Minutes:
(1) This report provided details of the proposed transfer of funding for all social services for people with learning disabilities currently living in NHS accommodation in Kent.
(2) Mr Gibbens said that the purpose of the report was to advise Cabinet on some of the detailed work which had been undertaken since the report to Cabinet at its meeting in March 2008. This report was not seeking at this time confirmation that the transfer should go ahead as there was still a considerable amount of work to be done to resolve some outstanding issues. The report detailed the risks attached to the project, both with continuing and ceasing with the current arrangements. The report outlined the mitigation processes which were in place and showed that the risks of ceasing with the current arrangements were greater than those for continuing. The report did however ask for Cabinet’s agreement for some specific tasks and work streams to continue so that work to sustain momentum in improving service quality could continue.
(3) The report also asked for the County Council to accept and manage a capital grant of £6m, on behalf of the PCT’s, subject to certain assurances from the Department of Health. Without this agreement, Mr Gibbens said there was a very real risk that some or not all of this capital grant would have to be returned to Government which would be to the detriment of the programme and leave both the County Council and the PCT’s without the resources to improve the quality of the stock. The report also proposed that the Government should commission actuarial research to look at the long term demographics and cost of support for all people with learning difficulties (not jut those transferring from the NHS). Mr Gibbens concluded by saying that with the support of the PCT’s he commended the recommendations set out in the report for adoption by Cabinet. He also placed on record his thanks to the Chief Executives of the two NHS Trusts in Kent for their co-operation and engagement in this work which he said was an excellent example of the good partnership work which existed between KCC and the PCT’s.
(4) Mr Leidecker said that this report built on the earlier ambitious programme which the County Council agreed in 2002 to work in collaboration with the PCT’s and to more closely integrate health and social care provision through the pooling of budgets. The Government’s intention was to transfer the funds for supporting people with learning disabilities from the Health Service to local Government, confirmed earlier developments whereby local Government had taken the lead commissioning responsibility for learning difficulties. These earlier developments meant that KCC had in fact been managing integrated teams, for learning disability services since 2004. Miss Highwood referred to paragraph 9 of the report which commented in detail on the risks and mitigation that such a major policy change would bring. She said that it was acknowledged the financial risks were large, both immediately and after April 2011 and the immediate mitigation strategy was to ensure that the Section 256 Agreement that would need to be completed under the National Health Service Act 2006 was robust and fully protected the County Council’s interests. The discussions currently under way at the strategic level meant there would be sustained and robust lobbying undertaken to ensure that whatever in respect of these proposals full and proper regard was made as to the true costs of the service. The clarity of costing achieved through the Section 256 Agreement prior to April 2011 would facilitate that and would enable a robust response to be submitted to the Department of Health when it consulted on the proposed allocations.
(5) Mr Lynes expressed concern that once the agreements and contracts had been signed, then the County Council would be committed to providing this service with all the financial risks that that could entail. Whilst he was confident that KASS Officers had sought to mitigate the detrimental effects of the transfer as far as possible, and the transfer should proceed as planned, he believed the County Council should consider commissioning its own survey of the possible consequences of proceeding and for that work to possibly be undertaken jointly with some of the County Council’s neighbouring authorities. Mr Marsh also spoke about the financial risks and the need for the County Council to be clear as to the ongoing capital costs associated with maintenance and refurbishment.
(6) Miss Sutton said that this was an important priority for the PCT’s who needed to do all they could together with the County Council to make this was an open and transparent process. Mr Meikle said that the PCT’s had looked at the proposal in great detail and the capital programme had been developed around need. Mr Gilroy said that he believed it was right for the County Council to take over these responsibilities and he therefore generally therefore supported the thrust of what was being proposed. However, he was also concerned to ensure that the financial risks had been fully explored and therefore supported the undertaking of a dedicated piece of work in collaboration with the County Council’s PCT colleagues.
(7) Mr Carter concluded the discussion by saying before any contracts and agreements were signed, he wanted there to be complete clarity as to what the County Council’s on going financial responsibilities would be if it was to take over fully the provision of this service.
(8) Mr Carter said that it was essential that the County Council looked at these proposals in great detail and did everything it could in order to minimize any risk. He said he wished the Director of Law and Governance to look at the detail of any agreement on contracts to be entered into by the County Council under Section 256 to ensure that they were sound and robust. He also wanted the County Council’s audit team to examine the financial records and accounting processes to equally make sure that these were in good order. He said he agreed with Mr Lynes that the County Council needed an actuary report about the long term demands and potential financial risks. He said only when that information was to hand should the County Council consider proceeding with these proposals.
(9) Subject to the caviats outlined in the above paragraph and in particular the commissioning of a report on the Medium Term financial outlook and impact on the County Council’s social care budget should these proposals be proceeded with, Cabinet agreed as follows:-
(i) to agree that a progress report, based on this Cabinet paper, should be sent to Department of Health
(ii) To agree that Kent Adult Social Services should continue to lobby the Department of Health, directly and through the LGA, ADASS and CIPFA, to ensure that the risks identified in this report are mitigated as far as is possible.
(iii) to agree to manage the newly let care contracts on a temporary basis, on behalf of the NHS
(iv) to agree to receive and manage the capital grant on behalf of the PCTs, provided DH gives assurances on the issue of the obligation, and that therefore a way can be found to mitigate the risks of under funding
(v) to agree to propose to the Department of Health and LGA that a review is commissioned to identify future demands for social care support for adults with a learning disability and the costs, similar to the ‘Securing the Good Care of Older People’ review commissioned by the Kings Fund in 2006, with recommendations as to how these can be best addressed
(vi) to agree that once the outstanding issues identified above have been satisfactorily resolved, a further report should be brought to Cabinet, setting out the numbers and costs, and confirming a decision for the transfer to proceed as planned.