Agenda item

Mike Robinson (Director of Public Health) and Martin Calleja (Head of Transformation, Adult Social Care) presented the report that outlined the risk management arrangements for Adult Social Care and Public Health.

Mike Robinson drew the Committee’s attention to section 4 of the report (page 18), Managing Current Strategic Risks, and highlighted three key risks for Public Health:

·         Public Health grant reductions and removal of the ring-fence - The service had reviewed its contract arrangements to identify efficiencies and had set up a task and finish group to look at alternative delivery models.

·         Clinical governance risk - A clinical governance clause had been written into all NHS contracts to ensure robust governance was undertaken by the provider. There would be a review of other partners later this year.

·         Public Health restructure risk – The current Public Health team was hosted within Westminster City Council and had not undergone any significant change since its inception. While there was no current pressure to reduce costs the service was looking to increase its effectiveness and make sure its skills were accessible across all council departments.

Martin Calleja highlighted five key risks for Adult Social Care on page 20 of the report:

·         Reducing resources – Successive years of budgetary reductions and ever increasing demand on resources made this a key risk for the service.

·         Responding to changing legislation – The Care Act had created new requirements for the service. In response to this officers were working to change their service model to focus more on prevention and reablement to contain carer costs. Work was ongoing to identify further savings opportunities through service redesign and ‘smarter budgeting’.

·         Reducing customer satisfaction – There was an increased risk of reducing customer and carer satisfaction as the service carried out significant change programmes. To mitigate this risk the service was investing in more effective communications and change management.

·         Workforce risks – There were recruitment and retention risks for social care staff, both internal and commissioned. In response to this the service had formed a workforce board and written a workforce management plan.

·         Market unable to provide services – The adult social care market was fragile and there was a risk it would not provide the necessary level of services. The service was undertaking market management and development in partnership with the West London Alliance.

Mike Robinson and Martin Calleja both noted that the managed services programme continued to be a risk across both departments and they were working with HR and Finance colleagues to mitigate the impacts.

Members asked why the risks identified by Adult Social Care were so much more severe than those identified by Public Health; was there a different approach to risk management or did it simply reflect the reality of the different services? Mike Robinson responded that he was not aware of any difference in approach between the two services but was aware that the external risk environment for adult social care associated with demand and costs was significantly higher. Martin Calleja added that this feedback would be taken on board in undertaking the Q4 risk review.  He also agreed with Mike’s assessment of the more acute risk environment Adult Social Care was operating in compared to Public Health.

Members asked officers which, of the risks that had increased in score over the past 12 months, were the most concerning. Martin Calleja responded that the risks around budgetary pressures and increasing demand were the most uncertain. Balanced budget were anticipated across the three boroughs this financial year but  2016/17 would be very challenging.

Members noted that the risk management reports were badly presented, with tiny text and colour keys that were useless when agendas were printed in black and white. Officers agreed to improve them for the next meeting.

Members highlighted instability shown within the commissioning team on page 21 of the report under ‘Workforce risks’ where 39 of the 63 posts required external recruitment. Members asked how the service would resolve those recruitment issues. Martin Calleja responded that the workforce management plan and the commissioning risk register contained more detail on how that would be managed but some mitigations included extending notice periods for staff and looking to make managers into commissioners.

Members asked how many vacancies there were in the commissioning service at the present time. Officers responded that there were 24 vacancies but the service was using interims and moving staff from other areas of the business to support. The reason for the high number of vacancies was that the service was changing to adapt to a very different type of commissioning than was required in the past.

Members asked if there were comparable levels of vacancies within the Public Health service. Mike Robinson noted that the restructure referenced in the report was just a proposal and the current team was relatively stable with few vacancies.

Members asked if the Medium Term Financial Strategy had required a restructure. Mike Robinson responded that the restructure was not being planned to address cost savings but rather was designed to better integrate Public Health in other council services and spread understanding and accountability for health outcomes.

Members noted concerns about the recruitment issues highlighted in 4.3.4 of the report and asked officers to look again at their provision for that risks and return to the Committee to provide greater detail and assurance that a robust mitigation strategy was in place.

Members asked officers if other local authorities were offering more competitive salaries and benefits. Martin Calleja responded that this problem was a national issue and the best staff had a wide range of options to consider. He noted that some boroughs were offering more particularly for interim staff.  He noted that the issue was most significant for frontline social workers and carers.

Members asked if the current level of funding to meet new requirements of the Care Act 2014 was sufficient for the level of people with complex needs in the borough.  Martin Calleja said that whilst grant aid funding had met additional costs in 2015/16 the long term impact on demand was not yet known and the continuity of additional funding was not secure beyond 2016/17.  He noted  the service was working closer with health colleagues and investing in initiatives like the Better Care Fund and the ‘whole systems’ programme to help manage demand. Members asked for more information on the potential future cost of provision above the allocated budget.

Members, referring to 4.4.1 of the report, asked if the managed services programme was causing significant problems for the service. Martin Calleja reported that Adult Social Care had suffered serious problems such as direct payments not being paid but they had put in various contingencies to lessen the impact on vulnerable people and carers. Officers noted that managed services was improving but there was still a way to go before it was up to the required operational standard.

Members asked if the changing priorities and pressures of the shared service arrangements had contributed to staff recruitment and retention problems. Martin Calleja said that some staff liked the challenge and variety of working across the boroughs while others found it more challenging. Overall he felt it was an issue but not the most significant of issues for recruitment and retention.

Members, in reference to 4.3.5 of the report, asked if it was possible the Council was partly to blame for not communicating correctly with the market. Martin Calleja responded that the service needed to be facilitators of the market but many providers were facing squeezed profit margins and workforce retention difficulties that were difficult to address.

Members asked if there was a risk that the Council was taking certain aspects of the delivery programme, that relied heavily on the market, for granted. Members also noted that perhaps companies should be considered partners rather than suppliers. Officers said they would reflect further on these points and feedback to the senior leadership teams.

Members asked if there was a genuine culture of risk management within the services and that it was not just a seen as a box-ticking exercise.

Mike Robinson responded that in Public Health they held monthly staff meetings to discuss the risks of particular options. Staff consider the desired outcomes, interventions, and associated risks. Martin Calleja noted that in Adult Social Care there were staff workshops looking at how to improve service processes. By making sure staff were fully involved in the redesign it also gave them confidence about reducing the risks of managing with reduced resources.

Members asked officers for an example of where the risk management process had generated real action. Martin Calleja responded that the risks associated with financial delivery and meeting demand made officers put the customer journey project on twelve week accelerated programme to address savings concerns. He noted that risk management was a core part of the culture of the management team.

RESOLVED

1.            That the Committee reviewed the risk management arrangements that have been put in place by both the Adult Social Care and Public Health services and endorse the mitigating actions for each key high-level strategic risk.

2.            Members asked senior officers to address the recruitment issues in the Adult Social Care commissioning team and provide an update on progress to the Committee outside of the meeting. Members asked that the note to the Committee included detail of how the number of vacancies got to be so high.