Agenda item

10:15

Contact Officer: Lorna Baxter – Assistant Head of Finance (Corporate Finance),  01865 323971

The attached report (AS5) sets out the Business Improvement & Efficiency Strategy for the Social & Community Services Directorate. The strategy contains the identified pressures and proposed savings over the medium term from 2010/11 to 2014/15. For reference, the current financial context and the report to the Strategy & Partnerships Scrutiny Committee are included. The scrutiny committee is invited to consider and comment upon the strategies and the pressures and savings contained therin.

Comments from each scrutiny committee will be collated and fed back to the Cabinet by the Strategy and Partnerships Scrutiny Committee which meets on 14 January 2010.

Members of the Committee will have the opportunity to question the Cabinet Member for Adult Services, together with the Director for Social & Community Services, Mr Paul Purnell (Head of Social Care for Adults), Mr Simon Kearey (Head of Strategy and Transformation) and Heads of Service and other officers on the identified budget pressures. Officers from Financial Services will also be present at the meeting to answer any questions that the Committee may wish to ask.

The Director for Social & Community Services will commence this agenda item with a presentation to the Committee giving an overview of the budget.

The Scrutiny Committee is invited to consider and comment upon the Directorate Efficiency Strategy plus the identified pressures and proposals for savings contained therein.

13:15 – 13:45 SANDWICH LUNCH

The report before the Committee (AS5) set out the Business Improvement & Efficiency Strategy for Social & Community Services. The strategy contained the identified pressures and proposed savings over the medium term from 2010/11 to 2014/15. The Committee was invited to consider and comment on the strategyand the pressures and savings contained therein.

The Cabinet Member for Adult Services, together with Mr John Jackson (Director for Social & Community Services), Mr Paul Purnell (Head of Social Care for Adults), Mr Simon Kearey (Head of Strategy and Transformation) and Ms Maureen Elliott (Finance Business Partner – Social & Community Services) attended for this item, together with other Heads of Service, in order to answer the Committee’s questions in relation to the identified pressures and proposed savings.

The Assistant Head of Finance (Corporate Finance) also attended to answer any questions which the Committee may have wished to ask.

The Director for Social & Community Services gave an overview of the budget for Adult Services (Refer Annex 1) which covered the Directorate’s vision, how this relates to the Corporate Plan, some key figures, an overview of the Service and Resource Plan, demographic change, the Directorate’s Business lmprovement and Efficiency Strategy, delivering the unidentified savings, working with the NHS, potential risks 2010/11 and potential risks in the medium term.

The Committee then asked a number of questions. A selection of the Committee’s questions, together with the officers’ responses, is listed below:

·        If extra savings were required corporately would the Directorate be able to make further savings? ie had the Directorate left some money in reserve should this be needed?

It would probably be possible to make additional savings in the next financial year but the contingency was needed to cover the potential risks. These were the major overspend on the older persons pooled budget and the potential cost of free personal domiciliary care, should primary legislation be passed before the next General Election. Considerable savings were expected from Transforming Adult Social Care including Self Directed Support, but the potential risks in the medium term also had to be taken into account.

·        Why had there been an overspend on the older persons pooled budget?

This was a budget of two halves rather than a ‘pool’. The Primary Care Trust’s (PCT’s) half of the budget had been overspending for some time and related to Continuing Health Care. The Council’s half had been generally close to the budget but this year there had been an overspend.  A major factor in the overspend was that Delayed Transfers of Care (DTOC) had been reduced, in terms of speeding up hospital discharges. Therefore, most of the forecast overspend had come from the increased demand for community care, especially domiciliary care (home support). Officers were reasonably optimistic that this could be reduced to a £1.5m overspend by the year end.

·        If the overspend on the older persons pooled budget was to be reduced would this result in more DTOC?

It would be necessary to try to reduce weekly new commitments and to review more robustly some of the larger home based packages. This week a team would be reviewing and reassessing people and it was hoped that about 500 less people would be receiving domiciliary care by the end of this financial year. Some service users were receiving such large packages of care to enable them to remain at home that it would be reasonable for the Directorate to now enforce a ceiling policy. A home based package of care should not cost more than it would cost to meet a person’s needs in a care home. Some home based packages were costing £1,500 - £2,000 per week due to the number of carers that were required, whereas it was possible to purchase a bed in a care home for £700 or £800 per week.

·        How serious was this overspend?

Reducing the overspend to £1.5M would still mean that the Directorate’s room for manoeuvre was limited, especially in light of the Prime Minister’s pledge to offer free personal home care to anyone at the highest threshold of the eligibility criteria. This might be implemented from 1 October 2010 and could also generate claims from people who were self funding their care. Costs from the NHS might also come to Adult Social Care as some health needs might be redefined as social care. The costs of the proposal - should it be introduced - were unknown, as the government’s estimation of cost was based only on academic research. Work needed to be undertaken locally to gauge this. The government had said that it would make available £420M out of an estimated £670M and it was assuming that the shortfall could be met by local government efficiency savings. This would be extremely difficult. If introduced, free personal home care would be at the expense of other services or by increasing Council Tax. The Directorate had not included any funds in the Strategy for this potential change, as it was not known whether it would be introduced, or what the costs would be. The consultation would not officially end until 26 February, which would be after the Council had set its budget.

·        Would the Council’s ICT systems be sufficiently robust to deal with the transformation of Adult Social Care?

A review was currently underway. Sufficient capital funding was available. The results of the review should be available by the Summer.

·        Might the introduction of Self Directed Support result in a casual labour force for Adult Social Care? How could this be avoided?

Considerable work had been undertaken nationally in this area. A National Workforce Strategy had been launched in April and work was ongoing. There would need to be more registration and training of social care staff, not just social workers.

·        How would the take-up of community based services be encouraged?

This was the role of the Community Development Team, especially in relation to hard to reach communities. Current examples of community based services included the Oxfordshire Chinese Community & Advice Centre, the Good Neighbour Scheme and Volunteer Linkup in Witney (transport and befriending services). There was still more work to be done in this area.

·        What about transport planning and subsidy to get people from their homes to these services?

Officers were working on the Local Transport Plan and were encouraging members of the Health and Wellbeing Partnership Board to input into the next Plan.

·        What was the detail behind SC27 - pooled budget contributions from Oxfordshire Primary Care Trust (PCT) to meet increased health activity?

The PCT should be contributing more funding to the community equipment budget. A great deal of provision classified as home support was actually health care. The PCT would not be formally setting its budget until the end of January. Their financial situation was very tight and they were looking into it. Negotiations were underway.

·        SC40 [Home Support] Renegotiate all block contracts down to the average for the area. This was listed as a high financial risk. Was it likely that the providers would go out of a business as a result, which could end up costing the Directorate more if it had to go to other providers?

Contract staff were highly skilled in this area and made sensible decisions. Officers would also be looking into why some providers were charging above average for the area.

• Fuel poverty was an issue for many people. What could be done?

Addressing fuel poverty was not one of the Council’s key functions and the Directorate did not have the resources to undertake significant activity in this area. It was to be assumed that the District Councils were more involved. However, Mr Kearey undertook to look into whether information on fuel poverty could be provided as part of the Directorate’s provision of information to the public (eg. in libraries).

• The way in which the financial information had been presented to Scrutiny via the Directorate Business Improvement and Efficiency Strategies may cause the Media to gain an inaccurate overall impression of the budget proposals (as they contained insufficient emphasis on the amount of identified pressures that would actually be reinvested in services). Could the information please be made clearer to the Media?

Mrs Baxter undertook to make reference in the Service and Resource Planning Reports to Cabinet that £75m of the £106m of pressures (as quoted in the Media), would be reinvested in services.

Following debate, the Committee AGREED to forward the following advice to the Cabinet via the Strategy and Partnerships Scrutiny Committee:

This Committee:

a)                 wishes to express its concern regarding the capability of the Council’s ICT facilities to support the transformation of Adult Social Care, with particular regard to the roll out of Self Directed Support;

b)                 wishes the Directorate to continue its close liaison with NHS Oxfordshire (formerly Oxfordshire PCT), with particular attention to the grave financial situation facing NHS Oxfordshire, which will have ramifications for Adult Social Care given the amount of services that are delivered in partnership;

c)                  notes the importance of community development initiatives which aim to increase social capital, wellbeing and independence thus aiming to reduce demand for residential care and acute services; and that whilst there are already some good examples of this, there is still more to be done, including work to ensure that there is a cohesive system of integrated local community services in place;

d)     notes that the Adult Social Care budget for 2010/11 is balanced, whilst noting the two risks to the service identified by the Director, which are:

·        the major overspend on the older person’s pooled budget (which the Directorate plans to reduce); and

·        the financial implications for local authorities of the potentialintroduction of free personal domiciliary care forpeople with the highest levels of need, as outlined by government sources.

The Committeealso AGREED to express its thanks to Directorate and financial officers for the Directorate specific and generic budget briefing sessions, which in its view had been very useful.