Agenda item

Attending for this Item were:

Councillor Sheila Blagg, Cabinet Member with Responsibility for Adult Social Care

Sander Kristel, Director of Adult Services

Richard Keble, Strategic Commissioner – Adult Services

By way of introduction, the Cabinet Member highlighted that over the last four years there had been a number of changes in adult social care, not only with the introduction of the Care Act, but also a national shift towards independent living in older age and for those with specific needs.  Funding continued to be challenging and the future was uncertain given the need to further integrate health and social care.

The Director provided a presentation, which outlined:

·         The Gross Budget for 2016/17 is £201m, with £130m allocated for services for Older People and Adults with Learning Disabilities

·         Good quality services are being provided to around 6,600 service users, a fact recognised by the Care Quality Commission

·         Of these, 1,209 people had been supported to remain in their own home after leaving hospital and of those service users with Learning Disabilities, 77% were living independently

·         The budget was under continuing pressure due a number of reasons, including demographics, the number of adults with more complex health and social care needs, inflation and costs associated with the National Living Wage and issues with recruitment

·         The Corporate Strategy Planning process had highlighted a number of strands which could provide savings and provide better outcomes for service users, these included:

o   further work was required with providers on ways of contracting

o   continue to work on independent living models

o   increase the use of technology and effective use of equipment

o   work more closely with health partners and consider joint commissioning, being mindful of the recently submitted Sustainability and Transformation Plan (STP)

o   work more with carers, families and service users to better plan care and enable increasing independence

o   build stronger relations with the voluntary and community sector

o   invest in staff and strengthen values.

In the ensuing discussion, the following main points were raised:

·         The Panel Chairman reminded Members that the budget was the largest of the Council's Directorates, yet its income was complicated and expenditure uncertain due to changes in funding sources and population need.  In addition, Department of Health funding was not announced until later in the year, which clashed with the Council's medium term financial planning process

·         The Care Act had introduced duties which although had attracted initial funding, needed to be sustained.  Reference was made to the 2016 increase in Council Tax to boost adult social care budgets and whether the concept could be repeated

·         Everyone agreed that Health funding was complex and it was noted that some services which were previously provided by health partners were now the responsibility of the Council to deliver   

·         Directorate Reserves had depleted and although around £5.29m remained, it was designed to be utilised in emergency situations.  Members felt that the Directorate was unique as the demand for services could not be predicted and Reserves should not be relied upon to deliver core services.  Despite monthly budget monitoring, packages of care for some individuals was very costly

·         It was reported that Social Worker recruitment was difficult nationally, however, it was positive that a number of new positions had been filled

·         Officers worked closely with the Care Quality Commission and each organisation provided good Quality Assurance.  In relation to Care Homes, it was reported that monitoring provided all residents assurance, not just the individuals who were funded by the Council, but also those who were self-funders

·         In relation to commissioning, Officers work with over 300 providers to ensure that quality remains high yet achieve a good rate for services for older people.  By working in partnership, a competitive marketplace can be shaped and developed

·         Some Members were concerned that providers, in particular those providing homecare, had reported no increase in the rate received.  However, it was pointed out that providers are businesses and were all achieving a profit to a greater or lesser extent.  Each year a conversation is had with providers and there is no immediate crisis in the marketplace.  In addition, an uplift had been provided when the National Minimum Wage was raised in April 2016

·         In relation to Care Homes, the marketplace is very different, with homes being built which are bigger and more often by national organisations.  It was reported that weekly rates could be very high, however, homes were able to set rates for the Council, depending on supply and demand.  Self-Funders were reported to pay up to £950 per week in a newly built home

·         The capacity of a Home at a given time was complicated, as factors such as staffing ratios and weekend rates of pay had to be considered by the Home before accepting an individual.  It was suggested that although a bed may be physically available, the Home may decline due to Staffing ratios

·         Although in the last 18 months, 100 beds had been lost (half residential and half nursing), a number of new Homes had been built, overall providing a significant increase in the number of beds available

·         There was also more opportunities for Extra Care and Supported Living, whereby individuals were supported in the community rather than an institution and housing providers were key partners in this.  The three Worcestershire Clinical Commissioning Groups and the Local Authority were working together on the Transforming Care Programme to ensure that individuals with Learning Disabilities were supported locally, however, there was a need to rebalance the funding available 

·         In addition, the effective use of technology provided increased opportunities for living either independently or supported

·         Further work was required across all health and social care partners to build on the partnerships already in place.

The Chairman of Healthwatch was invited to contribute and commented that he had heard an honest discussion, which highlighted the complex area of adult social care and the difficulties that integrating health and social care provided.  It was further reported that the Herefordshire and Worcestershire Sustainability and Transformation Plan (STP) was due to be published on 22 November 2016, which would provide a blueprint for further integration across health economy partners.

The Equality and Diversity Manager reported that engagement with service users was effective, especially as service users were probably the most vulnerable.

The Cabinet Member and Director concluded that it was recognised that there were challenges ahead, battling the Council's statutory responsibility with the requirement to find savings and communication and engagement with services users, providers and the wider community was key.  In addition, increased partnership working with all health and social care partners was essential.

Following the discussion, the Panel agreed to invite a Representative from the Care Quality Commission to a future meeting, to provide an update on their work locally.