To receive and consider the report of the Cabinet Member for Finance and Corporate Finance.
Minutes:
Documents Considered:
Report of the Cabinet Member for Finance and Corporate Transformation.
Issues Discussed:
Children’s Services:
· There are a number of complicating factors within the report in terms of placements and the costs of placements and residential provision to meet the needs of children. The costs in that marketplace are increasing, with placements becoming fewer which is an increased budget pressure.
· In terms of resilience within the workforce and the ability to recruit and retain staff the Service has had to rely on agency workers and there is an impact of those costs on the Council, so the work done by ADSS to cap costs is welcomed as the need for agency staff has continued.
· There is a national problem in terms of placements for profit which is part of the national agenda around eliminating profit. However, we currently have exceptionally high cost placements and we are in a position that we have to find placements for children, sometimes quickly and they can be far away and expensive which is why the closer to home strategy is so important moving forwards. Recruitment and retention and the number of vacancies across Wales are national issues as well which is why the grow your own strategy is also so important.
Questions:
Question |
Response |
Could give quick view on some of those children with complex needs, why are those children costing so much in terms of placements, what are the themes behind the complex needs, and what are we doing at the preventative level to address that through collaborative working or early help. |
Officer Response: In terms of placements the position is that providers can charge for profit and they name their price. This is the position nationally and what we are trying to stop. Some of the placements that we need currently for children with complex needs are not available in Powys Sometimes there is also an overlap with Education and ALN and it can affect both the Children’s Services and ALN budgets.
The Service tracks all children looked after and there has been greater focus on those placements which have a higher cost and the reasons behind this. Some of these may have been historic placements with children and young people who experienced environmental themes. The preventative services through collaborative working with education, health and early intervention are in a much stronger position, with emphasis on community based working and a focus on early intervention. In addition the Flying Start programme is picking up on early themes for children and bringing these to our attention.
Whilst the Children Looked After figures have risen in quarter 3 but there are specific reasons for that and they will reduce, those themes have continued and become apparent during the pandemic but this has not led to the expected increase in numbers. Early intervention and a multi -agency approach is working in the ways which is intended. Welsh Government’s aim of care without profit is to bring those young people back into Powys and possibly stepped down from residential care into a foster family which fits with the Grow our Own Foster Carers strategy or placed back at home.
Even with the intervention work being undertaken, there always be a number of children with complex needs in future but it was hoped that numbers would be diminished. |
Unachieved efficiencies – continuing care. In relation to the £800K savings projected within the budget for the costs of children looked after, and the savings were due to attributing costs across other agencies. Is the £800k saving achievable, working with ADSS Cymru to achieve that. |
Officer Response: With Continuing Care there is a set eligibility criteria for meeting continuing care. There is a checklist devised by Health Boards which has been legislated in terms of Welsh Government. The Service works with Health professionals to identify if a child has continuing care needs.
There is no pooled budgets in respect of continuing care. The individual’s needs are assessed by both Health and Social Care with each agency picking up the costs for their relevant elements based on assessed need. |
This efficiency saving had a red BRAG rating last year. Therefore, was this a realistic efficiency and now that a process has been determined for which cases might be applicable, will next year’s budget be more realistic in terms of continuing care.
Are the thresholds correct in terms of what constitutes health by comparison to social care. |
Officer Response: We have been required to reassess every child to determine the level of need and what the package of care would look like and the cost implication.
It has been acknowledged that the figure is not realistic going forwards and there is not the volume of children with those high level needs to meet the criteria.
With continuing care there is legislation which determined the criteria to be met. Children’s Services have developed a working relationships with the Health Board in terms of those children and their identified needs. |
Special Guardianship Orders (SGO) and cost reductions not met. The project plan is being implemented but there does not appear to be a team in place. Could you remind Members what the project was and why the team is not in place and what is currently happening. |
Officer Response: The Special Guardianship Orders (SGO) project looks at special guardianship orders which are a different way of legally looking after a child. Where a child is subject to a care order the local authority would share parental responsibility. With an SGO the child may live in the same placement but under a different legal order, not sharing parental responsibility with the local authority. The Special Guardian has the parental responsibility and they share that with the parents. Savings are attached to this in a different way as the child is not looked after, does not have children looked after reviews or visits.
There have been delays but the Service is recruiting staff currently to develop the team and have it in place before the end of the financial year. |
There are two costs pressures of £353k for Bannau and £516k for children and residential loans which relate to the use of agency workers. Taking Bannau as an example what is the set budget for staffing costs to understand the percentage differential by comparison with the total budget. |
Officer Response: The staffing and on cost budget is set at £848k in total for 2022/23. The £353k agency overspend is additional over and above to date assuming vacancies are filled from period 7 to the end of the financial year.
Staffing remains a real pressure, despite the number of agency workers within the Service at present. The numbers of permanent staff are increasing in part through the Grow our Own programme |
Adult Services:
· The Service was projecting an overspend of £5k currently by the end of the financial year.
· That is based on achieving a savings target of £3.4m and the Service was on target to achieve that. £1.73m had already been achieved and there was an assurance regarding a further £1.699m by the end of financial year.
· The Committee’s attention was drawn to future pressures in the main relating to increasing pressures on demand over the winter period. The Service is also pre-empting potential increased requests from providers for contractual uplifts due to the wider costs of running a business. There is uncertainty in this but it regularly monitored in terms of potential additional pressures.
Questions:
Question |
Response |
For the year 2023 / 2024 the budget includes the use of £2.4m either from specific reserves or the Covid underfunded pressures. Is this one off funding depending on how the service intends to cope with this pressure. |
Officer Response: Those reserves are one off monies. As the Service has developed its Finance Resource Model (FRM) into 2023 / 24 we have accounted for additional pressures within that year. The mitigating actions are an extension of the efficiency themes such as looking at strength based reviews, promoting the use of Direct Payments as an alternative to the traditionally commissioned Domiciliary Care, and utilising as far as possible technology enabled care.
The Service has been working closely with providers over the past few years to ensure value for money from contracts which is becoming increasingly difficult as there is a difficult balance between achieving value for money and encouraging providers to remain in the market. The Commissioning Team is continuing to work with providers to achieve fair costs of care and ensure contracts are financially viable for providers.
The Commissioning Team has good working relationships with providers. The Commissioning Service has robust contract management processes in place which allows the Council to scrutinise costs and ensure that costs are evidence based. The tea is seeing increased pressures similar to those being faced by the Council such as recruitment and retention, and that partners are reliant on using agency staff which contributes to the additional cost, including increased utility costs and the tea works with providers to ensure that they remain viable. |
In terms of the investment made in the Delayed Transfer of Care (D-ToC) team, can we have an overview on how this impacts the budget going forward whilst ensuring that individuals are discharged with the right sized care packages and the potential financial implications of that. |
Officer Response: The Service has invested approximately £150k into this service to provide a dedicated hospital social work team funded through the base line budget. This allows the targeting of the resource at District General Hospitals out of county, supporting Powys patients to come back into county as soon as possible. This has allowed the facilitation of hospital transfers quicker than before.
Moving into the winter pressures period it is crucial that this targeted resource is in place to remove as far as possible blockages in the wider care system.
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Outcome:
· That any efficiencies identified as a result of collaborative arrangements in 2023 / 24 are realistic and achievable.
Supporting documents: