Agenda item

To review the Savings Tracker 2024/25 (Q2) which includes details of previously agreed savings relevant to Adults & Health. This item was deferred from the previous meeting.

Cllr Connor reminded the Panel that this was an item that had been deferred from the previous meeting on the Budget. She commented that the format of the tracker had been improved since the previous meeting and was now much clearer.

Neil Sinclair, Head of Finance (People), and Jo Baty responded to questions from the Panel about the savings tracker:

AHC_SAV_001 – Improved practices and processes to ensure that residents receive the right level of care

• Cllr Brennan noted the comment on the tracker that this item was “forecasted red from the start as the target is so large” and queried whether the target was realistic. Jo Baty clarified that the improvements to processes and practices referred to the reviews undertaken by social workers and ensuring that support packages were proportionate to the needs of the resident. This item also included the changes with Continuing Healthcare funding. Beverley Tarka explained that this was due to how budget processes worked and the establishment of a narrative when the approach to savings was developed. As the year then progressed there was improvement of processes and practices in various different areas, which meant that there was some duplication in the tracker (specifically combined with AHC_SAV_011 – Continuing Healthcare & AHC_SAV_012 – Strength Based Working). It was not possible to change the original narrative from a finance perspective but it was all part of the same overall exercise. So while two of the three budget lines were red, the overall target for the three lines was £2.2m and this was on track to be achieved through AHC_SAV_011 as set out on the tracker.
• Asked by Cllr Mason whether these changes were reflected on a risk register, Beverley Tarka explained that there was regular monthly monitoring of the savings trajectory and the risk of delivery with mitigations identified where necessary. The tracker showed an overall risk of non-delivery of savings of around £2.6m and the Finance took all risks into consideration when publishing budget monitoring reports. Neil Sinclair added that the risks of non-delivery had an impact on the forecast of the overall position for the Council and that this was a consistent ongoing process.

AHC_SAV_004 – Contract Reviews

• Cllr Connor noted that the tracker referred to resource constraints within the Commissioning team and requested further detail on progress in this area. Beverley Tarka explained that there had been joint commissioners prior to the recent decision of the ICB to reduce their revenue costs by 30%. There were now local authority-based commissioners and the required restructuring had taken some time, leading to the challenge in delivering savings. Going forward, there was an invest-to-save proposal to enhance the commissioning resource as this was key to achieving a number of strategic sustainable outcomes over the course of the MTFS period. Jo Baty added that they were already thinking about what would be required next year to bring savings through and so some of the savings line would be rolled forward and adjusted next year as commissioning capacity was developed.

AHC_SAV_011 – Continuing Healthcare

• Asked about progress on this item, Beverley Tarka noted that there had been investment in this project to embed knowledge and competency throughout the teams engaged in this process.
• Helena Kania expressed concerns that Continuing Healthcare was underfunded and was difficult to obtain for people who needed it. Beverley Tarka emphasised that the Council had overachieved on the savings target but acknowledged that it could be challenging for people to obtain a Continuing Healthcare assessment. The national trends around Continuing Healthcare were reducing and London was particularly adversely affected. She added that it could sometimes be helpful for experts with a legal framework and background to champion families when they needed to appeal and make their case.

AHC_SAV_013 – Direct Payments

• Cllr Connor noted that this saving involved a long teem increase in the use of Direct Payments and queried why more people weren’t moving to Direct Payments. Jo Baty responded that, while some people saw them as enabling more choice and control, some others felt that it involved more administration for them personally in managing their own budget. This work was championed locally by Disability Action Haringey who were proactively engaged as part of locality teams. She added that Direct Payments were often an effective way of working with young people and their families to consider what options were possible for them and to help them build independence and to exercise choice and control.
• Asked by Cllr Iyngkaran how more people to be persuaded to move to Direct Payments, Cllr das Neves observed that the status quo could be hard to change for some people. Jo Baty added that there could be a need for champions and advocates to support people in making this change as some may have the impression that Direct Payments sound financial and bureaucratic. It may also be necessary to adopt a more targeted approach as young people may want the opportunity for more creative choices whereas older people might be more likely to prioritise the availability of care. Cllr Connor noted that it may be helpful for the Panel to obtain a greater understanding of how Direct Payments was being communicated to residents. (ACTION)

AHC_SAV_018 – Grant Review (BCF-S75)

• Cllr O’Donovan requested further details on negotiating with the ICB as specified in the tracker. Cllr das Neves said that the issues in this area had been documented in the public domain and that, across North Central London, local authorities had taken a joint approach in some areas. She added that this set out a challenge on building relationships on budgets in order to drive forward a prevention and early intervention agenda. Beverley Tarka added that there were bound to be tensions when there were two financially challenged systems but she felt that there was a real motivation to reset how they worked together going forward. Cllr das Neves added that the Council Leader would now sit on the Integrated Care Board which was a further opportunity for collaboration. Cllr Connor suggested that the Panel should note the joint pressures and commissioning work in this area as an ongoing risk area to monitor. (ACTION)

AHC_SAV_019 – Mental Health Service Review

• Cllr Connor noted that this saving involved a focus on bringing high-cost out of Borough placements back into local provision of care and requested further detail on the capacity of local providers to do this. Jo Baty said that there was part of the capacity to do this but added that there was also a need to develop the local mental health offer, be creative and look at what others were doing. This included areas such as housing, employment and creative day opportunities as well as strengthening the Council’s position on Section 117 arrangements. Beverley Tarka added that, in terms of benchmarking, Haringey was an outlier in the cost of care and support packages for people with mental health needs. With social workers seconded to the Trust, the Council had less control and some people had ended up in very expensive out-of-Borough placements. Bringing the social workers back in-house had enabled more control and focus on the holistic outcomes for individuals. The future development of accommodation pathways and holistic support also had the potential to reduce costs as it was starting from a high base.

AHC_SAV_021 – Supported Living Review

• Asked by Cllr Connor for further detail on the proposed savings and the resource constraints in the Commissioning Team, Beverley Tarka explained that this was about the cost of care and getting better at commissioning for outcomes rather than activity. In some cases, support needs may not be as high as originally envisaged and so improvements were required in how the costs of that support were reviewed in order to ensure value for money.
• Cllr Connor queried how often it would be possible to undertake reviews, noting that it had previously been challenging to do so with the care plan reviews. Beverley Tarka explained that there were currently two separate processes with the social worker and then the contract commissioner. By bringing these two processes together in would be possible to achieve better outcomes, for example through better monitoring of staff to client ratios. She noted that a provider would always flag when there was a need for an increase in costs but that the Council had not always been as proactive when there was a reduced need for support. This required additional capacity on the commissioning side with an invest-to-save approach.
• Cllr Connor commented that the Panel may wish to continue to monitor this piece of work in order to be reassured that support levels for clients were being maintained as savings were being achieved. (ACTION)

CYP_SAV_008 – Transitions

• Asked by Cllr Connor about the recruitment issues set out in the tracker, Jo Baty explained that the transitions team was a relatively small team based in the Children’s department with an initial 38 young people transitioning through to adult social care. This would need to be scaled up in future years with higher numbers expected. Efficiencies in transitions required a corporate response as a range of different services may be required when transitioning into adulthood. Neil Sinclair added that the initial business case from 2023 included assumptions based on the available data at the time but, now that project delivery was in progress, the savings could be reprofiled in future years as better data became available.
• Cllr Connor expressed concern about reducing funding in this area when the feedback to Councillors from families is that they required more support and suggested that a more detailed breakdown of the savings would be useful in future. Cllr das Neves commented that nationally there was less money associated with individuals after they turned 18 and so this could mean that there were issues with people’s expectations after transitioning. Adult Social Care had a duty to provide care under the Care Act and also a financial duty to meet national expectations. Part of the work in this area was to start on that journey earlier to help prepare for that change. She added that it would also be helpful to develop system-wide thinking on how best to improve outcomes for young people with complex needs including on opportunities for work and reducing repeat admissions to hospital. Cllr Connor commented that it would be helpful for the Panel to see a more detailed breakdown of the cost savings in this area. (ACTION) Cllr das Neves suggested that this area of work could be usefully discussed in more detail at a future scrutiny meeting. (ACTION)
• Cllr O’Donovan underlined the importance of taking a long-term view of changes in this area in order to ensure that outcomes and costs were not worsened in future.
• Cllr Mason highlighted the substantial increase in mental health concerns among young people and the importance of maintaining support for them after the age of 18.

General

• Cllr Iyngkaran noted that, of the overall savings target of £5.5m, only £2.9m was projected to be achieved and asked what confidence there was that the remaining £2.6m could also be achieved by the end of the financial year. Neil Sinclair responded that there had been a significant amount of work undertaken to review the savings and that £2.9m was a fair representation of the likely delivery of savings by the end of the financial year.
• Asked by Cllr Connor how the £2.6m total of unachieved savings would be addressed, Beverley Tarka said that the Department was constantly working on mitigations as an ongoing process.
• Cllr Mason noted the pressures on recruitment and resources noted against the savings marked as red and queried whether these vulnerabilities could be better factored in when the savings targets were set at the beginning of the year. Beverley Tarka responded that Adult Social Care had historically achieved around 80% of savings so there was a good track record and they had a high level of confidence in these savings. However, there had been significant additional challenges in the past year, mainly in the form of demand pressures and also a CQC assurance process, which had led to resources being diverted to deal with these. The savings targets were monitored each month with mitigations being put in place where possible. Looking ahead, it was anticipated that the care sector as a whole was expected to face ongoing challenges with rising demand and increases in complexity of need, particularly with frailty and dementia. This could also have a knock-on effect on the NHS, such as through issues with hospital discharge, and further underlined the need for sustainable funding for adult social care which she said was an under-resourced sector.
• Asked by Cllr Connor about any further invest-to-save work ongoing in adult social care, Jo Baty said that recruiting and retaining high quality staff was an ongoing challenge in adult social care and so there were initiatives in this area such as recruitment days, improved induction for new staff and a strengthened workforce development programme. Beverley Tarka added that there were opportunities resulting from the bringing together of Adults and Housing because of the link between adult social care and accommodation pathways. The development of assistive technology also provided future opportunities, while acknowledging the importance of digital inclusion. Sara Sutton then spoke about wider digital transformation as a way of creating efficiency opportunities and freeing up capacity within the workforce to focus on delivering best outcomes for residents. She also added that there were further opportunities for multidisciplinary working across adults, housing and health. Cllr Connor suggested that it would be useful for the Panel to see more about new ways of working as part of the Panel’s next work programme. (ACTION)
• Cllr O’Donovan acknowledged the work that had been done to achieve the savings as well as maintaining a high quality of care for residents.