Agenda item

This report sets out the budget proposals for adult social care services covered by this Policy and Accountability Committee (PAC). An update is also provided on any proposed changes in fees and charges

Hitesh Jolapara provided a corporate perspective on future public expenditure.  National expenditure had continued to decline up to 2018-19, where there had been a slight uplift.  General grant funding had reduced by £3.3 million, representing a 60% reduction in real terms.  Each year, one-off funding allocation was provided to Children’s Services and Adult Social Care and there had been a growth in business rates, as part of a pilot to divert funds direct to councils. 

Comparatively, urban and city authorities had traditionally lost out to provincial needs, and this might be impacted by the governments fair funding review. H&F was expected to achieve £34 million in savings, to maintain a balanced budget.  Growth for 2019-20 included a council tax increase of 2%, accepting the social care precept; and the Council’s share of business rates would be 48%, generating approximately £78 million but likely to be lower as the rates process was subject to appeal.

Lisa Redfern provided the Adult Social Care (ASC) financial overview. ASC prioritised enabling people to live independently at home, providing support for them and their carers.  Underpinned by an approach that advocated co- production, ASC aimed to deliver integrated care.  In terms of highlights, the Council had, for the fifth consecutive year, agreed not to impose homecare charges, and it was significant that it was the only authority able to do so. Similarly, the costs of meals on wheels (£2 per meal), and of providing the Careline (medical alert) facility would also remain static. 

Despite these positive achievements, there remained significant challenges.  Demand for ASC continued to increase. People were living longer and enjoyed a better quality of life but longevity varied from area to area. Local authority funding had decreased and the cost of care had continued to rise. The care market was volatile but the Council was committed to ensuring that all staff received the London Living Wage (LLW).  Supporting 3100 residents, the discharge of patients had an impact on the ASC budget, with people leaving hospital with greater acuity of need. 

ASC would deliver a balanced budget and achieve significant savings.  Excellent feedback had been received from CQC, and the Community Independence Service, which now offered a blue print for providing community based services, had been highly commended.  ASC continued to work hard to streamline and improve back office provision, looking for ways to be innovative and cost efficient. Consequently, the deployment of agency staff had been reduced by 50%. 

The Transitions Into Adulthood service was an example of developing innovative services, designed to fit around need.  Working jointly with Children’s Services, the aim was to work with young people from the age of fourteen.  Earlier intervention allowed a more bespoke, tailored support offer.  Growth funding for this year was non-recurrent and there was no guarantee that the winter pressures grant funding would continue in future years.  The Better Care Fund programme was also under review. Salary costs constituted the single, biggest budgetary pressure, exacerbated by the Councils commitment to LLW.

Councillor Lloyd-Harris commended the report and acknowledged the difficulties faced by the department and the needs of vulnerable people.  Given the continued decisions to not charge for homecare services, meals on wheels provision and Careline support, she asked how sustainable this was.  Lisa Redfern acknowledged the inherent challenges but pointed out that this was the approach taken by the Council Administration and a political priority to deliver the best possible services to residents.  Councillor Coleman continued, that they had taken a decision to accept the ASC funding precept this year so that they could continue to fund these provisions.  It was morally and practically right to support individuals leaving hospital prematurely, with greater acuity of care.  Meals on Wheels was subsidised but nutritious meals helped to maintain a healthy diet and could also tackle social isolation and loneliness. 

Victoria Brignell commented that charging for homecare was a tax on being disabled.  Charging for schools and roads would never be similarly contemplated and commended the Administration’s decision to not levy a charge for this essential service. She asked what impact the £3.3 million in savings would have on services in practice.  Lisa Redfern hoped that people would not see an impact on the services they received. This would be about how change could be affected in a way that would be transformative.  They were now working more closely with the operations team and resolving issues more quickly.  Identifying service improvements had also resulted in savings. 

Councillor Umeh commented that this was a well-prepared budget, given the huge reduction in funding allocated by government and was satisfied that all the identified risks had been considered. 

Bryan Naylor welcomed report and observed that over 40% of residents were satisfied with the services received however, this was not reflected across the Borough.  Part of the issue was raising awareness about what services were available and that older people found this difficult.  He asked if there were any plans to address this. Lisa Redfern concurred and acknowledged that how information was communicated to residents was a primary concern.  She gave an assurance that the budget review process applied an equalities impact assessment for each possible saving.  Nine years of austerity had meant fewer staff so making each contact count was critical.  Last year, a list of 12 care standards was developed and included, for example, treating a person with dignity and respect. 

Jim Grealy commended the report for its clarity and insight.  He asked how the range of charges now being passed to ASC would be picked up, without destabilising the ASC budget.  Lisa Redfern explained that the department had first considered this two years earlier.  Greater acuity of need meant that people required increasingly more complex care packages, on being discharged from hospital.  This high cost pressure and had been factored into future planning.  Provision of social care had evolved and required a quantitative approach in collecting and analysing data. It was difficult to predict future need and how local demand could be sustained, given the expectations of the CCG.  Councillor Coleman commented that there was no doubt that hospitals were asking people to leave earlier than they should be.  This was a concern although the level of danger in each case varied. ASC was expected to meet the extra cost of providing much needed support where this arose, but this was difficult to evidence.  Lisa Redfern explained that there was a need to adjust the perception as to who provided care.  Nationally, there was a misconception that that it was the NHS, overlooking the care for adults provided by social care.

RESOLVED

That the guillotine be agreed and the meeting be extended to 21:30.

Commenting on the issue of early discharge, Jen Nightingale felt that this was a huge concern, particularly in the context of mental health provision.  Lisa Redfern agreed and reported that the CIS was likely to receive an outstanding service award, which co-ordinated and brought together varied professional clinical staff groups.  This was an excellent model of care and operated like a virtual ward, but was expensive and required continued investment.  Referring to community neurological provision, there was a high cost in providing community based and in-patient care, and most NHS delayed discharge cases were patients with neurological needs which needed to be carefully managed.  ASC funded a neurological doctor to provide support within CIS.

Councillor Kwon asked about homecare provision.  Other than the fact that the service was free, she asked if there were any other limitations such as time, performance; and about performance monitoring measures.  It was explained that there were regular reviews undertaken, the frequency of which correlated to the level of need.  Homecare providers varied in terms of the quality of provision and contracts were monitored in-house.  Homecare provision could be linked to issues around NHS recruitment and retention, highlighted earlier.  Podiatry services for example, toenail clipping was a basic need, as long toenails could cause trips and falls.  Podiatry services had been cut by 40% and this decision had been reached by factoring in clinical safety standards.

Councillor Richardson thanked officers for providing a strong strategic overview.  They had prepared a detailed and insightful review of the current financial pressures, and potential ways in which these could be mitigated.

RESOLVED

That the Committee noted the report.