Agenda item

(To receive a report by the Head of Finance – Adult Care and Community Wellbeing, which details the Council's budget proposals for Adult Care and Community Wellbein) for the financial year 1 April 2022 – 31 March 2023 and the assumptions made given the national context)

Consideration was given to a report by the Head of Finance – Adult Social Care and Wellbeing, which invited the Committee to consider a report on Adult Care and Community Wellbeing Budget Proposals 2022/23 which was due to be considered to the Executive on the 8 February 2022.

It was forecasted that the service would remain within the proposed budget for 2022-23, subject that the subject to the Council’s approval of the introduction of a deferred 3% adult social care applied to cover the cost pressures at any costs arising from the social care reforms in 2023 which were currently covered via a dedicated grant.

She outlined the proposal which detailed that the proposed budget would be sufficient for the Adult Care and Community Wellbeing Service,

The main increases in cost within the budget were:

• £6.262m in respect of the financial rate paid to providers. The largest cost pressure facing adult social care related to the rate paid for care across all services and service types, with a rise in the National Living Wage to £9.50 per hour
• £3.507m reflecting demand across adult social care, particularly in working age adults and mental health, with around a 4% increase in demand for services
• £2.273m new costs arising from the Market Sustainability and Fair Cost of Care Fund 2022 to 2023 published December 2021, in which the Council had received a grant to support the market and move towards paying the fair cost of care. There were conditions alongside the grant that would be predominantly to support the market to move towards paying the fair cost of care as per the social care reforms in the ‘Build Back Better’

The Committee was advised of the key improvements within the service which were underway or due to commence in 2022/23, which included: 

• Continued investments in front line services including housing, reablement, digital technology and community-based services
• Financial Assessment Improvement Programme which aimed to make the process easier to navigate for the individual and provide clarity on the charges through its charging policy
• Continuing to utilise the Better Care Fund (BCF)/Improved Better Care Fund (iBCF) as the vehicle which brought NHS and local government together and delivered the core conditions of the grant

The Council were yet to receive the national guidance which would provide further details of what would be included within the Better Care Fund. However, confirmation had been received that the iBCF would include an inflationary uplift paid directly to the Council of just over £1m.

Members were referred to the table at paragraph 5.1 of the report, which summarised the social care reform announcements to date, highlighting Lincolnshire County Council financial allocation, where it was known. Of the £5.3bn that had been included within the Building Back Better fund within the Autumn statement, £3.6m had been allocated for the fair cost of care in the capital thresholds, and £1.7m had been allocated to support the Council’s wider social care system.

In order for the Council to ensure that they were eligible to continue to receive the grant funding for the next two years , local authorities would need to submit a cost of care exercise and a provisional market sustainability plan setting out a local strategy for the next three years to the Department of Health and Social Care.

Work was ongoing to understand how systems and processes could be amended to introduce the care cap which would be introduced in October 2023.

Consideration was given to the report and during the discussion, the following points were noted:

• The Committee unanimously supported the budget proposals for Adult Care and Community Wellbeing.  The Committee also supported the proposed increase of 3% in the social care precept for 2022-23
• The Government had announced the social care charging system with the intention to address what was commonly seen as an unfair and unequitable system for charging social care between those who paid privately and those who received public support. Officers were working to identify what the differential looked like for both the private and public sector within Lincolnshire. There would be a cost reduction for people paying privately for their care, once the changes were introduced in 2023. However, the cost reduction was not likely to be as great as anticipated as there would be a higher threshold before people received state subsidy, and also a cap on how much people paid. It was emphasised that changes only related to personal care costs and not ‘hotel costs’, which would still be borne by the individual.
• It was highlighted that the number of financial assessments that the Council would have to undertake would likely double from 10,000 to 20,000 a year, as there would be a need to assess privately funded residents and to address the long-standing differential between funded and private costs, which would be costly. Analysis had indicated that a large proportion of the extra money received by the government would largely subsidise people who were currently paying privately for care. 
• The Committee recorded its appreciation to all the officers who had managed the cost pressures on the service over recent years. 
• The Committee also acknowledged the future costs pressures on Adult Care and Community Wellbeing, as a result of the proposed reforms of adult social care, would be substantial, as well as cost pressures on other council services.  The Committee noted that all these pressures would be reflected in the Council’s medium term financial strategy. 
• The Committee recognised the importance of innovation as one way of addressing the budget pressures, and suggested that items be included on future agendas which would look at ways to be more innovative in their approach and included the Improvement Programme for working practices, including initial contact, signposting, assessment and wellbeing services; reviewing the process for financial assessments, including the proposed cap on individual costs and changes to the assessment process; the use of digital technology; and the opportunities arising from the introduction of the integrated care system in Lincolnshire, including consolidating neighbourhood team working.  
• The Committee welcomed the innovative approach that the Council had taken to address staffing issues within the care sector, in particular attracting young people to consider a career in care. It was noted that the Council had been successful in working with organisations within the hospitality industry to attract employees to work in the care sector during downturns in demand within the hospitality sector and upskilling care workers to allow them to take on more responsibility or to train to become nursing staff.
• The Committee raised concerns that social care reforms would lead to an increase in demand for residential care and a significant impact on the Council’s budget for adult care.
• The changes around government policy on integrated care systems had been deferred to July 2022.
• The Better Care Fund remained a significant element in the Council’s ability to manage budgets in future years.
• The Committee highlighted the importance of ensuring that adult care staff had sufficient training and development opportunities and that the Council were stimulating the labour market financially. 
• The Committee recognised the cost pressures that were faced within the adult care and community wellbeing directorate and emphasised the importance of innovation within the sector.
• It was vital that the processes for assessing and signposting people to financial assessments for care were efficient.
• The Committee were encouraged by the expansion of digitalisation and using technology as a way of communicating within communities.

RESOLVED:

1.    That the recommendations to the Executive be supported;

2.    That a summary of the comments made be passed on to the Executive as part of their consideration of this item.