Agenda item
Adult Social Care budget issues
The Director of Adult Social Services will attend the meeting to provide a presentation for Members on current budget issues facing this service.
Minutes:
Alison Elliott (Director of Adult Social Services) gave a financial overview of the adult social services budget by means of a Powerpoint presentation. She began by showing the savings target for adult social services of £9.8M plus a target to reduce the £1.2M overspend from 2010/11 which together amounted to 12% of the adult social services budget. She outlined the current financial position and organisation of the service. Alison Elliott explained where the key savings were being found - in commissioning to get the best service for the best price possible, in mental health by redesigning the community network scheme, adopting a more effective placement strategy and redesigning support worker roles, through direct services by providing more community support through the personalisation of services and the customer journey with the redesign of adult social services and staffing levels so that a better service was provided at a more efficient and cheaper level. This approach would include enhancement of the reablement service which provided short term intensive support designed to allow people to live more independently in the longer term. Alison Elliott drew attention to the pressures on the budget and the actions being taken to deal with these. She referred to the historical problem of overspending and the continued risks to the budget. It was a demand led service with access to the service currently set at substantial and critical with no plans to change this. The service was dealing an aging population and Brent had an increasing number of children moving into adulthood. With a reducing budget it was not possible to continue to provide services as in the past. The less challenging issues had been tackled and it was now necessary to consider more radical ways of delivering services. Discussions were taking place with counterparts in the Health Service over how services could be commissioned more efficiently between the two services in order to meet demands but at less cost. Alison Elliot finished by saying progress had been good with a current projected overspend of £498,000 and she expressed confidence that the savings target would be met.
In answer to a question, Alison Elliott replied that 17½ was the age at which responsibility for dealing with the person was transferred from the Children and Families department to the Adult Social Care department but the funding to support that person was transferred upon them reaching 19 years age. She felt this was too late and that her service needed to be closer involved with the child at 14 years old. This was being considered. Alison Elliot also explained that in the past there had not been stringent enough tests carried out to ensure someone being supported by the Council was in fact a Brent resident. When it came to light that a person was properly the responsibility of another borough, that borough was given six weeks notice that responsibility would be passed over to it. In such cases, it was very difficult to recover past costs but efforts were made to do this.
In addressing the question as to how demand could be managed, Alison Elliott explained that the early results from the reablement service appeared to show that longer term costs could be controlled but that a longer assessment of this was needed. Also, if discussions with counterparts in the Health Service did not result in agreement on more efficient procurement then further consideration would have to be given on how savings could be made internally. The relationship with the voluntary sector was also being looked at and work was being carried out at a West London level.
In answer to a question around how the future transfer to the Council of responsibility for public health was being managed, Alison Elliott explained that there was a One Council project dealing with this but the details were still not clear. Clive Heaphy (Director of Finance and Corporate Services) added that there was no agreed definition of what constituted public health and different interpretations were being put on it. It was likely the Council would get around £25M to take on this function but whether this would be sufficient could not currently be validated. The Council viewed the public health function to be a largely preventative service, whereas up to now the Health Service had treated it as a medical function.
Members of the committee discussed how the level of need was assessed and the point at which the Council intervened in relation to when later more expensive care was needed. Concern was expressed over how the money allocated for care packages was monitored to ensure it was spent as intended. Whilst it was recognised that direct payments to clients offered them more freedom and choice, it also led to more financial risk. It was explained that advice was given to all those seeking support as to how they might access other services and that there were a number of checking mechanisms in place to ensure the money allocated was properly spent. One such mechanism that was proving effective was the issue of pre-paid cash cards which allowed for easier and more effective monitoring of how the money was being spent. It was hoped to expand the use of these cards. Clive Heaphy added that government proposals to pay people their benefit entitlement direct into their bank accounts from which they might choose not to use it for the purpose it was paid was a big issue that would need to be addressed.
It was explained to the committee that around 40-45% of the savings target had already been banked and the risks to achieving the other 55-60% had been identified and were being addressed. Part of the savings was being achieved by putting a freeze on recruitment. Attempts were being made to complete a risk assessment on this but the necessary management information was not currently available from the North West London Hospitals Trust. It was hoped that further discussions would elicit this.
A question was asked as to what proportion of the direct services budget the £750,000 savings being taken from it was. An undertaking was given to supply members of the committee with this information together with feedback on the outcome of the discussions taking place with the North West London Hospitals Trust.
The Chair thanked Alison Elliott and Altin Bozhani (Finance Officer) for attending the meeting.
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