Agenda item

Adult Care Budget Forecast and Savings Update

Cabinet Portfolio: Adult Social Care and Health

Strategic Directorate: Adult Care, Housing and Public Health

Minutes:

Consideration was given to a report which provided an update of the forecast budget position for Adult Care, Housing General Fund and Public Health. The savings plan was an integral part of the financial position and further information was provided to explain the impact in 2019/20 and how this relates to the Council’s Budget report.

 

It was reported that the Adult Care Housing and Public Health Directorate had forecast an overspend of £1.4m, largely as a result of an increase in demand for Adult Social Care.  This was based on full delivery of savings identified by implementing the new target operating model and part year savings from the reassessment programme and review of Learning Disability services. It was noted that, whilst the overall number of people in receipt of care was stable, people were presenting with increasingly complex needs and the average cost was increasing.  There were timing issues associated with the delivery of some savings and also some budget pressures which had been addressed in the Council’s Budget report (minute 313 refers).  The principle remained that the Adult Care savings would be delivered in full by 2021/22, either in the way originally proposed or by approved variations where required.

 

Members noted that the new Targeted Operating Model (TOM) was implemented on 21 October 2019 and all of the key milestones had been met. The planned savings of £1.6m in 2019/20 and £3.1m in 2020/21 were forecast to be fully delivered. It was noted that this was a significant change programme for the directorate, where halfway through the financial year the whole service moved to a new staffing structure; including new pathways and new ways of working. The change was supported by a workforce development programme and had been also supported by external partners. This was a people centred programme designed to empower and engage staff from front line through to senior leaders, which had been implemented and utilised across the Health and Care system. It was a 12-15-week programme, where the purpose for Rotherham would be to build capability and confidence in the workforce to be able to deliver the future model. This had now been completed with further training planned throughout next financial year to support the ongoing professional development of staff.

 

It was reported that the Reassessment Programme aimed to ensure that care packages were proportionate across Older People, Physical Disability and Mental Health client groups by undertaking care package reviews of existing eligible customers. It was noted that the difficulty in recruiting staff had impacted the ability of the reassessment teams to deliver the required level of activity. In April 2019 the rolling Adult Social Care Social Worker recruitment campaign had commenced, to address the vacancy pressures as well as applying more rigorous selection processes to raise the standards of candidates and quality of workforce. The reassessment team was now at full capacity, but initial delays had meant the saving would not be fully delivered in 2019/20.

 

Furthermore, it was reported that the My Front Door programme had been re-profiled for the amended In-House Services timeline. The net additional cost (£182k) was due to the cost of new packages of care. The programme prioritised the care and support needs of people who use the in-house services, ensuring the new arrangements are in place prior to existing services being decommissioned and before any saving could be released. The timing of the overall programme had been delayed but was expected to be delivered in full by 2021/22.

 

The budget gap was still a concern but the picture had improved from the last few years and the service had worked very hard to reduce the deficit in the context of austerity and demand pressures.  The challenge through the Judicial Review had affected savings programmes for learning disability transformation and reassessments, which continued under the My Front Door programme, as it had impacted on timing and also successful recruitment of staff.  One off additional income had helped with delivery of the savings programme.

 

Although good plans were developed when services were reconfigured,  Members questioned whether implementation usually took longer than planned to deliver the savings.  There had been challenges and with the learning disability reassessments some people would receive more funding as a result, some the same and some less.  Savings would follow from the building side. It was also acknowledged that the TOM had delayed some of the transformation work slightly but the structure needed to be put in place and people in posts.

 

This had been a mild winter but hospital admissions had been quite high, creating significant demand for the Integrated Discharge Team due to an increase in health conditions that required social care support.  Officers highlighted that despite talk about winter pressures, nowadays services no longer experienced a reduction in hospital admissions or primary care demand at other times throughout the year.

 

Assurances were sought that the budget could be brought under control. The Cabinet Member confirmed that the budget position was discussed on a weekly basis with the Strategic Director and was confident in the information provided.  Weekly performance meetings also undertook detailed analysis and considered what else needed to be done.  A degree of unpredictability existed as no guarantee could be given that a large number of high cost cases would not come through.  In terms of things that could be predicted and seen as going in the right direction, reassessments were starting at Addison so that should feed through and Oaks would be going to Estates.  The new respite homes would save £250,000 p.a. and would come through quite quickly.

 

Officers reiterated that significant governance was in place at all levels within the Council around the spend, from case audits all the way through to decision-making around costs, coupled with an extensive workforce development programme for staff to ensure the best use of resources to manage demand.

 

Given recent discussion on sickness absence, Members queried if the impact of holding vacancies in Adult Care on other staff and on sickness absence had been factored in. Holding vacancies needed to be done in a considered way and running alongside the development of the care pathway was work around commissioning, where a restructure was imminent, but vacancies there had slightly less of an impact on the frontline.  The service was mindful about holding vacancies and this included in the period leading up to the operating model when particular vacancies were held. Managers were aware of potential sickness absence and the need to use stress risk assessments and to understand fully the impact on a team, in addition to being clear on the longer term plans.  There was not a specific policy to hold vacancies, this was more of a historical issue, and the new model was predicated on having people in post, with the revolving recruitment programme in place.  Agency staff were brought in when necessary.

 

Clarification was sought on the use of £0.2m reserves in Public Health.  Public Health was centrally funded from Westminster and in the knowledge that the grant funding would reduce year on year, the service had tried to create a reserve pool to mitigate against this lost revenue to avoid making severe cutbacks within Public Health.  As the grant had now been increased for 2020-21 the reserve was looked at again.  Public Health reserves had been used to fund services during the year but the reserves supporting the savings mitigation related to several different general fund reserves, with the main one being the Housing General Fund Transformation Reserve which had been drawn down to support the position on the savings.

 

Confirmation was sought that the expected target savings set out in the report would be achieved by 2020-21.  The Cabinet Member was confident but unable to give an absolute guarantee and reiterated the point about any new care packages requiring significant funding.  The big question marks had been getting the TOM right, which was now almost totally complete, and the work at Oaks and Addison, which was progressing.

 

The Chair suggested that a further report be brought back in six months unless anything drastic occurred before then that needed scrutiny.

 

Resolved:-

 

1)    To note the information contained within the report.

 

2)    To have a further report in six months as part of the ongoing budget monitoring work.

 

Supporting documents: