Agenda item

Resolved:

·         Figures would be provided detailing the savings made as a result of the new ways of working outlined in the report at section 8.3 onwards.

·         Figures would be provided setting out the alignment of the expenditure between adult social care and mental health services.

·         Analysis would be provided on the health of patients who had been discharged from hospital with an enhanced package of social care - as well as the longer term financial impact on the Council.

·         Information would return to the Committee (when it became available) setting out the plans for funding from the improved Better Care Fund.

·         Future updates should be provided about the work the Council was going to undertake on demand management and cost control.

4.1      Councillor Chris Best (Cabinet Member for Health, Wellbeing and Older People) was invited to address the Committee. The following key points were noted:

·         The report highlighted the usual pressures facing adult social care, which included: early hospital discharge; increasing longevity and complexity of needs; transition arrangements between children’s and adult’s social care; the rising demands of people living with dementia; responsibilities relating to deprivation of liberty safeguards.

·         The Council was eagerly awaiting further announcements from Government about future funding. Previous announcements (including a 2% increase in funding for pressures) had merely served as a ‘sticking plaster’ to for the long term issues facing funding for social care.

·         Ultimately, the work of carers should be more highly valued. Lewisham paid London Living Wage – but not all councils did.

·         The Council was working hard to support residents and to meet its responsibilities within the statutory framework.

4.2      Joan Hutton (Head of Adult Social Care) introduced the report. The following key points were noted:

·         The report outlined the budget for 2018-19 and detailed the expenditure on care (which accounted for the majority of spending).

·         Some examples of spending on care packages and levels of activity had been included in the report.

·         The Council focused support on those who had the highest levels of need.

·         Information had been provided about the levels of hospital discharge and the funding available to support this work.

·         There were growing numbers of people presenting with dementia – and this presented a pressure for services.

·         Savings had already been delivered from the adult social care budget.

·         Integration with health services was ongoing – the Council was working with colleagues in health and in children’s services to reduce duplication and contain costs.

·         Communication with potential care service users at an early stage was of vital importance.

·         Work was also taking place to ensure that systems, processes and methods for invoicing supported the delivery of frontline services.

4.3      Joan Hutton and Dee Carlin (Joint Commissioner) responded to questions from the Committee, the following key points were noted:

·         The Council worked with partners, using a variety of means, to prevent vulnerable people from having to make repeated visits to A&E.

·         Adult mental health casework and support services were recorded on different systems. Work was taking place to share information between the systems.

·         The Council shared data with partners in mental health services and ensured that statutory returns were made. However, it was hoped that improved use of data between partners would allow better analysis and targeting of support.

·         The report to the Committee outlined the adult social care spend – not the whole healthcare spend in Lewisham.

·         There were agreements in place across a number of client groups which ‘aligned’ spending between adult social care and health.

·         The joint commissioning budget did not show the entirety of spend on client groups in adult social care. To consider the totality of this spending the Committee would need to review the budget for Lewisham’s clinical commissioning group.

·         Lewisham was providing more intensive support as a result of early discharge.

·         Once people who had been admitted to hospital were medically fit their home was usually the best environment for them.

·         The level of people returning to hospital following discharge and reablement in Lewisham was low. Information about the long term care and support requirements of people receiving this support was collected by the Council and this indicated that discharge services were performing well.

·         Spending via the adult social care precept and the improved better care fund would continue on the priorities that had previously been identified. Work would also take place to improve local services for young people. There would also be some additional spending on services for people living with dementia.

·         It was important to ensure that the local care market remained viable and buoyant.

·         The Council did all it could to contain costs whilst managing risks and ensuring that services were safe.

4.4      In Committee discussions, the following key points were also noted:

·         Figures were requested detailing the levels of savings that had been generated via the Council’s new ways of working (as outlined in the report).

·         Reassurance had been given to members of the Committee about the compatibility of data and systems between the Council and partners in mental health over an extended period; but this reassurance appeared to be in doubt.

·         Figures and additional detail were sought regarding the joint expenditure between health and social care.

·         Detail was sought regarding the plans for funding from the improved Better Care Fund.

4.5      Councillor Best responded to a question about the impact of the cuts on the rest of the Council’s budget due to the requirement of maintaining services in adult social care, the following key points were noted:

·         She understood the pressures facing the Council and the whole organisation had to work together in order to meet the challenge.

·         The Council’s responsibilities in social care were set out in the care act.

·         Work was taking place to bring some services into the borough. Specific work was taking place with people using learning disability services.

·         In particular, the ‘shared lives’ project was bringing some services back into the borough – which would help to manage the costs of complex cases.

·         A number of new initiatives to support the care market in the borough and improve services were being developed.

·         More than £30m in savings had been achieved in adult social care services over the period of austerity.

4.6      Councillor De Ryk responded to a question about budget pressures, the following key points were noted:

·         Additional funding from government had a significant and welcome impact on adult social care services. The Government should make additional funding available for the pressures in children’s social care.

·         Further work should take in care services place to better understand and manage demand.

·         Ensuring that people were well enough to support themselves (and prevented from having to access care services) would be a key future focus.

·         The management review ‘star chamber’ process highlighted the importance of understanding costs, improving processes and strengthening performance across the Council.

4.7       Resolved:

·         Figures would be provided detailing the savings made as a result of the new ways of working outlined in the report at section 8.3 onwards.

·         Figures would be provided setting out the alignment of the expenditure between adult social care and mental health services.

·         Analysis would be provided on the health of patients who had been discharged from hospital with an enhanced package of social care - as well as the longer term financial impact on the Council.

·         Information would return to the Committee (when it became available) setting out the plans for funding from the improved Better Care Fund.

·         Future updates should be provided about the work the Council was going to undertake on demand management and cost control.