Purpose of report: Scrutiny of Services and Budgets
To scrutinise the Invest to Save applications for the Continuing Health Care Team approved by the Cabinet Member for Adult Social Care Decisions on 4 September 2013.
Confidential - not for publication by virtue of paragraph 3 of Part 1 of Schedule 12A of the Local Government Act 1972
Information relating to the financial or business affairs of any particular person (including the authority holding that information)
Minutes:
Declarations of interest: None.
Witnesses:
Sarah Mitchell, Strategic Director for Adult Social Care
Sheila Little, Chief Finance Officer and Deputy Director for Business Services
Neill Moore, Senior Principal Accountant
Sue Lewry-Jones, Chief Internal Auditor
Mel Few, Cabinet Member for Adult Social Care
Nick Harrison, Chairman of the Audit and Governance Committee
Key points raised during the discussion:
1. The Committee was informed that the Continuing Health Care team provided an essential role in mitigating cost to Surrey County Council by ensuring people accessed the appropriate care pathways. It was highlighted that there were a number of cases under review and that the cost of these was significant enough to justify the expenditure on a Continuing Health Care team. The Committee heard that one of the proposed outcomes of the Care Bill would be closer working together between the NHS and Adult Social Care about which organisation funds care pathways. This would enable the work of the Continuing Health Care team to cease, as it would be embedded in processes elsewhere.
2. The Committee queried when it was likely that there would no longer be a requirement for the Continuing Health Care team. Officers explained that there was a challenge in the spread of responsibility across the different Clinical Commissioning Groups (CCGs), but also commented that the Care Bill would potentially clarify matters in relation to the funding of care.
3. The Committee was told that the cost of the team was not included in the base budget as the income generated by the team’s work resolving complex cases did not always come back within the financial year.
4. Officers outlined that any bid for money from the invest to save fund had an obligation to repay the amount borrowed over a specified number of years. This requirement had been introduced since the beginning of the 2012/13 financial year. This repayment was built into the Directorate’s base budget and reflected in the Medium Term Financial Plan (MTFP). The view was expressed by officers that this requirement to repay had seen a reduction in the number of bids the fund was receiving.
5. The Committee was informed that the invest to save fund was overseen by an Investment Panel. This had been set up in 2010 as a direct response to an external audit on governance arrangements in relation to capital investment. It was highlighted that the panel did not approve or decide anything, but ensured that each business case in relation to an invest to save bid is subject to robust challenge before going to decision. The Committee was informed that there was work being undertaken to review the membership and processes in relation to the Investment Panel, with a view to widening its membership to include heads of services.
6. Members raised the question of why the Investment Panel had not met in person to discuss the two invest to save bids. It was clarified by officers that the challenge had been undertaken electronically, as it had been more pragmatic to do so on the occasions in question. A meeting of the Investment Panel on 27 August 2013 had been cancelled, but the electronic consultation on the two bids was subsequently noted at the next Panel meeting on 5 September 2013.
7. It was highlighted that Adult Social Care had been required to progress the bids in order to present them for the Cabinet Member decision meeting on 4 September 2013. Members of the Investment Panel confirmed that they had oversight of the papers coming to Cabinet Member decision in advance of the meeting, and had met with the service to provide challenge and seek reassurances. The Committee raised concerns that this had not been adequately reflected in the reports, which gave an impression that the Investment Panel had met to discuss the bid. Officers expressed the view that the preference would always be to meet face to face, but it was on occasion more practicable to conduct discussions electronically or by other means.
8. Members expressed the view that the work of the Continuing Health Care team should be built into the Directorate’s base budget. It was highlighted by officers that the temporary nature of the team’s work, and the long-term recovery of costs, had informed the decision to hold the cost of this team outside the base budget. The Committee was informed that there was precedence to fund the Continuing Health Care team through Invest to Save bids in previous years. Officers confirmed that it would have a significant impact on the Directorate’s requirement to make savings of £47 million, if the Continuing Health Care team was funded through the base budget.
9. The Committee discussed the impact of including the cost of the Continuing Health Care team in the base budget for the future. Officers commented that the team’s work was specifically to address a historic back-log and that future conversations around continuing health care would be managed within the locality teams. When questioned how long a dedicated Continuing Health Care team would be required, officers estimated it as a possible further two years.
Recommendations:
a) That the Committee endorses the proposal and review of the Investment Panel, which it is hoped will strengthen its role.
b) That the Audit & Governance Panel review the new structure, membership and procedures of the Investment Panel, and report to Council Overview & Scrutiny Committee on their findings.
Action by: Chairman of Audit & Governance Panel/ Chairman of Council Overview & Scrutiny Committee
c) That officers ensure that decision trails are mapped and recorded accurately within minutes and papers.
Action by: Adult Social Care
d) That the cost of the Continuing Health Care team is included in the business plan for 2014/15 onwards.
Action by: Adult Social Care
Actions/further information to be provided:
None.
Committee Next Steps:
None.