Agenda item

To provide information to the Community and Wellbeing Scrutiny Committee regarding the implementation of the Adult Social Care Transformation Plan.

Councillor Nerva, as Lead Cabinet Member for Adult Social Care, Public Health and Leisure, introduced the report, which provided information regarding the implementation of the Adult Social Care (ASC) Transformation Programme. He highlighted that the programme took into account comments made by the CQC as well as learning from other areas of work. Claudia Brown (Director of Adult Social Care, Brent Council) added that the programme focused on the Council’s drivers for change and what was being put in place to ensure change occurred, highlighting the enablers being used to make that happen.

Harry Peacock (Head of Performance, Change and Assurance, Brent Council) outlined further details of the programme, which had been rescoped to incorporate all areas where ASC wanted to see change. The programme focused on 4 frontline facing areas; how ASC worked with partners and customers to maximise people’s independence; how ASC ensured practice was strength-based and reflected the needs and outcomes that people wanted; how early intervention work could be provided to prevent, reduce or delay the need for formal care and; how ASC could use digital and tech enabled care to support residents to be independent and live safe and well in their own home. It was recognised that, to make radical change, it was essential to have support from other areas, so the transformation programme includes enabling workstreams across commissioning, finance, performance and data, and underpinning the entire programme was co-production.

The Chair thanked presenters for their introduction and invited comments and questions from the Committee, with the following issues raised:

The Committee highlighted the commitment in slide 5 of the appendix – ‘working with you to live your best life’ – and asked what that meant in practice. Officers explained that it meant working with people in a way that gave them the solutions that mattered and worked for them. ASC understood that people’s circumstances could be challenging and that there were things the Council and ASC could to do support them further. For example, the Transformation Programme looked for ways to support people much earlier in their life to delay, reduce or remove the need to enter formal care. To do this, there would be a need to do things differently and shift resources into the right areas.  

In relation to the aspirations outlined in the Programme, particularly in relation to the use of new technology to support the deliver of care, the Committee highlighted that training would be essential to equip staff with the relevant skills to deliver. Officers confirmed that training had been considered and ASC was working with Triple Value Impact to develop the digital blueprint. A key aspect of that work was about working with resident groups, staff and providers to take up that technology. It was recognised that, as well as equipping people with the skills to use technology, there would be an element of culture and behavioural change needed to show the positive impact of technology and bring people on board.

The Committee asked if the financial implications of implementation had been considered. Harry Peacock confirmed that one of the key enablers of the programme was finance. It was important for ASC to understand demand and where it was coming from, as the data showed increased demand for mental health services and Learning Disability support. Officers were working with commissioning to see how the increased cost of care and the pressure in the care market could be managed and met in a sustainable way and working with finance colleagues to ensure ASC could meet the current budget pressures and deliver a sustainable financial model. It was added that finance was a challenge for every local authority delivering ASC across the country. Claudia Brown added that not everything provided would be a Council funded care cost, so it was important to recognise the resource available in the community and use those resources well. The Programme did not ask for a lot of new money and aimed to work within the budget already available, re-allocating funding from areas that were underspending to areas where extra budget might be required. ASC was also utilising extra government grants where possible to facilitate the programme.

In considering the aim to work within the budget available, the Committee asked how confident officers were that ASC would be able to deliver everything the Transformation Programme sought to do within the current budget and without an overspend, particularly following the additional National Insurance contributions providers, agencies and the Council would now be required to make. Rachel Crossley (Corporate Director Community Health and Wellbeing, Brent Council) acknowledged that it would be a challenge, but advised members that the aim was to deliver the programme within the budgets available and get it right. She explained that the Transformation Programme worked in tandem with the budget proposals due to be presented to Cabinet and Council in February and included business as usual demand as well as the bigger savings programs the Council was required to consult on. There was around £7m of pressure, with workplans against all of them. She confirmed that the Council was clear what those programs of work looked like and growth had been planned into those areas. Officers added that ASC also had a Financial Strategy for the next year which was being regularly monitored. In addition to the ASC budget, members were advised that that the programme was a whole Council endeavour using transformation resources across the Council. For example, the budget for digitisation and technology was not coming from the ASC budget. As such, there was prioritisation of this programme in other departments across the Council and the programme helped ASC remain within its budget and deliver for residents. Councillor Nerva added that he hoped in the future for discussions relating to one public purse, where there was greater collaboration across partners including the local authority and NWL Integrated Care Board (ICB) around a single pot of money to ensure the best delivery of services to local residents in the most efficient way.

Noting that the Transformation Programme looked to shift to an early intervention and prevention approach, the Committee asked how it would be possible to do preventative action without additional funding. Harry Peacock advised that part of the programme aimed to understand what the Council was already spending on intervention and prevention, which was significant. He provided the example of the reablement service the Council delivered to those who did not have Care Act eligible needs or did not need a financial assessment, which cost in the region of £2.8m for resources and £2.3m on care and support. For every 100 service users that went through reablement, 70 did not go on to long-term formal care and support, so the Council knew that investment was working. Other examples provided included the money being spent alongside health colleagues for community equipment and the money spent alongside the housing services department for the Disabled Facilities Grant. For some of the workstreams, including tech enabled care, this was being funded by government grant. Rachel Crossley added that money also came through the NHS for prevention, but tended to focus on medical prevention. She felt that the NWL ICB should be more involved in the social, economic development stages of the prevention approach and there were conversations needed around how health inequalities funding and prevention resource was used. She highlighted that more advice had been included in the NHSE guidance around how ICBs used money on developing and supporting Integrated Neighbourhood Teams (INTs), and so she felt there was a need to look at that pool of funding together to use it more impactfully.

The Committee asked for clarification on the figures in relation to slide 2 of the appendix, which showed a 22% increase in demand for support for people with mental health issues. They queried whether this related to a particular profile, for example people over 60, people with dementia, people with Learning Disabilities or younger adults. It was clarified that the22% increase related to the increase over the last 3 years, meaning that since 2021-22 until the current year there had been a 22% increase in the number of people with mental health issues supported by the local authority. The number of people with mental health problems supported in 2021-22 was around 640 people, and the local authority was now supporting around 700 people, showing a significant impact on the level of demand for mental health support. Officers agreed to provide supplementary information outlining how many people were being supported with a mental health issue broken down by age, gender, ethnicity, deprivation and other demographic metrics.

The Committee understood the rationale for the priority around maximising independence, but raised concerns that there was a risk of pushing people who needed support into a space where they were forced to be independent and not able to be. They asked what safeguards were in place to ensure that did not happen. Claudia Brown highlighted that the priority to maximise independence was not about people with Care Act needs being forced into independence, but about providing information to the community and providing resources to individuals to ensure that, wherever they could, they could be independent. For example, this could be a mixed package where some support was provided by the individual and ASC topped that up with a support package. Where there was a Care Act duty to deliver on a need that would be done, but if an assessment found that the individual could do certain aspects independently or had family members willing to support them to be independent then ASC would aim to support them to do that. Individuals would be monitored to ensure that if they needed to they could come back into the ASC space.

The Chair thanked those present for their contributions and drew the item to a close. He invited members to make recommendations with the following RESOLVED:

i)               For ASC to implement a set of measurements for the Transformation Programme to track progress and improvements.

As well as recommendations, the Committee made an information request during the discussion, recorded as follows:

i)               To provide supplementary information outlining how many people were being supported with a mental health issue broken down by age, gender, ethnicity, deprivation and other demographic metrics.