Agenda item

This report analyses the latest performance for 2019-20 and forecasts the financial outturn position by reference to the service plans and budgets for all the relevant Health and Adult Social Care services falling under the responsibility of the Corporate Director of Health, Housing & Adult Social Care.

Members considered a report which analysed the latest performance for 2019-20 and forecasted the financial outturn position by reference to the service plans and budgets for all the relevant Health and Adult Social Care services falling under the responsibility of the Corporate Director of Health, Housing & Adult Social Care.  The Corporate Director of Health, Housing and Adult Social Care, the Head of Finance: Adults, Children & Education and the Strategic Support Manager (Adults and Public Health), were in attendance to present the report and to respond to questions.

The following information was provided in response to questions from committee members:

·        Officers provided assurances that the budget set for 20/21 would be sufficient given predicted overspend on a range of the 19/20 accounts.  £4.8m revenue would be directed to the Adult Social Care budget.  Some of that would mitigate some of the pressures in existing growth in the 20/21 budget.  Officers would consider underlying causes of these pressures.

·        The Corporate Director along with colleagues in the Finance team held weekly monitoring meetings to consider pressure points in budgets across the whole directorate and was confident that areas of her directorate were under control.  However, noted that York had a markedly high number of self-funders which drives up the cost of care in this area.  Further work needed to be undertaken in influencing how care is provided.

·        In relation to the length of time it had taken to transition to a model more focused on independent living, officers explained that one obstacle had been that the term ‘independent living’ had encompassed a range of differing definitions and approaches and had varied between different care settings.

·        Members were very interested to hear about the Grand Care Pilot and requested further information on this in due course.  Officers explained that twenty service users were trialling different technologies apps and censors which would help pick up vital signs and inform carers.  The feedback had been positive. The City of York Council had the opportunity to be at the forefront of this kind of project. 

·        Regarding Continuing Health Care funding and whether the Council or the NHS pay for this and the implications for patients if funding were to be denied, the Corporate Director of Health, Housing and Adult Social Care assured Members that staff had been employed to undertake these assessments working alongside colleagues in the health service to ensure a completely integrated assessment of health care based on patient need and without delay.

·        Regarding mitigations totalling £0.9m and some of that sum arising from direct payment contingency levels, officers clarified that there had been a concern regarding the Council not being able to reclaim payments to client accounts which had not been spent.  A system had been put in place this year which had allowed the Council to reclaim £600k.  Work was being undertaken to put a permanent technological solution in place.

·        Officers confirmed that overspend and underspend can be balanced out between the different directorates and all directorates consider where savings can be made.

·        Officers confirmed that where single patient use equipment such as crutches, frames etc. were no longer required by that patient, they were not necessarily collected and re-issued for use to another service user.  Officers agreed to give this consideration and to report back to this Committee in due course.

·        In relation to forecast overspend at: the Small Day, Supported Employment services and the Avenue, officers explained that they were working with services to increase efficiency and make improvements.  Members requested further information on the help offered.

·        Regarding supporting those with mental health issues to live independently, this depended upon the degree to which service users could live independently.  This could be about physical or mental health problems, the living environment and a range of variables.  Sometimes people struggle even with a lot of help.  Support services listen and are responsive and flexible. 

·        Key performance Indicator: ASCOF1H regarding percentage of adults in contact with secondary mental health services living independently had indicated that this aspect was deteriorating.  Paragraph 34 of the report had explained this.  There had been a slight deterioration which would represent 6 people.  This indicator had also been due to a recording issue regarding the source of data as originally the information had been provided by Tees, Esk and Wear Valleys (TEWV), then from NHS England.

·        Members requested further information on spend options under consideration for the additional budget allocations to the current substance misuse contract totalling £200k.

·        Officers clarified that planned budgetary reductions in relation to Substance Misuse were likely to go ahead. The Council would usually know the amount of allocation regarding the Public Health budget in November.  As this was not known, officers were not in a position to make plans regarding this funding.  If an uplift was received that was significantly higher than estimated, there may be an opportunity for Executive to review this.

·        Regarding £49k overspend on long active reversible contraceptive (LARC) there had been higher than expected take up.  This is jointly commissioned with VOY CCG.  This is a free choice based service that both the Council and NHS are legally obliged to offer.  There may be other budgets the service could draw from to support this. 

·        Regarding alcohol and substance misuse and the York rates being lower than the national average, the figures do not take into account local factors which are complex in terms of mental health and involvement with the criminal justice system.  Changing Lives were working with TEWV and North Yorkshire Police on this aspect.  This was discussed regularly within the CCG and is a priority of the Health and Wellbeing Board (HWBB). 

·        Childhood Obesity – the Healthy Child service will weigh and measure every child in reception year and year 6.  It was noted that work needed to be undertaken for young people on the pathway from identifying a child as being above a healthy weight in the school based child measurement programme.  This is a cultural issue and a complex area of health.  York does not have a dedicated service to work with families, although health workers cover mandatory requirements and many aspects of this work unintentionally, such as: weaning, what is a healthy diet and exercise.

·        Regarding The 2019/20 Q2 data on improving access to psychological therapies (IAPT) in the Vale of York CCG area shows the following: referrals to IAPT (504 per 100,000) are lower than the England average.  Members requested further information regarding why there was a lower rate of referral.    

Resolved: That the Committee considered and noted the 2019/20  Finance  And  Performance  Third  Quarter  Report for Health  And  Adult  Social Care.

Reason:     So that the Committee is updated on the latest financial and performance position for 2019/20.