To consider the submitted report on the above and to make recommendations to the Cabinet.

The Board received an update on the Multiple Complex Needs Alliance (MCNA) Review as set out in the submitted report.  The Leader of the Council (Councillor David Thomas), the Consultant in Public Health (Bruce Bell) as well as the Interim General Manager Public Health Services with Torbay and South Devon NHS Trust and member of the Growth in Action (MCNA) Strategy Group (Simon Acton) attended the meeting and responded to questions.  The MCNA had been operating for two years (since 21 June 2022) bringing services together and the report highlighted the successes as well as the need for improvements such as a more integrated approach; the importance on focusing on the importance of relationships and the need for service users to work with the same person for continuity of support; cessation of supplementary central Government grant funding; and lack of suitable move on accommodation.

Members asked questions in relation to how the voice of the service user was being heard; the benefit of having more detail about the transformation and culture change; what were the problems around officer capacity; had the MCNA approached charities to support their work; how much was the current grant that was at risk; what action would benefit the MCNA the most; the importance of addressing the lack of suitable move on accommodation and the need to take brave decisions; and if the MCNA works with other local authorities across Devon who may have capacity in their accommodation.

In response to questions around mental health, Members were advised that the inclusion of mental health in the Alliance was explored with the Clinical Commissioning Group (CCG) at the time of procurement process, but this was not possible.  Members were informed of the dual diagnosis function and work within Torbay Recovery Initiatives and the work that the Alliance was doing with mental health services to work better together.

Regarding move on accommodation there were up to 15 residential rehabilitation placements for up to 12 months with around 10 to 15 people successfully completing the programme.  There was a wider need for accommodation with the Council having statutory responsibilities for domestic abuse accommodation and staying safe accommodation.  Devon experiences similar challenges regarding suitable accommodation.  The MCNA work supported the Housing Policies moving forward with outreach being important part of engagement and support.  Working with the community, voluntary and faith sectors was well established and there were further opportunities to work with Torbay Community and Community Builders in addition to the work already done with YES Brixham and YES Paignton.  It was noted that the MCNA could benefit from being part of a central hub together with wider services e.g. health, education, housing and psychology where users could talk about their housing and other needs without being stigmatised for needing support; as well as inclusive recovery focussed community support. 

Members were informed that hearing the voice of the user was fundamental and would be explored in different ways, subject to funding, including surveys, speaking to users and their peers on their experiences on what was good and what they wanted to change and continuing those discussions and involving them in the solutions and telling them what had been done as a result. 

The Board was advised that response staff and commissioners across the Alliance were busy delivering and overseeing service delivery with constrained capacity to realise the culture and transformational change required of the Alliance Agreement.  While progress had been made looking at lived experience and co-production, further focus and work was needed on certain change elements, including workforce development and support for wider alliance across the Teams to achieve synergies and effective ways of working, working closely with Torbay Council Commissioners to collectively learn from experiences.

Members noted that the total funding for the MCNA was between £2m to £3m with approximately £200,000 (Note:  following the meeting it was confirmed that this was £798,000 and not £200,000) of additional funding from the Supplementary Substance Misuse Treatment and Recovery Grant (SSMTR) which was at risk for 2025/2026.  At the last meeting of the Board, Members raised concern about the lack of sustainable funding for domestic abuse and sexual violence services and the MCNA report also referred to the lack of sustainable grant funding for drug and alcohol services.  Members were concerned over the lack of certainty around the future grant funding and the impact on the MCNA.

Resolved (unanimously):

1.         that the improvements made in the performance and quality of support as well as the positive changes made through the Multiple Complex Needs Alliance (MCNA) be acknowledged;

2.         that the attendance of members of the MCNA Oversight Board to offer support and challenge to the Alliance Leadership Team be endorsed;

3.         that the Overview and Scrutiny Board seeks assurance over the coming 12-months that the transformational opportunities afforded by the Alliance approach are observable and progressing towards realisation and a report be brought to the Board in Autumn 2025 when the Safer Torbay update comes to the Board;

4.         that the Cabinet be advised of the Boards concerns:

a.         in respect of the lack of suitable, affordable move on accommodation which is compromising the functioning and outcomes of the Alliance.  This is adversely impacting on those vulnerable residents being supported but unable to move on with their lives.  Consideration of funding and access to accommodation to meet the needs these residents is urgently required to address the impacts being faced; and

b.         in respect of the risk to delivery and outcomes gained from central government grants for drug and alcohol treatment and domestic violence and sexual abuse support due to these coming to an end on 31 March 2025.  This external grant funding has significantly benefited the available support, experience and outcomes for vulnerable Torbay residents and consideration needs to be given to this risk, impact and therefore budget considerations in 2025/26 if central government does not reinstate or mainstream this funding.  For domestic abuse specifically, there remains a statutory duty to provide support in designated safe accommodation;

5.         that the Overview and Scrutiny Co-ordinator be requested to write to the local Members of Parliament to ask them what the proposals are around the base funding for drug and alcohol services from 2025/2026 and raise awareness of the risk of loss of critical services in Torbay; and

6.         that the Priority and Resources Review Panel be requested to consider the funding for Drug and Alcohol Services as part of the budget review for 2025/2026.