Agenda item

The report provides an update on the Community Services Transformation Programme and sets out a number of recommendations.

Cllr Alison Born introduced the report, moved the officer recommendation, and made the following statement:

“This paper provides an update on the programme of work that has resulted from the decision taken by Cabinet and also by the B&NES, Swindon and Wiltshire (BSW) Integrated Care Board (ICB) in May 2022 not to extend the HCRG Care Group contract for integrated community health and care services beyond March 2024.

The work is divided into three programmes:

1. Future provision of adult social care services and services delivered by sub-contractors – led by B&NES Council
2. Future provision of the public health services that are currently included in the HCRG Care Group contract – led by Public Health
3. Future provision of community children’s and adults’ health and care services (excluding adult social care) that are currently included in the HCRG Care Group contract – led by the ICB

Programme One

In November 2022, Cabinet took the decision to bring adult social care services back in house to be run by B&NES Council from April 2024. This decision was not taken lightly, we were aware that the health and care landscape had changed considerably since the contract was let and that the flat cash nature of the agreement would present immediate challenges.

The financial pressures in the contract are compounded by the costs associated with significant contractual change and provision has been made for this within our budgets. However, that provision is short term, and the adult social care model must be cost neutral from 2025/26. This will be addressed through a re-design process during 2024/25 which is necessary to ensure that our services can respond to current needs and are financially sustainable.

The programme relating to adult social care is well established and well led. There is a meaningful staff engagement programme and active communication with community partners. We are very grateful to the staff working in community services for their continued hard work and dedication through this period of change. A recent audit of the Adult Social Care transfer programme has provided a high level of assurance and we can be confident of a successful transfer for the start date on 1^st April 2024 with continuity of care provision.

Programmes Two and Three

Due to the impact of NHS reorganisation in 2022, the ICB started work on the community health services programme (programme 3) several months later than the local authority. As public health services (programme 2) are linked closely to community health services, a decision taken by the ICB (and endorsed by the lead member) to delay the start date for the new community services contract until 2025 has had an impact on the timescale for workstreams 2 and 3.

A procurement process, based on competitive dialogue is now underway for programme 3 with the expectation of contract award in the summer of 2024 with contract commencement in April 2025. This change to the procurement timescale, requires the ICB to issue new one-year contracts to existing community service providers to maintain provision across BSW until new contracts are in place from April 2025.

The B&NES contribution to the interim contract remains in line with existing costs at £18.2 million for the year 24/25. This includes the council’s contribution to community health services, the Better Care Fund for that period and to the public health and third sector sub-contracts included in The Prime.

The ICB will provide the Lead Commissioning function for these interim contracts, with local authorities working in partnership as co-commissioners. To date, Council officers have worked closely with the ICB on this process and will continue to play an active role in the work to identify new provider(s) for community health and care services in BSW and to monitor the interim contracts.

From April 2025 B&NES council will have commissioning responsibility for its own public health and community partner services and work is underway with community partners to ensure that they are engaged fully in this process.

Community Wellbeing Hub

This paper also includes actions relating to the future of the Community Wellbeing Hub which was developed in 2020 as part of the B&NES response to the Pandemic. The Hub provides rapid access to community services and its role in helping to shift the health and care system towards prevention, integrated working and the reduction of inequalities was noted to be exceptional in the recent LGA peer review of adult social care.

Partnership funding has been secured to maintain the Community Wellbeing Hub until March 2025 and work is underway to develop a business case to ensure its sustainability beyond that date. The business case will come to a future Cabinet meeting as will proposals for the re-design of Adult Care services.

Recommendation

This paper provides assurance to Cabinet of the robustness of this complex work programme which is being conducted collaboratively with partners. I ask you to note the progress and endorse the recommendations summarised in the report, including the continued delegation of decision making to the directors of public Health and Adult social Care and the lead Member.”

Cllr Paul May seconded the motion and made the following statement:

“I wish to second this proposal, which is a quite complex set of recommendations but sets out a professional approach in support of the Liberal Democrat proposal to bring adult services back in house, plus some direct follow-on decisions such a major decision entails.

Since the service was put out to Virgin, then taken over by HCRG, there have been concerns about the pressures of a contracted service and its performance with the associated bureaucracy involved.

That contract was for a zero-inflation price, so at the end there were bound to be additional financial pressures which the papers address. The whole health and care world has changed with the creation of the BSW ICB and their ability to test the health commissioning on a wider geographical area.

Social Care and Public Health is B&NES’s direct responsibility re adults and children’s services. Transferring adult services back in house within a tight timescale of April 2024 is a major professional task so we must support a whole range of B&NES professional actions to deliver it, including partnership working, TUPE, and most of all commitment that services to vulnerable adults are protected from day one.

The NHS health contracts are one year behind our proposals so there is a need for a 12-month temporary extension and, regardless of the separation, we are working collaboratively with them to protect both our community and the many voluntary sectors sub-contracted by HCRG.

As the Children and Young People Cabinet member, we already have in-house social care and as a smallish local authority we will and do work closely with the team to seek new ways of joint working on a larger scale that this decision offers.

The voluntary sector is effective and really valuable, so we need to work with them and deal with the risks for them.

The Wellbeing hub was a great benefit arising from Covid and continues to support our communities and as a challenge moving forward the business case for its survival is something we must not forget because its value has been proven but funding remains an issue.

I commend the officers for such a comprehensive commitment and fully support Councillor Born’s proposal.”

Cllr Kevin Guy thanked Cllr Born and her team for the commendable work that is taking place to support the transformation of community services.

RESOLVED (unanimously):

Transfer of Adult Social Care services

1.  To note the update on progress of the transfer of Adult Social Care (ASC) services and the outcome of the internal audit.

2.  To endorse continuation of the delegated responsibility for the transfer of ASC services to the Director of Adult Social Services, in consultation with the Lead Cabinet member for Adult Services, noting the November 2022 Cabinet approval for the transfer of ASC to B&NES Council (Transfer Decision Ref: E3393) including the delegated responsibility for the transfer of ASC services to the Director of Adult Social Services, and the commitment held against the social care reserve as a mitigation against any financial risk associated with the transfer following due diligence on current and future operating costs. Members will be aware of the underlying pressure on the Quarter 2 ASC revenue budget due to increasing demand in learning disability and older people services. The service is working hard to deliver in year mitigations to address revenue pressures. This is expected to place a demand on the ASC reserve to support the move to a balanced budget.

Commissioning of Public Health services

3.  To approve the delegated responsibility for the commissioning of Public Health services to the Director of Public Health and Prevention, in consultation with the Lead Cabinet member for Adult Services.

4.  To endorse the proposal for the direct commissioning of Public Health services as of 1 April 2025 (through current arrangements via a mix of directly delivered and sub-contracted services by HCRG Care Group through existing contract arrangements until 31 March 2024) and subsequently the interim arrangements until 31 March 2025, as referred to below. Noting delegated authority for the future commissioning of these services sits with the Director of Public Health and Prevention.

5.  To approve the revised best estimate of funding liability of £18,116,521 which includes contributions for Community Health, Public Health and Community Partners delivered services and the Council’s contribution towards the Better Care Fund (BCF) for 2024/25 in respect of the approved proposal for an interim contractual arrangement. This is in accordance with the decision taken in July 2023 (see Update on Contractual Arrangement Decision 23/24 Ref: E3469) and services will be delivered within the existing budgetary envelopes.

6.  To approve the proposals for the Council to commission Community Partner delivered services directly (excluding those in the Health Strategic Commissioning Group, see Section 3.17 of the report) as of 1 April 2025 (currently delivered through the existing arrangement with the HCRG Care Group and proposed interim arrangements until 31 March 2025 as referred to below). Noting delegated authority for the future commissioning of these services sits with the Director of Adult Social Services and the Director of Public Health and Prevention Services.

7.  To endorse the continued engagement and involvement of relevant officers in the procurement process for the Integrated Community Based Care programme, including the approach to selection, timelines and public engagement for community services beyond April 2025, as per the request from colleagues on the ICB Board noting any future decisions around commissioning decisions will be in accordance with existing delegations.

8.  To agree ongoing support from officers to determine the strategic case for a Community Wellbeing Hub (CWH) and to agree to Phase 2 of the Outline Business Case (OBC) commencing to inform a final OBC.  A subsequent paper will be presented to Cabinet at a later date (note existing arrangements from Section 3.26 of the report).