Agenda and minutes

Apologies for absence were received from Councillors A P Maughan and M A Whittington.

The Chief Executive reported that having received a notice under Regulation 13 of the Local Government (Committees and Political Groups) Regulations 1990, he had appointed Councillor P Skinner as a replacement member of the Committee in place of Councillor M A Whittington for this meeting only.

There were no declarations of interest at this point in the meeting.

RESOLVED

            That the minutes of the meeting held on 5 September 2018 be signed by the Chairman as a correct record.

There were no announcements by the Chairman, Executive Councillor or Lead Officers.

(To receive a report by Carl Miller, Commercial and Procurement Manager – People Services, which invites the Committee to consider a report on the commissioning and procurement of Integrated Lifestyle Support Services (ILS), which is due to be considered by the Executive Councillor for Adult Care, Health and Children's Services between 12 and 19 October 2018)

The Committee received a report which provided members with the opportunity to consider a report on the commissioning and procurement of Integrated Lifestyle Support Services (ILS) which was due to be considered by the Executive Councillor for Adult Care, Health and Children's Services between 12 and 19 October 2018.

Members were advised that the Council currently commissioned a range of services for the prevention and management of unhealthy lifestyles.  These services were commissioned to address single lifestyle issues or with a particular intensive focus, such as smoking cessation, NHS Health Checks and alcohol treatment services.

It was noted that the existing stop smoking services delivered an evidence based intervention, but it was queried whether this provided value for money.  Members were also informed that obesity and being overweight was as much of an issue for the population in general as smoking was.  The authority was keen to review the stop smoking service as it was coming to the end of its contract with the current provider.  It was highlighted that there was a particular issue with people who had long term conditions and continued to smoke, as any surgery and anaesthesia represented a risk due to their unhealthy lifestyles.

The conclusion of the current Local Stop Smoking Service provided an opportunity to develop a more holistic approach which supported people with multiple unhealthy behaviours to improve their health and wellbeing through the commissioning of an Integrated Lifestyle Support (ILS) service.  The aim was to fundamentally change the approach.  Whilst people who wanted to quit smoking would continue to be supported the support would be broadened out to help people with diet, exercise and alcohol consumption.  It was reported that people who smoked would more often be overweight and/or would drink too much alcohol, as it had been found that people tended to have more than one unhealthy behaviour.

In relation to the contract structure, members were advised that the contract would be a 3 +1 + 1 years, as this would be a new service to Lincolnshire, and there was a need to ensure that it delivered value for money.  It was noted that the proposed maximum annual funding for the contract would be £2.75m per annum, and the contract would be made up of a block payment amount to cover core costs of delivering the service, with the addition of performance related payment linked to the delivery of contract outcomes in order to retain an incentive for the provide to drive improvements in the delivery of outcomes and performance.  In terms of next steps, the Committee was advised that an 'Invitation to Tender' would be issued in November 2018, followed by a process of evaluation.  It was expected that the contract would be a consortium model, with a lead provider working with a number of partners.  The contract would be awarded in March 2019, and the service would go live in July 2019.

Members were provided with the opportunity to ask questions to the officers present in relation  ...  view the full minutes text for item 34.

(To receive a report by David Stacey, Programme Manager (Strategy and Performance) which provides the Committee with details of the current Community Wellbeing Commissioning Strategy 2017-2020)

Consideration was given to a report which provided the Committee with an opportunity to provide feedback on the current Community Wellbeing Commissioning Strategy 2017 – 2020.  It was reported that the purpose of this commissioning strategy was to improve and protect the health and wellbeing of the people in Lincolnshire.  It was thought this could be best achieved when people were supported to be independent, make healthier choices and live healthier lives.

Members were advised that this was the strategy that was currently in existence and officers would value the views of the Committee of how it could be changed over the next 12 months, for example, what was useful in the current strategy and what may be useful in the future.

In terms of the actions in the current strategy, all actions were either in progress or nearing completion.  A conversation had also commenced regarding understanding what the core duties were and what could be delivered by the authority, and what services were bought in.

Members were provided with an opportunity to ask questions to the officers present regarding the information contained within the report and some of the points raised included the following:

·         It was queried whether large companies could be engaged with more to promote wellbeing initiatives to their staff.  It was commented that large supermarkets such as Tesco had engaged with the authority in the past.

·         It was commented that there were a lot of facilities within communities, such as village halls, and there was a need to connect and engage with these facilities in order to make better use of them.

·         It was noted that the Director of Public Health had spoken with the Chief Executive of Lincolnshire Co-op regarding the flu jabs for staff, and they had picked up the co-ordination of the county wide programme.  It was noted that this scheme was a payment by outcome, and therefore it did not matter where someone would get their flu jab.  It was believed that this approach provided better services for the people of Lincolnshire.

·         It was queried whether there was evidence to show that smoking e-cigarettes made a difference to smoking rates and a person's health.  It was noted that if someone who smoked traditional cigarettes completely switched to e-cigarettes there was a significant reduction in risk.  However, the best option was still to stop smoking completely.  It was reported that smoking prevalence across the country had dropped significantly, however there were still comparatively high levels of smoking in Lincolnshire.  It was not possible at this time to answer whether the use of e-cigarettes was reducing the smoking rate.

·         It was suggested that there was a need to speak with United Lincolnshire Hospitals NHS Trust regarding enforcing their ban on smoking at the entrance to hospitals, and it was thought that this was one area where staff could lead by example.

·         It was noted that one of the areas being picked up was obesity and physical activity, and a member of staff had been  ...  view the full minutes text for item 35.

(To receive a report by Emma Krasinska, Carers Lead, Adult Care and Community Wellbeing, which provides the Committee with an opportunity to consider the Carers Commissioning Strategy 2016-2018)

Consideration was given to a report which provided the Committee with the opportunity to comment on the current content of the Carers Commissioning Strategy 2017-2020.  The purpose of this strategy was to support the health and wellbeing of carers of all ages in Lincolnshire.  It was believed that there were around 80,000 carers in Lincolnshire, but of these only around 30,000 of these were known to the County Council. 

The Committee was guided through the report and some of the statistics highlighted were as follows:

·         85% of carers co-habit with the person they support

·         62% of carers had a disability or long standing illness

·         19% of carers were not in paid employment because of their caring responsibilities

·         37% of carers had as much social contact as they would like (although it was noted that this also meant that over 60% were not getting as much social contact as they would like)

It was reported that all the actions were either in progress or complete, but it was acknowledged that there was a need for more work around this agenda.  Carers support now reported to the Director Public Health and considerations for those with caring responsibilities were being incorporated into every aspect of the directorate's work.

It was highlighted that one area where more work was required was around the employers of carers, and how they were taking care of those of their workforce who were carers.  It was queried whether there were things that should be picked up around this area.

Members were provided with the opportunity to ask questions to the officers present in relation to the information contained within the report and some of the points raised during discussion included the following:

·         For every instance where a carer asked for help, it was likely that there would be 10 who did not.  The care system would not survive without those carers, therefore it was important that they were supported.

·         In terms of carers and employment, it was noted that where people were desperate to get back into the job market, early outreach was important.  It was also very important to ensure that any carers who were also in employment managed to keep that job.  A big part of the work being done with Carers First was getting people back into employment and helping people who were struggling. 

·         It was important to note that a person could become a carer in an instant, for example if a loved one had an accident, or a stroke.

·         People who had been a carer for a long time may be unsure about re-entering employment, particularly if they had to also rely on day centres, as the hours were not always employment friendly.

·         It was commented that it was important to realise that caring for someone did not need to be a full time role, although in a lot of cases it would be.

·         In terms of the amount of social contact carers received, it was highlighted that some of the South Holland  ...  view the full minutes text for item 36.

(To receive a report by Carolyn Nice, Assistant Director Adult Frailty and Long Term Conditions, which provides the Committee with details of the current Adult Frailty and Long Term Conditions Commissioning Strategy 2016 – 2019)

Consideration was given to a report which contained the key strategic aims of the Adult Frailty and Long Term Conditions Commissioning Strategy 2016 – 2019 and set out what had been achieved since the implementation in 2016.  It was reported that the Strategy and associated activities supported people with eligible needs as outlined by the Care Act 2014.  The customer groups supported by this strategy were Older People, People with Physical Disabilities and People with Sensory Impairments.  It was noted that this Strategy was due to be refreshed and officers were keen to receive feedback on what the Committee would like to see included going forward.

It was noted that there were a number of areas where there had been some success and good achievements.  There was a need to ensure that the strategies linked together, as people will pick up one strategy but not necessarily another.  Members were advised that the home care contract had been re-procured since the strategy was introduced, and personal budgets had been introduced which were to help people make more informed choices about their care.  It was also noted that pre-paid cards had also been introduced to make the personal budgets easier for people to manage.

Members were provided with the opportunity to ask questions of the officers present in relation to the information contained within the report and some of the points raised during discussion included the following:

·         It was clarified that in relation to personal budgets, a person would have an assessment and the results would then give an indication of what their personal budget would be.  A social worker would then go through the support plan with the person and the personal budget may then increase or decrease based on the person's needs.  The personal budget would cover the cost of the care and the person would then have a number of options on how to spend it, they could either opt for commissioned services or a direct payment.  A person receiving a direct payment was able to spend that money in a way that met the outcomes of their support plan.  It was noted that they did have to submit receipts and the receipts would be audited, as the authority tracked what people were buying with their direct payments.  A lot of people would purchase agency support.  There was a need to look at whether people were getting the best they could for their direct payment.

·         There was a need for balance between the choice of direct payment and commissioning responsibilities.

·         There was a need to ensure that the care provided was suitable for a person's needs.

·         In was considered important that when people came out of hospital they were able to return to independence.  Members were advised that there were teams based within hospitals who would assess patients as to whether they would require any adaptations or home care.  In relation to adaptations It was noted that people would not stay in hospital whilst these were carried out if  ...  view the full minutes text for item 37.

(To receive a report by Carolyn Nice, Assistant Director Adult Frailty and Long Term Conditions, which provides the Committee with an opportunity to consider the refreshed Joint Strategy for Dementia for 2018-2021 which had been developed and co-produced with strategic partners, people who live with dementia, their families and carers to provide a strategic framework around dementia for the next three years)

Consideration was given to the Joint Strategy for Dementia 2018-2021 which was a refresh of the existing Joint Strategy for Dementia Care 2014-2017 and had been developed and co-produced with strategic partners, people who lived with dementia, their families and carers to provide a strategic framework around dementia for the next three years. 

It was reported that the Strategy refresh set out the vision and details of the achievements since the implementation of the Lincolnshire Joint Strategy for Dementia 2014 – 2017.  It was also noted that the Strategy had been presented to the Lincolnshire Health and Wellbeing Board.

Members were provided with the opportunity to ask questions to the officers present in relation to the information contained within the report and some of the points raised during discussion included the following:

·         It was suggested whether the questions used in the initial diagnosis of dementia could be carried out online.

·         More work was needed around prevention and it was acknowledged that people were being diagnosed too late and the current system did not enable people to live well with dementia.

·         There would be an easy read summary included with the Strategy.  It would also include how carers could be supported and also those people with an early diagnosis of dementia, and what they should expect from the Lincolnshire County Council offer.  It was noted that the dementia family support service was due to be reprocured.

·         There was a need to be smarter about getting people to plan in advance the care they would like, as often by the time medical staff intervened it was too late for the person to make those decisions.  It was important to ensure that people could have that choice about their future.

·         The picture for Lincolnshire was variable in terms of care offered, and there was an aim for it to become more consistent.  There was confidence that the proposed governance structure would assist in delivering the priorities of the Strategy.

·         There had been comprehensive engagement with carers to get their views and address their concerns.

·         It was queried how effective was counselling for someone with dementia.  In terms of early intervention, it was noted that faster that the person could receive support and advice the better, it was also noted that advice for the family needed to be linked into this.

·         There was a need to empower primary care providers to access these pathways and to raise awareness of dementia.

The meeting was adjourned from 12.48pm until 12.56pm

RESOLVED

1.    That the draft Lincolnshire Joint Strategy for Dementia be supported.

2.    That a summary document for the Strategy be developed.

(To receive a report from Steve Houchin, Head of Finance, Adult Care and Community Wellbeing, which provides the Committee with the opportunity to consider the budget outturn projection for 2018/19)

Consideration was given to a report which set out the Adult Care and Community Wellbeing 2018/19 outturn projection.  It was reported that the Adult Care and Community Wellbeing (AC&CW) net budget was £221.288m, and the gross figure for 18/19 was £281.804m.  Based on current information available to 31 August 2018, it was estimated that AC&CW would produce a breakeven budget for the financial year 2018/19.  The increasing strategic importance of the Better Care Fund (BCF) had also meant that the impact to AC&CW also had to be reflected in service budgets.

It was noted that corporately, the County Council was expected to balance its budget until March 2020.  There was an assumption that the authority would have a balanced budget until 2022.  In comparison to some other areas, Lincolnshire was doing well.

It was noted that the Executive would be meeting on 18 December 2018 to agree the budget, and the final statement figure should be received around that time.

It was queried whether the underspend and balanced budget equated to the delivery of quality services, and members were assured that it did.

RESOLVED

            That the budget outturn projection for 2018/19 be noted.

(To receive a report by Simon Evans, Health Scrutiny Officer, which provides the Committee with the opportunity to consider its work programme for the coming year)

The Committee received a report which enabled members to consider the work programme, which was reviewed at each meeting.

Members were invited to consider whether to establish a working group to review the information prepared by organisations such as the local Government Association and the County Council Network, in anticipation of the Government's publication of the green paper on Care and Support for Older People.

During discussion of the work programme the following issues were highlighted:

·         It was expected that that the green paper would now be published in December 2018, and so would be removed from the agenda for the November 2018 meeting.

·         It was commented that there was a need to expand digital development into the agenda, for the short term, medium term and long term.

·         In relation to the working group, it was thought that it was likely to only consist of a small number of meetings.

·         It was suggested that the issues around rurality should be added to the agenda as it impacted on so many things that had been raised during the course of the meeting.

·         It was suggested that issues such as rural isolation, charging for services and income streams should be looked at as part of the working group.

RESOLVED

1.    That the work programme as discussed be agreed.

2.    That a working group be established to review the information prepared by the Local Government Association, the County Councils Network and any other relevant body, in anticipation of the Government's Green paper on the Care and Support for Older People.