The report of the Strategic Director, Health and Wellbeing, (Document “E”) provides information on the achievement of the savings in the Department of Health and Wellbeing as at the end of quarter one 2019..

Recommended –

That the report be noted.

(Wendy Wilkinson – 01274 434163)

The report of the Strategic Director, Health and Wellbeing, (Document “E”) provided information on the achievement of the savings in the Department of Health and Wellbeing as at the end of quarter one 2019.

The Director, Health & Wellbeing reported that savings were being achieved by doing the right thing for people and would take time to embed.  It was explained that, nationally, it was recognised that Social Care had been underfunded for a considerable time.  The Government’s Green Paper on Social Care had been delayed four times and services were being managed piecemeal until that legislation was in place. 

It was explained that measures were being adopted to working practices to avoid; reduce or delay the time when people became reliant on long term care.  Increasing numbers of residents were living with disabilities but the funding was reducing.  It was known that not supporting residents would drive people into crisis so the service was working with more people at an earlier stage to delay the need for high end support.  Those measures would also increase the capacity to manage demand for people with higher needs.  Hospital discharge figures evidenced that those measures were effective.

Examples cited included reports of one resident with learning disabilities who had been placed in supported living, with 24 hour support, 10 years previously.   He was now supported to live in his own home.   Those measures were providing savings to the service, but more importantly, giving him the independence he had always wanted.    A person with memory problems had received costly home care visits to remind him to take essential medication.  That resident now has a watch which reminds him when he should take his treatment.

It was reported that the Authority was now the 5^th best nationally against delayed hospital discharges.  Repeat visits to hospital after 91 days were also reducing and helped the service confirm that the measures where having the correct impact.

Reductions in young people going into residential care were also reported and it was explained that only two admissions had been made during the year.

Investments had been made with NHS England to provide new units for supported living and it was explained that the Bronte development should be up and running within the next couple of months.

Members were assured that Issues with quality of care were reducing as work had been undertaken with providers to ensure that a better quality of care was provided.  Investment had been made in Home Care Services with separate payments for travel time and the cessation of 15 minute visits. Members questioned the payments for travel and were advised that the service paid, at an over base rate, for 30 minute visits.  Those payments included compensation for travel time and the 30 minute visits were not compromised through travel. 

It was acknowledged that the winter months would incur additional costs but Members were advised that the service would end the year in a better financial position than in previous years. 

Whilst supporting the actions to prevent too much intervention being undertaken too soon the assessments to ensure people’s requirements were being met were queried.  It was explained that a previous 42 page document had been amended to take a proportionate approach.  Initiatives to allow people to remain in their home included a £200 grant which could be approved in a timely fashion to address factors which could have resulted in home care being required.  An example of a person with a twin tub washing machine which they found difficult to use was discussed.  That resident had been given a grant to allow the purchase of an automatic washing machine which prevented them requiring home care. 

The budget proposals appended to Document “E” included the reduction from seven to four operational air quality management stations.  In response to discussions it was agreed to send out a link to the Council’s consultation on air quality.

A co-opted Member referred to The Big Conversation work involving 600 people with autism / learning difficulties which had found that they did not want carers but wanted other help to allow them to live independently.   That Member expressed concern about budget proposals to change the way the Council and its partners delivered customer facing services, focussing on customers getting the right support at the right time.  She was worried about welfare advice moving to an on line platform and the removal of face to face support. 

The Strategic Director explained that information and advice services had challenging budget targets but no decision had yet been made on the provision of those services.  It was acknowledged that not all people could access on line services and a mix of provision was required.  A model was being tested and work was being undertaken with the corporate customer services centre on best practice.  Concerns had been recognised and work was being conducted with providers.

A Member suggested that the amount of support for those services had only recently been allocated to that Welfare Advice and Customer Transformation and she questioned how budget cuts  would now be managed.  In response Members were advised that the topic would be the subject of a future report to the Committee.

In response to concerns regarding the Substance Misuse Service it was reported that a supervised medication service would continue but instead of having many small contracts there would be a partnership with only one contract and people would be supported holistically.

A Member questioned if autism was a learning disability or categorised as a mental heath issue and he was advised that some autism was associated with learning difficulties; some with mental health and some with neither condition.  The referral service would provide diagnoses and the Department of Health & Wellbeing was responsible for after diagnosis care and support.  A future report was being provided at the next scheduled meeting on the assessment process.

Members raised concern that research had suggested that demand for services by people with limited ability to pay was increasing.  The health hazards of isolation and findings that loneliness was as detrimental to peoples’ health as smoking 15 cigarettes a day were discussed.  Members related examples of visits to their constituents who had no contact with other people for considerable lengths of time.  It was felt that the impact of keeping elderly people in their own homes would increase loneliness. The Director of Public Health provided assurances that the detrimental effects of social isolation were being considered.

A Member raised the impact of the Council’s Playing Pitch Strategy and reported that 12.4% of residents used outdoor space for exercise.  She was concerned that public health policies were relying on people getting more exercise and keeping healthy whilst the Playing Pitch Strategy was reducing important recreation spaces. The reduction of spaces in her ward for investment in other areas was detrimental to people who may not be able to afford facilities such as sports centres and pools and relied on playing fields for play and recreation.  She implored the Strategic Director to challenge that strategy to prevent outdoor space being taken out of communities. 

The Strategic Director acknowledged the benefits of physical activity and reported that the strategy provided investment in additional sports facilities. 

The Portfolio Holder with responsibility for Healthy People and Places addressed the meeting and explained that the Council’s Public Health Department and the Department of Place were working to encourage people to be healthy and active using the spaces available but stressed they must be good places.  Living well and encouraging older people to stay active may not necessarily include recreation grounds.  Revenue raised from the sale of assets would be invested across the district.

Resolved –

That the report be noted.

ACTION: Strategic Director, Health & Wellbeing