Agenda item

·         To receive an Adults & Health finance update for Quarter 1 of 2022/23.

·         To provide an overview on Adult Social Care throughput for each service area.

Sean Huang, Business Partner, and Josephine Lyseight, Head of Finance (People), provided the Panel with a finance update with data from Quarter 1 of 2022/23. Adults and Health was forecast to spend £121.7m against a budget of £112.4m representing an adverse variance of £9.3m at Q1. Around £7.9m of this adverse variance was attributed to adult social care with the remainder to housing demand, mainly due to a loss of temporary accommodation units. The breakdown of adverse variance in adult social care was:

• Older People - £2.701m
• Learning Difficulties - £3.195m
• Mental Health - £2.347m

Sean Huang explained that the main driver for this had been a substantial increase in demand including new high complexity clients coming into the system. The residual impact of Covid included worsening health conditions and frailty leading to greater demand and complexity. There was a risk around hospital discharge with an increase in the number of clients along with inflationary pressures.

In addition, there had been some slippage in savings delivery, although £4.8m of the £5.3m required savings were on target to be delivered. The areas that were not being achieved were mainly stretch targets that were projected to slip into future years due to demand pressures. However, there had been a one-off £1m recovery of aged debt which would contribute towards savings.

He continued that there was a very small overspend in adult commissioning and that public health spending was projected to break even.

Mitigations to address the budget shortfalls included:

• A review into the top 30 high-cost learning disability and top 44 high-cost mental health packages.
• An ongoing integrated care review to identify efficiencies, particularly on transition to long-term care.
• Working with health partners to address hospital discharge funding and identify the correct pathways.

On capital spending there were a projected underspend of around £2.1m against an original budget of £13.2m for the current financial year. This was due to some delays to capital projects and so the funding would be reprofiled into future years.

Gill Taylor, Assistant Director for Communities and Housing Support, Sean Huang and Josephine Lyseight then responded to questions from the Panel:

• Asked by Cllr Iyngkaran why there had been no spending at all on Capital Scheme 218 on Social Emotional & Mental Health Provision, Gill Taylor explained that this funding had been identified to improve services on a bespoke basis. However, the thinking had changed on how to use this funding and so new redefined capital bids in this area were in development.
• Asked by Cllr Iyngkaran about the expected opening of the service at Canning Crescent (Capital Scheme 213), Gill Taylor said that there had been construction delays but that the service was expected to open in October 2022.
• Helena Kania asked for further explanation about the comment in the report about ensuring that hospital discharge was appropriate and via the correct pathway. Beverley Tarka explained that this related to where people were discharged to, whether this be reablement at home or more supported bed-based rehabilitation or a nursing/residential home. During the Covid-19 pandemic, the NHS and the Council had put together a number of step-down facilities to enable the throughput of patient from hospitals and they continued to work together, including on helping people to choose the type of support most appropriate for their needs. Beverley Tarka acknowledged that patients were not always able to access their first choice during the pandemic due to the extreme pressure on hospitals. Vicky Murphy added that they were working hard to ensure that every resident had choice in where they wanted to go but that they were also seeing a significant increase in referrals and there was a high financial cost to some pathways. Cllr das Neves commented that this discussion highlighted the challenges faced by the Council in this area including higher demand for services, workforce issues and people sometimes deconditioning in hospital more than used to be the case. These were also challenges that faced other local authorities across London.
• Cllr Gourtsoyannis requested clarification about the reasons for the Temporary Accommodation overspend set out on page 43 of the agenda pack. Gill Taylor explained that there were huge supply challenges across London with many Boroughs needing to use bed and breakfast accommodation and the overall per unit cost to local authorities rising significantly. The Homelessness Prevention Grant (HPG) of around £8m per year covered a range of initiatives including meeting the gap between rents and the Local Housing Allowance (LHA). However, as that gap widened due to the increased unit costs, the HPG could not cover all of this leading to an overall shortfall. The Government were currently in the process of reviewing the HPG and Haringey, as one of the largest beneficiaries of the HPG, could potentially lose up to 40% of this grant funding.
• Asked by Cllr Connor whether the adverse variance in Q1 would be recovered, Josephine Lyseight said that the outturn figures factored in the mitigations that were already in place, previously agreed savings targets and the pressures faced by the Department so this represented a current forecast of the end of year figures. Sean Huang added that a lot of additional demand was coming through and that this was being seen by many Boroughs across London which were also consequently in overspend positions. Beverley Tarka added that the onus was on officers to identify alternative mitigations in circumstances where the current mitigations were not working. Some of the areas where there were thought to be opportunities for this were set out on page 45 of the agenda pack.
• Asked by Cllr Connor about new savings proposals that may be required as a result of the current financial circumstances, Beverley Tarka said that these were already being worked on and that it was thought that some could be put in place in the current year and others in future years. However, it was too early to specify whether additional savings could be achieved in the current year.
• Asked by Cllr Connor whether more money would need to be added to the budget this year to offset the projected overspend, Beverley Tarka said that the budget was set at the beginning of the year and so additional in-year funding was not expected. However, the growth in demand for services and the complexity of need in the local population could impact on funding requirements for future years. Josephine Lyseight confirmed that expectations would be for the Department to drive down costs in-year as required but added that the pressures faced by Adult Services were a corporate issue for the Council.
• Cllr Iyngkaran asked whether equivalent Q1 figures for the previous year were available for comparison. Josephine Lyseight said that while these were not at hand at the meeting, these could be provided if required. (ACTION)
• Cllr Brennan expressed concerns that mitigations could result in reductions in services provided for residents but asked whether the intention was for greater use of home care in order both to save money as well as being what some people would prefer. Beverley Tarka responded that, in order for people in such circumstances to remain at home and improve, they would require various interventions in the community but there were currently workforce shortages in various areas such as physios and therapists. It was therefore essential to ensure that people placed at home can be appropriately supported.