Agenda item

Resolved: that the report be noted; that the service should be commended on its successes to date; the Committee believes that – despite the risks and pressures – the service should continue to work on managing costs and on managing demand.

6.1    Tom Brown (Executive Director for Community Services) introduced the report – the following key points were noted:

·         The budget for adult social care was currently projected to underspend by £1.9m.

·         Some of the underspend was predicated on the allocation of non-recurring grants. There was no indication what decisions would be taken by government regarding those grants next year.

·         There were a number of risks facing the service – these included demographic pressures of an older population and associated pressures on hospital admissions and discharge.

·         This week Lewisham Hospital had been in a “particularly bad state”. The standard grading for pressure on services was based on a green, amber red rating. Beyond the standard rating system there was also a ‘black’ rating, which is where the hospital had been this week.

·         There was more demand in the emergency department than there were beds available. Inevitably, this meant that there was more demand for discharge of patients to adult services – combined with higher levels of dependency. This resulted in increased financial pressures on the Council.

·         There were also increasing numbers of complex cases reaching adult social care from children’s social care.

·         The caseload was around 30 young people a year – not all of whom had high support costs – but a significant number that did (of typically £1500-£2000 a week each).

·         The team in adult social care had a good understanding of the pressures on the service and the costs. The service worked hard to remain within its statutory obligations whilst also delivering services within the resources that were available.

6.2    Tom Brown responded to questions from the Committee – the following key points were noted:

·         The service was working to manage the costs associated with complex cases. A joint transitions team had been created to manage the transition from children’s to adult social care.

·         Adult services were working with young people from an earlier age to ensure that they were as independent as possible. The support provided was individualised and needs based.

·         This work was shifting the focus onto developing independence for young people and encouraging them to maximise their abilities rather than on just providing institutional care.

·         More generally, the service moving from a clinical/health based model to a more social care/assets based approach which emphasised enablement and assets.

·         More than 60% of service users who went through the social care enablement process no longer required ongoing care.

·         Work was also taking place to ensure that residential care and support could be provided locally.

·         The large majority of residents were treated at Lewisham Hospital (although about 10% went to Denmark Hill).

·         There were a number of complex issues associated with linking the different IT systems being used by the service.

·         The consolidation of IT systems would allow for the streamlining of social work processes.

·         The charts in the report provided an overview of the costs associated with care packages – however – it should be noted that each April there was an increase in costs due to inflation.

·         The cost of care packages for older adults was relatively stable – but there was an increased cost associated with complex care for younger people.

·         Officers were confident that the service would underspend its budget this year – but there were challenges in the coming year, including: the requirement to make cuts and unrelenting pressures on existing budgets.

·         If grants from government for social care were ended – there would be significant implications for the NHS.

·         The local domiciliary care market was good. The Council’s support for the London Living Wage was important.

·         The local (and national) residential care market was more fragile. This was for a number of reasons – including facility costs and the lack of nurses.

·         Lewisham was also susceptible to residential care pressures from neighbouring boroughs. If one local provider closed – there would be a ripple effect across the market in south east London.

6.3    In Committee discussions the following key point was also noted:

·         Members were concerned about the assumptions made in the budget strategy – given that (based on demographics) numbers of service users were likely to increase and that (given the pressure on residential providers) service costs were also likely to increase.

6.4    Resolved: that the report be noted; that the service should be commended on its successes to date; the Committee believes that – despite the risks and pressures – the service should continue to work on managing costs and on managing demand.