Agenda item

The purpose of this report is to provide further information to support the Panel’s scrutiny of the Medium Term Financial Strategy in relation to Priority 2.

It was noted that the role of the panel was to scrutinise budget proposals in relation to Priority 2 – “Empower all adults to live healthy, long and fulfilling lives”  and to put forward recommendations for consideration by the Overview and Scrutiny Committee in January. The panel was informed finalised budget scrutiny recommendations would be presented to Cabinet in February 2015.

 

Beverley Tarka, in response to a question raised by the Chair, advised that in October 2014 a decision had been taken to undertake a desk top review of people using adult social services. The desk top review had not resulted in a formal report being published but the panel was informed that:   

 

-       A randomly selected sample, of the service user base, had been used for the exercise including older people, people with learning disabilities, people with mental health needs, and people with physical disabilities.

 

-       The information collated had helped to determine whether service users had reablement potential and whether current service levels were appropriate. 

 

-       The sample size for the review was 5%.

 

-       A multi disciplinary team, including social workers, occupational therapists, and a personal budgets manager, had undertaken the review.

 

-       The desk top review, in addition to other activities including a workshop facilitated by Gerald Pilkington Associates, had been used to inform high level proposals in relation to reablement.

 

-       Further work would be required in order to develop proposals for reablement once a decision, on how to proceed, had been made by Council.

 

There was a short discussion of the review.  

 

The Haven / Neighbourhoods Connects 

 

The following issues were discussed:

 

-       The aims and objectives of the Neighbourhood Connects project in terms of supporting timely discharge from hospital and contributing to reduced social isolation.

 

-       The evaluation of the Age UK Haringey Pilot, including suggestions/recommendations that had been put forward in relation to developing future proposals.

 

-       The methodology that had been used to evaluate the Age UK Haringey Pilot.

 

-       Concerns about replacing a valued day care service (The Haven) with a service (Neighbourhood Connects) that, in the opinion of the panel, had not been fully tested.

 

-       Concerns about whether the needs of clients using the Haven could be met by the Neighbourhood Connects model. These concerns were based on the information that had been provided to the panel in relation to the proposals.

 

-       Significant concerns about whether Neighbourhood Connects could meet the needs of the most vulnerable day care centre users. 

 

-       The budget for the Haven (noted in the report as £384,400 – excluding overheads and capital charges).

 

-       The impact of the proposed changes for people with learning disabilities.

 

-       The implications of the Care Act (2014) in relation to the proposals that had been put forward. 

 

-       Work that had been carried out by other local authorities, including community development work in Camden.

 

-       The service specification and tendering process for the Neighbourhood Connects project. It was noted the expected start date for the new service was March 2015.

 

-       Transitional arrangements for clients using the Haven.

 

-       The importance of the “make every contact count” programme and the work that had been taking place between Adult Social Services and Public Health in relation to providing clients with information, advice and guidance to ensure signposting to appropriate services.

 

-       Costs in relation to care packages and the assessment process.  It was noted that the Adult Social Services budget for care packages was approx £55 million.

 

Beverley Tarka, in response to a question concerning unit costs for adult social care services, informed the panel that there was no evidence that an expansion of traditional buildings based day care for older people would result in a reduction of more expensive residential care. It was noted that the majority of older people who received day care also received additional care services.

 

Cllr Morton, Cabinet Member for Health and Wellbeing, in response to questions, informed the panel that due to cuts in funding from Government the London Borough of Haringey needed to deliver services differently. Cllr Morton commented that the Haven delivered services to 50-70 residents whereas Neighbourhoods Connects would help address the needs of a much wider number of residents, across the borough.

 

The Haynes and the Grange

 

Beverley Tarka informed the panel that the high level proposal for the Haynes and the Grange was to develop a social enterprise model to deliver a specialist dementia service.

 

Charlotte Pomery, Assistant Director for Commissioning, commented that a social enterprise was a business with a social purpose and that any profits made by the organisation would be ploughed back into the enterprise for the benefit of the business or community in which it sat.

 

The following points were discussed:

 

-       The support needs for clients with high level dementia care needs.

 

-       Support needs for carers.

 

-       The information on social enterprises that had been gathered by officers, including details from local authorities who had already developed social enterprise models to deliver services. 

 

-       Commissioning by outcomes.

 

-       The timeframe for developing and implementing the new model. It was noted that the panel believed further information was required in terms of transition plans.

 

-       Issues in relation to tendering and procurement, including possible routes to market and options for engaging with potential service providers.

 

-       Issues in relation to monitoring services delivered via a social enterprise model in terms of quality, activity and need.

 

-       The implications of the Care Act (2014) in relation to the proposals that had been put forward.

 

-       The legal covenant relating to the use of the Haynes.

 

The panel was informed that should the high level proposal be agreed by Council in February 2015 a full business case would be developed. This would take into account all the costs and benefits of the model, including consideration of the resources that would be needed to deliver the service.

 

Osborne Grove Nursing Home

 

The proposals in relation to the Osborne Grove Nursing Home were noted by the panel with the following issues discussed:

 

-       Transition planning

 

-       The development of community reablement

 

-       Step-Down Care

 

-       The capacity of other nursing homes in the borough

 

-       Extra care facilities for older people

 

-       The communication that had taken place between the Council and Haringey Clinical Commissioning Group concerning the budget proposals for Osbourne Grove Nursing Home.

 

-       The importance of providing services that were sustainable.

 

Care Purchasing Packages

 

The proposals in relation to care purchasing packages were discussed. It was noted that the proposals would involve a reassessment of existing packages in the context of promoting a reablement approach to enable people to live independently. 

 

A number of issues were considered including:

 

-       The criteria for reablement

 

-       The reassessment process for care packages

 

-       The use of council reserves

 

-       Concerns regarding the achievability of the necessary increases in personal, community, family and voluntary sector resources that would be required by the proposal.   

 

New Pathways for People with Learning Disabilities

 

The proposals in relation to new pathways for people with learning disabilities (accommodation) were noted by the panel.

 

The proposal in relation to new pathways for people with leaning disabilities (day opportunities) were discussed. A number of issues were considered including:

 

-       The impact of closing three of the four day centres and providing services instead through a social investment/voluntary sector model.

 

-       The potential for long-term additional costs to the Council should customers be less able to access community based activities.

 

-       The impact of personal budgets

 

-       The impact of the proposed closures on carers

 

-       Voluntary sector engagement

 

New pathways for people with disabilities

 

The proposals in relation to new pathways for people with disabilities were noted with concern. It was agreed that the concerns, raised by the panel in December 2014, should be noted by the Cabinet Member for Health and Wellbeing.    

 

In addition, a number of issues were discussed in relation to the level of pay of care staff and the impact of London Living Wage levels.  

 

New pathways for people with mental health needs

 

The proposals in relation to new pathways for people with disabilities were noted with concern. It was recommended that the concerns, raised by the panel in December 2014, should be noted by the Cabinet Member for Health and Wellbeing.    

 

Care Purchasing Residential Care

 

The proposals in relation to care purchasing residential care were noted with concern. It was agreed that a recommendation should be made that the concerns, raised by the panel in December 2014, should be noted by the Cabinet Member for Health and Wellbeing.    

 

Voluntary Sector Savings 

 

The proposals in relation to voluntary sector savings were discussed by the panel. The following issues were considered:

 

-       Concerns about the savings proposed and the retendering for a range of services.

 

-       The potential reduction in voluntary sector activity

 

-       The briefings sessions that had taken place between the council and the sector to develop proposals and to improve coordination and support.

 

-       The financial viability of the sector

 

The Chair thanked the members of the public for attending and informed them that their input had helped the Adults and Health Scrutiny Panel to finalise their recommendations (listed below) in relation to the draft medium term financial strategy. 

 

RESOLVED:

 

1.    That the proposals in relation to the Osbourne Grove Nursing Home be noted (Priority 2 – Item 11).

 

2.    That the proposals in relation to the closure of Linden House (Priority 2 – Item 12) be noted.

 

3.    That the update, tabled at the meeting by the Director of Public Health, in relation to Priority 2 – Items 20 – 23 be noted.    

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4.    That in addition to the recommendations and concerns raised by the panel in December 2014 the panel recommended:   

 

Priority 2 – Item 11

 

(a)  That a decision about the proposed closure of the Haven Day Centre be deferred until 2016/17 and that no decision be made until a review has been undertaken to ensure the Neighbourhoods Connects model is appropriate for the most vulnerable day centre users.

 

(b)  That before proposals for the re-provision of the Haynes and Grange Service be considered by Cabinet, further information be sought by the Cabinet Member for Health and Wellbeing on (i) transition plans and (b) the legal covenant relating to the use of the Haynes and the social enterprise proposals.   

 

Priority 2 – Item 13

 

(a)  That both the Roundway Centre and Ermine Road Centre be kept open.

 

(b)  That the Allways Centre and Central Day Centre (Birbeck Road) remain open until further information is made available for consideration by the Cabinet Member for Health and Wellbeing in relation to voluntary sector engagement and the social investment model to ensure adequate provision of service, especially for those with high level learning disabilities.

 

Priority 2 – Items 14 and 15 

 

(a)  That the panel’s concerns (listed below) be noted by Cabinet :

 

-       The achievability of savings to be generated by the development of the Shared Lives services as a social enterprise

 

-       The potential detrimental effects on recruitment of staff to care for clients should levels of pay be offered by providers that fall below London Living Wage levels and that further information be provided regarding pay rates offered.

 

(b)  That all support workers / staff who care for clients be paid the London Living Wage.

 

Priority 2 – Item 17

 

(a)  That the panel’s concerns relating to new models of social work and care management be noted by Cabinet.

 

Priority 2 – Item 18

 

(a)  That the proposals in relation to Care Purchasing Packages be rejected and removed from the Draft Medium Term Financial Strategy.

 

Priority 2 – Item 19

 

(a)    That there be no further cuts to the voluntary sector.