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ITEM EX5 - SUPPLEMENT B - ANNEX 3

EXECUTIVE – 19 MARCH 2002

BUDGET MONITORING

SOCIAL SERVICES BUDGET PROPOSAL 2002-03

  Proposed Reductions to keep within Available Resources

1. The main impact of bringing the activity into line with the proposed budget, will be to reduce the number of children’s homes placements, and the availability of respite care for children with a disability. The reduction of places in children’s homes will affect the response to children looked after by the County Council. This may lead to some children, and young people, remaining in the community where it has been considered it is not in their best interests.
2. The numbers of children looked after have reduced from 470 in April 2001 to 430 in February 2002. Some resources have been allocated to purchase additional foster care. A further reduction in children looked after is needed to ease pressure on independent residential placements. Whilst the current trend identifies a reduction, it is difficult to anticipate whether this will be sustained or improved, when nationally the numbers of children looked after have been increasing.
3. The plans include re-investing revenue into foster care, adoption and supporting kinship care placements. This is essential to ensure Oxfordshire retains its foster carers and meets its objectives to maintain and develop placements for children with families. The closure of Resource Centres for children with a disability will have a significant impact on these children and their families. The service provided is of vital support to parents, carers, brothers and sisters. It will be essential to provide other forms of respite care, through the home support service, community based activities, and where possible overnight respite through the foster care service. As with the children’s homes, it will be necessary to re-invest revenue into home support, play and leisure activities, but this will not compensate for the lost residential respite care places. The withdrawal of funding from the Resource Centres will have a direct impact on the contract and joint work established with Barnardo’s. Detailed negotiations will be necessary with Barnardo’s to see what level of service can be maintained in a partnership with them.
4. Financial support to homeless families to secure temporary accommodation to prevent children entering the looked after system will cease.
5. The change in services has been necessary because current activity exceeds the available budget. The change, and reductions are primarily identified in high-cost, low-volume services, to achieve a reshaped service within the available budget.

Older People

6. The main impact of bringing the activity into line with the budget will be to reduce the amount of long term care available. There will be a reduction in the number of residential or nursing home places purchased and this could affect how quickly older people are able to move out of hospital or place an additional burden on carers, if at home.
7. The reductions in home support services will be achieved by continuing to use the eligibility criteria agreed by Social Services Committee in October 2001. This necessitates a high level of need before assistance can be provided. The overall aim, however, is to concentrate our efforts on providing more short term intensive assistance to help older people regain independence rather than relying on long term support.
8. We also aim to reduce high cost provision available to only a few people in order to maintain a lower level of provision to larger numbers of people. For this reason it is proposed to cease to provide night care.
9. Finally, while placing a priority on services which support older people at home, such as day services, there is a need to review the range of day services provided as the costs now exceed the finance available. This will lead to the closure or amalgamation of some local services.

Mental Health

10. The department has worked hard over recent years to improve mental health services from what was a very low funding base. The current aim is to increase the number of people helped to live in the community rather than in more expensive residential placements, often a long way from Oxfordshire. Reductions made in such placements will be supported by increasing community based support.

Physical Disabilities

11. The spend on services for people with physical disabilities in Oxfordshire has for the last few years been over-committed against the allocated budget. This was highlighted in the Best Value review undertaken during 2000. This has meant that at the beginning of each financial year the allocated budget has shown an over-commitment due to long standing care and client commitments and that is without providing services to new clients to the department.
12. The rationale for reducing the spend in this area is in relation to the average number of hours someone with a physical disability receives compared with an older person. By re-assessing all service users against the revised eligibility criteria the reduction in spend can be achieved. The aim is both to reduce the level of service being received and also to increase the number of people receiving a low level service (to increase the very low level PI rating for numbers of people supported to live in the community).
13. The impact of this decision will be that people who have for some time received a certain number of care hours per week will have these reduced. This will lead to increased pressure on family carers, increased risks for individuals and legal challenges and complaints.
14. There will also be a reduction in the number of people supported in residential care ensuring that the traditional small over-commitment of this budget does not continue.
15. A reduction in the service agreement budget will lead to some long standing services ceasing and to others being reduced.
16. The reduction in the budget for equipment services will lead to the priority for equipment provision being to reduce potential commitments to other departmental budgets - for example where the provision of a piece of equipment would prevent a residential care admission or home support being required.
17. Whilst these reductions in services are achievable there is a risk to these occurring within one financial year.

Learning Disabilities

18. All service users with a learning disability will have their Care Plan reassessed. This process started in January, and already is indicating that savings can be made. The aim is to provide a lower level of service, but to maintain the same number of clients. Firstly, home support, currently running at 20 hours per week per user; will be reduced in line with changes in eligibility criteria. Transport costs, for example to and from respite care will also be reduced. This is likely to create pressures, especially for family carers, who could mount a challenge against the decisions.
19. The Best Value Review of Learning Disability indicated that a thorough review of Contracts and Services Agreements was needed. No target savings were put against this through the BV Review, but savings will be made.
20. There is an over commitment on Section 28a. This saving will be made by an increase in funding from Health, or, more likely a decrease in service through the Care Manager review process.
21. The budget for Adult Family Placement is overspending this year. Activity will be reduced over next year to ensure expenditure remains within the budget. Stopping all new placements until the budget is on target, and prioritising the waiting list will do this. As many of these placements are for short term and respite care, this is likely to place additional pressures on carers.
22. As users are reassessed, it is anticipated that day service attendance will also be decreased, but without additional costs elsewhere, i.e. in residential care. At this stage it is not anticipated that any day centre will close, but this will be reviewed after 3 months and reconsidered if savings are not being made.
23. There is a reduction of £700k that has yet to be allocated to home support, day care or service agreements. The measures outlined above will contribute towards this saving but the detail has yet to be worked up. Given the scale of the reduction, there is a risk that the proposals will not be delivered.

Support Services

24. For the 2002/03 financial year, the support services have been prioritised, and there are no significant proposals for reduction in activity. This decision reflects the recent FINE report, as well as Department of Health feedback on our Information for Social Care submission. Both of these papers reflected on the need to develop our performance and financial management arrangements, and invest in developing the IT infrastructure to support the work of the Department. It was also felt important to continue to support staff in managing the scale of reduction in activity. It may well be possible to make larger scale reductions in support service activity in future years, once we have developed more robust systems, and have more stable levels of activity.
25. The reductions that have been proposed in the support services revenue provision include £500,000 from IT provision. It is not intended to reduce the associated activity (especially given the priority given to this expenditure above). Instead, this expenditure will be funded from capital receipts associated with the reduction in service activity proposed elsewhere in this paper.
26. There is a proposed reduction of £150,000 across all support services and small grants. The detail of how this reduction will be managed has not yet been agreed, but is likely to involve some degree of managing staff vacancies. An addition to the contingency of £37,000 is shown within support services. This is to balance the Social services budget to the resources allocated by the Council.
    
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