Agenda item

ADULTS SERVICES CONTRACTS - UPDATE

Minutes:

The Sub-Committee received a briefing on Commissioning and Contract Management in Adult Social Care Contracts. The Deputy Chief Executive and Executive Director of Education, Care and Health Services, Ade Adetosoye, attended the meeting accompanied by Paul Feven, Interim Director of Programmes and Tricia Wennell, Head of Assessment and Care Management. 

 

A new Division had been set up headed by Paul Feven to work out, with the CCG, how to get best value for the “Bromley pound” in a situation where it was necessary to meet rising demand for services with reducing resources. The Government was anticipating that partial integration would be achieved by 2020. A joint leadership team was already in place and staff had been appointed to three joint posts. There was a secure foundation of good relationships, and a shared desire to promote independence and improve critical services. Although there were still differences in culture and terminology, there were shared drivers. Members commented that this was a cogent approach, and it was important to have a proactive mind-set. 

 

The Council needed to establish a clear picture of the level of demand for services five to ten years ahead – this would help to shape the market with providers. The new departmental structures provided a clearer vision and focus and a firm platform for becoming a commissioning authority. Two members of staff from the Education, Care and Health Services Department had joined the Commissioning Board. The Executive Director assured the Sub-Committee that although the Secretary of State required him to focus on Children’s Services, he was, in addition, able to devote sufficient time to Adult’s Services, and that the Department had adequate resources.

 

It was explained that personal budgets were the sums allocated to provide care services for eligible people. Direct payments were one of the mechanisms people could choose to use to pay for their care needs. The proportion of people using direct payments in Bromley was around 26% - the aspiration was to increase this figure. Vibrance were contracted to work in the community assisting clients and building a register of Personal Assistants (PA’s); at present the market was not large enough and most people still preferred the Council to buy in their services from a framework. A business case was being developed for moving to a system where the default was to direct payments. Other local authorities in London appeared to have much higher levels of direct payments - as high as 50% - but there was not consistency about how these figures were arrived at and Bromley’s proportion represented true direct payments.

 

Members asked about how the Council checked that direct payments were used for the purposes intended. Officers confirmed that nearly all cases ran smoothly, and that there were rigorous and extensive checks carried out by both Care Services and Finance, including a detailed review within the first nine weeks, an annual review and mid-year reviews if monitoring data was not submitted. The PA’s themselves were the “eyes and ears” of Care Services. Staff were instructed to offer direct payments to all clients, and the Council could not refuse a request for direct payments. Officers were looking at what was putting people off direct payments; one issue was that carers could themselves be quite elderly and not confident about having the responsibility or dealing with the online monitoring. It was confirmed that in some circumstances, direct payments could be made to relatives.

 

Members asked about arrangements for increasing the value of contracts, and when variations would be triggered. This was down to brokerage, and drawing down from contracts, and monitoring was in place to prevent ceiling rates being exceeded. Spot purchases were also made where necessary. Sign-off was needed from five officers before a placement was made.    

 

The Chairman commented that it was important for the Care Services PDS Committee to be aware of the joint commissioning with the CCG, and to ensure that outcomes were acceptable to the Council.

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