Agenda item

Councillor Roche, Cabinet Member for Adult Social Care and Health, supported by AnneMarie Lubanski, Strategic Director for Adult Care and Housing, introduced the report which highlighted the budget pressures and actions being taken in relation to the Adult Social Care budget. 

There was a forecast overspend of £5.169m against a net revenue budget of £62.675m for Adult Social Services. The main budget pressures were due to the increase in demand for services mainly in respect of Direct Payments, domiciliary and residential care plus anticipated shortfall in delivering the 2017/18 budget savings within the current financial year.

One of the main budget savings measures identified was the continued review ofout of area and high cost care packages across all services to identify opportunities to reduce costs and rigorously pursue all Continuing Health Care funding applications with the Clinical Commissioning Group. Any change to an individual care package required by law a reassessment of need and, therefore, a systems change would take time if sustainable change was to take place and a planned approach required.

Budget meetings were held with senior managers to review in detail the budget forecasts, monitor demographic pressures, to identify further savings opportunities and to mitigate pressures. Options being considered towards the recovery of the current overspend included:-

·                A detailed review of all expenditure within in-house provider services.

·                Review of Direct Payments including auditing of individual bank accounts with the aim of clawing back any accumulated surpluses.

·                Further review of all budgets across the Directorate to determine any expenditure that could be either stopped, delayed or reduced to mitigate the impact of in-year budget pressures.

·                Vacancy management which was not integral to the improvement plan.

·                Strengthening the process for Continuing Health Care (CHC) to enable income to be recovered more efficiently.

·                Target the new teams to where there could be cost avoidance and monitor the impact to develop better value personalised care.   

Progress continued on the delivery of the Adult Services Improvement Programme to improve the current practice and processes and increase capacity to support frontline pressures and additional reports on a range of options for future service delivery, including consultation with service users and carers.

Discussion ensued with the following issues raised/clarified:-

·                The residential and nursing care budgets including a mixture of residential, nursing and supported living the latter due to clients moving into supported living and never moving on.  A dedicated piece of work was required in the future with regard to encouraging providers to help people live independently.

·                Clarification of the Direct Payment budget pressures was part of the £60M budget and was not separate.  This was part of the assessment of a client to assess their level of need, ascertain their indicative budget and how they would like to receive services.  Some would chose a domiciliary package and others would want Direct Payments to choose how their services were provided.  It was coded differently because of the indicators that had to be counted.

·                Adult Care faced an increase in demand for services with an ageing population and Rotherham was likely to increase above the national average.  The vision of Adult Social Care was, that despite the elderly adult numbers rising, the numbers going into institutionalised care should reduce.

·                It was a statutory requirement that the Health and Wellbeing Board consider the Joint Strategic Needs Assessment.   Partnership working with commissioning with the TRFT and CCG KPMG on cohort segmentation across Health and Social Care and the Borough would also identify the JSNA to give demography trends in conjunction with the Council Plan.

·                Although the assessment for Continuing Health Care funding was a joint assessment with a Local Authority representativesitting on the Panel, it was a Health decision.  There needed to be improved robust and stronger processes to bring the funding in quicker once it was agreed and work was taking place with that aim currently.

·                The situation and Recovery Strategy were being monitored.  There was now a new overall action plan for Adult Social Care as well as an impending refresh of the vision of Adult Social Care.

·                The savings target for this year and some of last year were not met in relation mainly to Learning Disabilities.  Work was being carried out in terms of re-profiling when those savings were likely to come through with scenario building in relation to activity.  The Interim Assistant Director had been tasked with pushing some of the projects but they would be reliant upon individual assessments.  The Authority was also working with, and had oversight from, the LGA’s national lead on Risk and Finances.  A meeting had been held recently to consider Rotherham’s saving proposals and he was very clear that the Service had to re-profile; he considered them to be achievable but not in terms of how they were currently profiled.  He considered that there were flexibilities as the budget currently stood and would be able to deliver a good Adult Social Care but some of the “legacy” issues needed to be sorted and would provide a much more efficient Adult Care Service.

·                As part of the improved Better Care Fund the Authority, alongside Health colleagues, was working in terms of areas of work where the impact of Winter Pressures could be mitigated.  This included investment further in Social Prescribing, Age UK front door at A&E, a contingency for Winter Pressures within the IBCS and Interim Director attendance at the A&E Delivery Board.

·                Public Health work with Directorates with respect to all frontline workers receiving vouchers for flu jabs.  It had also been agreed that work would take place with providers to ascertain if the voucher scheme could be extended.

Resolved:-  (1)  That the latest financial forecast against budget for 2017/18 and the progress being made to mitigate the budget pressures be noted.

(2)  That the Chairman of this Board and Chairman of the Health Select Commission meet with the Cabinet Member for Adult Social Care and Health and the Strategic Director for Adult Social Care and Housing and relevant officers to discuss future reporting of the budget.