Agenda item

The Sub-Committee will be provided with an overview of the Adult Social Care budget proposals for 2021-22. (To follow)

The Sub-Committee considered a presentation from the Executive Director for Health, Wellbeing and Adults on the 2021-22 budget for Adult Social Care. The Sub-Committee was asked for to review the social care budget with a view to feeding any concerns into the consideration of the full budget by the Scrutiny & Overview Committee in February.

A copy of the presentation delivered by the Executive Director can be found at the following link:-

https://democracy.croydon.gov.uk/ieListDocuments.aspx?CId=168&MId=2162&Ver=4

Following the presentation the Sub-Committee was given the opportunity to ask questions about the information provided. The first question related to the cost for adult social care as part of the Council’s total budget and whether this was in keeping with other local authorities. It was advised that the adult social care budget in Croydon equated to approximately 31% of the total budget, which was lower than some authorities where it could be as high as 36%. It was suggested by a member of the Sub-Committee that the overall percentage in Croydon maybe lower due to the higher cost of children’s social care.

The next question concerned the take up of personal budgets, in particular why the take up in Croydon had been low and how was this being addressed. It was advised that there was a need to make personal budgets mainstream as part of the core practice. However, this would only work if the right services were available to purchase in the borough. Many people were already on direct payments, but these were managed by the Council, which was not the true form of personal budgets.

As a follow up, it was questioned what support was being provided to help people make the move to direct payments.  It was advised that direct payments were not seen as the answer to saving money, rather it gave people more choice and control over their care. There were good advocates in Croydon who had been supporting people opting for direct payment, but it was important to have a multi-faceted approach that was right for each individual case.

It was agreed that when increasing the take up of direct payments, it was important to have a balance between autonomy and supporting individuals to use the autonomy effectively. Assurance was sought that there would be effective communication on the implications for individuals thinking of moving to direct payments once the plans had been finalised. It was advised that the e-marketplace was a key priority, as it was important for people to be able to see what services were available. Communication was essential and the service constantly worked to get this right, with work underway to explore how best to capture the voice of residents.

In response to a question about transitioning some of the services provided to the voluntary sector, it was advised that discussions were currently ongoing. So far there had been a mixed response from the voluntary sector, particularly as the Council had in the process of reducing its costs, had less grants available for the sector.  Transparency was needed about the cost of service delivery to ensure there was an informed discussion about how they can be delivered more efficiently by the voluntary sector.

Concern was raised about the support available to assist people with restoring their social networks after the pandemic, with it questioned what support could be provided by the Council. In response it was advised that this was something that worried both health and social care partners, as the impact from the pandemic was likely to be felt for a number of years. The Health and Wellbeing Board was being reshaped and would focus on post pandemic priorities such as this. The South London and Maudsley NHS Trust was also reviewing its crisis offer and looking to simplify pathways into the service.

It was highlighted that there had been attempts in the past to reduce the adult social care budget, which had not always been effective. As such it was questioned how it would be different this time. It was advised that the service now had more intelligence and knowledge about its spending. There was also more support to look at placements and packages of care. The service was looking to move to an assets based model to build on the strengths rather than weaknesses. It was important to ensure that people were not pulled into the care system unnecessarily and instead support was given at the right time.

In light of the need to make savings, it was questioned whether there was the potential to make savings through pooling budgets with health care partners. In response it was advised that there was an intention to pool health and social care budgets across the length of the medium term financial strategy, which included looking at commissioning arrangements. One of the key aims was to keep services local at a place level.

It was noted that mental health support was a particular issue for adults receiving care packages or those in placements, with concern raised that issues requiring short term additional expenditure may not be addressed given the financial challenges facing the Council.  In was confirmed that there had been investment from the health service which had enabled the development of wellbeing hubs. The initial benefits from these would start to become tangible in the next quarter.

It was agreed that an update on commissioning and plans for 2021-22 would be scheduled into the work programme of the Sub-Committee for a deep dive in the near future.

It was highlighted that the Report in the Public Interest by the Council’s external auditor, Grant Thornton, had raised concern that the Council had repeatedly identified savings in Adult Social Care, but had failed in the delivery of these savings. As such the reasons for the continued overspend was questioned. It was advised that Croydon should not be different to other boroughs in terms of complexity. Croydon was an importer for areas such as care homes, but every borough had different aspects that make them unique. Croydon had high cost placements, which meant there was a need to shift the balance from residential care to independent living.

In response to a question about whether a mixed approach could be taken for those who were unsure about whether to sign up for direct payments and commissioning their own services, it was advised that reassurance could be taken from other boroughs who had already moved to this model. There was a need to move the focus away from budgets and spend toward an outcomes and aspirations based model. To bring about this change, communication including conversations with individuals and ongoing testing would be essential to work out what was best for people.

As a follow-up, it was questioned whether there was a need for a new set of indicators to measure success. It was advised that there was currently a baseline indicator on the cost of care. Going forward there would be a need to ensure that the outcomes being delivered provided good value for money. Making the change to direct payments, would necessitate complex conversations with individuals to ensure their needs continued to be met. For the elderly there would also be the need to weigh up the risk of any changes to their care.

The final question of the session related to how the work to deliver savings would tie into the Council’s Localities Strategy. It was advised that Social Care would continue to work alongside GPs and personal independence coordinators in localities. There was also a need to work with health partners to ensure the investment in younger adults was delivering the required outcomes.

At the conclusion of this item the Chair thanked the Executive Director for Health, Wellbeing & Adults for his engagement with the questions of the Sub-Committee.

Conclusions.

At the conclusion of this item the Sub-Committee reached the following conclusions:-

1.    There was a number of big challenges in Adult Social Care, particularly for those in the 18-65 age groups, which would require the Sub-Committee to maintain a watch brief over the service in the coming year.

2.    The Sub-Committee welcomed the use of comparative data to design a realistic savings programme. However, its deliverability would need to be tested and monitored throughout the forthcoming year.

3.    The Sub-Committee agreed that it would add a deep dive on commissioning into its work plan for 2021-22.

4.    Although the savings programme presented to the Sub-Committee seemed to address the budget deficit and identified further savings, at this stage it was difficult to make any definitive judgement on the likelihood of it being delivered. 

5.    It was essential that a system of ongoing monitoring was in place to understand the impact on residents from the changes to prevent creating further issues in the future.