Agenda item

This report provides a finance update for Quarter 3 of 2024/25. It was considered by the Cabinet in March 2025 and by the Overview & Scrutiny Committee in April 2025.

It was proposed at the Overview & Scrutiny Committee meeting that the parts of the report relating to Adult Social Care services should be considered in further detail by the Adults & Health Scrutiny Panel.

Discussion at the meeting will therefore be limited to finance issues relating to Adult Social Care services.

The minutes of the discussion at the Overview & Scrutiny Committee meeting in April 2025 are available to view at: https://www.minutes.haringey.gov.uk/mgAi.aspx?ID=82208

The report for this item provided a finance update for Quarter 3 of 2024/25 and was previously presented to Cabinet in March 2025 and the Overview & Scrutiny Committee in April 2025. Jo Baty provided some information about the aspects of this report that related to adult social care. She reported that there had been an adverse movement of £1.1m in adult social care compared to Quarter 2 meaning that the forecast position moved from £14.5m to £15.6m overbudget. Contributing factors to this included an increase in older adult support needs and increased costs relating to complex cases. Conversely, there had been a lower than expected number of young people transitioning to adult social care from children’s services. There was work underway to better forecast and to ensure that controls were in place to mitigate against expensive packages of care for transfers over from children’s to adult services without any focus on independence, employment and supported living. An Adult Social Care Programme Board, chaired by Jo Baty, had been established which provided a leadership group with ownership and accountability for savings, efficiencies and improvement across the whole service. She acknowledged the vital role of partner agencies and co-production with residents in the service modernisation and improvement agenda. She also noted that, even with sophisticated forecasting tools, there was a degree of unpredictability with demand-led services and this impacted on all London Boroughs.

Jo Baty, Sara Sutton, Neil Sinclair (Head of Finance – People) and Cllr das Neves then responded to questions from the Panel:

• Cllr Mason expressed concerns about the increased number of adults aged 50-64 requiring support and queried the balance between physical and mental health difficulties in that group, whether the Covid pandemic was a factor in this and what support was being provided from the Government. Neil Sinclair, Head of Finance (People), confirmed that no additional funding had been provided from the Government on this specific area. Jo Baty said that details on the number of physical and mental health conditions could be provided in writing. (ACTION) She added that there had been recent discussions with Disability Action Haringey about supporting more residents with physical disabilities and that there were also better and stronger relationships with the Mental Health Trust. In relation to Covid, Sara Sutton said that modelling carried out at the time by the Integrated Care Board (ICB) had predicted that there would be a 20% increase in the acuity and complexity of cases as a consequence of the pandemic. Cllr das Neves commented that there was a relatively high proportion of people in Haringey with two or more long-term health conditions and that issues such as underinvestment in services that help people to maintain good health were a factor in this.
• Cllr Iyngkaran requested further details on the number of additional cases and the associated costs that had contributed towards the £1.1m adverse variation in the past quarter. Jo Baty clarified that there were many different groups of residents that factored in the overall costs and so it was important to understand the reasons for spikes in demand in certain groups which is why it was important to improve the modelling and forecasting for this. 
• Asked by Cllr Connor for further clarification on the case numbers, Neil Sinclair explained that at the beginning of the year there had been approximately 500 younger adults with a care package with a physical disability characteristic and by the end of year this had reached almost 600 cases, despite the fact that the figures had been reasonably flat in the preceding two to three years. Much of this rise had been seen from people in the 50-64 cohort who were not previously known to the Council. He added that there had been work to improve the forecasting of data for anticipated transitions to adult social care which would have an input to the budget setting process for 2026/27 onwards. Cllr das Neves added that the Council was working with an external organisation called 31ten which was helping with the forecasting, including comparisons to statistically similar Boroughs. It was also important to consider the regular movement of people between Boroughs because of their housing circumstances and the emergence of particularly high cost cases as these could result in variances from previous forecasts. Cllr Connor commented that it would be useful to see a breakdown of these figures in the specific cohorts and details of the forecasting work in future reports to scrutiny. (ACTION)
• Cllr O’Donovan queried whether more residents could be coming forward for assessments because they were concerned about the potential future changes in the qualification criteria. Jo Baty responded that there were likely to be a number of factors and could also include the situation with the cost of living and the Council’s outreach work in this area.
• Asked by Cllr Connor about the reprofiling of savings that would not be delivered, Jo Baty explained that there were a number of savings which were pushed forward to 2025/26 or brought together under existing savings areas. This year the Department had tried to create clear standalone savings with a business case for each one. Items set out in the spreadsheet in the agenda papers as ‘Contract Review’ and ‘Supported Living Review’ included £900k of savings to be achieved in the next financial year. She added that there had been a lack of capacity in commissioning and so new commissioning staff had been brought in to help achieve these savings and further savings in future years. In transitions there had been delays in bringing staff on board and so the savings had not been achieved early enough but the Council was working with partners in care and health services to look at working better together to make efficiency savings. Neil Sinclair explained that factors including the need for investment in the service to make future savings, the writing-off of some savings and inflation uplifts for providers was used to establish the baseline financial position for 2025/26. This included an investment of around £31m into adult social care placements. Sara Sutton added that this included necessary areas of growth in areas such as staffing but even this was likely to be challenging with current demand pressures.
• Cllr Brennan raised a query about housing voids and it was noted that, although this was included under the Adults, Housing & Health section, the housing aspects did not fall within the remit of the Adults & Health Scrutiny Panel.
• Cllr Connor commented that it would be useful to understand further how the savings impact on residents in future reports including, for example, if an Equality Impact Assessment had been carried out. (ACTION)