Agenda item

Purpose: To discuss the measures being taken to manage the Directorate budget, with a particular focus on Adult Social Care. 

(Councillors David Rendel and Jeff Beck declared a personal interest in Agenda item 5 by virtue of the fact that they had relatives living in a care home in West Berkshire.  As their interest was personal and not prejudicial they were permitted to take part in the debate and vote on the matter).

The Committee considered a report (Agenda Item 5) concerning the budget pressures within Adult Social Care.

Jan Evans introduced the item by highlighting the following points made in the report:

·                    The month 8 budget position was little changed from that reported at month 7, with a forecast overspend of just over £2m. 

·                    Negotiations with NHS Berkshire West with regard to Continuing Health Care cases did not achieve the level of savings hoped for.

·                    A pressure of £830k had been identified due to the number and complexity of need of older residents and those with a physical disability.  An example of this was where an elderly individual, who was perhaps very frail, was discharged from hospital with substantial needs to be met to allow them to stay in their own home.  Two carers often had to be employed in this circumstance. 

·                    The option of ceasing to offer new nursing home placements was considered, but there was concern that the Royal Berkshire Hospital (RBH) would fine local authorities for delayed transfer of care which removed this possibility.  The Council had not been fined by the RBH as any delays had been kept to a minimum.  However, the North Hampshire Hospital had fined the Council a sum of £12k. 

·                    NHS Berkshire West had funded 14 nursing home placements up to 31 March 2011 to help reduce the immediate pressure, this amounted to savings of around £150k.  These placements were in the budget build for next year. 

·                    A total of 8 capital depleters were identified in 2009/10 and these were still being funded.  This had risen by a further 14 in the current financial year and the Client Financial Services Team had identified a further 6 that could potentially be added in the coming months.  This would continue to be a pressure in 2011/12 and provision for 28 capital depleters had been built into the budget.  The recession was felt to be a factor in the increase in capital depleters.  This and other pressures had been included in budget modelling work undertaken with Accountancy which, it was hoped, would lead to a significant increase in the budget from 2011/12 onwards. 

·                    A difficulty with managing the capital depleters budget was the fact that many clients were self funding when they originally moved into a nursing home, however this meant they were not known to the Council when they came forward for assistance. This became an option when an individual’s capital had depleted to the threshold level of £23.5k (this covered total cash assets as well as property).  It was however possible to estimate the length of time a client would reside in a nursing home, which meant some turnover was expected in the next year. 

·                    Approximately 36% of clients did not contribute to their care, the remainder contributed up to £100 per week.

·                    People were living longer, but with a greater degree of frailty and need than was previously the case.  They could be at significant risk if they were not appropriately assisted.  The level of assistance required was based on eligibility criteria. 

Members felt there was some scope based on the awareness of the age profile of clients, services required and cost etc to help manage future service provision and budgets.  Jan Evans described modelling work in place to achieve this.  The work covered all the major commissioning budgets, gave consideration to strategies for supporting people and analysed activity data over the previous 3 years to help identify trends, all alongside knowledge of the service.  The fact that client cost was increasing was also considered as was national demographic data.  This linked to the budget modelling work undertaken with Accountancy which was soon to be endorsed.  Jan Evans agreed to look at ways of extending work on local demographics based on the awareness of the number of over 85 year olds currently in the system and expected in future who were more costly to support. 

It was then queried whether there was any software available that could assist with modelling and Jan Evans was not aware of such a system elsewhere in the country at this time.

Returning to the subject of capital depleters, it was noted that this became more expensive as an individual’s capital reduced below the £23.5k threshold until it reached the level when care was fully funded.  This level of detail had not been covered in the modelling and Councillor Jeff Brooks proposed that it should be included. 

A comparative analysis of other Berkshire local authorities had commenced.  An issue in West Berkshire was its level of rurality compared to elsewhere.  Differing levels of affluence impacted on the number of clients requiring financial assistance with their care, i.e. numbers in Wokingham were fewer than West Berkshire.

It was then questioned whether the figure arrived at from the budget modelling exercise was sufficient for the coming financial year.  Jan Evans advised that while this could not be completely accurate, the figure produced was based on the detailed information already described, many variables were taken into account, external and internal accountancy advice was sought and as a result this was felt to be sufficient to meet current demand.  Contingency was factored into the risk fund. 

Andy Walker added that the model for 2011/12 was an improvement and he was confident that an appropriate sum of money had been identified.  The model would continue to be monitored and modified for future years. 

While this work was acknowledged, concern remained for some Members that overspends could continue as in previous years.  I.e. the budget for 2010/11 was found to be insufficient early on in the financial year, although it had remained fairly steady since that time.  Under budgeting could lead to savings again needing to be found from elsewhere in the budget. 

In response, Andy Walker advised that there was significant financial challenge in the medium term and it was therefore vital to keep budgeting accurate and tightly managed. 

RESOLVED that:

(1)       Jan Evans would look at ways of extending work on local demographics based on the age profile of residents. 

(2)       The need for future modelling to include the increasing costs of capital depleters be recommended.