To report on the current budget position in Adult Social Care and Strategic Housing.

The Committee considered a report on the current budget position in Adult Social Care and Strategic Housing.

The report stated that the projected outturn for adult social care was an overspend of £3.4 million.  Paragraph 3 of the report detailed the overspends on Learning Disabilities, Older People, Physical Disabilities, Mental Health and Service Strategy.  It noted the consideration given to the adult social care budget by Cabinet on 29th June and the variations to the forecast budget position.

Changes to the risk sharing aspects of the Section 31 Agreements with the Primary Care Trust for 2006/07 were also referred to in the report.  In the case of Mental Health this meant that any overspend relating to the Council’s proportion of the mental health service expenditure would not be funded by the Primary Care Trust (PCT) and the whole risk would fall to the Council.  In the case of the learning disabilities service the Council carried the full financial risk for the Council and PCT outturn position.

The Assistant County Treasurer commented that it was early in the financial year and drew attention to ongoing efforts to manage the overspend.  He reminded the Committee that the findings of the analysis of adult social care needs and services were expected by the end of the Summer.  Work to draw on the experience of high performing authorities was also continuing.  The focus was on the longer term and the introduction of preventative measures which would reduce demand for services.

The projected outturn for Strategic Housing was an overspend of £83,000 although it was noted that if demand for temporary accommodation increased this would create pressures.  Attention was drawn to the success of measures introduced to reduce the number of people presenting themselves as homeless.

In the ensuing discussion the following principal points were made:

·          The findings of a recent internal audit of budget management in social care were welcomed.  It was suggested that these findings demonstrated that the difficulties in the social care budget were not a result of poor financial management but were clearly a consequence of increasing demand for services.  Concern was expressed that there had been undue delay in reaching this conclusion and that the restrictions on services as a consequence had had a detrimental impact.  The position would not be remedied until priorities changed and resources for social care were added to the base budget.

      It was noted that in October 2005 the Committee had urged that there should be a careful reassessment of the budget with a view to establishing a realistic budget for 2006/7.  It was asked why at such an early stage in the 2006/7 financial year such a large overspend was projected.

            It was also asked whether the projected overspend assumed that the contingency for social care which had been created as part of the 2006/07 budget had been spent.

      The Director of Adult and Community Services replied that in 2005/6 Cabinet had felt itself to be faced with monthly reports showing ever-increasing overspends on the social care budget.  The view had been taken that a different approach was needed and the figures presented to the Committee were assessed to be the worst case scenario.  It remained the case, however, that the budget was volatile, with the potential for one service user with significant needs to incur significant expenditure.

            The projected overspend did not take account of the £1.3 million contingency sum for social care established by the Council in setting the 2006/7 budget, £1 million of which was nominally earmarked for adult social care with the remainder for Children’s Services.  Allowing for these resources and management action the expectation was that the projected overspend would be reduced to about £2 million.  In setting the budget for 2006/7 there had been an awareness of projected pressures but a balance had had to be struck by the Council given the constraints and pressures on the Council’s budget as a whole. 

·         A question was asked about the unit costs of services and the extent to which these were used as a basis of comparison with other authorities.  The Head of Adult Social Care confirmed that comparative unit costs were analysed. She reminded the Committee of the comparatively high unit costs in the County for the provision of services to people with a learning disability because of the disproportionate number of people in residential care.  She outlined some of the knock on effects on the Council’s finances because of the inability to claim certain benefits and the ineligibility for certain grants as a consequence.

·          A question was asked about the forecast trends for the areas of overspend set out in paragraph 3 of the report.  The Head of Adult Social Care replied that the Learning Disability budget was unpredictable.  It was sensitive to the needs of individuals, some of which were very complex, and the prospect of a number of older carers ceasing to be able to act as carers was another factor.  The overspend on the budget for older people could also increase given the demographic pressures within the County.  The overspend on physical disabilities could increase for the same reasons as expenditure on older people.  There was scope for change by reducing the amount of residential care and providing support in other ways.  The right type of housing was needed to support this change and a housing strategy was being developed.  In terms of mental health expenditure the proportion of people requiring care was increasing and the Council was working with the Primary Care Trust on the issues.  The overspend on Service Strategy was not expected to increase.

·          Concern was expressed about the consequences of setting thresholds for eligibility at too high a level.  It was suggested that providing services at a lower threshold might enable preventative measures to be taken which in addition to being preferable for the person needing care would also be more cost effective. 

      In reply the Head of Adult Social Care said that the Council was not alone in setting a threshold whereby only those with critical and substantial needs were eligible for care.  However, the need to move to an emphasis on preventative measures, reducing reliance on social care and encouraging greater independence was recognised.  The findings of the analysis of adult social care needs and services would inform consideration of the options open to the Council.

·          The success of the prevention team within the homelessness section and the creation of a specific fund to help to prevent people going into temporary accommodation was welcomed.

·          It was asked why there had been changes to the risk sharing aspects of the Section 31 Agreements with the PCT for 2006/7 for both Mental Health and Learning Disabilities, with what appeared to be an unfavourable outcome for the Council.

      The Director commented that the risk sharing agreement had been changed because the Council had not been able to meet the additional level of investment required for the PCT to take the full risk.  The social care contingency fund could be drawn on if necessary.  Some pressures had been identified but it was still possible that these could be met through efficiency savings by the PCT and further negotiation.

      The Cabinet Member (Social Care Adults and Health) said that she had pursued the matter during negotiations but unfortunately it had not proved possible to find the additional investment necessary.

      Concern was expressed at what appeared to be a short-sighted approach, increasing the financial risk to the Council, and it was requested that a briefing paper on the Section 31 arrangements be circulated to every member of the Committee.

·          In response to a question about the prospect of changes to the delivery of learning disability services generating savings in the current financial year the Director commented that whilst the majority of the expected savings would be achieved in future years it was expected that there would be some saving in the current year.

·          It was noted that Mrs P Turvey (Social Services Accountant ) who had dealt with social care finances for the Council and its predecessors for some 44 years had retired.  The Committee recorded its thanks for such long service.

RESOLVED:

That    (a)   the report on the Adult Social Care and Strategic Housing budget be noted whilst recording the Committee’s concerns and emphasising the Committee’s wish to keep the budget under continuing review;

               and

            (b)    a briefing paper on the rationale for the changes to the risk sharing agreements with the Primary Care Trust for Mental Health and Learning Disabilities services be circulated to Members of the Committee.