Agenda item

6.1  The Group gave consideration to two papers on Proposed Areas for Savings for 2016/17, one from Children and Young People Services and one from Adult Social Care and Commissioning in Health and Community Services.

 

6.2  The Chair welcomed to the meeting the authors of the reports:

 

  Sheila Durr, AD Children and Young People’s Service (SD)

  Jackie Moylan, Assistant Director of Finance (CYPS & LHRR) (JM)

  Kim Wright, Corporate Director, Health and Community Services (KW)

  Rob Blackstone, AD Adult Social Care (RB)

  Genette Laws, AD Commissioning (GL)

  James Newman, Head of Finance, Community Services (JN) 

 

 

6.3  It was noted that the following were also present for this item:

 

  Cllr Anntoinette Bramble, Cabinet Member for Children’s Services

  Cllr Rob Chapman, Labour Group Chief Whip

  Cllr Ann Munn, Chair of Health in Hackney Scrutiny Commission

 

6.4  JM and SD introduced the paper from Children’s Services and took Members through the 1CYPS principles.  The following points were noted:

 

a)  The key approach in the service was to intervene early to prevent spend in statutory areas and this kept Hackney’s rate of statutory provision low compared to its statistical neighbours.

b)  The biggest cost was in supporting families to keep their children with intervention as prevention being the key.  Demand came from the public considering that care was a viable option for their children and there was a balance always to be stuck between the benefits of the state providing a service to a child vs the need to empower the parents to provide for their own child. 

c)  The aim was to have as few children as possible facing statutory processes because often these processes could do harm to them therefore it was important not to over intervene. Managing of rights and their resource implications became issues when the child comes in contact with social services.

d)  Some children were supported up to 18 years of age because often it was cheaper in the long run to intervene rather than not.  In times of austerity it was harder to demonstrate the effectiveness of prevention.

e)  The key with 1CYPS was that money was focused where it had the most impact and all services were measured carefully.

f)  The Youth Hubs were experiencing their biggest footfall ever

g)  Only the best staff were employed and retained by the service and this was at the forefront in any restructure.  The Service wanted most children’s social care work to happen out in the community and the aim was to be able to empower the community and address any abuse that may happen.

h)  It was important to note that the majority of children who came into care did go home again or to other next of kin and this had been useful in the community for building trust in the service.

i)  They had gone through the whole service to minimise referrals between services and have everyone working with same early-help mind-set.

 

6.5  Cllr Bramble added that while the impact of central government cuts had been significant, the model for the service remained as child centred.  They had had redundancies and they were mindful that there had been a real shift in the service to a focus on prevention.  The Chair commented that Members were now well aware of the focus on prevention rather than crisis management. 

 

Questions and answers – Children and Young People Services

 

6.6  Cllr Munn asked whether having a greater spend on Adult Social Care would save money on Children’s Social Care.

 

6.7  RB replied that he and SD worked closely together particular on the issue of transitions.  There were numerous examples but one he cited was the work on supporting families with children who have disabilities in getting the children into colleges, which invariably were out of borough.  He added that on the Promoting Independence Strategy there was much cross over on the principles.  He added that it was not outside the realms of possibility that budgets might be aligned in the future.  SD added that it worked in the other direction too where a failure to act sufficiently on an adult social care issue would have an impact on any children involved and this would lead to an impact on their service down the line.

 

6.8  Cllr Bunt asked how they went about co-commissioning?

 

6.9  SD replied that there were a number of examples such as Supporting People, Special Educational Needs, co-locating work in Children’s Centres and the placing social workers in schools.  The focus was on ‘whole family’.  Housing was another key cross cutting area.  RB added that retaining of social workers was an issue here.  Adult care social workers also reported children’s care issues and the reporting systems were now much more rigorous.  He added that the focus now was on the ‘Hackney Pound’ and ensuring that wass spent most efficiently.

 

6.10  Cllr Potter asked, with reference to chart one on p.13, why there was such a variation across London in terms of spend on prevention vs spend on statutory services and why, for example, Brent was so low.

 

6.11  SD pointed out that Brent has in fact been criticised by Ofsted on this.  JM added that Hackney’s spend was not high compared to our statistical neighbours.  SD added that the clear stated commitment to a whole family approach in Hackney was unique and the ethos and way of working was different from many.  An early intervention focus was of course contingent on proving its impact at the other end of the scale.

 

6.12  Cllr Chapman stated that there was £2m savings referred to for 2016/7 but asked for detail on how this was going to be saved.

 

6.13  SD replied that less was being spent on management.  The Young Hackney team were spending more time in the Youth Hubs.  More value was being sought from the contracts with the VCS and there were more joined up processes such triage and family support services.  There was also a greater emphasis on cutting out duplication of services going to families.  Cllr Bramble added clarification that management level remits had been widened.  SD added that the focus was in putting statutory capability and expertise across the whole service with, for example, putting social workers in to schools.  If child protection issues now arose in schools they could be identified sooner and perhaps dealt with in the schools.  In the new model it would be easier to flip between the statutory and non-statutory services and for example fewer children’s issues in schools would have to be escalated to the statutory service.

 

6.14  The Chair commented that it felt like the youth service had of late been shunted around and asked what these changes meant for the relationship between a young person and their social worker. 

 

6.15  SD replied that the new model put Youth Justice closer to Child Protection.  Some child protection cases would for example be in families known to the Youth Justice system. While the service might be reducing in some aspects the regulatory framework remained the same.

 

6.16  Cllr Bunt asked what gaps were being addressed in the changes.

 

6.17  SD replied that she was worried about changes to demand in the system.  She was concerned that in-year cuts had been announced in the Youth Justice Board and that generally developments occurred much more quickly now.  There was a need now for a very flexible approach but they had many examples of where the service had invested and so had saved significant costs. Cllr Bramble added that it was the pressure of constant central government cuts which was the concern.  SD added that the Chief Executive of Children England had recently criticised what was happening by commenting that the government was trying to build a market at the same time as it was cutting the sector which commissioned the services in this market.

 

6.18  Cllr Munn asked for clarification on this issue of reducing the burden of regulation.

 

6.19  SD explained that there was a lag in the regulatory system in that some things which were statutory no longer had any impact and the whole Statutory Performance Framework was very out of date.  The Conservative government had promised to reduce bureaucracy but hadn’t done this and in fact had added more so the statutory framework was greater and there was an industry now in servicing it.  The addition of the whole machinery of Ofsted regulation on top was a huge cost and councils for example had to maintain resources focused solely on regulation.  She explained that in her department there was a regulatory post called the Independent Reviewing Officer and this had to be held by a social worker of at least 3 years standing post qualification and their role was just to check on the social workers.  When a service was high performing, as Hackney’s was, this was a waste of scarce resources as an expensive social worker had to be paid to effectively tick boxes for Ofsted.  RB added that in Adult Social Care they had a Performance Team who tried to keep the regulation activity burden to the statutory minimum and in addition they try to use these posts more flexibly and keep them constantly under review.  JM added that restrictions such as this made it more difficult to make cost savings on admin.

 

6.20  Cllr Potter asked how the crisis in the shortage of foster carers was progressing and how this came about in the first place.

 

6.21  Cllr Bramble replied that one factor locally was that the age profile of foster carers was increasing and as they got older they were taking fewer children.  SD added that in Hackney too people didn’t have the types of houses which would allow them to take in more children.  Black female foster carers were the stalwarts of the service.  SD added that private sector fostering was a huge industry and councils were not able to compete with them on a level playing field. They had to share with them all their market information and data but this is one way.  They also had to buy in foster care from private agencies because of the demand pressures and this costs twice as much as in-house provision and most were not located in Hackney.

 

6.22  The Chair stated that if Hackney was to have a fruitful campaign to recruit new foster carers they needed to know who these people might be and what information or data did they have on them?

 

6.33  SD replied that it was a challenge.  They had previously done campaigns but the quality of the candidates coming forward had been poor.  Word of mouth was a vital factor in encouraging people to try fostering.  There was also a campaign currently to encourage staff to recommend fostering to friends and family.  There was also a 6-borough campaign.  One angle was to encourage potential foster parents to come to North London as they would have a greater chance of getting the children they wanted here. 

 

6.34  Cllr Fajana-Thomas asked if the monetary incentive was working.

 

6.35  SD replied that the recommenders would only get the payment if the candidate had been through the process and been successful so there would be a 6 month lag.  Cllr Bramble added that the borough also shared expertise and training for foster carers with other boroughs. 

 

6.36  The Chair asked if the profile of the typical foster parent was altering at all from being a middle aged black woman. 

 

6.37  SD replied that the profile of newcomers to it was getting younger but black females predominated and they were of course trying to target as wide a range of people as possible.  She added that they had tried to engage more full time professionals in foster caring but most had found it too exhausting.  Hackney’s USP however was in the training it did provide for foster carers. 

 

6.38  The Chair asked if it was still worth persevering with those who might not last long because overall the time spent with a child would be relatively short and at least there would be a carer provided. 

 

6.39  Cllr Bramble replied that the aim was to return the child to its family or wider family and so 1 or 2 years fostering in a child’s life might be sufficient for them.  It was worth it therefore to have as many carers available as possible so an intervention could be made with every child who needed it. SD added that this could be a factor in future campaigns – to come and join us even for 1 or 2 years.

 

6.40  Cllr Potter asked if the Council could lobby on the lack of a level playing field in the foster care market.

 

6.41  SD replied that this was being done.  She added that when the NAO assessed the efficiency of council foster services they found that most councils underestimated the costs they added on and it remained significantly cheaper to do fostering in-house than via private providers.

 

6.42  Cllrs Munn and Chapman asked if it was possible before the next meeting to see more detail on the savings proposals which were being worked up.

 

6.43   Cllr Potter asked about the impact of all this on staff morale.

 

6.44  SD replied that a workforce strategy was in place further to the ‘reclaim youth work’ initiative.  It was important that talented and ambitious staff knew that there were structures for career progression in place for them in Hackney. She added that staff who left Hackney had no problem in securing jobs elsewhere.  RB echoed this, stating that retaining good staff was real challenge in the current market.  Cuts in staff development therefore need to be avoided. 

 

6.45  Cllr Munn asked whether recruitment costs were a problem?

 

6.46  RB replied that there had been instances when they had advertised and got little or no response, then went to the appointed agency which still produced nothing.  He added that he would not recruit staff who were of poor quality however challenging the recruitment process might be.  He added that he was lucky to have some social workers in his team who had been there 6 years and this was very unusual in London.  The problem of other authorities poaching staff was one he shared with children’s social care.  Cllr Munn added that it would be interesting to see a comparison of recruitment costs across Children’s vs Adult social care.  RB replied that he had just recruited newly qualified junior social worker who had been working in a restaurant for example.  SD added that they had had success in recruiting from continental Europe e.g. Sweden and Germany.

 

6.47  The Chair thanked the officers from CYP Services for their report and attendance.

 

6.48  GL took Members through the briefing report on Adult Social Care and Commissioning.  She stated that the previous cost savings plans had delivered cashable savings and it was now necessary to look at more significant reform to deliver the level of savings requested.  Recently the team had been visited by Prof John Bolton from the Department of Health who was investigating Hackney as an example of good practice in having managed down demand spend while satisfaction with services were still going up.  It was now necessary to look at all options including all non-statutory services such as Supporting People and to examine all possibilities for income generation and at what other authorities were charging for.  There was a need to look carefully at what they might be able to stop doing and to revisit the current three tiered structure of service delivery. 

 

  Questions and answers – Adult Social Care

 

6.49  Cllr Fajana-Thomas asked about the savings in service transformation.

 

6.50  GL replied that there were a range of changes but one for example was the re-commissioning of the telecare team.  One lead provider for the whole service replaced the previous two.  This delivered savings of £120K and they were looking at a whole range of areas.

 

6.51  Cllr Fajana-Thomas asked about the reference to 65 external providers for Supporting People and whether this was normal. 

 

6.52  GL replied that Supporting People had a long history and spend was across a number of public agencies (PCTs, Probation, Councils etc).  The service transformation involved bringing together spend and going for economies of scale with fewer contractors.  Previously there had been a large number of very small contracts focused on the needs of particular groups.  It also had been quite a tiered service.  The aim now was to look at smaller number of contracts and to focus them on those with the most need.  The number of contractors had reduced from 63 to 35 and the services were now serving c. 3000 people rather than 7300 in the past.  RB added that a lot of work was going on in the background on whether service were delivering what was needed and successful partnerships had been established with ELFT or through the Integrated Mental Health Team.  He added that he led on the Section 75 contract with ELFT for example and he made sure they wre still delivering in Hackney, despite their expansion nationally.  He chaired governance meetings each month to ensure delivery was on target.

 

6.53  Cllr Bunt asked where the under spend of £1m in mental health care support came from.

 

6.54  RB replied that the under spend came through via all the savings. They did for example make savings in staffing when a restructuring was coming down the line and for example on day care there would be a move next year to one centre.  JN added that a new government led process for presenting information on clients (‘Primary Support Regions’), would also contribute to savings.  RB added that he attended a Pan London Partnership Meeting on Mental Health and Hackney had been singled out by the NHS at those meetings for its model of delivery.  The focus on promoting independence rather than perpetuating creating dependence was proving successful.

 

6.55  KW (who had just joined the meeting) added that at the end of every year they went through an exercise on right-sizing budgets and she personally went through any consistent underspends and requested that they be offered up as savings. There had to be a forensic line by line analysis of the ASC budget as it was the biggest spend in the Council and close scrutiny of the budget was also carried out by the Chief Executive.

 

6.56  Cllr Munn asked in relation to 2017-18 budget and beyond, whether there was some clarity about things the Council should no longer be doing and were there any significant items here.

 

6.57  KW replied that they had virtually exhausted the potential for cost savings in each service area over the last few rounds and Promoting Independence would be likely to be exhausted as a potential area by the end of this year. They would have to look at the big spend non statutory items such as the number of Supporting People contracts.  RB added that Provided Services, in particular Housing with Care, was a big spend area that needed to be looked at.  There would be savings from the new Day Care Strategy and on Transport.  The challenge now was about how to re-focus, looking at different operating models.

 

6.58  Cllr Potter asked whether more services would be brought in house. She also asked about the Single Commissioning Plan with key partners and about what impact they were seeing of the welfare reforms.

 

6.59  KW replied that the focus wasn’t about whether or not to bring something in-house but to examine the model of delivery and how services might be delivered more efficiently.  In the past they had missed opportunities to look at what might be done differently.  She added that the CCG and Public Health also face significant reductions and given that there will be less resources everywhere all partners have to challenge themselves to look at new models of delivery and this involved providers such as the Homerton and not just commissioners.  RB added that the shared services agenda was a significant issue now.  KW added that broadly speaking the CCGs budget here was £400m, ASC’s £84m, Public Health £29m and there were also significant input from ELFT.  A lot of money was being spent across the partners and the challenge was to find synergies here which could deliver savings. 

 

6.60  Cllr Potter asked for further detail on the broad spend by each partner in the borough on social care.  Cllr Chapman commented that this was an excellent report but because more advanced proposals must now be nearly completed, the Task Group would benefit from seeing these, particularly relating to 2016/17.

 

6.61  KW replied that they would be able to bring to the Task Group the ‘direction of travel’ proposals.  A number of ideas were being explored including charging £5 per week for Telecare for example.  Day Care Integration was expected to deliver £700K inc. £300K this year.  Work was also ongoing with the CCG on joint funding of services.  The task for 2017 and beyond would be tougher and options were being explored for Provided Services and Supporting People. 

 

6.62  Cllr Chapman stated that ASC was the largest budget and so very difficult decisions would have to be made about what might have to stop.  What was the possibility of this happening for 2016/7?

 

6.63  KW replied that it was not likely for 2016/7 but would be a factor for 2017/8 onwards and they could go through this in more detail at the next meeting. 

 

6.64  Cllr Fajana-Thomas asked whether there would be a requirement to consult on Equality Impact Assessments?

 

6.65  GL replied that it would be necessary to speak to service users and EIAs were vital in ensuring that impact was minimised. 

 

6.66  Cllr Chapman asked about the synergies with CCG, HUHFT and ELFT and Cllr Potter asked if they could receive a breakdown of spend and function on these.

 

6.67  GL replied that tackling delayed hospital discharges was a key bit of partnership working.  The partnership approach looked at whole care pathways and moving relatively small amounts of money to have more impact.  RB added that the ‘One Hackney’ partnership initiative (aimed at the over 70s) had also been making some early progress.  He had 5 social workers now involved in it and they really appreciated the new way of working.  The Promoting Independence Strategy had a training programme behind it.  People are looking at that closely and it had the potential to be the start of a new alliance.  The IIT (formerly RICs) service based at the Homerton involved intensive prevention work and ultimately a move towards quadrant based working (based on the 4 Hackney CCG quadrants).

 

6.68  Cllr Munn asked why the Task Group was looking at Adult and Children’s social care together.

 

6.69  KW replied that there was a sense that having a focus on young people can preclude thinking about the whole family and that there might be an appetite to better join up adults and children’s services, which the Task Group could explore further.  JN reminded Members that prior to the Children’s Act adult and children services were part of one Social Services department.  RB added that as the beginning of his career as a social worker he had worked across both services all the time. 

 

6.70  KW explained that recently in Hackney they had established Leadership Summits which comprised the leaders/chief executives of the CCG, ELFT, HUHFT, CHUHSE, GP Confederation and the Council, to explore what the future might look like were they to collaborate better.  Having gone through this process there was now a much better understanding of the issues across the partners and a sense that the Hackney Pound needed to be used more wisely.  The Summits should encourage the partners to take the leap of faith necessary and to trust one another more so that progress on collaboration and integration could be made.  ‘One Hackney’ fitted very well into this but it had proved very difficult at the beginning.  They were now looking at case studies of issues that didn’t work well and trying to learn from them.  In the beginning there would be 30 people at these meetings.  Trust had to be earned and there had to be fewer people at these meetings and there had to be learning from the process. 

 

6.71  Cllr Fajana-Thomas asked what modelling had been done on the impact of the welfare reforms on ASC’s budget. 

 

6.72  JN replied that there had been no impact yet on collection rates for charges.  There was of course a ‘fairer charging’ policy in place.  The other significant impact on the budget would be from the Care Act because there would be a need for a much higher number of care assessments to be done.  One aspect of Hackney’s demographic that would have a bearing here was that there weren’t a large number of self funders for social care.  Overall there currently wasn’t a significant income pressure. The way in which the Council charged for residential care was also nationally determined. 

 

6.73  The Chair asked about the difficult balancing of health vs social care funding and its impact on the service’s income.

 

6.74  JN replied that most of the income generation activity was with the partners and the Council had less of an opportunity to generate income from service users.  They were however looking at Telecare charging. 

 

6.75  The Chair thanked the officers for their papers and for their attendance.

 

ACTION:

a)  The AD Adult Social Care, AD Commissioning and the AD Children and Young People Services to each provide more detail on the advanced savings proposals which are being offered in each of their budget areas.   b)  The AD Adult Social Care and AD Commissioning to provide a brief outline of the total adult social care spend for the borough encompassing what is commissioned by the Council, the CCG and NHSE with a breakdown of spend and function.   c)  The AD Adult Social Care to provide further detail on ‘One Hackney’ and the future plans for it.   d)  O&S Officer to invite Cllr McShane to the next meeting of the Task Group.   e)  O&S Officer to ensure that electronic agendas for each of the Task Groups be emailed to all Members to remind them that this work is taking place and that they are welcome to attend.