Agenda item

Report FSD21006

The Committee considered a report setting out the draft Adult Care and Health Portfolio Budget for 2020/21, which incorporated future cost pressures, planned mitigation measures and savings from transformation and other budget options which were reported to the Council’s Executive on 13^th January 2021. Members were requested to provide their comments on the proposed savings and identify any further action to be taken to reduce cost pressures facing the Local Authority over the next four years. The Chairman noted that there was an extensive list of influences which may impact on the budget.

A Member noted that with regards to increased costs, a rate of 1-1.5% had been allocated to the Adult Social Care budget and queried why this was lower than the overall increase to the Council’s budget of 2%. The Head of Finance for Adults, Health and Housing advised that the Director of Finance’s report to the Executive assumed contract price increases of 2% inflation across the Council, however it was usual practice for a lower amount to be allocated to the portfolios based on the current CPI level. It was highlighted that all portfolios had been allocated the same percentage increase of between 1-1.5%. The remainder of the inflation amount remained in Central Contingency, which could be drawn down if departments incurred increased inflationary pressures during the year.

The Member further noted that the Shared Lives service was an excellent programme, but as there appeared to be no increase in the numbers on stream, questioned how savings of £0.5m would be achieved. The Head of Finance for Adults, Health and Housing acknowledged that so far this year, there had been not been an increase in uptake. This was partly due to staffing issues, which had been outside of the department’s control, as well as the impact of the COVID-19 pandemic. However, there was now a strong plan in place to increase uptake going forward. The Portfolio Holder for Adult Care and Health highlighted that the Information Briefing provided to the meeting had included a business case for the Shared Lives programme. It was intended to enhance the recruitment process and develop a more robust process for identifying people to provide support. Reassurance was given that this had been carefully considered, and it was anticipated that an improved service would be delivered, with more people willing to take on the role of a Shared Lives carer.

With regards to a question relating to the implementation of savings previously deferred, the Director of Adult Social Care noted that these were saving included in previous years with no clear plans to deliver them. This was now being corrected, and saving targets were built into the budget, and the directorate were working hard to build robust plans to provide these savings. Members were assured that there was now an “owner” for each saving target, and regular monitoring place to look at their delivery. In response to a further question regarding the strength-based provision, the Director of Adult Social Care reminded Members that they had previously been advised of the role out of a new approach. The directorate would be working with social workers and providers to build on people’s strengths and utilise support, rather than just provide services that were static. This work was reflected in the saving, as was the retendering of the home care services which would take a reablement approach to work with providers and ensure they had targets to reduce the ongoing demand for services. The Head of Finance for Adults, Health and Housing highlighted that further details regarding these savings would be included in the regular budget monitoring reports that would be provided to the Committee in the new financial year, and would show any progress made towards delivering them.

A Member noted the reference made in the report to the effect of ongoing population increases and questioned whether current figures should be used. The Assistant Director for Strategy, Performance and Corporate Transformation said there were a number of sources used to gather an understanding of the population. The GLA produced a London-wide prediction based on the number of households in each borough, and Adult Social Care used ‘POPPI’ and ‘PANSI’ data sources, which provided information related to older people. Locally, there was also a 3 to 5-year trend for Adult Social Care, which was also used to make predictions and assumptions, and more recently they had been looking at information around hospital discharges. They had worked with health partners to look at live data relating to the flow of hospital discharges; the proportion that were likely to require support; and any impact on budgets.

In relation to the credit figure of £140k included in the draft revenue budget under the heading of Public Health, a Member questioned whether this money should be spent to help address the ongoing health issues mentioned earlier in the meeting. The Head of Finance for Adults, Health and Housing advised that the Public Health budget was still ringfenced, and that the credit budget of £140k was controllable budget which was effectively used to cover some of the corporate overheads. A Member commented that they were unable to see how the savings within the Public Health budget could be achieved, even if they were overheads. As the budget was ringfenced, it was considered that all this money would be required, and possibly more.

Following the meeting, the Head of Finance for Adults, Health and Housing confirmed that there were no additional savings in 2021-22 in Public Health, and the £140k credit controllable budget was the same as the current 2020-21 budget.

The  Head of Finance for Adults, Health and Housing informed Members that due to the degree of uncertainty, an allocation of £1.4m had been included within the Council’s Central Contingency which would be available to help address the long-term impact of COVID-19 on Adult Social Care budgets for 2021-22. Government grant funding of £7.8m for COVID pressures had also been announced, which it was noted could increase.

In response to a question, the Director of Adult Social Care said that she would agree that Adult Social Care was underfunded at a national level. However, the directorate was still required to take responsibility to help manage the Council’s budget. The demand on this was growing, due to the complexity of the young people coming from children’s services into adult services, highlighting the need to ensure best use of the resources available.

A Member noted that there was an anticipated increase in demand for memory and cognition services. This was to be offset by an equivalent level of savings, and it was questioned how these would be made. The Head of Finance for Adults, Health and Housing advised that this had been requested to show the increase in complexity of the care required. This growth was highlighted, but also recognised that the service was managing to mitigate the pressure within budget. It was requested that Members be provided with a further update on how this figure was calculated.

In response to questions from a Member, the Head of Finance for Adults, Health and Housing highlighted that in relation to the overspends being funded in the budget, was the projected full year effect of this years’ overspend. This included some of the impact of COVID-19, but as the ultimate long-term impact was not yet known, some funding had been kept in contingency. The overspends that had occurred this year were not related to COVID, and were underlying budget pressures that had arisen due to the high number of new clients, particularly in learning disability and mental health services. It was noted that for learning disability services, work was undertaken early in the year to project growth based on the transition register. However, this year there had been a number of additional clients that had not been included on this list which had caused an in-year overspend. The impact on the budget for 2021-22 would be significantly higher, as the service would have these clients from the beginning of the year, and therefore the full year effect of the overspend was included in the 2021-22 budget growth allocations.

The Head of Finance for Adults, Health and Housing noted they were aware that there would likely be increased spending due to the impact of COVID-19. However, at this point in time, it was not something that could easily be quantified. There had sadly been a significant number of deaths as a result of COVID-19, which would reduce some of the spend on budgets. Due to this uncertainty, the impact on Adult Social Care was not known so money had been kept in Central Contingency, and could be drawn once the pressures became clear.

With regards to the Transformation Programme, the Head of Finance for Adults, Health and Housing advised that all of the £1.2m savings in the current years’ budget were included in the baseline budget for 2021-22. Currently, not all savings had been achieved, which had been reported through budget monitoring reports and was mainly due to the impact of COVID-19. Work was ongoing, and a number were on target to be fully achieved for next year’s budget. For 2021-22, only a corporate transformation saving relating to training had been included – no additional transformation savings had been included for Adult Social Care, however mitigation savings had been identified. Work was continuing to identify future transformation savings, and they would be considered for future budget reports.

RESOLVED that:

i)  The financial forecast for 2021/21 to 2024/25 be noted;

ii)  Members’ comments on the initial draft Adult Care and Health Portfolio budget 2021/22 as a basis for setting the 2021/22 budget be noted; and,

iii)  Members’ comments on the initial draft Adult Care and Health Portfolio budget 2021/22 be provided to the meeting of the Council’s Executive on 10^th February 2021.