Agenda item

4.            Lewisham Future Programme: 2016/17 DRAFT Revenue Budget Savings Proposals for Scrutiny

4.1      David Austin (Head of Corporate Resources) introduced the main savings report; the following key points were noted:

·           This report should be seen in the context of the Medium Term Financial Strategy that was presented at Mayor and Cabinet meeting in July, which presents the Council’s financial strategy up 2019/20. The Council is working towards the savings targets set for the Lewisham Future Programme, as public austerity is expected to continue.

·           The Comprehensive Spending Review will be announced on 25 November, with the Local Government Financial Settlement (LGFS) expected to be announced in early December. It isn’t until the LGFS that Council will know what budget it can set in February.

·           It was agreed by Councillors last year that £45m of savings needed to be identified in setting the budget for 2016/17. The proposals presented amount to savings of between £25m and £26m, which leaves a gap of about £20m to fill. Further savings are still being developed, and will be presented to the Committee when they’re available.

·           The specific proposals for this committee to examine in detail amount to roughly £8m, of which roughly £3m are proposals for the 2015/16 budget and £5m are proposals for the 2017/18 budget.

4.2      Aileen Buckton (Executive Director for Community Services) introduced the adult social care savings proposals. The following key points were noted:

·           The proposals look ahead for two financial years, and for those proposals due to be implemented in 2017/18, detailed plans will only be brought forward at a later date.

·           The proposals A11 to A15 fit within the overall framework of Adult Social Care Integration.

·           The Public Health savings proposals have been developed to meet the targets from the Lewisham Future Programme, but don’t contain any plans to deal with the in-year savings to Public Health Grant proposed by central government.

4.3      Aileen Buckton and Joan Hutton (Head of Assessment and Care Management) responded to questions from the Committee on savings proposals A11: Managing and improving transitions plans. The following key points were noted:

·           The Council is developing supported living schemes for young people with complex needs in the borough, to avoid the cost of expensive out of borough placements. Work has started to develop these proposals with a target to implement them as part of the 2017/18 budget. A detailed proposal for the creation of these places is expected to be presented to a Mayor and Cabinet meeting in the autumn.

·           Choices between different types of provision will be available to young adults, but these choices will be constrained by the budget available to the Council, the resources of young people themselves and their relatives as well as the availability of other services.

·           The provision of additional places at House on the Hill would happen in a phased way, with a total capacity of 40 places but initially only 10 places becoming available. Aside from the places at House on the Hill, other places will be created in the borough.

4.4      RESOLVED: that the Committee be provided with information on the number of places becoming available as well as an indication of the number of young people affected by this proposal.

4.5      Joan Hutton introduced savings proposal A12: Reducing costs of staff management, assessment and care planning. The following key points were noted:

·           This proposal aims to redesign the management structure, to reduce the costs for assessments and make best use of professional staff. There are no details yet as to which staff would be affected.

·           This work will be done in cooperation with key partners.

 4.6     Dee Carlin (Head of Joint Commissioning) responded to questions from the Committee on savings proposal A13: Alternative Delivery Models for the provision of care and support services, including mental health. The following key points were noted:

·           The Council will be working with partners to develop better ways of delivering care while using the Better Care Fund. This saving would result from the use of new models of care and demand management.

·           This proposal will be developed as part of the integrated care programme, in collaboration with health partners. Mental Health provision is now part of the work programme for the integrated care programme.

4.7      Joan Hutton and Aileen Buckton responded to questions from the Committee on  savings proposals A14: Achieving best value in care packages. The following key points were noted:

·         The Council will work with residents to develop their support plans. As part of this their care needs will be identified and worked through in detail. Residents will be encouraged to use their own resources in the form of support from family and the community to avoid the need for the Council’s social care services.

·         This proposal entails a change in approach to practice in accordance with the Care Act. The Care Act aims to improve care but also to better coordinate care and avoid duplication of work. One of the principles of the Better Care Fund is to invest in adult social care services if it prevents further hospital admissions down the line.

·         For some residents, the Council may recommend local clubs they can attend to combat isolation and loneliness. In other cases, the Council may offer specific equipment so residents can continue to wash themselves instead of needing daily care visits.

·         For those residents that still need care delivered, a risk assessment would take place to identify which care the Council will provide.

·         The Council has invested in the voluntary sector in recent years to create some of the services required, such as the Meet me at the Albany programme. Officer will be mindful of the cuts to funding happening within the voluntary sector when referring residents to these services.

·         The Council has worked with the voluntary sector to develop sustainable services, and will look at ways to increase its income if services developed with support from the Council become profitable – depending on previous negotations about support offered and its potential benefits.

·         The Council offers support to residents in a crisis as well as support by a key worker to ensure sustainable.

·        The Committee noted that the proposal did not contain sufficient detail about the services that would be cut nor the basis for the estimations of the expected savings, for the Committee to adequately comment on the proposal.

4.8      The Committee resolved to advise the Public Accounts Select Committee of the following:

The Committee submits that there was insufficient information on how this proposal would impact on service users; especially on which services may no longer be available. The Committee requested monitoring reports at key stages of the implementation of this strand of work which should include risk analysis of the impacts on service users. The Committee welcomed the suggestion by officers to provide anonymised case studies of service users affected by changes to support plans as part of the information provided for this savings proposal. The Committee requested reassurance that service users would be supported in avoiding future crisis situations, as well as being supported during a crisis. In addition, the Committee commented on the difficulties of managing expectations as to what the Council will be able to provide and therefore highlighted the need to engage with both service users and practitioners to affect this change in culture.

4.9      RESOLVED: to refer the Committee’s views to the Public Accounts Select Committee.

4.10    Dee Carlin responded to questions from the Committee on savings proposal A15: New Delivery Models for extra care – Provision of Contracts. The following key points were noted:

·           A number of new extra care schemes are currently being built in the borough. This provides an opportunity for the Council to completely review its extra care contracts, which are due to expire at the end of 2017.

·           As new schemes are being developed, this provides an opportunity for the Council to closely work with providers to design the scheme to specifically suit residents’ needs. 

·           The need for residential care is reducing, and models for extra care housing are developing. For both adults with dementia and people who are extra frail, the Council can now provide nursing care for people with very complex needs in extra care housing.

4.11    Danny Ruta (Director of Public Health) responded to questions from the Committee on savings proposal A16 Public Health (not including sexual health, drugs and alcohol). The following key points were noted:

·         There are three categories of savings proposed under A16. The prescribed medication saving is straightforward efficiency savings, as payments for public health related medication can now be disaggregated from CCG payments to GP’s.

·         The proposals for dental health savings will have the least impact on public health. Lewisham Council is the only borough in London that still employs a specific dental infection control nurse, and there is a lack of evidence that this disadvantages the rest of London.  

·         Government’s proposals for in-year savings to the Public Health Grant add further uncertainty to which services Public Health can provide.

4.12    Councillor Chris Best (Cabinet Member for Health, Wellbeing and Older People) commented on savings proposal A16 Public Health:

·           These savings proposals include a plan to cease the provision of free swimming. Greater uptake was expected when the programme was introduced, and greater uptake would have created greater value for money.

·           Beneficial public health outcomes can be dereived from exercise when it is frequent. Of the under 16’s who use the programme, many use it very infrequently so are not increasing their health in the long term.

·           The Council offers a number of other programmes to encourage exercise in the over 60’s, such as walking football and providing outside gyms in parks.

·           As part of the leisure centre contracts, the Council would aim to create affordable membership deals to mitigate a loss of service for residents that are currently using the free swimming programme.

4.13    Danny Ruta responded to questions from the Committee on savings proposal A17 Sexual Health Transformation. The following key points were noted:

·           This proposal ties into work being done to reconfigure the provision of sexual health services across London. There is a move to provide more online services, and a number of clinics may close as a result of the reconfiguration.

·           Currently sexual health is an open access service which is free at the point or delivery. Residents from Lewisham can access services across London, and the costs are charged to Lewisham Council. These services can costs more to provide in other London Boroughs than Lewisham so this work is being done to encourage residents to use local sexual health services. 

4.14    Geeta Subramaniam (Head of Crime Reduction and Supporting People) responded to questions from the Committee on savings proposal K4 Drug and Alcohol Service. The following key points were noted:

·           The first aspect of the savings proposal entails a change in the way methadone is prescribed. The second element of the savings proposal would entail reducing the cost price of the service when reprocuring in 2017.

·           Currently methadone is prescribed for 12 weeks in all cases. Following this proposal, more regular reviews of the prescriptions  would be introdcuced which would result in the prescription of methadone according to need, which could be less than 12 weeks, which would result in a reduction of prescription costs. Discussions with the current provider are ongoing about the proposed regularity of these reviews.

·           The current provider employs a doctor (MD) to review patients’ need for methadone and who is responsible for issuing the prescriptions.

4.15    Geeta Subramaniam responded to questions from the Committee on savings proposal B2 Supporting People. The following key points were noted:

·           The savings agreed for the 2015/16 budget are currently being implemented. As this is a saving proposed for the budget of 2107/18, the proposal is still being developed.

·           The further savings proposed will have an impact on service users. Not everyone who receives a service now, will be able to receive services in the future.

·           Officers are working to identify ways to minimise the impact of these proposals on vulnerable residents. Officers are investigating whether housing benefit payments could be used to pay for the accommodation provided as part of the current service. Officers are also working to identify any alternative support networks in the community that could replace services currently provided by the Council.

·           The Committee expressed concern that this proposal contains a risk that additional costs could fall on other public services, such as, for instance, the Council’s Housing Options Centre, the hospital and adult social care services.

·           The Committee also commented that this proposal could also increase anti-social behaviour.

·           The Committee was sceptical that alternative provision could be found outside the Council to replace these services.

4.16    The Committee resolved to advise the Public Accounts Select Committee of the following:

The Committee notes with great concern the potential impact of removing services for some of the most vulnerable residents in the borough, as these services often function as a last resort. The Committee is also concerned about the risk of this proposal leading to cost shunts to other services. The Committee is supportive of work undertaken to identify alternative sources of funding for these services and to identify other support networks. The Committee rejects the proposal to reduce the provision of the accommodation and floating support services for these vulnerable residents.

4.17    RESOLVED: to refer the Committee’s views to the Public Accounts Select Committee.

4.18    Standing orders were suspended at 21.20 to enable the completion of Committee business.

4.19    David Austin responded to questions from the Committee on savings proposal O4 Financial Assessments review. The following key points were noted:

·                The Benefit Service became responsible for adult social care financial assessments in October 2014. The proposal would entail refining the procedures used to perform financial assessments as well increasing the use of technology.

·                Officers would carefully assess how to increase the use of technology while keeping the service accessible for residents.

            The Committee thanked officers for their hard work in developing these proposals.

4.20    RESOLVED: to refer the Committee’s views on the savings proposals to the Public Accounts Select Committee.