Agenda item

Performance Monitoring (Quarter 2 – July to September 2021)

The Panel had received summary data on the five performance indicators it monitored.  Performance in admissions to permanent care in both adults aged 18 to 64 and aged 65+ had fallen, however, Officers had developed an action plan for operational, finance, reporting and commissioning staff which focussed on all admissions, especially alternative provisions such as shared lives and supported living.  Officers were mindful of the impact of the fragile domiciliary care market and residents in care homes who were no longer funded through NHS Continuing Health Care.  Alongside this, Information, advice and guidance for self funders was ongoing. 

There had been an improvement in the level of performance for the indicator on the outcomes of short-term services, i.e. the proportion of people with no ongoing social care needs following a reablement service and also the indicator on older people remaining at home following a hospital discharge and a reablement service.  Both indicators had a seasonal trend in performance, with winter months performing less well.

The final indicator, on the number of Annual Care Packages completed, showed improved performance, however, the target of 95% had not been met across all service areas.  Staffing issues and vacancy rates in learning disability services and mental health had been reviewed and recruitment was underway.

During the discussion, the following key points were made:

·         In relation to mental health staffing, Officers reported that workforce issues had impacted on the number of annual care packages which could be completed.  Human Resources had looked at market forces, and regional comparators in salary, and recruitment was underway

·         A Member asked why the Target for Admissions to Permanent Care per 100,000 (65+) had changed from 480 in the Quarter 1 Performance Report, considered at the 29 September meeting, to the Quarter 2 figure of 574.  Officers reported that the target was reviewed each year but would provide further detail on this change after the meeting

·         The number of Agency Staff required to fill gaps was increasing.  This was also the national picture and a wider market issue, with particular impact on Domiciliary Care

·         Around 5% of the Care Home workforce had left as a result of the national requirement for staff, contractors and volunteers to be fully vaccinated against COVID-19 from mid November.  This contractual requirement was also to be implemented for all front line health and social care providers from April 2022

·         In response to a query about the large age range for Admissions to Permanent Care per 100,000 (18-64), Officers clarified that there was much more detailed age profile data and that they were able to follow trends and trigger points.  The Director agreed to share some further information to the Panel on Shared Lives and Supported Living and reminded Members that last year was not a typical year for the Directorate

·         Ideally, Care Package discussions should begin on admission to hospital, however, this was generally not the case due to hospital pressures.  A new Patient Tracker system had recently been implemented, resulting in community health and social care working together and working towards discharge on the planned day.

In-year Budget Monitoring and 2022/23 Budget Scrutiny

The Head of Finance outlined that the Adult Services budget, as at the end of Quarter 2, was forecast to be broadly balanced by the end of the financial year.  Risk areas included increased placement costs for Learning Disabilities and a forecasted reduction in income generation.  There were underspends in Direct Payment income recovery and Physical Disability services.

Looking forward to 2022/23, risks and potential pressures included increases to the cost of care, taking into account increases to the National Minimum Wage, costs associated with staff shortages and general living costs as a result of both the pandemic and leaving the European Union.  An increase in service demand above forecast and the impact of delayed discharges from acute hospitals were also risks.  The level of Government funding was never certain and the impact of the lifetime care cap would become clearer in time.

In response to Member questions, main points included:

·         The forecasted level of income for Learning Disability services was less than Budget and the Council was working with Clinical Commissioning Group colleagues to review levels of funding

·         Income Recovery from Direct Payments would take place after conversations and engagement.  A contingency was acceptable, however, if the Council was funding over and above the level of outgoings and welfare was not at risk, then it was the correct course of action to recover some of the payments made

·         For the benefit of new Members, further information would be shared on the Directorate’s Transformation Plan, the ‘3 Pillar’ Strategy

·         The Head of Finance clarified that all budgets were a fair forecast.