Meeting documents

Buckinghamshire will experience significant housing growth in the forthcoming decades, which will be set out in the District Council Local Plans.  This will have significant impact on the future demand for County Council services.

 

Each of the County Council’s four Select Committees will be holding themed meetings during July 2017 to investigate whether the County Council is ready for Growth.  The outline scope for this piece of work was agreed by the Transport, Environment and Communities Select Committee on 21st March 2017 and the final scoping document is attached for information.

 

The focus of this meeting will be around Adult Social Care and Public Health services.

 

The Health & Adult Social Care Select Committee will be considering the following key areas in its quest to examine the extent to which the County Council is ready for growth.

 

·         Plans and Strategies for managing demand on adult social care services;

·         Governance;

·         Commissioning of services;

·         Use of data sources to predict and manage future demand on services;

·         Public Health.

 

Contributors:

Sheila Norris, Executive Director, Communities, Health & Adult Social Care

Jane O’Grady, Director for Public Health

Tracey Ironmonger, Assistant Director for Public Health

Jane Bowie, Director of Joint Commissioning

Ali Bulman, Service Director (ASC Operations)

 

 

Lin Hazell, Cabinet Member for Health & Wellbeing, Mr Brown, Cabinet Member for Community Engagement and Public Health, Ms S Norris, Executive Director, Communities, Health & Adult Social Care, Dr J O’Grady, Director for Public Health and Ms J Bowie attended the meeting for Members of the Committee to seek evidence whether the County Council is ready for growth.

 

The Committee considered the following key areas for planning for Growth in Adult Social Care and Public Health in Buckinghamshire – Plans and Strategies, Governance, Commissioning of services, Use of data sources and Public Health.

 

Members received a PowerPoint update from the officers in attendance, followed by an opportunity to ask questions. The key findings and recommendations would then be included in a final report to be presented by the TEC Select Committee to Cabinet in October 2017.

 

Dr O’Grady and Ms Norris took Members through part 1 of the presentation which outlined the impact of Growth on Health and Wellbeing and Public Health.

 

The following points were raised and discussed:

 

• The Committee discussed the new homes being built, with less family living space and outside space for communities and how this was to the detriment to the health and wellbeing of children.  Dr O’Grady stated that Public Health were working with developers to ensure community spaces were being considered.
• The Committee discussed the state of the public realm and the need to make these environments safe for all to use.  Dr O’Grady stated that this was a shared problem and they were working with communities and other public sector partners to find solutions. 
• The Committee asked for examples of where Public Health input had an impact on planning developments, Dr O’Grady reiterated Public Health presence on working groups and in discussions with planners but no examples were given
• The Committee also discussed Active Bucks and the funding only being for a limited time.  Dr O’Grady confirmed that although the funding for Active Bucks had stopped, 70% of activities were now self-sufficient and continue to be run
• Provision for the elderly was also discussed and the closure of sheltered housing and the impact that has.  Some examples were raised and Ms Bowie agreed to follow them up with colleagues

ACTION: Ms Bowie

 

Ms Bowie took Members through part 2 of the presentation which outlined the impact of Growth on Adult Social Care

 

The following points were raised and discussed:

 

• The Committee discussed the work to support people to remain in their own homes and the work that needed to be done with families and nurses to help them better understand the support available.  Ms Bowie confirmed that re-enablement figures were not  as strong as they would like them to be therefore this was an area of focus

• The integration of Health and Social Care was also discussed.  A roadmap to 2020 had been to the CHASC Board which included integrating commissioning, governance and back office functions

 

The Committee asked questions set out under the following headings:

 

Bucks Strategic Infrastructure Plan

The Committee queried what the plan was expecting to achieve, the contribution CHASC made to the final plan and whether the plan was being used to help shape and inform CHASC BU plan.  It was confirmed that CHASC officers had been involved in drafting the plan, which looked to enable more community options and conversations had about the type of models that do not work well.  The business unit had inputted into the plan and it was acknowledged that the was a really positive approach and supported the ongoing relationships and conversations with District colleagues and developers.  They also confirmed they were looking at other authorities to develop best practice around this.

 

Plans and Strategies

It was queried who had overall responsibility for delivering the CHASC Business Unit Plans, especially the action plans to deal with the predicted growth; as well as  how well Public Health information had been used to inform the Council’s Business Unit plans.  Ms Bowie responded that the responsibility was shared amongst Senior Management colleagues.

 

The Market Position Statement would be drafted by the end of this year, which would map out how organisations would work together.

 

The overarching Joint Strategic Needs Assessment (JSNA) was a joint responsibility between Health and Adult Social Care with a lot of core data that informed business unit plans. 

 

Financial Planning and Budget control

The Committee discussed the budget monitoring process being over a 4 year period and whether CHASC colleagues agreed that doing this over a longer term would help achieve greater pace in planning services to meet future demand.  Ms Norris confirmed that whilst the overall medium term planning (MTP) process was on a 4 year rolling plan, officers continued to look further ahead; although some areas were harder to plan than others.  A longer term capital programme would be beneficial.

 

S106 money

The Committee asked how well opportunities relating to Section106 money was maximised.  Dr O’Grady confirmed that CHASC were sighted on the developments and the use of 106 money.

 

Other sources of external funding

The Committee asked how well CHASC were at identifying and exploiting external funding streams to help meet future demand and who was responsible for this.  Ms Norris stated that CHASC were working on ensuring services were charged at the right rates and that these were affordable. This would also rely on income being collected as efficiently as possible.  Ms Norris also confirmed that conversations were ongoing with the NHS.

 

Income Generation

The Committee asked what plans were in place to look at the possible income generation opportunities across the Business Unit; were there projects being  developed which would place the Council in a provider role rather than a commissioning one (for example, Housing for Older People). 

 

Ms Bowie confirmed that reducing the number of placements in care homes would have an adverse effect on the income and work was underway to ensure that the right income streams between BCC and Health were in place.  Ms Bowie also highlighted that the County Council were working with local communities to ensure that they were maximising existing resources in the community.

 

The Committee discussed the value of selling BCC services to other bodies and Assistive Technology was highlighted as an area that could be explored.

 

It was questioned that with the growing demand on the service and the reassessment of all care packages, whether officers felt there was significant resource to do this.  Ms Norris confirmed that there was opportunity to enlist other providers to carry out some of the work as long as this was supervised.

 

The Committee also discussed the reluctance of some residents in approaching the service for help in fear of being removed from their home.  Ms Norris stated that conversations were needed early on and support was to be provided to people in their own homes as early as possible; the County Council worked closely with the voluntary and community sector as well as GPs. 

 

Opportunities

The Committee asked officers to provide more details in relation to opportunities, to build a range of different housing options for older people.  Ms Bowie cited the Extra Care facilities that were already available and interest in looking at how these could be further developed.   Populations in care homes had shifted nationally and locally and the County Council were looking at the balance between nursing and residential.

 

Governance

The Committee asked which Officers from CHASC attended the Officer Working Group and how the information was disseminated across the BU to help inform and shape the work of the BU and how they ensured actions were taken forward and managed effectively.  Ms Bowie confirmed feedback was provided through the ASC Leadership Group and Members would be briefed directly when necessary.  She confirmed that someone from the Commissioning team attended along with Tracey Ironmonger, Assistant Director for Public Health.

 

Assessment of current arrangements

The Committee queried what was working well with the current governance arrangements and how these could be improved.  Ms Norris stated that governance arrangements around Growth needed to continue to be reviewed; although presently these were working effectively to ensure different council functions were linking up.  The Committee also discussed the impact of Brexit; issues would be explored by the Brexit Group which had recently been set up.

 

Senior Management Team

The Committee asked if planning for growth was discussed regularly at Senior Management Team meetings and what informed these discussions.  Ms Norris confirmed there were various boards and forums where information and strategic issues were being shared and that Growth was a regular agenda item on agendas at different levels within the organisation.

 

Commissioning of Services

The Committee questioned if any Workforce planning modelling had been done around the impact of Brexit on the market and other external factors, including National Living Wage and the changes in the population profile.  It was confirmed that links were in place with discussions taking place nationally with key groups.  There were also conversations with local health providers and an event with social care providers taking place w/c 31 July which would include discussions about the impact of Brexit

 

Dementia

The Committee asked what plans were in place to meet the rising number of people with dementia both in terms of the specialist care homes and also support for carers.  Ms Bowie confirmed that there was a joint Dementia Strategy with our health partners and that there were suitable joint arrangements in place to support people from the point of diagnosis and ongoing.  ASC also worked with care home providers and linked into other resources including Assistive Technology.

 

Self-funders

The Committee discussed if any modelling had beenundertaken to highlight whether there would be an increase or a decrease in self-funders in Buckinghamshire and the impact on services.  Ms Bowie advised that there were 65% of self-funders in Buckinghamshire, which was high.  Work was underway to look at how best to support self-funders to ensure they were not being over exposed and that they had the right information available to them to ensure their decisions were well informed.

 

Transition from Children to Adult Services

The Committee highlighted the importance of using information held within Children’s Services to help inform future demand on Adult Services.  Ms Norris confirmed that there was joint working with Ms Bowie having joint commissioning responsibility.  It was agreed that more could be done to help aid the parents on how they prepare their children for adulthood.

 

Learning from other authorities

The Committee asked if there were other local authorities held in high regard in terms of how they were handling the pressure on services and shaping their future delivery of services.  Mrs Gibb mentioned Harrogate and Dorset and Ms Norris stated that they also learnt through the regional work they do with ASC colleagues where they share best practice.

 

Public Health

 

Planning and Development

The Committee queried the influence and involvement with developers; it was confirmed that there was a Commissioning officer with lead responsibility for housing; with provision and joint arrangements with a number of housing providers in Buckinghamshire.  It was  confirmed that Public Health were statutory consultees for building care home facilities

 

Public Health information

The Committee asked how information and data was shared across the County Council from Public health on future population needs.  Dr O’Grady confirmed that population projections had been disseminated around the authority; officers were working with the District Council, BCC planners and the NHS.