The Committee considered a report providing the budget monitoring position for 2021/22 for the Adult Care and Health Portfolio, based on activity up to the end of May 2021.
The Head of Finance for Adults, Health and Housing advised that the current position of the Adult Care and Health Portfolio was a projected overspend of £23k. It was noted that in the table provided in Appendix 1A of the report COVID grants were listed under the ‘Adult Social Care’ heading. This was an assumed amount at this point and would be revised during the year, with a report presented to the Council’s Executive requesting approval to draw down the final allocation to help cover the significant pressures that had arisen in Assessment and Care Management due to the impact of the COVID-19 pandemic. The Head of Finance for Adults, Health and Housing informed Members that this included pressures relating to post-discharge packages. Previously NHS England had funded packages of care for six weeks following a patient’s discharge from hospital, but from July 2021 this had been reduced to four weeks. Hospital discharge funding had been due to end in September, but the government had recently announced that would be continued, although it was not known for how long.
In response to a question, the Head of Finance for Adults, Health and Housing said that the £1m of COVID grant funding that was assumed had been provisionally allocated from the Contain Outbreak Management Fund – there were some conditions, but it was broadly to be used to help the Local Authority manage the pandemic. The COVID grant funding was presented as a separate line within the ACH Portfolio Budget Monitoring Summary to provide transparency – it was noted that this would be refined later in the year, but at present a significant amount of the pressures that had arisen in Assessment and Care Management were related to the COVID-19 pandemic. Another Member suggested that, going forward, consideration could be given to presenting two version of the accounts with, and without, the COVID grants included.
A Co-opted Member noted the underspend on Mental Health and enquired where this had occurred. The Head of Finance for Adults, Health and Housing advised that this related to the Oxleas NHS Foundation Trust contract and it had been agreed that a review of the s31 arrangements would be undertaken. £20k would be carried forward and added to the budget to be used specifically for this review.
A Member highlighted a statement in the report, relating to services for the over 65’s, that “domiciliary care is projected to underspend by £927k and direct payments to overspend by £123k” and asked how both had arisen. It was agreed that the Director of Adult Social Care would look at this in further detail and provide a response following the meeting.
Members noted the ringfenced funding which had accumulated in the Public Health budget over recent years and queried whether purposes were being fulfilled if this money was not being spent. The Director for Public Health advised that in recent years, savings had been made as part of the Transformation Programme, specifically in relation to sexual health, where a number of services had been reconfigured and moved online, and the recommissioning of substance misuse services. It was highlighted that substance misuse referrals were increasing significantly – the service now faced considerable pressures and further resources would be required. The COVID Outbreak Management and contact tracing services had been established during the pandemic using the current Public Health grant. This had been a ‘one-off’ payment and there were concerns that these services were likely to be required going forward. During the autumn the Directorate would look at how the underspend could be utilised in future years, ensuring that sustainable services were established. A Member suggested that officers could report back to the Committee at future meetings with a programme of how the various elements of ringfenced funding could be spent. Another Member considered that the areas of overspend should be the main focus.
RESOLVED that the Portfolio Holder for Adult Care and Health:
i) Note the projected overspend of £23k on controllable expenditure based on information as at May 2021; and
ii) Agree the release of amounts carried forward from 2020/21 as set out in section 3.5 of the report.