Agenda item - Presentation, HASC Commissioning Strategy

13.1    This item was introduced by Rob Persey, BHCC Executive Director, Health & Adult Social Care (HASC). Mr Persey told the committee that a draft Commissioning Strategy had been presented to the Health & Wellbeing Board in 2020. Completion of the Strategy had not progressed as planned, as officers had been required to focus on responding to the Covid emergency. However, the principles of the draft Strategy are being used to inform commissioning – e.g.:

·         Partnership & collaboration

·         Prevention & empowerment

·         Person-centred and outcome focused

·         Co-production with service users

·         Value for money

·         Valuing the workforce.

13.2    Since 2020 the context within which social care commissioning has operated has changed significantly, due to the pandemic, to increased workforce pressures, and to the establishment of an Integrated Care System (ICS), due to go live in April 2022.

13.3    Major commissioning activity in 2022/23 will include:

·         Domiciliary Care contract

·         Residential/Nursing Care contracts

·         Supported Living/Community Support/Day Services contracts

·         Community Equipment Service contract

·         Knoll House.

13.4    Currently, local authorities across the South East are working to develop a co-ordinated Market Position Statement. The Brighton & Hove HASC Commissioning Strategy will need to reflect, and must therefore follow, the publication of this Statement.

13.5    Fran McCabe asked whether thought had been given to designing seamless services around service users, rather than commissioning discrete services that people had to navigate between. Mr Persey acknowledged the value of this holistic approach and noted that aspects of this type of care were already being commissioned. For example, where people have a temporary placement in a care home setting and then return to their own homes, some care homes have been commissioned for their staff to provide initial homecare support in order to ensure continuity of care. Moving to more holistic commissioning models is complicated by the need to deliver all statutory services and to maintain a sustainable local care market, but commissioners are committed to working with service users and experts by experience to deliver person-centred services.

13.6    Ms McCabe noted that more imaginative models of working might have workforce benefits also. Mr Persey agreed, and told members that a health & care system workforce strategy was being developed at ICS level. This includes identifying new roles that the system requires, looking across health and care services; and also seeking to optimise the capacity of the whole system workforce. BHCC Human Resources are involved in this work as is the Voluntary & Community sector.

13.7    Cllr McNair asked a question about whether the roles of community nurses might change. Lola Banjoko, Brighton & Hove CCG Managing Director, responded that this is being actively considered as part of the development of place-based planning, particularly in terms of providing wrap-around support for patients with complex needs (e.g. multiple Long Term Conditions). The system recognises that there are currently significant staffing challenges in community healthcare.

13.8    In response to a question from the Chair on financial pressures on Adult Social Care, Mr Persey told members that there is less money available in real terms than 10 years’ ago, despite an increase in demand and in acuity of need. In recent months there has been increased funding via Government grants and a significant degree of additional support from the local NHS. This has enabled more funding to be passed on to care providers; and there has been really effective working between ASC and the NHS: for example, the joint procurement of care beds. This additional support and funding has been welcome, but short-term and short notice funding does not allow for the proper planning of services; what is required is a long-term ASC funding settlement.

13.9    In reply to a question from the Chair about capacity within the HASC Commissioning team, Mr Persey told the committee that HASC is working closely with BHCC Families, Children & Schools and with  NHS commissioners to align commissioning activity. It is currently too early to say what if any additional capacity may be required in HASC commissioning.

13.10  In answer to a question from the Chair about co-production, Mr Persey told members that officers are seeking to identify best practice in current commissioning in order to embed this in the new strategy.

13.11  The Chair asked what care workforce problems are specific to Brighton & Hove, rather than just shared issues nationally. Mr Persey responded that Brighton & Hove has a large hospitality and retail sector which can attract care workers as pay and conditions in hospitality and retail may be better than in care. Also, the city care market is made up of a large number of small providers. This means that providers are not always able to provide the staff training that larger providers could, with the council having to offer additional support. In addition, organisational staff career pathways may be limited for small providers; the system needs to think about how to offer career progression in order to retain staff in the sector.