Archived decisions

9. DECLARATIONS OF INTEREST

Members were mindful that, where they believed they

had a personal or personal prejudicial interest in any

matter to be considered at the meeting, they should

normally at the time of the debate declare their interest,

and having regard to the circumstances described in

paragraphs 9, 10, 11 and 12 of the County Council's

Code of Conduct, consider whether to leave the

meeting whilst the matter was discussed save for

exercising any right to speak in accordance with

Paragraph 12 of the Code.

There were no declarations of interest.

10. MINUTES

The Minutes of the Committee held on 24 July 2009 were confirmed as a correct record and signed by the Chairman.

Arising thereon:

a. Minute No. 2 - Work Programme

The Chairman reported that following discussions with key officers it was felt that the proposal to look at "Why People get Alcohol Problems" was not an appropriate review for the Committee to undertake as work to look into such factors was currently ongoing. He advised Members that NHS Hampshire had been promoting Alcohol Awareness Week, details of which had been circulated.

11. CHAIRMAN'S COMMUNICATIONS

a. Councillor Pat West

The Chairman reported that Councillor Pat West had broken her foot which had resulted in her not being able to attend the meeting.

RESOLVED:

That the best wishes of the Committee be sent to Councillor Pat West and that she be wished a speedy recovery.

b. County Council Briefing

The Chairman reported that there would be a full Council Briefing on Adult Services on 25 November 2009, he urged all Members to attend.

c. Budget Briefing

The Chairman reminded Members that the Committee's budget briefing had been scheduled to take place on 1 December 2009, he urged all Members to attend.

d. Access to Services for People with Alcohol Problems

The Chairman reported that following the review of Access to Services for People with Alcohol Problems the performance in relation to national alcohol focused activity by service providers was still outstanding. There was still insufficient data to present a full picture to the Committee and the item had, therefore, been deferred to enable the Committee to be presented with all information.

12. MENTAL CAPACITY ACT

The Director of Adult Services presented a report on performance in Year 2 of the Independent Mental Capacity Act and the introduction of Deprivation of Liberty Safeguards (Item 5 in the Minute Book). Details were given about the Independent Mental Capacity Advocacy Service and Deprivation of Liberty Safeguards.

The Mental Capacity Act 2005 introduced a number of new measures to support people who lacked capacity to make particular decisions at particular times. One of those new measures was the Independent Mental Capacity Advocacy Service service, which was intended to provide representation of the wishes and feelings of people who lacked capacity, when they had no-one else to speak for them and they were having specific decisions made for them. Decision-makers had a legal duty to instruct advocates from the Independent Mental Capacity Advocacy Service when they were making decisions for unbefriended people about where they should live and whether or not they should have serious medical treatment. There were also discretionary powers to instruct an Independent Mental Capacity Advocacy when there were safeguarding adults proceedings involving people who lacked capacity, and for care reviews involving decisions about accommodation. In Hampshire, the Independent Mental Capacity Advocacy Service was jointly commissioned by the County Council and the Primary Care Trust from Hampshire Advocacy Regional Group, a consortium of advocacy schemes across Hampshire. Each member scheme had advocates trained for this work so that there were 25 Independent Mental Capacity Advocacies available across Hampshire and there was a central co-ordinator who received all referrals and allocated them appropriately. The service began on 1 April 2007. The most significant increases between 2007/08 and2008/09 were in referrals for decisions relating to serious medical treatment, which was evidence of increasing awareness of The most significant increases between 2007/08 and2008/09 were in referrals for decisions relating to serious medical treatment, which was evidence of increasing awareness of Independent Mental Capacity Advocacy and Mental Capacity Advocacy with health staff, and in adult protection cases: a decision was taken to relax the criteria for this discretionary power for people over 65 so that all adult protection cases for unbefriended people would be referred to Independent Mental Capacity Advocacy, as there was a lack of general advocacy for older people. It had not been able to show comparisons with national figures this year as the national Annual Report for Independent Mental Capacity Advocacy for 2008/2009 had not been published. The increase in referrals from 2007/08 to 2008/2009, fuelled by work with health colleagues and a widening of eligible recipients, has not yet been replicated in 2009/2010. At the recent contract monitoring meeting for the Independent Mental Capacity Advocacy service it had been decided that since there was some capacity in the contract the following initiatives would be put in place for the remainder of the year:

· Use of the discretionary power to provide an Independent Mental Capacity Advocacy for care reviews will be promoted and encouraged within Adult Services

· All relatives of someone who was deprived of their liberty would be offered support from an Independent Mental Capacity Advocacy, rather than just those who request the service.

· Once the national comparator figures were available the performance of the Hampshire service would be assessed and targets set for any necessary increases in activity in the year 2010/2011.

The Deprivation of Liberty Safeguards were introduced in April 2009 to protect the human rights of people who lacked capacity and were deprived of liberty in registered care homes or hospitals, but were not detained under the Mental Health Act 1983. This amendment to the Mental Capacity Act 2005 was a result of the European Court of Human Rights judgement in the Bournewood Case in October 2004. The main objective of Deprivation of Liberty Safeguards were to prevent deprivation of liberty whenever possible. However, when it was necessary in the person's best interests to prevent harm to them they would be assessed by a doctor and another staff member (social worker, nurse, Occupational Therapist or psychologist) to help the County Council (for care homes) or the Primary Care Trust (for hospitals) determine whether or not the deprivation should go ahead. Unbefriended people who were deprived of their liberty were entitled to a paid representative, and those with family representatives had access to the Independent Mental Capacity Advocacy Service for support. The County Council operated a joint Deprivation of Liberty Safeguards system with Hampshire Primary Care Trust, as the two supervisory bodies in the county, to receive referrals from all care homes and hospitals (managing authorities) and carried out assessments. The final decision about whether or not to authorise deprivation of liberty had to be made by the relevant supervisory body. The joint system was governed by a working agreement with NHS Hampshire. Before Deprivation of Liberty Safeguards were implemented, supervisory bodies were asked to submit estimates of how many assessments they were likely to be undertaking. In Hampshire a questionnaire was sent out to registered care homes asking them how many residents were likely to experience the factors that can lead to a deprivation of liberty. Based on the responses received, from 40% of homes in the county, it was calculated that there could be up to 1000 assessments per year undertaken for people in care homes and hospitals in Hampshire. The Department of Health also made estimates based on number of care home beds, population and other factors and suggested that there might be in the region of 500 assessments in Hampshire. These figures were very difficult to estimate in advance of putting the legislation into practice and were calculated for planning purposes. It was clearly evident from the figures that the actual number of assessments was much smaller than anticipated either by the Department of Health or the County Council. The priority of Deprivation of Liberty Safeguards work was to ensure that all managing authorities were fully aware of the legal position regarding Deprivation of Liberty, to provide protection for all people who need to be deprived of liberty in their best interests and to minimise any unlawful deprivation of liberty. In future, supervisory bodies would be asked to submit estimates of future activity based on the number of assessments that had already happened, which would be far more accurate. During the first six months of the Deprivation of Liberty Safeguards service, experience of operating the system had led to some conclusions about how the system needed to operate in future. Staff working in the system had been very busy, even with much lower activity levels than anticipated, and this was due in considerable part to the complexity of the Department of Health defined system.

The ability to carry out plans for resourcing the Deprivation of Liberty Safeguards system was dependent on availability of budget. Department of Health funding for Mental Capacity Act and Deprivation of Liberty Safeguards, located in the area based grants, had only been specified until March 2011, which was limiting the potential for planning further ahead.

RESOLVED:

That an update on the Deprivation of Liberty Safeguards service be given when the national comparator data was available, in order to scrutinise assessment and referral details and when known Deprivation of Liberty Safeguards and Independent Mental Capacity Advocacy be covered in the budget presentation for 2010/11.

13. MENTAL HEALTH

The Director of Adult Services presented a report on performance in relation to the annual mental Health National Service Framework, the use of the Mental Health Act and the National Service User Survey (Item 4 in the Minute Book).

This was the final year of the National Service Framework ten year programme for modernising mental health services. NHS Hampshire and the County Council's Adult Services held joint responsibility for the implementation and monitoring of the National Service Framework in partnership with statutory, third sector organisations, service users and carers. In Hampshire there were three Local Implementation Teams covering the South East, West and North of the county and one Stakeholder Group in the North East, which were the primary means for achieving this. There had been annual assessments on a range of targets since 2000, which had changed depending on national progress on implementation and, in recent years, the responses to the themed reviews. For the first time since 2000, there were no red ratings within Hampshire and no ratings had regressed from last year.

Under the provisions of the Mental Health Act 1983 the County Council has a duty to appoint a `sufficient' number of Adult Mental Health Professionals to carry out its legal responsibilities of assessment of individuals who were identified as suffering from a mental disorder and in need of hospital admission, which might require detention. The Adult Mental Health Professional service was managed in collaboration with Hampshire Partnership NHS Foundation Trust and Surrey and Borders Partnership NHS Foundation Trust . Section 7 of the Act (Guardianship) gave the County Council powers in relation to people with mental disorder; to require residence, to require attendance at a specified time for the purpose of medical treatment, occupation, education or training, or to require access by a Doctor, Adult Mental Health Professional or other person specified by the guardian. Of the 1,574 assessments that took place across Hampshire, 80% involved adults aged 18-65, 16% older people, 3% children and young people and 1% people with a learning disability. The assessment of older people continued a downward trend and there was a slight reduction in assessments of people with a learning disability. Section 136 (the Police removing a mentally ill person from a public place to a place of safety) referrals made up a large percentage of the Approved Mental Health Professionals workload, and 71% of referrals made in 2008/09 resulted in no admission for further assessment. Investigation was currently ongoing into how these figures could be decreased, but emerging findings showed that alcohol was a factor in these (which was excluded under the Mental Health Act). Closer working and tighter police practices would be the solutions.

There had been a change in focus for the 2009 national Service User Survey which had resulted in comparisons with previous years being difficult. Initial data showed that 54% of people who had used in-patient services in Hampshire Partnership NHS Foundation Trust had considered them excellent or very good compared with the national average of 48%. Initial data for Surrey and Borders NHS Foundation Trust did not appear to be so positive but of its four unite only one admitted Hampshire residents.

NHS Hampshire and Adult Services were developing a joint health and social care commissioning strategy which would act as a vehicle for achieving personalisation, choice, quality and empowerment to improve access to services and reduce inequalities in outcomes over the next few years. Events for and consultations with service users were underway and a web site would be set up to give information about the process, progress and contributions received. It was proposed that the draft strategy would be written by May 2010 with formal consultation in summer 2010.

RESOLVED:

That:

a. the report be received and welcomed

b. the draft Mental Health Joint Commissioning Strategy

be presented to the Committee in July 2010.

14. PERSONALISATION AND COMMUNITY

INNOVATIONS (TRANSFORMATION OF ADULT SOCIAL CARE)

The Director of Adult Services presented a report giving an update on the transformation of Adult Social Care and progress on the Hampshire model with specific reference to work around the free crisis care pillar and the early intervention work being undertaken through Community Innovation Teams (Item 6 In the Minute Book).

The concordat "Putting People First - a shared vision and commitment to the transformation of Adult Social Care", made manifest a commitment to transform social care in this country by 2011. This involved moving to a more "personalised" system which emphasised the individual's dignity, right to self determination, choice, control and power over the support they receive. The vision gave greater recognition to the importance of prevention along with building community capacity and requires a whole system change. In 2008 the County Council undertook its own investigation into the future of a personalised social care system through a wide ranging consultation process. As a result it developed the Hampshire Model of Personalisation and this now framed the work of the Adult Services Department and the County Council. The Hampshire Model was a holistic and practical model to `put people first'. This was not just about adult services or social care; it is designed to stretch across all County Council departments covering everything from transport, to recreation, culture and other services. In this way the model created the opportunity for more integrated services and built on the benefits of working in partnership. Following the recommendations made by the Hampshire Commission six key areas were identified in order to address the areas of concern raised by the citizens of Hampshire. These 6 key areas were:

· Universal Offer - Access to Information and advice

· Free Crisis Care - To offer free crisis care for those who meet the eligibility criteria and who are at risk of admission to hospital or long term residential and nursing care, and at point of hospital discharge, when the risk of loss of independent and re-admission are high.

· Self Directed Support (SDS) - People would be able to make choices about how they want to live their life and the social care they need to have to help them to do that.

· Carers - To position Hampshire County Council's cares support and information solutions at the forefront of best practice

· User Involvement - To engage with service users throughout this process through their own user led organisations at a local and national level.

· Market Development - Developing the care market to support individual choice

Alongside these 6 pillars, there are two additional transformation streams which were:

· Learning Disabilities Transformation - to transform the services delivered to people with a learning disability and their carers.

· Process and Efficiency - to create a modern business which provided responsive customer focussed and efficient services.

Details were given of each of the pillars the development of personalisation within existing services, making the transition including workforce and culture and funding.

RESOLVED:

That the Committee receives further updates on the Transformation of Social care as follows:

· Self Directed Support / Service User Involvement (April 2010).

· Community Innovations / Free Crisis Care (July 2010).

· Learning Disabilities / Universal Offer (November 2010).

· Future funding for the Transformation of Social Care (when available).

15. HEALTH AND WELLBEING PARTNERSHIP

The Director of Adult Services presented a report giving information on the Hampshire Health and Wellbeing Partnership which was the principal vehicle for enabling a collaborative approach across Hampshire in order to deliver the health and wellbeing aspirations described within Shaping our Future together Hampshire's Sustainable Community Strategy 2008-2018. (Item 7 in the Minute Book). Details were given about the purpose and function of the Board and its key activities. A website on the partnership was in the process of being established.

The Board of the Partnership had been active for 15 months, but was still in its infancy given its work programme. All meetings took place in Winchester, details of which would be displayed on the Partnership's website

RESOLVED:

That the report be noted and the link to the new website be sent to all Members when available.

16. PREPARING FOR AN ELDERLY POPULATION (AGE

PROOFING MAINSTREAM PUBLIC SERVICES)

The Chief Executive updated the Committee on the progress that had been made to date by the Preparing for an Elderly Population Review Panel. Responses from stakeholders indicated that there was no set definition of older people and different organisations used ages from 50 upwards. Conclusions showed that:

· The majority of County Council Departments and partners did not engage specifically with the older person demographic.

· Where there was engagement feedback in an appropriate manner needed to be relayed to the older people who had contributed.

· Older people needed to feel that they had influence over planning and delivery of mainstream services.

· There was a lack of information relating to what services were available as to what services were available to older people and how they could be accessed.

In order to identify possible areas for improvement further questions had been sent to stakeholders with a deadline for replies of 1 December 2009. Following that a further meeting of the Review Panel would be arranged.

17. WORK PROGRAMME

The Chief Executive presented the work programme (Item 9 in the Minute Book).

RESOLVED:

That the Committee's Work Programme be approved

subject to the issues raised at this meeting.

Information be presented to the Committee when available.

An update on the Deprivation of Liberty Safeguards service be given when the national comparator data was available. Deprivation of Liberty Safeguards and Independent Mental Capacity Advocacy be included in the budget presentation for 2010/11.

The draft Mental Health Joint Commissioning Strategy be presented to the Committee in July 2010

The Committee receives further updates on the Transformation of Social care as follows:

Self Directed Support / Service User Involvement (April 2010).

Community Innovations / Free Crisis Care (July 2010).

Learning Disabilities / Universal Offer (November 2010).

Future funding for the Transformation of Social Care (when available).

Future Meeting

The new Health and Wellbeing Partnership website link be sent to all Members when available.

The Committee be updated on progress with the review

The work programme be updated to reflect issues raised at the meeting.