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Agenda item

Risk Deep Dive - Health and Social Care Integration

Minutes:

The committee heard from the Director of Strategic Commissioning and Investment on health and social care integration. It was explained health and social care integration was identified as a corporate risk when Clinical Commissioning Group’s were replaced by Integrated Care Board’s (ICB). The borough had a good history of integration, with pre-existing pooled budgets and joint arrangements. To manage the identified risk a number of governance arrangements were put in place to help the council work closely with the ICB. The system had matured, and now included aligned commissioning and the integrated front door. There was also alignment of the NHS ten-year plan and the council’s tackling inequalities and 2030 plans.

 

The committee raised and discussed the following main points;

·         The potential for the NHS 10 – Year Plan to lead to further structural changes

·         That government funding and resources were prioritizing the NHS and the importance of the council receiving some of that benefit. It was explained that it was a challenge due to a focus on NHS acute provision and hospital discharge but it was recognized that the adult social care offer was wide ranging and an important tool to deliver on prevention.

·         A committee member felt it was a concern that the council was expected to do more work around prevention but without the flow of resources and suggested this be revisited. It was explained that prevention encompassed a lot of the council’s work and the case needed to be made to the government.

·         How the NHS and council were managing increasing financial pressures and risks in their shared budget, for example how the partnership would manage an overspend. It was explained that the ICB and council would share any overspend and any savings. There had not been any issues to date.

·         A committee member highlighted that the ICB had recently tried to remove some joint funding, but the plans had been stopped. They asked if there was a risk of this reoccurring due to financial difficulties. It was explained that a range of savings would need to be delivered across the partnership, and it was important to keep an open dialogue.

·         A committee member asked whether, because the ICB covered 5 boroughs, the better managed councils would end up contributing more. It was explained that officers were aware of the risk and worked hard to demonstrate there were nuances.

·         The accountability of ICB decisions.

·         A committee member asked for clarity around assistive technology and whether there was a risk caused by less human contact. It was explained that assistive technology allowed for a less intrusive approach, for example someone with epilepsy could have a detector on at night rather than someone in the room. Assessments were thorough and identified a person’s individual needs and this could include social contact and support for someone otherwise socially isolated. This could also have a smaller carbon footprint.

·         Whether the exclusion of the council’s ‘fairer together’ mission from the report had implications for the success of the mission. It was explained the omission was an oversight and it was crucial to the service that they provide the right support at the right time in the right place. 

·         The difficulty of managing demand. It was explained a strength-based practice model focused on individuals strengths and working with people early to avoid escalating needs.

·         How the Council ensured procured services were providing value for money and not over charging. It was explained that the council was good at managing the market but recognized some packages of support were expensive when people presented with complex and challenging needs. This represented a small proportion of the support provided. The council undertook robust commissioning activity around pricing to ensure providers were paid fairly and would benchmark all providers across the market to ensure the council was not being overcharged.

·         The Chair highlighted there was a predicted overspend of approx. £1,000,000 in adult social care and this was mainly due to the unavailability of beds in care homes and the ensuing requirement to purchase provision elsewhere. It was explained that occupancy rates could not fall too high or too low and it was important to understand where overspends arise and how to minimize the council’s vulnerability. The Director of Strategic Commissioning and Investment explained the overspend on care homes had reduced significantly and the council was currently at around 90% occupancy.  It was also explained that performance data was showing less people were being admitted to care homes due to the strength-based model which helped people to remain in their homes for longer.

·         The accommodation strategy had been approved by Executive and would be published shortly. The needs analysis showed a strong understanding of the borough, good predictive analysis and an understanding of the level of needs. There was work underway across the council to address those needs.

·         It was highlighted that the fairer together mission had been renamed empowering people.

 

RESOLVED:

To note the risk management strategy for the principal risk.

 

Supporting documents: