To seek the views of the adults and wellbeing scrutiny committee on the budget proposals for 2019/20 as they relate to the remit of the committee.

The draft budget for adults and communities was introduced by the Director Adults and Communities (DAC) and the Chief Finance Officer (CFO)

The DAC outlined the priority of the Adults and Communities directorate to establish a strengths based modelling approach to the provision of care services. The approach made an assessment of the need of clients of care services and sought to involve the local community and community-based organisations in the provision of care and support. The policy involved a reduction in cost but customer satisfaction with services had increased. It was explained that a number of existing care clients had been assessed under the old model of provision of care but were still in the system. A weakness in the previous framework and resulting assessments of care had caused a lack of autonomy for care clients and in some cases an over prescription of care packages. Targeted reviews were being undertaken to increase the level of independence to clients to ensure care packages were suitable to meet the level of need. The DAC provided details of the Community Development project to establish the support that existed in local communities and local initiatives which could be undertaken to enhance support.

During the debate the committee raised the comments outlined below:

·         It was queried what clients of care were required to provide for themselves before determining what would be included in a care plan. The DAC explained that the role of families was included in strength-based modelling and an assessment of community support. A holistic offer was made to the client including all suitable support within the local community; the role of the community broker was highlighted as an important feature of access to community support. It was explained that other local authorities were looking at the approach of the Council as a potential example for their provision of care services in the future.

·         The reviews of care packages were queried and the frequency of such reviews. The requirement for delicacy during reviews was highlighted in the communication of any reduction in the provision of care. The DAC confirmed that 80% of care plans were currently reviewed annually. The need for sensitivity during changes to care packages was acknowledged but it was important that over prescription in packages was addressed to avoid clients becoming dependent on a level of care that was not required. Under the strengths based model a reduction in the care package was mitigated by community support available.

·         In the event that a care package review resulted in an assessment of a requirement for an increase in the provision of care, the committee queried how reactive the service was to respond to this increase in need. The DAC acknowledged that an improvement to the speed of response was required which the Home First service sought to achieve.

·         The committee queried the number of self-funders for care and whether there was an increasing number that the Council would have to support financially as their level of assets decreased to below £23,000. The CFO confirmed that the number of self-funders was understood and the capacity that existed in the market place. Occasionally the council had to step in to meet the costs of an individual’s care needs but there was not felt to be a worrying trend in the level of self-funders. The DAC confirmed that the risk to the Council of self-funders reaching the threshold was continually assessed. Programmes, such as Home First, which focused on keeping people in their homes and out of residential care would help to reduce the costs of care to individuals and the Council.

·         The notion of co-housing of old people in bespoke communities was raised and the planning and construction of multi-generational homes. The DAC explained that a range of commissioning options were being considered including remaining at home or in a community of homes enabled by assistive technology. The use of new technology to enable people to remain in their homes was a priority and sought to build on the work of the faster shire project. The Cabinet Member Health and Wellbeing explained the range of adaptations that were installed in homes to support independent living.   

·         The use of assistive technology to support care, enable independence and promote mobility was raised by the committee and an interest in seeing a proposed strategy for technology enabled care was expressed.

·         The committee emphasised the importance of activities such as lunch clubs which should be included in plans for community development. The DAC acknowledged the importance of such community initiatives which helped to address issues of social isolation and loneliness.

·         The committee considered the allocation of section 106 (developer contributions) funding to support local community facilities for adult social care. The Deputy Solicitor to the Council confirmed that section 106 funding could be utilised for local facilities.

·         The funding from central government to address hospital admissions was raised and the extent of the problem in Herefordshire was queried. The provision of domiciliary services in rural areas was queried and the contribution made to avoiding admissions to hospital. The DAC explained that the delay of transfer of care was too high. Support for domiciliary services was required and Home First was supporting efforts to prevent admissions and facilitate transfer from hospital settings.

There was a brief adjournment at 10.55 a.m. The meeting reconvened at 10.58 a.m. and the committee continued the discussion as below:

·         The committee questioned care provision for vulnerable adults with significant care needs and sought assurances that the Hillside Centre project could be delivered and sustained in the long term. It was commented that the budget on a capital project such as the Hillside Centre could be subject to flex and overspending.  The DAC explained that in developing the proposal for the Hillside Centre the council had engaged an expert on running care homes, undertaken assessments on the deliverability of the scheme and had ensured the project was robust. The Cabinet Member Health and Wellbeing explained that the need for the centre had been established and it provided a facility into the future when demand for dementia facilities would increase significantly. The DAC explained that the development partner had assessed the figures associated with the cost of the project and a contingency had been built into the budget to address potential increases in cost.

·         The committee raised the public health grant and its importance to the council to support the prevention strategy. The CFO explained that the grant should be used to its utmost whilst it was available.

·         The committee queried the spend to save initiatives and how the proposals would be delivered. Details of how progress would be reported to committee was requested. The CFO explained that reporting of the progress of the spend to save changes would be provided to the committee which would be set against the savings proposals.

The statutory scrutiny officer presented a summary of recommendations emerging from the discussion regarding the draft budget which were approved by the committee.

RESOLVED: that

1.    The committee supported the proposed budget.

2.    The committee would like to see a strategy for investment in technology enabled care and a budget allocated to take this forward

3.    The committee would like to see a review of current commissioning of domiciliary care, especially in our more rural parts of the county

4.    The committee would like consideration given to a percentage of section 106 contributions being allocated for adult social care

5.    The committee would like to see the spend to save business cases and the timing of when financial savings will be delivered