Agenda item

To consider the attached report of the Director of Finance & Business Services / Strategic Director, Places & Organisational Capacity.

Prior to going through the Quarter 1 Finance and Performance report for Adult Social Care, the Officers from the Directorate provided some background information in order to contextualise the budget position.

Lorraine Butcher, the Strategic Director of Children, Families and Adults, noted that it had been well documented that the adult social care system, both nationally and locally was under considerable pressure. The recent White Paper ‘Caring for our future: reforming care and support’ (July 2012), demonstrated that the Government was aware of the need for change and reform and to some extent the White Paper also suggested how this reform would be achieved. Having said this, Lorraine Butcher explained that the changes proposed in the White Paper would take time to be implemented and in the meantime the Council was undertaking a number of steps to ensure that the budget was being managed correctly.

For instance, Lucia Scally, Head of Strategic Commissioning and Safeguarding, reported that the Directorate had recently invited a consultant to carry out an independent review of the Adult Social Care budget spend over the life of the Council. Part of this review had included bench marking the Council with other CIPFA (The Chartered Institute of Public Finance and Accountancy) comparator authorities in terms of the following:

·         Review of business plans and proposals to achieve financial sustainability for Adult Social Care

·         Review of fees to providers

The key conclusion from this review was that the prices that the Council paid for care and support were aligned to those in other authorities. However, the amount and type of care and support was greater when compared with the other CIPFA Councils e.g. use of nursing care. Additionally, Lucia Scally noted that the demographics of Cheshire East meant that the Council had to provide high cost individual support packages to deal with an increasingly older population. In summary, the Council had to address these pressures on the budget but in order to do so a change of approach was required. Lucia Scally explained such a change would require the Council to move away from a traditional approach of providing care for people to helping people to re-gain independence from care support, drawing on the existing assets in the local community and by continuing to support unpaid carers.

In light of this background, Dominic Oakeshott, Head of Business Management and Challenge presented the Quarter 1 Finance and Performance Review highlighting the following key points:

·         The Adults Service had a net budget of £98.6m with an emerging pressure on this budget identified at £11.4m.

·         The pressures on the budget were primarily from care costs, particularly for those customers with learning disabilities.

·         £7.3m of remedial measures had been identified which would reduce the net forecast position to an estimated £4.1m overspend.

·         That the service had been able to manage the demand for services which had resulted in limited growth in the number of new customers entering services. In part, this could be attributed to the enhanced use of re-ablement services.

It was queried why the Council had seen a consistent overspend in the Adults Service since Local Government Reorganisation and whether this was due to  the budget being set at an insufficient level. Dominic Oakeshott acknowledged that it had taken time to understand the unique nature of Cheshire East, particularly in terms of the amount of nursing home beds and returning self funders. He reported however that the Council now had a better understanding of the situation and good idea of what action was required. As part of gaining this understanding, the Council had taken steps to learn from other Councils on how to successfully reduce costs.

It was questioned whether, as part of the benchmarking process, the Council had compared how much sheltered accommodation was available against other authorities. Lucia Scally acknowledged that this hadn’t been done and that the service would explore performing such a comparison.

It was stated that it appeared in order to reduce the demand on services and to encourage people to remain independent for longer this would require a change of culture throughout the Council. Councillor Janet Clowes noted that work was ongoing with a range of Council services and partners in order to try and change cultures and attitudes to assist people to remain independent for longer. Providing a couple of examples, Councillor Janet Clowes drew attention to the dialogue that was occurring between officers from the Adults Service and those involved in developing the Local Plan. Additionally, the Council was working with hospitals in order to attempt to reduce the number of unnecessary discharges from hospital care into residential or nursing care. Lorraine Butcher added that the only Adults Service performance indicators that the Council had not met their targets on related to the number of hospital discharges into residential care. Cheshire West and Chester had the same issue and this therefore suggested that a long term cultural issue was behind this.

It was queried how the Council intended to enhance the use of re-ablement. Lucia Scally explained that at the current time, re-ablement services were only offered to customers at particular points in their care pathway. Moving forward, it was intended to embed re-ablement throughout all services.

It was asserted that unpaid carers were vital for managing the costs of social care. It was therefore queried whether the Council was making the requisite investment to support carers. Lucia Scally reassured the Committee that in the re-design of the Council’s Adult Services, Carers would have a key role in helping to deliver positive outcomes. The Council had produced a Carers’ Strategy to articulate how Carers would be supported in their role.

It was questioned how the Council would ensure that it was achieving value for money on its contracts with providers – both corporately and for individuals. Lucia Scally asserted that this was a whole system responsibility in which the Care Quality Commission (CQC), the Council and the individual would all have a role to play. Lucia Scally acknowledged however that the Council needed to get better at linking information together so that collective action could be taken.

It was queried whether the issue relating to returning self funders was unique to Cheshire East. Lucia Scally reported that this was not the case and other CIPFA comparator Councils had or were experiencing the same challenge. Lucia Scally noted that the Council was planning to speak to individuals and their families to understand why people had taken that particular care pathway.

RESOLVED:

a)    That the report be noted.

b)    That the Head of Strategic Commissioning and Safeguarding be requested to explore comparing the number of sheltered accommodation places in Cheshire East with Comparator CIPFA authorities.