Agenda item

To consider and comment on the Council’s draft 5 year (2017/2018 to 2021/2022) Medium Term Financial Strategy proposals relating to the Scrutiny Panel’s remit (Priority 2).

Councillor Jason Arthur, Cabinet Member for Finance and Heath, introduced proposals within the draft Medium Term Financial Strategy (MTFS) relating to Priority 2 of the Corporate Plan. He stated that they needed to be seen within the context of the very severe cuts that there had been to local government funding since 2010. It was noted this had impacted considerably on the Councils ability to provide services, especially in the light of increases in demand. It was noted that at Quarter 2 (September 2016) the Council was projecting a full-year deficit of £22m.

 

The Panel was informed that the draft MTFS used the last year of the approved MTFS (2017/18), adjusted for known changes, and added a further four years (2018/19, 2019/20, 2020/21 and 2021/22). Councillor Arthur explained, after taking into account anticipated funding reductions, demand pressures and a review of the base financial position, including the achievability of previously agreed savings, that further savings were required to bridge the resulting budget gap.    

 

In terms of proposals, relating to Priority 2 of the Corporate Plan, Cllr Arthur explained that officers had developed proposals to address the budget gap with a particular focus on: partnership working; promoting independence; asset utilisation; and fees and charges.

 

The following issues were considered in relation to demand pressures for adult social care:

 

-       It was noted increasing client numbers, particularly those requiring relatively high levels of care, was a key reason for the gap.

 

-       The fact that pressures experienced in Haringey were consistent with wider national trends in health and social care, with demand for services far outstripping resources.

 

-       The importance of rebalancing resources, as part of the 2017/18 – 2021/22 MTFS, to support growth/demand pressures in adult social care.

 

Following the Panel’s budget monitoring meeting, held on 17 November 2016, it was agreed information on demand/budget pressures relating to adult social care, provided by the Corporate Delivery Unit, had helped to improve understanding on a range of issues.

 

During the discussion, reference was made to a recent announcement from the Secretary of State for Communities and Local Government concerning a £240m transfer from the New Homes Bonus to adult social care funding and confirmation that local authorities would be able to raise the council tax precept for care by 3% in the next two years (2017/18 – 2018/19). However, it was noted that the net increase of the social care precept would need to remain at 6% over the next three financial years, meaning if councils chose to levy 3% in both 2017-18 and in 2018-19, they would not be able to raise a precept in 2019-20. Cllr Arthur explained Haringey’s approach to the precept would be considered as part of the wider work that was taking place to finalise the MTFS for 2017/18 – 2021/22. A variety of issues were also considered, including:

 

-       The Improved Better Care Fund allocations.

 

-       Developments concerning Haringey’s Integrated Target Operating Model (ITOM).

 

-       The key cost drivers for adult social care i.e. the number, cost and duration of packages of care for individual clients.

 

-       Projected adult social care client numbers and costs. This included the fact that numbers, outlined in tables 9 and 10 of the 13 December Cabinet report, had been translated into a financial forecast which averaged an increase of 4% cost increase per year over the lifetime of the new MTFS.  

 

The Panel was informed the gap between the natural trajectory and the budget for 2017/18 was around £29m. It was noted that this could only be achieved by either reducing the level of spend or increasing the amount of budget. David Tully, Head of Finance, explained the revised MTFS worked on the basis that there were already measures in place, as part of existing plans, which would reduce the natural trajectory spend by £9m and that after taking into account the passporting of the Adult Social Care precept and adjusting for previously agreed savings, that had been added back to the base, the amount required to fund the gap for adult social care demand in 2017/18 was £11.889m. It was noted the same principles applied for future years.

 

The Panel considered the proposed revenue savings proposals for Priority 2 as follows:

 

2.1 – Supported Housing Review

 

Charlotte Pomery, Assistant Director for Commissioning, stated that the aim of this proposal was to bring together the resources of housing-related support and adult social care to optimise use of supported housing assets in the borough. It was explained that this would create a coherent pathway of service for these groups, who had a range of needs, focused on addressing risk and vulnerability, tenancy preparation and breaking the cycle of homelessness. It was noted that the saving would be possible through the recommissioning of services in 2017, yielding a saving in 2018/19. During the discussion, consideration was given to a variety of issues, including:

 

-       Work that had taken place via both the cross-party Supported Housing Review Members Working Group and the Housing and Regeneration Scrutiny Panel.

 

-       Questions on how the commissioning of services would change once budgets had been fully integrated.

 

-       The number of units of housing-related support accommodation for people with leaning disabilities.

 

-       The importance of maximising independence and autonomy for adults who are living either in residential care or other types of supported housing.

 

-       The rationale for developing a strategy in order to move people from supported housing units to more independent living through the Keyring scheme. 

 

AGREED:  That the Supported Housing Review proposal be noted.

 

2.2 – Osborne Grove

 

The Cabinet Member advised the weekly cost per bed at Osborne Grove was £1,214 and explained that this was higher than the average market rate of nursing care at £824/week. The Panel noted there was significant demand for nursing care with limited capacity in Haringey and locally. With this in mind, the Cabinet Member explained consideration had been given to whether the Osborne Grove site could deliver extra capacity. The following points were noted:

 

-       Given the good location and condition of the site, opportunities existed to make better use of the day centre and car park.

 

-       An options appraisal was underway to maximise the number of units that could be offered from the site. It was explained that this was to reduce unit costs and to maintain care in a sustainable way.

 

The Cabinet Member advised the panel that in each of the options, the current nursing care capacity of 32 beds would be maintained. Any additional capacity created would either be of nursing beds or extra care sheltered housing units. It was noted that options ranged from procuring an alternative provider to develop out the site and/or to provide care to maintaining the current model and capacity.

 

The Panel went on to discuss, more generally, the pros and cons of various service delivery options including outsourcing and “insourcing”, among others. In addition, the following issues were discussed:

 

-       Findings, and action plans developed, following inspections carried out by the Care Quality Commission during November 2015. 

 

-       The fact there were a variety of options that needed to be explored and that the range of savings associated with different options ranged from £0 to £672k.

 

-       The importance of consulting existing clients to ensure disruption was minimised if/when work was carried out on the site. It was noted that current service users would be considered as part of the EqIA for the proposal. 

 

During the discussion, consideration was also given to a variety of issues, including lessons that had been learnt from previous decisions concerning Osborne Grove.

 

AGREED:  That the proposal concerning Osborne Grove be noted

 

2.3 – Fees and Charges Review

 

John Everson, Assistant Director, Adult Social Services, reported that the aim of this proposal was to amend fees and charges in order to bring them into line with other London boroughs and to enable cost recovery where possible and appropriate. Mr Everson explained that savings proposals had been put forward in relation to:

 

Disability Related Expenditure (DRE)

 

Mr Everson advised that Haringey operated a 65% (£35.82) disregard and that this policy had stayed the same since 2004. It was noted that other authorities had reduced the disregard for financial assessment purposes of DRE and that the range was from a flat rate of £10.00 to a rate of 35% (£19.00). The Panel was informed that the proposal for Haringey was to operate a DRE of £40%, (£22.04) by 2019/20 (i.e. 55% (£30.31 per week) saving an estimated £129k in 2017/18, 45% (£24.80 per week) and an estimated £244k in 2018/19.

 

Transport to day opportunities

 

The Panel was informed that this proposal related to charging users, who had been assessed as having the ability to pay, for the full cost of transport as part of the charge for the overall package of day care.

 

Self-funders administration fee

 

The Panel was informed that the Council managed care provision for 64 full-cost service users (those deemed to have enough disposable income to pay for their own care) and did not charge. It was noted that the proposal was to implement an administration fee. 

 

AGREED: 

 

(a)  That the Equality Impact Assessment, for the Disability Related Expenditure proposal, be made available for consideration by OSC on 30 January, before final budget scrutiny recommendations are agreed. This should include narrative on the individual impact of the proposal. 

 

(b)  That concern be expressed about the potential impact of the Disability Related Expenditure proposal and that consideration be given to limiting the impact by reducing the cut and by spreading the reduction out over five years, rather than three.

 

(c)  That a report be made to a future meeting of the Panel on the impact of the proposed DRE changes. This should include monitoring of the Equality Impact Assessment action plan and consideration of how changes are monitored via annual care assessments. Consideration should also be given to commissioning an independent audit to ensure the impact of any change is fully understood. 

 

(d)  The principle of charging for a whole package of care, rather than treating  travel costs separately, was supported by the Panel. However, it was agreed further information, about the cost implications of the Transport to Day Opportunities proposal, especially the total number of service users affected, should be made available to the Overview and Scrutiny Committee, before final budget scrutiny recommendations are agreed.

 

(e)  That concern be expressed about the timing of the Transport to Day Opportunities saving proposal, especially in view of the number of changes already taking place across day activities for people with learning disabilities and older people with dementia. With this in mind, consideration should be given to moving this proposal back to later in the MTFS period

 

2.4 – Technology Improvement

 

Ms Pomery advised that this proposal was about using technology to maximise independence, with a particular focus on using Assistive Technology (AT) and online information to signpost and enable residents to self-assess. During the discussion, consideration was given to a variety of issues, including:

 

-       The importance of ensuring the right information was available at the right time and in the right place to enable citizens, service users and carers to help themselves effectively and be aware of their own emerging or existing heath conditions so they could take steps to manage these.

 

-       An update on the future of Haricare (Haringey's directory for adults who need care and support) was provided in view of concerns, raised by the Panel, that correct  information was not always available online.

 

-       The importance of promoting activities that enabled residents to find support in the community and to remain in their home, deferring moves into Residential Care or receiving other packages of support when they are not necessary. 

 

In terms of using online information to signpost and enable residents to self-assess, based on work carried out at other local authorities, it was noted that significant savings could be made. In addition, it was explained that the use of AT, and online information and assessment, promoted independence and helped to improve quality of life, as demonstrated on pages 80 and 81 of the report.   Whilst the Panel acknowledged the benefits of this proposal it was noted that technology improvements, on their own, would not tackle issues relating to social isolation, especially if contact with some services reduced as a result.

AGREED:  That the proposal concerning Technology Improvement be noted.

 

2.5 – Market Efficiencies

 

The Panel was informed that five different approaches would be used to reduce costs incurred in commissioning packages of care for clients. Ms Pomery explained costs would be reduced by:

 

-       Implementing a new approach to residential and nursing procurements to reduce costs working with boroughs across North Central London.

 

-       Gaining leverage on providers in Learning Disabilities and Mental Health to negotiate price reductions in existing packages with an increased focus on maximising independence.

 

-       Developing new care and delivery models for people with the most complex needs and behaviour that challenges.

 

-       Changing the terms of the residential placement agreement to reduce the amount Haringey will pay when service users are hospitalised in line with comparator boroughs; a one off debt recovery from care homes against hospitalisation of service users.

 

-       Ending the subsidy for meals on wheels.

 

In response to questions, on the subsidy for meals on wheels, Ms Pomery explained that there were a range of options available for people needing support to access a hot meal during the day. Moving forwards it was reported that the role of the Council would be to help individuals to decide which option they wanted and that this would be  explored as part of the assessment and support planning process. The Panel was assured users would  be able to access culturally specific meals, with a range available as part of options being explored both for delivery and in the community. It was noted the Council was seeking to ensure consistency of costs, however some appeared more expensive. The Panel was informed that this would be considered as part of the EqIA for the proposal. The Panel was advised that where a luncheon club was an assessed need, and the user eligible, adult social care transport would be arranged.

 

During discussion consideration was given to a variety of issues, including the benefits of each approach and the cost benefit analysis. In addition, whilst the Meals on Wheels service provided access to hot and nutritious food, it was agreed that an important element of the service, that needed to be retained, was its ability to tackle issues relating to social isolation and loss of independence.  

 

AGREED:  That the Market Efficiencies proposal be noted.

 

2.6 – New Models of Care

 

The Cabinet Member reported that these proposals were at an early stage of development. However, the Panel was informed that potentially there were substantial savings achievable across Priority 2 from moving to an integrated model of delivery. It was noted that the largest element of this would be savings made through integration with (i) Haringey CCG, (II) the Wellbeing Partnership with Islington Council and CCG and (iii) additional savings across the North Central London cluster.

 

Mr Everson advised that there were additional potential savings as a result of proposals to redesign adult social care through:

 

-       Further reductions in new packages of care through a more preventative approach linked into primary care and community services.

 

-       Further staff reductions as part of service redesign, including through more integrated ways of working. It was noted that this would include services provided through Adults Social Care, Public Health and the Clinical Commissioning Group.

 

The Panel was assured that savings proposed for Haringey had been based on those achieved in models elsewhere. However, the Panel agreed further information, on the type of savings proposed, should be made available to demonstrate how savings of £1.4m would be achieved. It was agreed that this narrative should be considered by the Overview and Scrutiny Committee before final budget scrutiny recommendations were agreed in January.

 

AGREED:

 

(a)  That additional information, on New Models of Care, be made available for consideration by the Overview and Scrutiny Committee before final budget scrutiny recommendations are agreed.  This should include narrative on the range/type of savings proposed, including staffing, to demonstrate how savings of £1.4 million would be achieved. 

 

(b)  That the Cabinet Member for Finance and Health be asked to host a Member Learning and Development session, for all Members during the first half of 2017, on New Models of Care. This should include an update on the Haringey and Islington Health and Wellbeing Boards.

 

(c)  That an update on progress with the development of New Models of Care be submitted to a future meeting of the Panel during 2017/18.

 

At the conclusion of the item, the Chair thanked the Cabinet Member and officers for their attendance.