Agenda item

Report FSD21066

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 September 2021.

The Director of Finance highlighted that the Adult Care and Health Portfolio was in a good position this year with COVID funding and hospital discharge funding having been received. However following the government spending review it had been confirmed that no further specific COVID funding would be received next year and therefore consideration would need to be given for use of the money already received to deal with the pressures ahead.

The Director of Finance noted that further funding was expected this year in relation to hospital discharge, which would be reflected in the next Budget Monitoring report presented to the Committee. Members were advised that the challenge would be the following year when no specific money for hospital discharge had been made available to Local Authorities – long hospital waiting lists had been highlighted in the media, and there was likely to be a need to try and get patients in and out of hospital as quickly as possible which was bound to have an impact. This would be discussed in further detail with the Director of Adult Social Care as part of making a case for funding next year from the SE London ICS.

A Member noted that the current overspend for Assessment and Care Management – Care Placements was estimated at £2,455k, with the bulk of it relating to residential and nursing home placements and enquired if there had been a spike in the number of placements or an increase in fees. The Director of Finance noted that assumptions had been made at government level that residential and nursing home costs may reduce, however other significant costs pressures, such as Long Covid and the transition between young people and adult placements, were now being faced. These pressures had been anticipated and were referenced in the Social Care transformation work, which was continuing, and some changes needed time to be implemented.

In response to questions, the Director of Adult Social Care advised that a number of Learning Disabilities reviews had taken place. There were significant cost pressures associated with young people transitioning into Adult Services, and the department were now working with these young people earlier. The Assistant Director for Integrated Commissioning was also looking at commissioning local services that were cost effective. It was further noted that the Association of Directors of Adult Social Services (ADASS) undertook a review of spending each year, which had shown that spending on young people was an outlier for the Council. Spending on older people was below the national average, however this was skewed by the high number of people who funded private care. There was a programme in place to review high-cost placements – this had been held back by the pandemic as negotiations could be delicate and needed to be held face to face, but it was hoped that this would be taken forward again soon.

A Member highlighted the reference made in the report to the ‘Services for 65+’ and the need to “minimise placements above the guide rates and officers continue to consider costs when placements are being agreed, whilst at the same time needing to ensure the service users’ needs are met”, and it was queried how this would be balanced. The Director of Adult Social Care said that during the pandemic, in order to alleviate pressure in the NHS, people had been leaving hospital more unwell and the costs charged for care had been higher than expected. The Assistant Director for Operational Services and her team would be reviewing this – the pressures experienced by providers meant that they were cautious about what they could deliver, with demands for more 1-2-1 support, which was more expensive. The Director of Finance noted it was anticipated that money would be made available next year, as the government recognised the commissioning challenges and cost pressures, subject to the Local Government Settlement and white paper due shortly. The draft budget report, to be presented in January 2022, would give more indication of this funding and the Portfolio Plan would monitor risk.

In response to questions, the Director of Adult Social Care advised that there had been a significant shift this quarter, with the Mental Health underspend reducing by £200k which highlighted that demand for services was increasing. The Director of Finance highlighted that Mental Health was a significant cost pressure and acknowledged that it was not possible to accurately predict the full impact of the pandemic – estimates had been made, but this would need to be closely monitored over the coming years.

In response to a question related to staffing, the Director of Adult Social Care confirmed that the vacancies in the Quality Assurance and Safeguarding service had now been recruited to.

RESOLVED that the Portfolio Holder for Adult Care and Health note the projected overspend of £225k on controllable expenditure based on information as at September 2021.