To approve as a correct record the minutes of the Health and Wellbeing Overview and Scrutiny Committee meeting held on 11 March 2014.

The Minutes of the Health and Well-being Overview and Scrutiny Committee, held on 11 March 2014, were approved as a correct record.

Councillor Gupta declared a non-pecuniary interest in respect of Agenda Item 6 as he was associated with a number of voluntary organisations including Thurrock CVS and the Older People’s Parliament. He also declared a non-pecuniary interest in respect to agenda item 8 as his daughter was disabled and he was a carer.

Councillor Curtis declared a non-pecuniary interest in respect to Agenda Item 6 as his daughter worked in adult social care, his wife was a member of HealthWatch and that he worked with the Citizen’s Advice Bureau.

Mr Evans declared a non-pecuniary interest in respect to agenda item 6 as he was a director of HealthWatch and Thurrock Coalition, which was related to the Thurrock Centre for Independent Living. 

Ms James declared a non-pecuniary interest in respect to agenda item 6 as she was a representative of HealthWatch.

This item is reserved to discuss any issues raised by the HealthWatch co-opted member or designated representative.

The Committee noted that there were no issues to be raised at this meeting.

The Committee noted the Equality Impact Assessment document provided by Thurrock Coalition to be considered in conjunction with this report.

The Committee learnt that the Council had to save around £37.7 million over three years. £15 million worth of savings had been identified so far but there was a budget gap still to be closed. More savings were needed and these would be brought forward to Cabinet in August and September. The budget calculations were based on a number of assumptions including that a 1% pay increase and increment awards would be given to staff and that council tax would be raised. More specifically, the adult social care budgets had not taken into account any possible additional costs caused by the forthcoming Care Act. It was assumed these would be funded by central government.

The pressures on adult social care were increasing as it was very much demand led and two thirds of the budget was spent on placements.

Members understood the savings were being made as a response to a reduction in local government grants by central government plus an increase in demand for the services. It was also discussed why the savings were only impacting on the year 2015/16 and not on future years. It was explained that the department had endeavoured to put as much savings in the first year as possible and although the savings would be made continually throughout ensuing years, they were only registered as savings when they were taken from the base budget.

Officers clarified that public consultation took the form of online surveys, taking the reports to overview and scrutiny committees but also through formal consultations like the one conducted for the meals on wheels service. The final decision on all budget items would not be taken until February 2015.

Officers stated that the department was a low spend department and to make savings they had focussed on protecting statutory duties, making savings as much as they could through improving procurement and obtaining external funding.

Efficiency in Public Health Commissioning

Councillor Gupta raised concerns that the savings made to a variety of services would decrease the effectiveness of them. Officers replied that all the services were still running and that the efficiencies made (which had reduced the duplication of work among other changes) had actually improved service delivery to residents. For example, in terms of weight management services, the money was being put into projects that provided community activities and support that reached a more diverse base of residents for longer than a twelve week programme. Officers clarified that the ‘other’ category was a sum of money reserved for any projects or issues that the community identified as needing more support. There was potential for this money to bolster one of the services which had been reviewed but officers were confident that the services were performing better and therefore would not require further funding.

Older People Voluntary Sector Contracts

Councillor Gupta felt that this saving needed to be returned to Cabinet for  ...  view the full minutes text for item 4.

The results of the consultation had shown that 70% of services users preferred the service to remain the same. 10% had preferred the option that overview and scrutiny had originally agreed to go out for consultation last municipal year. 

Councillor Gupta stated that he had visited residents in his ward who received the meals on wheels service and they were all very elderly and disabled. He felt that a change in service would have a massive impact on them and therefore, he was inclined on this evidence to keep the service the same. Officers responded that there was no guarantee that when the contract came up for renewal, the current providers would remain as this service would be subject to tender.  Under the proposed change these service users would be able to receive the same type of service. In addition, the proposed service redesign would save the council £2.75 per meal per day.

Councillor O’Keeffe-Ray highlighted that most of those receiving the service were lonely and it was important to maintain human contact with their meal delivery people.

RESOLVED:

That a combination of option 3 and 6 be presented to Cabinet for decision.

The Committee learnt that there were two residential short break services in operation in Thurrock up to April 2014. The Breakaway service was being renegotiated so that instead of the Council paying for exclusive use of three beds under a block contract, service users would be able to use a personal budget and pay Breakaway directly for the number of nights stayed at the service. An earlier negotiation with Breakaway had already achieved a 10% reduction in costs. Hathaway Road, the second service, which had also provided short break services for disabled people , would no longer be used for short breaks. This closure of the service at Hathaway Road would affect nine residents, although many were already using Breakaway as an alternative. The staff affected had already been re-deployed.

The reason for ceasing short break services at Hathaway Road was partly due to low demand.  Many disabled people and their carers preferred different forms of respite care. Many users wanted to be with their friends or go on holiday rather than stay in residential care, or receive care in their own home. HealthWatch had been involved in the review of this service and Kim James highlighted that many carers did not want to move their loved ones from their homes when they themselves went out for the day or evening or on holiday.

Included in the review of short breaks was a desire to increase the range of short break options in Thurrock, both residential and non-residential, so that people had a wider choice.

The proposed change in access to the Breakaway services from block contract to spot purchase, as well as the intended increase in short break options meant that a fair and open system for allocating time there or the amount of the personal budget should be devised. A couple of different options for this were presented in the appendix of the report. Councillor Key stated that he preferred the second system.

It was clarified that the exact savings figure was uncertain but would range between £50,000 and £65,000.

RESOLVED: That:

1.         The Committee note a wide review and initial work to develop short break options for disabled adults has now started and the results of that review will be reported back to Committee.

2.         The Committee note the decision of the Director of Adults, Health and Commissioning, in consultation with the portfolio holder, that Hathaway Road Short break Service is permanently closed.

3.         The comments on the allocation system above be noted by officers.

The Committee received a presentation on Public Health that set out to introduce the service, its roles and responsibilities as well as its current projects. The presentation took in the following key issues:

·         The health profile of Thurrock, which highlighted a higher proportion of children living in poverty, a lower female life expectancy and lower levels of statutory homelessness compared to the England average.
The challenges surrounding eating habits and levels of physical activity and the proportion of adults who smoke.

·         The key roles of health improvement, health protection and healthcare public health.

·         The provision of specific services including sexual health and contraceptive services, national child measurement programme and the NHS Health Check Programme.

·         Projects undertaken including the very successful ‘Beat the Street’ and ‘New year, New You’ Campaign.

The Director for Adults, Health and Commissioning stated that Public Health had made a major and positive impact upon the Council’s priorities since it had joined the Council.

Public Health had worked with five comparative councils to understand how they spent their money on these services. Following on from this they had consulted relevant community groups including schools and the Youth Cabinet to understand what the needs for these services were. As a result of this work, a new model of delivering school nursing and weight management was designed. In relation to school nursing, the model has met approval with the schools and nurses themselves. The changes included the nurse wearing a uniform and working in clusters to effectively provide support. Before the Council goes out to tender, officers are working with a company called Benson Model to provide detail to the contract requirements.

With regards to weight management, residents had identified the need for locally specific services and this is what will be supported. Services for very obese people would require specialist support that would be provided at a regional level.

RESOLVED that the report be noted.

RESOLVED that the impact assessments on the savings for HealthWatch, the Voluntary Sector Organisations and Supporting People be categories 3 and 4 provided at September’s meeting.