Agenda item

The Health & Social Care Sub-Committee is asked to review the information provided on the identified budget proposals and reach a conclusion on the following:-

1.    The savings are deliverable, sustainable and are not at unacceptable risk.

2.    The impact on service users and the wider community is understood.

3.    That all reasonable alternative options have been explored and no better options exist.

The Sub-Committee considered a report, set out on pages 5 to 26 of the agenda, which provided a response to the budget challenge set by the Sub-Committee concerning the ongoing management of care packages and managing demand in Adult Social Care.

The report was introduced and the questions of the Sub-Committee answered by the following officers:-

·         Annette McPartland - Corporate Director for Adult Social Care and Health

·         Bianca Byrne – Head of Strategic Commissioning & Improvement

·         Richard Eyre – Head of Improvement

·         Matthew Davis – Interim Director of Finance

During the introduction it was highlighted that the assessment of care packages was based upon a strength based approach and had to be managed within the regulations set out in the Health & Care Act. If an assessment was needed it was carried out through consultation with the service user and their carers to identify the best outcomes for the user. The Adult Safeguarding Board and other panels were in place to ensure that people were being safeguarded. It would be unlawful if an individual experienced harm or the level of care provided was unsafe for an individual and as such social workers, as registered practitioners, had a duty to ensure that the care provided was safe.

Included within the report was the Adult Social Care Strategy which set out the principles for transforming the service. It was highlighted that at present Adult Social Care was on track to meet 100% of its savings targets for 2021-22.

Following the introduction the Sub-Committee was given the opportunity to question the information provided. The first question related to the need to account for inflation in the budget, with a 4% increase included. As inflation was currently above 5% it was questioned whether there was enough flexibility in the budget to account for this increase. It was confirmed that inflation was being monitored as it was a known risk to the budget. Work was underway to review the corporate inflation provision to establish what could be afforded.

It highlighted that service user feedback and involvement in the commissioning process was important in ensuring the delivery of good quality services. As such it was questioned how service users would be involved going forward and how they could provide feedback if they were unhappy about a service. Reassurance was given that people were at the heart of the commissioning process and it was seen as essential to feed in the voice of service users, with this principle being a key driver in the commissioning model the Adult Social Care service was working towards. If a service user had a concern about the level of service provided, in the first instance this should be reported to the provider and shared with the Council.

The service also worked with user groups such as the Autism Board and the Croydon Adult Social Services User Panel (CASSUP) to consider how services were commissioned. It was essential that workstreams had the involvement of residents in designing the system, which need to include honest conversations about the amount of money available.

Given it could be challenging to deliver savings, it was questioned whether there was alternative plans in place if it became apparent that particular savings could not achieved. It was highlighted that Adult Social Care was a demand led service and as such it was crucial to manage this demand through early intervention in order to support carers to continue caring. Growth had been built into the budget to account for increased demand, which had been based upon evidence developed in partnership with the Local Government Association (LGA). If growth was not included in the budget, then the service would be overspent from day one.  There was also a need to ensure that the health service was meeting the cost of health related issues and that people paying for their care services were charged appropriately.

A demand management system was being established to review from end to end the level of support required by service users, to ensure there was a realistic picture of the potential cost. There was also a need to review services commissioned by the Council a number of years ago to ensure that they continued to deliver the necessary outcomes required by the Council.

The budget for Adult Social Care was reviewed within the service on a weekly basis and by the Section 151 Officer and the Chief Executive on a monthly basis. If there was an over spend, there would be an expectation that this would be rectified by the service. The Chair of the Sub-Committee highlighted that from their review of the Transitions Service earlier in the year, reassurance could be taken that the team was able to effectively manage its budgets.

Reassurance was sought that the Service had the right software packages and financial controls in place to ensure that the budget could be effectively managed. It was confirmed that the Service had two systems in place that had been introduced during the pandemic which enable the whole system to be monitored. These systems were still a work in progress, but month on month improvement was being made.

The Service also used a software system called CareCubed, which was a placement negotiation tool that allowed national data sets to be reviewed alongside the care and support details for a service user to provide an indicative cost of care. Having this tool in place allowed the service to negotiate with providers on what they were able to provide and so far it had delivered £170,000 of savings from reviewing a minimal number of cases.  The next stage of the process would be to roll the system out into the Children with Disabilities team, which would also have the benefit of helping with transitions as young people moved through the care system.

The Interim Director of Finance, Matthew Davis, confirmed that the Adult Social Care service now had a greater level of control of its budget compared to a year ago. The Spend Control Panel had originally been reviewing care packages on an individual basis, but as there was now reassurance that the team was keeping a tight control of the budget a weekly overview was provided instead. Although an absolute guarantee could not be given that there would be no unexpected costs before the year end, there was reasonable confidence that the monthly figures were accurate and the budget would be delivered.

CASSUP Co-optee, Yusuf Osman, highlighted there had been three suggestion made by CASSUP when they were consulted on the Adult Social Care Strategy and asked whether these had been captured in the document. The suggested changes were the inclusion of sensory impairment to the list of impairment groups, the need to reflect people either born with or who developed an early impairment and a need to strengthen the section on the Council continuing to provide statutory support. It was confirmed that these changes had been incorporated in the document following the CASSUP meeting.

It was noted that the Sub-Committee had previously received updates on the need for reassessing the support for learning disabled and as such it was questioned how the Strategy encompassed this work and also tied into other strategies such as the Autism Strategy. It was confirmed that the Strategy covered all adults from young people in the Transitions service at 14 through to the end of life. It was intended that the Strategy would be able to evolve in order to take account of future changes within the system. The Service was currently doing a lot of engagement on learning disability services and had ensured the inclusion of learning disability and the transforming care cohort in the Health and Care Plan. It was important that Social Care did not work in isolation and was joined up with other services and strategies. It was agreed that the delivery of the Adult Social Services Strategy may be something the Sub-Committee might want to revisit later in 2022.

In response to a question about how the content of the strategy would be communicated to the public it was advised that a communications plan had been created alongside the strategy which set out who the Service needed to engage with and an easy read version would be produced.

An update the current position of staffing in the Service was requested. It was confirmed the main challenge was the recruitment and retention of staff in the Discharge and Transition teams. It was essential that staff, particularly those newly qualified, felt looked after by the Council through good quality supervision and support with complex cases. Social workers also predominately worked from the office rather than remotely, which helped to ensure there was a connection with staff.

Following discussion of this item the Chair thanked the officers in attendance for their openness in engaging with the questions of the Sub-Committee.

Conclusions

At the end of this item the Health & Social Care Sub-Committee reached the following conclusions:

1.    From the evidence provided by officers it was reasonable to conclude that the budget being proposed for Adult Social Care was both sustainable and deliverable, with a commendable focus on working with individuals to ensure their needs were being met.

2.    With the 2021-22 budget on track for delivery, there was evidence that the financial controls within the service had improved over the past year.

3.    Given the information provided and the reassurance of officers that any change to care packages would be managed in cooperation with service users and their carers, it was reasonable to conclude that any changes to care packages would be closely monitored to prevent any unnecessary harm.

4.    The Sub-Committee was broadly supported the of the Adult Social Care Strategy, acknowledging it would take a role in testing both its implementation, and the impacts on residents, carers and the budget.