Web Agenda/Minutes Summary Document

Meeting Name:
Adult, Community Services and Health Overview and Scrutiny Panel

Meeting Date:
09/07/2009 Pick

Meeting Time:


Location:


Sub Committee / User Forum etc (if required):




Members Present:

Non-Members Present:

Confidentiality: Part I


Document Type: Agenda


Document Status: Final

COUNCILLOR MEADOWCROFT (CHAIRMAN)
COUNCILLOR MRS ENDACOTT (VICE-CHAIRMAN)
COUNCILLORS BASKERVILLE, MRS EVANS, LENTON, MAJEED, MRS NAPIER, MRS PROCTOR & MRS YONG

SUBSTITUTE MEMBERS
COUNCILLORS HERDSON, MRS KEMP, MRS LUXTON, PENFOLD & D. WILSON

ITEM	SUBJECT	WARD	PAGE NO
1	APOLOGIES FOR ABSENCE To receive any apologies for absence
2	DECLARATIONS OF INTEREST To receive Declarations of Interests from Members of the Panel in respect of any item to be considered at the meeting.		-
3	MINUTES To confirm the Part I Minutes of the meetings of the Panel held on 7 and 9 July 2009.	All	i-v & viii-xi
4	RIGHT CARE RIGHT PLACE To receive an update on the implementation of the proposals to modernise health services in East Berkshire arising from the Right Care Right Place consultation.	All	1
5	PERSONALISATION WITHIN ADULT SOCIAL CARE To consider the report being submitted to Cabinet on 28 September on the timing of implementing self-directed support and a new contribution policy.	All	2
6	SERVICE MONITORING REPORT To consider activity within the Adult, Community Services and Health services during the period to 31 July 2009.	All	8
7	WORK PROGRAMME The following items are scheduled for discussion at the meeting of the Panel to be held on 9 November 2009. Service Monitoring Report Work Programme Heatherwood Hospital Update 2010/11 Preliminary Budget Report (to be submitted to Cabinet on 22 October 2009)	All	-
8	LOCAL GOVERNMENT ACT 1972 – EXCLUSION OF THE PUBLIC To consider passing the following resolution:- “That under Section 100(A)(4) of the Local Government Act 1972, the public be excluded from the remainder of the meeting whilst discussion takes place on items 9-11 on the grounds that they involve the likely disclosure of exempt information as defined in Paragraph 3 of part I of Schedule 12A of the Act"	-	-

 Meetings 090907 Acshosp Right Care Update

Date: 24 September 2009

Member Reporting: Cllr S Dudley

Contact Officer(s): Allan Brown – 01628 683701

Wards affected: ALL

1. SUMMARY

1.1 This report requests Cabinet to reconsider recommendations on the timing of implementing self-directed support and a new contribution policy. It follows a report to Cabinet on 25th June 2009, which requested approval to undertake a limited implementation of self-directed support, and consultation on a new council policy for contributions towards the cost of non-residential care. Since agreement to this was given by Cabinet, there have been further guidelines from the Department of Health entitled ‘Fairer Contributions’ July 2009.

1.2 In addition, a recent external consultants’ review of progress on self-directed support recommended bringing forward implementation in order to maximise the benefits of the new approach for all new and existing users during 2010-11. There are also overall budget efficiencies that need addressing to ensure sufficient budget is available for prevention & re-ablement, eligible needs and personal budgets, through service subsidy and maximising income. Dept of Health (DoH) also issued in July a consultation paper on eligibility criteria, that reinforces determining ‘Fair Access Criteria’ in line with budget availability, currently critical and substantial in RBWM.

1.3 Bringing in a new contribution policy, involves changing from charging for specific services, to a fairer more equitable generic contribution policy based on a personal budget, and is fundamental to the overall success of delivering personal budgets for all service users. Revisions need to be made to the consultation and require further Cabinet approval. Currently, users receiving home care are financially assessed, older people using day services pay a flat rate charge, but mental health, disabled or learning disabled users pay no charge.

1.4 The outcome of the consultation and options for charging and mitigation will be reported for Cabinet for decision on 17 December 2009, as will progress on the implementation of self-directed support.

2. RECOMMENDATION

2.1 That the Director of Adult & Community Services be authorised to proceed with implementing self-directed support for all new users from January 2010 and to begin transferring existing users to personal budgets in June 2010.

2.2 The results of the consultation on the new council policy for contributions towards personal budgets costs of non-residential care to be reported back to cabinet in December 2009, with options for implementation.

3.1 Background

The national context and the Council’s Transforming Adult Social Care programme were described in some detail in the June report to Cabinet, and this information is still applicable.

Changes in Planned Implementation

The key difference between the recommendations within this report and the report to Cabinet on 25 June this year is in respect of the phasing of existing services users into self directed support. As the phasing proposals feature in the consultation documents for the new contribution policy then these consultation documents will also need to be updated. Under the current recommendation it is considered that the benefits of SDS to both service users and the Council can be accelerated by bringing existing service users into the programme from April 2010 rather than delaying this for over a year. This change arises following an external review by a consultant of the RBWM transforming adult social care programme, following which the Programme Board have recommended bringing forward implementation.

Implementation Issues

There had been concerns about having appropriate processes in place for determining resource allocations. Since then several Berkshire and other authorities and PCTs have taken a DoH tested model called ‘FACE’ (Functional Analysis of Care Environments) which is a suite of computer-based tools that allocates needs to resources with a clear audit framework. FACE is the country’s leading supplier of assessment tools to health and social care. Consideration will be given to procuring FACE or another suitable resource allocation tool. One benefit of such a procurement will be to lessen the risk that the failure to develop an “in-house” system would delay the implementation of SDS and therefore give greater confidence that an earlier implementation is achievable.

3.1 4 Changes to the contribution and charging policy

The proposed new contribution policy was given as an Appendix to the June report to Cabinet. The policy has not since changed, but following the issue of updated guidance on fairer charging by DoH, the draft policy has been assessed for conformity with the new guidelines with particular regard to meeting the needs of people with disabilities.

The new contribution policy involves changing from charging for specific services, to a fairer more equitable generic contribution policy based on a personal budget. This is fundamental to the overall success of delivering personal budgets for all service users. Currently, users receiving home care are financially assessed, older people using day services pay a flat rate charge, but mental health, disabled or learning disabled users pay no charge for daycare. Currently service users assessed under S117 of the Mental Health Act may not be charged to contribute towards their services, this will not change.

3.1.5 What will the changes in the contribution policy mean?

Councils have discretion as to whether to provide free or subsidised services. RBWM currently has charges for some, not all services, and not for all service users. The new policy will have a different impact on different users of services. The DoH guidance recognises councils will want to consider no longer providing free or subsidised services. It expects councils to ensure, where there is a charge, that individuals are not expected to make unreasonable contributions or contributions which are not reasonably practicable for them to pay. The current charging policy is based on this principle as will be the new contribution policy. A full Equality Impact Assessment will be completed to assess the impact, and what, if any, mitigation might be needed.

3.1.6 What will the charges be?

The Fairer Charging Guidance still applies whereby a users net income should not be reduced below levels set out in the guidance. This restates that regard should be paid to the effect of any charge on a users net income, which should not be reduced below basic Income Support or Pension Credit, plus 25%. Some users will continue to have no charge. Local policy on disability related expenditure should be consistent with the Fairer Charging Guidance, which requires taking account of additional expenditure because of an individual’s expenditure.

3.1.7 What will the impact be?

Policy changes are required to take account of Disability Impact, Human Rights and Equality issues. An initial EQIA indicates there will be an impact on those who currently pay no charge for services. As part of the consultation, consideration will be given to what the impact might be on individuals or groups of individuals who do not currently make a contribution towards their service in order to ensure Disability Discrimination duties are addressed.

3.1.8 Fair Access to Care Eligibility

The development of Transforming Social Care has to be set alongside resources available. The DoH consultation paper July 2009 ‘Prioritising need in the context of Putting People First’ reinforces the expectation that prevention and well-being are prioritised, as well as offering advice and support to those able to fund their own services, as is the case in the Council. The Transformation Programme Board is looking at ways of improving and maximising input from universal services such as Leisure and Libraries, as well as utilising the Social Care Reform Grant, and reshaping existing resources, such as increasing the capacity of reablement services to improve individuals functioning to prevent the need for high level and high cost services. This will form part of overall efficiency savings to ensure the overall budget for care is targeted at those in most need.

4. OPTIONS AVAILABLE AND RISK ASSESSMENT

4.1 Options

	Option	Comments	Financial Implications
	1. Maintain the planned progressive roll-out of personal budgets per June report to Cabinet on this subject, with an initial live implementation on 1st December 2009.	The full benefits of personalisation are not available for all service users, or for the Council, for several years. This view is supported by the recommendations of an external consultant.	Revenue As anticipated efficiencies arising from improved commissioning arrangements under self directed support will occur over several years, potential savings of over £0.5m over the period may not be achieved. Capital – none.
	2. Commence live implementation on 1st January 2010 with an accelerated roll-out programme during 2010-11.	This option enables officers to prepare adequately for the live implementation and delivers the benefits or personalisation more quickly than previously planned. This is the recommended option.	Revenue Under this option over £0.5m additional savings from more effective commissioning are anticipated. Capital - none

There is a risk that the process of self-directed support will not enable citizens to achieve their outcomes and that they will therefore be dissatisfied with the Council’s service to them. This risk will be managed by thorough preparation and testing, including learning from the experience of the 13 local authorities that were selected by government as early adopters in 2007, and by opting for a limited scale implementation in which any service shortfalls may be quickly remedied and procedures subsequently refined.

There is a risk that the process by which personal budgets are calculated could generate in aggregate a sum that exceeds the current Adult Services care budget, creating a financial pressure. This risk will be managed by allocating a sum of money to the Resource Allocation System (RAS - the pool of money available to be disbursed in personal budgets and the method of personal budget calculation within that) that represents the current Adult Services care budget less a sum that will enable incorrect individual allocations and any unforeseen contingencies to be dealt with.

There is a risk that citizens will spend their personal budgets on inappropriate services that will not meet their needs, with a consequent safeguarding risk, and which may also represent a misuse of public funds due to irresponsible or fraudulent behaviour. This risk will be managed by a number of checks and approval steps built into the self-directed support process, in which risk indicators may result in the council insisting that a person’s budget be managed on his or her behalf rather than being issued as a cash payment. Regular reviews of outcomes, the frequency of which will be at the council’s discretion, will enable care workers to identify inappropriate use of funds and take corrective action.

There is a risk that the price of some care services will increase as a result of individuals commissioning their own care, and therefore the authority no longer being in a position to enter into long-term block contracts with providers. New commissioning strategies focusing on, for example, framework agreements are being planned in order to mitigate this risk. In this way the council intends to lead the development of new services and associated markets.

There is a risk that the introduction of personal budgets, and the greater choice of service that these will offer, may result in an increase in the number of people coming forward to request assessment of need. Experience from early adopting authorities suggests that ethnic minority communities in particular will accept publicly funded care if enabled to direct their own package of support. The allocation of funds through the resource allocation system will be made in recognition of this risk.

5. CONSULTATIONS CARRIED OUT

5.1 This report requests approval to carry out consultation on a new contribution policy as described above, and in accordance with the DoH ‘Fairer Charging’ and ‘Fairer Contribution’ Guidance.

6. COMMENTS FROM THE OVERVIEW AND SCRUTINY PANEL

Overview and Scrutiny Panel meets on September 7^th and comments will be reported back to Cabinet.

7. IMPLICATIONS

The following implications have been addressed where indicated below.

	Legal	Finance	Planning	Property	Procurement	DMT
Name:	ü	ü		N/A	N/A	ü
Date Approved:	26/8	26/8	N/A

	Directors Group	Lead Member	Ward Cllrs (if Appropriate)	Leader’s Office	Scrutiny Panel
Name:
Date Approved:	26/8

Date: 27 August 2009

Member Reporting: Councillor Kellaway

Contact Officer(s): Andrew Brooker, Head of Finance, x6341

Wards affected: All

1. SUMMARY

1.1 This report reviews the exceptional movements in the Royal Borough’s spending plans. Directors report their relative performance separately and this area will develop further over the forthcoming months.

1.2 A mechanism to take known savings into reserves was introduced to help support future years Council Taxes. There are, however, some anticipated additional costs which managers are asked to reduce.

1.3 It is however acknowledged that the recession is having an impact on Car Park revenue and Cabinet is being asked to allocate £100k of the Economic Contingency Reserve, set up for that purpose, to compensate the Environmental Services budget for that loss of revenue.

1.4 The revised end of year General reserves balances are expected to be £4.008m with a total of £1.956m being held in Contingency Reserves.

1.5 There has been some slippage of the capital programme into 2010/11 but the remaining schemes remain on target for 2009-10.

2. RECOMMENDATION: That:

i) This month’s movements, £910k, in the revenue budget contained in paragraph 3.2 be approved.

ii) The provisional revenue and capital outturn figures be noted.

ii) It be agreed that £22k of the Area Based Grant be used towards climate change and £10k towards training for teachers, detailed in 3.2.

iii) That Directors work with Lead members to develop proposals to contain expenditure within current budget limits.

3. SUPPORTING INFORMATION

3.1 Budget Movements

3.2 There have been a number of budget movements since the 1^st April 2009. These are summarised below:

		£'000
	Original Budget	87,081
1	Changes Approved up to July Cabinet	208
	Changes Recommended for August Cabinet
2	Pension contribution on redundancy - Education services	78
3	Employment panel decision re. restructure	24
4	New Area-based grant from DSCF for training for teachers (in order for designated teachers to fulfil their responsibilities effectively) *	10
5	LPSA reward money *	255
6	PPG (LAA) money *	537
7	Software for Exchequer Services	19
8	Climate change grant (for implementing the planning policy statement on climate change and undertaking an impact assessment)	22
9	Other	4
	Reductions to support future years Council Tax
10	New home to school transport contracts *	(139)
	Allocation from Economic Contingency Reserve
11	Compensation for loss of Car Park revenue *	100
	Total changes for August Cabinet	910
	New Service Expenditure Budget	88,199

* Note 4, 5, 6, 10 & 11 are movements in Earmarked Reserves

3.3 A new process was introduced last month to identify and extract savings that could be used to support future years council tax levels. Where there is a distinct saving the current years budget is reduced and the consequential saving diverted to a separate contingency fund. This month a net total of £39k was set aside.

3.4 Where savings are uncertain this is noted on the revenue summary and kept under review for a period of time (typically three months). If, during that time, it is clear that there is indeed a definite saving the agreed sum is extracted to the contingency fund.

3.5 The latest information on pay awards indicates that a 1% increase is more likely than the 0.5% previously reported. Anticipated savings have therefore been reduced by £110k to 390k. The sum to be transferred to the economic contingency reserve has been reduced accordingly.

3.6 Current Estimated Outturn

Directors have reassessed their anticipated spend based on current activity and costs are expected to be £0.917m greater than the approved estimate. Each Director has summarised their service pressures in Appendix A. However the key pressures and savings arise from:

Children’s Services - Safeguarding Children +£695k. Mainly related to increasing numbers of children in care (reflecting the national trend) and the high cost of agency social workers.
Adult & Community Services - Adult Social Care -£205k, mainly relating to demographic changes

Environmental Services. Reduced car parking income, mainly in Maidenhead car parks has been attributed to current economic conditions. An allocation of £100k from the Economic Contingency Reserve has been made accordingly.

General Reserves are expected to stand at £4.008m. Including the contingency reserves, the overall reserves position is therefore £5.964m. This compares favourably with the £4.53m minimum level recommended in the February Budget Report to Council.

5. CAPITAL

5.1 Capital Budget Movements

The approved 2009-10 capital budget as at 30^th June was £57,465k gross which is £1,982k higher than last month (£55,483k), explained mainly by LSC funding for Charters £1,791k and S106 funding for Ascot United Football Club £120k.
Exp Inc Net
£'000 £'000 £'000
Approved Budget July 2009 57,465 -46,171 11,294
Variances identified (512) 0 (512)
Slippage to 2010/11 (1,602) 1,432 (170)
Projected capital programme 2009/2010 55,351 -44,739 10,612
Appendix C contains the details of the variances reported in July 2009

Additional slippage identified in July 2009 relates to Maidenhead Station Transport Hub (£45k), Maidenhead Environmental Improvements (£65k) and Windsor Dials Conversion to Pay and Display (£60k).

5.2 Overall Programme Status

The project statistics show the following position as at the end of July 2009:

Number of Schemes in Programme 482
Yet to Start 10%
In Progress 67%
(Of which Ongoing Annual Programmes 10%
e.g. Disabled Facilities Grant)
Completed 8%
Devolved Formula Capital Grant schemes 15%

6. OPTIONS AVAILABLE AND RISK ASSESSMENT

6.1 Options

	Option	Comments	Financial Implications
	1. Accept the report	Directors have a responsibility for managing their Services within the Budget approved by Council. Cabinet has limited power to vary those budgets within the overall budget and policy framework or to re-define the priorities agreed when the budget was approved. Cabinet does however have responsibility for considering the impact on future year’s budgets of the decisions taken.	Revenue Capital
	2. Reject the report	This is not an option as The Local Government Act 2003 requires the Royal Borough to monitor its financial position	Revenue Capital

Risk assessments are carried out as a matter of course for the delivery of individual services. The main Financial risks are included on the Council’s Risk Register. The removal of budget from Directors reduces their flexibility when cost pressures arise during the year. In mitigation, where manager are unable to contain costs within revised budget provisions they can bid against the contingency pool containing the budget reduction.

The Councils Financial Strategy outlines the measures available to it in the event of a series of events that lead to significant projected budget variances being reported.

7. CONSULTATIONS CARRIED OUT

No specific consultation is carried out as this is a regular monitoring report

8. COMMENTS FROM THE OVERVIEW AND SCRUTINY PANEL

Relevant components of this report will be considered by each of the four scrutiny panels as part of their next round of meetings.

IMPLICATIONS

9. The following implications have been addressed where indicated below.

 Meetings 090907 Acshosp Service Monitoring Appx1

 Meetings 090907 Acshosp Service Monitoring Appx2

 Meetings 090907 Acshosp Service Monitoring Appx3

 Meetings 090907 Acshosp Service Monitoring Appx4