Budgetary Issues and Financial Risk for the Service over the period 2009/ /12

Transcription

1 Page 45

2 Page 46

3 ADULT CARE Description of the Service To commission, arrange and provide good quality services for the support and protection of adults with community care needs in ways that promote independence, autonomy and social inclusion. The Adult Care Service arranges or provides a range of community care services to adults who are vulnerable as a result of old age, physical and learning disabilities, sensory impairments, serious illness, and mental health problems, and to their carers Budgetary Issues and Financial Risk for the Service over the period 2009/ /12 Further to Value for Money reviews of the service, a Modernisation Programme is delivering service improvements and greater efficiency over the next three years. The programme comprises a number of key projects, which are geared to improvements in the following areas: Home Support Services Management of Contracts with service providers Monitoring of contracts with providers, including enhanced technological solutions Extra Care Housing Expensive care placements The application of eligibility criteria for the funding of social and health care responsibilities Services to people with Learning Disabilities Value for Money reductions have been made to the service budget totalling 2 million over the years 2006/7 and 2007/8. The Modernisation Programme is in place to deliver these reductions, and clearly, any under-achievement will require that alternative measures are implemented. The growing demand for services, for example as a result of the ageing population, will also put pressure on funding and commissioning plans need to be robust and prudent in the light of a somewhat unpredictable landscape. The reduction of the Supporting People (SP) grant and the application of SP eligibility criteria at review of services is likely to result in costs having to be met by Adult Care budgets. The transfer of Adult Care Grants to Area Based Grants (ABGs) potentially poses some very real financial risks to Adult Care in the next few years, although the full implications of this transfer of funding are not yet known. The Government has determined that Local Authorities should develop the transition to self directed support which will give the user of services choice as to the type of service. This major development incorporates the identification of individual budgets for each user of services which can be used to purchase services from a provider of their choice. The management of Adult Care, together with colleagues from Finance have been assessing the impact of the issues identified above and are preparing a medium term financial plan, relating to 2009/10 to 2012/13, which determines the potential financial impact of the risks and identifies potential savings that can achieve a balanced budget. Although this work is still in its early stages it is being anticipated that, with the net impact of modernisation, Adult Care could achieve a balanced budget in 2011/12. Specific financial pressures and options for saving have been identified for the next two to three years and these will be closely monitored through the monthly Finance Boards. Page 47

4 Performance Information KEY NATIONAL PERFORMANCE INDICATORS PI No Performance Indicator 2005/6 Actual 2006/7 Actual 2007/8 Actual Direction BV53 Intensive home care per 1,000 population aged 65 or over BV54 Older people helped to live at home per 1,000 pop aged BV56 Percentage of items of equipment delivered within 7 working days 91% 92.55% 96% BV195 Acceptable waiting time for assessment 69.10% 82.04% 90.7% BV196 BV201 PAF C72 Clients receiving all services in care packages within 4 weeks of completion of assessment The number of adults and older people receiving direct payments at 31 March per 100,000 population aged 18 years and over. Older people aged 65 or over admitted to residential/nursing care during the year 95.84% 94.8% 93.9% PAF C73 Adults aged 18 to 64 admitted to residential/nursing care during the year PAF D40 Clients receiving a review 53% 50% 69.9% PAF C62 Services for carers 2.4% 7% 9.9% The Annual Performance Assessment by CSCI for 2006/07 resulted in the service being downgraded from 2 star with promising prospects to 1 star with promising prospects. In part this downgrade was due to a lack of improvement in the performance of key indicators such D40 and even where performance did improve, for example against C62 and BV201, this improvement was not deemed be significant enough. During 2007/08 a great deal of work was undertaken to analyse and address the reasons for poor performance. Regular performance management meetings were established to ensure the data was being regularly monitored and to agree action to be taken as appropriate. Business Objects reports have made available to managers to enable them to manage their own team s performance. During 2007/08 a major data cleansing exercise was also undertaken to ensure the integrity of the data. This resulted in improved performance against some indicators, such as D40 and C62 but also resulted in a drop in performance against BV54. Overall in 2007/08 13 of our national performance indicators (BVPIs and CSCI performance assessment framework PIs) improved and 4 got worse. Our improved performance was recognised the 2007/08 CSCI Annual Performance Assessment when we were upgraded once again to 2 stars with promising prospects for adult care. Page 48

5 For 2008/09 we are continuing to closely monitor performance against all our PIs, including the new National Indicator Set. We have set ambitious targets particularly against NI130 Self Directed Support which is a target in the Local Area Agreement. In addition to the monthly performance monitoring meetings, a Performance Board made up of the senior management team and staff in Performance and Development has been established by the Interim Director for Adult Care. Key Improvement activities over the period 2009/ /12 Adult care has agreed a transformation programme made up of a number of high profile projects which will result in whole service transformation. The successful implementation of these projects are key to the continuous improvement of the service and its ability to meet the demands of national agendas and new challenges, particularly that of delivering self directed care and increased demand for services. The development of individual budgets and the associated service change required by this is a key aim of the transformation programme. The challenging target agreed with the Local Area Agreement is to have 1980 people in receipt of self directed support (direct payments or individual budgets) by March The development of a wider range of services, including universal and preventative services, such as those developed through the POPPs pilot is also a particular priority of the transformation plan and will support the need to meet increased demand within finite resources. Other key projects within the programme are: Re-commissioning of all domiciliary care contracts Full implementation of the reablement service Externalisation of in house domiciliary care service Electronic Monitoring of care providers Review of day care Review of fees and charges Embedding financial management Implementation of IAS case management system The implementation of a new case management system for adult care is planned for June The new Integrated Adults System will help to streamline processes and will improve the provision of management and performance information. The exercise of implementing this system is a major task which will require the support and involvement of the whole service. Following the Annual Performance Assessment a number of areas for improvement and these will form the basis of an update to the existing service improvement action plan which was developed following the inspection of older people s services in 2006/07. The areas identified include: To continue the implementation of single assessment process. To increase the provision of intermediate care services. To increase the number of reviews undertaken. To continue with partners developments to improve outcomes for people with long-term conditions. To continue work with health partners to establish an effective and safe hospital discharge system. To develop a system of monitoring the outcomes for people who are signposted to non care managed services. To continue to develop ways to help people assess their own needs. To increase the percentage of assessments of older people completed within 2 weeks. To extend out of hours services in line with council plans. To improve advocacy services in line with the council s action plan following the 2007 service inspection. To continue to promote direct payments and self directed care through the council s transformation programme. Page 49

6 To continue to improve safeguarding procedures and systems for recording referrals of abuse. To increase the level of provision of extra care housing and telecare. To reduce high cost out of county placements for people with learning disabilities. Reducing the number of people admitted to residential care remains a key priority and we are working with housing services and RBH to develop the use of telecare and extra housing which will enable more people to remain as independent for as long as possible. Page 50

7 ADULT CARE 2008/ / / /12 REVISED ORIGINAL ORIGINAL ORIGINAL ESTIMATE ESTIMATE ESTIMATE ESTIMATE ' 000 ' 000 ' 000 ' 000 Functions provided by Service 632 Management and General Support ,015 Commissioning Services 1,065 1,075 1,091 1,832 Social Inclusion Business Unit 1,763 1,811 1,860 32,846 Older Persons & Physical & Sensory Services 32,824 33,319 33,875 4,669 Mental Health Services 4,817 4,927 5,027 12,551 Learning Disability Services RMBC Funded 12,642 12,990 13,338 53,545 Net cost of providing services to the Public 53,923 55,024 56,167 Types of Expenditure 22,665 Employees and related expenses 20,094 20,533 20,679 1,441 Premises related expenses 1,486 1,523 1,548 1,275 Transport related expenses 1,225 1,272 1, Supplies and services 2,980 3,925 4,490 28,791 Agency and contracted services 28,129 27,778 27,032 4,797 Central departmental and support services 4,977 5,067 5,142 0 Capital financing Less internal service departmental recharges Contribution to/-from a reserve Income 393 Grants - Government and other 899 1, ,795 Rents, Fees & Charges 4,111 4,010 4,059 53,545 Net cost of providing services to the Public 53,923 55,024 56,167 Page 51

8 ADULT CARE VARIATION STATEMENT 2008/09 Est 2008/09 Est 2009/10 Est. 2010/11 to Est to Est to Est 2009/ / /12 ' 000 ' 000 ' 000 Base Estimate 53,545 53,923 55,024 Revised Estimate 53,545 53,923 55,024 1 Budget brought forward from previous year Estimate - Total Requirements 53,342 53,923 55,024 2 RSG Changes - Transfer of responsibility Adjusted Estimate 53,342 53,923 55,024 3 Contribution to Capital Growth Inflation 1,189 1,065 1,092 6 Other increased costs Efficiency Savings -1, Contribution to balances Internal charges Asset Rentals Switches Estimate 53,923 55,024 56,167 Increased/(Decreased) Requirements 378 1,101 1,143 Page 52

9 CAPITAL Detailed below are schemes approved as part of the 2009/10 capital programme and provisional budgets for future years. Scheme Description Objectives Budget 2009/10 ' 000 Social Care - Upgrade facilities Mental Health Ring fenced Capital to support services to adults with community care needs Comprises various elements to improve access to services and develop socially inclusive projects Expenditure for An additional supported IT Infrastructure borrowing allocation has been granted specifically for IT. To support Adult Care in the delivery of services to vulnerable adult groups Improve Social Inclusion of People with Mental Health problems To support the IT infrastructure within the Adult Care service. Budget 2010/11 ' 000 Budget 2011/12 ' Total Page 53

10 MANAGEMENT AND GENERAL SUPPORT Description of the Service In March 2008, following the loss of a star, an Interim Director of Adult social Services was appointed. At the same time a member of the Senior Management Team (SMT) became Interim Head of Operations and an external appointment was made to Head of Transformation to lead on the introduction of the Personalisation Agenda. This division comprises of SMT and their administrative support. The senior team is responsible for the operational management of all services provided by Adult Care The senior team is responsible for commissioning services, including joint commissioning with other services / agencies, where appropriate or necessary The senior team is responsible for the strategic planning of services The senior team incorporates the team responsible for the learning & development needs of the Adult Care service and also provides the learning & development activities of Children s services. Budgetary Issues and Financial Risks for the Service over the period 2009/ /12 The issues facing the senior management team are as described in the overall service commentary, i.e.: Following Value for Money reviews of the service, a Modernisation Programme will deliver service improvements and greater efficiency over the next three years. The programme comprises a number of key projects which are geared to improvements in the following areas: Home Support Services Management of contracts with service providers Monitoring of contracts with providers, including enhanced technological solutions Extra Care Housing Expensive care placements The application of eligibility criteria for the funding of social and health care responsibilities Services to people with Learning Disabilities Development of wider use of assistive technology The learning and development services are supported by grant which from 2008/9 becomes part of the ABGs, the impact of this change and the effect on the Adult Care Service is not yet known. Key Improvement activities over the period 2009/ /12 As above, the senior team s key activities are as described in the overall service commentary, namely: The next three years will see improvements in the following areas (some of which are directly linked to the Modernisation Programme outlined above) and which address areas of growing demand and high levels of spending: Introduction of the personalisation agenda by March 2011 there must be 1980 service users in receipt of Individual Budgets Transformation of home support services centred on short term intensive re-enablement approach which will promote independence Development of extra care housing for older people within the Councils Housing Strategy for Older People Improved commissioning and contracting of services with a range of providers which will deliver better outcomes for service users and carers Enhanced integration with the NHS where it can improve services for users and carers, including joint commissioning of services Reduction in waiting times for assessment & review of needs Further growth in use of direct payments and individual budgets Increasing socially inclusive outcomes for service users and carers, including successful implementation of the Partnerships for Older People Project pilot Continued development of mental health services in partnership with the NHS Page 54

11 Monitoring of new contracts for supported living in Learning Disabilities services and improved value for money across other Learning Disability services, for example day and employment services MANAGEMENT AND GENERAL SUPPORT 2008/ / / /12 REVISED ORIGINAL ORIGINAL ORIGINAL ESTIMATE ESTIMATE ESTIMATE ESTIMATE ' 000 ' 000 ' 000 ' 000 Functions provided by Service 632 Management and General Support Net cost of providing services to the Public Types of Expenditure 1,957 Employees and related expenses 1,988 2,023 2, Premises related expenses Transport related expenses Supplies and services Agency and contracted services ,508 Central departmental and support services 2,612 2,656 2,674 0 Capital financing ,165 Less internal service departmental recharges 4,165 4,165 4,165 3 Contribution to/-from a reserve Income 0 Grants - Government and other Rents, Fees & Charges Net cost of providing services to the Public Page 55

12 COMMISSIONING SERVICES Description of the Service This area of service includes: Senior commissioning staff to ensure the process of identifying planning and securing the availability, quality, fairness and value for money care and support needs across the range of service user groups, either by direct management or through agreement with other organisations. Commissioning/Contract Management/Monitoring staff who commission, implement contracts or monitor the appropriateness and quality of services procured by in-house, the third sector or from independent providers. Senior Commissioning Managers are responsible for identifying the care and support needs of the client base and for ensuring that service user outcomes are met through robust, value for money contracts that are appropriately managed and monitored. The areas of service for which services are commissioned are Older People, Physical and Sensory Impairment, Learning Disabilities and Mental Health (including drug and alcohol services). Wherever it is appropriate commissioning managers will work jointly with colleagues in the Primary Care Trust (PCT) to improve outcomes for service users and carers who need both social care and health services. Budgetary Issues and Financial Risks for the Service over the period 2009/ /12 The commissioning service plays a major part in delivering the modernisation programme, in respect of ensuring that services continue to develop their capacity to meet needs, and in relation to improved contract management and monitoring, thus contributing to the achievement of improved Value for Money. Key risks emanate from cost pressures from external providers, the growing demand for services and the development of new ways of arranging services, particularly individual budgets and direct payments. Robust quality and contract monitoring is required to ensure that services are of a good quality and are delivered within budget parameters. The level of funding available through joint commissioning of services with the NHS and the impact of the application of Continuing Health Criteria (CHC) present risks due to a degree of uncertainty and unpredictability. Key Improvement activities over the period 2009/ /12 Home Support Services specification of services and ways of working Management of Contracts with service providers Monitoring of contracts with providers, including enhanced technological solutions Extra Care Housing specification of services and planning development over next 4 years Expensive care placements re-negotiation of contracts following needs review, and development of local solutions where appropriate Page 56

13 COMMISSIONING SERVICES 2008/ / / /12 REVISED ORIGINAL ORIGINAL ORIGINAL ESTIMATE ESTIMATE ESTIMATE ESTIMATE ' 000 ' 000 ' 000 ' 000 Functions provided by Service 1,015 Commissioning Services 1,065 1,075 1,091 1,015 Net cost of providing services to the Public 1,065 1,075 1,091 Types of Expenditure 514 Employees and related expenses Premises related expenses Transport related expenses Supplies and services Agency and contracted services Central departmental and support services Capital financing Less internal service departmental recharges Contribution to/-from a reserve Income 0 Grants - Government and other Rents, Fees & Charges ,015 Net cost of providing services to the Public 1,065 1,075 1,091 Page 57

14 SOCIAL INCLUSION BUSINESS UNIT Description of the Service The Social Inclusion Unit (SIU) provides support to disabled people and carers in different ways from more traditional approaches. It adopts a person centred approach to identify barriers to inclusion for vulnerable adults, and provides support to engage in education, employment and other independent living activities. The service also provides community-based rehabilitation to people with neurological damage, for example following stroke. SIU also developed the Carers Service which achieved Beacon Status in 2005/6, and the empowering, socially inclusive approach at the heart of this was applied to the successful submission for the POPPs pilot. The service leads on the development of Direct Payments, an alternative to the conventional way of arranging services for people with care needs. This will be subsumed in the development of Individual Budgets, part of the move towards self-directed care and the greater empowerment, choice and control for service users and their carers. The areas of service provided are: The Carers Resource Rochdale Employment Development Service (REDS) Rochdale Learning Network Moving On Direct Payments support The service is characterised by strong partnership working with other services and agencies, including Learners and Young People, Policy and Regeneration, Department of Work and Pensions, PCT and Pennine Care, and voluntary and community sector organisations. SIU makes a significant contribution to corporate activities / objectives particularly in relation to meeting the Equality Standards, and targets related to disabled people and employment. Budgetary Issues and Financial Risks for the Service over the period 2009/ /12 SIU developments have been largely dependent on external funding, all of which is time limited, and this causes great uncertainty in terms of long-term viability of activities. The socially inclusive / empowering approach is a model now being replicated in national policy, for example in the White Paper Our Health Our Care Our Say, and is inherent on the POPPs pilot. As the latter progresses and tests out the application of this kind of model to older people, the learning to other groups can be evaluated and may inform a wider shift of mainstream budgets to the Social Inclusion Business Unit model. Similarly, the integration of learning and employment is a model that is expected to be adopted nationally from 2010 with the development of the Foundation Learning Tier. The predominant risk is the uncertainty or loss of external funding. The Carers grant became part of the ABGs in and the impact of this change is not yet known. There will also be significant changes to LSC funding in the next year or two. If grant funding is reduced mainstream funding would need to be made available to ensure the continuation of the service s innovative approach. Key Improvement activities over the period 2009/ /12 Continued access to external funding to support activities Meet the Local Area Agreement stretch target (for people on incapacity benefit entering employment) Sustained development of the Carers Resource and numbers of carers accessing services Contribute to performance requirements (e.g. NI130, NI135) Increased number of Direct Payment recipients, and development of individual budgets Engagement in POPPs pilot to evaluate applicability to all user groups To take lead on commissioning services for people of working age with physical/sensory impairment Page 58

15 SOCIAL INCLUSION BUSINESS UNIT 2008/ / / /12 REVISED ORIGINAL ORIGINAL ORIGINAL ESTIMATE ESTIMATE ESTIMATE ESTIMATE ' 000 ' 000 ' 000 ' 000 Functions provided by Service 1,832 Social Inclusion Business Unit 1,763 1,811 1,860 1,832 Net cost of providing services to the Public 1,763 1,811 1,860 Types of Expenditure 1,120 Employees and related expenses 1,044 1,071 1, Premises related expenses Transport related expenses Supplies and services Agency and contracted services Central departmental and support services Capital financing Less internal service departmental recharges Contribution to/-from a reserve Income 14 Grants - Government and other Rents, Fees & Charges ,832 Net cost of providing services to the Public 1,763 1,811 1,860 Page 59

16 OLDER PERSONS AND PHYSICAL AND SENSORY SERVICES Description of the Service This area of service aims to promote the independence of older people and adults with physical disabilities and sensory impairments. This is done through a range of services including providing easily accessible information so potential users of services and their carers can make informed choices assessment and care management services that assist people in identifying their needs encouraging those who are eligible to use Direct Payments or Individual Budgets ensuring the successful discharge of those in hospital providing equipment and adaptations to support people to continue living in their own homes installing community alarms and assistive technology into people's homes day time activities extra care housing services to support carers such as respite care long term residential and nursing home care for those it is no longer possible to support at home Partnerships with the NHS exist to improve outcomes for service users and their carers, including: Intermediate care and rehabilitation including use of the Council s two rehabilitation centres Single line management of intermediate care and hospital discharge services An Integrated Community Equipment Service (ICEs) managed by the local authority Integrated specialist teams for older people with mental health problems ( MERITs ) Budgetary Issues and Financial Risks for the Service over the period 2009/ /12 It is estimated that the demand for services to older people will increase by 3% every year for the next 20 years. This together with rising public expectation about the quality of services presents a real financial risk to public services generally and Adult Care in particular. The rising demand for support at home, supporting the national policy direction, has presented severe financial challenges and overspending has resulted in particular in relation to independent home care. Setting fee levels for residential and nursing care will remain an issue with introducing incentives for improved quality. In a reducing market for this care, budget setting will include how this can be achieved. The VFM review concluded that home care services provided relatively poor value for money, and this is being addressed as a priority as part of the Modernisation Programme. The nature and scale of changes required presents a challenge in terms of sustaining services and meeting new demand whilst the changes required are put in place over the next 12 months. The low level of extra care housing will be addressed and care will be needed to ensure that it is targeted correctly to shift spending from residential care. In relation to physically and sensory impaired people, rising demand for equipment and adaptations remains a challenge to ensure independence is not undermined by delays / lack of funding, whilst the low level of supported housing for disabled people remains a challenge and development priority. This area is piloting self-assessment to improve choice and control for users and carers. Our success in being awarded pilot status for the Partnerships for Older People Projects will be used to test new ways of working which will have an impact on how future funding will be deployed. A major service inspection was undertaken in 2007 by the Commission for Care Inspection, and the Action Plan addressing its recommendations includes improved quality assurance, contract monitoring and developing self-directed care. Page 60

17 Risks in this area emanate from high and to some extent unpredictable levels of demand, the impact of new ways of working, for example re-ablement and individual budgets and upward cost pressures regarding fees and quality of care issues. The risks associated with the Modernisation Programme are most relevant to this area of service. The uncertain impact of the application of CHC criteria is a major risk factor, whilst delivery of improvements may have resource implications subject to value for money gains being the first priority. This service area includes funding from the preserved rights grant which from 2008/9 becomes part of the ABGs, the impact of this change on Adult Care Services is not yet known. Key Improvement activities over the period 2009/ /12 Deliver the changes in Home Support, to put in place a short term, intensive re-ablement service Embed self-directed care including Direct Payments in our approach and focus on improved outcomes for users and carers Deliver the extra care housing project, in partnership with the Strategic Housing service, and increase supported housing for disabled people of working age Improve contracts and monitoring in respect of external suppliers, particularly home care, in line with changes to in-house services (within the modernisation programme) Development of integration/partnership with NHS & others to improve outcomes for users and carers. Develop partnership with the PCT to increase funding to equipment services Develop use of assistive technology through use of the relevant grant and to mainstream thereafter Achieve appropriate fee levels for care homes, including incentives / rewards for high quality & ensure general improvement in quality of care homes for older people Improve performance in respect of reviews and sustain good performance across other indicators Page 61

18 Page 62

19 OLDER PERSONS AND PHYSICAL AND SENSORY SERVICES 2008/ / / /12 REVISED ORIGINAL ORIGINAL ORIGINAL ESTIMATE ESTIMATE ESTIMATE ESTIMATE ' 000 ' 000 ' 000 ' 000 Functions provided by Service 1,202 Management 1,212 1,240 1,247 2,684 Older Persons Assessment Services 2,735 2,798 2,863 1,762 Physical & Sensory Asses & Equip Services 1,804 1,842 1,860 3,890 Resource Centres 4,061 4,124 4, Day Services ,818 Home Support 1,155 1,141 1,129 2,245 STARS 2,367 2,402 2,449 0 Modernisation ,851 Externally Provided Services 17,862 18,173 18, Transport Services Careline Services Services Supported by Grant ,846 Net cost of providing services to the Public 32,824 33,319 33,875 Types of Expenditure ,123 Employees and related expenses 10,494 10,689 10, Premises related expenses 973 1,000 1, Transport related expenses Supplies and services 1,714 2,725 3,368 19,597 Agency and contracted services 18,653 17,945 16,831 2,701 Central departmental and support services 2,701 2,701 2,701 0 Capital financing Less internal service departmental recharges Contribution to/-from a reserve Income 379 Grants - Government and other 885 1, ,188 Rents, Fees & Charges 1,525 1,381 1,379 32,846 Net cost of providing services to the Public 32,824 33,319 33,875 Page 63

20 MENTAL HEALTH SERVICES Description of the Service This area of service provides care and support to people with serious mental health or drug and alcohol problems through a range of services, including: Assessment and care management Social work & community support Day time therapeutic activities Outreach to people who have difficulty accessing services Supported living services through supported tenancies Respite care services Residential care Residential & community de-toxification programmes Voluntary sector advice & support services Support back into training and employment The service is characterised by strong partnership working, particularly with the NHS, in two main ways. Firstly, services are commissioned jointly with the Heywood, Middleton and Rochdale Primary Care Trust to ensure that health and social care needs are met in as seamless a way as possible. Secondly, provision of services is managed through the Pennine Care Mental Health Trust via single line management of its own staff and those of the local authority under the auspices of a formal Section 75 agreement. Budgetary Issues and Financial Risks for the Service over the period 2009/ /12 There has been an historic under investment in Mental Health services in the borough, and efforts to address that legacy have pre-dominated over recent years. Joint commissioning arrangements have improved the position significantly and increased investment has been evidenced through the PCT s local delivery plan, informed and influenced by the Local Implementation Team (which is charged with delivering the national policy requirements for mental health). Sustaining further development of services will be the key challenge over the next three years in the context of significant pressures facing health and local authority budgets. An increasing spend on agency placements, i.e. specialist residential placements, has also put additional pressure on the service budget. Risks in this area stem from new legislation, particularly the Mental Capacity Act as well as the application of CHC criteria. Demand can be somewhat unpredictable and there is sometimes a need for expensive specialist placements which may not be eligible for Continuing Health Care funding. This area of service includes the mental health grant and the preserved rights grant which from 2008/9 become part of the ABGs, the impact of the change on Adult Care services is not yet known. Key Improvement activities over the period 2009/ /12 Continued improvement to meet national policy requirements, e.g. full implementation of crisis resolution teams Ensure improved outcomes for users and carers are clearly identified and evidenced Meet requirements of new Mental Health Bill Meet performance requirements, e.g. assessment and review targets, carers services and drug and alcohol treatment targets Monitor and develop impact of and outcomes from partnership with Pennine Care to ensure the arrangement continues to realise improvements Address agency placements and increased spending via modernisation programme and develop more cost-effective local solutions Page 64

21 MENTAL HEALTH SERVICES 2008/ / / /12 REVISED ORIGINAL ORIGINAL ORIGINAL ESTIMATE ESTIMATE ESTIMATE ESTIMATE ' 000 ' 000 ' 000 ' 000 Functions provided by Service 234 Management Assessment Services ,340 Externally Provided Services 1,368 1,394 1, Day and Therapeutic Services Supported Living ,068 Services Supported by Mental Health Grant 1,128 1,161 1, Drugs and Alcohol Services ,669 Net cost of providing services to the Public 4,817 4,927 5,027 Types of Expenditure 2,826 Employees and related expenses 2,907 2,982 3, Premises related expenses Transport related expenses Supplies and services ,663 Agency and contracted services 1,700 1,736 1, Central departmental and support services Capital financing Less internal service departmental recharges Contribution to/-from a reserve Income 0 Grants - Government and other Rents, Fees & Charges ,669 Net cost of providing services to the Public 4,817 4,927 5,027 Page 65

22 LEARNING DISABILITY SERVICES RMBC FUNDED Description of the Service The council s in-house services for adults with learning disabilities are purchased by the pooled budget. The areas of service are: The Community Support Team (supported living service): provides 24 hour staffing to houses where service users live as tenants throughout the borough, and is registered with CSCI as a domiciliary service Day services: providing day time support and community based activities in dispersed settings in Rochdale, Pennines and Heywood (the Middleton area service was subject to market testing and transferred to an external provider from 1 April 2006) Respite Care provided at Hareland House, this offers respite care for up to 5 people at any one time, and is registered with CSCI as a residential care home Adult Placement Service: vets and approves carers who offer supported board and lodging to people with learning disabilities Assessment and Care Management Team: undertakes assessment / review of service users and carers needs on which care plans are based to meet identified need. Budgetary Issues and Financial Risks for the Service over the period 2009/ /12 Rising demand from an increasing population of people with learning disabilities has created very severe financial pressures on the budget. The re-commissioning of supported living services completed in 2007 resulted in a successful in-house bid, and a larger Community Support Team is now in place. Challenging efficiency targets are in place, particularly to meet the requirements of the reduced Supporting People grant. Other efficiency gains are required to maintain and develop services whilst bridging the funding gap faced by the Pooled Budget. The rising demand for services, particularly for profoundly disabled people making the transition from education to adult services, presents major risks in relation to ensuring that budget provision is adequate and expenditure is contained within budget limits. This area of service is particularly susceptible to reductions in Supporting People grant funding. The risks associated with the application of Continuing Health Care criteria are also relevant, and the high cost nature of services remains a significant factor. Key Improvement activities over the period 2009/ /12 Respond to the re-commissioning (i.e. market testing) of services where appropriate Continue to maintain or improve services and meet regulatory requirements Maximise capacity within existing services Ensure that the care management team meets performance requirements for assessments and reviews, and is fully integrated with the NHS community team Reduce expensive out of borough placements and make best use of local services Contract management and monitoring of all contracts with external providers Service redesign programme to ensure best value Page 66

23 LEARNING DISABILITY SERVICES RMBC FUNDED 2008/ / / /12 REVISED ORIGINAL ORIGINAL ORIGINAL ESTIMATE ESTIMATE ESTIMATE ESTIMATE ' 000 ' 000 ' 000 ' 000 Functions provided by Service RMBC Internal Provider Services 2,242 Supported Living 2,272 2,330 2,383 3,436 Day Services 3,202 3,186 3, Other ,980 Contribution to other (non RMBC Provider) 6,263 6,553 6,853 12,551 Net cost of providing services to the Public 12,642 12,990 13,338 Types of Expenditure 5,082 Employees and related expenses 5,120 5,248 5, Premises related expenses Transport related expenses Supplies and services ,599 Agency and contracted services 6,825 7,127 7, Central departmental and support services Capital financing Less internal service departmental recharges Contribution to/-from a reserve Income 0 Grants - Government and other Rents, Fees & Charges ,551 Net cost of providing services to the Public 12,642 12,990 13,338 Page 67

24 LEARNING DISABILITIES POOLED BUDGET Description of the Service The funding for adults with learning disabilities, provided by RMBC and Heywood, Middleton and Rochdale PCT, is managed as one pooled budget. The pooled budget was created under Section 31 of the Health Act 1999, which introduced new flexibilities for local authorities and the NHS to support different ways of working where there is a common purpose. The pooled budget, managed by the RMBC as the lead agency, is an integrated commissioning budget. The budget purchases a range of services from a range of statutory and independent providers, including: Advocacy Assessment and Care management Carers Payments Community living services (supported tenancies usually with 24 hour staffing) Day & employment services Home Care Residential Respite care Specialist Psychology and Psychiatric Services RMBC s contribution to the Learning Disability Pooled Budget is included within Adult Care s expenditure budgets. Budgetary Issues and Financial Risks for the Service over the period 2009/ /12 Rising demand from an increasing population of people with learning disabilities has created very severe financial pressures on the budget. Combined with the high cost of services, this has led the LD Partnership Board to embark on a re-commissioning programme, which will continue to be the key issue over the next three years. An integral part of this will be the detailed assessment of the Value For Money for each of the services provided which will determine the prioritization of any re-commissioning activity that might take place, as issues become clearer, they will be reported through normal budget monitoring procedures. A government directive to transfer social care funding from the local NHS to the LA in 2009/10 onwards will effectively mean that the pooled budget will not continue from 2009/10; however, joint commissioning protocols will continue and health & social care LD budgets will be operated on an aligned basis. The impact of new Continuing Health Care (CHC) guidance may also impact on the LD Pooled Budget. A three year commissioning strategy is now being implemented, including value for money initiatives, and under-achievement of efficiencies is a risk. Key Improvement activities over the period 2009/ /12 Monitoring the outcomes from the re-commissioning of the Supported Living Service. Consideration of other service areas to determine whether re-commissioning is appropriate based outcomes from Value for Money activity across the service. Ensuring that services maintain or improve quality and meet regulatory requirements Ensure that services are available at the right capacity to meet existing and new needs Page 68

25 LEARNING DISABILITY POOLED BUDGET 2008/ / / /12 REVISED ORIGINAL ORIGINAL ORIGINAL ESTIMATE ESTIMATE ESTIMATE ESTIMATE ' 000 ' 000 ' 000 ' 000 Functions provided by Service 612 Care & Assessment Management Team ,198 4,338 Block Contracts 4,425 4,513 4,604 18,943 External Placements 18,940 18,958 19,060-23,893 Cont from Funding Partners/Other Income -24,215-24,316-24,862 0 Net cost of providing services to the Public Types of Expenditure 566 Employees and related expenses Premises related expenses Transport related expenses Supplies and services ,076 Agency and contracted services 23,163 23,261 23,447 0 Central departmental and support services Capital financing Less internal service departmental recharges Contribution to/-from a reserve Income 0 Grants - Government and other ,893 Rents, Fees & Charges & Contributions from Partners 24,215 24,317 24,861 0 Net cost of providing services to the Public Page 69

26 CARE & ASSESMENT MANAGEMENT TEAM Description of the Service The costs associated with the Commissioning Manager and his team are held within this Area of Service. Budgetary Issues and Financial Risks for the Service over the period 2009/ /12 The ever increasing number of service users meeting the current criteria for services supplied by the LD Pool is creating further pressures on the Care & Assessment Management Team. In addition detailed work on Value for Money and potential re-commissioning of services will create further pressures on the team. These issues have been addressed within the 3 year commissioning strategy which includes a number of invest to save initiatives. Key Improvement activities over the period 2009/ /12 Develop services that promote independence, choice & control in line with the personalisation agenda. Lead role in undertaking Value for Money Assessments of all services provided by the LD Pool. Lead role in the consideration of other service areas to determine whether re-commissioning is appropriate based outcomes from Value for Money activity across the service. Lead role in ensuring that services maintain or improve quality and meet regulatory requirements Lead role in ensuring that services are available at the right capacity to meet existing and new needs Page 70

27 BLOCK CONTRACTS Description of the Service Block Contracts are held with RMBC and H,M&R PCT for the provision of the following services :- Day Care Respite Care & Assessment Teams Adult Placement Budgetary Issues and Financial Risks for the Service over the period 2009/ /12 The ever increasing number of service users meeting the current criteria for services supplied by the LD Pool is creating further pressures on the LD Pool and it is therefore imperative that the LD Pool ensures it gains maximum benefit from the block contracts. These contracts will therefore be subject to Value for Money Assessments in the pursuit of this goal. This alongside work to ensure contracts are fit for purpose in terms of the personalisation agenda. Key Improvement activities over the period 2009/ /12 Undertaking Value for Money Assessments of all services provided through the Block Contracts. Ensure that services maintain or improve quality and meet regulatory requirements Ensure that services are available at the right capacity to meet existing and new needs Page 71

28 EXTERNAL PLACEMENTS Description of the Service Services are procured with external providers / carers for a variety of services covering :- Advocacy Carers payments Community living services (supported tenancies usually with 24 hour staffing) Day Care Home Care Residential Care Respite Care Specialist Psychology / Psychiatric Services Budgetary Issues and Financial Risks for the Service over the period 2009/ /12 The ever increasing number of service users meeting the current criteria for services supplied by the LD Pool is creating further pressures on the External Placements area of service and as a result this area will also be subject to rigorous Value for Money Assessments. Key Improvement activities over the period 2009/ /12 Undertaking Value for Money Assessments of all services provided through the External Placements. Ensure that services maintain or improve quality and meet regulatory requirements Ensure that services are available at the right capacity to meet existing and new needs Page 72

29 CONTRIBUTION FROM FUNDING PARTNERS / OTHER INCOME Description of the Service Income for the LD Pool received from a variety of different sources :- Funding from Funding Partners RMBC and Heywood, Middleton and Rochdale PCT Preserved Rights Grant Client Contributions Supporting People Grant (for the Supported Living Contract) Miscellaneous contributions from other LA s / PCTs for specific service users Interest on Balances Budgetary Issues and Financial Risks for the Service over the period 2009/ /12 It is imperative that all income streams are maximized as the ever increasing numbers of service users requiring services is creating budget pressures on the services. Key Improvement activities over the period 2009/ /12 Maximise all income streams. Look for any other relevant income streams that could be used to supplement current funding streams. Page 73

30 Page 74