Agenda item

This report provides information to the Community and Wellbeing Scrutiny Committee on the activities of day services including during the COVID-19 pandemic.

Gill Vickers (Operational Director Adult Social Care) introduced the report. The Committee were advised that any day service provision started with an assessment of the individual and how their needs could be supported, looking at whether some form of day support needed to be commissioned through an independent provider, direct payments or a community support package. Adult social care were beginning to look at shaping the market to be clear all providers needed to be responsive and accessible to all groups of residents within Brent.

The Committee heard that during the pandemic all providers worked with social care teams where they had to shut buildings and looked at priority needs and how they could deliver through follow up phone calls, virtual working, and where permitted meeting outdoors to balance that need for occupation and mental wellbeing against safety from COVID-19.

James Pearce (Interim Head of Service for Complex and Direct Services, Brent Council) highlighted the immense challenge of the last year from March 2020. A decision had been made in March 2020 in line with the majority of London boroughs and across the country to shut building bases of day centres down which had planning implications for how to provide day services to those in receipt. This was in line with Public Health England guidance. He advised that the report outlined a narrative of what was done during the year to try to enable and ensure maintenance of those clients and family members. He added that generally clients and family members were strongly in agreement with the actions taken particularly during the first lockdown as the cohort were some of the most vulnerable in society and subject to the highest risk of outcome were they to contract COVID-19. Alternative methods to enable and support clients were put in place after a period of planning, including welfare calls at least weekly. An integral part of keeping in touch was identifying where people were struggling and needing additional support such as food supplies, activity and physical support, so work was often done in collaboration with colleagues from the learning disabilities team to arrange further support.

The Committee heard that opportunity to consider a digital and virtual response was realised, particularly for those with significant isolation, so activity packs were developed and online sessions were delivered with a number of areas where that had been effective managed and were still functioning still.

James Pearce advised that the team had also began looking at co-production with independent providers of day care to ensure what was being offered was aligned with the Council offer, directly involving staff and visiting other services to see how they were working.

The Chair thanked adult social care colleagues for introducing the paper and invited those present to ask questions, with the following issues raised:

The Committee asked for assurance that independent advisers who provided culturally appropriate support would not be decommissioned if they had an unsuitable building. James Pearce advised that their challenge was to make buildings usable and viable. Andrew Davies added that it was not the intention of the Council to recommission services without buildings and was not a conversation that had taken place with any independent day care providers. The Council respected the roots community providers had in the Borough and agreed they needed to support and work with providers across the cultural spectrum.

Andrew Davies confirmed that there was no intention to only guarantee payments to independent care providers until the end of June 2021, and the Council intended to work with day care providers and support them to reopen their services as well as help build their offer going forward through things such as virtual working and outreach. He highlighted that the Council had been paying independent day care providers on commissioned hours and services throughout the pandemic since March 2020 and at some point the Council would need to revert back to paying on actual delivered service but no decision had been made as to when that would be.

The Committee asked for a comment about the implications of the new model of delivering independent healthcare and whether independent providers would be expected to take more critically ill patients. Andrew Davies advised that there would be no requirement for independent day care providers to work with critically ill people but there had been several conversations with day care providers explaining that the people adult social care worked with did have complex needs and the reality was that the people day care providers would work with today had more complex needs than 15 years ago as a result of people living longer and comorbidities, therefore the Council did need day care providers who could work with a whole range of needs including complex needs.

The Committee asked what alternative structures were put in place as a result of the pandemic for more elderly day care users who may have been in isolation due to vulnerability to covid. James Pearce advised that day services continued to provide those services they would have usually in a different capacity for those who benefited from coming to services during the day and was not a 24/7 provision but rather enabled people to cope with isolation better as some elderly service users refused their home care services on the basis of the risk of COVID-19. He advised that the IT offer worked well for some, particularly if they had a carer to support the use, but it was not for everyone and often day care services were making alternative arrangements for additional support for those people while being aware of the risks of COVID-19.

Members of the Committee expressed that the welfare calls by day services were especially good for the elderly and those unable to leave their homes, and suggested those were continued even if day centres returned to physical services. Some Committee members felt that the support offered during the pandemic met the basic hierarchy of needs around physiology and safety and felt it likely that complexity of needs as a result of those who might have been deprived of those services might be much higher. James Pearce advised that work was already underway to identify those who the Council felt were most vulnerable and only got the very basics in the past year who may now need something major very quickly in terms of support. He added that day centres had already resumed the activities it was able to such as outside activities in small groups and it would as the next phase of lockdown easement would resume a pilot in direct services which was hoped would move safely and quickly.

The Committee asked what had been learned through the pandemic about service users. James Pearce expressed that they had learnt that service user’s fortitude and ability to carry on in these circumstances had been underestimated. The service had learnt to harness the situation as an opportunity, for example they had learnt that one service user with particular needs who struggled to utilise the building usually was far happier doing activities outside, and so listening to the service users would be key going forward. Whatever the service did going forward needed to prepare it for anything more to come to ensure the service could survive. In terms of co-production, James Pearce advised that work was happening with external day care providers and in-house direct services looking to collaborate across the borough to help each other, and in terms of carers and service users the service worked with the carers Board, dementia steering group and other groups actively to understand from their experience. Andrew Davies added that they were designing services working with service users and their families directly on what services would look like in the future. In the past year services and offers had been combined in a way that hadn’t been done in the past and there was a wish to keep that moving forward into the future. Gill Vickers added that it was important to also get the views of the communities that the service had not yet been able to engage with.

The Chair moved on to invite Committee members to make recommendations, with the following recommendations RESOLVED:

i)              In relation to the questions sent by Councillor Mary Daly, a response from Adult Social Care and Commissioning would be finalised to be shared with the Committee and where possible shared in the public domain.

ii)             To invite a further report in 6-9 months on the performance of day care services.