Agenda item

Report FSD22012

The Committee considered a report setting out the draft Adult Care and Health Portfolio Budget for 2022/23, 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 12^th January 2022. 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.

It was noted that the text in variation note 7 in Appendix 1 of the Adult Care and Health Portfolio Draft Budget 2022/23 report (Item 9b, agenda page 53) should read as follows:

7. Increase uptake of the Shared Lives service (Cr £310k) – Shared Lives is a cost effective service and the further expansion of the scheme will both help to mitigate cost pressures and care for service users in a supportive setting where a high level of independence is maintained.

The Chairman highlighted that the current Adult Care and Health Portfolio budget included Phase 1 and Phase 2 Transformation Savings, totalling £1.2m per annum, however significant cost pressures remained. With regards to a query on mitigation, the Head of Finance for Adults, Health and Housing noted that there were increases, including £3.3m of inflationary increases, within the draft budget and a total of £7.1m of growth for the service budget. This totalled £10.4m, which was an increase of 13% on the 2021/22 budget. A summary of mitigations was provided in the table on page 52 of the agenda pack. This totalled £3.5m, however it was noted that the top two items (‘Use of iBCF from previous years to mitigate growth’ and ‘Allocation of unringfenced Covid funding from Reserves’) did not require any action as grant funding had already been received. The Test and Trace Public Health grant was also included, and with the savings listed under the ‘Real Changes’ section there was just under £1m of savings to be delivered. Most of this had been identified, and work was ongoing to ensure that mitigations within Public Health were identified as soon as possible.

A Member questioned how a savings target of £200k within Public Health could be justified. It was highlighted that the Public Health team had done an incredible job throughout the pandemic, and it was considered that more money should be spent within this area, rather than targets for savings being set. The Portfolio Holder for Adult Care and Health advised that some of the Public Health savings identified related to efficiencies within the commissioning of sexual health programmes. Members were reassured that the mandatory responsibilities within Public Health were being maintained and future priorities would be identified through the Health and Wellbeing Board and Joint Strategic Needs Assessments (JSNA).

In response to questions, the Director of Adult Social Care said that a piece of work was being undertaken looking at how the transition between young people and adult placements could be best managed, and a paper with a number of recommendations would be brought to the Corporate Board in the coming weeks. With regards to increasing the uptake of the Shared Lives scheme, it was noted that this had been a longstanding target which had been impacted by a number of setbacks. There had been several staff changes, however a new manager had now been appointed and 12 additional Shared Lives carers had been recruited. In response to a further question relating to the drug and alcohol service, the Director of Public Health advised that the service, for both children and young people and adults, had experienced significant pressures over the last couple of years. As drug related deaths had been increasing over time, a new service had been put in place and a substantial amount of joint working had been undertaken with partners, including the Coroner’s service, to target funding accordingly. With regards to alcohol, it was noted that there had been an increase in consumption over the last couple of years, resulting in an increase in consultations and referrals from GP services into the adult’s alcohol service. The increase seen within the children and young people service had thankfully been much smaller.

In response to questions, the Director of Adult Social Care advised that a number of vacancies had been deliberately held within the department whilst teams were restructured to prevent the need for redundancies. All of those posts would now be recruited to, and this process was underway. However, the difficulty in attracting staff into social care had been highlighted previously – a national campaign had been launched to help address this, and work was also underway at a local level to attract staff into the care business. With regards to supporting people at home, the Director of Adult Social Care highlighted that a number of services had been closed during the pandemic, including some respite services, and restrictions had prevented people from a number of different settings being brought together. Work was currently taking place to look at how both respite away from the home, and within people’s homes, was provided.

In response to a question regarding the amount of savings identified, the Director of Adult Social Care noted that the Adult Social Care budget was a large proportion of the Council’s overall spend and it was right that they were challenged to ensure they were making the most efficient use of the budget available. The report highlighted that there would be some significant additional pressures, including the cap on the amount of care that people would pay for. The savings identified would be challenging, but reassurance was given that the directorate would continue to meet its statutory requirements.

A Member noted the pressures on the mental health budget, which were continuing to build – this year there had been an overspend, however the full impact of the pandemic had not yet been seen. It was further noted that access to the contingency fund may be required if future outbreaks of COVID-19 occurred. In response to a question, the Director of Public Health said that the £160k listed for ‘Increased responsibilities for health protection’ related to increasing staffing levels within the Public Health team (two nurses and administration support). Over recent years temporary staff had been employed from funding received, which was not sustainable, and these appointments would allow the team to become more resilient and provide support to manage any future outbreaks. It was noted that COVID-19 testing and contact tracing had been funded separately by the government and it was anticipated that if this continued, additional funding would be received. The Member suggested that it would be helpful for this to be shown under the Public Health budget heading.

In response to a question, the Director of Adult Social Care advised that paragraph 7.1, which related to personnel implications, was a standard comment. It provided reassurance that if any individuals were to be impacted by potential changes the staff side would be consulted, however this was not currently anticipated.

RESOLVED that:

i)  The financial forecast for 2022/23 to 2025/26 be noted;

ii)   Members’ comments on the initial draft Adult Care and Health Portfolio budget 2022/23 as a basis for setting the 2022/23 budget be noted; and,

iii)   Members’ comments on the initial draft Adult Care and Health Portfolio budget 2022/23 be provided to the meeting of the Council’s Executive on 9^th February 2022.