Agenda and minutes

Members are reminded that at the start of the meeting they should declare any known interests in any matter to be considered, and also during the meeting if it becomes apparent that they have an interest in the matters being discussed.

 There were no declarations of interest.

To receive the minutes of the meeting held on 6^th July 2010

Resolved – That the minutes of the meeting held on 6^th July 2010 be accepted as a correct record. 

Matters Arising

Stephen Clinch provided the Board with an explanation of why the Council uses cash-accounting principles rather than accruals based procedure.

Stephen Clinch submitted a report concerning the 2010/11 financial position of the Swindon Mental Health Pooled Budget as at 31^st July 2010. At the end of July 2010, the forecast position on the Mental Health Pooled Budget was a forecast overspend of £0.328m based on existing commitments, with the key pressure being from demand on the community care budget. These pressures have resulted in identified actions, which will be delivered through the joint specialist health and community care placement panel.

A review of budgets and re-prioritisation of resources within Adult Social Care, as part of the 2010/11 budget resulted in a net reduction in funding to the Mental Health Pooled Budget of £0.250m, which resulted in funding falling from £6.470m to £6.220m.

The community care budgets total £4.874m and are managed within AWP on behalf of Swindon Borough Council.  The forecast overspend has risen from £0.200m in May 2010 to £0.241m in July 2010.

The Board expressed their disappointment and concern that a Commissioner from the PCT was not present at the meeting to present the report.

Resolved – (1) That the year to date and year end financial forecast for the Mental Health Pooled Budget be noted, together with any detailed actions contained within the report.

            (2) That a detailed list of the proposed savings and identified actions (with an explanation of each item “in plain English”) necessary to meet the projected £0.328m overspend be circulated to the Board.

David Collier, AWP, gave a verbal report demonstrating AWP performance against the targets set. He highlighted the AWP’s key performance target issues and actions taken by AWP to improve performance where required in 2010/11. He advised on those standards where performance had altered since the last written report and those that had remained static, categorised as green, amber or red status. He also highlighted the specific actions that had been undertaken to continue to seek improvements in overall achievement. He reported that 19 of the standards were ‘red’, 14 of which were new targets. He advised that there was an operational delivery plan for each of these standards and that significant progress had been made against each new and existing standard. All indicators, he advised, were progressing towards green.

The Board felt it would be useful in future reports to view figures that show the progress against indicators, and asked whether it was possible to have milestones built into the indicators.

The Board expressed their disappointment at not having a written report and asked AWP to ensure that, in future, all Balance Scorecards are sent out in written form with the Committee agenda.

Lisa Proctor submitted a report concerning the year to date and year-end forecast financial position for the s75 commissioning budget at the end of July 2010 for adult community services

She advised that the community care budget remains a high-risk area due to growing demand and increase in complexity of care. The forecast variance for the year end is £1.005m and this assumes achievement of savings totalling £1.24m. The increase in number of clients (in receipt of direct payments, domiciliary, residential or nursing care) has risen by 306 between July 2007 to July 2010. This represents an increase of 24% over the period. Normal demographic trends for older people in Swindon are around 2% per annum.

A number of actions are being implemented in 2010/11 to address the financial pressures and reduce the forecast over spend as summarised below:

• Review of individual domiciliary care packages and implement standardized process across joint community teams

• Review of guidance to care managers regarding cost of care packages

• Review of cost of in-house services against market factors

• Redesign of in-house domiciliary care and implement enablement service

• Audit of external home care packages

• Development and implementation of a Living within our Means policy

• Fully explore use of assistive technology to reduce cost of care packages and promote independent living.

• Outsourcing residential care services

• Review of day services

• Review of service commissioned from voluntary sector

The Board discussed the possible reasons for the 24% increase in Social Care clients.

Resolved – (1) That the budget and position as at July 2010 of the s75

Commissioning Budget for Adult Community Services be noted, together with any actions contained within the report.

(2) That Officers investigate the 24% increase in Social Care clients in greater detail and present a report to a future meeting of the Board.

Lisa Proctor submitted a report concerning the financial position for the

s75 Adult Commissioning – learning disability services as at 31st July 2010.

She advised that the largest budget element on social care spend is the cost of care packages at £11.436m. It remains a high-risk area given the significant unit cost of any additional unplanned new clients and the ‘needs-led’ nature of the service. Currently, the forecast commitments for the year end is £12.336m a net overspend of £0.9m on Budget. The pressures come from high complexity and individual costs of care from transition cases and from the increasing number of new packages of care being agreed. The number of clients receiving care (domiciliary, supported living, nursing or residential) has risen by 71 between July 2007 and July 2010. This equates to a rise of 31%, which is well above normal demographic factors.

The forecast of £12.336m assumes that a £0.526m of potential commitments are not entered into and a further £0.5m in brokerage savings are achieved in

2010/11.

A number of actions are being implemented in 2010/11 to address the financial pressures and reduce the forecast over spend as summarised below:

• Options appraisal of day services to ensure that resources are used to

            maximum effect to promote personalisation and independent living thus

            reducing the need for local authority provided services.

• Work with community teams to ensure that care packages are the most

            appropriate for their needs and that person centred plans are fully utilised

• Improve the role and function of the funding panel through joint working with commissioners across health and social care.

• Continue to review residential placements and care home placements to ensure alternative supported living services are explored fully.

• Brokerage use of the LD Fair Pricing tool to challenge prices.

• Review of health placements (including continuing health care) to ensure health and social care plans are being implemented effectively and explore alternative service provision in Swindon in line with the principles of Valuing People.
• Work with local providers to ensure a high level of knowledge and skills

            across health and social care is achieved to meet the needs of the individuals of Swindon to avoid costly out of area placements.

• Review of potential commitments with the aim of looking at alternative ways of meeting the care needs of the clients.

Resolved – That the financial position as at 31st July 2010 of the s75 Commissioning Budget for Learning Disability Services be noted, together with any actions contained within the report.

The Director of Law and Democratic Services submitted a report concerning a request from NHS Swindon for 3 paragraphs set out below to be added to the Boards Constitution. 

The paragraphs are:

“1. You have the right to expect your local NHS to assess the health requirements of the local community and to commission and put in place the services to meet those needs as considered necessary.”

“2. The NHS commits to provide you with the information you need to influence and scrutinise the planning and delivery of NHS services.”

“3.  The NHS commits to work in partnership with you, your family, carers and representatives” 

Resolved – (1) That with regard to paragraph 1 set out above, no wording be added to the Boards Constitution.

            (2) That with regard to paragraph 2 set out above, the following be added to the Constitution:

At 3.22 after “to monitor the delivering of services” add “including the provision of information to the public”.

            (3) That with regard to paragraph 3 set out above, no wording be added to the Boards Constitution.

            (4) That the following sentence be added to the Constitution:

“The Joint Commissioning Board respects the rights of patients and staff under the NHS Constitution”.

Ann Mooney expressed the concern of service users that there was little or no reliable information on whether Services were going to be cut or to be put out to tender. Se felt there was going to be a massive change and that service users were not being properly informed on current events. She was very concerned about the loss of the Swindon Listen Line, which, she felt, was a unique service.

She was concerned that the advent of User Lead Organisations (ULO) would lead to the loss of SUNS, MIND, TWIGS and other organisations.

Councillor Bennett thought that the ULO would be an umbrella organisation to manage and commission the services provided by SUNS, MIND etc. The aim was to reduce the number of voluntary organisations.

Diana Finch felt that the voluntary service organisations needed to work together to develop business cases for any tenders that may arise.

Ann Mooney thought that the current ULO’s in England were not working. She wanted the service users organisations to stay as they are. She felt strongly that service user organisations had to be lead by service users.

The Board noted the comments and aspirations of Ann Mooney.