Agenda item

16.1     In response to a request from the committee, the Director of Adult Social Care and Health provided some additional context for the report as follows:

·         Differing approaches are being taken in the ESBT area and the C4You area:

o   ESBT has a Strategic Investment Plan covering the total health and social care budget of c£864m. ESCC remains responsible for its share but budgets are fully aligned and there is a joint plan for making savings across the budget, based on reducing demand into acute care. This has meant that the NHS budget mitigates the impact of budget reductions in Adult Social Care as investment in social care reduces demand on more costly NHS services.

o   There have been discussions about aligning budgets in a similar way in the C4You area but High Weald Lewes Havens (HWLH) Clinical Commissioning Group (CCG) is currently taking a different approach based on aligning budgets with other CCGs. This means the Adult Social Care budget will continue to be set in a more traditional way in the HWLH area.

·         There has been a £27.8m savings requirement in Adult Social Care over three years (from 16/17). ESBT funding and additional Better Care Fund (BCF) money offset the level of savings required significantly in the current year (2017/18).

·         The original announcement of additional BCF monies indicated it was to be used in three ways: 1) to meet need; 2) to stabilise the market (hence fee increases); 3) to develop health and social care integration.

·         Delayed BCF planning guidance issued in July shifted the focus towards reducing Delayed Transfers of Care (DTOCs) and related performance indicators. Extremely challenging targets have been set for each local authority area. These changes led to the Local Government Association withdrawing support for the BCF guidance.

·         DTOC targets are based on the number of days of delay in hospital per 100,000 population. In East Sussex the NHS will be expected to reduce health related delays from 14.8 to 7.2 (i.e. c50% improvement). The social care delays starting point was 7.8 with an expectation to reduce to 2.9.

·         Local areas were required to submit a plan for using the BCF funding by 11 September and plans will be subject to an assurance process by October. Locally the impact of changes in direction has been well managed due to the existing partnerships in place, particularly in relation to ESBT as support for social care was already in the jointly agreed plan.

·         The DTOC target covers the whole year but there will be a review of progress in November based on the current trajectory. There have been suggestions that if the trajectory is not being met there will be some risk to local authority funding. However, a reduction in funding is likely to worsen the situation in areas not meeting the target.

·         The focus on DTOCs is linked to expectations of a very challenging winter for the NHS and social care. Part of the NHS Winter Plan is to reduce hospital bed occupancy to 85% by November and to hold this level through to March, something which has not been achieved in the past.

·         In terms of outlook, the 2018/19 position is sustainable due to the extra BCF funding but the department will continue to seek further efficiencies and savings to free up resource for front-line care.

·         A more significant issue is how to plan for 2019/20 without making long term commitments in the absence of a clear picture of longer term funding.

16.3     RESOLVED:

(1)  To receive a further update on proposed savings, including an update on the BCF, in November 2017.

(2)  To include previous reports on the impact of savings as appendices to the November RPPR report.

(3)  To establish an RPPR Board comprising all Members of the committee to meet on 21 December at 10am to consider the developing portfolio plans and savings proposals and to submit scrutiny’s final comments to Cabinet in January 2018.