Agenda item

Jane Shayler introduced this item.

She said that in 2014/15 a balanced budget had been achieved, though some money had been moved between different budget headings to reflect specific pressures. The Council and CCG make additional contributions to off-set pressures in the Learning Disabilities Pooled Budget (section 3.1 of the report).  Contributions were made on a proportionate basis to reflect the respective, proportionate contributions by the Council and CCG.  These contributions were held outside of the pool and treated slightly differently by the Council and CCG to reflect differences in accountancy/financial planning approaches.  Some funding transferred under a section 256 arrangement by the CCG to the Council to offset pressures in social care had been utilised to fund specific pressures.

Sarah James explained how funding had been reallocated. John Holden commented that this had worked so far, but it would not be possible to continue it for ever, so some very tough decisions would have to be taken about priorities.

Ashely Ayre said that there were increasing pressures on the health and Council budgets. More people are living longer, had increasingly complex needs, and were dependent on publicly-provided services. There were, for example, children with multiple health conditions being taken to school in ambulances. The issue of how choice could be afforded had to be addressed. The costs of providing services to those with statutory needs will continue to grow and could, eventually, account for the whole of the Council budget if new approaches to meeting health and care needs cannot be found.

Jane Shayler said that there would come a point it would have to be asked whether an individual’s choice of a particular form of support could be afforded.  A package of support for one individual could cost £250,000. A decision might have to be made, for example, that a particular care package for keeping someone in their own home could not be afforded, and that their needs could be met by placing them in a nursing home. There was great benefit in preventative services, which could be effective in the long term, though very difficult to measure. The danger is that the increased cost of meeting present, urgent, statutory, needs would mean that there was less to invest in prevention.

Councillor Brian Simmons asked about older people. Jane Shayler said that older people in the area were living longer and maintained their independence for longer than average, as was generally the case throughout the south of the country.

John Holden said that while the recommendation was simply to note the report, what had emerged from the discussion was that the Council and the CCG had to be clear about the extent to which individuals can be given a wide range of choices about both care setting and provider.  It was agreed that this is an area of policy that both the Council and the CCG will need to consider carefully and engage with both decision makers and the public to work through what is a reasonable and sustainable policy in relation to individual choice and control. 

Jane Shayler advised that there are already controls in place, including a quality assurance and audit function along with a panel process, chaired by senior managers in the CCG and Council to agree placements and packages of care above a threshold.  Practitioners presenting the case to panel provide information on the individual’s needs assessment and costed options for meeting that need.  The practitioner assessment and the advice given to individual and any family members does have a big influence on the proposed package or placement and, therefore, on the Council’s commissioning budgets.  Changes in policy on choice do, therefore, need to be supported by training and development to support practice change.

Councillor Brian Simmons asked about what happened when care homes went bankrupt, as had happened in the case of homes run by Southern Cross Healthcare. Jane Shayler referenced recent reports in relation to Four Seasons Care, which is the largest provider of care homes and is reported to have financial difficulties.  In this instance, with a provider of 20,000 care home placements across the Country, contingency plans are likely to focus on financial recovery as it would not be possible to relocate 20,000 vulnerable individuals to alternative care homes as there is insufficient supply to do so.  In the case of the failure of a smaller care provider, plans – particularly where there are concerns about quality/safety of care, the Council and CCG works together to support planned moves and/or ensuring continuity of care.  Locally, in the case of Four Season, contingency planning is taking place but at this early stage, there is no immediate need to mobilise such plans.

Asked about transfer of funding responsibility from another Local Authority area, Jane confirmed that there is a mechanism, “Ordinary Residence” by which one LA becomes responsible for funding the care of an individual placed by another LA. In such a case B&NES would assume responsibility for the costs. Some level of movement between areas is normal, though some Local Authorities have a proactive policy of moving people to other areas as a way of managing their costs.

RESOLVED:

1.  To note the 2014/15 financial outturns on the partnership budgets.

2.  To note the 2015/16 finance and performance update.