Agenda item

This report presents the Council’s Operational Plan to the Select Committee for consideration and feedback as part of the Council’s operational planning and budget development process.

The Director for Integrated Health & Care Commissioning introduced this item to the Select Committee. She spoke of the fast-changing social and economic landscape that we are seeing means increased demand for services and growing expectations of the Council at a time when there’s less money and fewer resources to help. She added that all Councils in the country are facing similar pressures, particularly if they deliver social care.

She stated that the Council has invested in and improved the efficiency and effectiveness of social care services for adults and young people and that in the future we will continue to prioritise caring for our most vulnerable residents.

She stated however, it was important to understand the impact of rising costs and growing demand in this area. She informed them that social care services already account for almost 75 pence out of every pound we spend and that by next year (2018/19) we forecast that this will rise to 80 pence in every pound (net). She added that prioritising these services means that all of our other services need to be funded from what’s left - requiring some really tough decisions on where our money is best spent.

She set out some of the reasons for the rising costs of care.

·  More people are living longer with complex conditions

·  More children and young people are living with complex care and educational needs – an individual care package can cost up to £250,000

·  Recent care home closures have pushed up local costs

·  The national living wage is rising faster than inflation, which has a big impact on highly staffed services such as social care

·  We have more responsibility for children with special educational needs and disabilities (SEND). The number of SEND statements rose from 692 to 1062 between 2014-2017

She said that the increasing demand for services – particularly social care, but also in other areas – is placing unprecedented pressure on the Council. She explained that there are areas where individuals and communities can help to manage demand in the future and make our money go further.

·  Working Together - Increased collaboration between the Council and local communities, parish councils, partners and voluntary organisations will become increasingly important.

·  Staying well - Looking after your health by exercising and eating well increases your chances of staying well for longer – reducing the pressure on care services in the future. Together with our health partners we are delivering a lot of programmes to help.

She addressed the key changes that the Council is proposing, explaining

the plan doesn’t intend to capture every activity that the Council carries out, but focuses on the key changes over the coming years and highlights key projects that will help achieve our vision for the future.

The Chair asked how many beds had been lost due to the recent care home closures.

The Director for Integrated Health & Care Commissioning replied that over the past 12 – 18 months approximately 110 beds have been lost. She added that there was a significant challenge of staff recruitment and retention being faced by care providers and this is adding to cost pressures and can impact on continuity of care if there is a high turnover of staff. She said that commissioners do work closely with providers.

She informed them that in February the Council is due to publish its draft Market Position Statement and suggested that this draft MPS come to the Committee in March for engagement.

Councillor Tim Ball commented that he was concerned about the proposed reduction in Day Care as he felt it had the potential to miss some people out who might then require additional and more costly needs in later life.

The Director for Integrated Health & Care Commissioning replied that this was a specific savings target to Day Care Services being provided by Virgin Care.  Day services had been redesigned to focus more on independent living skills and employment skills.  She added that in addition to the day services provided by Virgin Care, day services are commissioned from a wide range of providers, including in the voluntary sector.  She added that in addition to the redesign of day services, some efficiencies have been achieved from transport including moving to more flexible, smaller vehicles. She added that this would help address how people access day services.

She said that the redesign would also help to manage the learning disabilities purchased care budget as effective day services help people remain independent for longer and to access employment and meaningful occupation, which helps with general health and wellbeing and resilience. 

Councillor Eleanor Jackson stated that the Connections Day Services in Radstock should remain open.

The Director for Integrated Health & Care Commissioning replied that there were no current plans for this facility to close and the reference to longer-term issues with Connections are related to the age of the building, which is not ideal to support the delivery of a modern day service.

Councillor Eleanor Jackson commented that she agreed that there should be a coordinated approach to this work to maximise independence. She said that she was surprised that in terms or re-ablement and across the plan generally that dementia is not referenced.

She said that a lack of residential care was causing a pressure on the Council and called for it to be rigorous through the planning process to have agreed sites built upon.

The Director for Integrated Health & Care Commissioning replied that some common themes were established during the recent Frailty Summit alongside the need to erode organisational boundaries. She said that voluntary and community providers, including, for example, Age UK had offered to be part of a multi-disciplinary approach. There is also an important role for Care Navigators to facilitate the access to information of community services and enable connection with peers for mutual support.  An important theme, including from the Your Care Your Way Community Services Review and from the Frailty Summit is tackling loneliness and isolation, not only in older people or in more rural communities.  Younger people and those living in more urban environments can experience loneliness and isolation, which can impact significantly on health and wellbeing.

Councillor Charles Gerrish, Cabinet Member for Finance and Efficiency commented that he was aware that his colleague Councillor Paul Myers, Cabinet Member for Economic and Community Regeneration had held positive meetings with representatives of the third sector regarding their future involvement and looking to do things differently.

Councillor Eleanor Jackson asked what was meant by the term "over-prescription” within the plan.

The Director for Integrated Health & Care Commissioning replied that this term is in the context of carrying out assessments for longer term care in the most appropriate environment, and that was not always within the RUH as this can result in an overly medicalised approach to meeting an individual’s needs and that it is generally better to undertake an assessment of someone’s ongoing needs either when they have returned home or in an alternative, interim care setting, for example, a “step-down” or “Discharge to Assess” bed.

The Chair asked if there were any further comments in relation to Joint Working.

Councillor Vic Pritchard, Cabinet Member for Adult Care, Health and Wellbeing replied that further integration was planned over this year between the Council and CCG, alongside close working with the three authorities involved in the STP.

The Director for Integrated Health & Care Commissioning added that work was ongoing to establish a single view of Primary Care / Health & Social Care. She said that there was a focus on complex needs, urgent care, prevention of hospitalisation and return to home.

She explained that there was huge potential for benefits and to streamline decision making, although there would be a challenge concerning different staff groups and their respective governance and terms and conditions.

Councillor Charles Gerrish added that the Cabinet have met with the CCG and were due to do so again before the end of this financial year.

The Strategic Director for People & Communities addressed the Select Committee to explain that as well as the Adult Care matters highlighted within the plan by the Director for Integrated Health & Care Commissioning there were also elements referring to Public Health and those that are cross cutting.

Councillor Eleanor Jackson said that the proposal to reduce staff in Public Health can only be seen as a cut.

Councillor Charles Gerrish replied that this was not a Council policy, but as a reduction of funding received from Government.

Following a motion from Councillor Eleanor Jackson the Select Committee RESOLVED to note the report and thank officers for their work in preparing the Plan.

Councillors Eleanor Jackson and Tim Ball agreed with this resolution, and also wished to register their regret at the cuts, growth avoidance and efficiencies listed within the Plan.