Hounslow Council

Agenda item

Performance Focus - Adult Social Care


Cllr Chatt reminded the committee that at the last meeting it considered the Quarter 2 Performance Report, and discussed under-performing indicators and action plans. The committee decided to look more in-depth at the Adult Social Care indicators BPIs 64, 65 and 67, and attached to the cover report are the action plans for each indicator for Quarters 2 and 3.


Cllr Chatt welcomed Cllr Kaur and officers Mun Thong Phung, Nigel Howcutt and Sally Duhig to the meeting and asked them to provide the presentation that had been circulated prior to the meeting. The following summary of key points emerged from the presentation and discussion that followed:


·         The service had been set stretch targets for each of these indicators. However the impact of increased demand, increasing complexity of need and constrained finances has meant that these have not been achievable. The reality is that the service is having to provide a service at minimum thresholds in order to meet demand within resources.

·         Despite challenges the service has made significant strides in recent years and received a positive peer challenge recently.

·         The market is challenging, and getting the right availability of places at the right price is difficult. There have been examples of contractors threatening to give contracts back although this has been rare, not least because of the work the service does with providers. The service is this year looking to allow for inflation factors which is helping but affordability will continue to be a concern.

·         The Council takes a dual approach to providing residential care. Firstly it has its own provision which is used as the first port of call. This also provides the Council with a good understanding of the market. Secondly the Council works with West London boroughs to set a baseline rate across the sub-region, adjusted to take account of differences across Councils.

·         Unlike some authorities, the Council does not resort to 15 minute visits and we pay at the London Living Wage, including our contractors. Care packages continue to be based upon needs.

·         With respect to BPI 64 (proportion of older people still at home after 91 days after discharge) the service is undertaking a profiling of recipients to better understand levels of need. This will include looking at those who were back in hospital very quickly which raises the questions about whether they were fit for discharge of if the support required was in place.

·         BPI 65 (measure positive outcomes from CRS interventions) is one of two indicators (the other being BPI 66) that measures whether the CRS improves independence and reduces need for long term care. In future these two indicators will be merged into one in order to provide a single view.

·         Profiling is also being undertaken to better understanding these outcomes. 49% increase or sustain levels of independence. The nature of long term conditions however is that health often deteriorates affecting potential levels of independence. This deterioration would be worse without reablement and rehabilitation support

·         There were some recipients whose needs were such that it was more expensive to provide domiciliary care than it would be to provide residential care. Whilst the broad strategic direction was for community-based care, the Council has planned for an additional 180 units of Extra-Care Housing and was on target to achieve this. The committee pointed out that were land availability to be an issue then there were disposed sites that had previously been used for residential care but had not yet been developed for other purposes. However Cllr Kaur assured the committee that the pipeline for delivery of the units was in place.

·         Cllr Kaur had also instructed the service to look at improving the use of customer feedback to help understand where improvements could be better. The service currently collates compliments and complaints and monitors these monthly, but was developing proposals for a more systematic and deep-dive approach.

·         BPI 67 measure the timeliness of hospital discharges. The Council had significantly improved performance in this area, and was the best performing in West London and was performing better than the London average. It was felt that the target set was unrealistic given the environment described.

·         Moving forward the service would be reviewing all the targets to take account of the outcome of profiling, predicting future demand and through better use of benchmarking against sub-regional and regional performance.



·         Cllr Kaur and officers to return in 3-4 months to set out the results from the profiling and to provide an overview of market conditions and pressures

·         Support Cllr Kaur’s move to use customer feedback as part of future profiling and targeting

·         Recommend that the Council utilises the Adult Social Care Precept in full in order to meet demand pressures


Supporting documents: