Venue: County Hall, Worcester
Contact: Emma James /Jo Weston Overview & Scrutiny Officers
Apologies and Welcome
Apologies had been received from Mr A Fry and Mrs S Webb.
The Chairman welcomed everyone to the meeting including Members from the Health Overview and Scrutiny Committee (HOSC) who had been invited to participate in the joint discussion of the draft budget for Adult Services and Public Health.
Declarations of Interest
HOSC Member, Mrs F Smith, declared an Interest as her husband was the Council’s Cabinet Member with Responsibility for Health and Well-being.
Members of the public wishing to take part should notify the Head of Legal and Democratic Services, in writing or by email indicating the nature and content of their proposed participation no later than 9.00am on the working day before the meeting (in this case 22 January 2019). Enquiries can be made through the telephone number/email address below.
Confirmation of the Minutes of the Previous Meeting
Subject to the following amendment, the Minutes of the Meeting held on 6 November 2018 were agreed as a correct record and signed by the Chairman.
Minute 296, page 5, bullet point 8 in the general discussion, was amended to read:
· In response to a query about funding for domestic abuse, it was reported that Public Health Commissioners of domestic abuse services were working closely with District Councils.
The Cabinet Members and Directors responsible for Adult Services and Public Health had been invited to provide an overview of the draft budget for 2019/20 following a review of the 2018/19 budget position at the 6 November 2018 Panel meeting.
The Chief Financial Officer (CFO) provided the context to the budget consultation process and advised that comments from the Overview and Scrutiny Panels would be discussed by the Overview and Scrutiny Performance Board on 24 January and reported back to Council.
The key points included:
· that the overall income from grants and council tax would increase by £6.2m in 2019/20
· there was £35m of cost pressures from demand led services
· the forecast outturn for 2018/19 at Period 7 was for a £3m overspend.
The CFO advised that since the 13 December 2018 Cabinet Report, the County Council and its six District Council partners had been successful in its application to be a 75% Business Rate Retention Pilot, resulting in a one-off cash allocation of £4.9 million in 2019/20 to be used on services to prevent or reduce the costs of adult and children’s social care across the County.
Members were reminded of the massive cost pressure the Council was experiencing as a whole and the specific pressures around adult social care, resulting in social care precept announcements and government one off grants to further support the rising costs of care.
Overall, the forecast of £14.1 million increase in the net base budget for 2019/20 included increased cost pressures of £11.4 million including care services for older people, allowing for increased caseload, more complex care needs, the National Living Wage for 2019/20, and those transferring from children to adult care.
During the discussion, the following main points were made:
· Members were disappointed that the information before them was from the December Cabinet and that updated information was not available to Scrutiny for its January meetings and therefore the Panel was not scrutinising the most up to date information
· The CFO reassured the Panel that no changes affecting Adult Services were expected in the budget information being presented to January Cabinet
· Some assumptions were being made in relation to future government grants, however, it was confirmed that the social care precept was not continuing. In addition, local authorities were waiting on the Adult Care Green Paper to be published to inform the future direction of travel
· Despite some uncertainty about income, it was confirmed that the savings would be achieved this year. More savings, would however be required by the Council in 2020/21 and 2021/22
· The CFO and the Director of Adult Services were congratulated on the due diligence carried out in respect of the budget proposals and the work done to establish the reliability of Adult Services savings proposals
· In relation to the Business Rate Retention Pilot, Members were interested to learn more about how the £4.9m would be distributed across the County and how Districts could apply for funds. The Panel was told that an Operational Board would be established ... view the full minutes text for item 302.
The Cabinet Member with Responsibility (CMR) for Adult Social Care, Director of Adult Services and the Programme Manager responsible for the Adult Services Business Plan had been invited to provide an update on progress to date.
The CMR reported that the Plan was approved at the 15 November 2018 Cabinet and sought to promote independence and prevent, reduce and delay the need for care. In addition, safeguarding systems would be robust and the Council would actively engage with the provider market to ensure that current and future needs could be met. He emphasised the need to build community resilience going forward.
The key focus areas of the Plan were to:
· reduce the number of older and younger adults whose long-term support needs were met by admission to care homes
· increase the number of people whose short-term support services enabled them to live independently for longer
· increase the number of older people who stayed at home following re-ablement or rehabilitation
· sustain the current performance on delayed transfers of care from hospital
· prevent reduce or delay the need for care.
The Progress made to date was:
· the strengths-based model (3Cs) had been rolled out across all social work teams who were now co-located with neighbourhood teams and Learning Disabilities Team
· investment had been made in technology in residential and domiciliary care settings
· increased social worker capacity in acute settings
· Market Position Statement had been published
· Re-ablement and Front Door Review was in progress.
In the ensuing discussion, the following key points were made:
· The Panel welcomed the Plan and felt that co-locating with Neighbourhood Teams was a triumph
· The Patient Flow Centre, a multi-agency team who managed discharges from acute settings, was the only one in the Country and would need to be reviewed as to its sustainability given other work being carried out with health economy partners
· Delayed Transfers of Care (DToC) could be for a number of reasons, such as housing concerns, family disputes over where the next placement should be (more so if the family was self-funding the placement), waiting time for prescriptions or transport arrangements. The Director explained that not all of the processes helped people to leave hospital as quickly as possible and there was more work to do around this to improve the situation. Worcestershire, however was above target in this area and the Director would provide the Panel with details from across the West Midlands to compare statistics
· A Member felt the Plan and its vision and aims needed to be communicated more widely. Officers were working with the County Association for Local Councils (CALC) to disseminate information and build future community resilience. The point was made that CALC did not cover the whole of Worcestershire. The Director welcomed Members suggestions on alternative ways of communicating the Plan in their area.
· Nationally, there was a view that people were never too old to become active and locally work was being undertaken to support this view
· In response to a question about how safeguarding information was ... view the full minutes text for item 303.
The Director and Cabinet Member responsible for Adult Services, along with the Programme Manager, had been invited to provide an overview of the national Adult Social Care Outcomes Framework (ASCOF).
The Director reported that the ASCOF was an industry standard and provided trend information across the Country. It was verified each year in October, for the previous year, in this case 2017-18.
73% of the metrics were on or above average and in some areas, the Council was a leader, such as in the proportion of carers who receive self-directed support.
Officers acknowledged that some of the percentages looked wrong and they were investigating the reasons why.
In the ensuing discussion, the following key points were raised:
· One Member stressed the importance of adults with a learning disability being given the opportunity for paid employment and was informed that the small team of people focussed on supporting this area would be retained. No additional funding had been sought as performance was in the top third nationally, but their budget was safeguarded against any cuts. The Panel heard that some places, such as authorities part of the West Midlands Combined Authority, had plans which had been in place for a longer period. One Member also noted that voluntary opportunities could sometimes lead to employment
· The Cabinet Member suggested that he could discuss with the Leader, the possibility of promoting the benefits of employing adults with learning disabilities at the Local Enterprise Partnership (LEP) Conference, the last of which had around 500 local employers. The Panel welcomed and supported this suggestion
· In response to a question about how the Council was working to improve the performance in respect of the proportion of people who use services and who receive direct payments, the Director advised that Worcestershire was around the half way point nationally not an area of focus for the Directorate at present
· To assist Panel Members, the Director agreed to provide a briefing note on Direct Payments
· The Panel was pleased to read that delayed transfers of care from hospital that were attributable to adult social care were average in the comparator group.
In summary, the Panel Chairman thanked the Cabinet Member for his suggestion to raise awareness of learning disability employment opportunities at the LEP Conference and welcomed further information on direct payments from the Director.
The work programme was noted with no amendments at this stage.