To seek the view of the Committee on the current arrangements for the Adult Social Care business change programme, its governance and to endorse:-

·         the proposed approach for the Next Stage Integration Project for Wye Valley NHS Trust and Herefordshire council’s adult social care service and

·         the open book review process that has been undertaken in relation to Herefordshire’s residential & nursing care banded rates of payment.

The report is also to seek guidance from the committee on the key areas of the programme in which it would like to focus on during 2013/14

The Committee received a report on the current arrangements for the Adult Social Care business change programme.

The Interim Transformation Manager highlighted the following areas:

·         That meeting the needs of an aging population whilst improving outcomes and staying within reduced public sector budgets was a national issue.  The programme before the Committee had two stages.  The first of these was to regain control of finance and governance of the Adult Social Care system, the second was to redesign the adult social care system in Herefordshire. 

·         That the Council commissioned Wye Valley NHS Trust (WVT) and 2gether NHS Foundation Trust (2gether) to manage and provide a range of adult social care services on its behalf. Staff within adult social care were currently seconded from the Council to both organisations. Commissioning arrangements had to be reviewed as existing arrangements would cease when the current Section 75 agreements come to an end in September 2013 (WVT) and March 2014 (2gether). The Council also had to take account of the Care and Support Bill, the financial outlook and future transformation requirements.

·         Herefordshire had been slower than other councils in transforming services to date, and this, combined with the growth in older people meant there was a savings plan (within ASC alone) of £7.078m to ensure a balanced budget of £48.797m in 2013/14, of which  £3.9m was not yet assured.

·         £1m of savings would be delivered by the Next Stage Integration project in 2013/14.

·         The Next Stage Integration project would be supported by the Open Book Review into Residential & Nursing Care which was designed to ensure that there was a fair and transparent approach to the charging for residential & nursing care provision in Herefordshire. This would mean balancing considerations of the providers’ actual costs with the desire of the Council to obtain best value through a pricing structure which is fair to providers and customers as well as the Council. This structure would be one which was likely to ensure a reasonably stable and competitive market for services and deliver an appropriate quality of care.

In the ensuing discussion the following points were made:

That there was a risk register as part of the project.  The largest risk was that a significant part of the necessary savings of £7.078m would not be achieved.  There were also risks around embracing change, and the discharge of patients from hospital.  Both of these were being worked on with the Herefordshire Clinical Commissioning Group.

In reply to a question, the Director for People's Servicessaid that should the Service fail to achieve its budget, then vulnerable patients would be put at risk.  Work was underway with the hospital as a health and care system to review the Urgent Care pathway.  The principal concern was around the broad County services, not those provided by the hospital. Attention was being given to the discharge of patients, and an assessment would be undertaken of the Occupational Therapist Service. The Care Bill made it clear that people would be encouraged to take increased responsibility for their own wellbeing.

In reply to a question, she went on to say that the existing systems  ands processes were convoluted and difficult to use. Which is why change was being undertaken.  There was a generational issue to overcome, with both service users and providers.  The best solutions to issues were those undertaken by people by themselves. 

The Director concurred with a Member’s comment that there were many people who had yet to be assessed, but replied that 6 more social workers had been employed in order to help with the assessment process.  The Cabinet Member (Health and Wellbeing) added that one of the problems that the Council had was in understanding where it actually stood at the moment.  There were problems associated with the Wye Valley Trust, and these would be addressed as part of this process.  Assessments were behind where they should be, but this was partly as a result of the Council not having the control that it ought to have over the processes. 

In reply to a Member’s question as to how savings would be made in the remaining nine months of the year, the Cabinet Member said that at the last Council meeting, a recommendation to allow the Chief Executive to provide a balanced budget for 2013/14 had been agreed.  There would be a budget monitoring report to the meeting of Cabinet on the 25 July which would refer back to the budget in February, and indicate the existing position.  Further savings had been identified, and the governance structure and leadership was in place to make these savings.  The Council would engage with its partners to ensure savings were achievable, and was going out of its way to engage with users, carers and staff in order to achieve the end goal.  There was a finite amount of money available, and the Council was working to ensure that it was spent appropriately.

In reply to a further question, the Interim Transformation Manager said that some people could increase payments made to residential homes by way of third party top ups.  He added that carer’s assessments would be integrated as part of the process that assessed the needs of the service user, in order to ensure that the needs of both were met. 

RESOLVED:  That the Open Book Review should come before the Committee before it was finalised.