Agenda and minutes

Resolved:- That the minutes of the meeting held on 9^th March, 2009 be approved as a correct record.

Sue Sumpner and Doug Parkes gave a presentation in relation to Personalisation and Resource Allocation System (RAS)

The presentation drew specific attention to:

• Self/Support Assessment Questionnaire
• RAS and Charging (Client Contribution)
• Support Planning
• Brokerage/Support Services
• Implementing Support Plan
• Review and Audit
• Resource Allocation System
• Gross Budgets 2008/09
• Charging Issues
• Impact on Service users of removing subsidy/free services
• Average Care Package – Potential Impact on Directorate
• Financial Risks
• Next Steps

A question and answer session ensued and the following issues were discussed:

• How a decision was made as to whether a need or want as identified by a service user was essential or desirable.  It was confirmed that there is an eligibility criteria that service users were required to meet in order to qualify for any funding.
• Were there any other authorities undertaking this.  Confirmation was given that 13 other authorities were involved in the pilot but that as it was a national directive all authorities would eventually have to follow this route.

Sue and Doug were thanked for their informative presentation and members looked forward to regular progress reports in the future.

This item was deferred to the next meeting.

Tony Sanderson, Assistive Technology Project Manager presented the submitted report which provided a summary of the progress made by Neighbourhoods and Adult Services relating to Assistive Technology during 2008/2009.

Rotherham received a total of £441,941 Preventative Technology Grant (PTG) from the Department of Health under section31 of the Local Government Act 2003.  It was made up of £165,327 for 2006-07 and £276,621 for 2007-08.  Through the grant it was expected that councils would invest in telecare to help support individuals in the community.  This aimed to help an additional 160,000 older people nationally to live at home with safety and security and to reduce the number of avoidable admissions to residential/nursing care and hospital.  A specific project management resource was recruited on a short term secondment in August 2008 to deliver the assistive technology project using PTG funding.  The Project Manager’s key responsibilities included testing new assistive technology products and utilising the PTG effectively.  After consultation with the NAS Directorate Management Team (DMT) key areas of research and expenditure were identified and these were:

Smart Flat:  A property at Grafton House had been supplied with a suite of assistive technology devices.  Service users using the devices and evaluate which pieces of technology meet their specific needs.  The facility was currently at an embryonic stage, but if results proved positive further smart flats could be developed across the length and breadth of Rotherham.

3^rd Sector Trial:  DMT approved £130,000 expenditure for assistive technology for the 3^rd Sector in order to identify 500 new clients.  The current voluntary sector free six week trial had been challenging to find suitable clientele.  Additional promotional activity for the pilot was being undertaken via mail drop, press advertisement and internet and intranet to raise customer awareness of the trial.  Voluntary Action Rotherham were also raising awareness through the 3^rd sector contacts.  The trial would continue on a rolling basis until 500 clients had been identified and this would be followed by a secondary stage of evaluation.

Temperature Extreme: A temperature extreme monitor trail had been undertaken during December 2008/January 2009.  Individual disclaimers were signed by the trial group to indicate the action Rothercare had to take in the event of the temperature extreme sensor device being activated.  During the trial period no calls had been received by Rothercare.  However this technology opened the gateway for more specific trials to be undertaken with stakeholders such as Rotherham NHS.  These specific trials could include all clients that had been admitted to hospital with hypothermia related conditions.

Bogus Callers Alarms: During November 2008, 190 bogus caller alarms were deployed.  It was identified at an early stage that the existing Rothercare technology was not compatible with the bogus caller alarms due to the age of the software.  New base boxes had to be procured at an additional cost of £147.20.  In line with the project plan these pieces of technology had now been evaluated through a questionnaire and the results had proved very positive and indicated  ...  view the full minutes text for item 124.

Dominic Blaydon, Joint Commissioning Manager gave a presentation in relation to the Joint Strategic Needs Assessment.

The Joint Strategic Needs Assessment (JSNA) established the current and future health and social care needs of the Rotherham population.  It informs the priorities and targets set by the Local Area Agreement (LAA) and leads to agreed commissioning priorities that will improve outcomes and reduce health inequalities.

The JSNA Executive highlights a series of key issues that Rotherham MBC and NHS Rotherham would have to address over the next 5 years were:-

• The impact of an ageing population
• The potential impact on health, well-being and services of the economic downturn
• How to change patterns of exercise, diet, smoking and alcohol consumption
• How to reduce the gap between healthy and actual life expectancy
• The likely increase in prevalence of people with life limiting long term
• The increasing numbers of people with dementia and the development of new service models to address this
• The effectiveness of using preventive strategies to save future care costs
• Changes in the demographic profile of the learning disability population, and
• Whether shifting resources into community services reduces overall costs of care.

The JSNA incorporated the findings of a service user and carer engagement exercise.  The main outcomes from this engagement process were:-

• Support for services which promote independence and maintain people at home
• More support for carers both in the caring task and their own well-being
• Development of low level support services
• Targeting people who are socially isolated
• Better supported housing options including Extra Care Housing
• Alleviation of the impact of the economic downturn, and
• Access to transport and activities, especially in the evenings

The primary purpose of the JSNA was to inform current joint commissioning plans but it was also an opportunity to evaluate future needs for commissioning intelligence.

The four key steps that should be taken from this point on were:-

• More analysis at locality level, some of the current information could only be easily expressed for the whole of Rotherham and work was needed to make more data available at area assembly level
• Begin the process of reconfiguring services so that they addressed future needs.  A better understanding was needed of how demand for services would increase in the future if we continued with current service models.  We needed to demonstrate how much potential there was to modify future demand by commissioning programmes in areas such as, enabling healthy lifestyles at different ages, the earlier detection of long term conditions and the development of community care.
• Ensuring that the JSNA was accessible to health and social care professionals so that they could gain greatest benefit.  Work should be done on developing a web based JSNA, which was regularly updated and incorporated all the information from the DH dataset, and
• Bring together the JSNA and the Corporate Needs assessment so that there was clear demarcation and no duplication.

Resolved:- (1) That the JSNA be endorsed

(2) That the development of a web-based JSNA be supported.

Mark Scarrott, Finance Manager (Adult Services) presented the submitted report which informed members of the anticipated outturn against the approved Adult Services capital programme for the 2008/09 financial year.

The actual expenditure to the mid February 2009 was £8.2m against an approved programme of £9.1m and since the last report there had been some further slippage.  The latest forecast expenditure to the end of March was now £9m.  The approved schemes were funded from a variety of different funding sources including, unsupported borrowing, allocations from the capital receipts, Supported Capital Expenditure and specific capital grant funding.

The following information provided a brief summary of the latest position on the main projects within each client group.

Older People

The two new residential care homes were now fully operational.

The Assistive Technology Grant (which included funding from NHS Rotherham) was being managed jointly and was being used to purchase Telehealth and Telecare equipment to enable people to live in their own homes.  The procurement of equipment had now commenced which included lifeline connect alarms, low temperature sensors and fall detectors within peoples homes.  It was anticipated that expenditure would continue to be incurred in 2009/10 and any balance of funding would be carried forward to meet these costs.

A small element of the Department of Health specific grant (£20k) issued in 2007/08 to improve the environment within residential care provision was carried forward into 2008/09.  The balance of grant was being allocated across the independent residential care sector in accordance with the grant conditions and would be fully spent by the end of March 2009.

Learning Disabilities

The small balances of funding carried forward from 2007/08 were to be used for the equipment for Parkhill Lodge and within supported living schemes.

The refurbishment at Addison Day Centre, funded from the Council’s Strategic Maintenance Investment fund was now complete. 

There had been delays in the start of the refurbishment of the REACH Day Centre and the scheme was now due to commence in April 2009 which meant that the funding would be carried forward into 2009/10.

Mental Health

A small balance remained on the Cedar House capital budget and would be used for the purchase of additional equipment.  A large proportion of the Supported Capital Expenditure (SCE) allocation had been carried forward from previous years due to difficulties in finding suitable accommodation for the development of supported living schemes.  Suitable properties continued to be identified and spending plans were being developed jointly with RDASH.  It was now expected that this service would be commissioned in 2009/10 and would support the In-Patient re-Provision Exercise which was now at the formal planning stage.  The possibility of funding equipment purchased for direct payments was also being considered to reduce the current pressures on the mental health revenue budgets.  Further options were also being considered to provide more intensive supported living schemes with a range of providers and to fund a range of new assistive technologies for mental health clients, which would support their independence with  ...  view the full minutes text for item 126.

Kim Curry, Director of Commissioning and Partnerships presented the submitted report which summarised the Department of Health’s transformation agenda which focussed on patient choice, personalisation of services and diversity of provision. 

The paper required NHS Rotherham to create an internal separation of its commissioning and operational provider services.  The in-house providers would be developed to become business ready and have “first call” for service delivery in the initial stages.  It stated that existing staff and management should be given the opportunity to propose either the creation of social enterprises or NHS Community Foundation Trusts.

There were a number of potential providers:

• NHS organisations
• Foundation Trusts
• Social enterprises
• Commercial enterprises, and
• Contractual, partnership and joint working arrangements

Locally, joint commissioning had been effective in a prescribed number of areas.  In addition, there were areas of service, such as Occupational Therapy, that would benefit from a much more robust commissioning approach.

Once a clear separation between the PCT commissioning and provider functions had been achieved, a detailed implementation plan would need to be developed.  The approval process for moving to particular organisational forms would vary, as different forms had different requirement and regulators.  Throughout the processes to determine appropriate outcomes, attention should have been focused on the benefits realisation expected over a given period of time.  This would be of interest to key interest groups, notably LINks and the Social Care and Health Overview and Scrutiny Committee.

The Department of Health had established a timetable for implementation.  From October 2009, PCT commissioning arms should have completed service reviews and a market analysis, and established and published a procurement plan in line with the intentions in its 5 year Strategic Commissioning Plan.  During 2010, PCTs should develop their implementation plan.  Where a PCT decided to maintain direct provision, it should periodically review its service quality, viability and any financial risks or risk to sustainable services.

NHS Rotherham were about to begin a review of all provider services according to the guidance and the models described above may all be part of the consideration of the best models of commissioning and service provision.  The document requests that NHS Rotherham should take the Council’s views on board and the Scrutiny function should be involved and ratify the decisions.

Resolved:- (1) That the Cabinet Member note the developments and risk to transforming the provision of NHS Rotherham provider services.

(2) That the Cabinet Member request that the Adult Services and Health Scrutiny Panel be consulted during the developments

(3) That the Cabinet Member request that the Adult Services and Health Scrutiny Panel consider NHS Rotherham provider services as part of the annual scrutiny review programme.

The following items are likely to be considered in the absence of the press and public as being exempt under paragraph 4 of Part 1 of Schedule 12A to the Local Government Act 1972

Resolved:-  That, under Section 100A(4) of the Local Government Act 1972, the press and public be excluded from the meeting for the following item of business on the grounds that it involves the likely disclosure of exempt information as defined in paragraph 4 of Part 1 of Schedule 12A to the Local Government Act 1972, as amended.

Shona McFarlane, Director of Health and Wellbeing gave a presentation in relation to Housing and Support Services for Older People.

The presentation drew specific attention to:-

• Demographics and Changes in Aspiration
• Current issues
• Current model
• Service model
• Our plan for 2009/10
• What needs to happen
• Outcomes by 2010/11
• Risks and Mitigation
• Consequences of not doing this

A question and answer session ensued and the following issues were discussed:-

• The possible withdrawal of warden services.
• Where the homecare service fitted in to the new structure. 
• Whether consultation had taken place with the Trades Unions in respect of these proposals. 
• Who would be responsible for the new service? 
• It was suggested that an all member seminar be arranged in relation to the service to enable all elected members the chance to comment.
• How this service would affect the contract for the 80/20 split which was already in place. 
• It was further suggested that the Cabinet Member receive regular progress reports in relation to this new service.

Resolved:- (1) That subject to the consultation and agreement with the Cabinet Member for Neighbourhoods the proposal to integrate the sheltered housing warden role and that of the domiciliary care enabler role be supported to lead to one service being delivered.

(2) That a detailed project plan be worked up to include an analysis of all financial and workforce implications, a risk register and communication and change management plan.

Resolved:- That the next meeting be held on Monday 6^th April, 2009 commencing at 10.00 am.