Agenda item

(Indicative timing: 10.05am – 10.35am)

The Panel was updated on performance and financial information for services relating to Adult Services.

In-year 2022/23 Budget Monitoring – the Deputy Chief Finance Officer summarised the main points relevant to the forecast outturn, as included in the Agenda.

Adult Social Care was now showing an overspend, which was the picture for a number of local authorities with social care responsibilities. The current overspend was mainly due to an increase in clients and a significant rise in related costs; there had already been a growth of 2% in clients since the end of March which was forecast to reach 4% by the year end.  Budgets had factored in inflation, however costs were now increasing in so many areas, particularly in provider services.

The Gross overspend of £13.6m was being partially offset by a £7.1m one-off mitigation, giving a £6.5 m net overspend, which was fantastic but left much more work to do.

Discussion points

·         Regarding the task of identifying continued savings, the Strategic Director for People (the Director) referred to conversations within the Council as well as with other local authorities, with demand and contract management strategies being used where possible.  A downturn in demand was beginning to be seen, possibly post-Covid, although it was too early to rely on this.

·         Central Government’s ‘fair cost of care’ exercise and expectations on councils to set sustainable market rates, which would inevitably be higher than current rates, was worrying since the expectation amongst councils was that this Policy would drive costs considerably.

·         The Panel was assured that the Council was actively involved with the conversations taking place with central government regarding the ‘fair cost of care ‘reforms through local government networks, and the Leader had a meeting with MPs the following week – all councillors were encouraged to take positive action through their own interaction with local MPs.

·         Financial settlements for local government were not expected to be confirmed until very late before Christmas, and specific grants not confirmed in time for the Council’s budget setting process.

·         The Director acknowledged that invariably there may come a point where a council may have to make a call on its ability to continue to fulfil the statutory obligations of social care, which were set out in the Care Act 2014 – definitions in the legislation were quite open and there may be decisions to be made around some aspects of wellbeing, although it was emphasised that the Council had stopped providing ‘nice to have’ adult social care services some time ago. Importantly, aspects such as care for an elderly person living alone with care and support needs, was absolutely councils’ responsibility.

·         Providers were facing significant cost increases and the cost of care packages was therefore increasing.

·         Long-Covid was not an identifiable feature in increased numbers of clients.

Adult Services Performance Monitoring for 2022-23 Quarter 1 – the Principal Management Information Analyst talked through the background to each of the targets included in the Agenda.

Admission to permanent care for the 18-64 age group were 56 young people at the end of June. Numbers had been steadily growing from previously lower numbers in particular during the pandemic. Levels were now being managed down.

Admission to permanent care for older people figures were 746 at the end of June down from 804 at the end of March, following a concerted focus to reduce.

Performance for reablement was steadily increasing which was very positive. Performance for people aged 65+ at home following rehabilitation were good and just above target considering the challenging pressures during winter months.

Performance for annual care package reviews completed was now green for mental health teams. Pressures continued to impact on this target, and team representatives now met regularly to share good practice.

Discussion points

·         The Assistant Director for Adult Social Care acknowledged that the target for review of annual care packages had not been met for some time, with issues in particular client groups, therefore an external provider had been tasked with improving performance, however the provider had also experienced significant recruitment issues. The Council continued to do everything possible to fill permanent staff vacancies. The Panel was reassured that regular monitoring took place to ensure new assessments and care package reviews were prioritised effectively.

·         It was explained that the target for annual care package reviews was set at 95% since it was accepted that 100% was not realistic, however it was important to note that with increased levels of demand, there may be multiple contacts with people, rather than them being stable for a full year, with the result that the clock was constantly ticking.

·         The swings in data for admissions to permanent care for older people over between 2020 – 2022 were the result of Covid. Families’ informal arrangements to meet an individual’s needs in the short-term were unlikely to be sustainable long-term, resulting in an inevitable spike in demand and it was good news that numbers were now reducing.

·         In terms of the staffing pressures, there were a number of elements, for example significant recruitment issues for registered and non-registered social work staff – a levy had now been applied since pay rates were more favourable in some surrounding areas and retention had improved. The Council had its own social work academy. The broader care worker sector, most of which was within the independent sector, had experienced significant turnover with competition from other sectors. A range of initiatives were in place to make a career in care more appealing and the position varied with some teams fully staffed, and those in northern areas with more vacancies due to the proximity of Birmingham -  the pressures explained some of the variances in performance, impacted on the ability to provide care and were nationally a significant challenge.

·         It was difficult to pinpoint the reason for recruitment issues as whilst pay was not necessarily the top factor for social care staff deciding where to work, living cost increases made it increasingly important; for some, the pandemic had prompted retirement.

·         The Cabinet Member with Responsibility for Adult Social Care did not feel Brexit was a particular factor in social care workforce pressures in Worcestershire and pointed out that the wider local economy now recruited from a global rather than European workforce.

·         The Panel agreed the importance of promoting careers in the health and care sector, including earlier work with young people to promote the roles available.

·         Comment was invited from the representative of Healthwatch Worcestershire, who asked whether the percentage of people who did not require ongoing services following a reablement service referred only to people requiring services from the County Council or also the independent sector and was advised that it could be provided by both, although statutory responsibility lay with the Council.

Information requested:

·         The Directorate would provide examples of scenarios of care provided to the different cohorts of service users across the 18-64 age group, to develop understanding.

·         Report on staff vacancies and retention to be added to the Work Programme.