Agenda item

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

All Directorate Plans can be viewed at https://democracy.bathnes.gov.uk/ecCatDisplay.aspx?sch=doc&cat=13506

The Strategic Director for People and Communities introduced this item to the Panel. He informed them of the proposal to retain the 2% Council Tax precept for Adult Social Care that was introduced last year. 

He said that growth pressures of up to £4m for 2017/18 have been projected in adult social care particularly as a result of demographic change and inflationary pressures including the National Living Wage. It is considered that the savings proposals of 2.4m set out in the budget papers can be delivered through efficiencies and growth avoidance. This leaves the service with a funding gap of 1.6m. The Adult Social Care precept at 2 per cent will cover this gap and enable us to continue meeting our duties to assess and provide services in line with our existing plans.

Councillor Dine Romero asked if the savings associated with the Prime Provider Social Care & Health Contract were deliverable.

The Director of Integrated Health & Care Commissioning replied that existing savings targets from the Medium Term Financial Plan are incorporated into the contractual arrangements with Virgin and that these will be delivered in line with the approaches set out in the budget papers, including through efficiencies and new approaches to meeting individual’s needs, including support to access services that focus on prevention and enable people to maintain their independence. She added that the savings were challenging but that they were realistic and achievable.

She stated that the implementation of the new social care IT system, Liquidlogic, would support more streamlined business processes including payments to care providers and supporting earlier confirmation of the assessed level of financial contributions provided  / required for those individuals with the means to make a contribution to the cost of their care service. She added that Virgin can support these efficient ways of working by ensuring timely provision of information to be uploaded to Liquidlogic.

Councillor Dine Romero asked if more residents were to be expected to pay for their care.

The Director of Integrated Health & Care Commissioning replied that there is a national regulatory framework in place and that B&NES policies on social care contributions comply with the guidance and framework and that there was no expectation that individual contributions would increase. She stated that the intention is to improve the assessment process and support efficient collection of individual contributions to avoid individuals’ unnecessarily accumulating debt.

She reminded members of the Select Committee that phase two of the Care Act contained a cap on the use of people’s own funds and assets. She added that implementation of phase two had been delayed until at least April 2020 and at this stage no further information was available about whether phase two of the Care Act will be implemented from 2020 and/or be amended before implementation.

Councillor Eleanor Jackson commented that in her opinion growth avoidance should be seen as a cut to services. She said that she was concerned over the revised approach to transport provision relating to Day Care and, also, the Residential and Nursing re-commission. She asked if a risk analysis of the proposals had been carried out, if the impact of Brexit had been taken into account with the potential loss of EU hospital staff and care workers, if the care eligibility threshold would rise and if the Cabinet would consider raising the Council Tax precept for Adult Social Care to 3% this year rather than 2%.

Councillor Charles Gerrish, Cabinet Member for Finance & Efficiency replied that his approach to the precept was a prudent one, in line with the Government guidelines and that the proposal of 2% would remain for this year following its introduction last year. Although there is the option of increasing the precept to 3% in 2017/18, this would then need to reduce to 2% in 2018/19 and 1% in 2019/20 as overall a maximum 6% can be implemented over a 3-year period. He added that with regard to Brexit that B&NES could not operate in isolation and would take advice on the matter from the LGA. He said that the Prime Minister had stated that the referendum decision would not affect EU nationals.

He said that transport costs relating to people with Special Educational Needs had escalated way above expectations and that now the proposal is to empower users of the service to directly negotiate better arrangements.

The Chair asked if the funding could be used to pay a family member for the service.

Councillor Charles Gerrish replied that it could.

Councillor Eleanor Jackson asked if the bus that takes residents to the Swallow Café would be affected.

Councillor Charles Gerrish replied that no changes were planned if services were full / near capacity.

Councillor Paul May commented that B&NES was fortunate to have the quality of staff within its Adult Services.

Councillor Lin Patterson commented that she had concerns relating to cuts proposed to the Sexual Health Portfolio.

The Strategic Director for People and Communities replied that the planned savings were agreed as part of last years’ plan.

Following the meeting the Director of Public Health, Dr Bruce Laurence provided this additional information.

Sexual health portfolio

Reductions have been made in some of the budgets allocated to sexual health service providers. In particular:-

A reduced payment structure to GP practices and community pharmacies for delivery of a range of sexual health services has been agreed, enabling savings to be made with no impact on these front line services.

We have set an upper age limit (of 25) for women to access free emergency hormonal contraception (EHC) from community pharmacies. This is in line with most other areas across England, and enables the vast majority of women who require EHC from pharmacy to access it free of charge.

We have ended Council funding for the HIV Support Service delivered by Eddystone Trust one year earlier than planned. Public health commissioners have supported Eddystone Trust in funding bids to other organisations and we are pleased the organisation has recently been awarded funding from St John’s Hospital Trust to deliver services in B&NES.

Incentive payments provided to GP practices to opportunistically test young people aged 15 – 24 years old for chlamydia have ended. Chlamydia testing for this age range continues to be available from a wide range of services including young persons’ Clinic in a Box services in youth clubs and schools, community pharmacies, Contraception and Sexual Health clinics, GP practices and other sexual health services.

The Director of Integrated Health & Care Commissioning commented in response to Councillor Jackson’s query about savings from residential and nursing care commissioning, that this proposal has three key elements.  Firstly, it is important that people do not go into nursing or residential care earlier than they need to because there is strong evidence that this can have the unintended consequence of reducing people’s confidence, ability and skills in doing things for themselves and remaining independent.  The focus is on maximising independence and supporting people to remain at home, thus avoiding dependency through the ‘over-prescription’ of care placements and packages.  Other elements of the approach to savings from residential and nursing care are taking different approaches to commissioning and contracting and the implementation of a brokerage service to ensure best value, which is not just measured through the cost of a package or placement but also quality of the service provided.  Finally, work will continue on practice and culture to support a focus on the outcomes to be achieved for the individual.

In relation to Councillor Jackson’s query about Day Services for people with learning disabilities, the Director of Integrated Health & Care Commissioning explained that whilst some people do need to be able to access ‘traditional’ day services focused around a day centre.  However, an increasing number of people, including younger adults, want and need to be able to access day services that are focused on supporting them to gain and maintain employment and live independently in their own homes.

In response to Councillor Jackson’s query about changes to thresholds for care, the Director of Integrated Health & Care Commissioning that there is no proposal to change thresholds.  It is important that thresholds are fairly and consistently applied and, as previously stated, packages and placements are not ‘over-prescribed’, which can have the unintended consequence of increasing levels of dependency rather than enabling and supporting independence.

Councillor Geoff Ward said that he agreed that people should be enabled to live independently in their own home and community for as long as possible.

The Strategic Director for People and Communities stated that the proposals within the Directorate Plan are challenging and said that the Cabinet Members have been involved throughout the process as well as officers receiving advice from Ernst & Young to provide some assurance that the targets are realistic. He added that proposals have been very carefully considered and assessed, including in light of learning from best practice in other areas.

The Chair asked for assurance that equalities issues have been considered as far as they could be at this stage of the budget setting process.

The Director of Integrated Health & Care Commissioning said the proposals had received an initial assessment for equalities and risk.

The Inclusive Communities Manager said that at the point of the budget being accepted that she would expect further analysis to take place.

Councillor Lin Patterson said she was disturbed that this work had not already taken place and that the risks being described were the risk of not delivering the saving and not the risk to the public as that had not had not been fully assessed.

The Inclusive Communities Manager said that a template will have been completed for each proposal and that any impacts and risks have been considered as part of the development of the proposals, as well as measures to mitigate the impact where possible.

The Strategic Director for People and Communities confirmed that impact assessments were being delivered in a proportionate and staged process.

Councillor Eleanor Jackson requested that a statement be provided within the budget papers of the administration’s decision to retain the 2% Council Tax precept for Adult Social Care and for footnotes on the issues that Councillors have raised during the debate.

The Chair thanked the Select Committee for their comments and the officers for their contributions during the debate.