Agenda item - Possability People Disability Advice Centre Funding

Report of the Executive Lead, Strategy, Governance & Law (copy attached)

6.1       Geraldine Des Moulins, Chief Officer of Possability People, addressed the committee. Ashley Scarff, Director of Partnerships and Commissioning Integration, and Dr David Supple, Chair, of Brighton & Hove CCG, were present to respond to members’ questions.

6.2       Ms Des Moulins told members that Possability People:

·         have challenged the CCG’s decision to cease funding the Disability Advice Centre (DAC), but have not to date received a full response;

·         have also challenged the Equality Impact Assessment (EIA) process which underpinned the CCG’s decision;

·         Are unhappy with the mitigations offered in the EIA, particularly since they contend that there was no comprehensive attempt to check that alternative providers were willing and able to take on DAC clients;

·         Contend that the EIA was seemingly written after the funding decision had been taken (whereas it should have been used to inform the decision);

·         Argue that there is a clear evidence base for the health benefits of the DAC (including its role in reducing healthcare spend, particularly in terms of mental health services);

·         Wanted the HOSC to scrutinise the CCG’s decision-making process in terms of whether it accorded with Public Sector equalities duties.

6.3       In response to a question from Cllr Druitt on the EIA, Ms Des Moulins told members that Possability People have asked the CCG to clarify when the EIA was completed but have not yet received a response.

6.4       In answer to a query from Cllr Hills on alternative service provision, Ms Des Moulins informed the committee that she had spoken to alternative providers. There are some excellent services in the city, but all providers are struggling with capacity, particularly given the impact of Universal Credit. The DAC is the only specialist advice service for people with disabilities and some of the alternatives are not fully accessible.

6.5       In response to a question from Cllr Powell on numbers of people using the DAC, the committee was told that there were more than 4000 contacts in 2017/18. The number of contacts has been steadily rising in recent years. This service will not easily be replaced and there will be a real impact on people’s lives if they do not have rapid access to advice. This can lead to a loss of benefits and the danger that people’s problems may spiral out of control.

6.6       In answer to a question from Cllr Powell about engagement with the CCG, Ms Des Moulins told members that the short notice of closure meant that there had been no opportunity to put a case to the CCG or to prepare properly to wind-down the service.

6.7       Dr Supple told the committee that the CCG was required to use NHS funding wisely and to fulfil the NHS mandate. The CCG is required to meet its annual Control Total, and in a very constrained financial environment, this entails making very difficult decisions. The CCG has reviewed all its non-mandated commissioning and has subsequently reduced some funding. Ultimately, money invested in advice services is money that cannot be spent on treatment. Whilst there is a case to be made for investing more in long-term prevention, the NHS financial system does not currently work to facilitate this.

6.7       In response to a question from Cllr Grimshaw on the equalities impact of the decision, Dr Supple told members that the CCG did pay due regard to equalities; there are alternative advice services in the city. Ashley Scarff added that the CCG used its EIA to explore mitigatory measures prior to making a decision. This process was time-consuming, hence in part the ‘late’ notification of the decision. Cllr Grimshaw noted that whilst there are other advice services in the city, the DAC offers the only dedicated service for people with disabilities.

6.8       Fran McCabe noted that Healthwatch Brighton & Hove had recently published a report on Personal Independence Payment (PIP) assessments. People’s health problems can be exacerbated by the PIP process, and the DAC provides vital support to mitigate this. The fact that the decision to cease funding the DAC was made is indicative of how poorly integrated the city health and care system is. The decision also seems odd given the high prevalence of long term health conditions in Brighton & Hove (according to the city Joint Strategic Needs Assessment: JSNA). Dr Supple noted that the CCG did take JSNA data into account when making its decision. The NHS is faced with making a number of unpalatable decisions and remains committed to learning from all decisions in terms of ensuring that all mitigatory steps have been taken.

6.9       In response to a request from Cllr Powell, Dr Supple agreed to circulate the relevant EIA.

6.10    In answer to a query from Cllr Powell on consultation, Mr Scarff told members that there had been no formal consultation process; formal public consultation would not be required when a contract is not renewed.

6.11    In answer to a question from Cllr Powell on accessibility, Dr Supple told members that the CCG had not visited all the alternative provider sites to check their accessibility.

6.12    In response to a query from Cllr Hills on the timing of the announcement of the decision, Mr Scarff told members that the CCG had spent all available time exploring possible alternatives to ceasing funding.

6.13    In answer to a question from Cllr Hills on what it would take for the CCG to rethink its decision, Dr Supple responded that the CCG would reflect on the views expressed by HOSC members. Mr Scarff added that the CCG will monitor the impact of the decision, but that the CCG is bound to apply its resources to meet mandated requirements and to meet its control totals.

6.14    Cllr Druitt noted that the CCG announced its decision to cease funding the DAC after the city council had set its budget for the coming year. This meant that it was not possible for the council to plug the funding gap had it wished to do so. In the circumstances, the least the CCG should reasonably do would be to maintain funding this year until alternative arrangements can be made. Dr Supple responded by saying that there has been a historical lack of alignment between CCG and BHCC budget-setting processes which is being addressed. Mr Scarff added that there was a lesson to be learnt about terminology: the CCG believed it had been clear that the contract was being reviewed and that there was no certainty of ongoing funding and about risks to services at an early stage, but in hindsight could perhaps have spoken more bluntly to ensure this was fully understood.

6.15    In response to a question from Cllr McNair on the criteria for making savings, Mr Scarff told members that there are significant financial challenges and the CCG is mandated to prioritise clinical services.

6.16    There was discussion of the CCG’s funding. Dr Supple explained that in 2018/2019 the CCG was required to generate a surplus in order to meet its nationally-set control total but that this surplus was not available for commissioning.

6.17    Members discussed further action and it was agreed that the Chair should write to the CCG further expressing member concerns about the DAC decision and asking the CCG to reconsider its stance.

6.18    RESOLVED – that the report be noted.