Agenda item

6.1

The Committee received a joint presentation from Eugene Walker (Executive Director, Resources) and Greg Fell (Director of Public Health) on the current Council budget position, specifically with regard to health and social care services.  Also in attendance for this item were Councillor Olivia Blake (Cabinet Member for Finance), Councillor Chris Peace (Cabinet Adviser for Health and Social Care), John Doyle (Director of Business Strategy, People Services) and Eleanor Rutter (Consultant in Public Health).

6.2

Eugene Walker provided a summary of the overall position, highlighting the fact that the pressures reinforced by increased demand for health and social care represented one of the biggest issues facing this, and other Councils, for several years.  He stressed that the position was not sustainable in the long-term, and that it was almost certain that all Councils would run out of funding at some stage in the future.  Greg Fell reported on a number of imbalances in the local healthcare system, which included (a) higher rates of hospital admissions than other areas, (b) people spending too long in hospital; thereby having higher needs when they leave, (c) the increasing numbers of people being admitted to hospital, resulting in increasing numbers being discharged, thereby placing a rising demand for adult and social care services, (d) changes in the cohort of looked after children and an increase in out of city placements, resulting in a lack of ability to meet demand locally at times of crisis and (e) benchmarking showing that other health and social care systems elsewhere in the country were driving better use of resources, highlighting the need for the Sheffield system to be rebalanced. 

6.3

Eugene Walker referred to the Council’s present financial position, highlighting the current budget gap, service pressures from 2019/20 to 2022/23, the social care pressures in comparison to Government funding and a breakdown of social care pressures, indicating that such pressures were increasing faster than budget increases.  Mr. Walker also referred to the growing overspends, Clinical Commissioning Group (CCG) contributions and investments in respect of the Council’s social care costs, and referred to the Chancellor’s recent budget update.  Greg Fell concluded the presentation by reporting on what the budget pressures meant in practice for the Council, the next steps, focusing on the preferred approach of integrated commissioning a need to support localities and neighbourhoods to reduce avoidable emergency hospital admissions and a need for a comprehensive approach to prevention.

6.4

Councillor Chris Peace stated that the Council was now seeing the results of the huge budget cuts made to local government funding over the past eight years and the apparent lack of will from successive Governments to help meet the crisis being faced by local authorities.  She stated that, whilst the proposed changes with regard to integrated commissioning appeared ambitious, such changes were needed in order to sustain services in the long-term.

6.5

Councillor Olivia Blake stated that she was working very closely with Councillor Peace and relevant Council officers in terms of looking for a suitable solution.  She stressed that people needed to understand how badly the lack of Government funding had impacted on the Council’s ability to provide an effective social care service.

6.6

Members of the Committee raised questions, and the following responses were provided:-

·                 One of the main reasons as to why the system of having a single commissioning organisation, such as in Manchester, had been successful, was due to the level of Government funding provided.  It was hoped that Sheffield could develop and deliver a single commissioning plan to manage demand more effectively across the system, as well as ensuring a positive experience for users of health and care services across the City.

·                 It was considered that the extra demand in health and social care was not necessarily due to the aging population, but more to do with how ill people were.

·                 Joint commissioning was being pursued for Children’s as well as Adults’ Services, but the resource focus in the system was biased towards Adults.

·                 The reason why there were more hospital admissions in Sheffield than in other areas was believed to be simply due to the fact that we have two large hospitals, with more bed space.  In order to slow down the rate of hospital admissions, there was a need to create alternative provision.

·                 The Council and the CCG was constantly learning from good practice in terms of health care all over the world.  One example of good practice included Wigan, where £10m had been invested in voluntary and community sector organisations to look at, and deliver, alternative health provision, which was now resulting in financial benefits in terms of less hospital admissions.

·                 In terms of the provision of urgent care, the health system had dis-invested in out of hospital primary and community care, which had resulted in there being less capacity for people to be seen quickly which, in some cases, could result in people’s health deteriorating even further.

·                 The Better Care Fund was successful in that it had secured half the required budget savings at the time, but this had only been achieved through funding from the CCG.  It was accepted that the Council was the unviable element of the partnership and, if the Council was not able to provide services, this would have an adverse impact on acute care, thereby resulting in an increase in hospital admissions.  Bolton had already moved,  and Leeds was in the process of moving, away, from a health system of “payment by results”, which both areas considered purely a medium term financial saving.  It was imperative that the promised additional funding of £20bn from the Government was spent correctly, and for the benefit of the people of Sheffield.

·                 The purpose of the presentation was solely to provide an update in terms of the Council’s budget, and not the NHS budget.  Efforts would be made to arrange a meeting where officers of the CCG could attend, and update Members on the Group’s budget.

·                 With regard to Learning Disabilities pressures, a number of services/resources passed to the Council five/six years ago, therefore there was not as much NHS input as there used to be, apart from via Continuing Health Care packages.

·                 Although it had yet to be confirmed, there was a possibility that Sheffield could benefit from an additional, one-off payment of £7m in 2019/20, following the Government’s recent budget announcement.  Whilst this was welcomed, it was not deemed to be a long-term funding solution, and it was planned that it would be allocated towards prevention and home care.

·                 Mental Health Services had seen significant progress in a jointly commissioned approach to savings that had also included a three-way financial risk share, including the Provider Trust. As a result, a £4m overspend on a £6m budget around two/three years ago was now showing a much improved position. This was the kind of tripartite approach that was needed in the rest of the health and social care sector.

·                 The funding received from the Better Care Fund was still being allocated for the same purpose – prevention, which resulted in more money being sucked into acute care.

·                 It was accepted that reducing hospital admissions by just 15% would make a huge difference to the Council’s adult social care budget position. 

6.7

RESOLVED: That the Committee:-

(a)      notes the information reported as part of the presentation, together with the responses to the questions raised;

(b)      thanks Councillors Olivia Blake and Chris Peace and Eugene Walker, Greg Fell, John Doyle and Eleanor Rutter for attending the meeting, and responding to the questions raised; and

(c)      requests the Policy and Improvement Officer (Emily Standbrook-Shaw) to arrange for officers of the Clinical Commissioning Group to attend a future meeting of the Committee to provide an update on the Group’s budgetary position.