Agenda item

The Chair welcomed the following officers to present the item:

·  Tony Pounder, Director of Adult Services

·  Neil Kissock, Director of Financial Resources

·  Stephen Knight, Associate Director Newton Europe Consultants

·  Louise Taylor, Corporate Director Operations and Delivery.

 

In June the Scrutiny Committee received a presentation from Newton Europe which provided the Committee with an overview of how the role and remit of Newton's was contributing to the transformation of the design and delivery of services which would result in improved outcomes for adults. It was agreed that further updates would be provided to inform Members on the progress being made.

 

Newton Europe had been working with LCC on a major change programme called "Passport to Independence". Its aim was to help people stay healthy and independent for longer whilst improving practice and process which would lead to better outcomes for service users and overall financial savings. There are 4 main aims of the programme:

 

·  Promoting Wellbeing – this was working at the Community and Acute entry point to Adult Social Care to maximise usage of non-statutory services.

·  Promote and Support Independence – this project sought to promote independence through community assessments and reviews. Achieving this required improvements to the decision making practice within these teams, whilst also increasing the team productivity.

·  Reablement – this increased both the capacity of reablement and the independent outcomes people achieved through improved ways of working with providers.

·  Ordinary Lives – this was building on the potential of people with learning disabilities to enjoy an ordinary life.

 

The overall approach of work with Newton Europe was divided into 3 areas

 

·  Assessment – where were the biggest opportunities for improvement

·  Design – what were the solutions and how did we know they worked

·  Implementation and Sustainability – rolling out solutions that supported practice transformation across the County, locality by locality.

 

The presentation, which is appended to the minutes, went on to identify what had been achieved during the Design phase and what the wider system and partner benefits were.

 

Several examples were given of how different ways of working produced positive benefits for service users which included:

·  The number of people going into long term residential care had halved. From the Acute pathway alone this would lead to more than 250 fewer residential placements per year. The proportion of people going back to their own home directly from hospital went up by 25%.

·  The number of hours saved every year for community teams was a result of the screening service being able to solve more cases themselves. Teams increased the number of social care assessments and reviews by 91%.

·  More than 80% service users were receiving reablement within existing commissioning capacity and 13% more of reablement customers were fully reabled. 

 

It was paramount to ensure that the results of the review were sustainable. Once the criteria from the results of the review were met the Director of Adult Social Services had the authority to start a measurement period. During this period

·  Performance would be tracked weekly over a 3 month period with reduced levels of Newton support

·  Ways of work would be monitored to ensure they remain

·  The financial benefit delivered during this time would be what counted towards the Programme Contingent Fee Arrangement.

 

A financial update was also provided by Neil Kissock which explained the benefits, commercial model and costs of the programme and included:

·  Information on the KPI equations generated jointly with LCC and Newton detailing how savings will be calculated

·  The annualised benefit of each area of the programme identifying both the target and stretch (maximum) savings

·  The contract model upon which the fee structure for Newton Europe is based.

 

Questions and comments by the Committee in relation to the report were as follows:

 

·  It was pointed out to Committee that if people were self-funders it was up to them where they went to receive care. If however, they were looking for a local authority to provide support they could negotiate with LCC where they moved to. LCC would then pay the going rate that whichever local authority would pay within that area. LCC still kept track of people who had moved out of the area as it had responsibility in terms of funding and accountability.

 

·  In terms of care packages, if someone went into hospital, the hospital would alert LCC if it felt this person needed a care assessment. This triggers off a process which meant LCC allocated social workers or social care support officers who would then conduct care assessments. Where LCC needed to fund the care it made arrangements with care agencies, either for residential or domiciliary care.

 

·  Members enquired what the projection of need was in Lancashire over the next ten years or so. A number of factors were looked at in terms of projections around demands in Adult Social Care. At the moment there was a medium term financial strategy which went up to 2020/2021, that was reported to Cabinet on a quarterly basis. This strategy reflected an increase in demands of services in terms of population. There was a significant increase in the ageing population of around 2 – 3% each year.

 

·  The question was raised regarding what sort of fall off in performance there would be when the change programme was rolled out in a wider scale. The Committee was informed that performance in the pilot scheme had been exceptional. All areas of the programme had been benched marked against similar programmes in other authorities in terms of what was achieved across the whole county implementation.

 

·  Members pointed out that previously there had been delays on referrals for  occupational therapy and enquired if these delays had been eradicated. At the moment the Committee was informed that these delays had not been eradicated. At the beginning of the financial year 20 occupational therapy posts had been established. 14 of these were employed on a full time basis. The establishment had increased to 40 occupational therapists. There were different levels of improvement in different areas of the county. Occupational therapists (OTs) had a number of different roles. In some areas the waiting time for equipment had improved.

 

 

·  The Committee asked how much hospital OTs were relied upon to give advice. The prescriptions of hospital OTs regarding equipment and help people could get at home were entirely accepted. It was vital to have a joined up approach to decision making to make sure people got the right equipment and help.

 

·  Regarding social work and social care services 80% of staff were maintained over the holiday periods.. Money had also been made available to increase crisis hours. LCC was working with Newton Europe to make itself more efficient and cost effective but it could not assume that the whole system would work more effectively..

 

·  Regarding finances, if the savings went above £30 million. Newton Europe would get an additional one off payment of one third of the additional amount.

 

·  The work done around the Statutory Services Review identified that LCC had potentially a financial strategy agreed on the basis of lower quartile costs against its services. On this basis there were additional savings that would be deliverable of around £37 million on Adult Social Care.

 

• It was felt that it was cheaper for people to stay at home if domiciliary care was provided rather than go into residential care and there was a request for an update to see how many people looked after could be cared for at home. LCC was aiming to support as many people at home as possible. The Committee was informed that a Bite Size Briefing for Councillors on Residential Care was taking place on 17^th January 2017.

 

• Information on the amount of funds LCC had lost each year since 2010 would be circulated to Members

 

• It was stated that there was a crisis around the whole country regarding Adult Social Care. It was felt individual councils could not solve the problem, it had to be an issue for Government.

 

 

Resolved:

 

1.  The Committee note, comment and express concerns on the Newton Europe update

 

2.  A further update from Newton Europe come to April 2017 meeting of the Scrutiny Committee