Agenda and minutes

18.1     RESOLVED to agree the minutes.

19.2     Apologies were received from Cllr Enever. Cllr Galley substituted.

Disclosures by all members present of personal interests in matters on the agenda, the nature of any interest and whether the member regards the interest as prejudicial under the terms of the Code of Conduct.

20.1     Cllr Webb declared a personal, non-prejudicial interest as an unpaid co-ordinator for the Many Voices project in Hastings.

Notification of items which the Chair considers to be urgent and proposes to take at the appropriate part of the agenda. Any members who wish to raise urgent items are asked, wherever possible, to notify the Chair before the start of the meeting. In so doing, they must state the special circumstances which they consider justify the matter being considered urgent.

21.1     There were none.

The latest edition of the Forward Plan.The Committee is asked to make comments or request further information.

22.2     The Director of Adult Social Care and Health advised that items on Strengthening the East Sussex Better Together (ESBT) Alliance Arrangements (Cabinet) and Older People’s Day Opportunities Strategy (Lead Member for Adult Social Care and Health) had been deferred to the new year to enable further information to be taken into account. It was noted that opportunities for the ESBT Scrutiny Board and the Scrutiny Committee to scrutinise these items prior to decision would also be rearranged.

22.2     RESOLVED to note the Forward Plan.

23.1     The Chair invited the committee to engage in an exploratory discussion on the topic of prevention, based around issues outlined in the report. The following key points were raised in the discussion:

·         The importance of an evidence-based approach to identifying where best to invest to get a return in terms of outcomes and cost. This approach involves: a good understanding of need via sources like the Joint Strategic Needs Assessment (JSNA); understanding current performance e.g. through benchmarking with other areas; and awareness of best practice such as targeted NHS initiatives. Much of this work is supported by Public Health. This range of information enables decisions to be made about priorities, particularly in relation to health inequalities, areas of poor performance, or the needs of our type of population. From this, service specifications are developed which are now more outcomes focused, and services commissioned from the NHS, or from the third sector via the Commissioning Grants Prospectus. Services are then monitored and evaluated with this information feeding back into the loop.

·         The challenge of investing in prevention in a climate of financial constraint and increasing demand for reactive services. A particular challenge is the long-term nature of some preventative work which will not provide a payback for many years. However, the risk of focusing spending on current demand rather than prevention is that longer term demand will increase even further, storing up additional problems for the future. The payback period for prevention has always been an issue for the NHS which has predominantly remained a reactive, demand-led service. It is difficult to double-run services and there is a lack of money to invest in longer term prevention.

·         The importance of partnership working across agencies on prevention and the role of specialist vs mainstream services. Thresholds are in place for referral to certain specialist services, such as support to families, so that resources are focused where need is highest. At a lower level preventative work is built into mainstream services via the ‘Making Every Contact Count’ approach which prompts staff in frontline services to use contacts with patients/clients to provide information or advice on other services or lifestyle issues. If a case becomes more complex or there is a lack of engagement staff have the option to refer to Health and Social Care Connect.

·         Risks related to the ringfencing of the Public Health grant to local authorities. If the current ringfence (which runs to 2018/19) is not extended there is a risk to Councils’ ability to maintain investment in preventative services due to pressures on other parts of the Council to meet statutory duties. The grant includes allocations for drug and alcohol misuse and for smoking cessation. The Public Health grant has seen reductions in recent years but these have been smaller than the overall reductions to the County Council budget and have been managed by recommissioning or re-specifying services.

·         Whether prevention can be viewed as an ‘invest to save’ approach or whether, by  extending life expectancy and quality  ...  view the full minutes text for item 23.

24.1     The Strategic Commissioning Manager (Mental Health) introduced the report, providing the following additional information:

·         The Phase 1 services have been rolled into one contract to reduce overheads. The Wellbeing Centres already existed and there was a desire to continue these in an integrated way with new services.

·         The Personality Disorder Service will operate six days a week and will be fully operational by mid-December 2017.

·         The Crisis Cafes will open until 11pm each day and will link to other available services. The first café will open in Hastings and the model will then roll out to Eastbourne, with both aiming to be fully operational by Christmas 2017.

·         East Sussex was an early adopter of supported employment which has been operational locally for 10 years. The local model is seen as best practice and helps around 200 people with long term mental health conditions back into work annually. The service works closely with crisis teams to help people retain employment.

·         The Community Connector service is new but developed from two previous services. It aims to link people into mainstream services with support. The social prescribing aspect has been piloted in relation to welfare debt, housing, social and other support and saw a 60% reduction in people accessing GP appointments. The Community Connector service will target GP practices with high users of service.

·         The ‘hard to engage’ service has traditionally been provided by Seaview – it aims to build trust with service users and supports access to other services.

24.2     Further points were made in response to questions from the committee as follows:

·         Services expect to be supporting people with multiple needs and will link into drug and alcohol services.

·         The Personality Disorder Service target of engaging with 75 clients per year is linked to the available resource but also how services are being used at the moment. There is currently high use of specialist services by the target group, with poor outcomes, and the new service has been set clear outcomes for clients which are also linked to the impact on other services. There will be wider benefits to a larger group of clients through building the personality disorder expertise of the less specialist services.

·         The Crisis Cafes will operate until 11pm, seven days a week. There is expected to be a consequent reduction in instances of crisis and reduced impact on other services like A&E.

·         The expectation for the Employment Support Service of engaging with 500 clients reflects the total number the service works with each year. This results in 200 (40%) going into employment which is in line with the target. This 40% are able to move away from services and rehabilitate in a different way in the community. The other 300 clients still get positive outcomes from their engagement such as opportunities for voluntary work.

·         The newly commissioned services are funded in large part by different use of established budgets. The new services (Personality Disorder Service, Crisis Cafés and social prescribing) are all Clinical Commissioning Group  ...  view the full minutes text for item 24.

25.1     The committee considered a report on the Reconciling Policy, Performance and Resources (RPPR) process which provided an update on proposed savings plans for 2018/19 and areas of search for savings in 2019/20 and 2020/21.

25.2     The following points were made in response to questions from the committee:

·         The latest position in relation to the ESCC contribution to the East Sussex Better Together (ESBT) Strategic Investment Plan (SIP) will be reported  through quarter 2 monitoring and the budget for 2018/19 determined through the usual RPPR process.

·         The Adult Social Care outturn is currently projected to be a £1.1M overspend but it is expected that this will move closer to balance as the year progresses.

·         The overall ESBT situation is affected by limited ability to move costs out of the acute sector quickly enough. The local NHS will overspend but is subject to a different financial and regulatory regime. It is expected that the NHS position will be released over the next month in line with their national timetable.

·         More detail on the impact of proposed savings for 2018/19 will be available in time for the committee’s RPPR Board meeting in December. This meeting will also be able to look at any impact on Adult Social Care from the NHS position.

·         The savings requirement is calculated based on the overall budget, existing commitments, inflation and demographic pressures. As reflected in the earlier discussion on prevention, there will be choices around balancing services that support people in a preventative way versus the increasing emphasis on meeting statutory need. These choices will have an impact on demand in the future.

·         The longer term areas of search for savings would see substantial impact on preventative services. The proposed areas are based on the expected loss of specific government grants but a longer term social care funding solution is awaited. The government proposals on social care have been delayed to spring 2018 and it is not expected that a new system would be in place until 19/20 onwards at the earliest.

·         The Department has sought to minimise the impact of savings on services for vulnerable people such as Supporting People and refuges, but there are inevitably impacts from the significant cumulative savings which have been required over several years. Supporting People services still have a significant impact but, given their preventative nature, it is necessary to look at these services in terms of savings and be clear and open about what can be provided in future.

·         Statutory services to meet critical and substantial need can’t be cut but decisions have previously been taken to scale back care packages. It is not proposed to pursue this approach further due to the impact on meeting core needs. This means that other services must be targeted for savings.

·         In relation to community safety there is discussion underway with the Police and Crime Commissioner with regard to commissioning on a Sussex-wide basis as opposed to grant funding to local partnerships. This has the potential to offer economies of scale  ...  view the full minutes text for item 25.

26.1     The committee considered its future work programme and agreed to make the following amendments:

·         To hold a Scrutiny Board in February, in advance of the Lead Member decision on Older People’s Day Opportunities Strategy, to which all Members would be invited.

·         To explore the possibility of visiting an older people’s day service in advance of considering the Day Opportunities Strategy.

·         To add the table-top review on co-ordination of preventative work to the work programme.

·         To add an exploratory discussion on the theme of ‘integration’ to the agenda for March 2017.

·         To add the Care Quality Commission review of the East Sussex health and care system as a potential item for scrutiny, depending on the outcomes of the review.

·         To explore the possibility of visiting a Wellbeing Centre as a precursor to the April 2019 follow-up report on commissioned community mental health services.

26.2     RESOLVED to amend the work programme as outlined above.