Agenda item

To consider the report.

During the discussion, it was agreed that a report on the overdue reviews would be added to the work programme, to enable a deeper understanding of how they work and the challenges around them, as well as a report on Intermediate Care pathways.

Cllr Sarah Wakefield, Lead Member for Adult Services, introduced the report, and Christian Evans, Head of Finance Business Partnering, and Penny Gower, Service Manager – Adults and Public Health Finance, gave a presentation on the financial position of the whole council in Month 10 and Adult Social Care specifically, identifying the key drivers of the overspend and the in-year mitigations taken.

During the discussion, the following points were raised and responded to:

·       Very concerned about the number of overdue reviews. Would it be possible for a full report on overdue reviews? Yes, that can be added to a future agenda.

·       Can you expand on care home blocks? We have block contracts so that certain beds are available at a price we can afford. We are looking at what do we need and where, what is the utilisation of those, and we want utilisation to be 90-95%.

·       As we are demand-led, could we have a forward look at what the next year looks like, now that the budget for 24/25 has been set? We have had an increase in the 24/25 budget, and we have set the budget to people – basing it on people in and out. We have a very solid domiciliary care market based on international recruitment. However the coming change in law regarding visas for spouses means that may change. As we are now paying better, we have had care providers such as Brunel Care Home give feedback that the market is better. The other risk in terms of expenditure is care home failure – we have all heard of care home closures. If a large care home closes that would have a big impact. We have used data based on how many people die, how many people leave our service, how many people come to Somerset. We can’t budget for everything, and there is no wriggle room in the budget. If there is a change in legislation or other things that may happen, we will be able to bring that to you. We are monitoring and measuring these budgets like never before. We can now track budgets by individuals and this model has been looked at by 4 external partners. There is a trend increase of people who are self-funding whose capital has dropped below the £23250 maximum. We don’t have complete data on those who are self-funding. This year we have given a 3.2% rise to our providers. The cost of care has gone up 8-9%. Private customer increase is therefore between 8-15% - this has an impact on capital and it reduces below the £23250 maximum. Sometimes we have to move people because we cannot continue to pay the fee price for the care provision they are currently receiving.

·       Where do those people go? They will go to another care home that meets our fee rate. We try to get people as close as we can at a price we can afford that meets their needs. In future we need homes in the right place – a care home owner will just build on Wellington Road. We need care homes in the right place as part of the local plan across the county. Care homes are changing – not just places to live, places if you really need care. We are keeping more people at home and we need to build that in. It’s a good trend but it’s expensive all the way around. People in a care home generally cost more than people at home. Capital drop – people arrange their affairs so they don’t have to pay, this possibly needs legislation.

·       Are you aware of the impact of international recruitment on care homes? We work in partnership with our providers across the sector, everyone has done a lot of international recruitment. It is fantastic that people want to come to this country to do that job. We have done a survey with our providers on it, and there is a site that has everything in one place just to help them and make sure they are doing everything legally. It is effective supply in the market.

·       Carers are paid very little, are international recruits aware of how little that is? Yes, and we talk to them and they are aware and able to send money home.

·       With the change in law regarding partners of international recruits, do we know how many people are working under those visas in our care homes, people who are not sponsored by their employer? How do we get that information. We are working hard with the Home Office – we don’t know from the data we give how many people are sponsored in Somerset, that is why we have put that survey out. For those that we commission we have that data. For those we don’t commission, we don’t. ADASS and LGA are working with the Home Office to get this data.

·       There is a risk to moving residents – a judicial review decided that moving them purely on financial grounds was judged to be unlawful. I would expect to be challenged if we do that. After two years, under the Human Rights Act it is considered to be their home. We are aware of the legal case, we work with the family and the service user if they have capacity to see if we can top up. The case has given us some key points to look at in terms of what we need to do to be legal.

·       While we want to drive down costs, can we overspend on respite? The savings long-term are worthwhile, keeps people in their homes a lot longer. It’s a useful tool. While we see lines in our budget, what we also see is trend changes. As long as we are balanced at the bottom we are okay.

·       The 1947 baby boom population are now 77. There are a lot of people, putting pressure on just about everything. Where a home isn’t suitable, where is the planning for suitable small comfortable homes? Missing the importance of planning for future generations. We all get treated well and repaired well by the NHS and then we can’t live where we always live. We need to make changes in our planning system to plan for this. Now that we are a unitary authority there are more possibilities with this, to look at how housing and care are linked together and what are we planning for the future. Over the next six months there will be a housing and care linked strategy that will link in to the local plan. We are having conversations of providers of extra-care housing. There are some good new models of intergenerational housing that don’t necessarily need funding but we will be working through to build those.

·       Sedgemoor District Council were doing Homes for Life.

·       There have been issues with planned nursing homes not being built as developers weren’t interested. It is not just the local plan as developers have a say in this too. In South Somerset – the 5 year land supply is down to less than 3 years, giving developers carte blanche to do what they want. Some developers are not designing homes for local people, but for people from the South East who think Somerset is a nice place to retire to. Phosphates are the issue holding up housing, something needs to be down about the 5 year housing supply.

·       There is a need for more houses to downsize into, and what happens when people need facilities that they don’t have extra money to convert to, e.g. a wet room. We have a commissioned provider who does do alterations on homes – if the resident has money they will pay for it, otherwise the cost will be recouped when the home is sold.

·       How can we fit this into our workplan, how can we contribute to the local plan?

·       The bank beds that are paid to keep empty, how can they be utilised for respite care? Some block beds may be used for respite but not generally. Not everyone wants to go to a care home for respite, especially younger people with learning disabilities. There are a range of options in delivering respite for individuals.

·       In paragraph 5.4, additional costs within intermediate care have been identified. Where are those budgets, what are the costs? We have a budget, some paid for by the Better Care Fund, where we have more beds than we need and we have reduced those beds over the year. There is a £5m additional cost in this and we are working with ICB around funding. Sometimes when people leave hospital they need a bed and they are expected to die in that bed soon. In future we want Intermediate Care agreements (section 75 agreements) between Social Care and NHS to be really clear about who puts in what, how we split it, and when it goes overbudget what are we delivering. We can come back and show a better budget for this – for next financial year we are changing the budget report to allow us to highlight Intermediate Care.

·       It would be useful to have a separate item on Intermediate Care on the next agenda.

·       Is there any way we can cap care home fees? Is there any possibility of legislation? No. That was the goal of the fair cost of care exercise. There are real costs, they proved the new cost, trialled it in five authorities and then stopped it. Changing how social care is funded isn’t going to be done in the next five years if you look at the manifestos.

·       We should be wary of bungalows as suitable accessible housing as going up and down the stairs keeps people fit.