Agenda and minutes

Apologies for absence were received from Councillor Mrs J E Killey.

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

RESOLVED

            That the minutes of the meeting held on 29 November 2017 be signed by the Chairman as a correct record.

The Executive Director Adult Care and Community Wellbeing introduced Carolyn Nice who had recently been appointed as the Assistant Director for Adult Frailty and Long Term Conditions. 

(A report by Steven Houchin, Head of Finance, Adult Care and Wellbeing, in connection with the projected outturn of the Adult Care and Community Wellbeing budget for 2017/18)

Consideration was given to a report which provided the Committee with an opportunity to consider the outturn projection for Adult Care and Community Wellbeing for 2017/18.  It was reported that the Adult Care & Community Wellbeing (AC&CW) net budget was £216.229m, and based on current information available to 31 October 2017, it was estimated that AC&CW would produce an underspend of £0.221m or 0.10% of the overall budget.

Members were also advised that the increasing strategic importance of the Better Care Fund (BCF) had also meant that the impact the AC&CW had to be reflected in service budgets.

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

·         It was highlighted that direct payments was a significant area of growth in terms of budget pressures, particularly in relation to the physical disability service.  A projected overspend of £1.300m was expected for the service with the average package of care was now costing £11,514 per annum.

·         In relation to the capital budget, it was noted that the County was hoping to work with North Kesteven District Council on the development of extra care housing schemes.  It was also commented that sites in East Lindsey were also being looked at.  It was planned that a report on housing would be brought to the Committee later in the year.

·         It was commented that one area which had come up three times within the report had been delays to assessments – fairer charging, LPFT and Deprivation of Liberty (DoL's).  It was queried whether this would be an easy issue to address.

·         In relation to DoL's assessments, members were advised that there were complications in carrying these out as there was quite a lot of legal work which needed to take place.  It was also noted that following the Cheshire West judgement, the authority had received a large amount of requests for assessments which had caused a backlog.  Members were also advised that there were several different aspects to carrying out a DoL's assessment.  It was reported that LPFT had been commissioned to undertake them, but there had been an almost 10 fold increase in requests immediately following the Cheshire West judgement.  It was also highlighted that for DoL's, three different assessments were required.  It was anticipated that the government would introduce a new scheme for processing DoL's assessments, but this was now 18 months overdue.  The authority had put aside £1.5m in the budget to tackle the backlog of requests, and it was expected that the backlog would be dealt with by the end of 2018.  It was hoped that going forward from this point, the authority would have a position it could maintain.  It was noted that the numbers of requests had increased from 10 per month to about 120 per month.

·         Members were advised that it was expected  ...  view the full minutes text for item 38.

(A report by Steve Houchin, Head of Finance, Adult Care and Wellbeing, in connection with the Council's budget proposals for Adult Care & Community Wellbeing, 2018/19)

Consideration was given to a report and presentations which described the Council's budget proposals for Adult Care and Community Wellbeing.  The presentation provided the Committee with further information in relation to the following areas:

·         Progress to date

·         Financial context

·         The budget squeeze

·         BCF Recap

·         Budget 18/19 – 19-20

·         Cost pressures and savings – Safeguarding

·         Cost pressures and savings – Adult frailty & Long Term Conditions

·         Cost pressures and savings – Specialities

·         Cost pressures and savings – Carers

·         Cost pressures and Savings – Wellbeing

·         Capital

·         Next Steps

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

·         Members were advised that the overall impact of the national living wage for the previous year had been around £6m across the authority.

·         Mosaic would help to calculate base costs for the budget.

·         It was confirmed that providers were encouraged to be more efficient in the way they did things.

·         There was some confusion around historical arrangements for waking nights, and members were advised that there was an agreement that the authority would fund any obligations from April 2017 onwards, but there was no obligation to fund this retrospectively.  It was for each provider to make that decision.

·         It was commented that a balanced budget had been set, and it was acknowledged that there were considerable cost pressures that were outside of the control of the authority.

·         It was commented that if there was the opportunity for additional support from the Executive for Adult Care, it was requested whether this could be in the form of an improved IT system.

·         It was commented that the Committee appreciated the good work which was carried out by Steve Houchin and his team to control costs.

·         It was also highlighted that this council was very good at managing its budgets as there were many councils who had overspent in adult care.

·         It was also commented that whilst budget control was vital, it was important to remember that this service was about people.

RESOLVED

            That the comments made in relation to the proposed Adult Care and Community Wellbeing budget be noted.

(A report by Philip Garner, Health Improvement Programme Manager, which invites the Committee to consider a proposed decision on the re-procurement of Local Stop Smoking Service (LSSS))

Consideration was given to a report on the Local Stop Smoking Services (LSSS) Re-procurement which was due to be considered by the Executive Councillor on 17 January 2018.

Members were advised that there were two main aspects to consider, smoking cessation and tobacco control, and there were both short term and long term benefits to the re-procurement of this contract.  It was reported that this service had already been re-procured once, and there had been some efficiencies gained at that time.  It was highlighted that it was not proposed to look for any further efficiencies.  It was planned to offer the service to around 5,500 residents in Lincolnshire, and around 19-20% of Lincolnshire's population were smokers.

The service would aim to target those who required additional support to stop smoking, as evidence had shown that people were more likely to be successful if they had support rather than if they tried to do it themselves.

Members were advised that the current providers had been struggling to hit targets.  It was also reported that some big variations to the contract had been made during the life of the contract due to NHS changes, and so there could be some procurement risk to extending rather than re-commissioning.  It was also noted that the current contract was payment by results only, which had led to delays in payments and also the provider had not been able to invest in services and so were currently running the contract at a loss.  It was planned that the new contract would be a very similar to the current model with a prime provider and single point of contact.

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 included the following:

·         It was queried how the service would engage with people whose first language was not English and going forward, how would these groups be engaged with.  Members were advised that information was offered in other languages but some nationalities did not have the same sense of harm that the British did about smoking.  It was noted that there was still more education to do.  However, the authority would be able to procure this service every couple of years to ensure that there was a more targeted approach.

·         Clarification was sought regarding the figures stated in paragraphs 1.1 and 1.5 which set out the costs of smoking to the county.  Members were advised that these costs were extrapolated from national data.

·         It was confirmed that there was a net benefit to the national economy from smoking.

·         In terms of the contract going forward, there was a move away from the pure payment by results model as the provider was making a loss and was unable to invest in services.  It was queried therefore, whether there was a risk from going in the other direction with no incentive to be efficient or produce results.  Members were advised that it  ...  view the full minutes text for item 40.

(A report by Alina Hackney, Head of Commercial and Procurement – People Services, Commercial Team, which presents an overview of the current contract management arrangements for Adult Care and Community Wellbeing within the Commercial Team. The report outlines the contract types and the activities of the Commercial Team) 

Consideration was given to a report which presented an overview of the current contract management arrangements for Adult Care and Community Wellbeing within the Commercial Team.  Additionally, the report also provided an analysis of the work plan for procurement and commercial activity currently being undertaken and planned for the current year.

The Committee received a presentation which provided further information in relation to the following areas:

·         The Commercial Team – People Services

·         The Team Structure

·         Effective Commissioning

·         Successful Procurement Activity

·         Contract Management – Annual Summary

·         Visit Tracking & Provider Engagement

·         Risk Matrix

·         Market Intelligence

·         Management Reporting

·         Highlights in 2018

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

·         It was commented that these contracts drove the authority's agenda as a commissioning council, and on some occasions they would come to this Committee as pre-decision scrutiny.

·         It was important to look at what lessons had been learned from contracts as this would help to shape new contracts.  It was thought that this had been demonstrated in Adult Care as many contracts had been redesigned.

·         It was thought that the Committee should look at some of the bigger contracts in order to have that extra layer of scrutiny.

·         It was confirmed that there was a framework contract with standard terms and conditions and a service specification, which could be adjusted for each individual agreement.

·         The team was audited regularly by both internal and external audit.

·         There was a need for a balance between value for money and risk.

·         It was commented that the Annual report which was included with report was a good document.  It was noted that the next annual report was due at the beginning of April 2018 and would be brought to this Committee.

RESOLVED

            That the report and comments made be noted.

(A report by Emma Scarth, Strategic Programme Lead for Mosaic, which provides an update on progress since the system went live in December 2016 and sets out the strategic direction for future developments)

Consideration was given to a report which provided an update on progress since the Mosaic system went live in December 2016 and set out the strategic direction for future developments.  It was reported that the Mosaic system would replace a number of legacy systems.

Members were given a brief demonstration of the mosaic system and were provided with the opportunity to ask questions to the officers present in relation to the information contained within the report and the demonstration of the system and some of the points raised included the following:

·         It was queried what savings it was expected that Mosaic would generate, and where efficiencies would come into the process.  Members were advised that it would give a visibility to what services were going to an individual, and would give an opportunity to avoid duplication.  It would also show which services were delivering the best outcomes.

·         Mosaic should help with the making of more informed decision about commissioning and what services were more effective.

·         The system would also enable managers to manage the workload of social workers more effectively as it was a workflow based system.

·         It was commented that it was a very ambitious project, but there were concerns as the big IT contracts had not always been as successful as hoped.  It was queried whether more effort should be focused on making sure the system was working as officers wanted it at its current level before making any additions to functionality.

·         It was queried how many customers would be benefitted by the customer portal.  Members were informed that the initial target would be carers and family members such as sons and daughters who wanted to know what the latest situation was with a parent who was receiving care.  It was noted it would be a slow introduction of records.

·         It was queried whether the portal was something the authority should be putting money into and whether it should be up to the person to find out the information they want to know.  However, members were informed that this had been part of the original tender process and so did not require additional funding.  It was expected that use of the portal would be a 'slow burn' but it was considered important that people were able to access information about their loved ones at any time or place.

·         Members were advised that plans had been too ambitious five years ago and one of the first things the Strategic Programme Lead for Mosaic did when she came into post was to look at what had not been delivered and what would be achievable.  It was felt that a position had been reached where Mosaic was stable.  Time had been taken with Mosaic to get various aspects right before going live with the system.

·         The Chairman commented that he would like to see a more controlled approach to future developments.

·         It was suggested that a further report on the Mosaic system should be brought back to a future meeting towards  ...  view the full minutes text for item 42.

(A report by Simon Evans, Scrutiny Officer, in connection with theCommittee's work programme, which is reviewed at each meeting.  Members are encouraged to highlight items that could be included for consideration)

Consideration was given to a report which enabled the Committee to consider its work programme which was reviewed at each meeting.

RESOLVED

            That the work programme as presented be noted.