Adult Social Care Transformation Programme and Budget Issues
- Meeting of Budget and Finance Overview and Scrutiny Committee, Wednesday 15 September 2010 7.30 pm (Item 6.)
Officers will provide information about issues relating to the Adult Social Care transformation programme and budget challenges for 2011/12.
Martin Cheeseman (Director of Housing and Community Care) gave a presentation on this item, stating that the £2.8 million overspend in Adult Social Care in 2009/20 was not exceptional and was a reflection of demand pressures. The largest spending area in Adult Social Care was purchasing, whilst concessionary fares were also quite significant and could not be cut. The demographic pressures on the budget included the fact that people were living longer and as numbers of older residents grew, demand for care also increased and Martin Cheeseman advised that there were, for example, large costs involved in addressing dementia. Nationally, changes were taking place as to the way Adult Social Care services were delivered, including a move to personalisation and making customers less dependent, whilst there was also discussion with regard to classifying health care and social care and the Council had debated this with Brent Primary Care Trust (PCT). Adult Social Care tended to exceed its budget because of demand increases, however Martin Cheeseman advised that the Care Quality Commission had rated Adult Social Care services as good, but amongst issues they had raised included the fact that the Council was not assessing customers quickly or effectively enough and not all services were provided quickly enough. Members noted that Day Centres were experiencing a fall in visitors. Martin Cheeseman then outlined areas that needed to be undertaken effectively, including for example:-
· Effective gate keeping at the earliest stage to ensure customers were promptly informed of whether they are entitled to a service or not
· Immediate service designed to promote independence and not long term support and such a measure would also reduce costs
· Significantly reduce numbers in residential and nursing care of which there was currently a high proportion partly due to transfer of care from Brent PCT
· Changing services and commissioning and reapplying eligibility criteria
Martin Cheeseman advised that a joint West London Adult Social Care procurement exercise could result in £450,000 savings for the Council in the first year of implementation and £900,000 in subsequent years. Members noted that the Council’s criteria, like most local authorities, for providing adult social care was whether a resident had been assessed as having substantial needs, however consideration could be given as to whether this was being correctly applied, including whether people with low or medium level needs actually received services, and whether to raise the required level to critical needs. A number of projects were being undertaken to improve services and these included projects on Re-ablement, Customer Journey, Direct Services Review, Transport, Commissioning West London, Aids and Equipment and Health. Members noted that it was estimated that personalisation would generate savings of £1.173 million. There was also consultation presently taking place in respect of users who visited Day Centres and changes to this service could result in savings of between £852,000 and £1.015 million.
During Members’ discussion, Councillor Van Kalwala enquired how the overspends in Adult Social Care had come about in view that spending had been on target six months before. He asked what the savings targets for 2010/11 were and would increased demand continue to be a factor and details of the Customer Journey project were also sought. Councillor A Choudry enquired whether the budget would have been on target had it not been for the exceptional circumstances that had resulted in the overspend. He commented that some factors were outside the Council’s control and he sought further information on where quantifiable savings could be made and further clarity in respect of savings that could be generated from a joint West London Adult Social Care procurement exercise. Councillor Mashari referred to the costs mentioned in the presentation in respect of dementia and she enquired how customers contacted the Council to access these services. She also asked if she could have a copy of the Quality Care Commission report.
In reply, Martin Cheeseman advised that the overspend was due to additional expenses not previously identified in the Adult Social Care and assumptions that were not entirely accurate with regard to resources from other areas, such as Brent PCT. He advised that £3.5 million savings needed to be made during 2010/11, however there were a number of pressures that would make this challenging, such as an increase in the number moving from Child to Adult Social Care and other demographic pressures such as more residents needing care as they grew older and lived longer. Such factors would increase demand, whilst there was also the possibility that the Council’s Budget would be further reduced following the announcement of the Comprehensive Spending Review. In respect of the Adult Social Care West London Procurement, it was estimated that the Homecare contract would generate £900,000 savings which may even increase subject to TUPE arrangements. With regard to the Residential and Nursing Homes contract, the six West London boroughs involved would have greater ability to negotiate a better agreement with the provider.
Alison Elliot (Assistant Director – Community Care, Housing and Community Care) added that increases in dependency also meant more support which would increase demand on services. She advised that two projects had been devised to generate savings, and the first, the Customer Journey project, aimed to achieve a more efficient and leaner customer service. The second project on Direct Services aimed to make clients more independent and through being less dependent on services and it was anticipated that this would generate around £1 million savings. In addition, clients would be assessed more quickly and prevent duplication of assessments and this would lead to a better service requiring less financial resources. With regard to dementia, Alison Elliot advised that the Council was working with the Health Sector in developing this service and improve integration with Health Sector organisations and GPs. Further updates in respect of this could be provided to the relevant overview and scrutiny committee. Members heard that it was a statutory obligation of local authorities to provide clients with access to personalisation and whilst the focus was on the individual and providing them with choice, professionals would retain responsibility in providing support to the client. Alison Elliot added that there was a need to be more creative to meet support needs and support individuals in creating their own care plan and cases would be reviewed on an annual basis. It was noted that the Care Quality Commission report was due to go the Executive either in December 2010 or January 2011.
Jacqueline Casson (Senior Policy Officer, Policy and Regeneration) advised that the Customer Journey project also sought to indentify and achieve savings through changing processes and the type of customer contact used.