To seek the views of the adults and wellbeing scrutiny committee on the budget proposals for 2020/21 as they relate to the remit of the committee and on the draft corporate plan.

The chairperson explained that the three scrutiny committees would be reviewing the budget and corporate plan proposals in sequence, with meetings scheduled in November 2019 and again in January 2020.  This agenda item sought views on the proposals as they related to the remit of the adults and wellbeing scrutiny committee and the committee would make recommendations to the general scrutiny committee; the general scrutiny committee would then submit final recommendations from the three scrutiny committees to cabinet.

 

The chief finance officer was invited to deliver the presentation ‘Budget 20/21 and corporate priorities (2020-2024)’.  The key points are summarised below.

 

a.         The committee had been supplied with an early version of the proposed budget, including draft capital investment business cases, to provide the opportunity to question and challenge the work in development.

 

b.         An overview was provided of the council’s ‘ambition for Herefordshire’, key themes, and public engagement activity.

 

c.         The net revenue budget 2020/21 had been informed by the government’s spending plans, announced in September 2019, but the local government settlement would not be confirmed until after the UK parliamentary general election.  Consequently, assumptions had to be made, such as the level of rural services delivery grant.

 

d.         The total net budget was £156m, with an assumed 4% increase in Council Tax.

 

e.         An overview was provided of the base budget, known pressures (including contract inflation, fee uplift, increment, and savings) and additional pressures (looked after children, social care pool, legal structure, edge of care, and improving social care services).  The base budget requirement of £154.8m reflected that the council could balance its budget without having to make additional savings.

 

f.          The adults and communities directorate was commended for delivering within its budget and for making the best use of resources.

 

g.         The base net budget requirement for the adults and communities directorate showed a savings requirement of £0.6m and it was expected that the savings would be delivered.  Pressures of £2.7m were identified, reflecting contract inflation and demographic pressures.

 

h.         An overview was provided of the 2020/21 assumptions, including 4% increase in Council Tax (2% general and 2% adults social care), anticipated continuation of Improved Better Care Fund (£5.7m) and Public Health grant (£9.2m) funding, and 200 additional new homes above assumed growth in new homes.

 

i.           A graph showed savings achieved of £93m from 2010/11 to 2019/20.

 

j.           The position with earmarked reserves was outlined.

 

k.         Till receipts, showing charges per month for an average Band D property, for 2019/20 and 2020/21 were displayed.

 

Questions were invited from committee members on the budget and corporate plan in general.

 

The chairperson commented on the following:

 

·                Tribute was paid to the efforts of the council’s directors and their departments in managing the budgets in challenging financial circumstances.

 

·                Inconsistencies were identified in the use of terminology which could be confusing for the public, e.g. rural sparsity delivery grant (agenda page 29) and rural services delivery grant (agenda page 69).

 

·                Clarification was sought about the creation of a social care pooled budget.  The chief finance officer explained that this reflected funding in the central government 2019 spending review and further detail was awaited.  The chairperson asked that members be updated on this and on other developments in due course.

 

·                Attention was drawn to the proposed budget for adults and wellbeing (agenda page 72) and it was questioned whether there was sufficient headroom for both contract inflation and increasing demographic pressures.

 

The director of adults and communities noted the challenges and said that the proposed budget would enable the council to enter into commissioning and contracting conversations with providers but, as in any demand led service, there was a certain degree of unpredictability in terms of the numbers of people entering the system and the complexities of their needs.  It was anticipated that the demands could be met through a combination of setting the budget at the right rate and improvements within service delivery.  The vice-chairperson suggested that it would be helpful to include appropriate narratives on how the pressures were being managed, along with relevant cost benefit analyses.

 

Officers responded to questions from committee members, the key points included:

 

1.         The head of care commissioning explained that negotiations were underway with domiciliary and home based care providers.  An overview was provided of the workforce pressures and the need for appropriate inflationary uplift to ensure the sustainability and growth of local provision.  The director of adults and communities commented on the importance of the ongoing work to keep people well, to promote independence, and engage with communities in order to manage the demands in the most cost effective way possible.

 

2.         Following comments made by a committee member about the need to tackle loneliness and the potential for ‘community wheels’ to help people in rural areas connect with daily activities.  The director for adults and communities advised that there were no current proposals to invest in that particular scheme and commented on the investments in Talk Community hubs, and in the proposed super-hubs.  The acting director for economy and place reported that a number of public transport related elements were likely to be considered by the general scrutiny committee.  Another committee member commented on the potential for ‘good neighbour’ schemes to increase access to services and enhance social interaction.

 

3.         It was noted that the proposed 4% total increase in council tax was above the rate of inflation and it was questioned what other levels and models had been considered.   The chief finance officer reported that the Medium Term Financial Strategy, agreed by Council in February 2019, had assumed a 4.5% increase and the 4% was based on the advice from government, as part of the provisional settlement announced in September 2019.  No other modelling had been undertaken but other scenarios could be modelled should that be the wish of Council.

 

4.         Clarification was sought about paragraph 15 of the covering report (agenda page 20) and the savings requirement for adults and communities for 2020/21 of £0.6m.  The director for adults and communities explained how the principles set out within the Care Act were being delivered and care needs were being met but in a different way to traditional models of formal care, with the strengths based approach enabling people to maintain their independence for longer.  He added that the Herefordshire approach was increasingly recognised as a model of good practice in improving outcomes and reducing costs.  In response to a further question from the chairperson, the director reported that, by investing in additional resources earlier to address target areas of practice, the savings requirement was on course to be achieved.

 

5.         With reference made to the proposed budget till receipt (agenda page 31), the director for adults and communities outlined the ring-fenced grant for health improvement and how public health commissioned related services.  The director acknowledged that there had been varying degrees of success in the approaches taken to date, including the target for health checks, and work was being undertaken to secure improvements.

 

The chief finance officer continued with the presentation, with input from other attending officers.  The key points are summarised below.

 

Public housing

 

A.        An earmarked reserve had been created (£150k) to fund the investigation of different models of delivering council housing which could lead to investing up to £100m in housing in the four years from 2022/23.  It was anticipated that the income streams generated would cover the revenue costs of providing the housing, including any borrowing costs.

 

B.        It was reported that the treasury management strategy would need to be amended by Council; a training session was being arranged for members for January 2020.

 

C.        The acting director for economy and place said that this initiative highlighted the intention to address some of the challenges around housing delivery.  Attention was also drawn to the outline business case for ‘Bringing empty properties back into use’ (agenda page 47).

 

Assistive technology

 

D.        An investment of £2m was proposed to enhance the use of technology enabled living, both within the home and within communities to support wellbeing.

 

E.        The director for adults and communities commented on the importance of moving from reactive support to ‘upstream’ proactive support, utilising the potential of mobile and wearable devices.  The capital investment, supported by revenue for related services, would help with preparations for the national move from analogue to digital technologies, and would provide an opportunity for Herefordshire to take a leading role in helping people to maintain high levels of independence.

 

Super-hubs

 

F.         Attention was drawn to the outline business case that had been circulated in a supplement to the agenda.

 

G.        The head of community commissioning and resources explained that the super-hub concept differed to the Talk Community hubs, in that it would involve creating new community facilities in areas of higher need and inequality for a wider range of purposes, including public services, social and commercial enterprises, and for alternative/community transport.  It was reported that work was being undertaken to explore models of delivery and potential locations.

 

Multi-bedded care home and/or extra care facility

 

H.        An investment of up to £14m for the development of a large multi-bedded care home and/or extra care facility was in the early stages of being scoped.

 

I.          The assistant director all ages commissioning provided an overview of the challenges in the local care market, including: the size and fitness for purpose of some properties; the imminent retirement of some owners; the difficulties in placing some residents with the most complex care needs; and the high proportion of self funders.

 

J.         It was reported that this would be a decisive market intervention to increase local authority controlled bed capacity and support complex care needs, as well as providing opportunities for strengths-based and all ages approaches.  The committee was advised that other authorities were exploring similar solutions to address perceived issues in their local care sectors.

 

The chairperson invited attending cabinet members to comment on the budget and corporate plan proposals.  The main points are summarised below.

 

§    The leader of the council (and cabinet member corporate strategy and budget) drew attention to the three pillars of the corporate plan ‘community, economy, environment’.  It was noted that promoting healthy life choices and encouraging independence not only improved outcomes for people but also helped to manage the demands on council and NHS services.  Responding to a point made earlier in the meeting (point 3. above), the leader of the council acknowledged the need to review the proposed 4% total increase in council tax to ensure that it was appropriate.

 

§    The cabinet member finance and corporate services made a number of points, including: the attending officers and their teams were thanked for the hard work on the budget, for delivering savings, and for developing the capital investment proposals; the revised budgeting process provided the scrutiny committee with an opportunity to influence and contribute to the plans; the administration would continue to be prudent in managing the council’s resources, whilst creating resilience for the future and providing choices for the evolving needs of the community; the budget consultation and engagement process was outlined; it was emphasised that the increase in council tax comprised 2% for adults social care and 2% for everything else; recent inflation figures were noted and it was commented that the council had to plan pragmatically, especially given some of the uncertainties at a national level; recognising the connectivity between the directorates and budget areas, e.g. transport for communities, councillors and the public were encouraged to engage with the other scrutiny committees; there would be a shift in service delivery to a family centred approach, looking across the full age range; an investment in public housing of up to £100m could deliver around 1,000 homes to help address local need; the capital receipts generated by the sale of publicly owned smallholdings could be used to invest in assets of use and relevance to a wider section of the community and, in turn, generate new revenue funding streams; the proposal for a multi-bedded care home and/or extra care facility was a response to the fact that the market was not delivering the mix of care needed to service demand, it would provide better choice for residents, and it would help the council control costs; and committee members were urged to test the executive on the details of the business model to ensure that it could be delivered and that risks were mitigated.

 

§    The cabinet member health and wellbeing said that, despite the ongoing challenges, the adults and communities directorate was performing well and the degree of forward thinking and planning was encouraging.

 

The chairperson asked questions and made comments on the following:

 

o      Attention was drawn to appendix 4 (agenda page 33) and clarification was sought about the figure of £919k for ‘carehome and extra care development’ under ‘current capital programme’.  Later in the meeting, the director for adults and wellbeing reported that this figure related to an extension at Waverley House which did not proceed.

 

o      Clarification was also sought about the figure of £1.5m of ‘redirected funding’ for ‘technology enabled communities’.  The director for adults and communities provided an overview of the savings achieved during 2019/20.

 

o      It was acknowledged that the outline business cases were early iterations and that comments put forward were intended to inform the next iterations.

 

o      Further detail was sought on the assertion, in paragraph 24 of the covering report (agenda page 21), that ‘Latest assessment indicates a shortfall of around 4,000 social and affordable homes…’.  The cabinet member finance and corporate services explained that this was based on the strategic housing needs assessment, which formed part of the evidence based for the core strategy, and there was still a significant shortfall against demand; the review of the core strategy would revisit some of the evidence based assessments.

 

o      The chairperson suggested that an options appraisal for market intervention should be in scope.  In response to a comment about the need for risk analysis, the cabinet member finance and corporate services advised that some funding had been drawn down from reserves to undertake studies during this financial year to understand the different models of housing being evolved and operated by other councils in order to learn from them and avoid any problems that they had encountered.  The cabinet member recognised that policy adjustments could bring forward more affordable housing created by the market but the executive was also looking to find long term income streams for the council, using released capital from smallholdings to invest in new homes; it was commented that community land trusts could also bring forward small scale schemes.

 

o      It was noted that references had been made to using released capital from smallholdings but also to borrowing and clarity was sought on the likely combination.  The chief finance officer acknowledged that this was a valid point which would need to be addressed in the next iteration.

 

o      In response to a question, the acting director for economy and place advised that the outline business case for ‘bringing empty properties back into use’ identified costs of £0.8m over three years (agenda page 54) and reported that the earmarked reserve of £150k to fund the investigation of different models of delivering council housing had been agreed by cabinet at its last meeting (minute 100 of 24 October 2019 refers).  The chairperson suggested that this be clarified in terms of the proposed areas for investment slide (agenda page 79).

 

Questions and comments were invited from committee members on the capital investment budget proposals.

 

1)         A committee member commented on the need for clarity around language (e.g. council / social / public housing had been used variously) and for definitions of terms (such as ‘affordable housing’ and ‘Talk Community’) which could be understood by the general public.

 

Housing

 

2)         A committee member welcomed initiatives to bring empty properties back into use and for the redevelopment of brownfield sites for housing but, noting the reasons for stock transfers to housing associations in the past, commented on the need to explore future management arrangements for council housing and the implications in terms of ‘right to buy’.  It was also commented that housing associations needed to be encouraged to take on affordable housing in smaller developments.

 

3)         The vice-chairperson: questioned whether the proposals for empty properties would, in addition to providing grants, seek to secure some influence over the houses that were brought back into use; identified that ‘build our own sustainable council houses’ was the third highest priority identified by residents during the consultation; and, noting the challenges of finding appropriate land which was distributed appropriately, questioned whether the council would be partnering with a developer or looking to utilise as much of its own land as possible.

 

4)         The leader of the council said that the executive was mindful of potential risks but there was a need to deliver housing which the market was not providing currently, for the benefit of the community.

 

5)         The chairperson noted that the main body of the report did not reference bringing empty properties back into use, although an outline business case was provided as an attachment.  The chairperson suggested that a more detailed report could include: context in terms of the legal action that had been undertaken; the options available to achieve the desired outcomes; and clarification on what ‘long term’ meant in the sentence ‘286 Long term empty property as of September 2019’ (agenda page 51).  The chairperson commented that properties that had been empty for the longest might not be the priority necessarily, as these could cost the most to bring back into use, and there could be a more pressing need to target properties which had a community impact.

 

In response to questions from the chairperson, the cabinet member finance and corporate services confirmed that there would be a range of responses to different circumstances, and outlined the measures and inducements available to bring empty properties back into use.

 

6)         The chairperson suggested that it would be helpful if there was robust evidencing in terms of the 286 figure and the number of complaints received by the Environmental Health team.  It was acknowledged that there were social value benefits in all the suggestions but value for money for tax payers also had to be considered.  The chairperson also suggested that conditional use of renewables and appropriate design standards be included in scope.

 

7)         A committee member suggested that the efforts of the council to bring empty properties back into use should be communicated to the public.

 

8)         Another committee member welcomed the initiative but noted the potential for complications which could be expensive and time consuming.

 

9)         The acting director of economy and place recognised that the details of the scheme would be important and said that it was intended that there would be measures to improve the environmental performance of the buildings but also to help reduce heat poverty.

 

Assistive technology

 

10)      The chairperson considered the role of technology to support communities was inevitable but noted potential challenges in terms of data protection, cross system and cross border compatibility, and maintaining human connections, particularly in terms of blue light and other responders.

 

In response, the director for adults and communities: commented on the potential to collaborate with online retailers and technology companies in the development of assistive technologies; recognised that the work needed on data sharing arrangements should not be underestimated but said that progress was being made in the health and social care system; and acknowledged the importance of connectivity, not only to respond to situations, such as falls, but also to monitor vital statistics in order to pre-empt potential incidents.  The director also commented on the potential of the ‘Barcelona model’ of using assistive technology to not only monitor and respond but also to support and communicate with service users, with wider benefits in terms of the use of resources and innovation in the local economy.

 

11)      A committee member noted that some individuals did not want to use certain devices.

 

The director for adults and communities commented on developments in terms of wearable and other monitoring devices which could help to manage conditions and behaviours.

 

The leader of the council acknowledged that people could not be coerced into using certain devices but people were increasingly becoming acquainted with connected technologies in the home.

 

12)      A committee member commented on the importance of broadband connectivity and mobile signal reliability to support the spread of assistive technologies. 

The director for adults and communities outlined ongoing efforts to address infrastructure issues and the potential of other data networks to support service users.

 

13)      The vice-chairperson suggested that clarification was needed on: how the technology investment in terms of the adults and communities directorate related to the wider digital transformation, infrastructure and knowledge management proposals; the costs of replacing analogue equipment, such pendant alarms, with new digital technologies; and for a breakdown of the reasons why ‘56% of Herefordshire’s telecare users do not use the internet at home (2019 survey)’ (agenda page 39).

 

The director of adults and communities welcomed the points raised and commented on the importance of investment in proactive systems to support the health and wellbeing of the population and to mitigate long term risks.

 

14)      The cabinet member finance and corporate services said that assistive technology would be part of a suite of tools to address people’s needs, further details would be provided as part of the next stage of the budget process, and detailed business cases would be developed and reviewed prior to monies being spent.

 

Super-hubs

 

15)      In response to a question from the chairperson, the cabinet member finance and corporate services said that Talk Community hubs and super-hubs would be different according to the identified needs of the communities in which they were situated.

 

16)      A committee member questioned whether £2m was sufficient to deliver this project given the aims and objectives.

 

The director for adults and communities recognised the need for a strong business case, with the spend profile and benefits to the community clearly mapped out.  He added that various factors, including location, would determine whether one or two could be delivered.

 

The leader of the council commented on the potential to convert existing buildings and on the need to ensure that proper value was provided.

 

17)      The vice-chairperson: commented on the need for clarity in the narrative about different hub types; questioned the extent to which the proposals were being developed alongside partners in the health and social care system; and welcomed the potential growth in social enterprise and wider businesses.

 

18)      A committee member supported the proposal but cautioned that super-hubs should not duplicate or overlap with existing community facilities or activities to an unhelpful or counter-productive extent.

 

19)      Another committee member commented on the need to involve mental health providers.

 

20)      In response to questions raised, the head of community commissioning and resources: reported that work had been undertaken and was in progress to develop the proposals with NHS and other partners; there would be ongoing engagement and consultation with communities to understand their aspirations, unmet needs, and what could be achieved; acknowledged that the terminology and branding of the different concepts had to be coherent and descriptive; said that it was not the intention to replace or impose controls over existing community facilities but to complement them; outlined the potential to co-locate public services and utilise existing land assets, through conversion or new build; and emphasised that the proposals would be developed in detail before spending was committed.

 

Multi-bedded care home and/or extra care facility

 

21)      The chairperson suggested that more detail was needed in terms of revenue, projected needs analysis and modelling, potential impact on market conditions, bed numbers, and management arrangements.  Whilst noting the potential benefits of a centralised offer, there was a tension with the dispersed nature of the county which needed to be considered.

 

22)      A committee member considered that, in view of the changing demographics, such investment was necessary both to generate income and to reduce spend on placements.

 

23)      In terms of evidence base, the director for adults and communities reported that a new market position assessment was in development which would reflect the current landscape and future demand; this would be supported by an accommodation needs assessment for the population as a whole.  It was acknowledged that the location and implications of a centralised facility would need careful consideration.

 

The assistant director all ages commissioning commented on: the challenges of achieving economies of scale; the limitations of traditional care homes and the changing market conditions; the different models that could be considered and the implications in terms of revenue; the need to help people to remain independent for longer; and the importance of having a sustainable inventory of facilities.

 

24)      The chairperson also suggested that it would be helpful to understand the contract pressures in this context, the relationship to the Hillside development under ‘constraints and dependencies’ (agenda page 62), and for analysis on how the two business cases, taking control of pressures in the market and achieving a revenue stream, could be delivered within one property.

 

The cabinet member finance and corporate services acknowledged the need for appropriate modelling and analysis, and commented that every bed would generate a revenue stream which would contribute towards the operation of the facility.

 

The chairperson thanked the attending cabinet members and officers for their contributions and adjourned the meeting for a short time to provide an opportunity for the formulation of recommendations.

 

Following the adjournment, the following recommendations were agreed by the committee.

 

Resolved to recommend to the general scrutiny committee:

 

1.         the adults and wellbeing scrutiny committee welcomes the proposed areas for investment which support prevention and the strengths based agenda;

 

2.         acknowledging that the lack of specific details in the outline business cases was due to the timing constraints and early sight of potential projects coming forward, the committee would be pleased if attention can be given to the matters it has raised and for deeper levels of detail to be provided in the next iterations of the business cases; and

 

3.         that terminology and language be used consistently, using Plain English.