Agenda item

Mr Cuthbert presented the proposal to reform Adult Social Care. The report set out the five reasons for such a change.

In spring 2014, the three councils had commissioned an independent review of Operations beginning with focus groups from each borough. The groups were asked to explain their experiences and the reviewers picked four things that mattered most: control, quality coordination and clarity.

The report summarised the issues in respect of the changes in the borough’s population and the Council’s extended legal duties, brought about by the Care Act and the Children and Families Act.

The national policy of care in the community had meant that more complex care currently happened in or near people’s own homes. New initiatives like the Better Care Fund meant that this trend would continue. The Council’s medium-term financial plan showed that the budget for Adult Social Care, currently £64million would be £56million in 2016/2017. There would be a 10% reduction in Operations staff.

The report set out the proposals to reform Operations, with a simple service structure with only two teams, with a clearer role:

(i)      A short-term, integrated Community Independence Service to help people when a problem with their health or a crisis in their life put them at risk of losing their independence,

(ii)    A local service for people whose long-terms needs were mostly stable which helped them manage their support and lead an independent life.

Mr Cuthbert stated that whilst the proposals could be funded through the Better Care Fund in 2015/2016, the funding for the service was uncertain from the second year.

Mrs Bruce stated that the proposed new service enabled savings of £0.5million in 2015/2016 and plans for additional savings of £1.3m for 2016/2017.

Councillor Barlow queried the accountability of the different organisations. Mrs Bruce responded that Adult Social Care Operations would remain a  statutory service of the Council, integrated with health services. The Director of Health & Adult Social Care was the Accountable Officer for discharge of the Council’s statutory duties, unless it was agreed to delegate part of the duties going forward. This model did not delegate. The responsible GP would be held to account by Adult Social Care. The service specification would set out the hours, both in hours and out of hours operation.

Councillor Brown queried whether a unit on the Charing Cross site was still under consideration. Mrs Bruce responded that this model was primarily out of hospital care, whilst the Shaping a Healthier Future proposals were in respect of reconfiguration of acute hospitals. Mrs Bruce had not been briefed in respect of an intermediate facility on the Charing Cross site.

Councillor Lukey stated that a meeting with the CCG had been cancelled and would be re-scheduled, The Council needed to understand the better offer for that site. Councillor Lukey was not aware of the site proposals.

Councillor Holder commented that the proposals looked similar to the Whole System described by the CCG. Councillor Carlebach added that the proposals needed to be locality based, with a geographical area aligned with GP networks.

Councillor Chumnery queried how incidents of next day care in the community following discharge not happening fitted into the flow chart. Mrs Bruce responded that the top box of the flow chart had entire responsibility from the time a customer entered the system until a customer left because the service had come to an end. Some aspects of the Community Independence Service were already happening. There would be a multi-disciplinary agreement between hospitals and GPs and nurses. Adult Social Care would follow through to ensure that a home care package was in place. The risk was in respect of the interface, for example a GP not knowing that a  patient had been discharged. It was good practice for a patient not to be discharged after a certain time, and this would be written into the agreement. Currently, consultant geriatricians were coming out of the ward and into homes. This would be rolled out if people were happy with the model.

Mrs Bruce responded to a query from Mr McVeigh that the Operations budget would be reduced to £4miilon in 2016/2017 and there would be staff reductions. The new  model would respond better and more efficiently to customer needs. In addition, there would be investment from the CCG. An accountability framework and a quality framework would sit within the model. This detail had not been provided in the report.

Ms Domb noted that there should be a wrap around service. Many people had bad experiences and work was needed on discharge procedures at Imperial. Mrs Bruce responded that some of the issues were complex and Adult Social Care would welcome future scrutiny.

Councillor Vaughan commented that the report was a simplification of the customer journey and that people going through the system might not see the gains. He suggested that there should be a pilot to ensure that the system worked in practice. Mrs Bruce responded that the new model had been piloted by Kensington & Chelsea. It was not possible at this stage to detail savings and there remained some uncertainty in respect of the future of NHS/CCG model.

RESOLVED THAT:

An update report to provide more detail of the proposed model would be added to the work programme.