber and new Primary Care Trusts in Yorkshire and Humber

4. Programme Area: Chief Executives Office

5. Summary

The Department of Health (DOH) is consulting on its proposed boundaries for strategic health authorities (SHAs), primary care trusts (PCTs) and Ambulance Trusts in England more widely. This report advises of the DofH proposals for the existing South Yorkshire SHA and Rotherham PCT and proposes a response from Rotherham MBC to the proposals.

6. Recommendations

That the Panel: 1. Welcomes and supports the Department of Health’s proposals for a Yorkshire and Humber Strategic Health Authority, Yorkshire and Humber Ambulance Trust and Rotherham PCT coterminous with the local authority area boundaries 2. Considers and agrees that this report form the basis of the Council’s response to these important consultations 3. Is asked to consider offering its support to Doncaster MBC’s request that we support the creation of a single local PCT coterminous with the boundary of Doncaster MBC

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7. Proposals and Details

Background

The DOH are undertaking a series of inter-related reviews of the boundaries of SHAs, Ambulance Trusts and PCTs in England. These reviews look at the size of the bodies and their geographical boundaries, and not for example the services they provide.

Each review shares a number of common central aims and objectives, notably: • Support the shift of services towards patient centred care, with a greater focus on care in the community rather than in hospitals • Reduce administrative costs, releasing further resources for front-line care • Encourage better co-ordination between health, social care and other local services

In order to best support and develop this, the Department of Health is proposing that: • PCTs, SHAs and Ambulance Trusts should be generally larger, and that there should significantly fewer of them • Their boundaries should be co-terminous with other key agencies, notably regional bodies and local government

The review looked at Rotherham and the wider Yorkshire and Humber together. It has just published its draft proposals. These are, as they relate to Rotherham:

1. The creation of single Strategic Health Authority for the Yorkshire and Humber encompassing the existing South Yorkshire and West Yorkshire SHAs together with the majority of the North and East Yorkshire and North Lincolnshire SHA. 2. The creation of single Strategic Ambulance for the Yorkshire and Humber encompassing the existing South Yorkshire and West Yorkshire Ambulance Trust together with elements of the existing Tees, East and North Yorkshire and Lincolnshire Trusts. 3. No change to the boundaries of the existing Rotherham PCT whose boundaries are co-terminous with Rotherham MBC’s.

In terms of the other PCTs in South Yorkshire, they also proposing • Sheffield – reduce the existing 4 PCTs to one single PCT coterminous with Sheffield CC • Barnsley – no charge as the boundaries are co-termous with the Council • Doncaster – either reduce the existing 3 PCTs to one single PCT coterminous with Doncaster MBC or create a single Doncaster and Bassetlaw PCT from the three current PCTs and Bassetlaw PCT.

The proposals should also be seen in their wider context which has seen a number of Government proposals aimed at reviewing the scope and working of health partners. A good example is the recently released Health and Social Care White Paper which also has major implications for agencies involved in public health such

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as the development of practice based community health care. This White Paper will be the subject of a further report.

Proposed Council response

We should welcome the reviews and their proposals. Its main aims are to achieve efficiencies and improve coordination, which should be supported. The Department of Health estimate that nationally the proposals will save over £250m, of which South Yorkshire will share over £7m. The DofH also identify that common boundaries with other agencies notably Local Authorities and Regional Assemblies are key to developing co-ordination. Rotherham MBC has directly experienced the benefits this brings to joint working and the development of services. It is also against a background where cross agency working is becoming greater and more complex as reflected in the development of Local Area Agreements and Community Strategies.

One of the main concerns expressed about the DofH proposals is that the proposed regional Strategic Health and Ambulance Trust will cover too large an area, and will therefore will be too unwieldy and lack flexibility. In response, the DoH has promised that it will take steps to ensure that will not be the case, and that it will continue to work closely with partners.

A concern raised by Corporate Management Team is the possible new requirement for a budgetary surplus to be generated by each of the four Primary Care Trusts in order to address a deficit across the Strategic Health Authority area. As Rotherham PCT does not run a deficit, this equates to a transfer of resources out of Rotherham, and therefore we would not support this proposal.

Other than this concern, the proposals are sound and warrant our support.

The Council has also received a letter from Doncaster Central NHS PCT, Doncaster east PCT and Doncaster west PCT asking for our support for the creation of a single PCT coterminous with Doncaster MBC boundaries. This also has the support of Doncaster MBC.

The DofH have put forward two options (i) a Doncaster PCT sharing the boundary of Doncaster MBC and (ii) a Doncaster and Bassetlaw PCT spanning the boundaries of Doncaster MBC and Bassetlaw DC.

Rotherham Council has consistently argued that local authority and other administrative boundaries should align as far as possible. It was for example a central argument in our evidence to the recent Parliamentary Boundary Review. We should therefore consider offering our support to the Doncaster PCTs.

8. Finance

There are no significant financial implications with the proposed re-configuration of the boundaries

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9. Risks and Uncertainties

The main risk relates to ensuring sufficient commitment and resources from the Government to implement the final recommendations in relation to the boundaries. This is highly unlikely, and the indications are that the Government wishes for the reconfigurations to take place as soon as possible.

10. Policy and Performance Agenda Implications

There are no significant implications for policy and performance. The DoH considers that the new SHA will be in a stronger position to influence national policy.

11. Background Papers and Consultation

The deadline for comments for both consultation is the 22 March. This report has been agreed by Corporate Management Team. A copy of the draft paper have been forwarded to all Programme Areas for comment and information.

Department of Health – Ensuring a patient-led NHS: Consultation on a Strategic Health Authority for Yorkshire and the Humber and for New Primary Care Trusts in South Yorkshire and Configuration of NHS Trusts in England.

13. Contact Names: Andrew Towlerton, Policy & Research Manager, Chief Executive’s Office, tel 01709 822785, e-mail [email protected]

Joanna Walker, Policy Officer, Chief Executive’s Officer, tel 01709 822784, e-mail [email protected]

Page 5 Agenda Item 7 1st draft – for discussion by Panel on 2 March 2006

REVIEW OF NHS DENTAL PROVISION IN ROTHERHAM A Review by the Adult Services and Health Scrutiny Panel 2 February 2006

1. BACKGROUND TO THE REVIEW

1.1 Members had heard anecdotal evidence from the community that it is difficult to find an NHS dentist. In addition, recent media coverage had highlighted the issue, both locally and nationally.

1.2 The Department of Health’s Oral Health Strategy1 provides guidance for the public. It emphasises that dental/oral health results from ones lifestyle (diet, attitudes, beliefs and culture), rather than from dentists.

1.3 From April 2006, NHS dentists will be working to a new contract. Members wanted to look at the current situation to provide a baseline against which the effects of the new contract can be measured.

2. APPROACH AND TERMS OF REFERENCE

2.1 On 2 February 2006 we held a special meeting to find out how NHS dentistry currently operates, identify local access problems and suggest how they could be tackled.

2.2 This is the first phase of a two part review. A new NHS dental contract begins in April 2006 and the effects of this on access to NHS dental services will be looked at in 2007.

2.3 During the meeting, we heard evidence from witnesses representing service providers and users and also discussed anecdotal evidence from panel members. Oral and written evidence was provided by the following witnesses:

• Nigel Thomas, Director of Dental Public Health, Rotherham PCT • Jason Field, Dental Practitioner, member of the Dental Professional Executive and Chair of the Chair of the Local Dental Committee • Sandra Bann, GROW (Giving Real Opportunities to Women)2 • Diana Swanson, Carers 4 Carers/Carers’ Forum • Ranee Townsend, Clinical Director of Community Dental Services, Rotherham PCT • Staff from the Rotherham Health Advice Centre

2.4 Participation in the review was open to all members of the Adult

1 November, 2005 2 a registered charity, established in 1998. The organisation works with (often vulnerable) women of all ages and ethnic backgrounds, providing support, advocacy and training.

1 Page 6 1st draft – for discussion by Panel on 2 March 2006

Services and Health Scrutiny Panel. The following attended the meeting:

• Councillor John Doyle (Chairman) • Councillor Paddy Burke???? • Councillor Michael Clarke • Councillor Jane Havenhand • Councillor Allan Jackson • Councillor Iain St. John • Councillor John Turner • Councillor Peter Wootton • Sandra Bann (Rotherham PCT Patient and Public Involvement Forum) • Ann Clough, ROPES • George Hewitt (Rotherham Carers’ Forum) • Janet Mullins (Disability Network) • Ray Noble, (Rotherham Hard of Hearing Society) • Gladys Sherratt (Rotherham Hospitals Patient and Public Involvement Forum)

3. FINDINGS

3.1 Dental Health – the National Picture

3.1.1 Dental health of 5 year olds has not changed greatly since 1985. The vast majority of decay in 5 year olds is not treated (partly due to their reluctance to be treated) and less than half of this group is registered with a dentist. The 2003 target for this group is fewer than one filled/missing/decayed tooth per patient. Locally, only Bassetlaw and Chesterfield have managed to achieve this.

3.1.2 Dental health of 14 year olds and adults is improving, with most dental decay being treated. Older people are also keeping their own teeth for longer. In 1968, more than one third of the population had no teeth, but the situation has improved dramatically over the next 30 years, with the national figure in 1998 being only 13%. However, with more older people keeping their own teeth, there has been a rise in a particular type of tooth decay where the crown joins the root.

3.2 Dental Health in Rotherham

3.2.1 Whilst not the worst in South Yorkshire, Rotherham’s dental health was in the bottom quartile for England, mainly due to the absence of fluoride in the water and social deprivation.

3.2.2 There is a considerable variation in disease levels between wards in Rotherham with the 5 year olds in the more economically disadvantaged wards having three times the level of dental decay than in other wards. This was a reflection of the social economic status of communities, with poverty being closely linked to poor dental

2 Page 7 1st draft – for discussion by Panel on 2 March 2006

health.

3.2.3 Following national trends, dental health of 14 year olds and adults in Rotherham is improving. However, many patients attend dental practices irregularly due to anxiety over treatment or the costs.

3.2.4 Many vulnerable people do not see dental care as a priority other than in an emergency situation. Outstanding fees charged for missed appointments can result in dental treatment being refused until the account is paid. Often, the result is patients not seeking treatment and self-medicating for the pain at home.

3.3 Private Practice

3.3.1 Most dentists choosing to move from the NHS to private practice do it in order to reduce their workload. Benefits cited by private practitioners include improved working lives, seeing fewer patients for better quality and more appropriate oral care, and having time to spend with their patients.

3.3.2 Opting out of the NHS also gives dentists full control of how their practices are run.

3.3.3 Many dentists feel that under the NHS, they cannot provide their patients with the best quality treatment or level of care they wish to. It was felt very few conversions to Private practice were as the result of merely higher remuneration.

3.3.4 The difficulties in recruiting dentists have been made worse by competition from the ever-increasing number of private practices, who can offer a lighter patient caseload for greater remuneration.

3.4 Rotherham’s Dental Practices

3.4.1 Ninety per cent of dentistry is done in general dental practice.

3.4.2 Having recently lost 3 dental practices, Rotherham now has 31 remaining – employing at total of 79 dentists (approximately one dentist per 4280 population3). All provide NHS dentistry, but are full. There is a practice in each of the former mining communities. However, patients travel very widely and in the future practices will be moved/set up in areas of greatest need.

3.4.3 One practice focuses purely on orthodontics – an essential service, particularly to children.

3.5 Emergency Dental Services

3.5.1 Access to emergency care for unregistered patients is provided at the

3 This compares with one dentist for every 2,000 patients in France and one dentist per 1,000 patients in Scandinavia.

3 Page 8 1st draft – for discussion by Panel on 2 March 2006

Dearne Valley Dental Access4 Centre. However, it is difficult to obtain one of the 50 appointments available each day as they are generally all taken by 9.15 a.m. Once out of pain, unregistered patients have problems in accessing routine care.

3.5.2 Referrals should be made through NHS Direct. Patients are given a password that allows them to book an appointment the same day. Once all appointments are taken, patients are asked to call back the following day.

3.5.3 The Centre houses services provided by both local dentists and specialist hospital consultants. It includes four dental surgeries, plus support and teaching facilities for dental students. There are four full- time dentists, although there are plans to increase this to six.

3.5.4 The Centre occupies the ground floor of a new building in the grounds of Montagu Hospital, Adwick Road, Mexborough, Doncaster.

3.5.5 For some vulnerable patients, access to emergency dental care is made more difficult do to a shortage of money for bus fares/taxis and other difficulties in travelling to ‘out of town’ practices.

3.6 Health Advice Centre

3.6.1 This facility provides a wide range of health advice, including areas such as pain relief and where patients can access emergency or routine dental services. In recent times, a great many calls have been from residents unable to find a regular dentist.

3.7 Community Dental Service

3.7.1 The service provides a specialised referral service for those patients for whom there is evidence that treatment is not possible within the general dental service. It also provides oral health promotion programmes for priority groups in targeted areas and carries out surveys which measure the dental health of groups within the population as required by the Commissioners and the Department of Health.

3.7.2 It provides dental advice and treatment for:

• Children with specialised treatment needs e.g. - behaviour management problems - learning/physical disabilities - medical problems - social issues (looked after children, children in need, child protection register)

• Specific groups of adults e.g.

4 Which also caters for patients from Doncaster and Barnsley

4 Page 9 1st draft – for discussion by Panel on 2 March 2006

- Learning difficulties - Complex physical disabilities - Severe mental health problems - Older people who are housebound.

3.7.3 It provides oral health promotion programmes for priority groups e.g.

• Ante/post natal groups • Preschool groups • Adult day centres and special schools • Community groups 3.7.4 It also undertakes training of other health care workers, teachers and carers in oral health promotion and targeted dental screening programmes for schools and adult day centres.

Services are provided from : • Ferham Dental Clinic • Maltby Dental Clinic • Swallownest Dental Clinic • Wath Dental Clinic • Domiciliary care where appropriate

3.7.5 Patients are referred by general dental practitioners, general medical practitioners, health visitors, district nurses or any other health care workers, community workers or by the patient him/herself. However, patients will not be accepted by the service if they have been assessed as not requiring the specialised care provided by the community dental service. Lack of access to dental services alone is not a reason for referral to the community dental service.

3.7.6 The community dental service in Rotherham is part of a merged service with Barnsley and Doncaster community dental services. The merged service is provided by Rotherham Primary Care Trust.

3.7.7 The service has a staffing structure that includes 6 full time dentists. However, currently only 4 of these posts are filled.

3.8 Registration

3.8.1 The percentage of Rotherham’s children who are currently registered with a dentist broadly mirrors the national figure at ??%. Central Doncaster and Sheffield South West and West have significantly higher levels. In Rotherham, there is a shortage of practices that are currently able to take on children.

3.8.2 50% of 18 year olds and over are registered with a dentist against a national figure of 44% and falling.

3.9 Dental Training

3.10 In response to the improving dental health of the nation, the

5 Page 10 1st draft – for discussion by Panel on 2 March 2006

Government closed three dental schools in the early 1990’s. Although there has been a dramatic improvement in the dental health of under 35s, there is still a substantial need for dentist for older people, children and those who wanted cosmetic changes. The reduction in the number of dentists being trained has therefore led to the current national shortage (approximately 1,000).

To address this there has been a 25% increase in the number of dental students taken on this year. However, it will take 5 years to train these students before they can join the dental workforce.

3.11 Initiatives to increase NHS Dental Provision in Rotherham

3.11.1 Rotherham PCT is taking part in a national initiative to recruit dentists from overseas and through this has employed three Polish dentists, two of which are still working within the Borough. They have been a huge asset (due to a strong work ethic and good English language skills) and have also been well supported by the Borough’s Polish community. A further three Polish dentists will soon be recruited in the Borough. The initiative will be reviewed in one year’s time.

3.11.2 The PCT has recently been working with a dentist in Thorpe Hesley to transfer his premises into the Health Centre. This will double the number of surgeries and thus appointments available.

3.11.3 There are four training practices in Rotherham for new dentists (Vocational Dental Practitioners – VDP’s) where three wish to stay at the end of the training year in August 2006. Under the old arrangements, this would have been possible, as there is enough work. The new contract devolves funding to the PCT, but it appears that there would be no funding to keep these dentists in post after August.

3.11.4 The Dearne Valley Dental Access Centre contains support and teaching facilities for dental students. It provides students with experience of drop-in style dentistry as well as traditional continuing care.

3.12 New Dental Contract

3.12.1 Fees

Under the current arrangements, there are 400 chargeable ‘items’ of dentistry. From the 1st April, 2006 there will be just three patient charge bands:

• £15.50 (for x-rays, examinations, scale and polishes) • £42.50 (for any operative care) • £189.00 (for a crown, bridge or dentures).

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Most patients would pay considerably more under the new system5. It is unlikely to deliver any improvement in dental health and may make it worse, as it may considerably lengthen times between patients’ visits to a dentist.

The top band is substantially below the current maximum that an individual can pay6, so patients requiring very complex work would benefit from the new system. Although there would still be exemptions from charges for people on low incomes, it is felt that the new system could affect the poorer and elderly communities the hardest.

The new fee structure could lead to people attending less often (and thus affect the practice’s ability to achieve UDA7 value). In turn this would impact on their NHS funding and could push some into the private domain.

One option would be for those patients who could afford it, to take out private dental insurance8. However this would not be a priority (or, indeed an option) for people on low incomes and those over the age of 65 may find it difficult to obtain cover.

3.12.2 The main features of the new contract are as follows:

• If a dentist leaves the NHS, the funding will remain with the PCT so that it can commission alternative services elsewhere. • Dentists will no longer be paid per treatment they provide. Instead they will be paid monthly at a constant rate, based on the work they have done over the last 3 years - providing they maintain a certain workload. • Practice funding would depend on the collection of an agreed number of UDAs). No points would be collected for preventative work, so many dentists would not allocate time to this.9 • Registration of patients will end in April, 2006. Patients will still be on an ‘informal’ list but their formal relationship with a practice will only last as long as each course of treatment. It is hoped that this will free up access to services for occasional attenders. Theoretically, patients will be able to book an appointment with any dentist that is able to offer them an appointment. • Patients would be seen only when vacant appointment times arise.10 Patients will not be recalled for routine checkups on a six

5 for example, the cost of a small denture will rise from £60 to £189 and a crown from around £90 to £189. 6 currently £385 7 Units of Dental Activity 8 A typical premium could be £18.40 - £40.00 per month for a family of four 9 this contrasts with the current pilot scheme, in which the value of preventative work is acknowledged. 10 This could be months in advance

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monthly basis. The onus will be placed on individuals to ensure that they have regular check-ups at an appropriate frequency11, as agreed with their dentist. • There will be a disincentive to see new patients as more new patients ‘fail to attend’ and often need much more treatment12. • There will be no incentive to treat patients with specific needs (e.g. with learning disabilities). 3.12.3 PCTs will be responsible for developing a new out of hours service for pain relief. Where urgent out of hours treatment is required, it would probably be provided at a dental access centre, such as the one at Montagu Hospital. Rotherham Health Advice Centre will continue to give advice on pain relief and direct patients to emergency dental services.

3.12.4 Female dentists currently outnumber male and 70% of current dental students are female13. General dental practice will therefore need to change to accommodate the requirements of the increasing number of female dentists, offering more salaried positions and working arrangements that fit in with family responsibilities.

4. RECOMMENDATIONS

The panel recognises the PCT’s substantial efforts (within the available funding) to improve the NHS dental services within the borough.

The Panel has concerns about the new scale of charges; particularly the effect increased costs could have on people with low incomes seeking dental treatment.

4.1 The Panel supports:

4.1.1 Lobbying for fluoridation of Rotherham’s water supply, in order to bring about a substantial improvement in the Borough’s dental health.

4.1.2 the adding of incentives to undertake preventative work in the new contract.

4.1.3 protecting those least able to pay from huge extra costs under the new fee structure, ensuring benefits are claimed where appropriate.

4.1.4 the abolition of charges for missed appointments, particularly for vulnerable patients.

11 National Institute of Clinical Excellence (NICE) guidance suggests intervals of between 3 and 18 months, depending on the oral health of the patient 12 but the number of UDA points collected would be the same as for a patient requiring less treatment 13 The area of greatest undergraduate growth is in the recruitment of Asian women

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4.2 Communication and Education

4.2.1 Communicate the issues surrounding dental health and the shortage of dental care in the Borough

4.2.2 Improve access to information on NHS dental system – particularly with respect to the changes arising from the new contract. This information should be distributed as widely as possible e.g. to doctors’ surgeries/health centres and via voluntary sector agencies providing advice to vulnerable groups or those with specific needs.

4.2.3 Work with the Council’s Community Learning Service and other partners to promote the benefits of improved diet and lifestyle on dental health.

4.3 Rotherham PCT

The Panel supports close working between the Council and Rotherham PCT to gain better oral health for people in the Borough of Rotherham. It makes the following specific recommendations to the PCT:

4.3.1 Address the issue of no improvement in 5 year olds’ dental health over the last 20 years.

4.3.2 Work with dental practice owners to improve disabled access at many surgeries.

4.3.3 Identify innovative ways of developing and retaining the workforce providing NHS dentistry.

4.3.4 Ensure that upon discharge from a long stay in hospital, vulnerable patients14 be offered help with finding a dentist as part of their support arrangements15.

4.3.5 Explore the possibility of linking a dental check-up with the annual medical provided to all carers and service users16.

4.3.6 Prioritise the filling of the Community Dental Service’s two vacant posts so that vulnerable groups (e.g. disabled, housebound, looked after children) are able to access the dental services that they need.

4.3.7 Monitor the effect of increasing the number of appointments available at the Dearne Valley Dental Access Centre and consider setting up a second facility, elsewhere in the Borough if there is sufficient unmet demand for this service.

14 e.g. those with mental health problems 15 currently organised by Community Mental Health Nurses, the Community Mental Health Team and GP surgeries 16 that are on the Carers’ Register

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4.3.8 Ensure that the plans for a walk-in dental service at the proposed Primary Care Centre in Rotherham are realised.

4.3.9 Involve dentists in community groups (name?) already set up by PCT.

5. THE NEXT STEPS

5.1 Present the final report to Performance and Scrutiny Overview Committee, followed by Cabinet and Rotherham PCT.

5.2 Undertake the second phase of the review in spring/summer 2007, to assess the effect of the new contract on NHS dentistry in Rotherham.

10 Page 15 Agenda Item 8

ROTHERHAM BOROUGH COUNCIL – REPORT TO MEMBERS

1. Meeting: ADULT SERVICES AND HEALTH SCRUTINY PANEL

2. Date: 2 March 2006

Items for inclusion in Panel Work Programme 3. Title: 2006-2007

4. Programme Area: Chief Executive’s

5. Summary

For effective scrutiny of Adult Services and Health issues, the Panel must plan its work programme. This report begins the process by reminding members of the Panel’s remit and other issues which will influence its workload over the 2006/07 municipal year.

6. Recommendations

a. That Members consider the Panel’s remit in conjunction with the Council’s Corporate Priorities and suggest items that could be included in the Panel’s work programme for 2006/07.

b. That Members’ suggestions be incorporated into a draft work programme to be considered at the June meeting.

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7. Proposals and Details

7.1 The Panel’s remit includes scrutinising a wide range of issues across Health and Adult Services areas, including:

• Older People’s Strategy • Housing Adaptations and Supporting People • Learning Disability Services • Proposed changes to the way that Adult Services are delivered

• Public Health Strategy • Contributing to responses on statutory health consultations (i.e. where ‘substantial’1 developments or changes are proposed) • Providing comments on local health trusts as part of the Annual Health Check process • Any health services provided to the people of Rotherham.

Monitoring • Adult Services budget (and contributing to proposals as part of the budget-setting process) • Adult Services complaints • Action plans arising from external inspections.

7.2 The Council’s priorities are framed around five strategic themes:-

• Rotherham Achieving • Rotherham Alive • Rotherham Learning • Rotherham Proud • Rotherham Safe

and are underpinned by two cross-cutting themes:- • Fairness • Sustainable Development.

1 As defined in Section 7 of the Health and Social Care Act 2001

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8. Finance

8.1 All scrutiny work will be met from within existing Scrutiny and Democratic Services budgets.

8.2 There are no financial implications arising directly out of this report. Recommendations arising out of scrutiny reviews may have financial implications and these will need to be evaluated when such recommendations are referred to Cabinet.

9. Risks and Uncertainties

Although Scrutiny has a proactive role to play in the way that the Council operates, it must also be able to respond to issues that arise during the municipal year. The draft work programme has allowed for some ‘spare’ capacity in order to fulfil its reactive role, but nonetheless, the programme will require periodic revision in order to accommodate the key work in a timely way.

10. Policy and Performance Agenda Implications

Policy review work is being co-ordinated by Performance and Overview Scrutiny Committee, which may delegate work to individual scrutiny panels, including Adult Services and Health.

11. Background Papers and Consultation

• RMBC’s Forward Plan of Key Decisions • Rotherham’s Community Strategy

Contact: Delia Watts, Scrutiny Adviser, direct line: (01709) 822778 e-mail: [email protected] ………………………………..………

Page 18 Agenda Item 9

ROTHERHAM BOROUGH COUNCIL – REPORT TO MEMBERS

1. Meeting: ADULT SERVICES AND HEALTH SCRUTINY PANEL

2. Date: 2 March 2006

Co-option onto the Adult Services & Health Scrutiny 3. Title: Panel

4. Programme Area: Chief Executive’s

5. Summary

This report gives the Panel the opportunity to consider co-optee representation for the 2006/07 municipal year.

6. Recommendations

That

a. the Panel co-opts representatives from the following organisations for the 2006/07 municipal year:

o Speak Up o Rotherham Hard of Hearing Society o Carers’ Forum o Rotherham Older People’s Experience of Services (ROPES) o PPI Forum Rotherham Hospitals o PPI Forum Rotherham Primary Care o PPI Forum South Yorkshire Ambulance Service o Rotherham Ethnic Minority Alliance o Rotherham Diversity Forum.

b. those organisations be asked to forward their nominations for the 2006/07 municipal year.

c. the Panel considers whether there are any other organisations from which it wishes to co-opt a representative.

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7. Proposals and Details

7.1 Representatives of external organisations are co-opted onto the Panel for one municipal year. The Overview and Scrutiny Procedure Rules allow the Panel to …”appoint a number of people as non-voting co-optees”. The rationale for having non-voting co-optees is to inform scrutiny debate across the panel’s full remit, whilst avoiding duplication.

7.2 The Council is committed to its core value of ‘ensuring effective consultation and involvement’ that ‘properly informs Council policy and service improvements’. By involving representatives from a wide range of organisations the recommendations of the Scrutiny Panel will be better informed.

7.3 In previous years, scrutiny panels have not discussed which organisations they wish to co-opt representatives from until the first meeting of the municipal year. Due to the decision-making arrangements of the co-opting organisations, it has sometimes taken until September or October before the nominated individuals attend their first meeting.

7.4 One of the recommendations of the scrutiny review into co-option1 was that co-optees be invited to all relevant elected member training events. The Member training programme includes induction for new members early in the municipal year (i.e. from June onwards) and a range of other training sessions in late summer/early autumn. In order for co-optees to have the opportunity to attend this training, the process needs to begin much earlier. By agreeing which organisations the Panel wishes to co-opt from in March, new co-optees should be in place for the Panel’s first meeting of the new municipal year.

7.5 Over the last year, the Panel co-opted the following individuals:

• Janet Mullins, Disability Network • Victoria Farnsworth, Speak Up (supporter/substitute: Jonathan Evans) • Ray Noble, Rotherham Hard of Hearing Society • George Hewitt, Carers’ Forum (substitute: Diana Swanson) • Ann Clough, ROPES • Gladys Sherratt, PPI Forum Rotherham Hospitals (sub: Val Lindsay) • Sandra Bann, PPI Forum Rotherham Primary Care • Lizzie Williams, PPI Forum South Yorkshire Ambulance Service • Parveen Qureshi, REMA.

1 Co-option onto Scrutiny Panels, June 2004

Page 20

7.6 In general, attendance at Panel meetings by co-optees has been excellent, with individuals making excellent contributions to the scrutiny process.

7.7 The Disability Network folded in January 2006. To ensure that the Panel continues to have a representative of the disabled community, it is suggested that a nomination of an individual representing this group is sought from the Rotherham Diversity Forum.

8. Finance

Any additional expenses arising from having co-optees on the Panel (e.g. additional travel or catering costs in connection with a review or off-site meeting) will be met from existing Democratic Services budgets.

9. Risks and Uncertainties

It is impossible to devise a list of co-optee organisations that comprehensively covers all issues that may be covered by the Panel. However, it should be noted that the Panel has the option of co-opting additional specialists for any specific matter that it sees fit, as well as for scrutiny reviews.

10. Policy and Performance Agenda Implications

Involving external co-optees helps the Panel understand the different economic, social and local impacts when taking decisions on policies and activities. The Council’s commitment to being a ‘listening council’ is strengthened by its involvement of representatives of partner organisations and other community groups in Rotherham.

11. Background Papers and Consultation

• Co-optees onto Social and Community Services Scrutiny Panel 2005/06

The Panel’s Chairman supports the principle of co-option onto the Panel.

Contact: Delia Watts, Scrutiny Adviser, direct line: (01709) 822778 e-mail: [email protected] …………………………………..………

Page 21 Agenda Item 11

ROTHERHAM BOROUGH COUNCIL – REPORT TO MEMBERS

1. Meeting: Adult Social Care and Health Scrutiny Panel

2. Date: Thursday 2 March 2006

3. Title: Adult Social Services Revenue Budget Monitoring Report 2005/06 All Wards Affected 4. Programme Area: Adult Social Services

5. Summary

To inform members of the latest projected revenue expenditure against budget for Adult Services and Strategic Services, highlighting any budget variations and action plans to reduce areas of projected overspend.

6. Recommendations

That members receive the latest revenue budget monitoring report for 2005/06.

7. Proposals and Details

This latest budget monitoring report to be reported to members shows projected expenditure against budget based on actual expenditure for the period April to the end of January 2006. The overall position for Adult Social Services, including Strategic Services, shows that projected expenditure will be contained within the cash limited budget, therefore a nil variance. This is a result of an additional budget allocation, for this year only, of £1,796,000 for Adult Social Services to address the previously reported net overspend.

8. Finance

The main variations against approved budgets for both service areas can be summarised as follows:

Adult Services

The latest figures show an overall projected overspend to the year end of £520,600 (+ 0.99%) and increase of £49,000 since the last report, mainly due to additional cost of advertising for vacant posts.

Page 22

The main overall budget pressures are as a result of a significant increase in demographic pressures in both Older Peoples residential and domiciliary care services. Within Residential care there are now significantly more people supported than forecast at the start of the year. There is also an additional 780 hours of independent sector Home Care hours per week compared to 2004/05. As stated in previous reports another significant budget pressure is due to the increased take up of Direct Payments across all service areas over and above the revenue budget. There are now 265 clients supported through direct payments compared with 160 at the start of the financial year. In January 2005 members approved the implementation of the reinstatement for employees within Older Peoples homes and the Home Care service of the annual leave and sickness payments based on average hours rather than contracted hours. Social Services absorbed the one off payment and implementation costs in the 2004/05 revenue budget. An estimate of the full year costs of these revised arrangements have added to this years budget pressures. There is also a projected overspend on the Wardens Service due to a reduction in actual income collected. The other main recurrent budget pressures are within Learning Disability Services in respect of residential care and supported living schemes, due to high cost placements. Average occupancy levels within in-house Older Peoples residential care has reduced compared with 2004/05. This was discussed as part of the recent Base Budget Review exercise in accordance with the Modernisation strategy.

The overall budget pressures are being reduced by slippage on recruiting to vacant posts and underspends on the delays in implementing schemes, including start up and pump priming costs for Extra Care Housing and the Modernisation Strategy. The moratorium on procurement spending (non health and safety) which has been in place since August 2004 continues to apply. As in previous years all specific grants and income from partners has been fully allocated. Action to bring the overspend closer to budget includes reviewing the use of high cost care packages, reviewing vacancy management including the use of agency staff, reviewing the impact of increased demand for Direct Payments and Home Care. The Cabinet has now approved the measures to increase the Fair Access to Care Services Criteria from immediate effect and increase non–residential care charges phased over the next fourteen months. The Programme Area Senior Management Team has now agreed that all recruitment to existing vacant posts will be frozen for the remaining financial year. These measures together with the approval of additional budget for 2005/06 should ensure that that expenditure is contained within the revised cash limited budget.

Mental Health – Section 117

As reported in previous budget monitoring reports the balance on the provision made for re-imbursements under section 117 has now been taken into account on the advice from Corporate Finance to reduce the overall projected overspend within the Programme Area by £305,000.

Page 23

Strategic Services

Current projections show an overall projected underspend to the year end of £215,600 (-7.65%), an increase in the projected underspend of £49,000 from the last report. The main reason for the increase in projected underspend is further impact of the moratorium on external training courses and procurement spending together with some slippage on recruiting to vacant posts.

9. Risks and Uncertainties

There remains a number of recurrent budget pressures, Learning Disabilities residential care and supported living schemes, Demographic pressures on residential and domiciliary care service provision, Direct Payments and Corporate charges which we continue to monitor closely. A number of charges are still outstanding, including RBT affordability costs and the contribution to procurement savings, which may effect the final outturn position.

10. Policy and Performance Agenda Implications

The approved cash limited budget for 2005/06 has allowed existing levels of service to be maintained to support the most vulnerable people and continues to contribute to meeting the Council’s Corporate Plan and Community Strategy priorities.

11. Background Papers and Consultation

The attached Appendix 1 in the corporate format shows the projected outturn for both gross expenditure and gross income at service level together with proposed actions for reducing the overspends with the aim of bringing expenditure within budget by the end of the financial year.

Appendix 2 shows a summary of the net position for both the current and previous month, together with a more detailed breakdown of the main budget variances within Adult’s and Strategic Services

The detailed projections involve consultation with budget holders and scrutiny by each Service Area Management Team before final approval by the Programme Area Senior Management Team.

Contact Name : Mark Scarrott, Finance & Accountancy Manager (Social Services), Extension 3977, [email protected]

Revenue Budget Monitoring Report 2005/06 APPENDIX 1 Sheet 1 of 2 (Based on information available as at 31 January 2006)

Division of Service Expenditure Income Reasons/Implications Budget Proj'd out turn Variance Budget Proj'd out turn Variance ££££££

Further overspend on Older Peoples residential and domiciliary care services due to demographic pressures and significant increase in take up of Direct Payments across all service areas over and Adult Services 88,524,766 89,256,566 731,800 -35,924,546 -36,135,746 -211,200 above budget. Additional Learning Disabilities Residential Care placements since last report. Projected overspends reduced by slippage on recruiting to vacant posts and developments to services, applying all specific grants, moratorium on all procurement spending, approved changes to FACS criteria and increase in non-residential charging policy and one off additional budget allocation agreed by Cabinet. Page 24

Recurrent budget pressure on central charges based on previous outturns and overspend on Strategic Services 3,712,970 3,484,570 -228,400 -893,541 -880,741 12,800 complaints due to the increased demand and use of external contractors. Pressures offset by slippage on training grants and freeze on all external training courses.

Total 92,237,736 92,741,136 503,400 -36,818,087 -37,016,487 -198,400 Revenue Budget Monitoring Report 2005/06 APPENDIX 1 Sheet 2 of 2 (Based on information available as at 31 January 2006)

Division of Service VarianceRAG Status Actions Proposed and Revised RAG Status NET £ Financial Performance Intended Impact Financial Performance

Adult Services 520,600 Green Green Recurrent budget pressures within Learning Disabilities are being examined in Green Green detail in particularly a review of high cost placements and provision of transport. Continued review of use of agency staff and the increased demand for Direct Payments. Maximisation of all grant funding and further scrutiny on filling vacant posts. Moratorium in place on all procurement budgets (excluding health and safety) is in place. Further freeze on the recruitment to vacant posts is now in place.

Review of existing charging policy for non residential care services and Page 25 eligibility criteria has now been approved by the Cabinet.

Strategic Services -215,600 Green Green Review use of agency staff and external contracts within complaints. Review on Green Green filling vacant posts and moratorium on all procurement spending (excluding health and safety) and freeze on all external training courses in place.

305,000

Mental Health - Section 117 -305,000 Further advice from Local Government Ombudsman and Legal Services as Total 0 resulted in forecasted repayments on Section 117 to clients for previously charged is less than forecast. APPENDIX 2

REVENUE BUDGET PROJECTIONS 2005/06 Projected position based on the period 1 April 2005 to 31 January 2006

POTENTIAL POTENTIAL PERCENTAGE VARIATION VARIATION VARIATION NET CURRENT LAST CURRENT CURRENT SERVICE DIVISION EXPENDITURE/INCOME HEAD BUDGET PERIOD PERIOD PERIOD COMMENTS AND ACTION PROPOSED £££%

Overspend on Older Peoples residential and domiciliary care services due to demographic pressures and significant increase in take up of Direct Payments across all service areas over and above budget. Recurrent budget pressures on Learning Disabilities Residential Care placements and Supported

ADULT SERVICES Overall Budget 52,600,220 471,600 520,600 0.99% Living schemes. Page 26

Projected overspends reduced by slippage on recruiting to vacant posts and developments to services, applying all specific grants, moratorium on all procurement spending, reviewing existing FACS criteria and charging policy and one off additional budget allocation agreed by Cabinet.

Due to further advise from Ombudsman and Legal Services forecasted repayments now less than MENTAL HEALTH Section 117 Refunds 0 -305,000 -305,000 originally forecast.

Recurrent budget pressure on central charges based on previous outturns and overspend on STRATEGIC SERVICES Overall Budget 2,819,429 -166,600 -215,600 -7.65% complaints due to the increased demand and use of external contractors. Pressures offset by slippage on training grants and freeze on all external training courses.

55,419,649 0 0 0.00%

TOTAL POTENTIAL VARIATION FOR YEAR 0 0.00%

BUDGET (EXCLUDING CENTRAL AND FINANCING CHARGES) 55,419,649

PROJECTED OUTTURN (EXCLUDING CENTRAL AND FINANCING CHARGES) 55,419,649 SERVICE AREA : ADULT SERVICES

BUDGET PROJECTIONS 2005/06

Projected position based on the period 1 April 2005 to 31 January 2006

EXPENDITURE INCOME NET VARIANCE NET VARIANCE EXPENDITURE INCOME CURRENT PREVIOUS PERIOD EXPENDITURE / INCOME HEAD CODE GROSS BUDGET VARIANCE GROSS BUDGET VARIANCE PERIOD COMMENTS AND ACTION PROPOSED £ £££££

OLDER PEOPLE

-384,800 Assessment & Care Management UAE211 4,665,415 -360,800 -1,462,608 0 -360,800 Slippage on recruitment to vacant posts plus capping of new developments

-384,800 Assessment & Care Management UAE010 4,665,415 -360,800 -1,462,608 0 -360,800

0 Residential Care In House UAE222 7,312,867 0 -2,162,020 0 0 Potential for overspend on Repairs and Maintenance costs 155,700 Nursing Home Placements Indep UAE321 15,455,855 133,000 -3,496,100 0 133,000 Number of people supported has reduced by 13 to 94 more than forecast plus increase in short stay care. Action plan to divert not 0 Residential Care Independent UAE322 118,395 0 -50,000 0 0 delivering due to increasing levels of need 0 Supported & Other Acc. Independent UAE323 0 0 0 0 0 Page 27 155,700 Residential Care UAE020 22,887,117 133,000 -5,708,120 0 133,000

116,000 Home Care In House UAE232 8,614,314 127,000 -2,567,981 15,000 142,000 Increased costs of holidays and sickness cover due to accumulated leave taken in December. 151,000 Wardens Services UE5200 1,550,912 99,000 -1,589,186 20,000 119,000 Revised forecast showing increased income 53,000 Meals In House UAE233 985,656 80,000 -534,434 0 80,000 Increasing take up of tea time service and IT to Eat 0 Equipment In House UAE234 0 0 0 0 0 59,000 Other Community Services Independent UAE331 147,743 29,000 -48,112 0 29,000 Delays in reconfiguring bathing service 0 0

0 Meals Independent UAE333 0 0 0 108,000 Homecare Independent UAE332 2,184,529 220,000 -565,956 -112,000 108,000 Forecast increasing demand levels now confirmed despite more rigerous needs assessments.Estimated Increased income from 487,000 Care in Peoples Homes UAE030 13,483,154 555,000 -5,305,669 -77,000 478,000

-18,000 Day Care In House UAE241 683,208 -25,000 -500,641 0 -25,000 Impact of moratorium on spending 10,000 Day Care Independent UAE341 691,042 10,000 -215,263 0 10,000 Age Concern - slippage on Gershon saving

-8,000 Day Care UAE040 1,374,250 -15,000 -715,904 0 -15,000

42,000 Advice, Info and carers Support UAE351 441,299 42,000 -131,650 0 42,000 Significant increase in take up of Direct Payments

42,000 Advice & Info & Carers Support UAE050 441,299 42,000 -131,650 0 42,000

-73,000 Management & Admin Support, Transport UAE261 3,487,858 -79,400 -272,984 0 -79,400 Slippage on filling vacant posts and impact of moratorium

-73,000 Management & Admin Services UAE060 3,487,858 -79,400 -272,984 0 -79,400

-70,000 Extra Care Housing UAE080 120,000 -70,000 0 0 -70,000 Revised projected opening for Oak Trees scheme

148,900 Total Older People UAE000 46,459,093 204,800 -13,596,935 -77,000 127,800 SERVICE AREA : ADULT SERVICES

BUDGET PROJECTIONS 2005/06

Projected position based on the period 1 April 2005 to 31 January 2006

LEARNING DISABILITIES

-36,400 Assessment & Care Management UAL211 1,043,504 -36,400 -341,607 0 -36,400 Further Slippage on delaying filling vacant posts 0 Assessment & Care Management - Health UAL411 2,951,219 0 -2,951,219 0 0

-36,400 Assessment & Care Management UAL010 3,994,723 -36,400 -3,292,826 0 -36,400

-16,800 Residential Care In House UAL222 1,490,929 -8,200 -134,906 -6,900 -15,100 Slippage on filling vacant posts -25,500 Nursing Home Placements Indep UAL321 1,397,439 -25,500 -1,031,529 0 -25,500 Preserved Rights - Further discharges since last report 82,000 Residential Care Independent UAL322 4,575,498 82,000 -1,874,200 0 82,000 Recurrent pressure due to high cost care packages High cost placement since last report 0 Residential Care Health UAL324 1,965,672 0 -1,965,672 0 0 Page 28

39,700 Residential Care UAL020 9,429,538 48,300 -5,006,307 -6,900 41,400

36,600 Other Community Services Independent UAL331 168,230 104,400 0 -70,800 33,600 High cost care packages for Community Support 1,200 Supported & Other Acc In House UAL223 422,545 5,600 -346,508 -2,300 3,300 Small variations on a number of Supported Living Schemes 150,800 Supported & Other Acc. Independent UAL323 2,810,622 144,600 -2,681,005 6,200 150,800 Unfunded Ged Fund repayment and high cost care packages 3,000 Homecare Independent UAL332 37,480 3,000 -6,389 0 3,000 Increase in cost of care packages 33,000 In House Care Other UAL235 153,724 28,900 -55,281 0 28,900 Pressure on Family and Friends Scheme

224,600 Care in Peoples Homes UAL030 3,592,601 286,500 -3,089,183 -66,900 219,600

-3,500 Day Care In House UAL241 2,980,710 9,000 -257,601 -12,400 -3,400 Interim review of taxis resulted in reduced costs 57,000 Day Care Independent UAL341 519,514 53,300 -179,153 0 53,300 Over 19s college transport, Education funding withdrawn 0 Day Care Health UAL441 379,489 0 -379,489 0 0

53,500 Day Care UAL040 3,879,713 62,300 -816,243 -12,400 49,900

65,000 Advice, Info and carers Support UAL351 332,014 69,000 -121,902 0 69,000 Increased take up of Direct Payments

65,000 Advice & Info & Carers Support UAL050 332,014 69,000 -121,902 0 69,000

346,400 Total Learning Disabilities UAE000 21,228,589 429,700 -12,326,461 -86,200 343,500 SERVICE AREA : ADULT SERVICES

BUDGET PROJECTIONS 2005/06

Projected position based on the period 1 April 2005 to 31 January 2006

MENTAL HEALTH

-42,000 Assessment & Care Management UAM211 2,095,330 -12,400 -650,478 -48,000 -60,400 Delay in recriuting to Contracting and commissioning posts

-42,000 Assessment & Care Management UAM010 2,095,330 -12,400 -650,478 -48,000 -60,400

0 Residential Care In House UAM222 36,572 0 -23,786 0 0 26,000 Residential Care Independent UAM321 701,044 26,000 -168,140 0 26,000 Additional admission since last report -50,000 Supported & Other Acc. Independent UAM323 254,000 -50,000 -50,000 0 -50,000 Slippage on implementing new Supported Living Scheme

-24,000 Residential Care UAM020 991,616 -24,000 -241,926 0 -24,000

0 Home Care In House UAM232 42,053 0 -39,584 0 0 Page 29 0 Other Community Services Independent UAM331 570,584 -1,400 -176,144 0 -1,400 Slippage on staff recruitment -90,000 Homecare Independent UAM332 91,343 -90,000 -30,457 0 -90,000 Slippage on development of Crisis Unit

-90,000 Care in Peoples Homes UAM030 703,980 -91,400 -246,185 0 -91,400

3,500 Day Care In House UAM241 387,078 3,500 -103,390 0 3,500 Revised employee projections -5,700 Day Care Independent UAM341 255,898 -5,700 0 0 -5,700 Underspend on Kick Start employment scheme

-2,200 Day Care UAM040 642,976 -2,200 -103,390 0 -2,200

71,400 Advice, Info and carers Support UAM351 131,599 78,400 -7,000 0 78,400 Direct Payments increase in take up to meet targets

71,400 Advice & Info & Carers Support UAM050 131,599 78,400 -7,000 0 78,400

2,600 Management & Admin Support UAM261 13,586 1,900 -12,000 0 1,900 Godstone Road repairs and maintenance

2,600 Management & Admin Services UAM060 13,586 1,900 -12,000 0 1,900

-84,200 Total Mental Health UAM000 4,579,087 -49,700 -1,260,979 -48,000 -97,700 SERVICE AREA : ADULT SERVICES

BUDGET PROJECTIONS 2005/06

Projected position based on the period 1 April 2005 to 31 January 2006

PHYSICIAL DISABILITIES

-40,000 Assessment & Care Management UAP211 1,360,374 -40,000 -185,102 0 -40,000 Slippage on implementation of new developments

-40,000 Assessment & Care Management UAP010 1,360,374 -40,000 -185,102 0 -40,000

0 Residential Care In House UAP222 437,632 0 -34,332 0 0 0 Nursing Home Placements Indep UAP321 177,186 0 -135,186 0 0 35,500 Residential Care Independent UAP322 418,569 35,500 -25,000 0 35,500 2 New placements since last report 0 Supported & Other Acc. Independent UAP323 82,328 0 0 0 0

35,500 Residential Care UAP020 1,115,715 35,500 -194,518 0 35,500 Page 30

31,000 Equipment In House UAP234 544,644 31,000 -107,000 0 31,000 Projected overspend on repairs and maintenance at Kirk Hse 50,000 Other Community Services Independent UAP331 848,045 168,000 -69,073 -99,500 68,500 Increased take up of Direct Payments 20,000 Homecare Independent UAP332 345,414 20,000 -20,816 0 20,000 Care packages more expensive than forecast

101,000 Care in Peoples Homes UAP030 1,738,103 219,000 -196,889 -99,500 119,500

0 Day Care Independent UAP341 295,766 0 -31,000 0 0 Thursday Out and about Club under pressure but action plan developed to bring back to budget

0 Day Care UAP040 295,766 0 -31,000 0 0

-43,000 Advice, Info and carers Support UAP351 260,041 -32,000 -23,000 0 -32,000 Underspend on Caravan Holidays and delayed new development for HIV, Increased cost of supporting Assylum Seekers

-43,000 Advice & Info & Carers Support UAP050 260,041 -32,000 -23,000 0 -32,000

53,500 Total Physical Disabilities UAP000 4,769,999 182,500 -630,509 -99,500 83,000 SERVICE AREA : ADULT SERVICES

BUDGET PROJECTIONS 2005/06

Projected position based on the period 1 April 2005 to 31 January 2006

POLICY & DEVELOPMENT

0 Assessment & Care Management UAS211 51,565 -3,000 0 0 -3,000 Impact of procurement moratorium

0 Assessment & Care Management UAS010 51,565 -3,000 0 0 -3,000

0 Management & Admin Support UAS261 53,449 -2,000 0 0 -2,000 Impact of procurement moratorium 0 Management & Admin Social Services UAS461 0 0 0 0 0

0 Management & Admin Services UAS060 53,449 -2,000 0 0 -2,000

0 Total Policy & Development UAS000 105,014 -5,000 0 0 -5,000 Page 31 BUSINESS UNIT

-20,500 Administrative Support UAB463 350,443 -20,500 0 0 -20,500 Slippage on filling vacant posts -76,000 Fin. Assess'ts Contract Payt UAB464 537,623 -76,000 -28,000 0 -76,000 Slippage on filling vacant posts -12,000 Budget Support UAB466 195,025 -12,000 0 0 -12,000 Slippage on filling vacant posts 142,000 Business Unit Vacancy Factor UAB467 -118,522 142,000 0 0 142,000 Vacancy factor -33,500 Contracting and Commissioning UAB468 376,683 -33,500 -36,000 0 -33,500 Slippage on filling vacant posts 0 RBT - Procurement UAB469 991,923 0 000 0 Corporate Recharges/Costs UAB561 528,539 50,000 0 0 50,000 Projected overspend on Advertising District Audit, Telephones and Insurance.

0 Management & Admin Services UAB060 2,861,714 50,000 -64,000 0 50,000

0 Total Adults Business Unit UAB000 2,861,714 50,000 -64,000 0 50,000

0 Supporting People UAZ000 8,193,819 0 -7,875,662 0

HEAD OF SERVICE

7,000 Head of Function UAF260 327,451 -80,500 -170,000 99,500 19,000 Cost of Absence Management officer, ECH Care Assesmnt Costs of covering Executive Director post 7,000 Management & Admin Social Serv UAF060 327,451 -80,500 -170,000 99,500 19,000

7,000 Total Head of Function UAF000 327,451 -80,500 -170,000 99,500 19,000

471,600 Total Adult Services UA0000 88,524,766 731,800 -35,924,546 -211,200 520,600

TOTAL POTENTIAL VARIATION FOR YEAR 520,600

PROJECTED NET REVENUE OUTTURN (EXCLUDING CENTRAL AND FINANCING CHARGES) 53,120,820 SERVICE AREA : ADULT SERVICES

BUDGET PROJECTIONS 2005/06

Projected position based on the period 1 April 2005 to 31 January 2006

% VARIANCE AGAINST NET REVENUE BUDGET 0.99 Page 32 SERVICE AREA : STRATEGIC SERVICES

BUDGET PROJECTIONS 2005/06

Projected position based on the period 1 April 2005 to 31 January 2006

EXPENDITURE INCOME NET VARIANCE NET VARIANCE EXPENDITURE INCOME CURRENT PREVIOUS PERIOD EXPENDITURE / INCOME HEAD GROSS BUDGET VARIANCE GROSS BUDGET VARIANCE PERIOD COMMENTS AND ACTION PROPOSED £ £££££

6,900 Strategic Management 133,651 6,800 0 0 6,800 Vacancy Target £5.1K Vacancy Target, £9.5K Agency Staff and £22.8K Payments to Contractors less CSCI Reimbursement Grant 27,900 Complaints Procedure 123,889 36,600 0 -3,900 32,700 £3.9K

34,800 Service Strategy 257,540 43,400 0 -3,900 39,500

Salaries and non-pay. Freeze on external training courses -158,800 Training 1,450,347 -221,100 -817,182 -500 -221,600 and conferences. -300 Joint Funding 47,281 -400 -26,902 0 -400 £15.1K under Salaries, £1.0K over Car Allow/Travel, £2.0K under Communications, £8.5K overspend on IT Page 33 -14,400 Performance Info & Quality 1,079,686 -5,000 0 0 -5,000 Development, £2.8K CSC's £33.4K Staff vacancies and slippage due to Mat Leave, £1.0K under Car Allow/Travel, £9.5K under Equipment, -22,900 Management & Admin Costs 304,695 -43,300 0 -700 -44,000 £0.7K unbudgeted Income

25,500 Central Admin Charges 48,688 43,500 0 -100 43,400 Under funded - increase in Advertising costs, £1.9K CSC's 0 Human Resources 46,547 0000RBT Recharge £20.0K Salaries and Consultancy Fees, £1.0 under on Car 18,600 Head of Service 125,362 19,300 0 0 19,300 Allow and Official Expenses £58.9K Staff vacancies, £18.0K under recovery of income from Health (nb. Offset by underspend on salaries - Admin -43,800 Policy Planning & Research 320,567 -59,500 -22,457 18,000 -41,500 Post)

-196,100 Support Service 3,423,173 -266,500 -866,541 16,700 -249,800

£5.3K underspend. No commitments against revenue -5,300 HIV/AIDS Grants 32,254 -5,300 -27,000 0 -5,300 element of budget

-5,300 HIV/AIDS Grants 32,254 -5,300 -27,000 0 -5,300

-166,600 Total Strategic Services 3,712,967 -228,400 -893,541 12,800 -215,600

TOTAL POTENTIAL VARIATION FOR YEAR -215,600

PROJECTED NET REVENUE OUTTURN (EXCLUDING CENTRAL AND FINANCING CHARGES) 2,603,826

% VARIANCE AGAINST NET REVENUE BUDGET -7.65% Page 34 Agenda Item 12

ROTHERHAM BOROUGH COUNCIL – REPORT TO MEMBERS

1. Meeting: Scrutiny Panel Adult Social Services and Health 2. Date: 2nd March 2006 3. Title Half yearly report - Complaints Procedures 4. Programme Area: Adult Social Services

5. Summary:

The attached report gives details of complaints related to the Adult Social Services Programme Area for the first half of 2005/6 (April to September). In line with restructuring and establishment of separate Children and Young Peoples Services and Adult Social Services Programme Areas the report only covers information about adults.

An annual report will be brought to Members for the whole of 2005/6, in May 2006.

6. Recommendations

• Members are requested to receive this report.

7. Proposals and Details

The report details complaints at all stages of the procedure and the main focus is on the recommendations made and improvements to policies or procedures connected to service delivery.

Adult Social Services operate statutory complaints procedures under specific regulations and guidance arising out of the NHS and Community Care Act 1990. As the services separate from the previous overall Social Services work is underway to review the processes and procedures. This review will aim to make improvements to the cost, quality and timescale dimensions of more serious investigations so that service users receive an improved service.

8. Finance

A small number of adult serious complaints (stage 2) involve a formal investigation and these are often undertaken by external people on a fee basis. Similarly independent chairpersons are used for complaints review panels (stage3). The review will examine the costs involved and also examine other means of resolving complaints to services users’ satisfaction, e.g. mediation.

9. Risk and Uncertainties

Department of Health and Commission for Social Care Inspection consultation papers were released in 2004 regarding revised complaints procedures. Details

Page - 2 35 -

were expected to be published in January 2006 so that new procedures could be implemented from April 06. Possible changes include a time limit for making complaints, changes to timescales, independent review remaining with councils and the revised procedures will take these into account. Todate the revised procedures have not been published. The White Paper, Our Health Our Care Our Say gives a commitment to establishing joint complaints procedures for adult services with the NHS.

10. Policy and Performance Agenda Implications

Service assessments and inspections/reviews take account of the complaints made and the resultant learning/changes to provision. The original proposal for the CSCI to take over independent reviews of complaints (stage3) from Councils has now been withdrawn but will be considered as part of the proposals in the White Paper.

11. Background and Consultation

DoH Consultation Document – Learning from Complaints, Changes to the Social Services complaints Procedure for Adults. Our Health, Our Care, Our Say – White Paper

Contact Name: Ian Bradbury Planning, Workforce and Complaints Manager [email protected]

Page 36

Complaints Unit Half Yearly Report (Adult Services). April 1st 2005 – September 30th 2005.

Introduction This report covers the activity of the Complaints Unit in dealing with complaints under the NHS and Community Care Act procedures from 1/4/05 to 30/09/05 and comparing with information for the same period in 2004. The report will focus on the nature and outcomes of complaints, the recommendations made and resulting changes in practice.

1. Summary of Stage 1 Complaints Sixty three people registered 96 complaints at Stage 1 during the period covered by the report. This compares with 81 people making 107 complaints at Stage 1 in 2004. These figures indicate each complainant making an average of 1.6 complaints in 2005 compared with an average of 1.3 in 2004. However one complainant made 17 complaints. Without this figure, both the number of complainants and the number of complaints have fallen significantly compared to the same period last year.

TABLE 1

Stage 1 Complaints Summary Single Complaint 1-3 Complaints More than 3 Complaints No of People 54 (68) 4(12) 5 (1) Complaining Figures for the same period in 2004 are in brackets

TABLE 2 Resolution of Complaints at Stage 1 No of No of New Resolved Resolved Resolved Resolved Awaiting ongoing Complainants within 15 15 – 30 30 - 60 after 60 resolution complaints registering days days days days from2004/5 complaints as at 1/4/05 between 1/4/05 and 30/09/05 24 63 (81) 40 (46) 10 (11) 7 (9) 2(1) 4 (14)

Nearly two thirds of complainants raised issues about four service areas. Details of are contained in Table 3 below.

TABLE 3 Service Area No of Complainants Locality Team Older People 17 (21) Disability/Community Occupational 14 (21) Therapy Disability (Other) 8 (5) Business Support 6 (2) Learning Disability Services 5 (8) Residential/Day Care Elderly 3 (1)

Page 1 of 5

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Mental Health 3 (0) Home Care/Laundry 2 (2) Client Services 2 (14) Rothercare 2 (0) Intermediate Care/ Fast Response 1 (1)

Although the number of Stage 1 complaints regarding Occupational Therapy and Fieldwork Teams is high, very few progress to Stage 2. In 2005 1 person submitted three Stage 2 complaints regarding the Fieldwork Teams and no Stage 2 complaints were raised about Occupational Therapy Services. The vast majority of complaints about Occupational Therapy concern delays between referral and a full assessments and authorisation of equipment. The team offer second visits in cases where the Complainant is not happy with the original Stage 1 response and this appears to be instrumental in preventing complaints escalating to Stage 2.

Satisfaction at Stage 1 The aim of Stage 1 of the Social Services Complaints Process is to try and resolve issues informally. Therefore statistics are not kept on whether individual complaints are seen as upheld or not. However, a good indicator is the number of complainants who pursue their complaints to Stage 2 of which is very small. Satisfaction letters were sent to all complainants who had their complaint responded to under Stage 1.

TABLE 4 Social Services Stage 1 Complaints Satisfied Not Satisfied Not Not Complaint Satisfied Not with (Not taken Satisfied responded awaiting with how Satisfied outcome further) (Taken resolution Complaint with How to Stage Dealt With Complaint 2) was Dealt With 22 (36) 8 (7) 4 (3) 29 (35) 5 (15) 9 (3) 0(0) Fifty eight per cent of people who had their complaints dealt with in the period responded to the Satisfaction letter sent by the Complaints Unit. This compares to 72% for the same period last year. It should be noted however that the proportion of complaints outstanding was less than 7% in 2005 compared with nearly 19% in 2004. Among people responding 65% were satisfied with the outcome of their complaint at Stage 1 and less than 7% progressed to Stage 2.

Nature of Complaints (Social Services) Complaints were received about the following issues:- • Quality of Service • Refusal of Service • Lack of Service • Delay in Service • Cost • Discrimination

Page 2 of 5

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• Provision of Information • Complaints about Carers/Actions Of Staff • Confidentiality • Partnership

The most significant developments since 2004 have been increases in the number of complaints about:- • Lack of service 18 (12) • Quality 31(24) • Action of Staff 16 (10) Eleven of the complaints about quality came from 2 people. Once these are accounted for the total number of complaints about quality fell slightly. Six complaints about lack of service came from 1 complainant. Nevertheless this shows a rise in the proportion of complainants complaining about lack of service which may be affected by changes in eligibility criteria. One complainant made 3 complaints about the Action of Staff.

2. Summary of Stage 2 Complaints The number of complaints registered at Stage 2 in this period has increased compared to the same period last year. Four Complainants made 14 complaints between April 1st and September 30th 2005. This compares with only 2 people making 2 complaints for the same period last year. Each complainant submitted an average of 3 complaints in 2005 compared to only 1 during the same period in 2004. Lack of Service and Cost made up 8 of the 14 complaints investigated. Application of eligibility criteria for services and annual increases in charges appear to have been influential over the last 12 months. There would therefore appear to be a link between these and the increase in complaints progressing to Stage 2 of the process.

TABLE 5 Stage 2 Complaints Nature of Complaint Number of Complaints (1/4/05 -30/9/05)* Quality of Service 2 (1) Refusal of Service 1 (1) Lack of Service 4 (0) Action of Staff 1 (0) Information 2 (0) Cost 4 (0) Total 14 (2)

TABLE 6 Timescales Responded to within Responded to Responded to Awaiting TOTAL* 28 days within 90 days within 180 response days 1 (0) 1 (1) 0 (2) 2 (1) 4(4) *The figures for 2004 are higher than for the number of complaints registered in the period because some complaints registered prior to April 1st period will have been resolved in the period up to September 30th.

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TABLE 7 Outcomes from Stage 2 Year Complainants Upheld Not Upheld Part Inconclusive Withdrawn Total* Responded to Upheld 2005 4 (4) 7 (9) 6 (12) 4 (5) 1 (10) 3(0) 21 (36) *The outcomes do not tally with the numbers of complaints because not all complaints registered in one period will be adjudicated on in the same period.

3. Service Improvements The aim of the Complaints process is to ensure customers have complaints dealt with fairly and efficiently, maintains quality standards, identify areas for service improvement and inform Service Planning. Between April 1st and September 30th 2005, 4 complainants have had responses to complaints they have raised at Stage 2. As a result of these complaints a number of recommendations have been made to the Service Area and these are detailed below.

TABLE 8

Service Improvements Resulting from Complaints

Recommendation Action Protocol for ensuring that Contracting Complaints Manager and Commissioning and Concerns originating from Service Users or Contracts Manager currently finalising the protocol. their carers are also responded to as complaints Instruction to be issued to Home Care staff Business Development Manager issued new prohibiting them from recommending family guidelines to Home Care Managers or friends to do work for service users More effective monitoring of the quality of Review of Training needs of individual staff work from Interviewing Officers undertaken. Role of Interviewing Officers currently being reviewed as part of the development of Customer Service Centres Emphasize the importance of cooperating Induction training to include input on Complaints with Complaints Process to all staff Seek to review decisions regarding Care New procedures currently being developed for Adult Packages promptly and seek mediation Complaints. Process to include where and how before complaint progresses to Stage 2 mediation can be sought

4. Stage 3 / Ombudsman One Adult complaint went to Stage 3 during the period and the Panel upheld the findings of the Adjudicating Officer.

5. Conclusions Overall there has been a reduction in the number of people making complaints but a slight increase in the number of people having complaints dealt with at Stage 2. The proportion of Stage 2 complaints upheld or partially upheld remained roughly the same for both 2005 and 2004.

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Complaints are influenced by policy changes, changes in eligibility criteria and charges.

The time taken to complete Stage 2 investigations continues to be a pressure. A key target for the current year is to ensure that the maximum time for completing Stage 2 complaints is three months unless a longer timescale is agreed with the complainant and is in line with legislative requirements.

Further work will also take place to strengthen the monitoring of recommendations resulting from Stage 2 complaints. A programme of quarterly meetings will be arranged between the Complaints Manager and the Head of Adult Operational Services to confirm how recommendations are being implemented.

A Hurst Complaints Manager

Page 5 of 5

‘Building on Success – The Next Three Years’

Rotherham Intermediate Care Strategy 2005 – 2008

DRAFT ACTION PLAN

Strategic Objectives pg 15-16 Intermediate Care Strategy

1.To review the scope and capacity of intermediate care services required to support patients 2.To improve the efficiency and effectiveness of existing intermediate care services 3.To develop a clear governance framework for the management and delivery of intermediate care services across the Rotherham community. 4.To enhance access to intermediate care and ensure more people benefit from the service.

5. To ensure continuance of care support through the development of formal networks with interface services Page 41 6.To develop a communication and consultation strategy to facilitate the implementation of strategic objectives 7.Service Specification

Strategic Objective Action Required Rationale is detailed Lead Officer(s) Timescale within the strategy. Capacity

• Review of current capacity of IC services, including use and No: 1,2,4 Task Group April 06 Agenda Item13 average cost, staffing and pressures on services To be reviewed

Access and Eligibility

June 06 • Collate and review range of eligibility criteria in use within No: 1,2,4 Operational Group To be different elements of intermediate care, identifying reviewed inequities

• Identify gaps in services and restrictions in access to April 06 services e.g. people with mental health problems Task Group No: 1,2,4 To be accessing beds, out of hours access and provision reviewed

Strategic Objective Action Required Rationale is detailed Lead Officer(s) Timescale within the strategy. • Identify the shortfall in provision and need for specialist IC No: 1,2,4 Task Group April services, e.g. for older people with mental health conditions and produce options for addressing any shortfall

• Development and implementation of agreed admission and No:1,2,4 Operational Group Sept 06 discharge criteria for all services, including acute, intermediate and care at home services

Operational Group June 06 • Draft revised set of eligibility criteria to ensure an inclusive No:1,2,4 approach to intermediate care, taking account of national guidance and public health agenda

Workforce

• Develop proposals for neighbourhood integrated MDT’s for Page 42 IC, incorporating capacity for fast/slow stream, community No: 1,2 Task Group Feb 07 rehabilitation and enabling, fast response and provision of care in residential/nursing homes.

• Identify accommodation needs of workforce No: 2 Task Group Feb 07

• Formulate a workforce development strategy for IC and feed No: 2 into joint workforce development strategy Task Group Feb 07

• Review skills requirements of front line staff and introduce generic health and social care support workers to carry out No: 2 Task Group Feb 07 minor nursing tasks and implement therapy programmes in tandem with personal care plans, as necessary

• Identify career pathways to enable effective recruitment and No: 2 Task Group Feb 07 retention of skilled and committed staff

• Identify current shortfalls in skills and develop options and Task Group Feb 07 strategies for eliminating any shortfalls, including job No: 2 redesign, training programmes, recruitment drives, etc.

• Human Resources & Feb 07 Review revised NVQs in health and social care (due for No: 2 implementation in January 2005) and identify appropriate Learning & units/modules for ICS Development Strategic Objective Action Required Rationale is detailed Lead Officer(s) Timescale within the strategy.

Other:

• Ensure screening protocols for Dementia and Depression are June 06 incorporated into IC assessment processes No: 2,4 Task Group (Esra Bennett) • Enable all users of IC services to be offered the opportunity No: 2,4 June 06 of mental health screening

Task Group

• Identify person-centred assessment and care management (Esra Bennett) processes for individual programmes of intermediate care No: 1,2,4 June 06 Task Group (Esra Bennett)

• Ensure adequate data collections systems are in place to No: 3 Sam/Gill April 06 record and manage the delivery of services Page 43 Joint Commissioning Mar 07 • Review commissioning and contracting arrangements for the No:1,2,3,4 procurement of residential based IC services

Joint Commissioning Mar 07 • Review the current arrangements for ensuring the quality of

care provided in IC units and ensure compliance with NCS No:2,3,4

• Task Group & Joint April 06 Review current arrangements for managing admissions and No:2,3,4 discharges from IC units and ensure compliance with NCS Commissioning

• Review management arrangements and structure and develop proposals for new joint manager of IC services, No:3 Task Group June 06 including remit, lines of accountability, professional and operational management, budget implications

Task Group in June 06 • Review pooled budget arrangements and identify any No:1,2,3,5 consultation with changes required in order to improve service delivery APOG

• Develop proposals for medical access for IC, including ongoing and urgent response No;2,3,4,5 Task Group April 06

Strategic Objective Action Required Rationale is detailed Lead Officer(s) Timescale within the strategy.

• Develop appropriate and safe systems for managing No;2,3,4,5 Operational Group in Dec 06 medication provision and compliance during IC services consultation with community pharmacy

• Develop single point of access No: 1,2,3,4,5 Task Group/ Feb 07

Operational Group • Identify how links will be established with A & E, paramedic Task Group/ Feb 07 practitioners, GPs, community health and social care No: 1,2,3,4,5 Operational Group professionals, care homes and the hospice

• Develop proposals for increasing capacity of IC services in Task Group/ Feb 07 accordance with need and to meet targets e.g. out of No: 1,2,3,4,5 hours, increased availability of rehabilitation services, etc. Operational Group

Page 44 • Task Group/ Feb 07 Develop proposals for improving access to IC for people No: 1,2,3,4,5 with mental health problems Operational Group

• Identify links and opportunities to work more closely with the No:1,2,5 Operational Group Ongoing voluntary sector to deliver IC and maintain the enabling throughout culture the Strategy • Ensure all service users are encouraged to access No: 1,2,4,5 Operational Group community based facilities wherever possible

Operational Group • Ensure service users are provided with information and No:3,4,5 access to support services

• Develop care pathway for IC, identifying how IC pathway links with other significant pathways e.g. LTC, falls, Stroke, No:2,4,5 Task Group Bariatrics etc Mar 07

• Ensure IC is an integral part of the long term conditions model. No:1,2,3,4,5 Task Group Mar 07

Strategic Objective Action Required Rationale is detailed Lead Officer(s) Timescale within the strategy.

• Develop a communications strategy to keep all affected stakeholders informed of how IC modernization is being No; 6 Task Group Jun 06 managed and the achievement of significant milestones

• Develop a consultation strategy for IC staff and service Task Group Feb 06 users to keep them engaged and to enable them to No; 2,3,6 evaluate and comment on the modernization process (Completed)

• Develop a detailed services specification outlining the No:7 Task Group Mar 07 requirements for delivering and managing IC services

• Page 45 Develop a business plan for IC to identify the gaps in Task Group Mar 07 resources in IC and future developments in accordance No; 7 with local and national demands

• Identify within the business plan an outline project plan of how the modernization process will be managed No;7 Task Group Mar 07

IC Strategy 2005/05 Action Plan (Draft) 17.11.05 Page 46 Agenda Item 14

ROTHERHAM METROPOLITAN BOROUGH COUNCIL – REPORT TO MEMBERS

Meeting: Social and Community Support Scrutiny Panel Date: 2 March 2006 Report written by: Susan Sumpner – Direct Payments Manager

An Update of the Progress made within Direct Payments in the Social Services Programme Area.

1. Introduction

1.1 This report will provide the Scrutiny Panel with an update of the progress made with regard to Direct Payments.

1.2 It will also highlight areas of achievement and future plans for the continued development of the Direct Payments Scheme.

2. Background

2.1 Direct Payments were introduced in 1997 with the introduction of the Community Care (Direct Payments) Act.

2.2 In April 2003 Local Authorities have been required to make Direct Payments to people who are assessed as eligible to receive them and want them.

2.3 However within Rotherham Social Services Direct Payment take-up was relatively poor (24 people were receiving a Direct Payment in April 2004) and could affect the Councils star rating if the take-up remained low.

2.4 In March 2004 the Social and Community Support Scrutiny Panel agreed to the setting up of a Scrutiny Review Group for Direct Payments, following these concerns.

2.5 The outcome of this review was the publishing of a report that contained 14 recommendations that were to be implemented to develop Direct Payments.

2.6 These recommendations where taken forward and developed into an action plan to improve the operation and take-up of Direct Payments.

3. Current Position 2006

3.1 Currently they are 375 users receiving a Direct Payment this can be broken down into the following service areas:

1 Page 47

Physical Disability 73 Learning Disability 35 Older People 89 Sensory Team 30 Mental Health 75 Disabled Children 44 Carers 29 TOTAL 375

3.2 There has been a significant increase in the take up of Direct Payments within the last 18 months. This has been achieved through the implementation of a clear action plan that incorporates the 14 recommendations made by the Scrutiny Panel Review Group.

3.3 The following highlights the areas of improvements achieved:

¾ Training – Training in Direct Payments has been made mandatory and a revised training Programme as proved successful with training days being full and waiting list having to be applied. ¾ Champions – Direct Payment Champions have been identified for all service areas and are positively promoting Direct Payments. ¾ Support Service – The support services to Direct Payments have been re-tendered and the service specification improved to meet service users needs. ¾ Direct Payments Team – The Direct Payments Team is now fully operational and available on a full time basis. ¾ User Involvement – User involvement is promoted and encourage with a good representation. ¾ Promotion – A full review of all promotional material was undertaken and all new revised publications on Direct Payments have been produced. Events, conferences and group forums have been organised and well attended. ¾ Communication – Full use of the internet, newsletters and CD ROMs have been used for staff to access information on Direct Payments. Attendance at Team Meetings has also encouraged support for staff. ¾ Regional Network – A Direct Payments Network as been developed for the South Yorkshire Area, this network gives an opportunity to share ideas, good practice and any operational problems etc.

3.4 The areas for improvement that are currently in progress are:

¾ Data Base – The implementation of the data base to improve management information is in progress, this will provide Direct

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Payments with a more accurate reporting mechanism and an effective way of storing information. ¾ Audit Procedures – The current Direct Payment audit procedures are complicated and time consuming, work is in progress to improve this process.

3.5 Developments in Direct Payments yet to be achieved include:

¾ Commissioning – There is a need to review all existing services and plan how these can be reviewed, reconfigured, recommissioned and decommissioned if necessary so that budgets do not get tied up in in-house provision leaving budgets overspent.

4. Changes in Policy Context

4.1 The recent White Paper, Our Health, Our Say: A New Direction for Community Services (Jan 2006) sets a new direction for the whole health and social care system. It confirms the Vision in the ‘Green Paper’ Independence, Well-being and Choice in which services are delivered ensuring they fit into peoples lives. The White Paper clearly states that Direct Payments should be offered to anyone in need of social care services and seeks to extend the availability of Direct Payments. They expect Local Authorities to set challenging targets for the take-up of Direct Payments.

5. Good Practice

5.1 Rotherham as achieved recognition for the increase in take-up of Direct Payments for people with mental health problems and have been given the opportunity to work with the National Institute for Mental Health Education (NIMHE) for the next 12 months.

5.2 Rotherham has almost 4 times the national average of people with mental health problems receiving a Direct Payment and has the highest number of people with mental health problems receiving a Direct Payment.

6. Future Plans and Considerations

6.1 In order to build on the current success of Direct Payments in Rotherham we need to consider the following future plans:

¾ To revise local commissioning strategies to take account of the changing patterns of demand for Direct Payments. ¾ To Include Direct Payments on all assessment documentation to ensure that service users and carers have been given the opportunity to receive a Direct Payment.

3 Page 49

¾ To continue to promote Direct Payments and reduce inequalities from services areas as to who is eligible and who gets offered the option of a Direct Payment. ¾ To develop the Direct Payments Team in line with the continued increase in Direct Payments to include a Direct Payments Support Worker.

4 ROTHERHAM METROPOLITAN BOROUGH COUNCIL

SOCIAL SERVICES PROGRAMME AREA

FORWARD PLAN

KEY DECISIONS BETWEEN 31 MARCH 2006 AND 30 JUNE 2006 – HEAD OF ADULT SOCIAL SERVICES

Matter subject of Proposed date of Proposed Method of Steps for making Documents to be key decision key decision consultees consultation and date by which considered by representations decision-maker and must be received date expected to be available

MARCH 2006 Page 50

Social Services Service 27th March, 2006 Cabinet Member Service Plans will have To Social Services Covering report and Plans been approved by Management Team or plans. Social Services Senior Originator Management Team

APRIL 2006

Agenda Item15 MAY 2006 Adult Social Services, Learning and Development Plan 2006/07

JUNE 2006

KEY DECISIONS BETWEEN 31 MARCH 2006 AND 30 JUNE 2006 – HEAD OF COMMISSIONING, QUALITY AND PERFORMANCE

MARCH 2006

Page 51

APRIL 2006

MAY 2006

Adult Social Services, 22nd May, 2006 Cabinet Member Learning and To Adult Social Covering report and Learning and Development Plan will Services Management plan. Development Plan – have been approved by Team or Originator 2006/2007 Adult Social Services Senior Management Team

JUNE 2006

Page 52 Agenda Item 16

ROTHERHAM BOROUGH COUNCIL – REPORT TO MEMBERS

1. Meeting: ADULT SERVICES AND HEALTH SCRUTINY PANEL

2. Date: 2 March 2006

3. Title: Annual Health Check Responses

4. Programme Area: Chief Executive’s

5. Summary

This report gives the Panel the background to the Health Check process and provides them with the responses to the local health trusts that were drafted by the Annual Health Check Working Group.

6. Recommendations

That

a. the Annual Health Check responses be noted.

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7. Proposals and Details

7.1 In April 2005, the Healthcare Commission launched a new approach to assessing and reporting called the Annual Health Check. This system is based upon measuring performance within a framework of national standards and targets set by Government.

7.2 The Annual Health Check has replaced the old ‘star ratings’ assessment system and looks at a much broader range of issues than the targets used previously, and seeks to make much better use of the data, judgments and expertise of others to focus on measuring what matters to people who use and provide healthcare services.

7.3 The overall aim of the new assessment of performance, and the information gained through the process, is to promote improvements in healthcare. It will also help people to make better informed decisions about their care, promote the sharing of information and give clearer expectations on standards of performance.

7.4 In April 2006, each health trust is required to provide a declaration of its compliance (or otherwise) against the Department of Health’s 24 core standards1.

7.5 Overview and scrutiny committees (along with patient and public involvement forums and strategic health authorities) are being invited to make comments on the performance of their local PCTs. Overview and scrutiny committees are not expected to comment on the trust’s performance against each of the 24 core standards. Instead, comments should be based on the evidence they have gained through their health scrutiny work and, if possible, cross-referenced against the relevant core standard.

7.6 The trusts are required to submit overview and scrutiny comments, unedited, with their declarations. The Healthcare Commission takes these comments into account when assessing the trusts and awarding them an overall rating.

7.7 At the draft declaration stage (October 2005), the Adult Services and Health Scrutiny Panel received presentations from several of our local health trusts. It agreed that responsibility for drafting overview and scrutiny’s comments at the final declaration stage should be delegated to a small member working group, comprising members from both the Adult Services and Health and the Children and Young People’s Services Scrutiny Panels.

7.8 The group comprised the following Members:

• Cllr Rose McNeeley (Children and Young People’s Services) • Cllr John Swift (Children and Young People’s Services) • Cllr Jo Burton (Adult Services and Health)2

1 which were introduced in July 2004 2 Cllr John Turner was also nominated from the Adult Services and Health Panel, but was unable to attend the meeting

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It met on 14 February 2006 and agreed the responses attached at Appendices 1 to 5.

8. Finance

There are no financial implications arising from this report.

9. Risks and Uncertainties

Although it is not a specific requirement, the Healthcare Commission suggests that overview and scrutiny comments may be shared with the relevant trust, prior to submission. By doing this, we can ensure that any comment based on a misunderstanding can be modified, before it is submitted.

10. Policy and Performance Agenda Implications

Contributing towards the Annual Health Check process is part of the Panel’s health scrutiny remit.

11. Background Papers and Consultation

Guidance for Overview and Scrutiny Committess – preparing for the Final Declaration, Heathcare Commission, January 2006

Contact: Delia Watts, Scrutiny Adviser, direct line: (01709) 822778 e-mail: [email protected] ……………………………..………

Page 55 Appendix 1: Draft Response to Doncaster and South Humber Healthcare NHS Trust

Metropolitan Borough of Rotherham

Cllr John Doyle Rotherham Town Hall, The Crofts, Moorgate Street, Rotherham, South Yorkshire S60 2TH Telephone 01709 822722/1 Facsimile 01709 822734

23 February 2006

Dr Gillian Fairfield Chief Executive Doncaster and South Humber Healthcare NHS Trust St Catharine’s House Tickhill Road, Balby Doncaster DN4 8QN

Dear Dr Fairfield

Healthcare Commission – Standards for Better Health, Final Declaration 2006

Under Rotherham Council’s overview and scrutiny arrangements, responsibility for health scrutiny is shared by the Adult Services and Health Scrutiny Panel and the Children and Young People’s Services Scrutiny Panel. Both panels have a wide range of other responsibilities, in addition to their health scrutiny role. This gives them a full work programme that does not leave room for health reviews specifically for the Annual Health Check process. However, where relevant information is gathered through our other health scrutiny work we are happy to use it to inform comments to form part of your submission to the Healthcare Commission.

Unfortunately our 2005/06 programmes have not included any work that focuses on the Doncaster and South Humber Healthcare NHS Trust, so we do not feel able to comment on your compliance with the Core Standards this year.

Page 56 Appendix 1: Draft Response to Doncaster and South Humber Healthcare NHS Trust

Over the next few months both scrutiny panels will be drawing up plans for work in 2006/2007 and will bear in mind the Annual Health Check process when doing so. We support the broader basis upon which health check ratings will be based and welcome the opportunity to contribute to the process.

Yours sincerely

Cllr John Doyle Cllr Ann Russell Chair of the Adult Services and Health Chair of the Children and Young People’s Scrutiny Panel Services Scrutiny Panel

Page 57 Appendix 2: Draft Response to Rotherham NHS Foundation Trust

Metropolitan Borough of Rotherham

Cllr John Doyle Rotherham Town Hall, The Crofts, Moorgate Street, Rotherham, South Yorkshire S60 2TH Telephone 01709 822722/1 Facsimile 01709 822734

23 February 2006

Mrs Sue Ball Clinical Governance and Risk Manager Rotherham NHS Foundation Trust General Management D Level Rotherham General Hospital Moorgate Road Rotherham S60 2UD

Dear Mrs Ball

Healthcare Commission – Standards for Better Health, Final Declaration 2006

Unfortunately our 2005/06 programmes have not included any work that focuses on the Rotherham NHS Foundation Trust, so we do not feel able to comment on your compliance with the Core Standards this year.

We would, however, like to thank you for organising the training workshop on the Annual Health Check process back in September 2005. It was extremely informative to those that attended and demonstrated a commitment to engaging with the scrutiny process.

Page 58 Appendix 2: Draft Response to Rotherham NHS Foundation Trust

Yours sincerely

Cllr John Doyle Cllr Ann Russell Chair of the Adult Services and Health Chair of the Children and Young People’s Scrutiny Panel Services Scrutiny Panel

Page 59 Appendix 3: Draft Response to Sheffield Teaching Hospitals NHS Foundation Trust

Metropolitan Borough of Rotherham

Cllr John Doyle Rotherham Town Hall, The Crofts, Moorgate Street, Rotherham, South Yorkshire S60 2TH Telephone 01709 822722/1 Facsimile 01709 822734

23 February 2006

Mr H N Riley Assistant Chief Executive/Director of Modernisation Sheffield Teaching Hospitals NHS Foundation Trust 8 Beech Hill Road Sheffield S10 2SB

Dear Mr Riley

Healthcare Commission – Standards for Better Health, Final Declaration 2006

Unfortunately our 2005/06 programmes have not included any work that focuses on the Sheffield Teaching Hospitals NHS Foundation Trust, so we do not feel able to comment on your compliance with the Core Standards this year.

We would, however, like to highlight the dialogue between the Adult Services and Health Panel’s Scrutiny Adviser and Tony Moore, your General Manager, Clinical Governance, which has developed since the draft declaration stage in October 2005. This, together with the sharing of your draft declaration and supporting information, has given us a better understanding of your Trust’s work and demonstrated your commitment to engaging with the scrutiny process.

Page 60 Appendix 3: Draft Response to Sheffield Teaching Hospitals NHS Foundation Trust

Yours sincerely

Cllr John Doyle Cllr Ann Russell Chair of the Adult Services and Health Chair of the Children and Young People’s Scrutiny Panel Services Scrutiny Panel

Page 61 Appendix 4: Draft Response to South Yorkshire Ambulance Services NHS Trust

Metropolitan Borough of Rotherham

Cllr John Doyle Rotherham Town Hall, The Crofts, Moorgate Street, Rotherham, South Yorkshire S60 2TH Telephone 01709 822722/1 Facsimile 01709 822734

23 February 2006

Mr R Shannon Chief Executive South Yorkshire Ambulance Services NHS Trust Trust Headquarters Fairfield Moorgate Road Rotherham S60 2BQ

Dear Mr Shannon

Healthcare Commission – Standards for Better Health, Final Declaration 2006

Unfortunately our 2005/06 programmes have not included any work that focuses on the South Yorkshire Ambulance Services NHS Trust, so we do not feel able to comment on your compliance with the Core Standards this year.

We would, however, like to thank you for the presentation on your draft declaration that was given to the Adult Services and Health Scrutiny Panel back in October 2005. It provided Members with a good overview of the work of your Trust and demonstrated a commitment to engaging with the scrutiny process. Close working between our two organisations at officer level (through the Local Authority Health Officers Working Group) has also been very useful.

Page 62 Appendix 4: Draft Response to South Yorkshire Ambulance Services NHS Trust

Yours sincerely

Cllr John Doyle Cllr Ann Russell Chair of the Adult Services and Health Chair of the Children and Young People’s Scrutiny Panel Services Scrutiny Panel

Page 63 Appendix 5: Draft Response to Rotherham NHS Primary Care Trust

Metropolitan Borough of Rotherham

Cllr John Doyle Rotherham Town Hall, The Crofts, Moorgate Street, Rotherham, South Yorkshire S60 2TH Telephone 01709 822722/1 Facsimile 01709 822734

23 February 2006

Viv Ainsworth Head of Clinical Governance Rotherham NHS Primary Care Trust Oak House Moorhead Way, Bramley Rotherham S66 1YY

Dear Ms Ainsworth

Healthcare Commission – Standards for Better Health, Final Declaration 2006

• The Adult Services and Health Scrutiny Panel was pleased to be consulted on the PCT’s Podiatry Services reconfiguration at an early stage. Having made recommendations on the scope of the ensuing consultation exercise, it was gratifying to see that these suggestions had been taken up, when the final outcome of the exercise was reported back to the Panel some months later. This supports the Trust’s compliance with Core Standard C17.

• Over the last year, the Adult Services and Health Panel has been kept abreast of joint work being done by the Council and PCT on Rotherham’s Public Health Strategy and commends its direct links with the five themes of Rotherham’s Community Strategy. This supports the Trust’s compliance with Core Standards C22(a) and C22(c).

• The Panel has found the periodic updates on practice and PCT-led developments of care premises extremely valuable. A separate presentation on proposals for a Primary Care centre for Rotherham was very informative Page 64 Appendix 5: Draft Response to Rotherham NHS Primary Care Trust and the Panel was impressed with the professionalism with which the consultation was undertaken. This supports the Trust’s compliance with Core Standard C17.

• The Children and Young People’s Services Scrutiny Panel was consulted at an early stage on the child health promotion programme. This supports the Trust’s compliance with Core Standard C17.

• In addition, the Panel received evidence from PCT staff during its review on the Impact of Domestic Violence on Children. This supports the Trust’s compliance with Core Standard C7(b).

• Over the last year a cross-panel member working group has been working on a review of Childhood Obesity. Although the review is only now reaching its conclusion, it is worth mentioning the excellent support provided by the PCT in terms of the advice and information supplied and the witnesses who have given evidence. This also supports the Trust’s compliance with Core Standard C7(b).

• In February, we undertook a half day scrutiny review of NHS Dental Services in Rotherham. The support (in the form of oral and written evidence) that we received from the PCT was excellent and we look forward to submitting our final report and recommendations in due course. During the review, we learnt about service provided by the Health Advice Centre (supporting the Trust’s compliance with Core Standard C16) and the emergency treatment available at the Dearne Valley Dental Access Centre (supporting the Trust’s compliance with Core Standard C19). Members were concerned that the latter service’s capacity did not appear to be sufficient but were told by the Director of Dental Public Heath that plans were afoot to expand the services provision. Rotherham (mirroring the national situation) has a shortage of NHS dentists, but the Panel learned of a number of initiatives being undertaken to help improve the position, such as the employment of dentists from Poland. The effects of these initiatives will contribute to the Trust’s compliance with Core Standard C18.

We would also like to thank you for the presentation on your draft declaration that was given to the Adult Services and Health Scrutiny Panel back in October 2005. It provided Members with a good overview of the work of your Trust and demonstrated a commitment to engaging with the scrutiny process. Close working between our two organisations at officer level (through the Local Authority Health Officers Working Group) has also been very useful.

Yours sincerely

Cllr John Doyle Cllr Ann Russell Chair of the Adult Services and Health Chair of the Children and Young People’s Scrutiny Panel Services Scrutiny Panel

Page 65 Agenda Item 17

ADULT SERVICES AND HEALTH SCRUTINY PANEL Thursday, 5th January, 2006

Present:- Councillor Doyle (in the Chair); Councillors The Mayor (Councillor Jack), Burke, Burton, Clarke, Jackson, Turner and Wootton.

Also in attendance were Sandra Bann (PPI Forum Rotherham PCT), Mrs. A. Clough (ROPES), Victoria Farnsworth and Sally Ferguson (Speak Up), Mr. G. Hewitt (Rotherham Carers' Forum), Ms. J. Mullins (Disability Network), Mr. R. H. Noble (Rotherham Hard of Hearing Soc.), Gladys Sherratt (Rotherham Hospitals Patient Public Involvement Forum) and Lizzie Williams (S.Y. Ambulance Service PPI).

Apologies for absence were received from Councillors Darby, Havenhand and Hodgkiss.

75. APOLOGIES FOR ABSENCE.

Apologies for absence were received from Councillors Darby, Havenhand and Hodgkiss.

76. DECLARATIONS OF INTEREST.

There were no declarations of interest.

77. QUESTIONS FROM MEMBERS OF THE PUBLIC AND THE PRESS.

There were no questions from the press and public.

78. ADULT SOCIAL SERVICES REVENUE BUDGET REPORT

As part of the current base budget review within the Council (July, 2005 – March, 2006), the Scrutiny Panel considered a report by Mark Scarrott, Finance and Accountancy Manager to inform members of the latest budget monitoring position for 2005/06 in Adult Social Services.

The report set out in detail the following areas of work:-

- Revenue Budget Monitoring Report 2005-06 - Base Budget Review – Adult Services - Medium Term Financial Strategy (MTFS)

Revenue Budget Monitoring Report 2005-06

The latest revenue budget monitoring report based on actual expenditure for the period April to the end of October 2005 shows a projected overspend for the year of £848,350 or + 1.58% for Adult and Strategic Services against a net revenue budget of £53,623,649 (excluding Central Establishment Charges). This figure includes the balance after reimbursement of charges made under Section 117 of the Mental Health

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Act, which after further advice from Legal Services is now less than forecasted.

The report set out a summary of the main budget pressures, together with action taken to reduce the projected overspends.

Appendix 1 provided a summary of the latest budget monitoring projections for Adult Services and Strategic Services, together with key actions being taken to bring the projected expenditure closer to budget.

This showed a projected overspend in Adult Services of £1,298,250 and projected underspend of £144,900 in Strategic Services, with the addition of £305,000 from the Section 117 repayments to clients which brought it back to £848,350 underspend.

Base Budget Review – Adult Services

The key findings from the panel which had met to discuss the recent Base Budget Review of Adult Services for 2006/07 can be summarised below:-

- the need to review the eligibility criteria for access to care services - concern regarding the currently low occupancy levels within the Council’s in-house residential care provision and the impact on value for money within the overall service - acknowledgement of the recruitment and retention difficulties currently being experienced and the strategies being implemented regarding the mix of qualified and unqualified social work staff and the need to protect standards of service provision - explore further opportunities of partnership working with the Primary Care Trust - Further develop consultation with client groups to help manage customer expectations and allow better targeting of services - Review of existing fees and charges

The Cabinet on the 14th December, 2005 approved a report which recommended an increase to the Fair Access to Care criteria threshold from ‘Moderate high’ to ‘Substantial’ and the proposed phased increase of non-residential charges over the next three years, which will align charges with Rotherham’s comparator group of authorities.

Medium Term Financial Strategy (MTFS)

As part of the budget-setting process Programme Areas had been requested to submit funding bids for demographic pressures, policy and legislative changes for the next three financial years. Appendix 2 showed the latest list of budget issues and pressures facing Adult Social Services. These bids are currently being considered by Corporate Management Page 67

Team and Cabinet Members, along with submissions from other Programme Areas, and had therefore not been approved.

The funding bids consisted mainly of existing unfunded budget pressures, demographic pressures and specific grants which end and are required to maintain existing levels of service. In addition to these funding bids there is a further budget requirement to fund the inflationary increase in pay and prices. Also, in line with previous years, Programme Areas are currently undertaking an exercise in identifying both cashable and non-cashable savings which will also be considered in determining the overall cash limited budget which is allocated to Adult Social Services for 2006/07.

One area of development is the Extra Care Housing developments, one scheme per year over the next three years.

However, there remained a number of recurrent budget pressures, demographic pressures on residential and domiciliary care services, increased demand for Direct Payments and recurrent pressures within Learning Disabilities residential care and supported living schemes which continue to be monitored closely.

In addition, the Programme Area had been asked to uplift this year’s budget for paying price increases. This could add £1.7 million to the budget for Adult Services and Strategic Services.

More recently, Programme Areas had been asked to consider savings across the Council, in line with Gershon efficiency savings of 2.5% over the next financial year.

Cabinet approval to change the Fair Access to Care Criteria and increase charges for non-residential services in line with comparative authorities, together with other measures outlined in the report, will bring the current pressures closer to budget.

Bids have been made into the MTFS to take account of the increase in demographic pressures being faced by the service over the next three years and are currently being debated, together with bids from other Programme Areas.

The meeting raised the following questions:-

- How realistically are the ‘demographic pressures’ calculated? Calculations are based on Government and local statistics which show that in some parts of Rotherham people are likely to live longer and need more care. Service planning is based on the present figures. However, the issue is about finding resources to pay for predicted increases in demand.

- Was there any reason for the current low occupancy levels in Local Authority residential care compared to private care homes?

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Current occupancy levels within LA homes are approximately 70%. Two homes were at least 50% which was partly related to longer term plans for residential care. It was not a reflection on the quality of care but rather that people and their families are choosing not to go into homes which may have a limited lifespan.

- Had consideration been given to the impact on staff due to future homes closing? A great deal of discussions had already taken place with Trade Unions on this matter. It was envisaged that more staff would be needed in the long- term plans for home care and extra care housing schemes. Whilst no guarantees could be given, every effort would be made to ensure existing staff would be employed in a similar sector of expertise. There was sufficient staff to meet these growing demands.

- Was the Authority taking full advantage of Government grants which are available? The majority of grants from Department of Health were allocated but the Authority maximised the use of external grant funding and spent accordingly. This included negotiations with the Primary Care Trust to ensure the Authority received the maximum contributions towards jointly- provided services.

- As the Authority could not cut back on the number of clients to be cared for, could the present overspend situation affect the rest of the Council or could it mean an increase in Council Tax from April, 2006? The level of Council Tax was a matter for elected Members to determine. Work was currently taking place to address longer term solutions which it is hoped will include an agreement from the Council to allow carry forward of the overspend to the next 2/3 years in order to allow it to be clawed back over that period. In addition, the Programme Area will be looking at savings across the Council.

- Could the Authority guarantee no service cutbacks to clients? Every necessary action will be put into operation to minimise the impact on clients. The budget process was a balancing exercise to budget correctly for service provision in anticipation of service demands.

- Had possible increases in fuel and council taxes been taken into account in terms of the impact on the budget in future years and, in business terms, was there at least three estimates of what the overall budget will be for the next twelve months? The Medium Term Financial Strategy was part of this work in predicting demographic pressures. A figure of approximately £5.2 million has been requested for 2006/07. plus the pay and price increase.

- How many new residential homes will the Council have and when would the new development start? The original proposal was for three homes but a decision had been taken to develop two sixty bedded homes at this stage. It is hoped to Page 69

commence a tendering process this month with a view to selecting a contractor by the end of March, 2006. As part of the medium term strategy, Care Standards required the LA to have homes up to minimum standard by the end of 2007. One home will be located in Dinnington and the other in Swinton. Outline planning permission had been obtained, therefore work would progress to the next stage.

- If overspends are carried forward into future years, how could they be eliminated completely? Was there a strategy in place not to build up overspends? No guarantees could be given with regard to the reduction of overspends or their eradication. Corporate discussions were taking place within the LA. Increasing demands were difficult to predict and could increase as more people are being supported at home and being provided with service. Every action had been taken to reduce overspends, which could be reduced further if demands on the service decreased.

The Medium Term Financial Strategy was part of a strategy which had been factored into the exercise to increase the budget needed for the next three years to address the demographic pressures.

Once the Extra Care Housing Schemes are operating, the first of which was due to open in April, 2006, it is hoped it will avoid people coming into long-term care unnecessarily. This should reduce part of the overspend as it is anticipated that the number of people will reduce over a period of time.

In terms of Home Care provision, more people will stay at home but this will be managed by the provision of less intensive intermediate care packages as people keep their independence more and they require less support and care. Future generations are not expected to have some of the same illnesses which are attributed to heavy industry.

The Government, in acknowledging that Local Authorities are finding it difficult to meet rising demands, had given a two year settlement to allow Authorities to plan for this.

- Was the increase in Direct Payments takeup affecting the budget? Direct Payments was an excellent initiative. More people were on Direct Payments but this had meant an extra £1 million had been spent from this year’s budget which was not anticipated. Without the Direct Payments system, this money would have come from the Home Care budget, which has higher hourly costs.

- Did this Scrutiny Panel have any control over Central Establishment Charges? Central Establishment Charges are not part of the cash-limited element of the Programme Area’s budget but are included in statistical returns controlled by Central Finance team. These charges would include accommodation costs and central corporate finance charges.

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- What had the Authority expected to pay in Section 117 Mental Health repayments? Approximately £350,000 but, on the advice of the Ombudsman and Legal Services, it had only been necessary to pay less clients from April, 2002 and not from April, 1993. Corporate Finance had recently agreed that this money could be used to decrease the overspend this year.

- Was internal training still taking place? Mandatory training on health and safety courses was taking place with external trainers. Personal development courses and conferences organised externally were presently not taking place.

- What are the proposed increases in non-residential charges? Proposals would help to minimise some of the overspend in this financial year but the details of those proposals and the report agreed by Cabinet on 14th December, 2005 were confidential at this stage pending letters being sent to clients.

- Had this Scrutiny Panel been involved in the decision-making process regarding recent increases in residential care charges? This had been referred to at the last Scrutiny Panel meeting but the details of individual cases was confidential. The Programme Area had worked hard to minimise the affects to make it as fair as possible in terms of the measures that have been taken.

- In terms of Fair Charging Policies, could some clients be re-assessed to pay less in future? Some carers were worried that they are presently on a low charge for the care their companion receives and are they likely to have high percentage increases. It is possible that some people who may have been disregarded because of the level of income, come into the charging policy in the future. Under the current policy, there is a maximum charge at the moment for community based home care of £35 per week regardless of the level of care that people receive. Other neighbouring authorities have a maximum charge of £200-300 per week.

- Whilst it was the case that the iron and steel industry had declined in Rotherham, it was felt there were other factors to be considered in terms of the health of the elderly population, such as the effects of economic deprivation and social isolation. There is an analysis across Rotherham in terms of how environmental and deprivation issues are factored in and how these factors impact on people’s lives.

- Some clients who were unable to afford to pay increased charges may be forced to go without care. Services will continue to be available. It is the eligibility criteria that will change.

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Resolved:- (1) That the latest financial monitoring information for 2005/06 be received.

(2) That the current pressures within the 2005/06 revenue budget and implications for the 2006/07 budget be noted.

79. MINUTES OF A MEETING OF THE ADULT SERVICES AND HEALTH SCRUTINY PANEL HELD ON 1ST DECEMBER, 2005

Resolved:- That the minutes of the above meeting be received and agreed.

80. MATTER ARISING

Podiatry Reconfiguration

The Scrutiny Panel discussed the aims of the proposal by Rotherham PCT on the reconfiguration and development of Community Podiatry clinics in Rotherham.

The Scrutiny Adviser outlined the background on the matter and some of the main aims of the proposal, one of which was to look at a total of 32 clinics with a recommendation to reduce to 16 sites, but more clinics being run from those sites and giving patients more choice of attendance.

Particular reference was made to concerns raised by Dr. M. H. Husain of Greasbrough Medical Centre. One member present was in agreement to some of Dr. Husain’s concerns, in particular how elderly and frail people were being expected to travel to alternative sites, and felt Dr. Husain’s concerns had not been responded to at the last Scrutiny Panel meeting by health representatives. It was therefore questioned how the reconfiguration exercise could be in the best interests of the community.

The Scrutiny Adviser gave an assurance that one of the aims of the proposal was to give more flexibility, for example if a person was visiting a younger family member in a different part of the Borough, he/she could choose to attend another clinic.

One Member commented on recent changes to the Podiatry Service at Doncaster Gate Hospital, in particular the removal of several “social” patients whom it was felt were capable of taking care of their own chiropody requirements. This was in order for resources to be re-directed to other much needed work, for example the removal of bunions under local anaesthetic, and chiropody for pregnant women. Diabetic podiatry would still be available.

One Member felt that some patients who could not afford the extra charges, could miss out on chiropody treatment.

The Scrutiny Adviser reported that, on behalf of this Scrutiny Panel, a

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letter had been sent to the PCT reflecting the views of this Panel to the reconfiguration exercise. In addition, the PCT had taken a full note of the comments made at the last meeting by scrutiny panel members in attendance.

Proposal to Develop a Primary Care Centre for Rotherham

The closing date of the consultation was 31st December, 2005. Once further information was available from the PCT it would be reported to this Panel.

Resolved:- That consideration be given to Members of this Scrutiny Panel visiting key sites in the Borough. For example, the Podiatry Clinic at Doncaster Gate Hospital and the South Yorkshire Ambulance Service.

81. MINUTES OF A MEETING OF THE PERFORMANCE AND SCRUTINY OVERVIEW COMMITTEE HELD ON 11TH AND 25TH NOVEMBER AND 9TH DECEMBER, 2005

That the minutes of the meetings of the above Committee held on 11th and 25th November and 9th December, 2005 be received.

82. MATTER ARISING

Joint One Day Scrutiny Review (Elderly People and Transport Issues)

The Scrutiny Adviser reported that the above joint review would be led by the Regeneration Scrutiny Panel.

Further information would be provided to Members of the Adult Services and Health Scrutiny Panel in due course.

(THE CHAIRMAN AUTHORISED CONSIDERATION OF THE FOLLOWING ITEM IN ORDER TO KEEP MEMBERS FULLY INFORMED)

83. TRAINING SESSION

The Chair informed the meeting that arrangements were taking place for a half day training session to be organised by the Scrutiny Adviser.

This would take place in late February/early March at the Moorgate Crofts Business Centre. The event would include lunch and the opportunity for networking.

The training event would focus on the current knowledge of Scrutiny Panel members on health issues and how to address any gaps. An overview of local health structures and ‘hot health topics’ would also be included.

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Further information would be sent to all Members when a date for the event had been determined.

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ADULT SERVICES AND HEALTH SCRUTINY PANEL Thursday, 2nd February, 2006

Present:- Councillor Doyle (in the Chair); Councillors Burke, Clarke, Havenhand, Jackson, St.John, Turner and Wootton.

Also in attendance were Sandra Bann (PPI Forum Rotherham PCT), Mrs. A. Clough (ROPES), Mr. G. Hewitt (Rotherham Carers' Forum), Ms. J. Mullins (Disability Network), Mr. R. H. Noble (Rotherham Hard of Hearing Soc.) Diana Swanson (Carers for Carers/and Carers Forum), Irene Samuels (South Yorkshire Ambulance PPI Forum) and Gladys Sherratt (Patient Public Involvement Forum).

84. APOLOGIES FOR ABSENCE

Apologies for absence were received from Councillors Darby and Hodgkiss, Vicki Farnsworth, Jonathan Evans and Lizzie Williams.

85. DECLARATIONS OF INTEREST

There were no Declarations of Interest.

86. QUESTIONS FROM MEMBERS OF THE PUBLIC AND THE PRESS

There were no questions from members of the public or the press.

87. FOCUSING ON HEALTH SCRUTINY SESSION - 3RD MARCH, 2006

The Chairman gave a verbal update on a proposed format for undertaking the work of Health Scrutiny.

A session was to take place on 3rd March, 2006 at the Moorgate Crofts Business Park and would commence at 1.30 p.m.

Lunch would be included.

The programme of work would consider:-

- the current level of knowledge of Panel members - how any gaps in health issues could be met

As part of this exercise, Members of the Scrutiny Panel, including co- optees, would shortly be interviewed.

Resolved:- That Members of this Scrutiny Panel contact the Scrutiny Adviser to arrange a convenient interview appointment and to confirm their attendance on the 3rd March, 2006.

88. REVIEW OF NHS DENTAL PROVISION IN ROTHERHAM

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The Chairman gave an introduction and background to the review of NHS Dental Provision in Rotherham. It was being undertaken in response to concerns of members of the community, and current media coverage, on difficulties in obtaining dental treatment, particularly for those not listed with a Dentist.

The object of the Scrutiny Review was to look at the facts behind those concerns and formulate recommendations in terms of a way forward.

This was the first of two Scrutiny Reviews to be carried out on this subject. The next Review would take place in about one year’s time when the effects of the new dental contract that begins in April 2006 will be known and a comparison can be made with the position today.

89. EVIDENCE FROM NIGEL THOMAS, DIRECTOR OF DENTAL PUBLIC HEALTH, ROTHERHAM PCT

The meeting welcomed Nigel Thomas, Director of Dental Public Health, Rotherham PCT, and Consultant in Dental Public Health who explained to the Scrutiny Panel why there was a need for dentistry and a Dental Health Service.

Nigel Thomas outlined his past and present work experiences, in particular the work he had carried out on behalf of South Yorkshire over a great number of years.

A presentation was given on the following issues:-

- Oral Health Status in Rotherham (from age 5 to adult) - Dental Health in 5 year olds - first guarantee that all children can be seen together in school - true reflection of the family background - graph showing the percentage of filled, missing and decayed teeth - Trends in Dental Health in 5 year olds - last survey undertaken in 2003 - Dental Health of 5 year olds by Ward - Dental Health of 5 year olds – Conclusions - Dental Health of 14 year olds in South Yorkshire 2002-03 - Much higher proportion of children receiving active treatment - dentists are working with areas of higher disease than lower disease - year on year improvement - Dental Health of Adults - Next Adult Survey to take place in 2008 - lack of clinical surveys – much more difficult target group - patterns of dental health in adults is very similar to teenagers - only half Rotherham adults attend a dentist Page 76

- National percentage of adults with no teeth - The role of Primary Dental Care - Current Registrations with a Dentist in Rotherham - Location of Dental Practices and Dental Clinics - Recent Changes – 3 practices lost to Rotherham - Greasbrough - Broom - Maltby (this may re-open) - Private Sector - 3 practices largely private or going private:- - Brecks - Wickersley - Moorgate - Other practices have an element of private care - New Dental Contract - What may Patients notice? - Main Features of the Contract - Changes in Pain Relief - National Oral Health Strategy

The following facts were reported:-

Compared to neighbouring Authorities, although not the worst in South Yorkshire, Rotherham was in the bottom quartile for dental health in England. The position will be difficult to improve on because of the absence of fluoride in the water and the general economic environment.

The vast majority of decay in 5 year olds was not treated. However, it should be remembered that all of the teeth of a child of this age will eventually be replaced by adult teeth.

Set against a background where Dental Health in the UK had generally been improving year on year, this is not the case for 5 year olds. Whilst there had been a slight improvement in 1990, the situation was now regressing to the level of 1997 and results showed the situation was no better now than in 1985.

Less than half the children at the age of 5 years were registered with a Dentist nationally.

It was a difficult age group to provide dental care for as the patients are often unwilling to be treated. Most dental decay in 5 year olds is therefore untreated.

Only Bassetlaw and Chesterfield had managed to achieve the National target for 5 year olds for All England for 2003 (i.e. fewer than one filled/missing/decayed tooth per patient). On average a Rotherham 5 year old will have nearly two filled/missing/decayed teeth.

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There was a considerable variation in disease levels between Wards in Rotherham with the 5 year olds in some wards having three times the level of dental decay than in other wards. This was a reflection of the social economic status of communities, with poverty being closely linked to poor dental health.

However, the dental health of 14 year olds and adults is improving, in line with national trends. Most dental decay was being treated and older people were keeping their own teeth longer. The percentage of people with no teeth used to be more than one third of the population in 1968, with parts of Rotherham even higher. Partly due to fluoride-containing toothpaste, the situation improved dramatically over the next 30 years, with the national figure in 1998 being only 13%. However, with more older people keeping their own teeth, there has been a rise in a particular type of tooth decay where the crown joins the root.

In looking at these statistics and the level of improvement, the Government closed three dental schools in the early 1990’s. However, this has resulted in an insufficient number of dentists being trained – with the current national shortage being approximately 1,000.

There was a dramatic improvement in the dental health of those under 35. Increasingly dentists would be needed for the older members of society, children, and those who wanted cosmetic changes.

Ninety per cent of dentistry is done in general dental practice. There are now 31 dental practices in Rotherham consisting of 79 dentists (approximately 1 dentist per 4280 population). To put this into context, there is one dentist for every 2,000 patients in France, and in Scandinavia it is approximately 1 dentist per 1,000 patients.

To address this there has been a substantial increase in the number of dental students taken on this year – an increase of 25%. However, it will take 5 years to train these students and see the benefits of them coming out into the workforce.

Rotherham PCT was taking part in an overseas dentists initiative. Rotherham employed 3 Polish dentists. Two were still working here but one had returned to Poland. A further 3 would shortly be employed in the Borough. These were very valued workers who were often trained in English and were very hard working. They had been a huge asset to the borough and had also been well supported by the Borough’s Polish community. The initiative will be reviewed in one year’s time.

New Dental Contract

NHS dentistry had been set up in 1948 based on 1930s needs. Dental charges were brought in in 1951 as a way of regulating the demand on NHS dentists and people seeking care. The issue has been controversial from that period onwards. Page 78

There are presently 400 different ‘items’ of dentistry. From the 1st April, 2006 dentists would no longer be paid a fee for a piece of treatment. Instead there will be three patient charge bands - £15.50 (for x-rays, examinations, scale and polishes), £42.50 (for any operative care) and £189 (for a crown, bridge or dentures). The top band is substantially below the current maximum that an individual can pay (£385), so patients requiring very complex work would benefit from the new system. There would still be exemptions from charges for people on low incomes.

The main features of the contract:-

- from April 2006, if a dentist left the NHS, the funding will remain with the PCT, giving it the opportunity to provide service elsewhere - Dentists will be paid monthly at a constant rate, based on the work they have done over the last 3 years. They will have to continue with a similar workload - the major change was that registration would end in April, 2006. The Department of Health felt registration had not worked and that it had blocked up the system with regular patients so that others found it hard to get dental care. Patients would still be on an “informal” list but once their course of treatment was finished they were no longer associated with the practice until they re-visited in the future and opened up a new course. It was hoped this may free up access for patients currently not registered and who were occasional attenders.

Female dentists currently outnumber male and seventy per cent of current dental students are female. General dental practice will therefore need to change to accommodate the requirements of the increasing number of female dentists, offering salaried positions and those that fit in with family responsibilities. The are of greatest undergraduate growth was in recruitment of asian women.

Dental Registrations

Rotherham had about the National average of number of children listed within the Borough. Central Doncaster and Sheffield South West and West had significantly higher levels. The present difficulty is the shortage of practices that are able to take on children. In the age group18 years of age and over, it was slightly better in comparison Nationally. Fifty per cent of 18 year olds and over were registered with a dentist against a National figure of 44% and falling.

Number of Practices

There is a practice in every one of the former mining communities. However, patients travel very widely and in the future practices willl be moved/set up in areas of greatest need.

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Rotherham had one practice limited to Orthodontics which provides essential services, particularly to children.

Three practices had been lost to Rotherham recently. It costs the same to set up a part-time facility as a full-time one and practices need to have sufficient patients to make them profitable.

All of Rotherham’s 31 practices were full and all provided NHS dentistry. This posed a great deal of difficulty if a practice closed.

Work was taking place to improve the situation and the NHS had recently been working with a dentist in Thorpe Hesley to transfer his premises into the Health Centre where he had doubled the number of surgeries. The effect of this should be felt in 2006.

Private Sector

Once an NHS Dentist moved to private practice it was inevitably a permanent move away from the NHS. The main reason for moving was to reduce their workload. It was therefore a challenge for the PCT to replace those practitioners with NHS provision as best they could.

Pain Relief – This would change from April, 2006 when PCT’s would be responsible for developing a new out of hours care service. Where a dentist was required to provide urgent out of hours treatment it would probably be at an Access Centre. Advice on pain relief was provided by Rotherham Health Advice Centre. They had had very little to do with dentists in the past in that there were few patient enquiries. However, the bulk of their enquiries were now about dental care. They direct patients to the practice that was running the pain relief service or those who were able to take on new patients. This system would remain under the new contract.

National Oral Health Strategy

A new draft of an Oral Health Strategy was published by the Department of Health in November, 2005, intended to provide guidance for the public.

The document emphasised that dental/oral health did not come from dentists but from lifestyles – i.e. from diet, attitudes, beliefs and culture. It improved with raised income and education, particularly of the mother.

Summary

Dental treatment must go hand in hand with prevention. The PCT was working very hard within the funding available to improve the service but it was important that Rotherham people understood the issues surrounding dental health and the shortage of dental care in the Borough.

It was hoped RMBC and Rotherham PCT would work more closely to gain Page 80

better oral health for people in the Rotherham Borough.

Question from members of the Scrutiny Panel-

- what strategies were in place to improve the uptake of adults to become involved in dentistry? - there seemed to be a great deal of ethnic minority G.P’s – was that repeated in dentistry? - could patients be automatically removed from registration – and, if so, was there a complaints system for patients? - what exercise had been carried out with the public in consultation about Access Centres? - why was fluoride not in the water? - did pain relief mean extraction? - was the move to private dentistry from NHS expected to be continuous? - were Asian females academically better than English students? - had there been any thought given to home treatment – as people were living longer and for people with disabilities? - why was it not possible to see a dentist of your choice if you registered with a dentist? - could a patient chose another dentist after the 1st April, 2006? - were the three price bands only for NHS patients?

Comments from members of the Scrutiny Panel:-

- in terms of prevention, there seemed to be an onus placed on individuals to ensure that they have regular check-ups - need for Government to acknowledge salary levels of Dentists are often lower than those of G.P’s – leading to a shortage of students wishing to embark on a dental career - Need for professionals to collectively address the issue of no improvement in 5 year old dental health compared to 1985 - not convinced that fluoride in water was dangerous - the Joint Dental Health Service did not offer the pain relief that local dentists offered - concern regarding increased payments - lack of disabled access at many dental practices - with the changeover of NHS dentists to private care, and the incentive to take on fewer patients, this would obviously have a negative impact on the availability of dentists

90. EVIDENCE

1. Jason Field, Rotherham NHS Dentist

Delia Watts, Scrutiny Adviser, read out a report by Jason Field, Rotherham NHS Dentist.

Jason Field was Chair of the Local Dental Committee who felt the report

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was fairly representative of general dentists in the area.

The report responded to questions raised by Members of the Scrutiny Panel as contained on the meeting’s agenda.

The main summary of the report was:-

(a) From a dentist’s perspective, how has the situation changed for NHS dentists in recent years?

Over the years there had been a noticeable decline in the number of dentists. With competition on the increase for jobs from the steadily increasing numbers of private practices, this had worsened the situation in this area. It was still very difficult to recruit as there were so few dentists nationwide.

(b) Under the present arrangements, how easy is it to focus on preventative work rather than remedial treatment? Do you expect this to change with the new contract?

Under the current pilot, PDS, there were no penalties for prevention. Many practices had invested in training staff and gaining qualifications in Oral Health Education. However, the New Contract would involve collecting points (Units of Dental Activity – UDA). No points would be collected for this important role. As practice funding would be related to the collection of an agreed number of UDA’s, it would mean many would not be able to devote time to this important role. They would instead be chasing UDA’s. Dentists did not feel removed from any treadmill effect as was promised. This system would be far worse than the current pilot.

Workload. Unhappiness to let the government dictate what happened in their practice. The view that they cannot provide the best quality treatment or level of care they wished to provide for their patients under the NHS. It was felt very few conversions to Private practice were as the result of merely higher remuneration. Most cited improved working lives seeing fewer patients for better quality, more appropriate oral care, and having time to spend with their patients.

(d) Which groups of patients are most likely to let their registration lapse? What factors influence this?

Not sure what is meant by “groups”. Most attend irregularly due to anxiety. Cost was an issue. After April, the new contract removed registration for everyone. Patients would be seen Page 82

when vacant appointment times arose – months in advance in most cases. New Contract would bring with it a disincentive to see new patients. Currently only 1 out of 32 practices would take new patients in Rotherham, and that decision was under review. It was the case that more new patients “failed to attend” and would also need much more treatment. With regard to the UDA points system, obviously dentists would be keener to collect the 3 UDA in a 15 minute appointment, than by taking 2 hours to achieve the same UDA value.

Access to emergency care for unregistered patients was difficult. The Access Centre, which took calls from 8.45 a.m. was usually full by 9.15 a.m. for appointments that day. Once out of pain, patients then had problems in accessing routine care if unregistered. The Health Advice Centre was swamped with calls from patients wishing to find a dentist.

(e) What are your views on the effect the new contract will have on the number of NHS dentists working in Rotherham? Do you expect those who continue to work in a different way e.g. focussing on different patient groups?

The new contract was highly likely to see a reduction in the number of NHS dentists. Some would wish to leave the NHS for their own reasons, to convert to private practice, retire or seek work elsewhere.

There were 4 training practices in Rotherham for new dentists (Vocational Dental Practitioners – VDP’s) where 3 wish to stay at the end of the training year (August 2006). Under the old arrangements, this would have been possible if there was enough work – not a problem in Rotherham. The new contract devolved funding to the PCT. In this case it appeared that there would be no funding to keep these dentists in post after August. This was an ironical situation since there was now the surgeries, quality dentists, high dental need, yet now, potentially, no finances available. These dentists would then be lost to the area.

(f) What effect do you expect the new fee structure to have on dentists and their patients?

Fee Structure could impact as people attended less often. This could mean it affected the practice’s ability to achieve UDA value. In turn this would impact on their NHS funding and could push some into the private domain. For patients it would be much worse. Most would pay considerably more. Examples, small denture from £60 to £189 – Crown from around £90 to £189. It was unlikely to deliver any improvement in dental health, far from it, as it may considerably lengthen times

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between patients’ visits to a dentist. In addition, it was felt it could hit the poorer and elderly communities the hardest.

Are there any particular outcomes that you would like to see from this review?-

• the need to lobby for emphasis on prevention in dental care to be added to the new contract • to identify ways of retaining their workforce • to help to ensure least able to pay are protected from huge extra costs, ensuring benefits are claimed where appropriate

Members of the Scrutiny Panel felt some of these views contradicted those expressed by Nigel Thomas, Director of Dental Public Health, Rotherham PCT earlier in the meeting. It was therefore suggested that any anomalies be cross checked.

2. Sandra Bann, GROW

The meeting was briefly informed of the role the organisation GROW (Giving Real Opportunities to Women) played.

It was a registered charity which had been established in 1998. The organisation worked with women of all ages and ethnic backgrounds who gave a great deal of support, advocacy and training to women. Many referrals came from Social Services and other key Agencies where women attend.

Women involved with GROW were primarily lone parents who had no family support and were isolated, with no self-confidence and low self- esteem. Many of them were in abusive situations, had problems due to childbirth, mis-use of alcohol or suicidal. The organisation also offers support to asylum seeker women.

The main problem for GROW was that if a person did not go to a dentist for more than 12 months, they could turn up to discover they were not registered.

A number of examples were given of situations which the organisation had become involved in when helping women and children to access emergency dental care.

The main problem stemmed from lack of money for bus fares/taxis, difficulty in travelling to “out of town” practices, especially for women suffering from mental illness, and the fact that dental care was not seen as a priority to most women other than in an emergency situation.

Quite a lot of women who had missed an appointment then had to pay £5 deposit. This could be a problem, particularly mid-week if a family was receiving benefits. In one situation a mother with a young child had been Page 84

refused a dentist because of a £15 outstanding account.

In addition, if a family was placed on an emergency list they could be waiting a long time at a practice to be seen, as there may be several other patients in the same situation.

Dental information was not easily accessible and most women did not always know how to access services.

In terms of women from the Women’s Refuge, the Health Advice Centre asked a person what their level of pain was, issued them a password and then allocated a dentist on that day.

People only tended to think of dentists when a pain occurred, which was when the service was at its most crucial. A lot of women merely suffered the pain at home and self-medicated.

Women the Organisation worked with could not afford to take out private dental insurance and it would not be a priority for women living on benefits with low income and financial commitments.

The best outcome for this Review would be free dental access for everyone.

Prevention was not an option for these women inasmuch as nutritional food and eating more healthily would be too expensive.

3. Diana Swanson, Carers for Carers/and Carers Forum

Diana Swanson outlined her role in this Organisation which had been formed approximately five years ago. The group consisted of carers who ran a group for carers. The Group aimed to improve things for the next group of carers.

The main issue for the Group was that patients with severe mental health problems, in one case a person hospitalised for up to 12 months, could be offered sheltered accommodation and other services upon discharge from hospital, yet were not given assistance with dental care.

People with learning disabilities were sometimes difficult to treat.

A parent with two children who had special needs had found it difficult to access an emergency dentist, but was helped by the group to find one. The lesson learned from this example was that if an individual was able to access the system and knew where the information was, they were more likely to be able to get the service.

A lot of parents lived on the outskirts of Rotherham and it was a matter of them being able to access ready cash in their pockets for transport to a dentist on the day of a crisis.

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Investigations had been made into the insurance system. Monthly premiums of between £18.40 - £40.00 had been quoted for a family of four for six monthly visits. People on low incomes could not afford this.

A survey of approximately 60 people had been conducted to ascertain who could afford to pay this. Some had said they would try to pay it but would have to sacrifice something else.

The outcomes that the Carers and Carers Forum would like to see were:-

- Need for a greater link into GPs’ surgeries because in the case of mental health there is a Carers’ Register for all carers in Rotherham whereby carers and service users are entitled to a complete medical every 12 months - need to improve partnership working between Community Mental Health Nurses/Community Mental Health Team and GP surgeries – this should include a link to Dental Care when people leave Hospital - need to improve publicity of Dental Care services available to the community - need to involve Dentists in community groups already set up by PCT

91. DEARNE VALLEY DENTAL CENTRE

The Scrutiny Adviser read out the following information on behalf of the Dearne Valley Dental Access Centre:-

The centre is one of 34 being built across England and opened in November, 2004.

The aims/purpose of the Service is to provide patients, who are not registered with a dentist, with treatment for acute dental problems. It caters for patients across Rotherham, Barnsley and Doncaster.

Fifty appointment slots are available each day.

The Centre houses services provided by both local dentists and specialist hospital consultants. It includes four dental surgeries, plus support and teaching facilities for dental students.

The facility benefits the dental students as well as the patients by giving them experience of drop-in style dentistry as well as traditional continuing care.

The Centre occupies the ground floor of a new building in the grounds of Montagu Hospital, Adwick Road, Mexborough, Doncaster.

Referrals should be made through NHS Direct on 0845 4647. Page 86

Patients are given a password that allows them to book an appointment the same day. Once all appointments are taken, patients are asked to call back the following day.

There are four full-time dentists.

92. ANECDOTAL EVIDENCE ABOUT ACCESSING NHS DENTISTRY IN ROTHERHAM

Members gave a number of examples of personal experiences they had encountered as users of the NHS Dental Care system over a great number of years in Rotherham.

These covered:-

- need for Dentist to be fully aware of personal phobias/fears – e.g. needles/gas and air equipment - education/care and forethought of dental nurses

93. SYNOPSIS OF ORAL EVIDENCE AND BACKGROUND INFORMATION

Delia Watts, Scrutiny Adviser, read out the following evidence from Ranee Townsend, Clinical Director of Community Dental Services, Rotherham PCT.

Aims/purpose of the Service

- to provide a specialised referral service for those patients for whom there is evidence that treatment is not possible within the general dental service - to provide oral health promotion programmes for priority groups in targeted areas - to carry out surveys which measure the dental health of groups within the population as required by the Commissioners and the Department of Health

Services Provided:-

1. Dental advice and treatment for: (a) Children with specialised treatment needs e.g. - behaviour management problems - learning/physical disabilities - medical problems - social issues (looked after children, children in need, child protection register) (b) Specific groups of adults e.g. - Learning difficulties - Complex physical disabilities - Severe mental health problems

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- Older people who are housebound 2. Oral health promotion programmes for priority groups e.g. - Ante/post natal groups - Preschool groups - Adult day centres and special Schools - Community groups 3. Training of other health care workers, teachers and carers in oral health promotion 4. Targeted dental screening programmes for schools and adult day centres

Locations of Service Provision: - Ferham Dental Clinic - Maltby Dental Clinic - Swallownest Dental Clinic - Wath Dental Clinic - Domiciliary care where appropriate

Referral Pathway

- general dental practitioners - general medical practitioners - health visitors, district nurses or any other health care workers - community workers - self

Patients will not be accepted by the service if they have been assessed as not requiring the specialised care provided by the community dental service.

Lack of access to dental services alone is not a reason for referral to the community dental service.

Merged Service

The community dental service in Rotherham is part of a merged service with Barnsley and Doncaster community dental services. The merged service is provided by Rotherham Primary Care Trust.

Staffing

The service has a staffing structure that includes 6 full time dentists. However, currently only 4 of these posts are filled.

Resolved:- That the Scrutiny Adviser consider inviting Ranee Townsend, Clinical Director of Community Dental Service, Rotherham PCT to the Health Scrutiny session on 3rd March, 2006.

94. RECOMMENDATIONS ARISING FROM THE REVIEW

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• To note – that If a person cared for someone who was over 65 years of age, the person who was being cared for would not be accepted for dental insurance.

• The acute 50 appointments available per day (at the Dearne Valley Dental Access Centre) are insufficient and more need to be provided.

• Suitability of siting of the Dearne Valley Dental Access Centre for Rotherham residents – could the possibility of more dental units or expansion be explored?

• Clear correlation between social/economical factors on poor dental health – need for more education around the use of sugar and its detrimental affects on dental health.

• Lack of fluoride in drinking water – fluoride toothpaste is far more potent in one single application than chemical dilution/dosage of fluoride in drinking water – is there a need to campaign?

• To note – plans for walk-in Dental Surgery in town centre – need for monitoring and lobbying of NHS from organisations/RMBC.

• The new contract does not provide incentives to undertake preventative work.

• Need for greater link/integration between GP’s and NHS Dentists – need for more information in GP surgeries/Health Centres.

• Scrutiny Panel in full agreement with the recommendations of Jason Fields (NHS Dentist). (see Minute No. 90 of this meeting)

• Need to address more dental care for housebound/disabled members of community – i.e. access to dental care for all.

• Need to consider the dental needs of children of single parents – and financial impact of present charging system when appointments are not kept.

• Need to consider the number of contacts with looked after children – specifically via foster parents/carers

Resolved:- That the Scrutiny Adviser submit a summary report of the discussion at this Scrutiny Panel, to the March meeting. This should include recommendations/suggestions for a suitable way forward of this Review.

(THE CHAIRMAN AUTHORISED CONSIDERATION OF THE FOLLOWING ITEM

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IN ORDER TO KEEP MEMBERS FULLY INFORMED)

95. HOLIDAY AID

Councillor Jackson reported verbally on the role of both himself and Councillor Havenhand on the above Organisation.

Holiday Aid, a National Organisation, had been in existence for 17 years, during which time they had raised a total of £432,000. Monies raised by Rotherham were match funded by the National Organisation who had felt it to be more cost effective to purchase caravans for their own use rather than relying on other people. Overheads and running costs were met by the National body or by Leisure Travel. and there were no administration costs. Therefore all monies donated were used to benefit families.

This had meant that 1,211 Rotherham families had been able to access a holiday of some kind which normally they would not have been able to afford.

The bulk of the holidays were mainly taken on East coast caravan sites, or holiday camps,

Rotherham’s involvement in the Organisation had always been fully supported by the serving Mayor, this year being no exception.

As with all Charities, Holiday Aid had suffered due to other national disasters and fund-raising but had eventually met its target and as a consequence 35 families had been granted holidays next year. This could represent in the region of 600 or 700 people being able to access holidays, who largely consisted of disadvantaged families.

The role of Holiday Aid was purely as a fund-raiser and they did not decide who went on holiday.

Recommendations for assistance came from Social Services and various other professional organisations, most of whom were young families with children.

It was a worthwhile service to the community and was specifically focussed on Rotherham families. Families were amazed at the dramatic difference it made to the family by taking them away.

Work was presently concentrating on the potential for claiming tax rebates on donations. This would give a further 28p in the pound.

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ADULT SERVICES AND HEALTH SCRUTINY PANEL Wednesday, 8th February, 2006

Present:- Councillor Doyle (in the Chair); Councillors The Mayor (Councillor Jack), Clarke, Havenhand, Jackson, Kirk,, St.John, Stonebridge,Turner and Wootton.

Also in attendance were Victoria Farnsworth and Jonathan Evans (Speak Up), Mr. G. Hewitt (Rotherham Carers' Forum), Ms. J. Mullins (Disability Network), and Gladys Sherratt (Patient Public Involvement Forum).

Apologies for absence were received from Councillors Cutts and Darby, Mr. R. H. Noble (Rotherham Hard of Hearing Soc.) and Ann Clough (ROPES).

96. APOLOGIES FOR ABSENCE

Apologies for absence were received from Councillors Cutts and Darby, Ray Noble and Ann Clough.

97. DECLARATIONS OF INTEREST

There were no declarations of interest made at the meeting.

98. QUESTIONS FROM MEMBERS OF THE PUBLIC AND THE PRESS

There were no questions from the public or the press.

99. EXCLUSION OF THE PRESS AND PUBLIC

Resolved:- That, under Section 100A(4) of the Local Government Act 1972, the press and public be excluded from the meeting for the following item of business on the grounds that it involves the likely disclosure of exempt information as defined in Paragraph 8 of Part 1 of Schedule 12A to the Local Government Act 1972

100. BUDGET 2006/07

The Scrutiny Panel received the following PowerPoint presentation in respect of the Budget for 2006/2007 for the Adult Services and Health programme area:-

Present Policies Budget – Current Pressures

• Learning Disabilities (residential and existing pressures) • Residential Care Older People’s Services • Increase in demographic pressures around Community Support Services • Implementation of the Modernisation Strategy – project management – implications for units costs • Significant increase in Direct Payments

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• Increase in infrastructure costs for Home Care Service (CSCI registration) • Reinstatement of average holidays and sick pay – residential and home care service

Budget Priorities 06/07

• The key aim for this financial year is to set a more realistic base budget addressing existing significant pressures where possible • Demographic pressures on Adult Social Services • Cost of continuing increase in Direct Payments • Additional places in residential care (Older People) • Addressing home care demographic pressures • Funding for Extra Care Housing Schemes 06/07

• 2005/06 Recurrent Budget Pressures

• 2006/07 Demographic Pressures

The Acting Executive Director outlined the various stages of the budget process, including the base budget review, Council priorities and present policies, in order to formulate a realistic budget for the next financial year.

Members raised a number of questions on proposals contained within the Savings Issues Paper Register which were fully debated and responded to by the Acting Executive Director.

These questions related to:-

- Occupancy Levels - Use of Agency Staff in Care Homes - Direct Payments System/Financial Assessments - Demographic Pressures – both domiciliary and residential - Statistical Information/Evidence/Comparison with neighbouring authorities and nationally - Partnership arrangements with NHS/PCT/VAR/Support Services - Day Care Services - Pricing Policies/Benchmarking/Risk Assessment/Invest to Save - Community Transport

Resolved:- (1) That the officers be thanked for their presentation.

(2) That the Panel’s comments and concerns be forwarded for consideration in the further final stages of the budget deliberations, as discussed, but that Cabinet be asked to consider ways of mitigating the impact of some of the proposals for savings.

(3) That the concern of members that no budget information was Page 92

submitted in respect of Lifelong Learning be noted.

(4) That the suggestion regarding a Budget Book for all Members, at the conclusion of the Base Budget Review exercise, be supported.

(Exempt under Paragraph 8 – report contains financial information proposed to be incurred by the authority for the supply of goods or services).

Page 93 Agenda Item 18

PERFORMANCE AND SCRUTINY OVERVIEW COMMITTEE 21st December, 2005

Present:- Councillor Stonebridge (in the Chair); The Mayor (Councillor Jack), Councillors Barron, Clarke, Doyle, Hall, Hussain, G. A. Russell, P. A. Russell, R. S. Russell and Whelbourn.

An apology for absence was received from Councillor Sangster.

115. DECLARATIONS OF INTEREST

There were no declarations of interest made at this meeting.

116. QUESTIONS FROM MEMBERS OF THE PUBLIC AND THE PRESS

There were no questions from members of the public or press.

117. GUIDE FOR MEMBERS AND OFFICERS ON REPRESENTING THE COUNCIL ON OUTSIDE BODIES AND MEMBERS AND OFFICERS' INDEMNITY

Further to Minute No. 64 of the meeting of this Committee held on 30th September, 2005, Richard Waller, Team Manager, Non-Contentious Team, presented the submitted report relating to the above.

The report set out the terms of reference set by this Committee and the recommendations of the Corporate Management Team following consideration of the issue at its meeting on 29th April, 2005.

Also submitted was the draft Guide for Members and Officers on representing the Council on Outside Bodies and Members’ and Officers’ Indemnity.

The Guide was split into four sections and covered: (a) Council Representatives (b) Company Directors (c) Trustees and (d) Immunity and Indemnity.

A simple aide-memoire would be prepared for members and officers’ use once the Guide had been approved.

Discussion and a question and answer session ensued and the following issues were covered :-

- importance of knowing one’s role and in which capacity the Council is being represented

- conflict of interest

- need to ensure aware of responsibilities and seek guidance

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- immunity and acting beyond powers

- need to fulfil the community leadership role

- implications for indemnity at Parish Council meetings and surgeries

- implications for members who sit on organisations but were not nominated by the Council to sit on them

- defamation implications

- remuneration and risk

- circumstances in which indemnity would not be given

- reimbursement of Council or Insurer’s costs

- training needs

- briefing requirements and arrangements

Resolved:- (1) That, subject to (5) below, this Committee supports the Guide and its adoption be processed through Cabinet.

(2) That, subject to (5) below, this Committee supports the proposed indemnity at Appendix E to the Guide and its adoption be processed through Cabinet.

(3) That the Guide, including the indemnity at Appendix E to the Guide, be referred to the Standards Committee for consideration.

(4) That the Chief Executive, Head of Legal and Democratic Services, training officers and identified contact officers look at the identified needs for representatives on outside bodies.

(5) That further work be carried out on liability and the clarification of conflicts of interest.

(6) That the Members’ Training and Development Panel take up the issue of ensuring Members seek advice and training needs.

(7) That it be ensured that contact officers are identified and they keep in regular contact with representatives on Outside Bodies.

(8) That the Democratic Renewal Scrutiny Panel be requested to review the issue of representatives on outside bodies, linking this to the Council’s priorities and report back through the Cabinet.

(9) That Richard Waller be thanked for an informative report.

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118. CO-OPTION ONTO SCRUTINY PANELS

Cath Saltis, Head of Scrutiny Services, presented the submitted report indicating that, in order to help co-optees contribute to the scrutiny process, they had been provided with a comprehensive information pack. To enhance further their contribution, an extension of the co-option period from one to two years was proposed.

It was noted that, with the exception of the two tenant representatives on the Sustainable Communities Scrutiny Panel. co-optees have served on scrutiny panels for a one year period.

The co-option process was outlined, indicating that, for some organisations, the completion of the process could take up to six months. Such delays prevented representatives from benefiting from relevant training.

By extending the co-option period to two years, the administrative burden of nomination would be reduced for the organisations represented and co- optees would benefit from greater continuity and make a greater contribution to the scrutiny process.

Resolved:- (1) That the production and distribution of the information pack be noted and welcomed.

(2) That, with effect from April, 2006, the usual period of co-option onto scrutiny panels be for a period of two years.

119. MINUTES

Resolved:- That the minutes of the meeting held on 25th November, 2005 be approved as a correct record for signature by the Chairman subject to the joint one day scrutiny review on older people and transport (referred to in item 113(c)) being carried out by the Regeneration, Adult Services and Health and Children and Young People’s Scrutiny Panels.

120. WORK IN PROGRESS

Members of the Committee reported on the following issues :-

(a) Councillor Whelbourn reported

- that the scrutiny exercise on 12th December, 2005 had proved very useful and highlighted good questioning techniques

- on an initial meeting of the Electoral Services Review Group with Speak Up to discuss encouraging people with learning disabilities to take part in the democratic process and the production of a booklet on

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‘how to vote’ which was to be adapted from the Tameside model for submission to the Youth Cabinet

Councillor P. A. Russell, as the Council’s champion for learning disabilities, referred to a presentation that the Council was making in London on 18th January, 2006 and that the work being done by the Democratic Renewal Scrutiny Panel on involving people with learning disabilities could be useful for the presentation.

Agreed:- That Sioned-Mair Richards be requested to look at the possibility of linking up the initiatives.

- he had been asked to do a scrutiny session at the LGA Driving Improvement Conference in Newcastle on 1st March, 2006

- he had been asked by the Economic Social Research Council to give a presentation on ‘Managing the interface between scrutiny and the executive in a political environment’ in Warwick on 18th January, 2006

- the desirability of a further joint meeting with the Cabinet

121. CALL-IN ISSUES

There were no formal call in requests

Page 97 PERFORMANCE AND SCRUTINY OVERVIEW COMMITTEE - 20/01/06 1

PERFORMANCE AND SCRUTINY OVERVIEW COMMITTEE 20th January, 2006

Present:- Councillor Stonebridge (in the Chair); The Mayor (Councillor Jack), Councillors Barron, Clarke, Doyle, Hall, Hussain, G. A. Russell, R. S. Russell, Sangster and Whelbourn.

An apology for absence was received from Councillor P. A. Russell.

122. DECLARATIONS OF INTEREST

There were no declarations of interest made at this meeting.

123. QUESTIONS FROM MEMBERS OF THE PUBLIC AND THE PRESS

There were no questions from members of the public or press.

124. NEIGHBOURHOOD RENEWAL FUND (NRF) COMMISSIONING 2006/07 AND 2007/08

Lee Adams, Assistant Chief Executive, presented the submitted report relating to the above. The report indicated proposals for commissioning within the new round of NRF for 2006/07 and 2007/08 and sought support for the draft NRF Commissioning Framework.

The report outlined a process to ensure that funding was used strategically and to commission specific projects/pieces of work. This was designed to minimise the risk of local partners building up a further dependency on NRF funding and creating a future sustainability problem.

The report covered :-

- background situation - Steering Group - Area Assembly Fund and allocation breakdown - Community Chest - Resources, timescales and next steps - Existing project funding-reminder - Finance

Also submitted was the draft Commissioning Framework.

It was noted that the report had been considered by Cabinet at its meeting on 11th January, 2006 and the proposals were supported.

A question and answer session ensued and the following issues were covered :

- affordability - sustainability

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- exit strategies - spend by locality and focus on deprivation - impact of change in the Council on NRF - coherent grant aid and commissioning strategy - communities of interest - need to show spend and outputs/outcomes - working with partners - role of steering group and approval mechanism - executive responsibility - local Members : conflict of interest - governance - need to avoid duplication of work - concern re bureaucracy - need for clearer links to community strategy - need to ensure area assemblies and local members are working with the steering group

The general view was that involvement be welcomed as long as it was sustainable.

125. ACTION PLAN TO PROMOTE SOCIAL AND ECONOMIC WELL-BEING IN THE TOWN CENTRE

Further to Minute No. B163(2) of Cabinet held on 30th November, 2005, the Committee considered the submitted report, presented by Lee Adams, Assistant Chief Executive, relating to the above.

The report invited the Committee to consider the context, purpose and vision for developing a social and environmental well-being action plan to complement the Town centre Renaissance Programme. Further, it proposed a timescale for development, including consultation with Members, the public and key partners.

The report covered :-

- The Town Centre Renaissance Programme - The National and Regional Context - Local Context and Vision - Local Needs and Possible Areas for Focus - Developing the Action Plan - Timescales - Consultation

Discussion and a question and answer session ensued and the following issues were covered:-

- extent of footfall - next steps - elected Member input - consultation and need to consult with communities Page 99 PERFORMANCE AND SCRUTINY OVERVIEW COMMITTEE - 20/01/06 3

- Forge Island - architecture - level of ward member input - Police and Chamber of Commerce impact on business siting - deprivation in immediate vicinity of town centre - intermediate labour market - health deprivation profile - target group wanting to live in the town centre - Housing accommodation and allocations to key workers and low income families - profile of day and night economies - hotel accommodation - transport - town centre renaissance impact on spend per footfall - how to address ‘trickle down’ regarding Rotherham

The Chairman concluded the discussion and, in conclusion, highlighted the following issues :-

- whether the night economy was positive or negative

- need to know more regarding the size of the day and night economies, including a breakdown of age groups and gender

- health impact and actions

- need for elected member voice in appropriate arenas

- impact of the Police and Chamber of Commerce in determining the siting of businesses

- need to involve Ward Members

Resolved:- (1) That the information be noted and proposals be supported.

(2) That a progress report be submitted to a future meeting regarding the Town Centre Renaissance Programme.

126. CPA AND USE OF RESOURCES

Further to Minute No. B195(4) of Cabinet held on 11th January, 2006, the Committee considered the submitted report, as presented by Michael Walker, Performance and Quality Manager, relating to the above.

The report indicated that the new CPA use of resources judgement assessed how well the Council managed and use its financial resources. The assessment covered financial reporting, financial management, financial standing, internal control and value for money. This year, the Council had achieved a score of 3 (performing well) for use of resources, as shown in the attached draft report from the Audit Commission. The

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result had helped to ensure receipt of a 3 star CPA rating in December, 2005. Also submitted was a draft action plan.

Michael Walker gave a presentation covering :-

- CPA Use of Resources

- CPA The Harder Test

- Use of Resources CPA : Financial Reporting Financial Management Financial Standing Internal Controls Value for Money

- The way forward to the next level

Discussion and a question and answer session ensued and the following issues were covered :-

- current position and impact on scores - how much progress needed to move from level 3 to level 4 - quality of estimates - quality processes to enable continuous improvement - sustainability - reviewing key lines of enquiry (KLOE) - budget monitoring arrangements - ownership and management of budgets - need to identify budget holders and policy holders linked to the budget - nested compliance : need to ensure overarching priorities and themes are translated clearly into budget and work priorities - policy compliance - procurement boards

Resolved:- (1) That the content of the draft report from the Audit Commission and the overall scores for each category be noted and welcomed.

(2) That the action plan, now submitted, to address the areas for improvement, be approved as far as this Committee is concerned.

(3) That this Committee commends the linking of budget and policy ownership including the identification of Cabinet Members to lead and drive policies.

(4) That Cath Saltis and Matthew Gladstone liaise with a view to all key lines of enquiry being reviewed by the end of March, 2006.

(5) That the Committee places on record its thanks to Michael Walker for Page 101 PERFORMANCE AND SCRUTINY OVERVIEW COMMITTEE - 20/01/06 5

his services to the Council and he be wished every future success in his new post at Wigan Metropolitan Borough Council.

127. TIME OUT SESSION

Resolved:- That Members inform the scrutiny office of their availability in respect of the proposed dates.

128. MINUTES

Resolved:- That the minutes of the meeting held on 21st December, 2005 be approved as a correct record for signature by the Chairman.

129. MEMBERS CONSULTATION ADVISORY GROUP

Resolved:- That the minutes of the meeting of the Members Consultation Advisory Group held on 1st December, 2005 be received.

130. WORK IN PROGRESS

Members of the Committee reported on the following issues :-

(a) Councillors Whelbourn and Doyle referred to work regarding quality of report writing and plain English initiatives.

(b) Councillor Barron reported that a review was to take place regarding bullying policies in schools

(c) Councillor Hall reported that the full investigation inspection report of housing in the ownership of the Council was awaited. An interim report on gas appliances in OAP bungalows had been considered.

(d) Councillor Stonebridge reminded Members to indicate their preferred dates for the time out session and suggested possible items for discussion including :

- commissioning of reports by external auditors

- Cabinet reporting annually on adoption of scrutiny recommendations

- self assessment scrutiny working

- plain English initiatives

131. CALL-IN ISSUES

There were no formal call in requests.