Agenda and minutes

Councillor Kirsty Jones  -  caring responsibility

Councillor Sulcan Mahmood  -  work commitments

Councillor Sajid Mohammed  -   unwell

Sarah Collis  -  Chair, Healthwatch Nottingham and

Nottinghamshire

None

Minutes of the meeting held on 21 November 2024, for confirmation

The Committee confirmed the Minutes of the meeting held on 21 November 2024 as a correct record and they were signed by the Chair.

Report of the Statutory Scrutiny Officer

Councillor Pavlos Kotsonis, Executive Member for Adult Social Care and Health, and Vicky Murphy, Corporate Director for Adult Social Care and Health and Health presented a report on the proposed new efficiency-led savings and income proposals for Adult Social Care as part of the Council’s coming 2025/26 Budget. The following points were raised:

a)  There are a number of proposals within the Adult Social Care that build on previous savings agreed as part of the Council’s 2024/25 Budget. These new proposals are designed to streamline services to ensure that they are efficient, whilst reducing costs to the Council. There are clear focuses on early intervention and prevention in the community, the realignment of service pathways so that they are more straightforward, and the maximisation of grant funding from central Government and NHS England to achieve improved value for money.

b)  The demand for Adult Social Care services continues to rise across the city, along with the complexity of care needs. The Council aims to do as much as possible to support people in remaining independent whilst providing the appropriate levels of care and ensuring that needs are met. There will be a full review of intensive and high-cost care packages to ensure that provision remains appropriate to the need, with a key aim being to ensure that people can thrive. Engagement will be undertaken with Commissioning and Procurement colleagues to ensure that contracts are managed robustly so best value for money is achieved. There will be work done around Reablement services to improve outcomes for the people who use them and reduce the need for more intensive intervention on an ongoing basis.

c)  A review of the Direct Payments system will be carried out through dip-sampling to better understand where the full payment is not being used and where efficiencies can be made. However, no direct change to the policy for making Direct Payments is proposed at this time. There will also be a review of social care transport provision to ensure that a consistent, equitable and value for money service is provided. The review will be focused on individuals in receipt of mobility-related benefits and will consider how these could better meet a person’s transport needs. This activity will take place alongside a cross-cutting review aimed to optimise the Council’s internal vehicle fleet and reduce reliance on taxis, which has incurred an annual cost of £503,000.

d)  The 2025/26 Council Budget out for public consultation presents a range of cross-cutting proposals and the work to draw together delivery plans sits with the Council’s overall Transformation Board. This activity is in its early stages and establishing how the cross-cutting action will impact on individual directorates is still in development. As a cross-cutting issue, there are a number of different ‘front doors’ to services across the Council. Adult Social Care is exploring how points of access to services could be streamlined and work is underway to look at how other Local Authorities have successfully introduced more efficient systems and learn from their experiences.

The Committee raised the following points in discussion:

e)  The Committee asked what engagement with partners had taken place during the development of the proposals, particularly other care providers such as the NHS Nottingham and Nottinghamshire Integrated Care Board (ICB) that were considering savings proposals of their own, and how the potential cumulative impact to the whole care system had been considered. It was explained that the Council engages closely with the ICB on discussions around budget setting proposals and the need for joined-up working. Activity is underway to consider an aligned way of working to ensure continued care. Weekly meetings continue to take place to review cases and ensure that no one is left without the care that they need. Particular action was recently put underway to address the large number of people who are re-admitted to hospital within 48 hours of being discharged. The ICB and the Council will continue to work together through the budget process, acknowledging that the whole system is under significant pressure.

f)  The Committee asked what could be done to maximise the provision of care support through Direct Payments, as it had been shown that this was a more cost-effective way of delivering effective care provision. It was reported that it is an ambition of Adult Social Care to improve and extend the use of Direct Payments and the use of Personal Assistants, as this model has been shown to provide better care at reduced cost. However, there is a significant shortage of social care Personal Assistants, with the associated training process being fairly lengthy. This piece of work is yet to be started, but is currently being scoped.

g)  The Committee asked what work was being done to regularly review care packages and to increased joint working between Social Workers and Occupational Therapists, to ensure that care packages were in line with the need. It was set out that work is underway to increase strength-base practice within Social Worker teams, however, this is in the context of increasing service demand across the city. To help to mitigate this and ensure that the care package reviews are undertaken in a timely way, two independent companies have been engaged to do the review work, while also providing training to Social Workers in reviewing care packages. There is a significant push within Adult Social Care to ensure the right core service offer and achieve a position where there is not a need to rely on outside resources for care package review work.

h)  The Committee asked why 60% of people return to medical care within 48 hours of being discharged from hospital, and how effective processes of risk management were being put in place. It was explained that this figure was only established very recently, so work is underway to understand more around it and what it means locally, as well as how it compares nationally. Currently, around 60% of people discharged from hospital as medically fit (with a care package in place) return to hospital within 48 hours. As a result, clear engagement is needed with healthcare services to ensure that adequate integrated rehabilitation provision is in place for the most vulnerable people to reduce readmittance rates.

i)  The Committee asked how the review of Adult Social Care transport would be carried out, and what benchmarking work had been undertaken with other Local Authorities around social care transport policies and mobility payments. It was reported the transport review was designed to take place alongside a cross-cutting review of the overarching Corporate Transport Policy. The focus will be on people in receipt of mobility-related benefits like the Personal Independence Payments and exploring how to use the payments to achieve best value for money and promote independence. The cross cutting, corporate review will look at how to optimise the use of the internal vehicle fleet and reduce reliance on taxis, which are much more costly. Engagement is already underway on how other Local Authorities across the country have developed their social care transport policies and implemented more efficient ways of working. However, this work is still in its early stages and needs more time to develop.

j)  The Committee asked how ways of working at the strategic leadership level would change to respond to the need for significant transformation within Adult Social Care and monitor the transformation process. It was set out that significant savings needed to be made across Adult Social Care and that appropriate ways of working were in place at the strategic level to deliver these. Reporting and monitoring has changed in response to the challenges and new ways of working, to ensure effective performance management.

k)  The Committee asked what support was available for people to know what social care benefits they were entitled to and how best to access them. It was explained that Social Workers are very knowledgeable around signposting, helping and supporting services users in establishing what benefits they can access and how to apply for them, whether that is an application online or in person. There are also support staff within the Department for Work and Pensions who will help signpost people and show them to how to apply as a form of early intervention.

l)  The Committee noted that the Care Quality Commission had reported that consultation with social care service users and families could be improved and asked how the Council had engaged with these people around the new proposals. It was reported that, although not part of the wider public Council Budget consultation now underway, there will be direct consultation and engagement with both service users and social care staff, with public meetings taking place where appropriate. In January 2025, the Co-Production Community and Carers Board will be launched, which will be co-chaired by service users and developed in co-production with Nottingham people. This will also feed into commissioning activity and policy review.

m)  The Committee asked what plans there were to reinvest savings in the Adult Social Care service, and where the priority areas for this would be. It was set out that savings targets for 2023/24 and 2024/25 have not been met in full and so, even with reinvestment, overall savings targets have not yet been achieved. To meet these targets, it is essential that the Council invests in early intervention to reduce demand for later-stage and crisis services that are more intensive and costly. This is a national challenge and not unique to Nottingham, although the Council is in the highest quarter of Local Authority spend on Adult Social Care services.

n)  The Committee noted there were unrealised savings in previous Adult Social Care budget processes and asked whether the reasons for this had been reviewed. It was explained that one of the main contributing factors in the shortfall in achieving savings targets has been the significant increase in need, with further growing costs for commissioned services, while national funding levels have decreased. Adult Social Care is focused on ensuring an efficient core offer so that savings can be made across the service, and this approach is intended to ensure that other identified savings are deliverable. In 2023/24 and for some of 2024/25, the transformation programme across the Council was in its infancy. The savings that were due to be delivered as a result of transformation were delayed as the process was not as developed and mature as the savings programme required. Despite these delays, Adult Social Care found a number of mitigations to ensure that savings were made where possible as the Council’s transformation process develops, and that the strength-based practice continues to be established in all areas.

o)  The Committee members asked how the Council assessed service need and how it would maintain equity of access if there was a shift to digital access in most cases. It was reported that, although digital ‘front doors’ to services will be created, the Council will not be removing access through other means, so if someone is unable to use digital means they will still be able to access services and signposting through more traditional methods. Data dashboards are being used to set out who needs Adult Social Care services and where they live in the city, which new casework tools in place to make greater use of the available data.

p)  The Committee asked whether the Council had taken learning from other Local Authorities around the use of Artificial Intelligence (AI) to support access to services. It was set out that work was being done to explore different systems and what could be done with AI to support a range of services such as translation, responding to Subject Access Requests and updating notes within systems. All of these could result in enabling more time for Council staff to focus on providing services directly. However, this work is in its infancy and will take time to develop.

q)  The Committee noted that, ultimately, there was not a significant level of information available at this time on the potential impacts on the Adult Social Care service of the cross-cutting Budget proposals currently out for public consultation, so it was not yet possible for these to be scrutinised effectively in terms of their likely impacts on service users, the risks to delivery or the potential mitigations.

The Chair thanked the Executive Member for Adult Social Care and Health and the Corporate Director for Adult Social Care and Health for attending the meeting to present the report and answer the Committee’s questions.

Resolved:

1)  To request that a summary is provided of all of the new Adult Social Care savings and income proposals not requiring public consultation, alongside the existing summary of the ‘Review of Adult Social Care Transport’ proposals, with any associated Equality Impact Assessments included.

2)  To request that further information is provided on the new approach to the delivery of Direct Payments, as this develops.

3)  To request that further information is provided on the Council’s overarching Corporate Transport Policy in the context of how it will be used to support people with Adult Social Care needs.

4)  To request that further information is provided on how Personal Independence Payments in relation to mobility have been benchmarked against those of other Local Authorities.

5)  To request that further information is provided on now other Local Authorities have been developing the use of Artificial Intelligence to help improve access to and the delivery of services more efficiently.

6)  To request that further information is provided on how new data dashboards are being used to set out information relating to the delivery and performance of the Adult Social Care service in an accessible way.

7)  To recommend that Adult Social Care works as closely as possible with NHS partners in understanding the care needs and experiences of people to be discharged from hospital so that they can be supported effectively, to avoid any unmet needs resulting in them being rapidly readmitted to hospital following discharge.

8)  To recommend that a close partnership approach is taken by Adult Social Care with its healthcare partners on the effective identification and assessment of risk on a system-wide basis.

9)  To recommend that full consideration is given to how the Council as a whole can deliver early intervention action across its services so that people are able to access all available benefits and support as easily and as soon as possible, to prevent their care needs escalating unnecessarily.

10)To recommend that full consideration is given to the reasons behind why the needs of people within the Adult Social Care service can escalate to a point of crisis, and how early intervention can be used effectively to mitigate against this.

Report of the Statutory Scrutiny Officer

The Chair presented the Committee’s current Work Programme for the 2024/25 municipal year.

The Committee noted the Work Programme.