Agenda item
Adult Social Care - Budget Update (Oral Report)
To receive an oral report and consider the contents thereof.
Minutes:
Ms Anne Canning, Interim Corporate Director Education, Social Care and Wellbeing (ESW), gave an oral report which focused on areas of concern raised by the OSC including:
· Concern that the ESW directorate was required to make significant budget savings and change management programmes (such as Domiciliary Care Re-commissioning, Re-ablement, and modernising the Learning Disability Day Care), were off track, with consequent slippage in delivery of these savings. Given service delivery pressures would the savings be delivered?
· What assurance could be given that the quality of service provision would be maintained during the transition period to new service provision arrangements arising from merger of CSF and AHWB directorates, changes to service delivery and the transfer of PH responsibilities.
· The strength/ stability/continuity of strategic leadership provided by lengthy interim leadership roles, particularly in the context of the transfer of Public Health responsibilities to the authority and significant change management.
Key points were highlighted as follows:
· Ms Canning and Dr Banerjee had both recently been appointed as Interim Corporate Director ESW and Interim Director Public Health respectively; both had extensive experience in this field and were familiar with the routines and expectations of the authority, so strategic leadership would be robust. The directorate management team had also recently been strengthened with permanent appointments to the posts of Service Head Resources and Service Head Adult Social Care..
· The ESW directorate savings target for 2013/14 and how this was comprised was outlined (£10.681 million including £5.081 million and £1.5 million inherited from the AHWB and CSF directorates, with £4.1 million of new targets). The “forensic systems” in place to monitor/ ensure delivery of these savings were also outlined (Change and Efficiency Board [fortnightly], Directorate Management Team [monthly], Corporate Transformation Delivery Group [fortnightly]). OSC assured that Ms Canning and her management team were fully aware of this priority and were confident it was on track overall; alternative options for social care were being examined where there was a need to mitigate slippage in savings. A significant decision would be made the following week as to the viability of the ‘go live’ dates for new service provision arrangements (Domiciliary Care/ Homecare monitoring).
· The ESW savings to be met from ‘Vacancy Management’ (VM) were outlined (£3 million). Significant research had taken place on the standard vacancy rates in other local authorities and LBTH directorates and potential for consequent savings from VM before agreeing the target. Establishment mapping had been time consuming, however OSC assured of Officer confidence that the target would be met. The OSC were assured that there would be no impact on frontline service delivery from VM, and current staffing ratios and recruitment practice would be maintained. VM was not intended to reduce staffing, however a culture change was required:that staffing budgets were no longer ring-fenced and savings from non-recruitment could not be redirected for other initiatives within the service but contribute to ESW savings.
· The ESW savings to be delivered through a review of management and administration were outlined (£345k). Officers were confident that if the ESW restructuring went well that efficiency savings from combining functions could be delivered; however some delays and the impact thereof could not be predicted, as with the Children’s Centres review.
· There was a risk in relation to new Domiciliary Care arrangements/ savings, primarily due to failings in ICT systems for home care monitoring. A decision would be made the following week on viability of the ‘go live’ dates for this. Savings to be delivered through Re-ablement were posing a challenge and there may be a need to direct savings from elsewhere to correct slippage. Exact details of mitigating action for this or other slippage was not possible because of the complexity of linkages within the savings model Currently there was a predicted risk of a shortfall in ESW savings of £650k against a target of £10.6 million.
A comprehensive discussion followed which focused on the following points:-
· The Health Scrutiny Panel (HSP) had expressed concern and made a strong recommendation, that a permanent Director of PH in Tower Hamlets be appointed as soon as possible to ensure strong leadership during the period when the transfer of PH responsibilities to the Council would be having maximum impact. This was not a reflection on the Interim appointment, but a recognition of the potential difficulties of the transition process and risk to PH without a permanent appointment. Accordingly requested again that the HSP recommendation be expedited. The Interim Director of PH was determined to ensure transition arrangements were smooth and PH outcomes and life chances improved. The recommendation of a permanent appointment would be taken back for HR consideration.
· Comment that staff and trades unions had relayed concerns that the application of the proposed staff vacancy rates in the context of the current squeeze on staff/ resources would have a much greater impact on staff. Clarification sought and given on the consideration given to this and the extent of monitoring arrangements for the impact on staff including sickness absence monitoring. Data used for VM modelling was current not historic. Difficult restructures did result in increased sickness absence but management monitoring/ management of this had improved greatly and absence levels were down overall.
· Consideration that not paying staff for travel to and from the homes of residents receiving care services undermined the authority’s policy of paying the London Living Wage.
· Commenting that the authority’s re-ablement targets had not been met in the past 3 years, and domiciliary care targets had not been met due to failings of electronic homecare monitoring, clarification sought and given as to meeting these targets going forward given the environment of resource and staffing constraints. Consideration also that there was an urgent need for transparency as to how compensating savings would be achieved and a discussion of this with the Interim Director ESW was needed. Accordingly proposed that the HSP scrutinise the savings targets and progress on their delivery in more detail later in the year. The importance of electronic homecare monitoring was to enable scrutiny and challenge to ascertain if clients were receiving care that met expectations/ standards. Officers were confident the ICT issues on homecare monitoring would be resolved. The direction of travel was consistent with meeting Re-ablement provision/ associated savings, and there were no notional changes to the strategy which would continue moving forward. The scale of risk on the savings required of ESW was £650k, and Ms Canning undertook to report back and discuss plans for savings at the HSP as appropriate.
· Clarification/assurance sought and given as to whether the quality of social care services, and in particular care of the elderly, would be maintained despite savings requirements and analysis undertaken on this. Reiterated assurance that there would be no discernible impact on front line services and current staffing levels and recruitment practices for these services would be maintained. Assurance given that savings from the review of management and administration would not impact on service provision. Assurance also given that maintaining quality of care for the elderly was an absolute driver for service provision and no deterioration in front line services was envisaged.
· Clarification was sought and given as to the importance attached to provision of adult social care, by the Mayor and Cabinet Member for Health and Wellbeing; and its level of priority relative to other Mayoral priorities for the Borough, in the context that demand would grow and other authorities were already being forced into provision for the elderly and disabled via institutional care. The authority had statutory obligations in this area but additionally was the only authority in the UK to provide free homecare, it had also recently been rated by the Care Quality Commission as providing a “High standard and quality of care”. Future provision would depend on the resources available to the authority, and the position would continue to be reviewed. However there was no current intention to depart from the authority’s preferred policy of caring safely for residents in their own homes, for as long as possible, and to support this through improved use of technology and innovative working such as Re-ablement.
· In the context of commissioning services externally, what mechanisms were in place to monitor the effectiveness and efficiency of service provision. Also what systems were in place obtain client feedback and use this to inform commissioning. “Peer to Peer Review” initiatives were underway to train some client users on how to obtain feedback from others and to use this feedback to inform development of adult social care. Such information was starting to inform commissioning of children’s services, and this would be extended. Additional manual processes to monitor delivery of homecare services would not be cost effective, and officers were confident that ICT problems with electronic monitoring would be resolved. Requested that a summary report on Adult Social Care client complaints be presented to a future OSC.
The Chair Moved and it was:-
Resolved
1. That the contents of the oral report be noted;
2. That the Health Scrutiny Panel scrutinise Adult Social Care savings targets and progress on their delivery in more detail later in the year; and
3. That a summary report on Adult Social Care complaints be presented to a future OSC for consideration.
Action by:
Sarah Barr (Senior Strategy Policy & Performance Officer, Strategy Policy & Performance, CE’s)
Anne Canning (Interim Corporate Director Education, Social Care & Wellbeing)