To receive a verbal update.

Lynne Lidster, Head of Commissioning, gave a presentation to the panel on adult social care reform with the intention that Members could have more detailed briefings in the future.

The Government had published several White Papers in the previous nine months relating to adult social care which set out an ambitious agenda for change. The Health and Care Act had received Royal Assent, and had four main areas of focus:

-          Integration

-          Assurance/Inspection

-          Charging reforms

-          Market sustainability and fair cost of care

Lynne Lidster described how the Health and Care Act would impact the borough by creating Integrated Care Boards and Integrated Care Partnerships in each local area. The Health and Care Act proposed to reform charging for adult social care, including market sustainability and setting a fair cost for care. The current system was means and needs tested with many people paying for their care from their assets. If people were not eligible for publicly funded care, there was no limit on how much they might have to pay privately. The proposals would make the means test more generous and would set a ‘cap’ on the amount an individual would pay for care in their lifetime.

Councillor Baskerville thanked Lynne Lidster for the presentation and asked whether integration would include computer systems, as there was a frequent lack of communication between services which could lead to frustration. Councillor Baskerville also stated that he would appreciate simplified language as the jargon used in presentations and reports would be hard for an average layman to understand.

Kevin McDaniel, Executive Director of Children’s Services, explained that the term integration was used to mean all partners working together. Computer systems working together was not a requirement, but national work was ongoing on creating a single health record, but work had been ongoing for a number of years and was not yet complete. 

Lynne Lidster added that there was a system known as Connected Care in place which contained information on an individual which several services could access- for example, an A&E department would be able to access GP and adult social care records.

Councillor Story thanked Lynne Lidster for the presentation and asked which costs would not be covered under the lifetime cap on care costs of £86,000. Councillor Story also asked how much this would cost the council.

Lynne Lidster responded that costs such as food and drink were not covered under the cap. Additionally, anyone wishing to go to a more luxurious care home would have to cover the difference.

Kevin McDaniel stated that the figure of how much this would cost the council was unknown, as it was difficult to assess the future needs of the population. National work was ongoing to determine the value of this project, but this would be difficult to ascertain. The borough had sent feedback to the government, asking them to use a different formula which took into account the number of care home spaces, as the relative needs formula would be less accurate.

Councillor Del Campo asked when the funding changes would take effect and when the financial implications would be known prior to this date. Councillor Del Campo also stated that it may be worth considering restoring or increasing funding to voluntary organisations that provide support and early intervention in order to decrease the burden on the council.

Lynne Lidster responded that people could start progressing towards this cap on 1 October 2023, with any care paid for before this date not counting towards the cap. Additional funding would be provided to the borough.

Kevin McDaniel stated that the group known as the Integrated Care Partnership, formed of public sector partners and communities needed to set up a strategy that would outline the role that everyone would play, with the intention of enabling health colleagues to divert funds towards this early intervention.

Councillor Carole Da Costa stated that she was happy that CQC inspections were being introduced as she believed that these should have been implemented a long time ago. Councillor Carole Da Costa expressed that it was difficult for a person to go onto continuing NHS care and asked whether closer collaboration would make this process easier to navigate.

Lynne Lidster responded that she was not aware of any changes to continuing healthcare that would come as a result of the Health and Care Act. However, it was within the gift of local authorities and health partners to pool budgets around continuing healthcare, so the partnership approach may bring this conversation to the surface.

Councillor Carole Da Costa replied that she would have hoped that it would be a little easier and less stressful as a result of closer collaboration. Councillor Carole Da Costa also asked if individuals would be moved if they were unable to afford the changes in costs.

Lynne Lidster replied stating that this process doesn’t always involve social care as the individual may be self-funded. Lynne Lidster also stated that she was unable to say whether an individual would be moved or not.

Kevin McDaniel stated that the details of what the Health and Care Act would look like in practice still needed to be determined. There was a debate to be held on balancing the needs and the well-being of the individuals and the balancing of the budgets.

Councillor Tisi asked if the food and drink side of the costs was means tested. Councillor Tisi also asked if the cost cap date of 1 October 2023 would apply to everyone regardless of how much they had already paid.

Lynne Lidster confirmed that everything was means tested, and anyone with less than £100,000 would not pay for the cost of their care. Lynne Lidster also stated that the cost cap date was the same for everybody, with any money paid up until this date not contributing towards the total cost cap.

Councillor Tisi asked whether these people would be more likely to go below the £100,000 figure as they had already been paying for their care, and if so, how many people this was likely to include.

Lynne Lidster stated that the borough knew the number of people funding their own care, but they did not know how much money they had in the bank as this was a private matter. There may have been national modelling on average savings when entering a care home.

Councillor Clarke welcomed the closer integration of the services discussed and emphasised how complex the system was in its current form and how difficult it would be to implement the closer integration.

Councillor Carole Da Costa asked how out of borough residents in care would be funded if they exceeded the cost cap and whether this would be funded by the borough or the resident’s home borough.

Lynne Lidster stated that they were currently awaiting guidance on this issue and had expressed their thoughts on what should happen. The current rules were that if an individual had placed themselves in a care home in the borough from an outside borough, the local authority where the care home is situated would provide funding. In the consultation, Lynne Lidster suggested that if a resident in one borough wanted to enter a care home in another borough, they should register with their local authority in order to open a care account, but the consultation document had suggested that the government would not change the current rules.

Councillor Knowles asked if the closer integration of services would lead to decreased pressure on ambulances and hospitals as patients would be able to move out of hospital and into care. 

Lynne Lidster responded that this wasn’t a particularly big issue within the borough as there were joint teams at hospitals on a daily basis made up of hospital staff and social care staff working to bring people out of hospital.

Councillor Knowles also asked what a key success would look like for this closer integration.

Lynne Lidster stated that prevention would be a great indicator of success and best for residents, encompassing the ability to work holistically across adult social care and different partners.

Kevin McDaniel added that getting patients out of hospital and back to their own homes and living independently would be the ultimate measure of success as it would lead to a better value of life for the individual and would allow the system to be self-supporting.

The panel noted the presentation.