Transcript

This meeting is being audio recorded and will be uploaded to the council website. Could I remind people to speak directly to the microphones and switch microphones off after speaking? And could members please indicate if they wish to speak by raising their hands. I am happy to welcome four of the new committee members, Councillor Moss, Councillor Norton, Councillor Snowball and Councillor Vernon, who I think certainly Councillor Vernon has served on this committee before. We also have got some visiting former members and visiting speakers, but I'll introduce those at the time. I'm going to ask our legal representative just for some advice for members bearing in mind we're in the pre-election period, and I believe that Brian Reid is about to help us out with that, thank you. Thank you Madam Chair. Madam Chair, we are within the period of pre-election restrictions on publicity, given that there's a parliamentary general election on the floor, and while we're all very mindful of that. Madam Chair, I know that members treat such matters with great care, and we're always very respectful during periods of pre-election restrictions, in particular the need to ensure Madam Chair that what is said at meetings is not perceived as seeking support for a political party or candidate in the election. So it is important that we mention that to acknowledge it. Of course Madam Chair, this does not prevent legitimate debate and challenge on items on the agenda, but I'm sure Madam Chair that members will take care in terms of what they say this evening. Thank you Mr Reid, thank you for explaining that to us. If we move to items on the agenda, it's apologies for absence, are we any apologies for absence? No apologies Chair. So no apologies for absence. Has anybody got any declaration of interest as per items on the agenda? We can't see any hands. So if we move on to the minutes of the previous meeting, has anybody got any queries with the minutes of the previous meeting in terms of accuracy? I can't see any hands. I'm happy to propose those. I'll second all Madam. Councillor Randy's seconded. All those in favour? Eight. Any against? Any abstentions? Four abstentions members were at present at the last meeting. We now have public speaking and former Councillor Ayles is here and I believe she wishes to speak about items 5. So perhaps it's appropriate if Ayles speaks first. I think we're right Mr Ayles. Thank you for having me. I am here, I didn't know it was such a brilliant meeting but I do know it. I am speaking only in the Special Mental Health Forum, which is a branch from here that we have had in Macclesfield for a long time. I came upon it because the Chair suddenly passed away and was running to run for a long time and I was just an attendee so I was there and by events I just became the Chair. I'm honoured to serve in this way as well as I could. In the first place I wasn't sure of all the things he did because he did so well and I was this attendee who gave my views where I could and I was close to knowing how I have a long history of health and I was thinking in the health industry what it was. Anyway the first thing we had to do was to break together again and find out how he paid for the places and the lengths that he had and that took some time. That took a lot of things because we were not sure how he linked, how he managed the lengths, how much he paid for the rooms and the signatures of the banks and we had to go through all that. By the time we managed it we brought that together so so far we've had five meetings the night from the place that we could afford and with the bit of money we had in the bank because the previous funders are no longer there and we weren't sure how we could go about funding it. Ailish I'm sorry to interrupt you but we have a time limit for public speaking could you wrap up what you were saying please? Right so far we've had six meetings and six speakers and one of it is training and I've got two or three minutes. You've got about another 30 seconds. Okay and we are going to get some other signatures because two people died and we have an attendance between eight and eleven at each meeting. Thank you thank you for coming to speak to us. I'm now going to move on to item five but I want to make members aware that we've got a slight change to the agenda and we are going to take items nine and ten after item five and these are just appointments so can I welcome Sarah Sinkin who's caring for and representing and Maddy Lowry from CPUP who's joining by teams. Thank you. Maddy are you going to lead the presentation? Oh I can do I'm very happy to if that would be okay I had thought Mark or Keith might be doing it. Okay so Mark and Keith are going to do that and members have got the um we are having some difficulties with the presentation because the director's not working but members have seen the slides beforehand. Thank you. Would it would it help just interacting would it help if I put it on screen on teams? It's because of the size of the television it's not showing up when you want. Oh okay all right thank you that's fine. Mark are you starting off? Yeah yeah okay um so um I'm going to give an overview of um the Mental Health Partnership Board and an update on some of the progress around the Mental Health Plan. Okay so the Mental Health Partnership Board um we have reports and arrangements with the Health and Wellbeing Board and we also do updates on the Cheshire East Mental Health Plan to the Adults and Health Committee and also the Children and Families Committee so these updates are provided upon request. Okay so in terms of the membership so we've got partners from across a variety of organisations so health and obviously one of the prime partners as well as the local authority but we also got the the police, other voluntary sector groups and we have lots of people now on the board as well with lived experience so carers and people who are members of various local forums. So it's just to say as well as part of the partnership board we've got a number of organisations who have their own plans and strategies and work streams which have been combined and obviously reflected in the Cheshire East Place Mental Health Plan which went live back in April this year. So in terms of working with other lived experience groups and forums so I've got obviously the Cheshire East Care and Care Forum which Sarah is here today, the East Cheshire Mental Health Forum which covers the Macclesfield, Condleton areas, Rick Haywood just gives a little bit of an update on and we've also got the Cheshire East Carers Forum and we've got representatives and children's as well so the children and young people's co-production work stream we've got some members from that particular group as well. So we've probably noted there is a bit of a gap at the moment in terms of the local forums so we are looking to re-establish one which were based in crew so some of you might be familiar with the open mind forum so we're seeking throughout the course of this year to ensure that we have some representation from that forum on the partnership board so that that particular part of Cheshire East is represented as well. Okay so in terms of how people with lived experience work with the board so they've been in place since the inception of the board back in 2019 and we have a regular slot on the partnership board agenda as well each meeting followed with experienced groups and carers to provide any updates or raise any issues that are pertinent to that particular area and we also have heavily involved them in the development of the recent Cheshire East-based mental health plan so they were heavily involved in obviously the engagements and consultation activities as well this was obviously you know taken forward and included within within that plan as well so we can see obviously there's a heavy you know involvement from our parents, carers and people with lived experience within the partnership board. So one of the main activities that the board is currently focusing on is the Cheshire East-based mental health plan so at every meeting so that's on a bi-monthly basis and we have a specific focus on different priorities within the plan so we have nominated lead offices who specifically lead on each of them these priority areas they provide highlight reports to the board as well as verbal updates on progress so this gives you an opportunity for offices to obtain your feedback ideas for collaboration opportunities and also to escalate any items that perhaps you know require further support in terms of partnership interventions so that there's opportunities there for people to really collaborate and ensure that we deliver on what is in the plan. So we also have a risk register in place as well which identifies numbers of actions to ensure that we can mitigate some of these as best we can. So just going to move on now with a little bit of an overview of the monitoring for the Cheshire East-based mental health plan so I'll hand over to Martin. Okay so those of you not fully familiar with the plan there's six key priorities and I'll give an update on the first three of those and then we will take us through the priorities. So the first of those priorities is children and young people's mental health determination or well-being so in terms of what we've achieved since the inception of partnership and waiting times for children and people's initial appointments increased since last November and we've done what's essentially a deep dive. JSCA needs an analysis of children and young people's emotional well-being across the border. We've had good feedback from children and young people and teachers and parents about the My Happy Minds programme and as Mark alluded to just now where we've done with the Children and Young People's Co-corruption group and it has been fruitful I think in our team to get a shared and joint view of what our priorities should be. And the finding of work stream successfully reached its primary goal to support some families. So what's planned next? We're going to roll out the R1 platform and we'll just switch to the Education Team within the Council. Further implementation of the My Happy Minds programme and the delivery of focus groups for care for children and care leaders in particular with their remote particular emotional well-being and mental health needs. So as it varies through improvement, children and people, waiting times for treatment appointments and more developmental assessments have increased and you know it's just getting away from that but we're looking to see what we can do around waiting lab initiatives to support families whilst they are waiting for an assessment and a consumer benefits service. Moving on to Parity 2 which is Education, Employment and Training. Being a positive uptake in the senior mental health and doing roles in schools across the country and the world. An individual placement support service is in place to help people with mental health needs access employment in our supported employment team and supported employment strategy is now at the draft stage and that will be brought to committee later in the year when that's been developed. Some isolated and rural schools are struggling through staff time to do that you know some of our time with rural schools are on things in the pre-district and some are more rural areas and we will need to talk about how we support those schools to access and respect our providing education to support children in their community. Parity 3, Early Intervention and Prevention. So we've developed a local suicide action plan, you may be aware we have high incidence of self harm in the suicide compared to our statistic statistical libraries between the northern borough and just something we really need to double down on. We have more to go about strategy around physical health at the draft stage and we're looking at a training approach around making every contact count. What's coming next? The community's team will develop a systems post for support and we're going to re-establish a smart community just now, we have a user-led form in the crew. Working towards a monitoring of the framework of schools that are active including associated physical activity, action plan and partnership. And at this point I'll be able to click. Thank you very much Mark. As Mark said in his talk in advance, the mental health plan touches on a new range of cultural activity in our partners and I guess building a system for communities is probably a function of local problems. So in order to make the mental health plan digestible we've already identified certain areas which touch, in particular on the mental health commissioning role in our south and the ICB. So by example therefore we've been working about a homeless object. So this is across Cheshire, I'm linking that into the Cheshire East suicide prevention plan as well. What we're going to be doing next is a clear show of sale and I went to Mark and perhaps later on his support for care has been there of concern, seemed to have gone a little bit backwards I think in terms of support for care has been supporting them in their care as well. Issues around stigma and discrimination is something that we work further on in relation to establishing the path of some of the issues in relation to those two elements and also working with our health colleagues to identify funding for domestic abuse support especially in primary care and the iOS model by the way is a particular model to support youth with training support and I'm concerned about inclusion in practices and again touching on housing and development of a new vulnerable and older persons, housing staff which is a required area for improvement I think is forming a public program to develop a future teaming to see what we can estimate as well as mental health health and problems with the substance and the tools. And moving on to priority five, transformation of mental health services. Again a huge area we've been concentrating very much on the lower levels, lower level support for people with mental health issues and we are now moving to serve from making space, providing support for people up to six months to develop a low level mental health support pathway which relies on an active response housing service from ISL and one of our private libraries. There's always been a remote company actually has additional roles in reimbursement scheme, the Google could afford it the most. Anyway we think of our ICG colleagues have been providing them with a cost-finding care between our individuals and making them sort of prescribing and now providing for care for youth. Working time to access adult second-care mental health could not be traced but remain about four weeks except for three weeks. The longest rate of mental health is 12 weeks. Again a little bit of some progress there but we're not there yet but where we want to be and see what appears now with all the care communities we consider and deliver the transformation change at the local level and again that's that's jargon I guess trying to ensure that the relationship between second and primary care is as close as it possibly can be. I've already mentioned that in terms of what we will be doing next if you do the low level mental health pathway that's not concerning funding it has to be and we're coming to an end I think in terms of what we're going to be doing as an alternative for them and they are very successful it will be the provider or piece itself as a support for each and which probably they already have their maximum capacity. We want to engage with the provider market with a new service model to gain for people mental health and complex needs. The people emphasis is actually on lower levels of mental health we've got quite a wide dimension now of support for people complex and new and challenging mental health issues. What we find is now that we have a step time to be able to more and less supportive models of care and in order to make sure that they're more effective and cost effective ways to support them going forward. And finally we want to do this particular priority is monthly working list or focusing on monitoring and support for people in the path of universal assessment and in a way there in the first of July if you look at working list activity again working list is a huge area of consumer cost. We've already mentioned working list on the development or support for young people and it's been working with bringing that sort of physical gain from back culture and the bringing is that you're causing them for adults although A, B, C and O are some assessments so that's not a good news item and I agree to that in part too. And again there's a very complex list of models working lists of the increased amount of capacity not to serve this community. And finally relationship priority six places of support I mean we've made some great improvements in relation to support in young people with mental health problems and development with the local support team and basically from Ancoa which is a tier four establishment in the province of Chester, California. And that can be a danger in a number of young people coming into second year, 13 admissions in 22, 16 days in 24. So it's an impact on families in relation to working and it's proved very positive. There will be an evaluation of the of the service in October, a contract management community crisis that will move from the ICAQC W2 and we are continuing to work with our food crisis campaign and one in Acoa to support people with engaged mental health crisis and to develop more accessible communities. And Mark has already mentioned that in Ancoa including relationship to some of the schools, schools have been identified by the high referral rates and the crisis services and support initiatives to do this year. So overall I guess we can say there's been some progress unless these initiatives are gone in the opposite direction. Areas for proper detention, again as I mentioned support for care was a new one actually after a visit recently I guess is support for women's style of prison. There's been a number of issues that have been reached in terms of like in relation to style of prison and I see the description of the services and physical health care for women there as there are a few more notices for improvement there. And there's also concern about increasing the number of aged mental health assessments that are being done now from the police on prison but in the form of hospital bed. Again support for people with isolated schools and addressing those in the county. So I'm sure the number of people and adults across the board will be good in particular and increase the amount of diverse services. And I think that's concluded. I don't know if there's anything else you want to add there. Thank you, thank you Martin, Keith and Mark. So is there anything you want to add? Not a little bit, I don't think there's any questions. Thank you for that. Maddy is there anything you wish to add? No, I'm just here to help support any questions, it's fine. Thank you. And Councillor Garner is interested, we should speak to anybody else got questions. Can you put your hand up so we can write them down? We've got Councillor Snowball, Councillor Warrable, Councillor Colle, Councillor Clowes, anyone else? Right so we'll start with Councillor Garner. Thank you chair. So the reason I put my hand up halfway through the process is because I'm somewhat confused. I was under the impression that this report had come from the Cheshire East place part of the ICB and yet the report this afternoon has been exclusively presented by many of the Cheshire East staff. I have was never in favour of the setting up of the ICB and this is part of the reason because I suspect that Cheshire East is being asked to carry a lot of the work involved in these programs and yet the provision of services quite clearly is from CWP and other primary health providers and I am somewhat amused as to why we do not have a representative from the ICB here today to answer questions about the development of strategies etc because a lot of what we've been told this afternoon and I am sure the Cheshire East staff are doing excellent work in all of these areas but a lot of the work areas are not Cheshire East staff, we are not the service provider, the service provider is the mental health trust for other parts of the NHS and yet those people need to take responsibility for and ownership for the service delivery or failure thereof. It sounds to me like the failings in all of these services are from NHS providers and not from service provided by this council and I would like to know why there isn't anybody here today and I appreciate the name from CWP that's present but that is not good enough. The ICB when replacing the CCG was supposed to be interacting with us as members as well as with the council at large and that doesn't appear to be happening which was one of the things that I and former Councillor Judah were very keen to see happening and I'd be very sorry for the three gentlemen that have come here this afternoon because they are being held to ask to carry the can for failings of things beyond the walls of this organisation and I think if we are going to get reports like this we need to be able to challenge them and we need to be able to ask questions of those people who are responsible for the delivering services. We cannot just rely on our own good staff to do that and I'd like to register my concerns at this stage in the process. I know that colleagues will be asking specific questions about adaptation much of which sounds very good but where there are flaws those flaws appear to be for within the defined areas of work that don't come within this council so thank you very much. I'm really sorry Councillor Gardner. The report if it's anybody's mistake it's mine. We were asked to bring the partnership board. The partnership board is largely supported by the local authority with the involvement of staff from across the NHS and so bringing a paper about the partnership board and the partnership plan this is the report that we have brought. Maddie I know will absolutely be able to answer questions about delivery of services on the ground and I am very happy to go away and ask health colleagues from the ICB if they would be prepared to come and answer questions if that would be helpful but certainly a mental health partnership board and similarly at the end of the year when the learning disability partnership board comes it will be a presentation with age behind the local authority for those reasons. In that case I apologise because I've clearly misunderstood the reasons for the presentation and understand why these three gentlemen are here because I obviously work with them in a different capacity and I also for manager for interest of the minutes earlier on when former Councillor Aylin Head was speaking I forgot to say that I have also sat on that forum that she represents in the past so that should be thank you. Thank you Councillor Gardner. Councillor Slobel. Thank you chair. A couple of questions related to the last part of the presentation. Overall assessment where it says areas of focused attention including improving support for carers and a deep dive into supported style and Keith gave me a bit of information there. I would like to know a bit more about the nature of the support for carers and the improvement that are planned and also I was at the Cheshire East Hilton Walden board meeting last occasion and staff was mentioned I'd like to know a bit more about the plans as they've proceeded since then there was talk of a working group at the league bringing in various interested partners and I'm particularly interested in staff prison since I in a former life I've worked with staff at staff prison and with issues of staff prison I'm very interested in what can be done to address exactly the sort of concerns you're doing. Thank you. I understand that to give a really detailed answer might not be possible at this point in time give a free transfer and then give a written answer to the rest of the whole of the committee. Thank you. Okay so in response to the issues raised by the carers because probably not the Sarah that raised those in person at the last one meeting at the Mental Health Partnership board and Sarah submitted quite a lengthy list of what is being seen pretty nice by many of the caring board in relation to amongst all the things the withlaw at the New York statements, the caring carers of children and people and there's been some confusion from our permission provider in respect of pericare assessments and how those have been conducted we've been working with that permission provider to address those areas of confusion to exactly what they are permissioned to do and what they should be doing and support caring carers and responded to the other points into the writing and also that Sarah can pass those to caring for among this and there are still some things that we need to dig and on that that list of areas of concern that Sarah raised and let it on and I'm not continuing to worry about it until there we go. Okay yeah I'm in relation to style of prison and the main concern from our perspective on the mental health one is that we have scraped what we thought was to us and in respect of women who are going to the Middle East within a few days sometimes in a few hours and then notified that the mental presentation is set that they could be eligible for an assessment of the mental health path and can we go up and assess them and there's a couple of challenges with that first of all you have to arrange two doctors, two medical experts recommendations to be sought from two different doctors and of course a lot of these women amongst all of them are in different areas with Odom and Creston and it's very difficult to ensure that these individual women are properly assessed and they're properly arranged in the name prior to them having a unique scorecard everyone has been assessed and the scope that they arranged for but more than that by ensuring that somebody has an assessment to be honest with you and we had one particular incident the wrong way and I think it was about three hours before people got three minutes before attempt to sign for the in Northland area very quick inspection on the physical health care thinking by all the way to the U.S. from reports to the U.S.E. and the national reporting for the women who are pregnant and given birth in unsatisfactory circumstances planning whether the administration's education is problematic as well as general health care and so what we're trying to do is arrange darlings in the open room, the federal government is responsible for safe diving there and we are inviting the members of the local safe diving board as well as also members of the strategic network from the local community to get information on what reads and bring them out of the cold, it's a clause of institution and obviously it isn't but we want them to look to our public in this case today Thank you Kate and thank you for those responses to Council Wardlaw I don't know why that was a quick reminder, I was very interested in your response there I wasn't really talking about this, I asked what is, I find it difficult to understand why if someone in prison is approaching a release date that those assessments and preparations are not made in a timely manner, I'm sure there's been more but I can't think why that isn't all organised and we'll be left with Cheshire's council holding the ball in three or five hours or two days to go Surely there is a whole system behind the prison service that should, I can see your smile that should be in place in order that Cheshire East isn't forced to deal with all this at such a last minute The NHS does have guidelines for the transfer of a prison in the second quarter into the mental health act from prison to hospital where they do accept a permanent disorder which should be treated in hospital and the process takes about 21 to 28 years and then to the directory, the standing directory and the property and there are then the other entities in the process. The difficulty I think that they say when they're asked a very similar question is that a lot of these members first of all tell them of the different parts of the country, they're there for short sentences so they don't even get to know them very well before their time of use is at their own prominence A lot of them are drug and alcohol problems, so a lot of them already have, in fact probably all of them are drug and alcohol problems, in relation to domestic violence and the victims of exploitation all sorts of things and descriptions, so they're already a vulnerable group anyway, putting aside the fact that they're prisoners So I think what is to do with the number of women there, the late presentation sometimes in relation to the mental illness is the fact that they get a lot of them in their short sentences, six months, three months and by the time they get to know them and they stand their knees, they take their knees, they're almost there and I have asked them the question why they haven't really equalised the courses which are in place and they say it's because of that reason that they understand what they've used now because the time has basically been lost Thank you in case, Councillor Caulk? Sorry, thank you for letting me come back, thank you for that answer and it's entirely what I expected, in fact it's exactly what you really said in your presentation but can we not challenge that further, I don't expect you to answer that right now but it seems quite incongruous that the simple answer is we didn't know that sort of prison services telling us that there has to be accountability for their care and safeguarding of their prisoners and not just a last minute 24 hours, somebody who just needs to have to fix this, that's just my point of view The schools programme, I'd like to ask you about, Councillor Woldlock, can we Sorry, I had loads of questions, well, you gave to answer the answer before So I'll put the questions out to answer them, but the schools programme, does it involve the academies the roll out for the Happy Minds and the other programme, are we rolling that out to the academies as well as our schools and then the adult and older people pathway taking 11 weeks or 12 weeks or so Is that about dementia or is that a combination of other things, all of the wonderful mental health issues Thank you chair, thank you very much Can we quickly answer those please Yes, that's what I thought I would answer for So the older adult pathway is for, it can be either dementia or an older adult with mental health needs So we define it as people aged 65 and above accessing either, accessing community mental health services either for dementia or for older adults So I can get a breakdown after this about which numbers are which but what we're saying basically is it takes about 11 weeks to access is the average wait time Thank you For either of those pathways The schools question The schools question, I'll pick up whether our education's been following Are you going to provide written answer, thank you Councillor Colco Yeah, just very quickly, sorry Yeah, sorry very quickly, I wasn't taking that much time Just the priority three, the early intervention and prevention I'm not quite sure, I've read the thing and I listened to your presentation but I'm not actually sure what you're doing to intervene early and prevent all the problems arising It seems to rely quite heavily on active Cheshire doing a prescribing, I don't know if it's a social prescribing or which I'm actually in favour of but if we intervene very early then we prevent a lot of problems later on Martin do you want to answer that, thank you What we can do, probably subsequent to this is include a little bit more detail around talking of these and more, there is additional stuff going on, there's additional stuff (inaudible) So can you provide, you'll provide that committee in writing, thank you Councillor Cloud Thank you, a couple of things First of all this is an interesting report, however it's a bit data light whilst we don't need every last piece of information we do need some indication in terms of how many people are improving, how many are not improving what were the performance indicators that we are judging our plan against because it's going to be important to achieve one of the areas of improvement, what will we do next I'm assuming that my recollection of the plan, I know this was last April when we were looking at it but you know there were indicators, performance indicators so I would like to see something set against that so we can judge how well we are doing and it's early days yet, this is a four year plan so we're not, or five year plan, we're not expecting everything to have been done already but I think we need to see that direction of travel The second element of it is I'm really disappointed having listened at various bodies, whether that's the CCGs or whether it's partnership boards or whether it's health and wellbeing boards we have repeatedly had these delays and funding insecurities around neurodiversity both in our children and young people and in our adults and we know that these are a vulnerable group because not only do they have to manage those problems but the failure to manage them also increases their mental health problems so I would like to see what the longer term trajectory is for dealing with that because I don't want it to be another five years and we've still made no real progress and I do know that our health partners are ultimately responsible for quite a lot of that element in terms of assessment and the provision of care and support particularly from that health aspect so those are things I'm looking for not so much in this report but as we move forward I really would like to hear what's going to happen to addressing that thank you for those, I hope that those have been taken on board we get a bit more data, various ideas about direction of travel and also neurodiversity will you be able to provide a written answer to that or is it too early yet? we can provide a written answer to that, we're going to do it for sure thank you very much, thank you so this report is to receive a note so there's no vote, is everybody happy to receive a note before if you'd like to thank Maddie for attending and Sarah for attending and contributing to the question we're now going to move on to item 9 which is the Cheshire and Merseyside joint health scholarship related to the protocol I think Ryan will go to introduce this thank you Madam Chair and thank you very much please expect for the items to be brought forward but I'm very grateful to yourself and the Vice Chair Madam Chair the item 9 is on page 115 of the report pack before members this evening and it relates to the Cheshire and Merseyside joint health scrutiny protocol Madam Chair, committee members will be aware that the council has agreed to the establishment of the integrated care system the joint health scrutiny committee and of course Madam Chair this comprises nine authorities they're all listed on page 117 if you wish to have a look at those and the committee has got a protocol Madam Chair and that's been agreed already by all nine authorities the legislation and we have all those this evening if they wish to contribute but the legislation which underpins the protocol changed in January of this year and the change effectively in the legislation means that the joint committee can no longer refer substantial variations in health service matters direct to the Secretary of State for health and Madam Chair you can see a definition on page 116 paragraph 6 if you want to see that definition of substantial variations instead Madam Chair the joint committee must request that the Secretary of State call in service changes but the legislation notes that these circumstances must be exceptional so that's the change in legislation and we can see some information about exceptional circumstances on page 126 paragraph 6.2.2 but the amended protocol Madam Chair or the amendments in it must be approved by all nine authorities of which Cheshire East is born and so the council and chair needs to do that the recommendations are on page 116 it seeks a recommendation to council so council will be the ultimate determinant of this and Madam Chair we did check with our colleagues and the other nine authorities the vast majority of them have already approved the protocol there are one or two whose timing of committees or the council etc are still awaited but Madam Chair I'll answer any questions if your committee has any more are there any questions from the jury? I can't see any hands Councillor Cloud It's not a question it's just a reflection I have to say that my personal view which is not going to be a great deal of change in the grand scheme of things is that that removal of that right to forward to the Secretary of State our concerns it is unfortunate because we did use it and we used it to good effect in 2018-19 in terms of the rearrangement of mental health services across Cheshire East and in some of the rest of Cheshire in order to make sure that we had that provision within borough for our residents which might not otherwise have been the case so I see that as a disappointing change but I also understand that that calling aspect is still something that we can match onto even if the borough is going to be considerably higher Thank you Thank you Councillor Cloud I don't see as much point in the debate I'm happy to propose that we accept this to be recommended to council So all those in favour That's Tony's Labour, anybody against? Any abstentions? Two abstentions So that's 10 in favour and two abstentions I think we might just need to redo that I think we haven't got enough time So could you put your hands up again please Councillor Adams is your hand up sorry? Is your hand up? No, that's eleven four So that's eleven four, two abstentions Thank you, we now have got the right numbers If we move onto item 10 which is appointments to subcommittees, working groups, panels, boards and joint committees and again Mr Rees presenting this and Madam Chair, page 133 of the report's back, Madam Chair for members to look at if they wish, this is a regular report Madam Chair for the committee to make its nominations to various boards and partnerships each of them Madam Chair is listed between pages 134 and 136 and important when the terms of reference of each body are set out in the appendices between pages 141 and 161 Madam Chair, the recommendations are on page 134 and I ask the committee to agree those nominations one member each to the health and well-being board and the joint extra care health management board three nominations to the Safer Cheshire's partnership and two to the Cheshire's Combating Drugs partnership Madam Chair, my colleague Les Fisher has circulated the conduct of some very helpful discussions with both administrators and leaders so thank you for the cooperation of the groups I believe that there's been an addition to fill and complete the picture of Councillor Flayce who I believe is the proposed nominee or one of the proposed nominees to the Cheshire East's Combating Drugs partnership as well as people to their position Madam Chair and the recommendations are there in the report Thank you, any questions to Mr Reid? Councillor Snowball? Thank you Mr Reid, I just wanted to clarify I believe that I am the representative of Cheshire East's Health and Well-Being Board I think that I am the representative of the adults committee we have several representatives on the Health and Well-Being board I think we've got three, possibly four representatives on the Health and Well-Being board Thank you, thank you I'm happy to propose that we elect these people to represent the Council Is there anybody willing to second that? I'll second that Madam Chair All those in favour? That's unanimous That's unanimous, I think Anybody against? Any abstentions? That's unanimous, thank you Thank you very much Mr Reid We're now going to move back to item 6, the learning disability review Sorry, we're now going to move back to item 6, the learning disability respite review and this is going to be introduced by Mark Hughes in his evidence Thank you Right, okay So, the learning disability respite review has been conducted over the course of 23/24 and we're seeking, following the review to develop a learning disability respite service in the borough We've done a lot of analysis on the current services so we're ensuring that this new service continues to meet demand and needs offers value for money and also improved outcomes for people with learning disabilities as well We've conducted a very thorough review with lots of people across the borough including people who access respite services, carers, providers of learning disability services and also conversational with our social work teams who refer into these services as well Some of the key findings on the services have been included the benefits of respite, so respite is highly valued by carers to ensure carer break and prevent carer breakdown There's also some views on the actual service itself in terms of providing access to the community and integration with community activities as well We've also found that occupancy across our current commission services has dropped significantly post Covid so we've looked at the occupancy data which has shown that we're perhaps not achieving great value for money in the current model as well Our in-house service which is located over at Warren News really struggles to meet the needs of people with more complex learning disabilities This is apportioned a lot of the time to the actual layout of the building and also the staffing issues that this service also has as well to ensure we can support people who require greater support for example one to one support, waking night support So in terms of the new model that we're seeking to go out to tender for this service we're seeking a more person centred offer which can meet a variety of needs and also provide more integration with the wider community so for example more opportunities for individuals who are accessing respite to access eating activities to stay up late So that will be something that we want to heavily focus on in the service specification We're also looking at an improved accommodation offer as well We did a greater focus on the use of assistive technology which in turn will lead to promoting greater independence We also are seeking as part of the new model to reduce the number of units down from 8 to 6 as well so in terms of the geographical split we're proposing to have 4 units in the north of the borough This will include one emergency unit and two units within the south of the borough Part of this redesigned offer will mean that we are seeking to replace the respite provision which is located over at Warwick News in Macclesfield So we anticipate that through the redesign and the reduction in units that we will achieve some savings as well from this potential re-connection and also the need to spot purchase additional respite within the independent sector as well which can come at high cost Okay, are there any more questions? No, I think I have to go in terms of the familiar faces but answer any operational questions that may appear at the moment Thank you, are there any questions for officers? [unintelligible] Thank you, Jen. Thank you for the report, it's a very interesting report I'm just a little bit confused, you don't have to bear with me, I'm not, just bear with me In Children's Services it appears that going outside, you know commissioning children's homes for example has been an expensive option, you know, we used to have our own children's homes and we now commission them outside So I'm just a little bit confused as to why we can't do this ourselves You know, I understand that the more it uses is inadequate but we can invest a say if that's something that we've done very successfully in other departments Would it be better or would it not be better to create our own respite centres and do it ourselves? Would that be, why is this a cheaper option? That's one question, the other question is, we're doing a five plus two so a seven year contract has been proposed Is that going to be absolutely fixed costs so there's no risk at all or are there going to be instances that they can increase the price and if so, under what circumstances? Thank you, Jen Do you want to take those two Mark? Yeah, so on the first question as to why we are looking to commission this service externally So as part of the market engagement, we did a lot of analysis on what it would cost obviously We've run a commissioned external service compared to our in-house service And looking at the model that we wanted to develop which was based on the findings of the review So having a more person centred offer, having an offer which provided better accommodation Having an offer which produced better outcomes for people with the ability to go out in the community So taking all that into account, the actual cost of doing that in-house were far greater than what it would be to obviously deliver this externally And a lot of it comes down to obviously the cost of delivering services in-house in terms of the salaries and other costs associated with the local authority But the other thing as well was that we couldn't actually deliver the actual service that we wanted to within the Warwick News footprint So that was a significant barrier with the size of Warwick News and the layout We weren't able to provide things like en-suite bathroom facilities for everybody there Because at the moment that's our shared provision within that site So that was the reason we wanted to replicate what come through the engagement with the people who were using the services That model just wouldn't be cost effective to deliver as an in-house service So on the second question, in terms of the contract, so we are looking at a five plus two year extension So as part of that contract we want to ensure that there is sustainability in this contract for our providers to take this particular contract on board So to prove our provider engagement that was what had come back was obviously offering this greater sustainability for the market So in terms of obviously the cost of this, we are seeking to build into the contract that we will have annual uplifts as part of that contract To ensure that obviously it's sustainable for providers who are delivering this service But also to ensure that there is a mechanism by which we can award any increases So that will be put into the contract as well for when we commission the service Thank you Mark, Councillor Pleas Yeah, thank you, so first of all, we've tested the market and you are confident that there are providers out there who will set up a quality of care Care that we are looking for, that we can't provide ourselves at more than years anyway But that similarly they will be able to do that within a constant rate over that five, seven years that is as assured as possible Because we have experience of other adult social care providers who hold us basically over a valve And I don't want to be in that position over our elderly respite service The other element of this is that part of the reason when we were having earlier consultations The first consultation last July was some parents actually identifying that they weren't taking up residence because facilities were not good enough Or they were too far away So are we assured that if we then are providing a smaller number of beds with a higher quality We're not going to get into a little bit of a problem whereby those who are able to access elderly respite are drawn back to the service As indeed I would argue they should be because the services are then better than they were But there's a lot that we should be doing and my previous item on the agenda today is that of adult parents So is that fact related to this going forward? Can I leave that one to the end and ask Jonathan to make time for that one, thank you Councillor Gardner I recognise as this committee is represented on the LB Board the importance of respite to those who provide care But I'm wondering whether or not we are looking at the full panoply of options here I understand there will be occasions where it would be necessary for the care receiver to be relocated to receive care in order to provide the respite But is there not an option to allow people to be the care receiver to remain in their normal, basic domicile and then the care to go to them rather than the care being provided So I'm not suggesting we don't do what's suggested in this report I'm merely saying that I think there may be something else that we need to look at here which we have a responsibility to those people who provide care to people with learning disabilities Often long hours with a little support, direct support in terms of day to day and if we are going to keep those people doing that job, playing such an important role in the lives of those people with learning disabilities we need to make sure that they are themselves fit and healthy and restful And sometimes it's not a case of, you know, whereas if the careful person is in their own home I think there might be more uptake for them to be able to go away for a night somewhere or to go away for a weekend or even longer knowing that the person that they care for is being looked after in a comfortable place that they know and are comfortable in So that's just something that perhaps we can look at Thank you, I think Jill Brumer wants to comment on that Yes, thank you council member, excuse me. We do provide direct payments for respite as well so individuals can purchase respite to come to them but they will just keep then going somewhere else, so they can purchase beds coming to their houses We also do share lives as well for respite so they're going to somewhere else, you know I don't know what's happened there, thank you You're welcome, thank you Jill Councillor Wardlaw Thank you chair, I have experience in my family who have shared lives and I cannot speak highly enough of the facility Wonderful people changed my life, let me just share it So thank you to them I would like to pin you down a little bit please on page 29 paragraph 12. How is the plan ahead of us going to assist in reduction of costs on spot purchasing? We're having improved facilities which potentially will attract a wider audience which will mean perhaps a higher demand, which we were able to fulfil, so spot purchasing, I'm not clear how we're going to reduce that in this way and also just wanted to ask, do we know where we're going? Do you want to take that please? I think in terms of spot purchasing, generally speaking we've got a very small minority and we've got a complex multiple physical and living disability needs with a nursing home in two years as well and as I said in the report the certification on a contracted basis would be excessive and there are some very good providers in our area that do a great job with that and I can't see that necessarily changing quite honestly I hope that it was very brave, a very particular in-sport type of care, and there was a sort of service that we've been hearing against with our main in the region unit on laws, physically robust laws which are a little bit more private as well, not in the same extent as I think just described Thank you, Helen Charles, are you going to answer? So all questions have finished I'll just, so there have been some really important questions in there and I think that question about should we provide ourselves or should we commission is one that we are grappling with As you'll be aware, the prevailing view across the country has been that services should be commissioned for reasons of cost efficiency and effectiveness and that is an approach that has prevailed for about the last 20 years We're not unusual in having commissioned everything out, in fact we're unusual in that we retain provision unlike other local authorities Clearly things are changing and there now needs to be serious consideration to insourcing services, that has to be worked through very carefully to ensure that we don't end up increasing costs given the pressures we're already experiencing in adult social care And there is absolutely something about the market both in adults and in children's having become more commercialised and commoditised and that driving prices The bulk of what we spend does not go to the workforce and that raises some really serious questions So as I said, the prevailing mood about insourcing and externalisation is changing, we are exploring that ourselves but there is nothing that we will do that will have a direct impact within the next three years We must do things this year and next year that will bring down costs this year and next year We think a five year contract gives us the best opportunity, there won't be anything in there that doesn't stop us cancelling that contract if we have to, should we decide to have it insourced instead But we are at the moment clear that this is a way of making savings in the short term I would also say, and we will come on to this when we get into the finance papers, that at the moment there is clearly a level of provision around respite and care of support and the challenge has been about whether that is sufficient The question we are going to have to answer over the next 12 months is whether that is too much and with all the associated risks that go with that it doesn't alter the fact that we will have to bear down on activity and expenditure across all budget heads which will include carers and restaurants But we will come on to that soon I am sure Tell us about certain insurance costs and savings So at the moment this is our best assessment of the best way of controlling costs on this service It may change and we are very alive to that but there is nothing we can do to build something that will enable us to deliver respite care in house more quickly within the next two to three years Thank you for that, I am happy to propose recommendations on page 2930 that we approve the new model and that we can delegate authority towards contracts providers to the executive director of adults and health integration Does anybody wish to make any comments or debate about the issue, Councillor Gardner I am satisfied by the responses I received from the officers today that this is maybe not the ideal option but it is the pragmatic one that we need to take because we need to ensure that we have got some provision Because otherwise, and I hear exactly what Mrs Charlesworth May is saying about the pressure on the budget, but unfortunately the failure to allow these people to have some form of respite will only further expense, further down the line We must have them pick up a much bigger problem and a more capable one, so I am supportive of the proposition Councillor Calcutta, any other comments, Councillor Colquitt Yeah just very briefly, reluctantly I too support it, although I think I hear the language that Mrs Charlesworth May used and I feel that in the long term selling off Thank you, selling off the site and then using that money to help or put towards our own respite care centres elsewhere may be a better option Thank you for your comments, so we have been posed and seconded, all those in favour Right, so we have 12 votes, anybody against, anybody abstaining, 1 abstention, thank you very much, that's 12 for 1 abstention, thank you everybody for your patience We are on to item 7, the final part, and Nicky are you going to lead this? Yes thank you chair, this report is starting on page 73 of the plan for advising members to finalise the adults in health and community services for the financial year 2020 through 24 Members of the committee are asked to consider the financial report of the services as well as the terms of reference The recommendations listed on page 74 and recommendations to use for approval are listed on the table 1 page The final item in position is 11.8, the removal of expense, which is an increase from the FR3 forecast position in the financial area The reasons for this move are listed in the commentary on page 80, and it is made up of the various items as well as one large weakness A huge amount of work was going on to try and improve the overall position as FR3, but not all of the funds and improvements were able to be delivered within the time of sales host Things such as mitigations that were in train for 2024 and 2020 and it was hoped that they would start to deliver at the end of 2020, but not all who realised Agency reductions in costs that we weren't able to deliver at year end, some unsuccessful negotiations with providers Some light jobs evolved, some complex evolved direct payment refines at, and being unable to capitalise some costs with the usage of the disabled facilities ones Alongside these movements, the cost of external care have also continued to grow between effort offering new ends above the anticipated levels Client revenues are not increasing, but costs are, and so we have more high cost gains Work is also underway by both services and the finance teams to ensure that we understand as soon as possible the impacts of 2024 and 2025 And financial forms and point one will be carried out in July, using the April to June actuals We are reviewing the amount of our income and expenditure to the services to determine if any of these issues could have been identified earlier, which would have allowed us to take action soon Thank you very much Thank you very much. Are there any questions to the officer? Councillor Gardner and Councillor Kleinert Councillor Gardner So, thank you Nicky, I'm not sure whether it's going to be you or Jill or Helen in my arms for this I heard you say that we haven't had an increase in the number of clients customers But that we have an increase, that the customers that we do have are becoming increasingly complex and therefore defensive I am aware that for many years we have had an issue with a provider in the shelf of locus Whereby people were placed there on very high cost packages, which were being paid for by their families And that then the circumstances changed and we just released it for you from that attack. I appreciate that we don't have the ability to challenge our responsibilities in those circumstances But I am wondering if there is any way in which we can at that time renegotiate how much we are paying for that service Because I suspect that there may be issues and I appreciate that Helen and I have touched on this offline So I'm just wondering whether there is anything that could be shared now and I appreciate that it may not be possible And if it's felt too sensible, I'm happy to receive some form of an investment. Thank you Thank you Councillor Gardner, and providing you with those two is not our most expensive provider in the world The cost of our ridges of care have increased significantly. The cost of packages of care for people transitioning from children's services who have some really big AI needs are astronomical For example, we have 44 people from the age of 65 in residential care at a cost of 6.6 million a year, or 40 We have 109 people in supported living at a constant 8.3 million a year The costs of providing care are huge. We are seeing more individuals requiring 1 to 1 support, and 6 to 1 support, for 3 to 24 hours a day because of their parenting, their physical needs, their medical needs and the age of a woman And packages of care are 4,000 times a week, all of the time Thank you for what is a very comprehensive provider, I suppose Thank you, Councillor Gardner. Councillor Quayle? Thank you. So, obviously this is a retrospective look at the budget system And, you know, thank you to you and Canada in terms of identifying the investment in levels that we need to deal with But I'm very cognisant of the fact that we've got another agenda item to follow, and that has its own additional pressures So these pressures will be added concurrently to those that we already have And I welcome the fact that adults are able to actually room a 4 to 1 review in a July meeting We're playing a bit of catch up on some of our other committees, but for this committee where the costs are so high I think it's imperative that we do keep that really close on on what is happening In terms of some of these costs, I know that you have always been very much involved in working with some of our national bodies In terms of national care costs, working with ADAS and so on What is their feedback at the moment on this in the light of the fact that, you know, inflation rates coming down, energy costs have reduced That was what sort of triggered some of the spiralling costs What is anticipated to be the lag time between those rises gradually coming down Or at least us being able to challenge providers on their business cases against the costs that they're currently charging Thank you So, I think that's a really interesting question So, the North West happens to be an outlier on cost and activity for people with learning disabilities against the national average So, we have just commissioned a piece of work as North West ADAS to support all local authorities in the region to look at what is driving those costs And what interventions you might do in order to bring it down And this is pertinent for this paper but it's also pertinent for the next paper An initial assessment which is true locally as well as across the region is that we have a number of providers who have a traditional model of delivering service Which has not responded to either the pressures local authorities are experiencing or some of the changing service requirements that people are presenting So, we have some providers where we think there is over provision for people with lower level needs but perhaps not the right environment for people with higher level needs So, you have large workforces supporting people And we also think, but we haven't done the analysis to know categorically, we also think that we have high numbers of people in the North West associated with exposure of the old long-scale hospitals And that is still flowing through the system, not missed because I am very pleased to say people are living longer than they have ever lived with a learning disability So, if you look at learning disabilities as a group of people generally, as I said the North West is an outlier What I can say is having talked to my colleagues in London etc, they are also seeing significant spiking costs for people with additional needs Again linked to children coming through the system So, we're going to have to develop a new model of care for people with learning disabilities Going back to our last question, I think there is a case for building and insourcing services but that can't be done without due regard to the business case And we don't have our business case yet, so that is the sort of medium term proposition Older people it is different, so what we're seeing across the country is that those local authorities that have a high elderly population, which we have And a constrained NHS, which we have, are seeing a spike in prices beyond that, which we're seeing in other places So, some of our bordering local voltage structure, but down in Cornwall or up in Cumbria, seeing similar things I think that is about price, not necessarily about cost, price and demand, not necessarily about cost So that takes us to how do we get more transparency around costs and so you'll know that we're implementing Care Kid, which gives us transparency But the other thing that we need to do, and again is pertinent to the next paper Is that we will have to be much stricter about price, I'm sorry to say that the fair cost of care exercise nationwide 18 months, 2 years ago now, gave a head of steam to providers about prices and trying to pull that back really hard But, and again equally hard but absolutely necessary in the circumstances the local voltage finds itself in We are going to have to ask for more third party top-ups, so we will have to be much much stricter about our standard price And we will have to be much more direct in requiring the families to make a third party top-up if their accommodation of choice is more expensive than that Those are all tricky things to do, not things we have done historically, but they are absolutely things we're going to have to do now and forever I'll very quickly come back, just two things, Mrs Charles has made, I know, so in terms of third party top-ups, I'm assuming, sorry Councillor Blake do you need to leave? Okay, I'll put you on the list, I thought I was doing something very strict I've lost my thread now, yeah third party top-ups, so we're not just talking there about people coming into the system And perhaps having to make do with a home that is not exactly what they want because of cost But I'm assuming we're also talking about those top-up arrangements that then fail and may involve moving people from where they are to somewhere that satisfies our cost And then I suppose you've summarised what I was trying to say in terms of that head of steam that the fair cost of care raised 18 months ago But that was at the height of inflation and energy costs and everything else, so you know my challenge out there is that world does not exist at the moment We don't want to pay for good quality care but it's got to be accessible and it's got to be a financial system So I think I made the point that I think prices become disconnected from costs for older people Certainly top-ups for new people entering the system, moving people is much more difficult because of the risks associated with that but we can't rule it out And I think the head of steam you describe is absolutely what we've seen and we're now going to have to bear down on that because we have no alternative Just looking at the outcome of the commentary, I'm just wondering so late unanticipated changes have also affected the final position And you did say that you were going to look into what could have been predicted and what couldn't I'm interested in the fact that you know this is a new phenomenon, year on year anticipated savings have frequently not met, the targets have not reached And maybe we should become more realistic in our statements around what we actually and what would be the wish list and be achievable And just be more realistic about that but what I'm really specific about here is the agency recharges and the agency staffing I find agency figures across Cheshire East County difficult to understand, are they departmentalised, what agency figures are we speaking about here Is it care staff, is it administrative staff and how is that possible to predict So our agency within Adult Social Care, 50% of our agency is staffing within care boards where we struggle to recruit The cost of bringing in agency staff and care boards is actually complete from the council because we don't pay holiday pay and that kind of thing So 50% of our agency's vendors and care boards offer free vacancies The rest is in approved mental health professionals because we have to maintain a 24 hour 7 day a week statutory mental health service So we have agency owners because it's difficult to recruit, we have had for the past three years significant issues in recruiting occupational therapists We could not get occupational therapists, so we have a number of agency OTs who are now slowly being replaced by permanent ones We are managing to recruit and we're also trying to grow our own through the apprenticeship scheme And then it's social workers, so it is care boards and then the professional staff, social workers, occupational therapists and not administrative Thank you for that, Councillor Adams Thank you very much Councillor, can I come around Thank you Chair, I'm going to support the recommendation, I'm happy to either oppose it or second it But I'm just going to make a few comments in May I think that it's a personal view, probably going to be endorsed by the rest of the committee Adult social care costs need to be a national cost, not a local cost As you probably know our actual budget would increase by an extra 2% £5 million to actually go into the adult social care budget What we've got here is a significant drift, let's put it this way And of course looking at the budget next night, we've got about £37 million there and my only worry is that I accept what's been said in the report I said I'm happy to move the recommendation, but with the perception in the outside world I worry about other wounds, it's out there according to me And I think we're going to see that we've got a drift of something like £6.8 million and public perception up there isn't going to be very good Councillor Burton Thank you chair, my question was really, I was thinking about in terms of the cost, if it's the individual cost, the high needs of people And I was just thinking obviously it's important that they're prioritised I was thinking that we need to get back to control of the budget and everything else But is there anything that, I know a while ago we talked about this national care service ideas and a whole range of things that could be funded centrally through central government And I think in an exceptional situation like that that's actually in, is there nothing that central government can do to support this high level of care I mean presumably it's enough grants that we could, additional grants that we could get from additional places When we're on such finite budgets in this crisis situation that the statutory responsibility to these people I just cannot believe that we're not in a civilised society with this situation where we'll have these discussions Thank you Councillor Burton, do you want to answer quickly? In a word, no, there are no grants, where there are grants we have applied for them And I think what you've just said is exactly right, I cannot believe that in a civilised society this is where we find ourselves And that is applied to very social workers and cashieries at the moment, that we cannot believe that every day we are making decisions between where people would like to spend the remainder of their lives And where we will pay for them to spend the remainder of their lives And that is nothing that any of us came into this work to do, but that's where we find ourselves And that is being stuck between a rock and a hard place when it comes to care Because we all want to do what is right for individuals and to make sure that their lives are fulfilled So it is a rock and a hard place for us all Thank you Gill, right Now, if we can move on to recommendations on tax law which pass them around as proposed, we have to consider the factors relating to the adverse net revenue financial outlook terms And we have to item 3 scrutinise the context of annex 1 which we have done The only thing we have to approve is the supplementary revenue estimate request for allocation of additional grant funding Over 500,000 to 1 million in annex 1, section 2, table 2 That is the only thing that we have to approve And I am happy to second counsel Moran, if we could move to vote, all those in favour of approving the supplementary grant estimate That's unanimous, everybody in favour Now, if we can now move on to item number 9, which is the, sorry Edward even, service budget 24.5 adults and health committee Nicky, are you reading? Thank you Thank you, Jeff This report's also on page 93 of the pack Sets out the allocation of the approved budgets for 24.5, the adults and health committee And this is in line with the MTFS, it's approved by council in January 2021 Appendix A contains a summary of the revenue and capital budgets and the amount of service As well as a first update on progress against each revenue budget change-up in 2020.4.5 Appendix B contains a financial report and timetable for 2020.4.5 The recommendations are listed on each MTFS report Has anybody got any questions on the budget for 24.5? House of clowns Thank you So, first of all, I'm just going to find the RAG-rated elements So, I was just looking at those various items So, how are we mitigating against the new pressures in the year? Can I first also add, just at this point, and I've said this at all committees I think, to thank you very much for the RAG-rating against each budget line And it ties in very closely with what I requested of all committees back in January prior to the MTFS Finance meeting So, committee members have a relatively easy, immediate visual on how well we are meeting our obligations on each budget line Over the course of a financial year So, we've got some new ones there, so I think it's referred to at another meeting as a RAG-rating in some cases So, well done for that But we do have this investment, this red line element that we need to do to establish recurrent budget pressure And to recover in terms of 24.5 So, I'd like to know a little bit more about how we're doing that In terms of what you're going to tell us And similarly, because obviously in July that is the official end of our quarter one You know, the fact that we are going to be looking at it in July, where others are waiting till September I'd appreciate that as well So, that's what I was referring to in relation to the other positions In terms of I'll leave that there and let others ask those other questions Colin, do you want to add to that? So, I'll start by saying that we didn't quite have the opportunity, but actually last year broadly speaking, we delivered savings, we said we wouldn't set out to deliver What we weren't able to do was control that price pressure that we discussed And the price pressures, we're holding all of the risk at the moment in that line around the growth Which is where we anticipate price pressure Now, I know I've said this before, but there's repeating There are only four ways in which you can save money in adult social care Fewer people in receipt of a service, less service per person Reduced unit cost of service, or fewer staff Those are the only four things you can do Anything that you come up with that you might think about doing as a saving will fit under one of those four headings So, that is what we are going to have to do in order to bear down on the pressure that we're seeing We know that the front door has held June 23/24 We actually saw fewer people at the end of the period than we did at the beginning of the year But we know that that is coming under extreme pressure And that is being driven by age and complexity in the community And increased level of activity through the hospitals and children coming through from SEND But, you know, we're trying to hold back Reducing the amount of service that everybody gets requires us to review people And we're starting to look at how we can target reviews to reduce the amount of service that people receive That might be respite, it might be help around the home Clearly it won't be people in care homes because having entered a care home people can't They actually never move out of the care home The unit price is where we're putting a lot of focus And, as I've said, we've brought a tool to help us deal with that And we are currently setting and rolling out a base price that we want to go beyond That is in line with the fair cost of care that we came up with 18 months ago Sort of two things, one we know price has risen significantly beyond that But we also know that the things that are driving prices are starting to come down And then there is a question about our overall levels of staffing Which has always been lost on my list because we've not grown our workforce as activity has grown And although we ended the year, sorry, we ended 23/24 with fewer people in receipt of a service The number of people who came to the front door increased hugely And the number of people in receipt of an assessment increased hugely But we found ways of supporting them as well So, those are the four things we're doing, those are the four things we're focusing on In order to bring down expenditure I set out in the budget report in February this year the things, the biggest risks that we were facing They were untunded minimum wage, they were not being able to say categorically how many children were coming through the same system And the increase in activity we were seeing through the hospitals, one of those things have gone away So I think we just need to recognise that we will start doing things we have never done before That will be difficult for the team But I also anticipate it will be difficult for families and it will be difficult for councillors who will get the complaints And my only ask of councillors is that in full knowledge of what we're going to have to do Nobody robs the team about making a more expensive decision than officers have already made I'm going to leave it there if that's okay Thank you, Councillor Gardner Just a follow up on something that Mr Charles McMay just said regarding the not being able to assess the, send pressure that you're going through Is this because there are people in the system who are still waiting assessment Who are deemed to be children who very shortly will move into adulthood Or is it an issue of there not being enough relationship between the two departments I hope it's a former I'm going to go on to that one So there's a really important piece of work to be done to ensure that children have their EHCP status reviewed before they become families That is the piece of work that children's colleagues are now focusing on doing That will have a huge financial impact on adults Because if a child becomes a young adult with an EHCP they'll cost you significantly more than they would otherwise So it has been really difficult to make the judgement about how many children will become adults wanting to be eligible for adult social care For that very reason we hope we will have a better handle on that as we go through the next tribal months Can I just come back to that point of clarification? So what you're saying is that this work is being done but if somebody as a child is in receipt of some form of support If there's an EHCP there is no guarantee that we if they become an adult that they will get the same name of care I think it's almost inevitable they won't because Care Act's standards are very different So in order to have someone with a Care Act it's going to be different to children but if the EHCP would get some of these women children they wouldn't be eligible for adults If someone would have decided this is the care that they require then we'd fund a duty to provide that care For example a youngster who we were paying the weird sounds of requiring support take only £175,000 per year which is coming up for a minute The EHCP resulted in the package of care at the residential school being £375,000 per year cost to our schools because of the EHCP Sorry, I'm just clarifying something you just said So what you're saying is because the court determined this person Because there was a EHCP that stated residential education then and that was still in force at the point of moving over to adults The package of care that was suggested you couldn't, you know, enact that package of care I understand, thank you very much Yeah just a very brief comment I've just been looking at the reg rating, we've got the red in pay inflation I mean I voted for the budget so it was in there so I made this comment at various committee meetings That in previous years we put 5% in and the wage-claiming came in higher than that so it plays in there Probably the question as well because of the previous item there will be, how do I call it, there must have been some pay inflation in there as well But I do find that I've already, in April the agreement was open, that was July, so I thought I'd agree But as you can see we don't set up anywhere near 3% and we've already got some problem already Thank you, thank you very much The recommendations are on page 94 but they are to note, to note and to review So there's no vote required because I assume that most people are quite happy to know the report And I think we have reviewed the various items that are under the budget So we're now moving on, I think I'm right, to item 11 which is the meeting's stretch at ease health and wellbeing group which we just have to actually receive So I trust we're all willing to receive the health and wellbeing minutes Mr Casagarda? Yeah, I'm noting the attendance and the public use of absence and it would be helpful if we could know the rep, I mean obviously I know who Matt is But there are several other people today who know that I'm going to escape but there are other people who I don't know who they are And it would be helpful if we knew which body they were representing in the minutes that that could be passed on Because I meant yet again, with the exception of Louise Barry and Mark Wilkinson who are regular tech analysts And the person who is the Fire and Rescue Service that we are again heavy on chisholmese and emotion and light on other areas I'm sure we can take that away and ask for that So we now move on to item 12 which is the work programme Has anybody got, Helen do you want to introduce her? So we say we have updated this for a number of reviews and commissions that will come forward during the year I anticipate there will be further reviews, further items to be added as we start to look at the specific things we're going to do around bringing down the forecast overspend Can I just say we did have suggestions for an update on the one year contract but that's been done so far informally We had a request that at the September meeting we have some idea of direction of travel for quarter two and that we'd like some input into how the transformation programme will be affecting adult social tomorrow So we thought it could be added So again that would be a briefing then I can see Councillor Colker's got his hand up We have three pointers, one is really for a public health issue, a short while ago we, as you know I'm the chair of Everybody Health and Leisure, a short while ago we suffered the tragedy which doesn't even come close to one of our apprentices passing away through a cut, undiagnosed, completely asymptomatic cardiac arrest Now as a result of that we've had all our staff, well they'd been offered anyway, the opportunity of health screening up until the age of 35 And we understand that 5% of those are going to be referred for further investigation So I just wondered is there anything we can do to roll this out across the whole of Cheshire East or at least look at doing that Because in a school of 1000 we're talking about 50 kids who have got on those stats have got serious heart conditions that need further investigation There can be no symptoms, they just drop down there, so that's one issue, not an entire of it And the second issue, just very briefly, in children's, when I was on the children's screening committee we had read 33 visits of children's homes And I just wondered whether we could do something similar to our commissioned homes because as Councillors we quite often get complaints of sort of, and I'm sure you do the same, from families about, they aren't really very good And I just wondered whether we could go in there, have a look for ourselves, make comments, bring reports back as Councillors to this committee, in the same way as Children's Services did, and then direct 33 Just two issues to think about, thank you Obviously what, Councillor Charles, have you got any suggestions you'd like to put forward? Yes, so first of all I think I may have misunderstood, I thought we were having a quarter one report in July So in terms of the minutes, everything I said about a July meeting just struck, but the Chair has identified that we want to look at quarter one and quarter two in terms of the direction of travel in September, so apologies for that The other thing I just wanted to mention, and I think it's worth us thinking of a way that we might want to investigate this on our work programme And that is, Jill very kindly helped me with a very complicated case this week, and last week, for which I am very grateful But it was really quite concerning, the lack of communication between strategic and statutory partners So we had safeguarding, we had social work, we had NHS, we had fire, we had police, we had housing persons, we even had the RSPCA, and they were not talking to each other And I would like to, as a committee, bearing in mind that cost partnership working is the core of what we're doing in health And we had reports today, mental health reports, how important it is, could we look at our communication systems Because I do consider that that case last week demonstrated a gross failure of communication between partners I would like to also say at this point, adult social care came in and they saved the day, they haven't been told about all this, but they actually sorted it out So thank you very much So can we take your suggestions away and look at them and put them on the work programme Mike do you want to come back? Yes, I'm happy to, and obviously it's extremely saddening to hear about sudden unexplained deaths, especially in young people It's an extremely tragic circumstance and it must have been affected I know there's a staff who were working with everybody who were working closely with the individual, it must have been affected deeply, so I just want to know how much of an effect that must have had on them and that it was a very tragic circumstance The instances of sudden cardiac death in younger people are functionally very rare, but when it does occur it can be extremely tragic I think I'll need to come back to you with a written response on elements of this because I don't think I'm going to be able to do the topic in justice in a brief reply But in general these are extremely unusual and usually very difficult to detect circumstances where people have got often underlying things which are very difficult to detect and only tend to get found when a whole host of things comes together around that individual that leads to unfortunately a very tragic outcome and quite difficult to detect with random heart traces and things like that, so we'll come back to you in a little bit more depth on that Thank you very much indeed Thank you very much Matt Councillor Burton So you reminded me actually if there's something else that Councillor Loughlin said that I wanted to mention, I was wondering if there was an opportunity because we've all got lots of different things happening in our wards as Councillors and I certainly have around our books and health and I'm supporting different people, myself and the other Councillor and I was just thinking was there an opportunity for us to have an informal meeting as Councillors where we could share some of the things that are taking place within our ward and I don't know if that's something that needs to be raised here but I was wondering if that was something we could go forward and be part of the work programme I'm sure officers can take that away, look at that, thank you So has anybody else got any points? Councillor Moss It seems that it's not on the item, Councillor Gardiner do you want to ask a question? Mine was to do with the work programme and it was to thank you and officers for retiming, scheduling the item on the LB partnership to facilitate my holiday and thank you Thank you, we don't actually have any other business slot so could we just close the meeting and then we'll un-secret your question So thank you all for your attendance and good evening and hopefully you'll start to stay out in the garden and enjoy the weather Thank you Oh yeah, thank you. It was just a question of...