2018/19 Financial Position as at Month 9, December 2018
- Meeting of Commissioning Committee for Mental Health & Older People, Wednesday 27 February 2019 11.00 am (Item 7.)
Ms Sabera Ebrahim and Mr Pete Hesketh, Head of Finance, Integrated Support presented the report.
The meeting heard that:
· There were local authorities which had overspent despite having been allocated additional funds, but Lambeth had not done this. Lambeth was managing using the resources that it had.
· There was a significant financial risk on uncertainty on recurrent financial resources for social care for the health and care sector generally.
· There are cost pressures due to the increase in numbers of older people and people with physical disability, the length of time people were living, increase in unit cost and the general cost of living.
· Employers are required to pay at least the national Living Wage but this was increasing the cost.
· The House of Commons library had issued a issued ‘thinking so far’ document regarding the green paper. This would be circulated to the Committee.
· The government had said that said that it would be issued at the earliest opportunity.
· There was still dispute in central government regarding how much should be allocated to health care services; caps on expenditure were still being discussed.
· At the MADE event, a closer examination was made of the 12 super stranded individuals. Some themes included an individual need for more intense personalised support. There was one cohort that had a need for more forensic input. This needed escalation because the interaction between forensic teams and ward teams was not as good as it could be. This had been escalated to the South London Partnership. There was a small number of women with complex needs, some with drug taking issues or sexual exploitation issues.
· Patients reconnecting with the community could find themselves in unintended or unhelpful circumstances or environments.
· There were a number of other people who would discharged and readmitted hospital. Attempts had been made to manage risks for individuals.
· More work may need to be done to help find theright solutions. This may mean trailing an idea or process for 3 months.
· Some patients were fearful of being discharged and would exhibit behaviours to delay their discharge.
· At times, patients had been partially institutionalised and support had been given to patients to become more confident of being discharged.
· Taking the DoLs or Court of Protection route often took months. However, if patients refused to leave, then they would have to go through Court of Protection process.
· There were groups of people entrenched within the system who were all known to professionals working within it. Consideration needed to be given on how to interact with them with respect to their personal circumstances. Some had supportive families.
· In the field of Learning Disability and Homelessness, the cohort across the trust had 70/80 people who took up 60% of the bed occupancy. Some people would be admitted for 200 days or more.
· There had been some difficulty in finding the right person who could engage with a particular individual. There have been some workers who had been able to establish a relationship with one or two specific people, but not all patients had this type of support. Some would not talk to people or participate in assessments.
· Creative methods for dealing with people with significant challenging behaviour was difficult to implement as it could have impact on other residents, particularly in supported housing.
· The situation at Lambeth was progressing. The trust had target of discharging 75 men and was meeting its targets.
· There had been points where there were more beds than people.
· There was a challenge on how to deal with long stayers.
· SLaM Mental Health trust and MADE events had become part of routine practice.
· The main reason for the DTOC numbers at GSTT, King’s and St George’s was for people waiting for nursing home placements or choice of home but the numbers were already generally low.
That the Committee note:
1) The latest position on the Better Care Fund as at month 9 (December 2018).
2) The latest position on the aligned Mental Health budgets as at month 9 (December 2018)
3) The latest position on the aligned Older People budgets as at month 9 (December 2018)