Agenda item

Resolved: the committee agreed to note budget cuts proposals COM 3 to COM 7 and refer its views on COM 1 and COM 2 to the Public Accounts Committee in the following terms:

The committee notes the greater demand on voluntary and community sector (VCS) organisations which would result from the proposals in COM 1 and COM 2 and expresses concern about the impact of funding reductions for VCS partners (as set out in COM 12) at a time when they are being expected to do more. Given this, the committee requests that Mayor and Cabinet does not decide to make these budget cuts until it has carried out and considered an assessment of the extent to which VCS organisations will be able to meet the increased demand as a result of the proposals in COM 1 and 2.

David Austin (Head of Corporate Resources) introduced the report. The following key points were noted:

5.1       The council’s Medium Term Financial Strategy identified the need for continued cuts to be made to the council’s budget over the coming four years.

5.2       This report sets out £21m of cuts proposals against the target of £30m cuts in the two years to 2020/21 - £17m in 2019/20 and £13m in 2020/21.

5.3       The proposals are aligned to the 10 corporate objectives and Lewisham 2020 strategy.

5.4       Officers will be developing and returning with further cuts proposals for the second year (2020/21).

Aileen Buckton (Executive Director for Community Services) introduced budget cut proposal COM1: Managing demand at the point of access to adult social care services. The following key points were noted:

5.5       In order to manage increasing demands on adult social care services, officers are working towards a preventative approach focussed on identifying people who may need support in the future earlier, and working with individuals and organisations in the community to provide support which could delay the need for a formal package of adult social care services.

5.6       Social workers will look at an individual’s strengths, what they can do for themselves, and what other organisations and people, including relatives, in their community may be able to do, in order to make the best use of the available support and make the best use of the social care resources there are.

5.7       COM 1 is part of the Council’s work to manage increasing demands on adult social care.

5.8       National guidelines suggest that local authorities should not spend more than 15% of their adult social care budget on care packages of 10 hours or less, as this level of care can often be accessed by other means and by ensuring that correct levels of benefits are in place.

5.9       Lewisham currently spends 15.5% of its adult social care budget on packages of 10 hours or less. To reduce this the council will look at what else it might be able to do for this group of residents and whether there is other support in the community which can be utilised.

5.10    Officers do not expect a large increase in complaints as social workers will be working closely with individuals and their families to reach agreement.

5.11    The eligibility criteria for adult social care services are national criteria set out in the Care Act and are not expected to change.

5.12    In complex cases benefits advice will be available from advice services in the voluntary sector.

5.13    The people who would be affected by this proposal are by and large younger and likely to be able to gain a level of independence.

5.14    If someone has very complex needs they will be provided with the appropriate support.

5.15    A panel of senior managers will have oversight of all care package reviews and care packages will be reviewed carefully in line with what is feasible.

5.16    It is also important to think about the needs of carers and do a separate assessment for any services they require.

5.17    The principal social worker is developing training for all social workers on how to talk to residents and their family members about what they are able to do themselves and what other support is available which they may wish to access.

5.18    The council has in recent years developed the Community Connections service to work with organisation from the voluntary and community sector to help them grow their services and be more accessible.

5.19    As part of the quality assurance process, regular audits of individual care plans will be carried out to ensure that social workers are taking the same asset-based approach and that there is consistency.

5.20    Officers are confident that the proposed cut can be achieved.

The committee made a number of points. The following key points were noted:

5.21    Given that more people will be expected to access support from the voluntary and community sector, the committee queried whether an assessment has been carried out to ensure that the additional capacity is available.

5.22    The committee expressed concern that the proposal would lead to more pressure being put onto friends and family.

5.23    In cases where a small package of care is crucial to an individual and their family, the committee noted that there is a danger of support not being accessed if family members are expected to take on responsibility for arranging other services.

5.24    The committee also queried whether the identified risk of an increase in complaints could lead to an additional cost to the council.

Aileen Buckton (Executive Director for Community Services) introduced budget cut proposal COM2: Ensuring support plans optimise value for money. The following key points were noted:

5.25    Like COM 1 this proposal is part of the council’s work to manage increasing demands on adult social care.

5.26    As part of this proposal, all newly allocated cases will be based on medium-term goals to support people, where possible, to regain some independence and need less care.

5.27    There is a requirement to visit and reassess a care package annually, but for some people it might be appropriate to go back more frequently in order to adjust their package.

5.28    The proposal also includes an action to complete Continuing Healthcare decisions within national guidelines on timeframes so that the council does not continue funding care which should be funded by the NHS.

5.29    The council is also proposing to work proactively with the care market to purchase more personalised provision and fewer block contracts to meet people’s individual needs. There is a wide range of care providers in Lewisham, across different categories.

5.30    There is not a significant number of social worker vacancies in Lewisham. There are, however, some occupational therapist (OT) vacancies. There is a currently a shortage of OTs. While recruitment of social workers isn’t a problem, retention of social workers is an issue for all London boroughs.

5.31    Officers are confident that they have the workforce, social work staff and commissioners, to support this proposal.

5.32    Emergency reassessments are available (24 hours a day, seven days a week) if someone’s circumstances and needs change very quickly, and this is not going to change.

The committee made a number of comments. The following key points were noted:

5.33    The committee queried whether the adult social care workforce has the capacity to deal with an increased number of assessments, in particular in those cases where people’s circumstances and needs change very quickly.

5.34    The committee expressed some concern about the impact of funding reductions for voluntary sector partners at a time when the council is expecting them to provide more support.

Aileen Buckton (Executive Director for Community Services) introduced budget cut proposal COM3: Increase revenue from charging adult social care clients. The following key points were noted:

5.35    This proposal is focused on increasing revenue by ensuring that the council receives the charges for adult social care that it is owed and that it does not overpay providers.

5.36    As part of this proposal the council is introducing automated systems to provide more accurate billing and invoice processing. This will also allow charges to be adjusted more quickly when people’s care needs change.

5.37    This may lead to some undercharging being identified. In such cases social workers will meet with people face to face to explain and discuss.

5.38    If people need advice about benefits they may be entitled to, in order to maximise their income, social workers can signpost to independent advice agencies.

Aileen Buckton (Executive Director for Community Services) introduced budget cut proposal COM4: Reduce costs for learning disability and transitions. The following key points were noted:

5.39    This proposal is focused on reducing the costs associated with the transition from children’s to adult social care services for those with learning disability.

5.40    The council is in the process of establishing a new transition service which works with young people from an earlier age in order to become more independent and develop packages of support at a reduced cost.

5.41    Work needs to be done to develop the market in Lewisham and redevelop some of the educational and employment opportunities for young adults with learning disability so that they are able to stay in the borough.

5.42    Most supported living accommodation for people with learning disability is within the borough. There are currently 125 units in the borough from a range of providers.

The Chair proposed to suspend standing orders to continue the meeting. The Select Committee agreed to suspend standing orders.

Aileen Buckton (Executive Director for Community Services) introduced budget cut proposal COM5: Increase focus of personalisation. The following key points were noted:

5.43    This proposal is based on increasing the availability of two existing schemes: Personal Assistants and the Shared Lives service.

5.44    Personal Assistants are more prevalent among younger disabled adults. Arrangements need to be put in place, however, for occasions when a Personal Assistant may be unwell, for example.

5.45    The council is looking into the potential of developing training for domiciliary workers which would allow them to progress their career into the health or care market.

Dee Carlin (Head of Joint Commissioning) introduced budget cut proposal COM6: Reduction in mental health residential care costs. The following key points were noted:

5.46    This proposal is focused on reducing the costs of mental health residential care. It does not involve a reduction of care.

5.47    The council is working with providers to change the model of care of some of the existing residential providers from a Residential Care model to a Supported Living model.

5.48    This would allow service users to maximise housing benefit uptake to reduce costs to the adult social care budget.

5.49    Care would still be provided by the care provider, which will still be registered with the CQC.

5.50    Those who are assessed as requiring residential care will still have access to this.

Dee Carlin (Head of Joint Commissioning) introduced budget cut proposal COM7: Reduction in adult social care contribution to mental health integrated community services. The following key points were noted:

5.51    This proposal is focused on reducing management costs and overheads by integrating the stand-alone Social Inclusion and Referral Service (SIRS) within the rest of the mental health pathway. This has the potential to enhance services user care.

Resolved: the committee agreed to note budget cuts proposals COM 3 to COM 7 and refer its views on COM 1 and COM 2 to the Public Accounts Committee in the following terms:

The committee notes the greater demand on voluntary and community sector (VCS) organisations which would result from the proposals in COM 1 and COM 2 and expresses concern about the impact of funding reductions for VCS partners (as set out in COM 12) at a time when they are being expected to do more. Given this, the committee requests that Mayor and Cabinet does not decide to make these budget cuts until it has carried out and considered an assessment of the extent to which VCS organisations will be able to meet the increased demand as a result of the proposals in COM 1 and 2.