Agenda item

To consider the report.

The committee received the report and presentation and thanked Mel Lock, Penny Gower, and Emily Fulbrook for their hard work around the budget. They discussed care provider fee increases and expectations for future increases, and what the primary cost drivers were in this area.

Penny Gower, Service Manager, Adults & Public Health Finance, gave a presentation and a report that provided the overview on the current position in the whole council and Adult Services specifically, highlighting the pressures and mitigations in the service.

Mel Lock, Executive Director Adult Services and Lead Commissioner Adults & Health, detailed the challenges in the market of care providers and the work that had been ongoing to stabilise that, including international recruitment.

During the discussion, the following points were raised:

• There has been so much pressure on the team, with ten years of accounts done in one year, and we want to acknowledge how hard they’ve all been working.
• Concerns about innovation getting lost and working creatively with VCSEs. Would be great to hear more good news. Keeping people in their own homes gets communities and VCSEs working really well together, and we want to continue to drive that. We are also looking at how we can use AI to help us going forward. Budget constraints mean we have to innovate.
• How does the underachievement in commissioning relate to an overspend? This is linked to the My Life My Future saving – there is an expected lag in this. Will end up with £10m as two year savings.
• The reference to international recruitment highlights the importance of looking at workforce. There is a workforce board. There are risks to international recruitment, as the Home Office has offered licenses to many people and haven’t always checked if those are appropriate. This leads to risks around modern slavery and corruption. The government has also changed rules, such as not being able to bring a spouse. We are keeping an eye on this. As we are due an election, there may be further changes in the ways of working around this. There is a workforce plan for health but not for social care, but we are pushing with ADASS and Skills for Care to ask political parties to have a workforce plan for social care. Within Somerset Council, we have used a recruitment agency to recruit social workers from southern Africa – currently 15, and seeking another 10. Still working with local universities, but there is very low uptake for social work courses in Somerset. There is potential for a workshop on the workforce plan going forward.
• Cheaper beds are leaving the system and more expensive are coming in. Are we looking ahead and will bed prices come down? 70% of workforce within care is on national minimum wage. It is right that minimum wage increase, but there was no additional funding, and it adds to costs of care homes. Inflation, mortgages, etc. have all gone up and can’t see them reducing. We work closely with providers and provide a lot of support. We don’t have a lot of the big national providers so there are less overheads. We are expecting a levelling off.
• What mitigations are in place for placing people in care within a 30 mile radius of their home? These are looked at on an individual basis, working with care providers and VCSEs on the options and making those options realistic.
• Social care and residential/nursing care has changed a lot in the last few decades. In most cases, people placed in homes now have much higher needs, and there is an increased cost to supporting people in the community. Self-funders pay to subsidise the council. We should expect the cost of care to steadily rise, as people need to be employed to do that care. Committee should visit a care home to see how they are looked after.
• How does payment for care on hospital discharge work? How long does the NHS provide care for hospital discharges, and when are people expected to pay? Funding for hospital discharge is for things like reablement, joint funding comes out of the Better Care Fund. You are entitled to support when you need it, and if they can afford their care, they should pay for it.
• The direction of travel is getting people care in their own homes – will there be a capital receipt of nursing/residential homes, if it’s a building that won’t be needed once care is provided at home? Not if the home is owned by a private company. We do own some homes and lease them to Somerset Care, and we will have to look at what we will do with those. If you get housing solutions right with the right models, residential care will be different or eventually may not exist. Some care homes will reach the end of their lifespan and can’t be adapted anymore.
• People can have care in their homes at the same cost as nursing homes. How can we get that message out to people? The message is starting to get out there – it’s out there for people who can afford it. There are challenges around how we spend public money and how it is used for everyone, it depends what care is available to meet their need.
• Concerns about the cuts to mental health services– feels like the wrong time to cut that. No savings are savings we would want to put forward in an ideal world. There would be worse cuts if a Section 114 was issued and commissioners came in. We put forward the things that are the least worst.
• There was a government grant to help us educate our own carers - £19m between Bridgwater and Minehead. What is the progress on that? This is Bridgwater Academy, there is capital money coming in for the building, the work is still ongoing.
• Concerns about the impact of loneliness on people receiving care in their own homes. We are looking at how do we talk to families, do wrap around care, and support them to live the lives they want. If carers are the only people visiting that person, how do we support them? We need to find the right solution.

Cllr Slocombe (chair) thanked Mel Lock, Emily Fulbrook, and Penny Gower for their report and their hard work.