If you require further information about this agenda please contact: Joan Conlon 020 8583 2071 -. HEALTH AND SOCIAL CARE SCRUTINY PANEL A meeting of the Health and Social Care Scrutiny Panel will be held in the Civic Centre, Lampton Road, Hounslow TW3 4DN on Wednesday, 9 February 2005 at 7:00 pm MEMBERSHIP Councillor Barwood- Chair Councillors Bath, Cooper, Fisher, Khwaja, Muston, Nakamura, Sangha and Vaught. Co-optees - Cherna Crome and Mel Collins AGENDA 1. Apologies for Absence, Declaration of Interest and other communication from Members 2. Minutes of the meeting of 12 January 2005 (Pages 1 - 5) 3. Matters Arising 4. Brentford Development - Integrated Health Impact Assessment (Pages 6 - 25) Discussion and decision. For Members’ information: - Extracts from ‘Local Government of Health: Using the new power to tackle health inequalities’ Lucy Hamer, Health Development Agency. - ‘Clarifying Health Impact Assessment, integrated impact assessment and health needs assessment’ HDA 5. Strategic and Financial Direction of Key Local Health and Social Care (Pages 26 - 185) Providers: a) Primary Care Trust (PCT) Health Delivery Plan ~ Cath Attlee b) West Middlesex Business Plan – Gail Wannell & Tkaczyk Dominic (Director of Finance and Performance) c) Social Services and Health Partnerships Business Plan and Resource Management ~ Susanna White and Maggie Wilson. 6. Referrals from Patient's Forum To formally receive any 7. Urgent Business Any other business, which the Chair agrees to consider on the grounds of urgency. 8. Date of Next Meeting DECLARING INTERESTS Committee members are reminded that if they have a personal interest in any matter being discussed at the meeting they must declare the interest and if the interest is also a prejudicial interest then they may not take part in any discussion or vote on the matter. T.WELSH, Assistant Chief Executive (Legal) London Borough of Hounslow, Civic Centre, Lampton Road, Hounslow TW3 4DN 4 February 2005 Agenda Item 2 At a meeting of the Health and Social Care Scrutiny Panel held on Wednesday, 12 January 2005 at 7:00 pm at Civic Centre, Lampton Road, Hounslow TW3 4DN. Present: Councillor Barwood (Chair), Councillors Fisher and Sangha. Cherna Crome and Mel Collins Councillor G Lal (for agenda item 5) Others in Attendance: Hounslow Council – Isabelle Granet, Scrutiny Officer, Sue Spurlock, AD (Community Care) Social Services and Health Partnerships, Maggie Wilson, Head of Strategy and Performance, Social Services and Health Partnerships, Jitendra Koria, Independent Living Manager, Social Services and Health Partnerships and Mike Jones, Disability Network Hounslow. Hounslow Primary Care Trust – John James (left at approx 8.00pm), Christine Hay Apologies for Absence Councillors Bath, Cooper, Khwaja, Muston, Nakamura and Vaught. 53. Declaration of Interest and other communication from Members The Chair welcomed Councillor G Lal, Executive Member for Supporting Vulnerable People to the meeting. She stressed the Panel was very pleased to welcome him to the meeting and apologies for the low number of councillors present. 54. Minutes of the meeting of 15th December 2004 The minutes of the meeting of 15 December 2004 were confirmed. 55. Direct Payments - The Hounslow Scheme See report of the Assistant Director, Community Care, Social Services and Health Partnerships (Agenda Item No 4) Sue Spurlock, Assistant Director, Community Care gave a presentation which outlined the direct payment scheme operating in the London Borough of Hounslow. She introduced Mr Jitendra Koria, Independent Living Manager and Mr Mike Jones of Disability Network Hounslow to the Panel. A report was also circulated with the agenda to facilitate the discussion. The Panel noted that under the Community Care Direct Payments Act local authorities were given the power to offer cash payments to users of Community Care Services as an alternative to providing or arranging services. Direct Payments (DP) were an initiative that enabled service users to purchase their own care, gave them an opportunity to take control of their care packages – enabling users to choose when they wished the care package to be delivered, how they wished the care to be given and by whom. DP’s enabled users to have greater choice and flexibility. It was noted that DP was not a service instead it was a way of providing a service to the client groups as set out on page 1 of the report. 1 The Chair welcomed questions Councillor Sangha enquired what support mechanisms were available once service users chose to use Direct Payments. He was advised that once the client had shown a willingness to consider using the DP scheme a DP adviser who would support them through the entire process was appointed. The support was ongoing and just a phone call away. Councillor Fisher enquired about the key benefits and key difficulties for DP recipients and their carers. Sue Spurlock explained that the DP scheme allowed clients to organise their own care, offered more choice and gave clients control over their care arrangements. DP enabled the client to arrange support specially tailored to meet their needs. In terms of the ‘downside’ of the DP scheme it was suggested that clients sometimes found managing the monitoring & scrutiny aspect of the scheme to be a challenge, however the DP Adviser was on hand to support the client and feedback suggested that most clients felt able to secure greater continuity / flexibility of care with DP than they had previously experienced through local authority – arranged provision. Mel Collins, Co-opted Member asked about the steps taken to prevent fraudulent activity by the client/ carer in receipt of DP payments and the panel were advised that each recipient must provide returns to the DP Team that included, time sheets and or agency invoices, bank statements, other invoices receipts and the monitoring form. The DP team would scrutinise the information to ensure that the client was managing their DP correctly. Cherna Crome, Co-opted Member suggested that some Older People / carers found accessing and using Direct Payments difficult and she enquired whether there were any plans to introduce a voucher scheme. The panel noted that the Council were about to implement the voucher scheme in Hounslow. It was hoped that the voucher scheme could be used as a stepping-stone to clients using DP. In response to a question from the Chair on the support offered to DP clients if their carers / personal assistant left, the panel were advised that support to recruit and replace the personal assistant / carer would be offered, adverts would be placed and a contingency plan was always available. Clients would continue to be supported until a replacement carer was employed. The Chair enquired about leaving the scheme and was advised that if a person wished to cancel the direct payment and return to Hounslow managed services this could be arranged swiftly. A review of the reason why the person wished to leave the scheme would be conducted. Councillor Fisher questioned the DP rates paid in Hounslow and enquired whether they were comparable to other London Boroughs, she was particularly keen to be advised whether the payment made was less than if the client’s services were being provided directly by Hounslow managed services. The panel were advised that an hourly rate of £10.13 was paid to carers and this was comparable to rates paid in other boroughs. Clients were provided with lists of various agencies prepared to provide a service for the hourly rate, it was acknowledged that if a client had special needs a care panel could review the package and make amendments are required. The support provided to people on the DP scheme and in particular the involvement of the Voluntary Sector who acted as advocates on behalf of client was outlined. 2 The Panel enquired whether Social Services and Health Partnerships were monitoring / researching the strengths, weaknesses and barriers to accessing the DP scheme. The Panel wished to know if services were available for clients to purchase, what monitoring was carried out to ensure the client’s needs were being met and why some clients chose not to use DP. The panel were advised that client feedback suggested that services were available and suitable. The voluntary sector operating in this sector raise any concerns and these would be addressed. In terms of monitoring whether work was being carried out by agencies the DP Team relied on the client to advise if this was working / or not. Feedback to date suggested that agencies were meeting the needs of clients. Jitendra Koria outlined the key stages in progressing a referral to the Direct payment scheme to implementation. The panel were also advised of the mean testing of the DP scheme and were reminded that Direct Payment was not a service in itself but a means of getting a service and all services were ‘chargeable’. Isabelle Granet, Scrutiny Officer enquired whether funds were provided to enable the client to advertise for a carer/ personal assistant. She also asked about the care provision in cases where care was required 24 hours a day, and what training was provided to the client in recruiting suitable carers/ pa’s. Jitendra Koria advised that Social Service training was accessible to those employed as personal assistants/ carers, a one off, £200 ‘set-up’ payment was provided to enable clients to recruit a pa/ carer. A requirement for two carers / twenty-four hour care would be assessed as part of the care plan and could be provided for. In response to the Chairs question on what happen if the client overspent the panel was advised that if the client overspent the DP Team would offer support and advice to help rectify the situation. If the problem persists the Team would reassess the care package and discuss the way forward with the client.