Agenda item

The draft Adult Social Care & Housing Medium Term Service & Resource Plan (MTSRP) is presented for consideration by the Panel:

·  To ensure all members of the Panel are aware of the context for Service Action Planning

·  To enable comment on the strategic choices inherent in the medium term plan

·  To enable issues to be referred to the relevant Portfolio holder at an early stage in the service planning and budget process

The Panel is asked to:

1.  Comment on the medium term plan for Adult Social Care & Housing 

2.  Identify any issues requiring further consideration and highlighting as part of the budget process for 2013/14

3.  Identify any issues arising from the draft plan it wishes to refer to the relevant portfolio holder for further consideration

The Chairman invited Jane Shayler (Programme Director for Non-Acute Health, Social Care and Housing) to introduce the report.

Jane Shayler took the Panel through the report and explained the purpose of each appendix.  On a question from the Panel on what P2P means in the report Jane said that is the reference to Procure to Pay (more efficient way to enable people to pay their invoices for the Council). 

Jane Shayler highlighted the following key proposals in the service impact statement (for the benefit of the Panel):

There are two separate savings against the Council's contract with Sirona Care & Health.  Top of the first page of appendix 3 of the report, Decrease in Sirona contractual values as agreed, is capturing part of the saving that is already incorporated in the contract with Sirona.  Jane Shayler reminded the Panel that there is a three party contract for provision of care and health services between the Council, Sirona and the PCT (CCG as of April 2013).  On the page 3 of appendix 3 of the report there is more significant saving because that is a new savings target against Council's part of the contract with Sirona.  This has not been agreed yet with Sirona so it needs to be worked through in agreement and partnership with Sirona.  One of the areas that need to be explored is relatively recently published national Audit Commission report that looked at the cost in each LA for social care processes which indicates that there are some efficiencies in this area that could be made.  Jane Shayler reminded the panel that Sirona delivers a significant portion of adult social care on behalf of the Council.

The Chairman asked what the Audit Commission exactly determined in their report.

Jane Shayler responded that Audit Commission looked at the cost of adult social care processes around the assessment of individual needs, review processes, provision of the advice to individuals (around eligibility for example), but also looked at the other supporting processes.  Jane Shayler said that she always thought that we should treat benchmarking reports with caution because national organisations, like the Audit Commission, will be pretty skilful in analysing data though benchmarking does not always compare like for like.  Audit Commission report benchmarks cost associated processes prior to the transfer of Sirona.  Jane Shayler reminded the Panel that the AWP also manage some services in partnership with the Council.  The first saving target against that work is not in the next financial year and there is time to work up the detail of how the saving will be delivered and undertake a full impact assessment, including assessing an equalities impacts. 

Jane Shayler also said that one of the things that the Council could consider is whether we would be happy for individuals, who have relatively low level of need, to do something called ‘self-assess’ (i.e. if they need a piece of equipment that doesn't cost very much) to avoid the necessity of a service user going through a lengthy assessment process in order to access a minor aid and/or low-cost (or even freely available) service.

Councillor Jackson said that suggestion about the self-assessment is quite sensible and asked if GPs have any role in pointing people to the right services.

Jane Shayler responded said that she was specifically talking about an assessment of need that was undertaken by Sirona and the AWP under the fair access to care services eligibility criteria.  It does include role of GPs to identify people's needs.

Jane Shayler informed the Panel that under the savings heading, page 5 of appendix 3, there is significant sum of money in respect of use of the Section 256 funding in total of £1.5m.  Jane Shayler explained that £1m of the Section 256 money is currently non-recurring money and levels of funding and associated guidance for using this money is confirmed on an annual basis.  However, indications are that s256 funding will continue to be paid by the Department of Health.  Jane Shayler said that for next year, 2013/14, some of the money will not go through the CCG but it would come from the National Commissioning Board to Social Services directly.

The Chairman said that s256 compensates for the effectiveness of adult social care with the intention of saving the money for the NHS.  The Chairman asked how effective we are in measuring the outcomes resulting from this approach.

Jane Shayler said that one of the challenges is to find robust evidence on what you have prevented.  Ideally, the s256 money would prevent people ever needing health services.  One of the proxy measures used locally is delayed transfer of care from the RUH.  Some of the s256 money is used to fund extended research pilots.

Jane Shayler said to the Panel that the report before them is a 3 year plan.  It does at the moment assume that the £1million s256 money is not carried forward for 2014/15.  Savings targets in 2014/15-2015/16are significantly greater than for 2013/14.  Jane Shayler said that the Council is proposing to take the report to the Clinical Commissioning Committee in December, although that is not agreed yet, to seek agreement in principle for use of s256 funding in 2013/14, subject to confirmation of the allocation by the Department of Health.  Clinical Commissioning Committee will not be in position to make the decision until they have their own allocation of funding confirmed.

Jane Shayler said that the next significant saving is around reducing the number of people who are admitted to residential care by preventing those admissions.  BANES and South West benchmarked relatively high number of older people who were admitted to residential care as oppose to people who are held in the community.  If we bring the number of admissions in residential care more in line with the national benchmark then we could deliver savings.  The majority of people would prefer to remain in their homes rather to be in residential care.  One of the things that we need to pay more attention to is more effective advice to people who self-funding for their social care services.  We know that some people who are paying for their own services are admitting themselves to private residential care homes at an earlier time than their assessments suggests.  They are spending their own money and they spend their money quite quickly and then they come to social services and become eligible via social services to fund their stay.  One of the things we are proposing is for people who are self funded to have access to good advice and information from the Council to enable them to make informed choices about what sort of care services they use their money to fund.

Jane Shayler that the last saving proposal is significant saving proposal against Supporting People and Communities funding.  Jane Shayler said that this was the best way of achieving challenging savings targets and that she cannot offer the alternative, or better, proposal to achieve the same savings targets and have less impacts on service users.  The proposal around Supporting People and Communities saving is to reduce the overall amount of funding and focus the funding on those with higher levels of need.  The Supporting people Programme was designed to meet the low level of need.  In time, across the country, Supporting People funding has increasingly focused on meeting higher levels of need and supporting mainstream social services objectives, rather than the original aims of the Supporting People Programme. 

The Chairman said that he fully understands that Jane Shayler was asked to save the money within the Adult Social Care and Housing but he felt that the current Administration has the opportunity to consider what they consider low priority elsewhere and direct it to where it is most needed.  There are some areas of the Council that perhaps could cease in operation and it wouldn't be any great loss. The Chairman also said that there is little that the Panel could do and that there should be more support from the Council for funding services for vulnerable people rather than some other things that the Council funds.

Councillor Allen said that there are very difficult decisions to be made and suggested that political groups might want to discuss these matters outside the PDS Panels.  Councillor Allen agreed with the point made by the Chairman though he added that some of the savings are result of the cuts in the funding from the Government.

The Chairman commented that the unfortunate thing is that by the time of the Council Budget meeting it will be too late to do anything. 

Councillor Jackson asked if it is not within the scope of the Panel to ask the Cabinet to have another look at this budget.

The Chairman said that the Panel could say that they are not comfortable with the proposed budget.  The Panel could also ask to be presented with the budget proposals for the next year at very much earlier date.

Councillor Brett agreed with the Chairman that the Panel should expressed their concerns on the proposal and be presented at much earlier date the budget proposals for the next year and enable all Panels to look at the entire Medium Term Service & Resource Plan for the Council so that the Panels could make recommendations on areas of spend that should be prioritised and those areas of spend that should be considered by the Council not to be a priority.

Samantha Jones (Equalities Manager) reminded the Panel that Council and Elected Members have due regard to the need to eliminate discrimination; advance equality of opportunity; and foster good relations – when making decisions and setting policies. To do this, it is necessary for the organisation to understand the potential effects of its activities on different people. Where these are not immediately apparent, it may be necessary to carry out some form of assessment or analysis, in order to understand them.  Samantha Jones reminded the Panel that 2 Councils were taken to the court, one of which failed to consider equality effect of the decision they made.  One of the judges in court said 'please prove when making the decision you had demonstrate to me that you had no other financial room to maneuver'.

The Chairman thanked everyone who participated in this debate. 

It was RESOLVED that:

1)  The Panel requested that the budget for Adult Social Services and Housing should be more protected and that savings should be considered within other areas of the Council;

2)  The Panel requested that next year’s budget be presented at a much earlier date to the Panel (latest at September 2013);

3)  The Panel felt that it is essential that the Council protect frontline services for vulnerable people; and

4)  The Panel felt that all Officers and every Member of the Council should be aware that they have due regard to the need to eliminate discrimination; advance equality of opportunity; and foster good relations – when making decisions and setting policies, as per the advice of Equalities Manager.