Agenda item

a)    Care Act Adult Social Care Funding Reforms – VERBAL UPDATE

b)    Adult Social Care Contracts – VERBAL UPDATE

c)    Public Health Procurement Update

d)    Performance Dashboard Update – VERBAL UPDATE

a)     Care Act Adult Social Care Funding Reforms

Mr Gary Collier, the Council’s Health and Social Care Integration Manager, advised that Ms Sandra Taylor, the Council’s Executive Director of Adult Services and Health, had previously reported on this issue to the Committee on 19 July 2022.  At that time, it had been anticipated that a care cap of £86k in funding reforms would be introduced and there would be an increase in capital thresholds from £23,250 to £100,000.  There was also to be work around the fair cost of care to address the disparity in fees paid by the Council and those paid by self-funders. 

Following the autumn statement, it was now known that the £86k care cap and the increase in capital thresholds would be effective from 1 October 2025.  The care cap was the maximum amount that an individual would be expected to pay towards the cost of their care needs in their lifetime.  Mr Collier noted that there was already a deferred payment scheme in place which meant that householders would not necessarily have to sell their homes to contribute to meeting their care costs. 

Insofar as the fair cost of care work was concerned, councils continued to wait for information from the Government about their financial allocations to be able to undertake the work.  Mr Collier advised that the cost of those additional staff that would be needed to undertake the additional assessments had been included in the Government funding but would not now be needed until 2024/2025.  Work would need to start towards the end of 2023/2024.  As this was a live issue, Mr Collier would provide Members with an update once the issue about funding had been resolved. 

b)     Adult Social Care Contracts

Mr Collier advised that information in relation to adult social care expenditure had been circulated to Members.  This information had been split between the proportion of the budget used for in-house provided services (6% - for example, care homes and supported living schemes for people with learning disabilities), Council support services (25% - for example, staffing and staff related costs) and externally provided services (69% - for example, care homes, homecare, extra care housing and supported living schemes). 

Members asked that the numbers and information be broken down further, if possible, to provide the following:

·         How much was spent on contracts providing preventative action?

·         Spend split by provider type - social, voluntary and private provider.

·         Which providers had the largest number of contracts?

·         The number of local providers.

·         How much of the services were subcontracted?

·         Top 6 companies regarding the amount of funding that they received from the Council.

Mr Collier advised that the spend distribution for adult social care in Hillingdon would be broadly similar to that of other local authorities.  He would draft a proposal that reflected the meeting’s discussion to provide the Committee with more information about the breakdown of the Council’s spend on external providers and email it to the Chairman and Councillor Nelson to ensure that it met their needs before the next meeting on 26 January 2023. 

c)     Public Health Procurement Update

Ms Shikha Sharma, Consultant in Public Health at the Council, advised that, in April 2022, the Families, Health and Wellbeing Select Committee had received a report setting out the plan for public health procurement.  A one-year contract extension had been agreed by Cabinet in July 2022 to give officers time to formulate a planned approach.  Fortnightly meetings had been undertaken with contract leads to look at population needs and establish whether the services were delivering what they were supposed to.  Ms Kelly O’Neil, the Council’s Interim Director of Public Health, had been putting together the planned next steps to ensure that there was a consistent methodology. 

It was noted that the value of contracts had been listed in bullet points on page 12.  Members queried why this was so uneven and how that specific amount of money had been allocated to each contract.  For example, as obesity was thought to be a big issue in the Borough, why did weight management only get £25k when substance misuse services received £3.025m?  Ms Sharma advised that values of a number of the contracts were historic and that more investigation was needed to establish what each of the contracts was actually achieving.  Also, public health functions like sexual health services and health checks were ‘mandatory’ under the Health and Social Care Act 2012.  Therefore, sexual health services needed to fulfil the purpose as written in the law, which included prevention of the transmission of sexually transmitted infections and the provision of a contraception service for Hillingdon’s population.

Members queried whether the amount of money spent on a contract was locally decided of whether there was influence nationally or from North West London Integrated Care System (NWL ICS).  Ms Sharma advised that there were some services that were deemed ‘must do’ (such as sexual health) and some that would be discretionary (such as weight management).  The amounts allocated were based on the values that had been in place when Public Health had transferred to the local authority.  Ms O’Neill was looking into whether these services were achieving what they had been set out to do. 

It was noted that, as part of the planning process for the new contracts, there would be more focus on prevention and early intervention, service delivery and targeting higher risk and vulnerable groups.  Ms Sharma advised that Ms O’Neill had been working with contract leads who had undertaken needs assessments which fed into epidemiology and collected insights from residents and professionals to get a 360° view of residents’ needs.  During the pandemic, the way that people accessed services changed (e.g., SH:24), so feedback would be sought on the ways that individuals would prefer to receive services.  It was important that the contracts showed achievement against public health indicators as outlined in the Public Health Outcomes Framework (PHOF) which fed into the two broad goals for the Public Health Grant: (i) an increase in life expectancy; and (ii) a reduction in inequalities.  The Chairman noted that, at the Committee’s meeting on 26 January 2023, Members would like an update on this from Ms O’Neill and more of an explanation about what this would actually look like.

With regard to NHS Health Checks, Members expressed concern about the under-screening of specific groups in the Borough, which included minority men, and asked how these groups were being encouraged to participate.  Ms Sharma advised that the team was visiting identified areas of deprivation and diversity in the south of the Borough to encourage a greater update.  GPs had been targeted to encourage the uptake in men and there were plans to look at GP data to target areas where the uptake was not high.  Digital options were being investigated and NHS Health Checks had been publicised at a recent men’s health day.  It was agreed that Ms Sharma would ask Ms Becky Manvell to provide the Democratic Services Manager with an update on the improvements and whether or not these were on target to forward on to the Committee. 

Concern was expressed that there had been a number of women who had had more than one termination.  Ms Sharma advised that these tended to be younger women and that it was important that counselling sessions continued to be undertaken to talk about contraception with all women that requested a termination.  There had been an ongoing effort to educate women about pregnancy as well as supporting them to get back into work or education.  Ms Sharma would provide the Democratic Services Manager with the statistics on repeat terminations.

With regard to smoking cessation, Members were advised that Hillingdon would not prescribe vaping as a way to stop smoking until a vaping product had been supported by Medicines and Healthcare products Regulatory Agency (MHRA).  If someone wanted to quit smoking by vaping, that was fine but the Council would continue to encourage the use of the quit service.  Public Health did not monitor the number of people who quit smoking by going on to vape instead but would liaise with the commissioner to establish if any information was gathered about the number of people who had indicated that they would like to quit using a vape. 

Members expressed concern about the disproportionate number of men that accessed drugs and alcohol services.  Ms Sharma advised that getting women to use the service had been an ongoing challenge.  Officers had been in contact with services such as trafficking and criminal justice so it might be possible to get a more detailed explanation.  Once the needs assessment had been undertaken, it was anticipated that this would be clearer. 

Performance Dashboard Update

Mr Collier advised that the performance dashboard continued to be a work in progress and was due for completion in the new year.  He would be able to provide an update once the work had been completed. 

RESOLVED:  That:

1.    Mr Gary Collier provide the Chairman and Councillor Nelson with a further breakdown of the adult social care contract budget to ensure that it met their needs before the next meeting on 26 January 2023;

2.    Ms Kelly O’Neill provide the Committee with an explanation of what the new contracts would look like at the Committee’s meeting on 26 January 2023;

3.    Ms Shikha Sharma ask Ms Becky Manvell to provide the Democratic Services Manager with an update on the improvements to the update of NHS Health Checks and whether or not these were on target to forward on to the Committee;

4.    Ms Shikha Sharma provide the Democratic Services Manager with the statistics on repeat terminations;

5.    Ms Shikha Sharma liaise with the commissioner to establish if any information was gathered about the number of people who had indicated that they would like to quit using a vape and forward this to the Democratic Services Manager for circulation to the Committee; 

6.    Ms Shikha Sharma provide the Committee with a more detailed explanation about the disproportionate number of men accessing drug and alcohol services in Hillingdon; and

7.    the presentations be noted.