Agenda item

The Director of Adults’ Health and Care, alongside the Interim Director of Public Health, spoke to the report and presentation, which set out the departmental transformation to 2021 savings proposals and public consultation feedback (see Item 8 in the Minute Book).

Members heard an overview of the key findings of the balancing the budget consultation held by the County Council in summer 2019, and noted that all of departments in the Council had been asked to proportionately contribute a further 13% saving of their budget as part of the next ‘Transformation to 2021’ (Tt2021) programme. For Adults’ Health and Care, this resulted in an overall requirement of £43.1m (Adult Social Care £36.3m and Public Health £6.8m). With the proposed savings, this would bring the cumulative total to £242.4m by the end of 2022.  It was also identified that not only were savings being achieved, but also that Hampshire County Council continues to invest in adult social care service provision.  It was noted that Tt2019 was significantly more challenging than previous programmes and Tt2021 will be even more difficult with extended delivery and overlapping programmes with increasing risk and complexity.

There has been greater than anticipated demographic and service level challenges for an aging population and support needs increasing in terms of their complexity and impact on people’s lives.  £41m has been delivered of the challenge and 15m yet to deliver into this year and next.  The delivery of Tt2019 will be happening in parallel to Tt2021 savings.  There is continued uncertainty beyond 2020-21and pressure of quality and safety, workforce fit to deliver, and dual challenges due to increase in demand, complexity, and inflated costs of providing services. 

The key issues for the County Council have largely neutral implications and any additional funding for Adults Health and Care will offset the recently emerging pressure.

These five principles are the foundation for the departmental approach to Tt2021:

• Prevention: Strengthen the prevention strategy to reduce and/or contain demand. Includes: improved working with Carer’s and Voluntary and Community Sector (VCS), improved information and advice Connect to Support Hampshire (CtSH) and greater and wider use of Technology
• Independence: Increase the number of clients living independently and reduce the cost of care
• Productivity: Improve efficiency and productivity of the department’s operations
• External spend: Increase outcomes and service efficiency from commissioned services Income generation: Increase departmental income through traded services including technology enabled care

Within these principles were five main blocks, which centred on:

• Younger Adults services including learning disabilities, physical disabilities, mental health and children’s to adults' transition
• Older Adults services for people aged 65 and over
• In-house care provision
• Working differently
• National grant funding – resource to support provision

 All of these were underpinned by the theme of demand management and prevention.

Cllr Burgess left for another meeting at 12:38pm. 

For Public Health, a range of significant savings proposals across commissioned spend, will include mandated and non-mandated service areas such as:

• Substance Misuse
• Smoking Cessation
• Health Checks
• 0-19 Services

Increased focus will be on directing available funding to the most vulnerable and highest risk groups where it will have the greatest impact with a continued reduction of central expenses including restrictions on travel and training costs and all subject to the confirmed ending of the existing ‘ring-fence’.  The risks outlined may change subject to case law and new precedents and any reductions or perceived reductions managed through messaging to maintaining outcomes.

The report contained Equality Impact Assessments for each saving proposal work programme, and some areas will require further consultation.  Risks have been diligently reviewed, areas of mitigation identified, and further monitoring of impacts will continue.

The public consultation across Hampshire received just over 5400 responses but had a lower number of consultation responses than last time.   Further specific consultations will take place before any changes are implemented for the following--

• Learning disabilities and mental health integration with the NHS
• Older adults
• Alternatives to residential care (TBC)
• In-house service provision
• Public Health reductions to commissioned spend

These will be subject to detailed Stage 2 consultations and will be back to both HASC and Decision Days and key messages include:

• Strengths based approach
• Increased independence
• Housing
• Voluntary community sector
• Capital investment
• Co-production groups (critical friends and as grit to drive changes)
• Re-setting public expectations

In response to questions, Members heard:

• Partner organizations were consulted, and responses received from CCGs, Healthwatch, NHS, voluntary sector, etc. and the impact on their services.  Analysis of consultations were based on the quality of responses and free text comments continue to be analysed and will move forwards to Cabinet and Full Council. 
• Resetting public expectations will be challenging but must be prioritized.  Those at highest risk are prioritized but joined up working remains a challenge.  Voluntary sector partners are engaged to better impact those who need it most. 
• Pressure on voluntary sector organizations must be eased with support as they are able to provide support at lower costs.  Hampshire 2020 programme will be a collaboration between HCC, NHS, partners in the voluntary and community sector. 
• Population health and social prescribing are releasing resources that can be used to ensure the right resources being used for prevention rather than intervention.  The Lead and Chair of the STP are consistently challenging the NHS for a proactive approach to prevention rather than intervention.
• Connector Support HCC services have been commended for their success.
• CCG investment into demand management has an impact for balance and stability for a holistic approach for enriched lives rather than through pathways.  Continuity of care is a priority and organizational resilience is key.
• Proposals will be coming forward from CCBS for shared offices, cost savings, income generation, and greater integration.
• Supported employment will continue with younger people to enter them into paid employment with the council, partners, and other large employers in Hampshire and provide supported accommodation to allow for more independence.  Using a “commercial” approach to identifying opportunities that will allow people to grow with meaningful work for pay.
• Across the council, all conversations with voluntary sector are much more coordinated with line of sight before and are now more effective and choreographed.  Annualized grants and direction of service allows organizations to approach as a sector with outcomes that can be delivered.
• Engagement takes place with all parish and town councils, but parish and community magazines were suggested as a cost-effective solution for reaching out to small volunteer organizations.
• There are individual grant giving opportunities for councillors to provide grants close to their personal community and local places.  The council works with broad brush strokes, but micro organizations are just as important.
• The department will continue to push the envelope on these changes with increasingly more limits and challenges during an already difficult period.  The quantum of transformational change e.g. accommodation models, spending capital for savings, will be extending beyond the period and overlap with the next one.  Tt2021 will extend beyond 2021 financial year, pushing out the achievement of savings at least 3 years to safely deliver, if not 4.

Members noted:

• Explicit health focus for all HCC endeavours and departments would contribute to health and wellbeing and mainstream it within the organization.  The Executive Member for Public Health reiterated that collaboration on health and wellbeing was continuing with departments and directors. 
• An opportunity to closely review the budget details and fully understand implications and outcomes, as well as statutory responsibilities would be useful to Members prior to making recommendations.  Without forensic detail, it can be difficult to establish confidence in the specific proposals.

Cllr Finlay left at 1:29pm.

• The officers’ hard work in providing services and doing more with less, but the best way forwards possible is to consider sustainability.  While a balanced budget is vital, there is a responsibility to consider consequences and implications of cuts and failure to deliver services to the people of Hampshire (both financial and non-financial).  There is an ongoing duty to scrutinize and monitor these proposals. 

Cllr Cartwright left at 1:44pm

•  This is the Officers’ best work and responses to particular challenges but there are time-critical decisions and more work remains and further consultations necessary for significant changes.  The department maintains an excellent track record of success.

The Chairman noted the possibility that Cabinet may make changes to the T21 proposals submitted by each Department, although the level of savings would need to be the same.

The Chairman moved to the recommendation as set out in the paper--

That the Committee:

• Support the recommendations being proposed to the Executive Member for Adult Social Care and Health and Executive Member for Public Health in section 2 of the report.

A vote was taken on the proposed recommendation --

For: 8

Against: 5

Abstained: 0

The Chairman invited members to further review and highlight any concerns or questions to be followed up with the director and department and addressed at a future members’ workshop.

RESOLVED:

• Support the recommendations being proposed to the Executive Member for Adult Social Care and Health and Executive Member for Public Health in section 2 of the report.