Agenda item

The Panel was updated on performance and financial information for services relating to Adult Care and Well-Being.

Financial Information (Period 6 2019/20)

The Head of Finance referred to the information included in the agenda (appendix 2). Currently an overspend of £2.4m was predicted, which although a significant amount, equated to around 1.8% of the c£136m Adult Social Care net budget. Following a report to cabinet in September to discuss measures to mitigate directorate overspends, Adult Services had been working tirelessly to identify savings, which was a difficult situation, but had reduced the overspend to £2.4m from the previous figure of £3.3m. The forecast overspend included a one-off cost from the previous year’s restructuring for staff exit costs, therefore reducing the recurrent budget pressure to £1.8m.

The Head of Finance explained the most significant variances. The £2.2m overspend of the £33m Older People Residential and Nursing services budget was related to increased prices to provide services, rather than increasing numbers of people, for example wages, inflation and staff agency costs for nurses due to recruitment difficulties. People were coming into care later in life, which was good but meant they may have additional needs.

The £0.8m overspend on Learning Disability Services was again due to people living longer.

The Directorate’s £8.8m savings programme was mostly on target, achieved through working differently and avoiding spending, for example through the 3 Conversation social work model. The overall picture with the overspend was difficult but something officers continued to try to manage.

When asked about plans for the coming year, the Interim Director said that Adult Services would absolutely need to continue to do all it possibly could, so that the most vulnerable residents received services appropriate to them. The whole system was challenged, and while Worcestershire Acute Hospitals Trust was now showing signs of improvement, the continued pressure in this area affected Adult Services. The Directorate believed some demand was being caused by people remaining in hospital for longer in Worcestershire than they would in other hospitals areas, which had a knock-on effect on adult social care and therefore a range of initiatives were being used to manage the demand. The Director, however remained concerned, especially since adverse weather would exacerbate the year-round pressures.

The Assistant Director referred to the work of the onward care team, carried out by the Acute Trust and Health and Care Trust, which started early conversations with patients to identify support needs and accelerate discharge. Currently it was estimated that 2 out of 5 people who went into residential or nursing care started their journey in hospital.

The Vice-Chairman raised the importance of a night service, something which the Interim Director would report back on.

When asked if there was scope to work more with the NHS to help tackle budget pressures, the Adult Services officers said that the Sustainable Transformation Partnership had provided a means to revitalise previous discussions, for example regarding Continuing Healthcare, and there was appetite for shared commissioning from the commissioning network of 14 local authorities, of which the Interim Director was Chair.

A Panel member reported ongoing complaints from members of the public about the stress of Continuing Healthcare assessments and the Interim Director acknowledged this had also been raised during the Panel’s recent meeting with carers, although she pointed out that this process was wholly managed by the NHS. The Panel member explained that many residents believed it was managed by social care. The Officers completely recognised people’s confusion and explained that the Council had put a lot of effort in to help, with a dedicated team, but the situation remained a huge challenge. NHS colleagues had been asked to be much clearer, but whereas previously someone who had been assessed and given a continuing healthcare budget, would keep it, now that people were assessed every 6 months, this created stress and work.

A Panel member urged all councillors to contact Central Government about the need to invest in people and to highlight the financial pressures on all local authorities since budgets had been significantly reduced, and councils were having to manage overspend. It was acknowledged that the future direction for social care would not become clearer until after the forthcoming general election.

Performance Information (Quarter 2 July to September 2019)

The Interim Director drew attention to the key priorities for the Directorate of Adult Services, which were set out at the top of the performance information document. The priority to ‘sustain the current performance on delayed transfers of care from hospital’ reflected the fact that nationally, the Council was recognised as a strong partner in this process.

The following main points were raised:

·         In response to a query, the Director explained that comparator data regarding admissions to permanent care for those aged 16-64 (ASCOF 2a (1)) and 65+ (ASCOF 2a (2)) was not yet available for September 2019, and was co-ordinated by the Department of Health

·         Regarding the number of admissions to permanent care both performance indicators were significantly higher than the national average, and a member asked what was being done to understand this. The Assistant Director of Adult Services explained that a huge amount of work had been done, with no evidence that figures were due to social worker decisions. There would be further work to look at what interventions could have been done earlier, but in many instances the Council had very limited control. Investigations would continue, since managing demand was the only way forward.

·         The Assistant Director pointed out that organisations were given a set of formula, but no one verified whether this had been correctly interpreted.

·         The fact that the average age of self-funded individuals coming under the care of the Council was 87, was reassuring.

·         A Panel member asked whether numbers of social workers for each district could be provided and it was confirmed that this information would be provided and was readily available.

·         A member expressed surprise that it was not proving possible to pinpoint the reasons for Worcestershire’s high number of admissions to permanent care, and the officers explained that there were many factors involved. One example was complex discharge from hospital. Another factor was that less experienced agency doctors at the hospital who lacked confidence with decisions about discharge from hospital.

·         A Panel member was aware of incidences where discharge from hospital was not properly managed, and asked the officers to report this back, which they undertook to do.

·         The Interim Director stressed that she had been assured that admissions to permanent care were not down to Council practices, and that much of what was involved was not within the Council’s gift to give.

·         The Panel expressed an interest in understanding more about the issue of admissions to permanent care andsuggested it would be helpful to include other partners.

·         The CMR gave feedback on a recent meeting with the Chair of the Acute Hospitals Trust – who was very open and aware of the issues such as the workforce but had also said that working cultures were changing but would take time.

Regarding future monitoring, the Panel would like to visit the Patient Flow Centre and understand more about admissions to permanent care, however the importance of considering the financial priorities for 2020/21 before determining work plans was also acknowledged.

For future performance monitoring, the Interim Director was happy to discuss the format of the data, the aim being for it to be as helpful as possible to the Panel, and it was agreed this would be discussed during agenda planning with the Panel Chairman and Vice-Chairman.