Agenda item

To consider the report of the Director of Adults’ Health and Care and Deputy Chief Executive and Director of Corporate Resources prior to the decision of the Executive Member for Adult Social Care and Health.

The Director of Adults’ Health and Care provided an overview of current and expected financial challenges.  Members heard:

Nationally, social care inflation is close to 8% with pressures on the cost of buying services which far outstrip general inflation across the wider economy.  Above inflation increases to cost of delivering care and staffing lead to financial challenges in cost of provision of care, market conditions and growing number of people with a range of more complex support needs.  Inflationary pressures, growing needs, more population and funding challenges to social care remain.  Building upon current assumptions that have been successful in the past is a first step, but longer-term financial situations are needed. 

Social care staffing challenges across Hampshire are regulated by the CQC for quality of care with 35,000 people supporting those with social care needs in the sector both via the NHS and self-funded.  This is refreshed by 30% each year and managing turnover and the recruitment churn adds to constant inflationary pressure.  Cost, staffing, quality are the three major sector wide challenges to delivering care in the right way.  

Work is ongoing with partner organisations to promote social engagement and prevent isolation.  Social workers being available alongside 111 call responders help avoid at least 50 acute hospital bed admissions each month and cost to the overall system.  Frail and elderly people need more care with acute admissions as they can decompensate and lose self-mobilisation. 

The revised budget for 2019/20 is not dissimilar to the proposed budget for 2020/21. This is primarily due to the revised budget containing all the departmental cost of change expenditure.  The equivalent expenditure will be added to the 2020/21 in April budget when then requirement is fully developed.

Currently a breakeven outturn position is expected for 2019/20 but this is on the basis that all departmental cost of change, (£30m) is consumed. 

In response to questions, Members heard:

Overall the most important take away is the provision of care, i.e. buying or providing care.  In terms of managing priorities against costs, it is a complicated process due to the many issues bound up together.  Several different research-based figures are available in terms of the financial cost of social care under different models. 

In Hampshire, 60% of people pay for their own care and 40% paid for by the Hampshire County Council and the NHS.  While it is difficult to pin down exact numbers and the Care Act (2014) has changed some requirements and eligibility, a free social care system would be significantly more expensive than current arrangements. 

With limited reserves and cash flow, savings are ever challenging.  All upper tier authorities with social care responsibilities are managing their risk and currently, Hampshire County Council has 3 years of safe and secure provision of services, but beyond that window it is difficult to predict without foreseeing changes in funding.  As a high functioning council in adult social care, engagement and conversations are in place for new approaches to working.

Hampshire innovates and uses both hands-on and technology enabled care to improve the quality of daily living and independence.  Testing new technologies and co-bots’ pilots will assist carers with less stress and strain on the workforce.  Moving and handling musculoskeletal injuries can cause degraded capacity.  Safer working conditions retain the workforce better and attract new people.  There is continual demand which increases year on year, leading to social care pressures in providing ongoing support.

The forecast for savings from using new technologies and co-bots is difficult to determine, but the initial goal is to reduce the cost of double handed care which would allow one carer, rather than two, to safely mobilise individuals.  The budget for domiciliary care is growing with increasing challenges as people are getting bigger and heavier.  A significant reduction in double handed care allows for the release of funds for other spend or a reduction in the financial envelope.  Co-bots would be another useful tool in a complex process.

Nurses are now leading organisations and are key to their success.  Recruitment and retaining of qualified nurses are ongoing challenges in the wider sector but have been reversed for the time being with financial rewards, training and support, and quality working environments.

While there have been some challenges over recent months with the CQC, overall provisions are very good, and ratings have improved year on year.  The State of Care Report shows Hampshire at 88% and above the national average of 84%.

RESOLVED:

That the Health and Adult Social Care Select Committee consider the detailed budget proposals and -

1. Supported the recommendations being proposed to the Executive Member for Public Health.
2. Agreed any feedback or comments relating to the Select Committee’s recommendations for consideration by the Executive Member when making their decision.