To consider the report of the Finance Manager.
Minutes:
Documents:
· Period 5, August 2019, Adult Social Care
Discussion:
· At the end of period 5 the projected overspend at year end had reduced to £1.071M
· Additional savings of £539K have been achieved but this has been mitigated by pressures committed for 20 new and 14 temporary residential/nursing placements to reduce Delayed Transfers of Care (DToCs). It was noted that the ultimate aim was to discharge patients to their home but sometimes a step-down stage may be required. Officers continued to work closely with the Health Board to address the issue of DToCs and the trend was improving.
· The Committee sought assurance regarding unplanned issues arising during the year. The service intends to deliver all savings identified but the main pressures could occur over the winter period. The Regional Partnership Board and Health Board have committed £1M and this will be used to alleviate winter pressures.
· At the beginning of the financial year, pressures of £9.534M had been identified. To date £3.915M have materialised. There has been no uplift to service providers which will reduce this pressure by £2.762M.
· Savings of £7.8M had been identified at the beginning of the year – delivery of £2.7 have been achieved and if no uplifts are provided this will increase by a further £2.7M
· The Committee asked for progress in ensuring costs were appropriately apportioned between the Authority and Health Board. Continuing Health Care is a complex issue. Joint assessment is in place and a decision support tool is used in the decision-making process. An expert in this field has been reviewing cases which may not be clear cut. This process will ensure there is more clarity for both parties. It was suggested that a further report be provided to a future Committee.
· The Head of Commissioning was asked if strategies were in place with the Health Board for investment in early intervention and prevention. Section 33 agreements were in place which allowed the pooling of funds by both authorities. Such agreements were in place for Glan Irfon Intermediate Care Facility, Substance Misuse and the Equipment Service amongst others. There is also close co-operation in support for informal carers with Credu being jointly commissioned to provide an information and advice service.
· Officers were asked how the Authority compared with other Welsh Authorities. In some instances, Powys was ahead, for example with S33 Agreements which have been in place in some form since 2003, but other areas it are not so advanced.
· Members noted that the introduction of Glan Irfon in Builth Wells had received some opposition from the local community and asked if there was evidence to measure the success of the facility. Glan Irfon was an Intermediate Care Facility which was proving to be successful and had been accepted within the community. The service was currently working with a new provider to consider whether provision should be reviewed. For example, Members had suggested that palliative or end of life care should provided. There were 12 beds, 10 of which were currently occupied.
· The level of debt within the service was noted with half of the Council’s debt being recorded within the Adult Social Care budget. The Committee asked whether the Enforcement Agency was successful, and it was suggested that Income and Awards provide greater detail to a future meeting of the Committee. It was also noted that a legal charge could be put on a person’s property who was receiving residential care. A further report was requested on the legal implications of these charges.
· Plans were in place to use the Capital budget
· There was some confusion regarding the way the Council’s finance reports were presented. Savings are included in the budget at the start of the year and as they are achieved, the projected overspend reduces. The service was confident that the budget would balance by year end but advised that winter pressures were unpredictable.
Outcomes:
· Further information to be provided on the following topics:
o legal implications of legal charges against properties of those in residential care
o the work of the Enforcement Agency
o Continuing Health Care – apportionment of costs
Supporting documents: