Agenda and minutes

Apologies for absence were received by Cllr Dave and Cllr Orton.

Members will be asked to declare any interests they may have in the business to be discussed.

The Chair asked members of the commission to declare any interests for which there were none. 

The minutes of the meeting of the Adult Social Care Scrutiny Commission held on 30 November 2023 have been circulated and the Commission is asked to confirm them as a correct record.

The Chair highlighted that the minutes from the Joint Meeting of the Adult Social Care and Public Health and Health Integration Scrutiny Commission held on 30 November 2023 were included in the agenda pack and asked Members to confirm whether they were an accurate record.

The Chair further noted the outstanding action to receive a written briefing on the call handling of adult social care enquiries through customer services.

AGREED:

·       It was agreed that the minutes for the meeting on 30 November 2023 were a correct record.

The Monitoring Officer to report on any petitions received.

The Monitoring Officer noted that none had been received.

The Monitoring Officer to report on any questions, representations or statements of case.

The Monitoring Officer noted that none had been received.

The Director of Finance submits a draft report proposing the general fund revenue budget and capital programme for 2024/25. 

Members of the Commission will be asked to consider and provide any feedback which will be submitted to the Council Budget meeting in February 2024.

The Deputy City Mayor for Social Care, Health and Community Safety introduced the item highlighting the significant concerns locally and for other local authorities with responsibility for adult social care across the country in terms of growing needs and challenges to budgets. It was noted health and social care services continue to work together to fulfil the legal duty to meet the needs of residents but there are increasing pressures with a substantial proportion of the budget required to support a small percentage of people in the city.

The Director for Adult Social Care and Safeguarding and Director for Adult Social Care and Commissioning provided a presentation to set the context in which it was noted that:

·       Individuals seeking adult social care support and complexity of need has increased nationally. There has also been an increase in number of older people requiring long term care.

·       Most local authorities are predicting adult social care will overspend. Social Care reforms were paused and there are no funding solutions proposed to address financial challenges in the sector.

·       Benchmarking data illustrates Leicester are supporting a higher proportion of older people resulting in a higher spend for adult social care. Unit costs to pay for services such as home care and supported living compare well to the national average.

·       Growth has reduced with alternative support arrangement and less reliance on statutory support – although this is still above proposed budgeted growth. Prevention is important to reducing statutory spend and social care continue to work with the joint integrated board.

·       Four key work programmes have been identified to manage demand and associated costs including, reducing the average costs of supplied care packages; reducing the number of new entrants and overall service demand; raising effective productivity levels and improving partnership and stakeholder processes and joint service delivery.

The Head of Finance presented the report, and it was noted that:

·       The budget has been managed with reserves in recent years which are expected to run out in 2024/25. Further savings are required, otherwise a Section 114 notice would be likely in 2025/26 as the budget would not balance.

·       £14m budget growth is required for adult social care to support the growth in demand and needs with care packages as well as ensuring payment of the national living wage.

·       Any additional adult social care funding has been on an ad hoc basis rather than from a systematic reform of the overall funding. Government have indicated increased public sector funding overall from 2025/26 but the institute for fiscal studies have indicated increases for the NHS and defence means that there is likely to be a reduction in real terms funding for all other areas of expenditure including local government.

·       Other budget pressures include £17m growth in children’s social care driven by increasing children in care, complexity of need and unaccompanied asylum-seeking children; home to school transport for SEND pupils is also a cost pressure with the number of requests for education, health and care plans doubling since prior to  ...  view the full minutes text for item 38.

The Director of Adult Social Care and Safeguarding submits a report updating the Commission on proposed changes to the charging policy.

The Deputy City Mayor for Social Care, Health and Community Safety introduced the item and highlighted that the proposal is being considered as part of reviewing all spend and income due to the local authority’s difficult financial situation to protect the broader adult social care service and Council generally. It was noted that there is no accurate identified potential income/savings if the proposal were to proceed as everyone would need to be reassessed and discretion applied.

The Deputy City Mayor expressed thanks to the Director for Adult Social Care and Safeguarding and her team for their approach in consulting with individuals as part of the process.

The Director for Adult Social Care & Safeguarding presented the report, and it was noted that:

·       Members were informed in October 2023 of the consultation on the proposed changes to the charging policy. The consultation concluded on 31 December 2023 and analysis of meetings, surveys and representations is underway.

·       The Care Act 2014 altered financial charging and made it permissible for local authorities to take into account the full value of disability benefits – this has not been implemented locally despite a previous consultation. The current consultation proposes to implement changes to charges.

·       The consultation also included the proposal to introduce an admin charge where the local authority acts as an appointee for an individual and they have savings above £1,000. The proposed fee has been benchmarked against fees charged by other local authorities and is intended to cover back-office costs.

·       The report contains simplified examples of how the proposed changes may operate but recognised that it is a complex task, and everyone’s situation will be different and require assessment.

The Commission were assured that a further report will be provided once the consultation responses have been analysed alongside an equalities impact assessment.

In response to questions and comments from Members, it was noted that:

·       The additional £16m to fund care packages through the private sector is associated to external pressures such as increased growth in demand and complex needs, inflation and ensuring payment of the national living wage which is not directly comparable with managing the budget.

·       The proposed fee of between £14-£16 for acting as an appointee equates to the internal admin costs to process and benchmarking against other authorities. It is unknown whether other local authorities will introduce or increase their fees.

·       The potential income/savings if the proposal were to proceed is uncertain as consideration of individual cases and discretion would be applied rather than a blanket charge – this would comply with the Norfolk Judgment.

·       The Authority has only been able to estimate individuals in receipt of the higher rate based on DWP eligibility model as it does not currently charge to have accurate data. Everyone will also need to be assessed as individual circumstances will differ to how the benefits may be utilised to support care needs.

·       The cost to implement the change if the decision was taken to adopt the proposal would be included in the first year’s savings  ...  view the full minutes text for item 39.

The Director of Adult Social Care and Safeguarding submits a report providing the Commission with an overview on direct payments.

The Executive Lead Member for Social Care, Health and Community Safety thanked the Commission for requesting consideration of direct payments. It was noted that is an important topic which has been subject to local, regional and national discussions regarding use, challenges and recognition of the important work with Think Local / Act Personal (TLAP).

The Director for Adult Social Care & Safeguarding presented the report, and it was noted that:

·       Leicester was an early adopter and had celebrated its 25-year anniversary of using direct payments in which we benchmark well with the percentage of people in receipt. 

·       The premise of direct payments is to offer flexibility, choice and control for individuals, although a balance is required as challenges can arise with the use of public money. 

·       The Authority worked with TLAP to co-produce revised guidance to distribute to individuals about direct payments and captured learning from the pandemic where there was an expectation to increase flexibility on direct payments.

·       The Direct Payment Support Service is provided to support individuals in receipt of direct payments to manage the funds. Three providers are contracted to offer a range of services from fully enabling an individual to spend their direct payment award to limited employment support or payroll advice. 

·       The Authority worked with IMPACT at Birmingham University to undertake a year-long study on how black and ethnic minority communities use direct payments - a hyperlink to the research was included within the agenda pack.

·       Challenges persist around the financial audit expected of how individuals are spending direct payments. The flexibility, choice and control allow an individual to decide how to use their award and can limit oversight where the individual chooses a non-contracted provider or personal assistant. Advice is provided but concerns can arise to the ability to fully safeguard individuals using direct payments. Caution is exercised in ensuring direct payments are appropriate for an individual if they may be at risk, but this must be evidenced as choice to use direct payments is a legal right.

·       The use of direct payments in the city overall is positive. A working group has been developed to draw on support and address challenges to promote the benefits and protect public monies. 

The Commission praised the division for its 25-years of advocating the use of direct payments to give resident choice and control but recognised the concerns and risks.

In response to questions and comments from Members, it was noted that:

·       It is recognised that safeguarding concerns are possible with individuals using direct payments, such as the risk of exploitation. Oversight is only possible where an individual chooses a provider contracted with the local authority. The authority is liaising with the CQC about an approved list of agencies to promote to individuals and remove an agency where a safeguarding concern is referred and identified. Individuals can also employ a family member or friend and are not required to inform the Authority of details.

·       Individuals are encouraged to utilise the disclosure and barring service and check references if  ...  view the full minutes text for item 40.

The Director of Adult Social Care and Commissioning submits a report updating the Commission on the progression of the closure of the Hasting Road Day Centre.

The Deputy City Member for Social Care, Health and Community Safety assured the Commission of the additional resource allocated to ensure individuals and their families are appropriately supported in identifying and transitioning to alternative services and expressed her thanks to officers for their continued work following the difficult decision to close the day centre.

The Chair noted the Commission’s recognition in the positive progress and sensitive approach in managing the closure of the day centre.

AGREED:

·       The Commission noted the report.

·       The Commission requested the item remain on the work programme.

The Director of Adult Social Care and Commissioning submits a report updating the Commission on the results of the work undertaken by the Taskforce investigating the increasing cost of care packages within Adult Social Care.

The Chair noted the report contained within the agenda included responses made to recommendations of a Task Group and asked Members if there were any comments for which there were none.

AGREED:

·       The Commission noted the report.

The current work programme for the Commission is attached.  The Commission is asked to consider this and make comments and/or amendments as it considers necessary.

The Chair noted the final meeting of the municipal year will take place on 7 March 2024 and that the work programme had been busy discussing important topics.

Members were requested to email additional items for consideration to the Chair.

The Chair noted the Commission looks forward to welcoming the new Strategic Director for Social Care and Education, Laurence Jones, who is expected to start in role early February.

There being no further business, the meeting closed at 18.51.