Agenda item

To receive an overview of the next steps for Adults’ Health and Care in the Transformation to 2019 programme.

The Director and Deputy Director of Adults’ Health and Care attended before the Committee in order to present the Transformation to 2019 report, as well as an accompanying presentation (see Item 7 in the Minute Book). 

Members noted that briefings on Transformation to 2019 were starting to begin, which would see an additional £140m in savings from the County Council’s budget being identified over the next two years.  Of this, £56m would need to be achieved by Adults’ Health and Care.

The report and presentation aimed to provide the Committee with details around the previous transformation programmes, as well as an overview of the potential work streams in the future.  Paul Archer, the Deputy Director, had previously led a number of cost reduction programmes across the Council in his other role as Director of Transformation and Governance, and would bring this experience to Adults’ Health and Care.

Although the transformation programmes often focused on cost-saving, many of the changes since 2010 have seen investments in technology in order to

work as digitally as possible, enabling frontline workers to spend the largest proportion of their time helping people.  Further efficiencies would not result solely in cost reduction through contracts, but would focus more on innovation, reducing specifications where this was not helpful to providing sustainable services, and improving joint working.

The outline budget for Transformation to 2019 would be heard in September, which would outline the major themes of this work:

·      Prevention and demand management

·      Older People and Physical Disabilities – assisting to live (more) independently

·      Learning Disabilities and Mental Health – assisting to live (more) independently

·      Working differently

Similar to the discussions held during the STP item, the Department were aware that changes made should not shunt costs from one organisation to another, and that service users needed to be at the heart of changes proposed.  Additionally, it would be important to remain alive to ensuring that changing ways of working would not result in service users presenting with greater challenges in future because prevention has not central to services.

The £37m being allocated over a three-year period would be monitored by the Health and Wellbeing Board and the Department of Health, and the aim of this funding was primarily investing to save.

In response to questions, Members heard:

·      The ‘Balancing the Budget’ public consultation began at the start of July and would run towards the end of August.  The decision-making cycle would work to a February Full Council budget meeting.

·      That funding for disabled facilities grants are paid to upper tier authorities and routed to District and Borough Councils, a sum of approximately £10m a year.  Decisions on such grants should be collaborative, as the County Council has the social care responsibility and is often therefore required to make recommendations to the District or Borough Council for their funding approval.

·      The County were aware that each District and Borough Council in Hampshire also have their own efficiencies to make and corporate priorities, but the question should still be asked on how all public sector bodies can work better together.  Adults’ Health and Care had very good working relationships with local authorities across the geography and already worked well collaboratively.  A lot of the challenges were replicated at both tiers of local authority, and all worked for the same population.  The topic of social inclusion was a key area where all Councils would need to work well together.

·      Hampshire offered a range of carer support services, some formal and some informal.  Not all carers identify themselves, but given that the value of informal care nationally is estimated to be over £150bn a year, it was imperative that support and respite was made available to those carers who require it.  Part of the Council’s role in this would be in creating supportive communities, and it also had a duty to provide caring support to people who are eligible to receive this.

·      The Director of Public Health was leading work in the Council on how to reduce demand for Adult Services, ensuring a holistic approach to prevention.  There were opportunities to make better use of the assets and resources that the Council already has. 

·      The £37m previously noted was short term money, and this will have been exhausted by the time the £56m of savings would come out of the budget, as a recurrent saving.  The aim would be to pump prime some of these efficiencies, by investing to save in the short-term.

·      The vast majority of people do leave hospital in a timely manner.  The majority of those whose discharge is delayed have complex needs, need a specific care package, or require time to make a decision about where they should receive future care.  The Department takes regular snapshots of performance, and routinely less than 80 people in Hampshire are delayed for a social care reason.

·      In terms of the domiciliary and nursing care at home market, consideration was being given as to how staff are given the time they need to enable service users to look after themselves independently e.g. assisting an individual to get dressed on their own, rather than dressing them.  Care should always be of a good standard, but the wider issue remained that capacity in the care market was shrinking, so thought had to be given as to how to use finite capacity in the best way possible, e.g. through better use of technology (such as medicine reminders) and reducing social isolation.

It was outlined that the recommendations in the paper requested that the Committee note the challenges facing the Department in terms of this further round of transformation activities, and requested Members’ help in forming a working group, which would provide appropriate checks and balances to the social inclusion work stream of the programme.  Members were agreeable to this suggestion.

RESOLVED:

That the Committee:

a)  Noted the £140m Tt2019 programme challenge, headline timetable and within this noted the Adults’ Health and Care target of £56m.

b)  Noted the T19 approach being adopted by the Department and some of the key highlights emanating from the early opportunity assessment work described in section three of the report.

c) Acknowledged the engagement challenge across a range of important stakeholders as set out in section four of the report.

d) Agreed to the establishment of a HASC Member working group to specifically provide oversight and scrutiny to a forthcoming review of Social Inclusion services.  That Terms of Reference are provided to the September meeting of HASC for consideration and agreement..