Agenda item

This report is to inform the Adults and Health Scrutiny Panel of the financial performance of the Priority Two Services (Adults Social Care, Commissioning and Public Health). It is based on the financial position as at the end of quarter three (month nine).

The Chair informed the Panel that, in October 2015, the main Overview and Scrutiny Committee had agreed that each Scrutiny Panel could, during the course of the year, undertake a review of their areas overall service and financial performance.

Katherine Heffernan, Head of Finance, explained the main directorates contributing to Priority Two outcomes, set out in Haringey’s Corporate Plan 2015-18, were Adult Social Services, Commissioning and Public Health.

The Panel was informed that:

Ø  Information published with the agenda was based on the financial position at the end of quarter three (2015/16).

Ø  There were no significant variances against the Priority Two elements of Commissioning or Public Health.

Ø  As reported to Cabinet in January 2016, there was a significant forecast out-turn variance for Adult Social Services of a £12.9m overspend.  

The Panel considered how the out-turn variance for Adult Social Services was made up, the factors leading to the variances and action that was being taken to address the issues.

In response to questions, Ms Heffernan explained that there was a significant underspend against Assessment and Care Management and other services. The Panel was informed there had been underspends in staffing across a number of areas but especially in relation to Occupational Therapy and Social Workers, where the Council had experienced difficulties in recruitment. Beverley Tarka, Director of Adult Social Services, commented that action to address this had included work to develop a recruitment and retention strategy for the Adults Social Services workforce. During discussion, reference was made to the following:

Ø  Issues concerning pay, training and support in relation to recruitment, retention and staff turnover, including the pros and cons of employing agency workers and contractors and the use of “golden hellos”. 

Ø  The impact of the National Living Wage on the care sector.

Ø  The impact of staffing underspends in relation to care packages and costs.

The Panel considered a table, at section 5.3 of the report, that highlighted how the out-turn variance for Adult Social Services was made up. The Panel noted that the main overspend related to care purchasing, where both volumes and costs had continued to rise, and that savings assumptions made in the medium term financial strategy had taken longer to embed than originally estimated. The following issues were discussed:

Ø  The costs associated with care purchasing.

Ø  The work that had been done by the Council to address inflation up-lift and to enact a Fair Fee process.

Ø   The costs associated with implementing the Care Act 2014.

Ø  Issues in relation to supply and demand concerning an ageing population and an increasing number of residents having complex care needs. 

Ø  The Council’s Market Position Statement.

Ø  Information and analysis of Haringey’s local provider market for residential and nursing care in the borough.

In response to questions and concerns about the diversity and scale of savings required, Ms Tarka referred the members of the panel to section 5.9 of the report. It was noted that over the course of the year various actions had been taken to address the estimated outturn position. The following points were noted:

Ø  The Council had established a brokerage function, on a pilot basis, to micro-commission services for individuals following assessment and support planning. Charlotte Pomery, Assistant Director Commissioning, explained that the brokerage unit would help free up care management time and ensure the cost of care was appropriate and best value.

Ø  A joint project with health partners had been established to build an effective Intermediate Care Pathway. It was explained that this would include Haringey’s approach to reablement, It was also noted that a review of the Reablement Service had been carried out and that this had identified further potential in this area e.g. in relation to processes and pathways.

Ø  The Council had commissioned two extra sheltered schemes that would come into use during the summer of 2016. It was explained that this would offer an alternative to residential care.

Ø  A “Front Door” review was being carried out to ensure it was working effectively and people were getting appropriate support.

The Panel noted the remaining actions outlined in section 5.9 of the report and considered issues in relation to: the new operating model for Adults Social Services; the Council’s Transformation Reserve Fund; the finance and risk modelling work that had been undertaken in relation to the transformation of the adult care system in Haringey; and issues concerning budget proposals in relation to a 2% social care council tax precept. 

AGREED:

(a)  That the estimated outturn position and action being taken to address it be noted.

(b)   That an update on the financial performance of Priority 2 Services (Adults Social Care, Commissioning and Public Health) be considered by the Scrutiny Panel during Quarter 2 of 2016/17 (October 2016 was suggested for this budget monitoring scrutiny meeting).

(c)  That, in addition to (b) above, updates on the following issues be prioritised in developing the scrutiny work programme for 2016/17, and recommended for endorsement by the Overview and Scrutiny Committee:

(i)            The development of a recruitment and retention strategy for Adults Social Services (for consideration by the Scrutiny Panel in Spring/Summer 2016);

(ii)          The effectiveness of the Council’s brokerage service (for consideration by the Scrutiny Panel in February 2017);

(iii)         The Council’s Risk Management Plan in relation to Priority 2, the transformation of the adult care system in Haringey (for consideration by the Scrutiny Panel in September /  October 2016);

(iv)         The Intermediate Care Strategy with updates on progress made in delivering reablement and intermediate care services. It was agreed that this update should include information on processes, pathways and financial savings, including any barriers. For consideration by the Scrutiny Panel in February 2017.     

(d)  That consideration be given to how scrutiny should be informed of the outcomes of any new service commissioned or co commissioned in relation to Day Opportunities Transformation, as part of the High Level Project Plan item, that would be considered by the Scrutiny Panel at its meeting on 1 March 2016.