Agenda item

The following were in attendance:

Paula Furnival, Strategic Director for People

Steph Simcox, Head of Finance

Kerry McCrossan, Service Manager

Sally Baldry, Principal Management Information Analyst

Cllr Adrian Hardman, Cabinet Member with Responsibility for Adult Social Care (CMR)

Performance Information

The Principal Management Information Analyst summarised the key points for Quarter 2.

Regarding the number of admissions to permanent residential and nursing care, the Panel was reminded that this was part of a national definition, split between older and younger adults, which included 12 week disregards, and was expressed as a rate per 100,00 of the population. Unsurprisingly, due to COVID, the rate for older adults entering care homes had reduced (to 434 from 628 in March), which in terms of numbers of people was 853 in the rolling year to the end of March and across the year ending in September, had reduced to 617.  There was a similar pattern for younger adults, with the rate dropping from 17 per 100,000 to just over 12. Alongside these reductions, more people were receiving homecare and more younger adults were living in supported living arrangements.

There had been a dip in the proportion of people with no ongoing care needs following reablement after hospital discharge, however numbers were now starting to rise and all those coming out of hospital would now be offered some form of reablement. Figures for the number of older people remaining at home following hospital discharge and reablement had also dipped but had picked up from September.

Regarding annual care package reviews performance stood at approximately 85% and varied across teams with learning disability and mental health rated as red.

The Chairman commented that COVID-19 made analysis of performance more difficult and time would reveal whether trends continued.

In-Year Budget Information

The Head of Finance referred to the presentation slides which highlighted the main points from the Quarter 2 forecasted position. Currently, a very minor overspend of £260 was forecast which was a significant improvement on the Quarter 1 position of £2m – the main reasons being tighter control of spend, managing accountability, changes to entry pathways into residential and nursing care and a decrease in projected numbers of people coming into the care system.

Within the overall forecast position, there were variations between different client groups. Older People Services included a full year saving related to implementation of ‘Liberty Protection Safeguards’ (around £1.6m) which had been delayed by Central Government, along with staffing costs. Learning Disability and Mental Health Services were forecast to overspend due to increased average unit costs.

Physical Disabilities Services were due to underspend as activity numbers were lower than budged for, while Provider Services were overspending due to agency and overtime costs.

It was important to note that the forecast position excluded the impact of COVID-19 which would be funded from external funding sources such as the COVID-19 grant (£29m), test and Trace (£2.75m and Infection Control (£7.45m). Relevant areas where COVID-related spend/loss of income had been funded from such external resources included loss of income from clients, additional costs associated with supporting care providers, additional costs from personal protective equipment and a delay in implementation of change programmes.

The next couple of quarters would depend on the pandemic and the extent of the impact on the economy and on providers.

The Chairman invited discussion and the following main points were made:

·       Whilst welcoming the positive news about the reduced forecast overspend the Chairman pointed out that COVID-19 would have contributed to this. The Cabinet Member with Responsibility for Adult Social Care (CMR) pointed out that he felt the Directorate also had a much better grip on budgets and the Chairman emphasised that she had in no way intended to play down the achievements of the directorate teams in managing budgets.

·       The Chairman expressed concern about the overspends in Learning Disability and Mental Health Services and asked how this was likely to unfold? The Officers explained that budget forecasts were unlikely to be exact however prudent measures had been used in projections. The Director referred to two projects which related closely to these two groups of customers. Responsibility for mental health was shared with the Clinical Commissioning Group and costs and spend was being monitored. Linked to achieving a better balance and oversight of mental health, staff who had been working for Worcestershire Health and Care Trust were being moved back to the Council’s workforce.  Regarding learning disabilities, where S117 funding applied, work was taking place to redress the balance of funding with health colleagues.

2021/22 Budget - Emerging Pressures and Challenges

The Head of Finance referred to the presentation slides which set out the key areas being reviewed by the Directorate:

·       Changing nature of support - the Council was mindful that demand was latent and was working with partners to try and mitigate this

·       Unit costs for care provision including the impact of inflation and the National Minimum Wage

·       Market availability and ability to provide types of care needed by clients

·       ‘One system’ approach to intermediate care and learning from positive lessons of shared working with NHS, independent and voluntary and community sector

·       Delivering 2020/21 savings on organisational redesign which had been delayed by COVID

·       Consideration of a single ‘front door’ for access to Council services

·       Development of integrated community offer of Here2Help

·       Development of a strong digital offer for customers and clients

·       Moving towards a more reablement and enabling social care offer

·       A new all age disability offer.

In terms of the medium to long-term impact of COVID, areas being reviewed were provider sustainability, demand on the care sector, increased numbers of self-funders entering council care, economy, transport, funding availability, social distancing, engagement/communications, Here2Help development, ability to regenerate income collection and trading activities, and clients’ ability to pay their assessed charges.   The impact of Brexit was also being reviewed, including contracts, supply chain, funding, staffing, changes in legislation and impact on providers.

The Chairman thanked Officers for all their hard work in and for the outline of emerging pressures which she would relay to the Overview and Scrutiny Performance Board. Discussion was invited and the following main points were raised:

·       The success of the Here2Help scheme was emphasised, which it was hoped would be a long-term option and the Chairman reminded Panel members that its potential future development was being discussed that afternoon at the Corporate and Communities Overview and Scrutiny Panel, which was open to Panel members to attend.

·       The CMR referred to the £29.3m support from Government to the Council budget and highlighted that at some point the impact of COVID would need to be absorbed into everyday budgets, which would be a key moment for councils and a turbulent transition – and the Chairman echoed these comments.

·       The Healthwatch representative present said that he had found the update very comprehensive, but suggested that the impact of an ageing workforce may be pertinent for the future?  Whilst acknowledging this point, the Director advised that recruitment rates were monitored and recruitment for reablement roles was about to start, with a good response envisaged in part due to increased unemployment.

·       The Director thanked the Panel for their recognition of the Directorate’s work and highlighted the relentless impact of COVID on care staff and therefore the importance of resilience in the months ahead while the vaccine was rolled out.