Agenda and minutes

Apologies for absence were received from Councillor Mrs M J Overton MBE.

The Chief Executive reported that having received notice under Regulation 13 of the Local Government (Committees and Political Groups) Regulations 1990, she had appointed Councillor C L Strange as a replacement member of the Committee in place of Councillor A P Maughan until further notice.

There were no declarations of interest at this point in the meeting.  However, Councillor M A Whittington wished it to be noted that his mother was now in residential care which was being funded by the local authority.

RESOLVED

            That the minutes of the meeting held on 16 January 2019 be signed by the Chairman as a correct record.

There were no announcements by the Executive Councillor or lead officers.

(To receive a presentation from Glen Garrod, Executive Director Adult Care and Community Wellbeing in relation the NHS Long Term Plan)

The Committee received a presentation by the Executive Director for Adult Care and Community Wellbeing in relation to the NHS Long Term Plan which provided detailed information in relation to the following areas:

·         Some background: the Green Paper, the NHS plan and the Spending Review – it was anticipated that the Green Paper would either be released by the end of March or in May.  It would be a consultation document which would feed into the Spending Review.  There had been £20.5bn allocated to the NHS.  It was noted that the Plan had been produced following an intensive 12 week engagement period.

·         How the NHS Long Term Plan was developed – members were advised that this was a very engaging process, partly due to it being so intense.

·         Background – it was noted that the increase in funding of 3.4% per year was not what the NHS had asked for.  4.1% had been requested, which meant that the NHS was already working with less than it was thought was needed. The Prime Minister had also announced a number of conditions on which the £20.5bn would be dependent, including improved NHS efficiency and elimination of the NHS deficit.  The Long Term Plan's reference to 'integration' mostly referred to integration within the NHS rather than with adult social care, as the NHS  was currently very fragmented and there would be a need to re-integrate the NHS (for example in Lincolnshire there were 4 Clinical Commissioning Groups and 3 NHS provider trusts).  There was also an expectation to deliver significant improvements for patients.

·         What the NHS Long Term Plan will deliver for patients

·         Making sure everyone gets the best start in life

·         Delivering world-class care for major health problems…- it was noted that some respiratory conditions, such as asthma, were being exacerbated by cold, damp housing. There was also an increasing number of elderly people moving to the county to retire, who had pre-existing health conditions. 

·         Supporting people to age well… - this was the area of greatest interest for councils, as the NHS had historically invested more money on acute care than primary care. 

·         Delivering the ambitions of the NHS Long Term Plan:-

·         1. Doing things differently

·         2. Preventing illness and tackling health inequalities

·         3. Backing our workforce

·         4. Making better use of data and digital technology

·         5. Getting the most out of taxpayers' investment in the NHS

·         What this means for staff, patients and the public

·         How did the Association of Directors of Adult Social Services assess the Plan – ADASS had stated that the Green Paper and the NHS Long Term Plan should have been developed in parallel and a major opportunity had been missed; the absence of clarity and certainty about future social care funding represented a major risk to the ambitions of this NHS Plan.  However, ADASS had been positive about the proposed shift of resources to community and primary care; and the emphasis on personalisation and choice.

·         Reference was made in particular to paragraph 1.57 of the  ...  view the full minutes text for item 62.

(To receive a report by Katy Thomas, County Manager – Performance & Intelligence, which presents performance against Council Business Plan targets for Adult Care and Community Wellbeing as at the end of Quarter 3 2018/19)

Consideration was given to a report which presented performance against Council Business Plan targets for the Directorate as at the end of Quarter 3 2018/19.  A summary of performance against target for the year had been provided in Appendix A of the report.  It was also reported that a full analysis of each indicator over the year had been provided in Appendix B to the report.

It was noted that there were 26 measures across five commissioning strands.  Of these, 16 measures were achieving or exceeding target, three were reported annually, and of the measures not being achieved, five fell within the community wellbeing strategy.

In relation to the measures which had not met target the following was reported:

·         31 - % of alcohol users that left drug treatment successfully who do not re-present to treatment within 6 months – this had fallen slightly but there was a 3 month reporting time lag.  There had been some staffing issues, but these had started to improve and the performance was expected to stabilise between 35 – 37%.  A paper would be presented to Executive Departmental Management Team outlining further options.

·         34 – Chlamydia diagnoses per 100,000 15 – 24 year old – there was an action plan in place.  This measured the number of young people who had had the diagnostic test and the proportion of positive test results.  The rate of positive test results at 10.4% indicated that the targeted work was working well.  Even though Lincolnshire was below target, it was noted that the current performance was the third best in its CIPFA group and was also below the regional and national target.

·         109 – Number of Health and Social Care staff trained in Making Every Contact Count (MECC) – 662 staff had now been trained, and there were no concerns that the target would be missed at the end of the quarter.  It was confirmed that for 2019-20 this target would only reported annually.

·         111 – People successfully supported to stop smoking – it was noted that this had a three month time lag.  The Service was continuing to target the hardest to change groups.  There were some other issues with the service that had been recognised, but there would be a switch to the integrated lifestyle support service in the summer.  It was important that people were ready to change when they came to the service.  With the right support, it was possible to double the numbers of those successfully quitting.

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 noted that smoking was not always linked with obesity as some used it as a substitute for eating.  It was suggested whether this group could be targeted through their vanity for example how it could age them and have negative effects on their skin.

·         In terms of smoking, with 20 –  ...  view the full minutes text for item 63.

(To receive a report by Steve Houchin, Head of Finance – Adult Care and Community Wellbeing, which sets out the expected underspend for the financial year 2018/19)

Consideration was given to a report which set out the expected budget outturn projection for 2018/19.  It was noted that the Adult Care and Community Wellbeing net budget was £221.006m, and based on current information available to 31 December 2018, it was estimated that AC & CW would produce an underspend of £0.642m for the financial year 2018/19.

Members were guided through the report and 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:

·         Income lost from bad debts was £0.9m and it was queried whether there was a strategy to review the service from Serco and the credit control function.  It was noted that this amount was significant but it had already been included in the budget.  It was noted that the current process would be looked at.

·         The delays in completing financial assessments sometimes resulted in large amounts of back dated payments being made.

·         There was a need to recognise some of the good work and achievements.

·         It was queried what property debtor income was and members were advised that this referred to those service users who had a property who did not want to sell it when they went into residential care.  The authority would receive income from the sale of the property after the person had died.  This ensured that the person did not have to sell their house in their lifetime.

·         There were a number of service areas with cost pressures, and it was queried whether any of them were cyclical or recurrent.  It was noted that there were built-in cost pressures into the next financial year.  Adult Social Care was approaching 50% of the Council's total budget. The authority had a lot of increasing financial risk.

·         Specialist Adult Services was seeing a recurring pressure and there were a number of factors which were resulting in this.  One of the issues was that a lot more people were presenting with autism and mental health was also causing an increasing pressure.  The budget was £5.8m but increased last year to £6.1m and was due to be increased to £6.2m the next financial year, however due to the pressures described in the report members had approved an additional £600k for mental health services.

·         In terms of Learning Disabilities there was a particular increase in capacity issues as there were a lot of young people who came into the county through the education system that were not known to the authority.

·         There was also an increasing complexity of needs, combined with medical advances so life expectancy for certain conditions was increasing.

·         There were cases where the service user had not been known to the authority as they had been taken care of by family members for their whole life but then they were no longer able to care for them.

·         It was noted that these were not local problems, as there was information from other authorities that  ...  view the full minutes text for item 64.

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

The Committee received a report which provided members with an opportunity to consider its work programme for the coming year.

It was requested that brief summary reports be included with the agenda for the next meeting in relation to:

·         Autism – the increase in people presenting to adult care with autism

·         Type 2 Diabetes and the work going on to try to prevent it;

·         Antibiotic Prescribing by GP's

The Green Paper on the Future Funding of Adult Care was still scheduled for a future agenda, and it was expected that it would be released either before or after purdah.  A second Green Paper in relation to prevention was also expected, and a working group would look at the detail of that.

It was also noted that Director of Public Health's Annual Report would be on the agenda for the July 2019 meeting and not the May meeting.

RESOLVED

            That the activity above be noted and the work programme updated accordingly.