Issue - meetings

Katherine Heffernan, Head of Finance for Adults and Housing introduced the Budget Monitoring report.

A correction to the report was noted – Para 5.3, third line from the bottom should say ‘commissioning’ rather than ‘decommissioning’.

It was noted that the current financial pressure is due to an increased demand for services, particularly in older people services and mental health services.

There is also a large amount of pressure due to Continuing Healthcare where people leave the care of the NHS and need adult services.  Noted that the budgets  do not follow these cases.

Noted that whilst there is growing demand on services the budget is not growing.

There is uncertainty on the future of funding for social care with no decision currently being made by the Government following the Dilnott Commission report.

Noted that health inequalities in the area also have an impact as people are becoming ill earlier and this has an implication on services and therefore the budget.

Noted that the cost of caring for older people outside of hospital settings has a direct impact on social services and whilst this action may contribute to the health deficit reduction the costs are being shifted from the NHS onto social care.

Noted that the Fair Access to Care services (FACs) criteria for Haringey has not changed, and remains at the Critical/Substantial level.  Some authorities are just providing at a Critical level.

The Panel were reassured that there is ongoing and robust dialogue between health and social care colleagues about the shifting of costs from NHS services onto social care services, particularly around the continuing healthcare assessments.

Work is being undertaken to integrate commissioning by Section 75 and Section 256 arrangements.

(N.b Section 75, NHS Act 2006:

• “Pooled funds - the ability for partners each to contribute agreed funds to a single pot, to be spent on agreed projects for designated services
• Lead commissioning - the partners can agree to delegate commissioning of a service to one lead organisation
• Integrated provision - the partners can join together their staff, resources, and management structures to integrate the provision of a service from managerial level to the front line” (DoH website)

Section 256

“PCTs can make payments (service revenue or capital contributions) to the local authority to support specific additional local authority services. For example, where older people require a greater level of care in the community.

This is a grant for additional local authority spend (a contribution to the other

partner’s costs for care delivery), not a transfer of health functions to the local authority. The provision can be used to create joint budgets for joint

and integrated services.” (Audit Commission) ).

The Panel were informed that Adults is being extremely tough in negotiations, both in terms of multi-disciplinary assessments and also with regards to any cost shifting onto social care services. 

Noted that Adults and Health are also trying to work closer together to improve services for the service user and to provide a seamless service.

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