Agenda item

By way of introduction, the Director of Adult Services highlighted some facts from the previously circulated presentation, mainly:

·         At the end of Period 5 (end of August) there was a £15.2m overspend out of £125.4m net service Budget. Additional savings had been identified to reduce the overspend to £14.3m

·         The population of Worcestershire was 583,491.  77,377 were aged 65-74 and 56,678 were over 75, meaning that nearly one in four were over 65

·         The Council's 2018/19 budget for Adult Social Care was £187.671m

·         £97.036m was spend relating to older people and £60.083m was spend relating to adults with a learning disability

·         Increasing numbers of adults were requiring care, not only due to an ageing population but also due to people who had previously funded their own care becoming eligible for care due to depleting resources and young adults with disabilities whose own parents were becoming infirm

·         Costs were increasing, ranging from market forces such as the national minimum wage and fuel costs, to adults living longer with more complex needs and requiring more intensive care

·         It was important to better forecast demand and capacity, set out key priorities and work with the market to provide a position statement. 

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

·         Whilst Members understood the current position and the continual shift towards promoting independence, they were keen to know what any changes would mean to residents.  In response, it was suggested that whilst making savings, every effort would be made to protect front line services.  However, as a result, back office changes may result in response times being slower

·         The new model of social work (3 Conversation Model), had already seen some success and there would be a shift in collective community based services providing a greater offer than at present.  In addition, increased information advice and guidance would be available as self-help tools

·         The Panel was delighted to note additional central Government funding, however, agreed that a long term national solution was required

·         In relation to staff morale, it was reported that there was some nervousness in back office functions, but it was important to have honest discussions with those affected.  Morale was good in the locality teams and learning disability teams

·         Everyone agreed that the population needed to focus on prevention, to stay healthy and independent for longer.  It was reported that there was a good take up of NHS Health Checks in the County, designed for those aged 40 to 74 to identify early signs of conditions such as diabetes, stroke, heart or kidney disease.  However, there was a drop in childhood immunisations, such as measles, which was a cause of learning disability

·         A Member asked about the benefit of assistive technology to be informed that this was a fast growing market.  The Director added that the next development would be the use of the data from the technology, such as knowing that a person is dehydrated and alerting them to have a drink.  When asked whether technology saved money, it was reported that it wholeheartedly did

·         One Member asked what could be learned from Japan, which had the highest proportion of people aged 100+, to be told that self-care and a lower calorie intake helped, whereby Japanese people were recommended 80% of the UK recommended calorie intake

·         The County Council was awaiting the Government's Green Paper on Adult Social Care and the responses to it

·         One Member questioned why the Commissioning Strategy was only until 2019, to be informed that it was due to the market position statement being developed, which would in turn inform future strategies.     

In relation to specific budget monitoring, as at August 2018, the Chief Financial Officer (CFO) reiterated that in 2018/19 a £15.188m overspend in Adult Social Care was forecast.  Reasons included the growth and complexity of care packages and the delay in achieving savings targets, such as with the 3 Conversation Model, due to lack of clear data.  In addition, Directorate Reserves had been used in previous years to mitigate overspend and demand pressures, but these were now fully committed.

The Council acknowledged that the overspend would not be able to be clawed back by the end of the financial year.  However, additional in year savings had now been identified, resulting in a new forecast of £14.3m overspend.

There was an ongoing focus the size and shape of the Council going forward, whilst being mindful of meeting statutory commitments.

Members raised the following main points:

·         There was general agreement that the issues faced in Worcestershire were replicated nationally and it was hoped that the Government's Green Paper would address some concerns

·         The Panel hoped that the distribution of costs between health and social care was fair, with the CFO reporting that a true open book policy was required for transparency as health economy partners were part of the same system and everyone needed to work together to provide an integrated health and social care service

·         One Member asked about the Council Tax precept to be informed that, if increased, it would provide a one off investment, however, there needed to be a national solution to allow for long term planning rather than one off grants

·         The Cabinet Member reported that the system had to change.  A recent national poll had found that only 2% of respondents thought there was a problem with adult social care.  He went on to say that an information piece was required to promote that care was not free and discussions had to place across the generations

·         Discussions had taken place previously on whether to establish a Council owned domiciliary care company, however, there was not enough self-funded care packages to make it viable

·         The next stages were to stabilise the budget and manage the business by promoting prevention.     

The Director of Public Health reminded Members of her areas of responsibility, mainly in relation to prevention and the statutory duty of improving health and wellbeing and narrowing health inequalities across the County.

Members noted that financially, the Directorate was predicting a small surplus as of August 2018.

In the general discussion that followed, the main points included:

·         The national Public Health Ring-Fenced Grant (PHRFG) had been reducing year on year and was time limited, yet savings had to be achieved whilst delivering statutory duties

·         Financially, there was a risk when the ring-fence was removed, in 2020, as significant use was made of the grant outside core areas

·         There was now the opportunity to refocus on prevention services and work with partners to focus combined efforts to deliver statutory duties

·         One key message was to re-engage with the community about personal and community responsibility

·         Members were concerned about the demand for services in the future if the house building proposed for the County was delivered.  The Director quoted that around £70,000 had been invested into planning teams to ensure supplementary planning guidance included standards for homes, greenspaces etc

·         The Cabinet Member added that conversations were due to take place with Planners to ensure access to services, such as hospitals, were taken into consideration

·         There was a general agreement that Public Health could have a stronger role in planning matters.  The Director was pleased to report that objections had been raised at, and acted upon, recent District Council Licensing Committees in relation to the sale of alcohol and fast food 

·         In response to a query about funding for domestic abuse, it was reported that funding was delegated to District Councils

·         One Member questioned the level of joined up working with other agencies, such as bus companies, citing that if bus services did not run, there was an adverse effect on health and wellbeing due to increased isolation

·         A question was asked about what would happen if a service was no longer provided, such as 'quit smoking'.  In response, the Panel was advised that there would need to be closer monitoring and action taken if figures changed.

The Chairman thanked everyone for a very useful discussion and summarised the following actions:

·         The Panel requested regular updates on the Business Plan, especially on Provider services, financial forecasting and partnership working

·         The Panel supported the Cabinet Member in his wish to put pressure on central Government over adult social care funding

·         The Director of Public Health was congratulated for the forecasted surplus and the Panel hoped that partnership working would continue for prevention services

Further information was sought on how cost sharing with the NHS was undertaken, to establish what proportion was social care and what was health.