Agenda item

Purpose of the report: To share details of the Cabinet Member’s priority areas of work, including any strategy and policy developments, and provide an overview of the budget position and performance of services within the portfolio.

Witnesses:

Sinead Mooney, Cabinet Member for Adults and Public Health

Liz Uliasz, Deputy Director, Adult Social Care

Kate Scribbins, Chief Executive, Healthwatch Surrey

Nick Markwick, Co-Chair, Surrey Coalition of Disabled People

Key points raised during the discussion:

1. The Cabinet Member updated the Select Committee with regard to the Surrey Public Health Peer Challenge, mentioned in item 15 of the report. At the Peer Challenge meeting in November 2019, agreed-on recommendations included:
   1. To review and simplify the governance of the system;
   2. To ensure that Surrey County Council was clear about the expectations of the Public Health team;
   3. To ensure that the Public Health team accepted change and was clear about how they were delivering against the priorities set out for them.

The action plan would detail how these recommendations would be implemented, and the recommendations would be closely monitored.

2. The Chairman pointed out that care commitments were over budget and queried why there had been an overspend and what was being done to balance the budget. The Cabinet Member explained that mitigation measures were in place to ensure the budget was balanced, including a staffing underspend of £1.4 million, partly because of difficulties around recruitment; the level of inflation; managing providers’ expectations; an underspend of around £1.5 million on ASC internal transformation; and £1.8 million of funding carried forward from the 18/19 budget. Underspends would be offset against an increase in spending on care packages.
3. A Member expressed concern about managing providers’ expectations, as many care providers were already struggling financially. The Cabinet Member replied that a report would be coming forward with details of an uplift in funding for the upcoming year. The importance of working closely with providers was emphasised, as were improvements in communications in the past year. The Deputy Director of Adult Social Care added that the commissioning function had been strengthened and restructured, and that providers’ requests for increases in spending were dealt with on a case-by-case basis.
4. A Member asked for clarification on why there had been an underspend on transformation, despite the relatively high level of transformation that had been happening. The Deputy Director for ASC responded that the underspend was partly due to incomplete recruitment.
5. A Member queried whether the Council was working with district and borough councils to ensure that there were homes available countywide for people who needed care, with no neglected areas, and whether existing homes were being adapted or new facilities built. Cabinet had recently signed off three sites for the development of homes, with a focus on residents within those catchment areas. In addition, there were many private developments going through the planning process. The Council worked with districts and boroughs to develop residents’ own homes so that residents could live independently there.
6. The Select Committee queried stock levels of the flu jab. The Cabinet Member stated these had increased and would be available until February 2020.
7. The Co-Chair of the Surrey Coalition of Disabled People questioned the efficacy of direct payments, due to frequent delays, and asked what was being done to manage the market and liaise with residents. The Deputy Director of ASC acknowledged that performance around direct payments was not good and that indeed direct payments did not suit everyone, but that diagnostic work had been done by the Social Care Institute for Excellence (SCIE) and a working group had been set up to tackle this and residents were being worked with as part of the transformation journey.
8. A Member queried the pressure created on the budget of children with learning disabilities in transition. Pressures would be mitigated through improvements to the transition team and working with young people sooner, working with the SEND team, joining up ASC and young people’s services and ensuring that residents with learning disabilities had a stable home and good prospects in study and work.
9. The witnesses were asked for their views on the transformation and what the new view was of dealing with autism specifically. The Cabinet Member responded that there was a comprehensive Autism Partnership Board and Strategy with an easy-to-use website with information, support and signposts to services. The Deputy Director of ASC mentioned that the learning disabilities team had recently been centralised.
10. A Member requested more detail about the Healthy Surrey and Active Surrey initiatives, and asked for an update about the Healthy Surrey Website. The Cabinet Member informed the Select Committee that the website was very proactive and informative, and that so far in 2019 it had had over 150,000 visits and 300,000 page views.
11. The Select Committee questioned reviews of care packages by ASC. Members’ concern about individual cases could be raised with the Cabinet Member and would then be examined more closely. The Deputy Director of ASC added that the thresholds were set by statute and could not be changed. Moreover, residents could raise dissatisfaction with individual cases of reviews with Healthwatch.
12. The Select Committee asked about the Cabinet Member’s priorities. The budget was the top priority, followed by other ASC and mental health; accommodation with care and support; learning disabilities, specifically improving the offer to residents who had learning disabilities and managing the learning disabilities budget; reviewing care and support packages in a timely manner; reviewing complaint data, given recent findings from the ombudsman and an increase in the number of complaints.

Recommendations:

The Select Committee:

1.    Requests that the Cabinet Member for Adults and Public Health provides updates at future meetings on the specific measures being used to achieve a balanced ASC budget;

2.    Requests that an update measuring resident outcomes is provided at its meeting on 22 April 2020;

3.    Recommends that there is better publicity of the availability of flu jabs, both for Council staff and Surrey residents;

4.    Requests that a detailed report on plans for the Learning Disabilities and Autism Services is provided at a future meeting;

5.    Recommends that more is done to promote Healthwatch Surrey and the services it offers, particularly with respect to ASC;

6.    Requests that a report on complaints and ombudsman findings is provided at a future meeting.

Actions/further information required:

1.    For Members to give suggestions of suitable sites for care homes to ensure a wide spread of sites across the county;

2.    For the Cabinet Member to provide information about the overall balance between increases and decreases in care packages.