PART 1
(OPEN TO THE
PUBLIC)
ITEM NO. 5
REPORT OF THE LEAD MEMBER FOR ADULT SOCIAL CARE
TO THE BUDGET SCRUTINY MEETING ON 3rd OCTOBER 2007
TITLE:
Adult Social Care Budget Pressures
RECOMMENDATIONS:
It is recommended that Members:
(i)
Consider the contents of this report and be aware of the budget issues
affecting adult social care.
EXECUTIVE SUMMARY:
This report details the pressures and financial strategy for the Community, Health
and Social Care Directorate for 2007/08 in relation to Adult Social Care.
The Adult Social Services service has successfully remained within budget for the
last 6 years to 2006/07, contrary to the experience of other Authorities. This is
largely due to:
a) Focussing activity on re-enablement, which prevents potential long term care
commitments
b) A successful efficiency programme to create resources to re-invest to meet
growing demand
c) The pooled budget arrangements which have allowed joint planning of
resources between Salford Primary Care Trust and Salford City Council.
d) The flexibility of carrying underspend resources forward as part of the pooled
budget arrangements
There are pressures emerging for 2007/08 of approximately £500,000 for Learning
Difficulties, which can be met from pooled budget reserves. However, the pressure
for 2008/09 is estimated at £1.275m above current resource levels. These
projections will be considered as part of the budget setting process for 2008/09.
Demographic demand pressures in adult/older people services, are creating
pressures, which are materialising in the Direct Payments budget area for
2007/08. These are currently being offset by the home care re-enablement service
reducing the potential demand for long term home care.
The Directorate has mechanisms in place to manage expenditure, but the ability
to fully absorb the pressures will be subject significantly to demographic changes
– the number of people requiring support and the cost of individual packages of
support to meet needs.
The budget will be monitored closely during the remainder of 2007/08.
BACKGROUND DOCUMENTS:
(Available for public inspection)
Budgetary control reports 2007/08
Learning Difficulties 2006/07 Outturn report
ASSESSMENT OF RISK:
Medium – Actions are in place to mitigate cost pressures, but subject to
demographic demand pressures
SOURCE OF FUNDING:
Revenue Budget for Community, Health and Social Care
LEGAL ADVICE OBTAINED:
Not applicable for this overview report
FINANCIAL ADVICE OBTAINED:
Accountancy group for Community, Health and Social Care – Jon Higson
CONTACT OFFICERS:
Keith Darragh, Assistant Director, Resources
Tel. 793 3225
WARD(S) TO WHICH REPORT RELATE(S)
All
KEY COUNCIL POLICIES:
All
DETAIL:
1.
Purpose of Report
The Budget Scrutiny Committee requested a report on the pressures
facing Adult Social Care services within the Community, Health and Social
Care Directorate, to increase understanding of the potential overall impact
on financial resources and to assist with future financial planning.
The report was requested in the light of national pressures on social care
budgets and the volatility of Adult social care expenditure caused by
increasing demand and complexity of care, leading to higher care costs
and overall expenditure.
2.
Background - Adult Social Care Service Objectives
2.1
The Government’s latest White paper for Health and Social Care, “Our
Health, Our Care, Our Say” (2006), defines Adult Social Care as:
“The wide range of services designed to support people to maintain their
independence, enable them to play a fuller part in society, protect them in
vulnerable situations and manage complex relationships”
2.2
The range of services commissioned by the Community, Health and
Social Services Directorate in Salford has the primary aim of maintaining
people’s independence and maximising life chances, by providing
appropriate and proportionate social care support to vulnerable people.
2.3
Salford’s strategic commissioning approach recognises that there are
broadly two strands needed to meet the growing demands for service
which result from an ageing population and people with multiple and
complex disabilities:


Prevention
Modernising Services and developing alternative approaches to
support individuals.
2.4
The prevention strategy seeks to delay people needing more intensive
support by either re-enabling people or linking them to universal services
to create opportunities to slow down any deterioration in their general
wellbeing. An effective range of preventive services helps to manage the
demand for services now and in the future.
2.5
Salford’s continuous programme of developing modern, fit for purpose
services, seeks to commission services that are:





the right services, at the right time, at the right quality
valued by service users and meeting their needs
flexible and adaptable to change
meet expectations and standards expected by users
deliver on objectives of national and local policy.
3.
Salford Adult Social Care – Service and Financial Performance
3.1
The Commission for Social Care Inspection (CSCI) measures the
performance of Local Authority Adult Social Care services across the
Country and awards a performance score annually.
3.2
Since 2005 Salford Adult Social Care services has achieved the highest
performance rating achievable. The current rating is:

3 Star Performance level
(highest rating of 3 star – 0 Star)
 Serving people well = Yes
(highest rating of Yes, Most, Some, No)
 Capacity to improve = Excellent
(highest rating of Excellent, Promising, Uncertain, Poor)
3.3
As part of the overall assessment CSCI use a range of specific
measurable indicators indicating levels of performance. Salford has
achieved the top performance banding (level 5) in the following categories
3.3.1 Helping people to live at home – remaining in their own home /
tenancy:




People with Physical Disabilities
People with Learning Difficulties
People with Mental Health Problems
Older people (65+)
3.3.2 Intensive Home care support – helping people to live longer in
their own homes with intensive social care support, often working
jointly with NHS partners who provide community nursing support.
3.3.3 Waiting times for packages of care following assessment –
providing services to people who need them in a timely manner.
3.4
Alongside the excellent service performance rating, the Adult Social
Services Division within Community, Health and Social Care has
contained expenditure within budget resource for the last 6 financial years
to 2006/07. This is a very good and sustained financial performance,
which is not representative of Adult Social Services across the Country. A
number of Authorities have experienced overspends against budgets in
recent years, particularly for the Learning Difficulty service.
4.
Pressures in Adult Social Care - Strategic Context
4.1
The Wanless review of future demand for older people social care
identified that national expenditure on older people would grow from
£10.1billion in 2002 to £24billion by 2026 – an increase of 137% if current
services are projected forward. This indicated that the pressures in Adult
Social Care are a shared national issue which will remain for a very long
time.
4.2
Demand for services is rising in the main due to underlying demographic
issues:





An ageing population – resulting in people becoming frailer and
then needing support with everyday personal care
Increasing numbers and intensity of adults/older people with
disabilities – resulting in people living longer with higher community
based support needed from the NHS and Social Care.
Rising numbers of people with long term conditions
Rising numbers of young people with multiple disabilities moving
through from Children’s services
Adults with Learning Difficulties living into old age but with
associated disabilities
4.3
In addition to underlying demand pressures on the number and intensity of
service users needs, rising public expectations is a strong factor in the
range of services we commission for Salford people for the future. This
coupled with the personalisation agenda for social care services places
further pressure to balance highly individualised services with services
which can be purchased efficiently.
4.4
In Salford a large proportion of services are procured from the
independent sector. All long term residential services and long term home
care services are purchased from independent, private and voluntary
sector providers. Salford City Council’s in-house provision has been
configured to focus on specialised respite and home care re-enablement
services.
4.5
Managing the market to provide good quality, adaptable services at an
affordable price is an important element in the overall commissioning and
procurement cycle. Each year the Local Authority considers the rates paid
to the independent, private and voluntary sector for the services they
provide. The rates set must secure the range of services required, in
sufficient quantities, to meet the statutory responsibility of social care, but
within available resources.
4.6
Providers have told us that pay levels for care are at the lower end of pay
levels generally, so there is a disproportionate impact of changes to their
workforce costs when national minimum wages and holiday entitlement
are introduced. National improvements in employment conditions
therefore have to be taken into account when negotiating with providers in
Salford.
5.
Budget Setting 2007/08
5.1
The budget for Community, Health and Social Care for 2007/08 was set
with the following resource constraints:


A £1.2m efficiency target
£1m unfunded pressures within Learning difficulties arising from a
reduction in Supporting People grant £0.4m and additional
estimated costs of young people transferring from Children’s
disability services to the Adult Learning Difficulty service £0.6m
5.2
The Directorate has set a programme of change to achieve the efficiency
target of £1.2m, which is being implemented around e-procurement for
home care services, transport efficiencies, staffing (reducing overtime,
agency and recruitment costs), maximising income and reconfiguring
home care re-enablement services.
5.3
The Learning Difficulty service identified a range of actions to reconfigure
services to generate efficiency savings to offset the £1m budget
pressures. These are shown below



Closing internal properties and re-commissioning services in the
independent sector
Reviewing core packages of people supported
Bringing people back from out of borough places and specialist
placements to local provision within Salford
5.4
Additional resources were allocated to the Directorate to meet identified
growth in demand which materialised in the Direct Payments (£0.4m) and
Residential accommodation (£0.2m) budget areas during 2006/07.
6.
Budget Projections 2007/08
6.1
Budgetary control forecasts for 2007/08 for Adult Social Care (based on
budget monitoring to the end of August 2007) indicate current financial
pressures in:
6.1.1 Learning Difficulty services - £500,000
6.1.2 Adult / Older people services – overall lower expenditure on long
term home care has offset growing pressures on Direct Payments
6.2
The Learning Difficulty services £500,000 budget pressure for 2007/08 can be
met from accumulated previous years surplus, within the pooled budget
arrangements with the Primary Care Trust. However, this will leave an
unfunded ongoing pressure of £500,000 going into 2008/09, before any
new/additional pressures from growing demand / reductions in Supporting
People are taken into account.
So overall it is expected that the Adult Social Care expenditure can be
kept within the resources allocated for 2007/08.
7.
Budget Pressures 2008/09
7.1
Currently the main budget pressure which will impact on the 2008/09
budget is the Learning Difficulty service. The main drivers for the budget
pressures within Learning Difficulties are:
7.1.1 people with Learning Difficulties living longer – resulting in higher
full life costs
7.1.2 sustained growth in numbers of people with Learning Difficulties
entering the service over the next 10-15 years
7.1.3 better medical interventions means that people are surviving with
greater support needs. Individual support costs can be as high as
£250, 000 a year for the most complex needs
7.2
The Learning Difficulty service will show the greatest short term financial
pressure in the 2008/09 budget setting process with a total of £1.275m.
This is made up of the following elements




Projected pressure from additional cost of placements / reduced
supporting people income in 2007/08 - £500,000
2008/09 full year effect of placement costs of people placed for part
year in 2007/08 £400,000
2008/09 part year effect of new people entering services for the first
time in 2008/09 £175,000
Potential reduction in supporting people funding to joint tenancy
schemes in 2008/09 £200,000
7.3
The costs for young people coming into the service in 2008/09 are
estimated, pending an assessment of their need by the Learning Difficulty
service. Also, family support arrangements for young adults may change
resulting in a need for re-assessments and re-calculation of costs.
8.
Learning Difficulty Strategy to Manage Budget Pressures
8.1
The strategy to manage budget pressures for the Learning Difficulty
service is based on good service planning supported by three key
elements:
8.1.1 Pooled budget partnership
8.1.2 Governance arrangements of the pooled budget
8.1.3 Learning Difficulty service efficiency programme
8.2
The Learning Difficulty service is managed as part of a pooled budget
partnership with Salford Primary Care Trust. This has provided the benefit
of joint financial planning and single management structure for health and
social care needs of people with Learning Difficulties.
8.3
The pooled budget partnership also provides for a single management
structure and governance though the Partnership Board. This has
facilitated financial planning for Health and Social Care under a single
process, with joint responsibility for managing the budget.
8.4
The Learning Difficulty efficiency programme has been actively managed
over the last 5 years to generate savings to meet increased cost forecasts
from demographic changes. The plan has centred around the following
actions:
8.4.1 Review of home care contract with independent advocacy services
and negotiating reductions in level of payments;
8.4.2 Reductions in agency and overtime working within supported
tenancy network to reduce salary and wage costs;
8.4.3 Reorganise and rationalise tenancy network to reduce vacancies
for service user tenancies;
8.4.4 Assess and review people in out of borough placements and to
bring back to Salford, reducing overall care costs,
8.4.5 Increase income from independent living fund claims and
8.4.6 Review support needs of tenants to ensure support is meeting
personal care only.
8.5
As part of the pooled budget arrangements the Learning Difficulty service
is allowed to carry forward underspends. The accumulated balance
estimated to be available for 2008/09 is £450,000
9.
Adults/Older People Budget Pressures
9.1
The main drivers for the emerging budget pressures within Adults/Older
People Services are:
9.1.1 more people being supported at home with more complex needs;
9.1.2 faster discharge from hospitals with higher initial care needs
9.2
The demand for other adults and older people services is increasing in line
with local and national trends. However, the additional demand has been
offset by the pro-active work of the re-enablement team which has reenabled people and therefore diverted people from being dependent on
long term care services – in 2006/07 this has been calculated to have
been a £1.2m efficiency saving.
10.
Adults/Older People Strategy to manage Budget Pressures
10.1
The strategy to manage budget pressures within adult/Older People
Services is centred around the following:
10.1.1 Contracts & Commissioning – set contractual frameworks with
agreed weekly rates to ensure care is purchased at competitive
standard prices;
10.1.2 Managing demand through rehabilitative services which divert
service users from intensive long term care packages
10.1.3 Principal Managers budget meeting held monthly to identify trends
and take appropriate strategic actions to manage eligibility
thresholds and consistent commissioning activity;
10.1.4 Promote independence and signpost to universal services where
appropriate.
10.2
The strategy has successfully contained expenditure for Adult/Older
People Services over recent years. The whole range of actions will be
pursued to manage expenditure, but the ability to fully absorb the
demographic pressures and associated costs will need to be determined.
11.
Conclusions
11.1
Learning Difficulty and Adult/Older People Services are demand driven
personal services providing support to some of the most vulnerable people
in Salford.
11.2
The services have identified good financial management strategies which
control cost, establish contract frameworks, manage demand and promote
independence.
11.3
The Directorate has mechanisms in place to manage expenditure, but the
ability to fully absorb the pressures will be subject significantly to
demographic changes and the impact of the home care re-enablement
service.
11.4
Current expenditure projections for 2007/08 can be contained within
existing budget levels coupled with the utilisation of internal balances from
the pooled budget arrangements with the Primary Care Trust.
11.5
The major impact of the pressures will be experienced in 2008/09 if trends
continue on the current course for Learning Difficulties, with additional
financial pressures of £1.275m forecast. This will be further evaluated for
the budget setting process 2008/09.