Meeting documents

The Committee will receive an update on costs and progress in the delivery of budget savings in both Adult Social Care and Children’s Services.

Members will hear from the Cabinet Member/Deputy Cabinet Member, Finance Director and Executive Director/Director for each Service Area.

Contributors:

Mr Warren Whyte, Cabinet Member for Children's Services

Ms Wendy Mallen, Deputy Cabinet Member for Health & Wellbeing

Mr Richard Ambrose, Director of Finance & Procurement

Mr Tolis Vouyioukas, Executive Director for Children’s Services
Ms Jenny McAteer, Director for Quality, Performance & Standards, CHASC
Ms Bev Winter, Finance Director for Communities, Health & Adult Social Care
Ms Elizabeth Williams, Finance Director for Children's Services

Papers:

Report attached.

The Chairman welcomed Mr Warren Whyte, Cabinet Member for Children’s Services, Mrs Wendy Mallen, Deputy Cabinet Member for Health and Wellbeing, Mr Richard Ambrose, Director of Finance and Procurement, Mr Tolis Vouyioukas, Executive Director for Children’s Services, Ms Bev Winter, Finance Director for Communities, Health and Adult Social Care (CHASC), Ms Elizabeth Williams, Finance Director for Children’s Services and Ms Gillian Quinton, Executive Director for CHASC to the meeting. 

Members received an update from the Budget Board and the following items were raised and discussed:

• In response to a question regarding who attended the Budget Board and how often they were held, it was advised that they started on a weekly basis but this had now been changed to fortnightly. The meetings were chaired by the Director of Finance and Procurement and the relevant Executive Director and Service Directors would also be in attendance. 
• The committee discussed the action plans that were produced following the boards and how these would be monitored.  Mr Ambrose confirmed that an overall action plan had been produced and this would be reviewed at each board meeting. The initial focus was on improving governance and forecasting and most of the original actions were now completed. The budget boards could also undertake deep dives into certain issues and follow up actions would then be followed up within the Business Units. The Committee discussed debt management within the organisation and how this was being addressed.  Mr Ambrose assured the Committee that there was a renewed focus on debt management.  Mr Ambrose confirmed that debt had decreased in the last year by £3million with a specific debt team in place for historic debt. A key difference in the new Debt Management Strategy was that the debt team would take on any outstanding debts after 30 days, as opposed to 90 days previously.

Adult Social Care:

• The Deputy Cabinet Member for Health and Wellbeing gave an introduction, summarising the pressures faced by Adult Social Care, both locally and nationally. Emerging issues in Buckinghamshire included increasing complexity of domiciliary care packages, increasing numbers of older clients and an increasing number of self-funding clients running out of money and needing CHASC support.
• The Executive Director for CHASC highlighted that the struggling financial situation of the NHS was having an impact on Adult Social Care. Whilst Government had recently announced additional funding for the NHS, adequate funding for Adult Social Care was still not being addressed. There would be a Green Paper published in the autumn which would be critical in establishing a sustainable care system that goes across both health and social care.
• The budget allocated to Adult Social Care already accounted for  40 % of the Council’s total budget, and the Executive Director for CHASC noted that this needed to be managed tightly to avoid impacting on other services.  A transformation programme was currently underway to maintain the budget amid increasing demographic pressures. A detailed monitoring programme was in place which was already showing progress towards delivery of savings.
• The Chairman asked for clarification about the use of contingencies in CHASC. A budget of £128 million had been approved by the committee but there had been a budget transfer of £3,464,000.  The Director of Finance and Procurement confirmed that at the end of the previous budget year, a contingency of £2.8m had been released for demographic growth and pay pressures in CHASC. This had then been incorporated into the base budget for 2018-19. The Executive Director, CHASC advised that having contingencies was prudent financial management and they would only be drawn down if absolutely essential.  Members were advised that clients were staying in the system longer and individuals were presenting with more complex needs which resulted in higher placement costs.  In addition, the number of depleted self-funders had increased significantly over the past three years.
• This was often because individuals were going into care homes early and finding that their resources depleted quickly. The Council were trying to signpost to other support, such as telecare and remote sensors which helped to keep people independent in their own homes.
•  The CHASC Transformation programme had begun in January 2018 and was already delivering savings. The savings target against Reablement had not yet been realised. It was difficult to identify cashable savings as the main impact of Reablement was to prevent clients going into other areas of the system. An integrated approach with NHS therapy teams was being developed to improve the service. 

• The following approximate  figures were presented for service users in Buckinghamshire:800 people in residential care, 600 people in nursing care, 1200 people in domestic care, 1400 people in receipt of direct payments and a further 500 people in supported living. These numbers are similar to what was expected and budgeted for.
• There was a discussion regarding eligibility of clients for Continuing Health Care funding and the risks to Adult Social Care if users are no longer eligible.  The Executive Director explained that there is a national criteria and anyone who might be eligible were assessed by the Clinical Commissioning Group (CCG.) This should be a joint review between Oxford Health and Adult Social Care.  A social worker cannot always be in attendance, but reviews where costs could be diverted to ASC are prioritised. The Chairman asked the Finance Director for CHASC directly to identify her biggest areas of concern in terms of delivering the budget. In response she confirmed that the main concerns were an increase in complexity of needs leading to an increase in domiciliary care hours, the number of depleted self-funders and risks associated with Continuing Health Care. She also commented that workforce recruitment and retention could continue to be an issue, especially as NHS staff had recently received a significant pay award.    
• In response to a member’s question regarding the financial benefits of increased integration with the NHS, the Executive Director for CHASC advised that whilst patients were beginning to see the benefits, financial savings were unlikely to be seen until the next financial year.
• The Chairman thanked all the contributors for attending the meeting.

Children’s Services

• Mr Warren Whyte, Cabinet Member for Children’s Services introduced Mr Richard Nash, Service Director for Children’s Services, Mr. TolisVouyioukas, Executive Director for Children’s Services and Ms. Elizabeth Williams, Head of Finances for Children’s Services.  The Cabinet Member for Children’s Services highlighted significant changes to the management team and some of the key issues and national context for Children’s Services.  It was noted that the main pressure was that the number of looked after children in Buckinghamshire had increased to over 500. In addition, the number of Children in Need had increased by 12% and children subject to child protection plans had increased by 11% over the past year. Also there had been a delay in implementing the new early help service and improved short breaks service which has had a detrimental effect on the budget.

The Executive Director for Children’s Services outlined three key reasons as to why the  Children’s Services budget was currently under pressure:

• The 2017 Ofsted Inspection identified a number of existing cases that needed reworking, and this had led to an increase in both volume of work and legal spend.
• New cases are increasingly complex. Many cases feature themes such as domestic abuse, substance misuse and mental health issues. This created a challenging work environment for staff and it was highlighted that taking children into care is always the last resort.
• A prompt start had been made to the transformation programme, but it was unfortunate that the Early Help Review had been delayed.

• The Chairman reminded the Committee that the Council’s budget agreed in February 2018 had set aside £62.5million for Children’s Services and there had been an additional £5.4million allocated to the service during the financial year.  The Finance Director for Children’s Services explained that there had been a number of budget virementstotalling £1.2m during the year, for example for IT budget adjustments during the year.  In addition, various contingencies for Early Help, Social Care demography and High Cost Placements had been released.
• It was noted that the budget for Looked After Children had been set at £21.9m and the Legal budget was £2m.
• The Chairman asked for clarification as to why Early Help Savings delivery had been marked as green, given that changes to the service had been significantly delayed.  The Finance Director for Children’s Services advised that the savings targets for this year had been made in different ways including the release of contingencies and delays in recruitment to certain vacancies across the service. In response to a question as to what could be done to actively reduce legal costs, the Cabinet Member for Children’s Services commented that whilst the number of Looked After Children continued to rise, it was impossible to reduce costs in this area, but the focus was on preventing costs getting out of control.  It was important that social workers completed the elements of court preparation that they were responsible for before engaging Legal.  Service Director sign-off for the commissioning of external barristers had also been introduced.  The Cabinet Member reassured the Committee that a new Court Manager had also introduced improved internal processes.

·         It was noted that a £2,000,000 commitment was made in 2017 to invest in new residential placements in Buckinghamshire, to ensure that children and young people could be closer to home and to give the service better control over the budgets.  One home had already been opened and started to be occupied and a second  was on track to open this financial year. Sites for a further two homes were being sought. In addition, the Sufficiency Strategy aimed to increase the number of in-house foster carers.  A target to increase the number of in-house carers by 20% year on year had been set and the Executive Director, Children’s Services advised that he was confident that this would be reached. It was vital to get the right placement for each individual and whilst increasing in-house care capacity would support this, young people with more complex needs might still need to be placed externally.

The Chairman thanked all contributors for attending the meeting.