Agenda item

To consider a joint report of the Corporate Directors for People and for Corporate Director Corporate and Support Services.

At its meeting on 18 August 2015, the Executive received a report which included a Medium Term Financial Forecast for the period 2016/17 to 2020/21. That report illustrated the level of resources likely to be available in 2016/17 and the resulting budget position should the previously identified level of cash limit reductions be achieved.

In response to those forecasts, and in line with its previous proposals and statements of intent, the Executive brought forward a set of proposals for 2016/17. These have been informed by the strategic framework and are designed to address the budget reduction requirement.  At the meeting on 18 August Executive Councillors agreed to present to each scrutiny committee the relevant proposals relating to each committee’s remit, including the specific detailed business cases.

The Health and Wellbeing scrutiny committee is therefore receiving the following:

•        The Executive Report; Stockport Together – Integrating Health and Social Care

•        The Preventative Commissioning Project Update

•        The Information, Advice and Guidance Business Case

This Committee is asked to comment on the aspects of the attached reports, including the overall approach being taken for the intregration of Health and Social Care; in particular the plans for service change prior to entering into an agreed pooled budget.

The Scrutiny Committee is asked to comment on:

•        The attached business cases and project updates

•        The overall approach being taken to the development of the Council’s model of Integrated Health and Social Care, and

•        The proposed approach to pooling Health and Social Care budgets as outlined within the specific Health and Social Care report.

Officer contact: Andrew Webb or Steve Houston on 0161 474 3808 or 0161 474 4000

A joint report of the Corporate Directors for People and for Corporate and Support Services was submitted (copies of which had been circulated) detailing the Executive’s proposals to respond to the Medium Term Financial Forecast considered by the Executive in August 2015. The Executive had brought forward a set of proposals and statements of intent, in accordance with the Investing In Stockport strategic framework, that sought to respond to the required budget reductions. The Executive agreed to seek the views of scrutiny.

The accompanying documents to the report provided further detail on the following Investing In Stockport proposals:-

·         Preventative Commissioning Strategy – project update

·         Stockport Together: Integrated Health and Social Care – report and business case

·         Information, Advice & Guidance - business case

The Executive Councillor (Health & Wellbeing), the Deputy Director of Public Health and representatives of Corporate Director for Corporate and Support Services and Service Director (Adult Social Care) attended the meeting to present the proposals and to answer questions.

The following comments were made/issues raised in relation to the following proposals or updates:-

Preventative Commission Strategy – Project Update

·         Most of the savings requirement had already been achieved in the previous year, but the remaining £0.5m needed from the Public Health portfolio would be achieved through a combination of efficiencies; natural wastage; merger of a range of lifestyle-related services; bringing the Workforce Development Service back in-house; tariff deflation on contracts with Stockport Foundation Trust (FT).

·         The Scrutiny Committee had previously been broadly supportive of the reconfiguration of services where it could be demonstrated that different models of delivery could achieve better outcomes.

·         There would be further opportunities to integrating health visiting into other Council services once commissioning responsibilities passed to local authorities in October 2015.

·         Concerns were expressed about the impact on service users of applying the tariff deflator on FT contracts. In response it was stated that this was a standard part of NHS contracts designed to ensure efficiencies were made within NHS spend, usually through management efficiencies. It was not anticipated that this reduction would impact on frontline services.

Stockport Together

‘Plan B’ proposals

·         It was commented that the proposals represented significant risks for future service delivery and the reductions in service could lead to similar costs being borne elsewhere with adult social care, such as the reduction in size of the hospital social work team leading to fines caused by delayed discharge. In response it was acknowledged that these proposals carried risks but that changes in the model of care that would come about with the Stockport Together proposals would in time mitigate these risks. It was also commented that previous budget reductions meant that further reductions were likely to result in existing activity being limited.

·         In relation to discharge from hospitals, concerns were expressed that as well as the potential for delayed discharges there could also be an increase in inappropriate early discharge and whether, given the difficulties already experienced in this area, further reductions would exacerbate this problem. In response it was stated that discharge processes were being changed in any case to ensure that discharge was arranged on the basis of medical fitness. It was also reported that a ‘community ward’ was being created to cater for vulnerable older people whose medical condition fell short of admission but who could not be appropriately ‘discharged’.

·         Given the work going into Stockport Together and previous integration projects it was important to get an understanding of its impact and effectiveness. Stockport Together would be subject to further decisions moving forward but there remained unresolved issues around governance and its links with Greater Manchester devolution.

·         Questions were asked about the process for bringing out-of-area Learning Disability (LD) placements back to facilities within the borough, in particular what the process would be should the individual not wish to leave their current setting. In response it was stated that only a relatively modest proportion of the total number of out-of-borough placements would need to be brought back to Stockport to reach the target, although it was acknowledged that the process for rehousing could prove challenging and time intensive. It was suggested that due to the sensitivity of issues and people involved it may take more than one year to achieve these savings.

·         In response to a request for more detail on the proposed withdrawal of funding for mental health support workers it was stated that these proposals were subject to further consideration in light of changes being proposed by Pennine Care NHS Foundation Trust to their Community Mental Health Team. Further work was proposed on new service models.

·         It was commented that the risk inherent in the proposals was the potential ‘knock-on’ effect on other services which may lead to increased spend elsewhere. In response it was acknowledged that this was a potential risk and that the proposals were linked. It was also commented that these proposals needed to be seen within the context of work to change the relationship between residents and adult social care services in encouraging prevention and early intervention as well as increased use of technology to support self-care.

·         Assurance was sought and provided that the proposed changes to service had been considered as a whole and not in isolation from each other.

·         In response to a question about whether the reductions in the REaCH service would lead to greater costs it was stated that this proposal would not be proceeded with in the form within the Business Case. In light of a review of intermediate tier care services being undertaken by the Clinical Commissioning Group it was proposed to investigate savings that could be achieved through the rationalisation of these services. It may still result in redundancies, but these may be absorbed within a large pool of services.

·         Concerns were expressed that the model being presented was incomplete and that services for vulnerable people were being put at risk. In response, it was stated that the proposals were part of a complex process that involved moving from one model of care to another that in the medium to longer term would see savings and improvements in services.

Pooled Budget

·         Concerns were expressed about the governance arrangements for the pooled resources in the future, and about the adequacy of the current arrangements for scrutinising the work of the Health & Wellbeing Integrated Commissioning Board. In response it was stated that the limitations of the current governance arrangements had been recognised by the both partners and further work was underway to develop governance and risk management arrangements better suited to the larger resources that it was proposed to pool in 2016/17 and beyond. These proposals would be reported back in due course. It was also commented that there were limitations to the current governance arrangements for Stockport Together, including the role of the Health & Wellbeing Board, and that these would also need to be subject to further consideration.

·         Concerns were expressed about how feasible it was to deliver the Locality Working model across Stockport by the start of 2017/17. In response it was stated that the Executive had agreed to invest additional non-recurrent resources to accelerate the roll-out of the Proactive Care model and ensure it was in place for 2016/17.

Information, Advice & Guidance (IAG)

·         Concerns were expressed that the prosed implementation of the new delivery model (4-tier offer, based around digital services with enhanced support where needed) was over ambitious, given the need for consultation, reconfiguration and retendering. What would be the impact of not delivering change/ savings?

·         It was commented that the business case made no reference to the value added by staff working in these service areas, e.g., welfare rights, debt advice etc. These services had resulted in significant economic benefits to residents and in consequence the local economy. In response it was commented that it was not clear how many of people seeking support from IAG services could have found this information/ received these benefits, with or without assistance, online through government websites. As the majority of the costs of the services were staffing, this was where the costs need to be reduced. It was further responded that the 4-tier model would still provide support for residents who needed it.

·         Clarification was sought and provided on the Targeted Prevention Alliance and its role in targeting those in need of assistance prior to crisis point. Further work was needed to identify what further specialist IAG services might need to be tendered to support the Alliance.

The Chair summarised the issues raised during the course of the discussion, and highlighted the following issues:-

·         uncertainties in relation to wider Greater Manchester developments, particularly devolution;

·         concerns and uncertainty about the future governance arrangements for Stockport Together;

·         work to date on public health proposals was acknowledged;

·         concerns about the impact of the ‘Plan B’ proposals on hospital discharge; what was the ‘safety net’ for patients/ service users?

·         tension between large savings targets and potentially almost equal costs once services were reduced; some proposals seemed counterintuitive/ not worth the risk;

·         concerns about timescales for delivering savings, and what would happen if they were not achieved;

·         IAG proposals largely dependent on Digital by Design proposals being delivered and the risks associated with that;

·         concerns in relation to all the proposals about the risks, ‘safety net’/ mitigation measures for the most vulnerable and the Scrutiny Committee’s need for more information about what these would be;

·         in relation to budget pooling, progress so far was welcomed but risk needed to be recognised and governance/ scrutiny arrangements revisited;

·         concerns about how the proposals related to each other and whether sufficient regard had been given to their impact on other service areas.

RESOLVED – (1) That the report be noted and the comments of the Scrutiny Committee be forwarded to the Executive for their consideration.

(2) That the relevant executive councillors be requested to provide additional details about risks, mitigation and ‘safety net’ measures for vulnerable service users as part of the next report on the Investing in Stockport Executive Proposals.