Agenda item

5.1  The group gave consideration to two papers; a briefing on 1CYPS savings from Children and Young People’s Services; and a briefing on Adult Social Care and Commissioning draft savings proposals for 2016-17 from Adult Social Care and Commissioning in Health and Community Services. The group also gave consideration to an additional two papers which had been circulated to the group a day prior to the meeting; one paper on the proposed charging policy for integrated telecare service and one paper on the principles underpinning approaches to Commissioning housing related support and prevention services, both from Adult Social Care and Commissioning in Health and Community Services and both accompanied by a power point presentation.

 

5.2  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)

Cynthia Davis, Head of Commissioning and Procurement, Health and Community Services (CD)

  Genette Laws, AD Commissioning, Health and Community Services (GL)

  Ilona Sarulakis, Head of Adult Social Care (IS)

  Deirdre Worrell, AD Finance, Health and Community Services (DW) 

 

5.3  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 Jonathan McShane, Cabinet Member for Health, Social Care and Culture

  Cllr Ann Munn, Chair of Health in Hackney Scrutiny Commission

 

5.4  JM and SD introduced the briefing from Children and Young People’s Services. The following points were noted:

 

a)  The briefing included a breakdown of the savings achieved by the 1CYPS service redesign as well as reiterating the 1CYPS principles. Through the whole service redesign Children and Young People’s Services had managed to frontload the required savings and the savings were already being delivered.

b)  The savings delivered from within Young Hackney were achieved by reducing middle management, time spent in meetings and reducing the administrative tasks whilst ensuring that the frontline services were preserved and that services were restructured to deliver activities at times when young people are available, such as after school, evenings and weekends. 

c)  The whole workforce development strategy brought about opportunities for junior staff which is also a part of the wider workforce development strategy.

d)  Whilst the changes had yet to take full effect, the number of young people attending the youth hubs continued to increase and CYPS continued to invest in early help and prevention. Despite the current financial climate and a trend nationally whereby services have seen an increase in the number of people needing help and support, the number in Hackney had stabilised. However, further cuts to budgets would impact on statutory services which would also indirectly be affected by the effects of families suffering adversity.

 

Questions and answers – Children and Young People Services

 

5.5  The Members of the group asked questions around potential cuts to frontline services, foster care cost, the number of staff affected by redundancies in the 1CYPS restructure and what had been done to ensure that young people still received essential services. In response to these questions SD advised:

 

a)  At this point Children and Young People’s Services had not had to make cuts to front line services and were hoping that the focus on early intervention and prevention would contribute to any proposed savings going forward by releasing the pressure on statutory services. However, there were potentially some harder decisions to be made in 2017/18 and the greatest risk to service reduction remained around non-statutory youth services. 1CYPS continued to work closely with and to monitor the proposed cuts to other departments such as the Domestic Violence team, the Drugs and Alcohol Action Team, Mental Health services and Adult Social Care to understand and to mitigate the effect that cuts to these services would have on Children and Young People’s Services.

 

b)  The most important thing about fostering was to ensure that the ‘right’ children are taken into care. During austerity, the pressure was increasing on Children and Young People Services to ensure that children leaving care and foster carers were getting the right support as the support services available around them shrank.

 

c)  In total 147 members of staff were affected by the 1CYPS restructure with 34 voluntary redundancies and 12 compulsory redundancies being made. The redesign of the service took place following an activity audit, the main aim being to provide face to face activities and to ensure that young people had the opportunity to see a trusted adult who they can speak to. Middle management roles had been cut and part time roles and seasonal roles had been created; the change in working patterns had enabled the delivery of activities in the evenings and on the weekends to fit around the young people. In addition, staff that had been retained harboured a wide range of skills including the ability to detect early signs of gang activity, child sexual exploitation and other forms of child abuse.

 

d)  Children and Young People’s Services continued to work closely with Hackney Community and Voluntary Sector (HCVS) and had found that they had been supportive of the restructure and appreciative of the support 1CYPS had provided around efficiencies, evidence and monitoring. Strengthening the community and voluntary sector’s capacity to commission the right services and to secure funding would help to deliver non statutory support services, activities as well as run other provisions for children and young people in the borough.

 

5.6  Cllr Bramble added that Hackney Learning Trust has also done work around raising the profile of their services to attract children and young people from other boroughs and consequently generate income.

 

5.7  The Chair thanked the officers from Children and Young People’s Services for their report and attendance.

 

5.8  KM took Members through the briefing report on Adult Social Care and Commissioning savings proposals for 2016/17. She stated that the main discussion and the focus of the presentation are the proposals to introduce charges for the telecare service and the changing principles that will support the commissioning of housing related support.

 

5.9  GL introduced the briefing paper on the proposed charging policy for integrated telecare services. The following points were noted:

 

a)  The Council provided access to telecare  in order to support people to remain in their homes, increase or maintain their independence and to reduce the number of people needing ongoing social care support.

b)   Telecare was available to people regardless if they meet the Care Act’s eligibility criteria or not. Hackney had a telecare response team which meant that clients could be less reliant on friends and family.

c)  Telecare was currently free of charge and the annual cost of the contract was £509k. Only two London local authorities provided this service free of charge and amongst the local authorities that charged for telecare, there were a number of variations to their offer. Hackney and Tower Hamlets were the only two boroughs who did not charge at all, however some boroughs offered free telecare to residents who are over 85 years. A number of boroughs had added charges for the installation and replacement of the equipment as well as the monitoring of the sensors used, whereas others did not provide a specific telecare service and would only signpost to commercially available services such as Age UK.

d)  It was proposed that the charging model in Hackney would include a one-off installation fee of £25 and then a weekly charge of £5.50 with the first six weeks free in order to continue the good work that was already in place around hospital discharge. This option which was outlined as option 5 in the report, would charge according to means testing, those on pension credits would pay a reduced charge. It was felt that this option was fairer than a uniform charge and that it was transparent to the public and simple to administer. If this option was supported and taken forward there would need to be a three months consultation period involving existing users, the public and partner agencies and a full impact assessment. Following the consultation, officers would take a report to Cabinet to consider the outcome of the consultation and whether the implementation plan took into account any disproportionate impact on those with protected characteristics.

 

  Questions and answers – Adult Social Care - telecare

 

5.10  The Members of the group asked questions around how the options differ; fairness of the added expense; transitional costs; promotion and the consultation process. In response to these questions GL, KW and DW advised:

 

a)  The first option was not to introduce a charge for telecare. This would mean that the council would need to make savings elsewhere and had therefore not been recommended. The second option which proposes to charge everybody for telecare and would represent the highest income option and would treat each customer equally but could lead to a large number of people choosing to disengage with telecare. This could lead to increased costs for the Council in the future and had therefore not been recommended. The third charging option excludes residents over the age of 85 and was not recommended as it would disproportionately benefit white female customers as they made up a higher proportion of that age group. Similarly, the fourth option which proposes a charging policy that excludes Social Care eligible clients was not recommended as it would not meet revenue target of £245K.

b)  It was standard practice within support services to charge the majority of client groups more for a service to alleviate the cost for those that are eligible for a lower rate. However, it was essential to monitor how this would impact on the potential uptake and fall out of the service by existing users to ensure that the current client group weren’t adversely affected by the charge.

c)  The introduction of the charge would bring with it initial transitional costs around administration and installation which would need to be carefully accounted for. Similarly, it had been proposed that clients will be exempt from the charge for 6 weeks. This will be particularly important around hospital discharge and setting people up at home to promote independence and reduce hospital re-admissions and potentially save on future care costs.

d)  Telecare was not currently promoted in Hackney. It formed a part of the clients with complex needs, care package. However, there are a lot of products linked to telecare on the market which promoted independence, help elderly people keep safe as well as provide families support especially when those who didn’t live locally to their relatives.

e)  As a part of the consultation process, partner agencies and stakeholders would be given the opportunity to have their say and to give their feedback as it was essential that this service like others was shaped by the need of the service users.

 

5.11  The Members of the group raised concerns around the dangers of promoting the telecare response unit as a ‘goldstar service’ without clearly stating what the tasks the response unit actually will carry out and not to promote it as a ‘blue light’ service which possibly can’t be delivered.

 

5.12  CD introduced the briefing paper on the principles underpinning approaches to Commissioning housing related support and prevention services. The following points were noted:

 

a)  The report set out the commissioning principles underpinning the way new services were designed and how it shaped the strategy for commissioning, re-commissioning and de-commissioning decisions. 

b) The development of principles of commissioning, re-commissioning and de-commissioning which would inform future funding decisions and provide clarity to community and the markets was increasingly important at a time of a continued reduction in central government funding.

c)  The previous pathways for commissioning a variety of services were to provide ‘something for everyone, a little extra for some and more for those that need it the most’. However in the current financial climate, the vision for housing related support that would be delivered through the principles was ‘supporting people that are most vulnerable; enabling people to be active citizens; and moving on those that are capable’. In practice this meant that the preventative support offer is redesigned to ensure that there is targeted support to enable people with low to medium support needs to step down and to be signposted to universal services.

d) Adopting a strategic commissioning approach at times of austerity could deliver effective means for achieving financial efficiencies by taking a whole systems approach: assessing the needs of the population: determining priorities and planning capacity and building a business case which would be put forward to the project board, the Cabinet and the DLT board.

e)  De-commissioning sat within the methodology of commissioning and should be carried out in a planned way to ensure that services were fit for purpose and that the Council was making the best use of resources available with needs continuing to be met. De-commissioning was not simply closing services to release savings.

f)  The Care Act 2014 introduced new duties on local authorities to facilitate a diverse and sustainable market for high quality care for the benefit of the whole population, regardless of how the services were funded.

g) In order to deliver these outcomes the following principles would be used to shape processes, engagement and decision making. There would be a re–focus on adult social care and Supporting People investment to enable the Council to meet the needs of the most vulnerable. This would be achieved by commissioning for prevention; Supporting People and adult social care pathways; by consulting with service users, carers and other key stake holders; by taking a whole systems approach; by ensuring that services are fit for purpose and are meeting changing needs of residents; by taking a strategic approach to de-commissioning and by measuring the impact of service redesign had on other services such as housing, public health as well as the wider community.

 

5.13  KW added that the £13 million referred to as ‘Supporting People money’ was not proposed as savings for 2016/17. However, the expectation was that at the beginning of next year, conversations around how these funds were spent would start taking place and therefore there was no expectation on the group to make a decision in regards to housing related support (Supporting People) at this stage. 

 

  Questions and answers – Adult Social Care – housing related support

 

5.14  The Members of the group asked questions around how the needs of those people who do no longer meet the thresholds for intervention, in particular people with mental health issues would be met; how would housing services ensure that clients with complex needs were equipped to move on and how would needs continue to be met for the group that previously came under the heading ‘a little extra for some’ and who required ongoing support. The group also raised concerns in regards to how the Council would ensure that staff across different departments have the aptitude to deal with complex additional tasks where services have been ended.  In response to these questions CD, GL, DW and KW advised:

 

a)  Adult Social Care was currently having discussions with Housing around hoarding and what type of staff training was needed to ensure housing staff were equipped with the skills to deal with issues around hoarding and to spot early signs of mental ill health. In addition, services were working in close partnership to ensure that staff were equipped to make the right referrals as a part of a universal service.

b)  Supporting People provided a range of services to clients with different levels of need and provided valued help and support with budgeting, CV workshops and floating support. However, it was not a statutory service and even though their preventative services were much valued it remained essential to see whether there was flexibility to deliver services more efficiently.

c)  While looking strategically at all contracts and service level agreements, inconsistencies around costs and expectations had emerged which need to be addressed in a holistic way in order to understand efficiencies across the whole portfolio. So far, it had transpired that in some cases clients with medium to high need support were allocated fewer hours of floating support than some one with a low to medium need of support.

d)  Universal services council wide, such as Parks and Leisure, delivered a range of services which initially were adult social care initiatives such as the ‘new age games’. Initiatives like this had been successfully embedded and developed in universal services and were an example of how funding was best used to create less dependency on support services. In addition, Adult Social Care has been liaising with Public Health, in particular around their Pause Project as well as looking at best practice across the country for ways that make a difference in delivering services more efficiently.

e) Adult Social Care was working closely with key partners and stakeholders around recovery which was focused on equipping clients to move on; moving to joint commissioning with the CCG and with ELFT with regard to mental health. As mentioned at the first Budget Scrutiny Task Group 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.   Work was also taking place in regards to ensuring that access to housing was looked at so that there was somewhere for clients to move on to. However, the pressure on housing would continue to increase and to mitigate this they were exploring different avenues including working with RSLs around providing a certain level of support around the ‘Moving On’ pathways as a part of their service level agreement.

 

5.15   IS presented an update on the One Hackney programme. The following points were noted:

 

a)  The One Hackney was an integrated care service pilot programme with a focus on those in the age group 55-70 which had complex care needs.

b)  This pilot was funded by the CCG.

c)  The social workers were aligned with the GP Quadrants and worked alongside a multidisciplinary team to deliver a care plan to high risk individuals. The aim was to address and improve health as well as social care outcomes and to reduce hospital emergency admissions for people over the age of 60 thus helping to cut hospital costs in the long term.

d)  The programme had been extended until September 2016 on the back of the success so far in delivering against the targets. The ongoing evaluation and feedback from the agencies involved had been positive.

e)  The input from social workers had highlighted gaps in the service and the close partnership working across organisations had both improved the quality of referrals and reduced the number of referrals from GPs.

f)  The staff had embraced the opportunity to be involved in this partnership working and had also helped reduce the notion of there being a ‘them and us’ situation, this had helped with building relationships across organisations and had been supported by a large number of development days and user events.

g)  An unmet need had also been identified as a part of the programme which could tap into universal services early to prevent crisis further down the line.

h)  A decision would be made whether to fully adopt this model once the pilot had finished and been evaluated.

 

5.16  The Chair thanked the officers from Adult Social Care for their report and attendance.