Apologies were received from Mrs T Huffer and Mr D Minnery.  Mr R Evans substituted for Mrs Huffer. 

There were no disclosable pecuniary interests. 

To confirm the minutes of the meeting held on 16 November 2015, attached marked:  3

The Minutes of the meeting held on 16 November 2015 were confirmed as a correct record.

To receive any statements, questions or petitions of which members of the public have given notice.  Deadline for notification is 5.00 pm on Wednesday 9 December 2015

There were no questions from members of the public.

To receive any questions, statements or petitions of which Members of the Council have given notice.  Deadline for notification is 5.00 pm on Wednesday 9 December 2015.

There were no questions from Members of the Council.

Brigid Stacey, Acting Accountable Officer, and Donna McGrath, Chief Finance Officer, will attend the meeting to explain the current financial status of the CCG, provide a presentation on financial recovery and answer questions, so that the Committee is able to understand any implications for health and social care in Shropshire.

Donna McGrath, Chief Finance Officer, Shropshire Clinical Commissioning Group, was welcomed to the meeting. She explained that Brigid Stacey, Acting Accountable Officer, was unable to attend the meeting as she was due to meet the Turn Around Team which was about to commence its work.

She gave a presentation entitled ‘Explaining Shropshire CCG Finances’. The presentation covered:

·       The forecast deficit for 2015/16

·       The main causes of the deficit

·       The underlying position

·       Actions in place to control expenditure in year

·       What this would mean for 2016/17 planning round

·       The CCG approach to 2016/17

She explained that the year had started with a plan to deliver a £3.6 million surplus and that this had been recognised as high risk both by the CCG and by NHS England.  The CCG had overspent against three key lines of expenditure: Continued Health Care; Acute Contracts, and preparing for turnaround and winter. This had created a deficit of £7.9 m, which was £11.5 m adverse to the 2015/16 plan. This was a change from the widely publicised £10.6 m deficit caused, largely, by preparing for financial turnaround.  It was confirmed that the total budget was

£350 m.

In discussion of the main causes of the deficit, Members asked about the invoices for Continuing Health Care totalling £2.2m relating to 2014/15, and why they had not been known about and factored in.   The Chief Finance Officer explained that there was variability in invoice timing and sometimes decisions were made after the care had been delivered. External advice received had suggested that the CCG had been paying for patients that it should not have been paying for, but this advice had turned out to be not as realistic and legally sound as it could have been.

Members referred to £9m of unexpected costs incurred during the year and asked about the likelihood of this happening again the following year. The unexpected costs related to £4.4m Continuing Health Care and £6m of unplanned costs. Members also referred to Telford and Wrekin CCG which was predicting a surplus and asked why there was such a difference between the two CCGs.

The Chief Finance Officer explained that Telford and Wrekin CCG were advantaged by the Fair Share Target and had received extra funding in November and an uplift which Shropshire had not. If it was funded in the same way as Telford and Wrekin CCG, Shropshire CCG would be £8m better off.

Members asked why Telford and Wrekin had received this uplift but not Shropshire. They learnt that it had been around five years since the last calculation was made. Last year Telford and Wrekin had been deemed to be underfunded, but Shropshire CCG deemed to be over target as the rurality adjustment had been removed.  The sparsity adjustment currently only applied to four areas in the country.

The Chairman enquired about brokerage, NHS England had approved the CCG obtaining loans from other organisations to achieve a 1% surplus. Not all of this would be repayable, although £3.2m would need to  ...  view the full minutes text for item 41.

To consider what the Council has achieved, what challenges lie ahead and which areas will be the focus for improvement.  Report attached marked:  7

Members received the Shropshire Council Adult Social Care Local Account 2014 – 2015 (a copy is attached to the signed minutes).

The Committee was reminded that the Local Account was designed to demonstrate and describe performance in adult social care to local people, was designed to be user-focused and highlight the quality aspects of services provided, rather than numbers.

During discussion, Members asked questions and raised issues related to the following:

Telephone number for the First Point of Contact

Members commented positively on the success of the First Point of Contact.  It was confirmed that the telephone number for the FPOC was promoted on all adult social care publications and advertised in a variety of ways including through bulletins issued by Shropshire Association of Local Councils and Parish Magazines. 

Family Carers

A Member drew attention to the Focus on Carers page which showed that 66% of family carers said that they did not have enough control of their life.  Officers acknowledged that more could be done for carers. All carers services had recently been recommissioned and the Council would be working on developments with the NHS. The Carers Partnership Board was involved in considering what was needed.

Delayed transfers of care from hospital (for people aged 18+) attributable to adult social care

Members noted a deterioration in performance over the year and asked for the reasons for this. 

They heard that the national picture was also deteriorating for reasons including the increase in complexity of conditions of patients leaving hospital which often meant a significant package of domiciliary care was required.  In Shropshire this was often in very rural parts of the county.  A Member of the Committee remarked on the need for carers in rural areas to have access to satnav as some locations were very hard to find. 

Care particularly for hospital leavers had recently been commissioned and more was needed.  Recruitment to domiciliary care posts was discussed and work with schools, colleges and the Job Centre to encourage applications was underway. It was felt that more should be done nationally to recognise the work of those employed in social care and enhance training opportunities so that jobs were perceived in the same way as those in the health sector.

Members noted that a report covering hospital discharge delays would be considered at a meeting of the Joint Health Overview and Scrutiny Committee the following day.   It was also noted that 30.9% of national hospital discharge delays were related to social care.

Preventative Work

A Member asked where dementia fell within the primary support reasons listed on page 8 of the report. The Director explained that if the primary impact of dementia was the need for personal care support, that would be how a service user would be categorised.  The Council’s Social Care Information System was limited when it came to extracting information in other ways. 

Members also referred to other causes of mental confusion in older people, for example as a result of a urinary infection.  They  ...  view the full minutes text for item 42.

The Committee’s current work programme is attached for comment, marked 8

The Chairman reported that the CCG had requested an agenda item to brief the Committee on Non-Emergency Passenger Transport eligibility.  It was agreed to add this item to the 8 February meeting.

It was agreed to set up a small group of the Committee’s members to do a short piece of work to understand the Integrated Community Service and the different factors which impact on the service, and the level of activity, quality and impact of this service.  Councillors Dakin, Kidd, Moseley and Mullock volunteered to undertake this work.

The Committee agreed to a suggestion by the Head of Social Care Efficiency and Improvement that the agenda item on Support for Carers be added the work programme for October or shortly after then so that a new domiciliary contract would have been in place for six months.