Agenda item

This report presents the People and Communities Directorate Plan to the Panel for initial consideration and feedback as part of the Council’s service planning and budget development process.

The Chairman invited Jane Shayler (Director, Adult Care & Health Commissioning) to introduce the report.

Jane Shayler explained that this report sets out the framework for the service planning and budget processes which lead up to the statutory and legal requirement for the Council to set a budget in February 2016. Proportionate equality analysis is being carried out on the proposals within the Directorate Plans.

Jane Shayler explained that there is a single Directorate Plan for People & Communities, which covers all ages.  It has also been presented by Ashley Ayre to the Children & Young Peoples’ PDS Panel.  She would, therefore, focus on the Adult Care and Community Health part of the plan which encompasses provision of statutory services under the Care Act 2014, provision of residential and nursing care, re-ablement, domiciliary care, community mental health services, drug & alcohol treatment, rehabilitation and preventative support, and social work services for people with learning disability or mental health needs and those in intensive supported living and extra care services.  I would also provide the provision of preventative services which prevent, reduce or delay care and support needs and slow the escalation of costs in meeting individual care and support needs; delivery of services which support the effective functioning of the wider NHS system and prevent unnecessary hospital admissions or delays to discharge from hospital; securing either directly or through commissioning of the services required to discharge all duties.

Jane Shayler took the Panel through Appendix 4 of the report (Finance & Resource Impacts) and highlighted £450k proposal for Substance Misuse which would involve contract re-negotiation and overall would be likely to impact on provider organisations with some reduction of staff in those organisations.

The Panel highlighted the following points:

Councillor Ball expressed his concern in reduction of Substance Misuse services.  Councillor Ball added that he was aware that the DHI (Developing Health and Independence) had struggled to cope with existing pressure, especially with people who were on waiting list for the programme.  It would have a knock on effect if people would not be able to access services.  Councillor Ball said the taking £450k out of Substance Misuse services could have large impact on the community where people, who were in detox, live.  Councillor Ball concluded by saying that some reduction in services must be considered, but £450k may be a little bit too much for Substance Misuse services.

Jane Shayler acknowledged that there is a risk in terms of increased waiting times for services and on wider implications. Both providers and the commissioners were satisfied that proposals could mitigate those impacts through service redesign, efficiencies from co-location of services to reduce accommodation costs, some reduction in management costs, and a shift from residential to community detox and rehabilitation. People who go through detox would need to be properly motivated, whether it is residential or community detox.

Councillor Gerrish (Cabinet Member for Finance and Resources) commented that he viewed the changes as improvements and cited the proposal to offer fewer one-to-one sessions and more group work where peers could support each other.  Councillor Gerrish also said that there would be a reduction in management side by bringing two organisations to work together, which would not result in reduction of the front line staff.

Councillor May said that he had worked with Councillor Gerrish on the Council’s budget.  Councillor May also said that officers should be given credit for setting up these proposals and that practical approach in working with people in detox in the community was, in his experience, preferable to placing people in residential institutions away from their community.

Councillor Organ asked if Transition services (from childhood to adulthood) had improved.

Jane Shayler responded that Transition services had improved significantly.  Some years ago, after one Government assessment, B&NES had been placed in the bottom quartile.  However, after the last assessment B&NES had moved to the top quartile.

Councillor Jackson expressed her concern on the last paragraph of page 56 of the report ‘Greater targeting of prevention and early-intervention services may impact on access to such services for those people with lower level needs. There is also likely to be a reduction in the range and type of services offered and, therefore, the options given to individuals over the type of service put in place to meet their assessed, eligible care and support needs.’ Councillor Jackson believed that this could result in increased Delayed Transfers of Care from hospital

Councillor Jackson asked what we would lose under service redesign in ‘Healthy lives, healthy people: community small grants scheme £22k’ (page 57).

Councillor Jackson also asked how Public Health intelligence work and remodelling public health programme would save £13k.

Jane Shayler replied that there had been challenges on the delayed transfers of care and this was a particular issue in relation to community hospitals discharge as the community hospitals play an important part in facilitating discharge from the RUH but then it can prove difficult to identify a package or placement as the people being discharged from the community hospitals have complex needs and require ongoing intensive support  Jane acknowledged that there are growing difficulties in Domiciliary Care capacity, particularly in some geographical areas within B&NES and for people with particularly complex needs.  Recently, an cloud-based IT system had been developed to match individual need with available domiciliary care capacity.  The system had improved the speed at which an individual’s assessed needs are matched with a domiciliary care providers able to meet those needs. The system is also gathering valuable information on the geographical shortfall in domiciliary care provision as well as the sorts of complex needs that are proving difficult to meet through “standard” domiciliary care and this will inform future commissioning intentions. Jane emphasised that B&NES still has less of a problem  than neighbouring areas in terms of domiciliary care provision. 

Jane Shayler commented that Public Health intelligence work and remodelling public health programme saving of £13k would be achieved through sharing and anlysise of intelligence between the Council and CCG (ie “in-house”) teams rather than contracting with external NHS organisations.

Jane Shayler also said that Healthy lives, healthy people: community small grants scheme of £22k would be a reduction in service as this sum was made available to voluntary organisations to help them achieve various public health related goals.  The Public Health team believed that this saving could be achieved without significant impact on service users.  Jane Shayler emphasised that despite this relatively small reduction, the Council has, over a long period of time, invested significantly in prevention, early-intervention and self-management and is committed to continuing this as a key priority.

It was RESOLVED to:

1)  Note the report;

2)  Forward Committee’s comments and concerns (about the knock on effect) to the Cabinet to consider;

3)  Note mitigation steps taken by officers; and

4)  Commend officers for their work and acknowledge that further work has been undertaken in forecasting future budget.