Agenda item

Report to follow.

Cllr Connor introduced this item and welcomed a number of local residents who had joined the meeting to explain some of the issues that they had experienced in getting aids and adaptations installed in their homes.

A couple spoke about the difficulties that they had in getting the right adaptations for their son who has disabilities. They explained that they had made two complaints against the Council to the Local Government and Social Care Ombudsman which had been determined in their favour. The first was on home adaptations and they stated that the main problems were that they were encouraged not to have all the adaptations that were needed, they felt that they had experienced hostility from staff members and that there had been poor communications and delays to the adaptations which had still not been fully completed. In particular, there had been concerned about delays to arranging replacement sides to their son’s bed as this represented a serious safety issue. Despite this, there did not appear to be provision within the system to prioritise actions that had urgent safety implications or any recognition of the seriousness of the need for such equipment.

The family had been housed with a specialist housing association by the Council and there had recently been an issue with a flooded toilet. They said that, despite contacting the housing association, the flooding continued for nearly a week until they eventually hired their own plumber at a substantial expense.

Another resident with significant long-term mobility issues following an operation, spoke about her experience of needing a ramp to be installed at her home and adaptations to a toilet. She said that a visit had taken place to take measurements for this but then there was no further contact for a significant period of time. A contractor then made changes to the bathroom but the standard of the work was so poor that she contacted the Council the same day asking them to inspect the work. However, this was not done. The toilet later started leaking with the water pouring downstairs requiring an emergency call-out. The ramp had been significantly delayed meaning that she had not been able to use her back garden for four years. She felt that lack of communication had been a problem in her case that required significant improvement in the service.

A resident who acted as a carer to a family member spoke to the Panel about their difficulties. They had experienced problems in obtaining a wheelchair after applying months previously and had experienced delays and poor communications which had led to the submission of a formal complaint. She added that the district nurses had been very helpful and had explained the assessment process clearly but, after the application had been made and measurements had been taken for the wheelchair, they did not hear anything further for months. She felt that the lack of a clear process and the lack of communications made this a difficult service for residents to use. Beverley Tarka, Director for Adults, clarified that wheelchair assessment fell under the remit of Whittington Health NHS Trust.

Another resident who had experienced problems with aids and adaptations said that he felt there was often a lack of understanding from the Council about why aids and adaptations were needed. He said that after his hoist had broken, which he needed to stand up and move around, he was told he could stay in bed which was not an acceptable response. Contacting the Council could involve being kept on hold for long periods of time. He suggested that the Council should carry out cold calling. Decisions on aids and adaptations were made by a Panel but he said that no one from the Panel had visited him to understand his needs and he suggested that decisions were made on a financial basis. He also observed that some staff had “interim” in their job title meaning that they could leave at any time. Vicky Murphy welcomed the suggestion on cold calling and said that she would review the telephone waiting times and whether additional resource was required. (ACTION) She added that she held an interim position but was absolutely committed to her job and to residents. Beverley Tarka added that there was now an offer in place to allow service user representation to take place at the assessment panel. Cllr das Neves commented that this change had been a direct result of feedback received and added that there was further work to do, including on how the Council communicates with residents.

Vicky Murphy, Assistant Director for Adults, told the Panel that an improvement plan had been put in place. It had been recognised that the disruptions caused by the Covid-19 pandemic had led to longer delays in the process. The number of people awaiting Occupational Therapy (OT) assessment had increased to 66 in 2022/23 compared with 44 the year before. Only 70 had been transferred to the Major Adaptations team and waiting awaiting allocation to a surveyor compared to 232 the year before so processes had put in place to move cases through the system more quickly. Works on site and works waiting to start had increased substantially and work surveyed and going onto the tendering system had increased to 431 from 91 the previous year. Increases to OT staffing levels had been made but there was a national shortage in this area.

In relation to the specific concerns raised by residents, Vicky Murphy noted that there appeared to be an issue about the reviewing of work which was a step in the process so she said that she would like to review why that hadn’t happened in addition to the issues around communications, and to feedback on this. (ACTION)

Vicky Murphy and Beverley Tarka, Director for Adults, then responded to questions from Panel Members

• Asked by Helena Kania how residents could contact staff out of hours, Vicky Murphy explained that the main contact would be through the housing provider’s emergency number for repair issues. The out of hours social work team could be contacted for care issues, the number for which was provided on the Council website.
• Asked by Helena Kania whether residents each had a named staff member allocated to them for their case for continuity, Vicky Murphy confirmed that when a referral was registered on the system there was an allocated worker, though this could change over the different steps of process. One of the residents said that this had not happened in their case.
• Cllr Brennan asked about the staff shortages and whether the surveyors were in-house. Vicky Murphy and Beverley Tarka explained that there were five in-house surveyors in the Major Adaptations Team but that some work was outsourced as well. Beverley Tarka agreed that there were workforce challenges and that they had recruited through apprentice positions to invest in training in this area. Cllr das Neves emphasised a focus on building up the Council’s own team but that it also made sense to bring in external resource to help deal with the backlog of work in the meantime.
• Asked by Cllr Brennan whether the delays could be mainly attributed to the pandemic, Beverley Tarka acknowledged that there had been historic issues of delays and challenges along the whole pathway for adaptations, but these issues around supply and workforce had been exacerbated by the pandemic.
• Cllr Iyngkaran asked about the communication issues and about whether there was a culture within the Council on this issue that needed addressing. Beverley Tarka acknowledged that there was work to be done and that the    corporate management had a focus on changing the culture of the customer service offer and bringing a strong values base to how the Council interacts with all residents. She added that the challenges in this particular area had been highlighted and that this could lead to frustrations so there was work to be done on this.
• Cllr Gourtsoyannis observed that the Council’s perceived lack of transparency on decision-making was a theme that had emerged. One of the residents added that there was no way for residents to know what the performance management markers were. She also expressed concerns about the 11-stage process outlined on the slides and the possibility of residents falling through the gaps and not knowing who to escalate things to when there were delays. Vicky Murphy said that further explanation about the process, including timeframes, could be added to this and shared publicly. (ACTION) She added that their electronic system was being changed next year which would help to improve the process.
• Cllr Gourtsoyannis noted that the Covid-19 pandemic was often blamed for delays and other issues although some problems were pre-existing. He expressed concern that the current inflation crisis could end up being attributed to ongoing issues in a similar way. Cllr das Neves agreed that it would be wrong to just blame the pandemic for the problems in this area but reiterated that it was also evident that a lot of actions had not been possible due to the pandemic. A lot of additional funding had recently been put into adult social care in recognition not just of the inflation issue but also increased levels of demand. She also commented that adult social care was in crisis nationally with inadequate levels of funding.
• Cllr Peacock said that she received a lot of complaints about the difficulties of getting through to adult social care services over the phone and being kept on hold for a long time and that as a ward Councillor it was also difficult to get a quick response after referring cases or to get someone to check that work had been carried out correctly. Vicky Murphy reiterated that she would review the cases where issues with communications problems had been reported. She also committed to review Stage 11 of the process which required the Occupational Therapist and surveyor to visit to sign off completed works. (ACTION) Cllr das Neves suggested that information about incidences of where things had gone wrong could be collated to establish whether there were any common themes. (ACTION)

Following the discussion, the Panel made the following recommendations(ACTION):

• When the initial assessment is made by the Occupational Therapist, the resident/family requiring the aid/adaptation should remain part of the process around the procurement of the aid/adaptation and be actively involved in any changes or updates to the agreed provision.
• An advocate should be offered by the Council (rather than only when specifically requested) to help with the initial discussion and remain part of the process to provide support to the resident where required. An advocate should also be made available where required when a resident was attending a meeting of an assessment Panel.
• Key communications/decisions should be confirmed in writing by email/letter so that the resident/family has a record of this.
• There should be a clear explanation for any delays and the resident/family given the opportunity to discuss any changes.
• A named person and contact details should be provided to the resident/family and kept up to date during the process.
• Suggestions made by the resident/family should be recorded on the case file and treated in the same way as those from professional staff as the resident/family are experts in their own case and situation.
• A record should be kept by the Council of all delays and the timescales agreed with the resident/family. Where the agreed timescales are exceeded, there should be an alert triggered so that the resident/family can be appropriately updated on progress with expectations set and urgent issues to be prioritised.
• The Commissioning team should look at widening provider choices for aids and adaptations to provide alternative options when delays or other problems occur.