Agenda item

The Sub-Committee is recommended to

1.     Note the updates on:

•        2022/23 Period 7 (October 2022) budget and savings position.

•        2023/24 indicative savings (as of 10 January 2023).

•        The Council’s position in relation to the benchmarked key performance indicators.

2.     To consider any comments it may wish to make on the 2023-24 indicative savings proposals, which will be fed into the wider budget scrutiny process led by the Scrutiny & Overview Committee.

The Sub-Committee considered a report set out on pages 39 to 70 of the agenda which provided the 2022/23 Period 7 (October 2022) budget and savings position, 2023/24 indicative savings and benchmarked key performance indicators for the Adult Social Care & Health Directorate. The Corporate Director for Adult Social Care and Health introduced the item and summarised the report.

The Chair thanked officers for the detailed report and key performance data, and asked about the Period 7 Financial Monitoring figures. It was noted that an underspend was predicted for 2022/23, and it was asked why savings had not been achieved in some areas. The Director of Adult Social Care Operations highlighted the area of Disability Transitions; it was noted that significant savings had been made but that there had been difficulties in meeting the targets that had been set. The department was looking to address this through increased recruitment of staff to conduct reviews, as it was acknowledged that reviewing capacity was not sufficient; whilst there had been constant recruitment there had still been a shortfall in staffing. There had been better management of costs in the market since the start of the Director of Adult Social Care Policy & Improvement, by looking at ways to ensure the market remained resilient and was developed to provide better and more cost effective solutions.

The Sub-Committee heard that demand from 18-65 year olds was being well managed, and was the 19^th largest of London boroughs; Croydon was the third best performing borough for reducing demand from over 65s from the previous year. The Director of Adult Social Care Operations explained that the direction of travel on many indicators was good and that all cases were scrutinised heavily to ensure the best value was achieved with safe and legal outcomes.

On Table 4, page 41, the Chair asked about the savings that had not been delivered and to what extent workforce issues had contributed to this. The Corporate Director for Adult Social Care and Health explained that all of these numbers were being tracked, and that reviews were ongoing alongside work to ensure that the flow from hospital discharges remained consistent. There was not sufficient qualified social worker capacity in the market, and so it had been important to look at skill mixes in officers to see where non-social worker roles could provide support. The Corporate Director for Adult Social Care and Health highlighted that the quality of work had not dropped and that culture change in the department was ongoing.

The Director of Adult Social Care Policy & Improvement explained that there had been issues with recruiting to Commissioning inside of Adult Social Care, and that good strategic commissioning was vital to delivering savings targets through a partnership approach with Operations. Commissioning capacity was now in place, it was thought that the department was in a much better place moving into 2023/24 to deliver a greater pace around reviews which it was hoped would make savings targets achievable. The importance of supporting staff who had been under significant pressure for an extended period was noted, and failure to do this properly was highlighted as a risk.

The Corporate Director for Adult Social Care and Health added that the Improvement Panel and Opening the Books accountants had been positive about the governance and pace of change happening in Adult Social Care, but highlighted the importance of increasing capacity so that other issues could be addressed, for example, submission of bids. The Corporate Director for Adult Social Care and Health explained that managing demand on the department was vital in ensuring that savings continued to be delivered. The Cabinet Member for Health & Adult Social Care commented on the increased scrutiny of the department, and the improvements in governance that had taken place over the last year.

The Chair stated that they felt there had been challenging targets set for Adult Social Care in March 2022, and acknowledged that workforce and commissioning capacity had contributed to difficulty in achieving these in some areas. The Sub-Committee commended the Adult Social Work team in delivering the savings they had whilst maintaining service levels.

The Sub-Committee commented on concerns about compromising on the safety and quality of care packages in delivering savings and asked for reassurance that this was not the case.  The Corporate Director for Adult Social Care and Health stated that this was not happening, and that all individuals were assessed to ensure that their care needs were met in the most cost-effective way that could deliver the best outcomes for the service user; it was also important that reviews were carried out in a timely manner. Members heard that the department was going through assurance and would be inspected to verify that this was the case.

Members asked about ‘Resident Voice’ and how the community were being engaged. The Corporate Director for Adult Social Care and Health explained that they were doing everything possible ensure information was out there in the community, through the ‘Resident Voice’ Group, the Carers Group and Carewatch. These groups were also members of the Assurance Panel who ensured that the department were operating safely and providing a good quality of care. It was acknowledged that sometimes mistakes did happen, and people made complaints, but these were looked at and addressed on a case-by-case basis. Safeguarding Adult Reviews were scrutinised to ensure learning and improvements could be taken on board alongside feedback from carers and the community. The Director of Adult Social Care Policy & Improvement explained that the new ‘Resident Voice’ group was being worked with to find the best ways to engage and embed learning into the directorates Communication and Engagement Plan. It was acknowledged that individuals took in information in a number of different ways, and that communications needed to reflect this to ensure engagement was effective.

The Chair brought the Sub-Committee’s attention to the Key Performance Indicators (KPIs) in Appendix 1, and the 19% figure for ‘% of clients that have been reviewed who have been accessing long term support for more than 12 months at the end of the year 2021/22’. The Chair asked about the implications of not reviewing a service user for 12 months. The Director of Adult Social Care Operations explained that the statutory requirement in the Care Act was that clients were reviewed within 12 months, and that the figure in the report was poor. Members heard that it was possible that not all activity had been captured, which may have made figures worse; training to ensure there was accurate data recording in future had taken place. A lot of resource had been put into reducing Care Act assessment waiting lists, where risk was highest; now this was improved, it was thought there was increased capacity to conduct planned reviews and figures were moving in the right direction and at around 45-50%. A Reviewing Strategy was being developed with the aim of increasing this figure to 95%, looking at the needed resources and exploring the possibility of using an external partner to conduct reviews. Currently there were around 30 staff volunteers working additional hours at weekends to review cases; it was thought these volunteers would conduct around 1500 reviews in the coming year. It was highlighted that the risks of not reviewing clients within this timeframe were around safeguarding and the non-delivery of savings.

Members asked if there were service users who had not been reviewed for significantly longer than 12 months. The Corporate Director for Adult Social Care and Health explained that there had been targeted reviews to deliver efficiencies, but there had been some clients who had not been reviewed for 18 months. There had been spot checks of these cases and it was noted that the clients usually had an assigned social worker who was working with them and seeing them regularly to make care plan adjustments, but this had not been recorded as a review. Other cases were clients with ‘Shared Lives’ who were actively being worked with, but again this had not been recorded as a review. Members heard that changes in data recording for these cases could improve the review KPIs and the Staff Group would be engaged to carry this out and that it would be monitored through dashboards. There were out-of-borough placements that also needed to be reviewed on a regular basis, especially those without family members. The Sub-Committee commended the spot-checking of data in this way.

Members asked about the risk of burnout for social workers with high caseloads. The Corporate Director for Adult Social Care and Health explained that those doing overtime on reviews were being monitored closely, as were caseloads to ensure that these remained manageable. The Director of Adult Social Care Operations added that the quality of work was also being monitored, and that Heads of Service and Team Managers were watching caseloads to ensure the quality of work remained high. Outstanding reviews had been organised by the age of the cases to ensure these were tackled in an appropriate order.

The Chair pointed to the figures on the ‘Rate of 18-64 clients per 100,000 accessing nursing or residential long term support as at 31 Mar 22’ and asked about ‘Use of Resources’ data. The Director of Adult Social Care Policy & Improvement explained that there had not been ‘Use of Resources’ data when targets were set, and these had originally been set on a 3% growth limit. Members heard that reducing this figure was as much about conducting reviews of those accessing nursing or residential long-term support to see if there were viable alternatives for clients, as it was about looking for alternatives at the point where clients were initially entering care. The Sub-Committee heard that work with the market was also important, and the example of entering strategic provider relationships for assisted living as opposed to spot purchasing was given; a market position statement on future demand and support models was in development for publication in 2023.

The Chair asked about the issue of self-funders who ran out of money and ended up as Croydon clients, creating financial pressure. The Corporate Director for Adult Social Care and Health explained that there had been funding streams available for buying beds and that this had been pushed back on as it created additional risk for Croydon by inflating the market. Across South West London, a letter had been written by the Association of Directors of Adult Social Services to raise concerns about this, and other authorities buying beds in the borough to a similar effect; the preference was for people to return to, and receive care in, their own homes whilst retaining as much independence as possible. The Director of Adult Social Care Policy & Improvement agreed that self-funders did present a significant risk to Croydon, and explained that a ‘Fair Cost of Care’ exercise had been carried out over summer 2022 with residential, domiciliary and nursing home providers with figures still due to be published. Members heard that it was incredibly difficult to identify the number of self-funders, but it was thought that this was around 1,000 people, or a third of the total number. Inflation presented challenges for self-funders and the longer high inflation persisted, the greater risk there was to Croydon. Modelling had taken place on the number of self-funders to prepare for anticipated charging reforms, and when self-funders would likely need to come to the Council for support. Demand and inflation modelling was being incorporated into the budget setting for 2023/24 to ensure proper growth bids were in place and that the budget was sustainable.

The Chair related a question from Selhurst Ward Councillors about plans in the 2023/24 budget for closing the Whitehorse Day Centre and Cherry Orchard Garden Centre, both of which catered to residents with learning disabilities. It was asked if the impacts of these closures had been properly assessed, whether there had been sufficient consultation with service users and if the proposed savings were significant. The Corporate Director for Adult Social Care and Health explained that they would be meeting with Ward Councillors to discuss this in January 2023; the Whitehorse Day Centre service would not be closed, but there was work to find alternative buildings to provide efficiencies. The Sub-Committee heard that service users of both sites were being engaged on the plans, and that no decisions had been taken on either site. The Corporate Director for Adult Social Care and Health stated that an Equality Impact assessment on the proposals had been completed. Members heard that all provisions in the directorate had been looked at through the lens of statutory provision, which running a garden centre was not, however use of the Cherry Orchard Garden Centre featured on the care plans of 11 service users, all of which would need to be looked at closely should it close to find alternative provision. In addition to this, there were nine volunteers who worked at the Centre who would also be carefully considered for alternative provision. The decision on these sites would ultimately be made by Members and it was acknowledged that the potential savings were not large in and of themselves but contributed to wider financial figures. A comprehensive report considering all factors would be provided to support any decision that was made. The Whitehorse Day Centre supported 65 people on average and work was ongoing with these individuals, their families and staff; none of the staff or care packages for service users were at risk, as a new location for these services was being investigated. It was highlighted that both sites required ongoing investment, should they be retained, and that services were moving to an ‘Active Lives’ approach to ensure that people were engaged in the community, as opposed to building based services.

The Chair asked about the proposed deletion of the ‘Active Lives’ post, and the Corporate Director for Adult Social Care and Health explained that this was a vacant post and would not have a detrimental effect on the service as a whole. The Chair stated they were heartened by responses given by officers on the 2023/24 and current 2022/23 budgets and the good understanding of risk inherent in the proposed savings.

Conclusions

The Sub-Committee were of the view that the Adult Social Care and Health directorate were in a reasonably strong position in managing its budget.

The Sub-Committee were of the view that the Corporate Director for Adult Social Care and Health had a good understanding of the risks involved in delivering the 2022/23 and 2023/24 budgets.

The Sub-Committee were confident that the Adult Social Care department were on track to deliver the 2022/23 budget.

The Sub-Committee were of the view that, as discussions on other options were ongoing, they could not reach a view on whether better options for savings existed.

The Sub-Committee were of the view that the Cabinet Member and department understood the impact of savings proposals on service users and the wider community.

The Sub-Committee were of the view that proposed budget for 2023/24 appeared to be deliverable, sustainable and did not present an unacceptable risk.