Agenda item

This report sets out the budget proposals for the services covered by the Committee.  An update is also provided on any proposed changes in fees and charges in the budget.  Cabinet will present their revenue budget and council tax proposals to Budget Council on 24 February 2022.  A balanced budget will be set in accordance with the Local Government Finance Act 1992.

In recognition of the significant increases in the cost to living for residents due to inflation and Government tax increases, the administration proposes to freeze council tax and not to apply the government modelled 1% Adult Social Care precept increase.

7.1           Councillor Richardson reported that there was a minor amendment to the papers to replace appendix 2 of the report.  Emily Hill provided a corporate overview to the Medium-Term Financial Strategy 2022/23 (MTFS) within the context of government policy.  The borough had seen a funding reduction in real terms since 2010, with about 20% less lower funding overall, although social care demand had increased exponentially.  The 2021 autumn spending review implemented changes to local government public spending anticipated within the next three to four years.  Greater efficiency savings were required, identifying and eliminating waste to protect service provision.  The amount that could be saved without impacting on services was rapidly shrinking as efficiencies became increasingly difficult to identify.

7.2           A one-off government grant allocation of £6 million was an additional investment to compensate for the increase in national insurance.  An added concern was the increase in inflation, most recently at 5% which added further cost pressures, particularly impacted by Covid-19. Overarching corporate concerns included Covid recovery and how this was likely to develop, regardless of covid restrictions, demand or potential variants. In addition to inflationary increases, Brexit remained a concern together with wider economic developments, future local government financial and levelling up reforms which were likely to be detrimental to London.

Lisa Redfern highlighted key Adult Social Care (ASC) achievements and despite another difficult year, frontline services would continue to be delivered, and within a balanced budget.  The volume of demand was significant, and the department continued to maintain its vision to compassionately support residents. Home care services and the direct payment scheme supported over 2000 residents, including older and disabled people.  The Meals and A Chat (previously Meals on Wheels) service model had been refreshed to help address social isolation and loneliness.  ASC also worked preventively with residents, with the support of CAN (Community Aid Network) volunteers. Other compassionate, financial decisions included no increase to Careline charges and paying contractors and sub-contractors a London living wage.  A decision to close care and residential homes had actively helped to protect vulnerable residents.  The council had also been an early adopter of lateral flow testing and had ensured that isolating care staff had received financial support.  Workforce development had considered how demand could be better managed working closely with care home providers, helping to prevent delayed discharges. Whole systems working between social and primary care colleagues had shaped and improved reablement practices, working with providers to actively support residents.

7.3           The department consistently sought innovative ways in which residents could be supported and services protected, such as using Amazon to order community equipment to be sent to residents quickly.  Better value and efficient service delivery were key hallmarks of innovative provision that included strong leadership and workforce sustainability practices to effectively manage services.  The River Court short break service dealing with high needs cases had achieved a third, “outstanding” Care Quality Commission (CQC) rating, which was a significant achievement, as had the reablement service, which had also been categorised as “outstanding”. To provide context, this had been critical in nurturing a high performance of hospital discharges, despite the high volume of pandemic cases. During the December-January period, up to 400 people across North West London had been discharged per day, including many with high and complex needs.   The pressure on beds caused by the pandemic had a corresponding effect with rapid and phenomenal discharge rates.  The multi-agency safeguarding hub was functioning very well, triaging safeguarding referrals which allowed them to be effectively dealt with in a timely manner.

7.4           Challenges were highlighted and in line with corporate concerns.  A new white parliamentary white paper, People at the Heart of Care: adult social care reform, December 2021 did little to address the social care funding crisis.  The fragility of social care funding had been further exposed by Covid-19 and Lisa Redfern advocated for parity of funding for social care.  The first year of the pandemic had seen a number of care home provider closures highlighting the fragility of the care market and reflecting a national pattern.  Locally, there was less reliance on care homes as many H&F residents preferred to be supported in their own homes.   As alluded to by Emily Hill, the department was finding it harder each year to identify savings, against a backdrop of increased demographic and demand pressures, and the growing cost of transition services from children’s to adult services.

7.5           Prakash Daryanani provided technical details underpinning the social care spending plans for 2022/23.  Approval of the gross social care budget of £95.6 million was anticipated in February 2022, in line with the council’s budget strategy. This an increased investment on the previous year in response to the challenges and pressures being experienced in social care.  Appendix 1a of the report outlined a planned expenditure schedule for the additional £5.5 million. Demographic pressures and learning-disabled transitioning cases were a significant cost pressure in terms of market management and inflationary costs, including cost of living increases. A planned £67.58 (71%) million of the budget spend was apportioned to care homes or direct payments. Approximately 85% of the total budget directly supported services, with about 9% on management and frontline social care staff.  The department was now supporting significantly more residents than in previous years as residents were being discharged from hospital with greater acuity of need. This coupled with the need to pay the London Living Wage to residential care and nursing home staff and increased market unit costs represented significant financial challenges.  There had been a slight increase in direct payments, attributed to the council’s strategic policy to increase the number of residents in receipt of direct payments as this offered greater independence and control.

7.6           Dr Nicola Lang outlined the council’s Public Health Covid-19 response during waves 1 and 2. The council’s agile decision to implement testing in care homes was the first nationally in April 2020, followed by staff testing in May 2020. This innovative and ground-breaking partnership approach was replicated in other areas which fostered closer links between health and social care. The borough was also the first in London to adopt lateral flow testing. Working in partnership with environmental health colleagues, the approach had also helped to influence a change in prisons policy, persuading the Ministry of Justice to replicate Covid-19 testing in care homes.  An innovative H&F decision to appoint an infection control clinician in a senior role ensured that social care was better able to represent the community voice in discussions with health colleagues. 

7.7           In terms Public Health finances, Prakash Daryanani explained that the 2022/23 grant was likely to include an inflationary increase (reported in the October 2021 local government spending review) with an additional grant allocation to be used for public health priorities.  Efficiency savings of £170k had been identified (Appendix 1b) but much of this would be reinvested in public health to protect resources. Schemes to address food poverty, promotion of healthy eating, and an increase during the summer in substance misuse would receive reinvested resources.  The Public Health budget was £22.6 million, allocated across a range of different services protecting children and families delivered by different council departments providing public health outcomes. The entire budget was fully grant funded so did not include council taxpayer funding.

7.8           Councillor Richardson welcomed the report and commended the work of reablement services and River Court for their outstanding CQC recognition.  Councillor Richardson also thanked officers for their continued commitment to the residents of H&F, their tenacity, good sense and compassion in responding to the pandemic.

7.9           Councillor Jonathan Caleb-Landy echoed Councillor Richardson’s heartfelt words.  He sought further details about the cost savings in relation to employees and planned efficiencies in response to austerity.  Lisa Redfern responded that social care had borne the brunt of nationally imposed financial cuts over the past decade since austerity was introduced. There was an obligation and responsibility on senior officers to reform and improve care through innovation and modern reforms without curtailing services. They had explored different ways of working, such as working with the CAN volunteers, with a mix of unqualified volunteers working with frontline staff. The use of digital services was being explored to maintain contact time with residents who have complex needs.  It was recognised that simple equipment purchases through an online provider like Amazon could meet day to day, basic needs.  Better efficiencies could also be obtained around health commissioning and contracting, and finally, an outstanding reablement service ensured that residents were encouraged to maintain their independence rather than cutting services and help to avoid longer term dependency on care.  Prakash Daryanani endorsed the response and added that much of the work built on what had already been achieved.  However, much could be done in utilising digital skills in response to service demand, through better leadership and management.

7.10        Councillor Caleb-Landy welcomed the responses and commended the desire to maintain ruthless efficiency in spending while maintaining and improving primary services, in a challenging financial environment. He agreed that social care was an area that required greater funding and enquired if there was a government plan for delivering social care within the next three years.  In terms of social care funding Lisa Redfern responded that there was currently no solution.  Referencing a recent presentation to John Jackson, a former director of adult social services and accountant, she explained his view that that the financial position for social services was bleak and likely to deteriorate further.  There were expectations about white paper, People at the heart of care which had not materialised but currently, at least the residents of H&F were not required to pay for their home care direct payment, or anything else that supported their quality of life or independent living. 

7.11        Unfortunately, this was not replicated nationally at this time and Councillor Coleman predicted that in three years’ time, any additional allocation will be passed to the NHS.  Currently, H&F was supporting residents in their own homes, ensuring that they avoided admission or readmission into hospital, and which was a cost saving to the NHS.  Councillor Coleman urged the NHS to reflect on areas of work by social care which was being provided more efficiently and effectively than the NHS, currently.

7.12        Councillor Richardson reflected on the stark picture presented by officers, recognising that the government a faced a compelling obligation to support the most vulnerable in the community through social care.  She enquired if all the covid-19 funding allocated to H&F had been received, and if Covid-19 related expenditure had been recouped.  Prakash Daryanani explained that there had been a range of government grants and some funding received via the ‘hospital’ process which required a detailed monthly returns report. However, the initial funding allocations had been received and reimbursed to providers, in line with regulations.  A further £7 million in Covid-19 related support would be allocated until the end of the financial year with no expectation that further funds would be made available post-April.  Emily Hill added that it had been a particularly difficult time for social care to manage specific grants that were passported through to social care providers.  The council had also received Covid-19 grant funds which had covered additional Covid-19 related costs  but had not been fully compensated for income losses from the government scheme.  It was confirmed that there was no Covid-19 funding planned post April.

7.13        Councillor Richardson commented that granularity around the continued problems relating to the provision of NHS healthcare for people with complex, high needs and how their care was funding was a concern and this was confirmed by Lisa Redfern.  It was a monthly struggle to ensure that those eligible for ‘free’ NHS support to cover all aspects of their care was provided by social care, at a significant cost, which they sought to recoup back from the NHS.  This had on occasion warranted strongly worded letters or the threat of legal action and discharge to assess actions were a good example of where the Integrated Care System was seeking to recharge the department and which Lisa Redfern and her colleagues were battling against.

7.14        Councillor Amanda Lloyd-Harris commended the work led by Lisa Redfern and her colleagues in identifying efficiencies across the board and acknowledged the difficulties inherent within this.  She commented that there would need to be efficiencies in other parts of the council, such as gangs unit and enforcement, in order to support social care provision to meet the needs the of an aging population.  Councillor Lloyd-Harris also commended the work of officers, and particularly volunteers during the pandemic and asked whether the connections established through this could continue, and if further outreach to new volunteers could be undertaken.  Councillor Lloyd-Harris also concurred that money would not go beyond the NHS to fund social care provision.  Lisa Redfern stated that they would try to ensure that volunteering opportunities continue to be utilised and expressions to volunteer were followed up, particularly to help with preventative work.  Councillor Lloyd-Harris welcomed this, particularly as she was aware of many, including herself, who had offered qualified support which had unfortunately not been utilised.

7.15        Councillor Coleman welcomed Councillor Lloyd-Harris’s agreement on NHS funding but clarified that funding for enforcement and the gang’s unit was well spent. Funding had been identified as a consequence of ruthless financial efficiency and resolved issues inherited by administration. Councillor Coleman stated that a strategic and farsighted approach to managing social care services within a limited budget had demonstrated that it was possible to do so without the loss of frontline services. The investment in law enforcement teams was necessary to address residents’ concerns about anti-social behaviour, to tackle problem gangs, support victims of crime and those drawn into gang culture. In the brief discussion that followed Councillor Coleman advocated support for this approach, in contrast to Councillor Lloyd-Harris’s fundamental viewpoint.  Councillor Coleman stated that the police gang’s unit was a different provision compared to the council’s Children’s Services unit, and that the police representation on the council’s Health and Wellbeing Board indicated a willingness to engage with the council.

7.16        Councillor Coleman commended public health and social care officers for their significant efforts and commitments supporting the residents of the borough, and in particular, Lisa Redfern, Dr Nicola Lang, Linda Jackson, and also, Prakash Daryanani, Jo Baty, Christopher Nicklin, Roy Morgan, Julius Olu, Phyllis McKenzie, Lee Fernando and many other officers who had done extraordinary work.

ACTION:

Director of social Care to further explore how qualified volunteers could be utilised.

RESOLVED

That the report be noted.