5.1 The Chair introduced Susanna White: Strategic Director of Health and Community Services. She went through the presentation tabled at the meeting.
5.2 The strategic director first outlined the national picture, and explained the budgetary pressures caused by the recent banking crisis. This has led to a large reduction in the council’s overall budget and a hold on NHS spend. There is a national move to towards more choice and control. The U.K has an aging population and a rise dementia. This is an era of long term conditions and one of the challenges to redesigning the health and care system around this. Recently there have been to two big scandals in the care of older people and people with learning disabilities.
5.3 The strategic director than turned to the local context and explained that there are extreme pressures on the budget from young disabled people moving into adult services; there are about 40 people moving into the system each year adding about £2million to the budget. One way of providing better and cheaper care is to move towards more community care and less residential care but finding appropriate premises is a challenge in Southwark. Adult social care intends to put more emphasis on reenablement and this become a bigger service.
5.4 Southwark Council will need to make saving of around 25% of its budget, and is also set to lose significant grants. Adult social care is 30% of council spend. However NHS money is coming in to the council. There will be £4.5 million plus £900,000 for reenablement.
5.5 The strategic director commented that the overall reduction in spend will be mean it is impossible for this not to impact on care. The council will need to find savings of £7.7 million this financial year (11/12). She reported that in the face of reduced budgets and increased demand the council need to provide more advice and support, rather than do so much. There will be cuts to day-care and lunch clubs. Delivering care within the council’s budget, while maintaining quality, will be a challenge, and the strategic director welcomed advice from the committee.
5.6 The chair requested an update on Southwark’s Southern Cross care homes, which are part of failing national chain own by private equity. The strategic director reported that Southern Cross operate three care homes in Southwark, and all have lease back arrangements with their respective landlords; which Southern Cross reports they can no longer afford. NHP, also a private equity vehicle, owns two of the homes. They are trying to renegotiate their arrangements with this landlord.
5.7 The strategic director explained that the council have contingencies if these care homes fail, however Southern Cross have an effective monopoly on nursing homes. The emphasis will be on people staying where they are and finding a way to run these homes. The other alternative is hospital. If the landlord was to ask them to go then we would work with health colleagues; however we hope it does not come to this.
5.8 A member of the committee asked if there had been a precedent to the £7.7 million reduction in the adult care budget. The strategic director responded that there had not been in her memory.
5.9 A member asked if the council had made a submission to the Dilnot Commission review. The strategic director undertook to find out and report back to the committee. Cllr Noakes reported that a submission had been made on the Big Care debate. [Following the meeting the Strategic Director reported that no submission to the Dilnot commission had been made by the council].
5.10 The strategic director was asked about progress on personalisation and the introduction of personal budgets. It was reported that the council is on target; a special project has been set up and all voluntary day centre users, who are eligible for care, will receive a budget. Some people are choosing self directed budgets rather than personal budgets as many older people prefer this arrangement.
5.11 A member asked about preserving quality and the strategic director commented that it is very difficult situation, sometimes there will be a decrease in quantity but they are aiming to not to reduce quality. A member voiced concerns about the impact on staff and that many people comment on the importance of the social aspect of care provision.
5.12 The strategic director was asked about her particular concerns and she responded that she is concerned about care in people’s homes. The council has moved to having equity in payment to providers, and we now have only two providers. Recipients of care packages were given a choice of using their personal budgets to stay with their current providers. Quality of services in peoples' homes is a national issue. Southwark is trying to be fair and have equal relationships across providers, while monitoring care regularly. However there is not always a clear relationship between price and quality; substantial sums were spent on Winterbourne View.
5.13 A member asked about contracts and any steps that the council takes to ensue that care workers are not hard done by. The strategic director reported that the council does not take a role between the providers and their employees, as long as they are lawful. A further question was asked about contracting criteria that the council sets and the strategic director stated that the council looks at quality, but not the relationship with employees.
5.14 The strategic director was asked about day-care services for mental health service users and she explained that Southwark has 6 centres, while other boroughs have far fewer providers. This situation is being looked at as an opportunity to release money that can then go into personal budgets. The council has been working with SlaM to see how resources can be better shared.
5.15 A member asked if sheltered housing was being used by normal, younger people. The strategic director undertook to find out more and report back to the committee. [This paper is circulated with the minutes]
5.16 The chair spoke about the growing number of people with complex needs and asked the strategic director to elaborate on some of the challenges. She responded that her presentation had touched on the younger cohort of disabled people with complex needs entering the adult care system each year. This is a caused by a number of factors including the fact that more children are surviving as premature babies, and so is linked to improvements to in medical care. Alongside this many people with learning difficulties are living longer, fuller lives and need care as they grow older. Other conditions are also on the rise, including autism, and there has also been an increase in challenging behaviour. The adult care team has started a new programme working with 14 – 23 years, to prevent the adverse effects of what can be a funding fall off, and also in recognition that maturity can come at a later stage.
5.17 A member asked about performance of the Care Quality Commission (CQC). The strategic director commented that the committee needs to be aware that it is facing major cuts. There is an issue of risk management that the council needs to manage. Alongside that we are looking at a changing relationship between the council and citizen; people will need to take more control of their own lives. The council role is moving more towards providing advice and enabling.
5.18 A member asked about the role of the council in monitoring providers and the role of training. The strategic director responded that they are not monitoring training directly but they are involved in monitoring quality.
5.19 The strategic director ended by saying that there will be a change in what the council can deliver, given its reduced resources, and therefore the type of support the council gives will be altering. For example rather than day services the council is looking to release money for personal budgets. However the strategic director emphasised that this can’t be an abrupt change of culture. The council is facilitating conversations with services users, staff and providers, but there are no simple answers.
RESOLVED