Agenda item

Zena Cooke, Corporate Director Finance, and Dave Shipton, Head of Finance (Policy, Planning & Strategy) were in attendance for this item.

1. Deputy Leader and Cabinet Member for Finance and Traded Services, Mr Oakford, provided the committee with a high-level overview of the current financial position of the Council and the process of the budget between now and March 2024. Mr Oakford noted the current deficit for this year was around £30 million with a budget gap of £20 million. The current projected overspend for Adult Social Care and Health was at £30.4 million, but the Corporate Director and other directors had identified management action to bring this number down. It was said that spending controls had been put in place with a note sent around to all employees of the Council. For next year the budget gap was at £100 million, with around £50 million of savings identified. Mr Oakford thanked Mr Smith and his staff for finding savings of £50 million which could be made over the next few years. A gap of £50 million remained which would have to be identified through savings or increased revenue by January 2024.  

2. Mr Watkins made some further comments on the impact on the directorate to identify savings. He thanked the corporate director and his team for their work to find savings while maintaining and improving care for residents through the redesign of services. It was noted that solid plans were in place to deliver savings going forward. 

3. Mr Richard Smith noted that it was a very difficult year and that the next few years would also be very difficult. It was said that there was a need to reduce the overall ongoing demand for Social Care services. Going forward prevention would be key and they were working closely with Public Health colleagues on this with a digital prevention offer commissioned as part of the move away from the traditional offer. The creation of community teams would support people in their communities and help prevent people from entering residential care. Mr Smith noted that they would still support those with eligible needs, and it was up to the Council how best to do this. Mr Smith thanked his team, and finance, for their work. 

4. A Member asked the Cabinet Member what the section ‘Adult Social Care service redesign phase 2 of the ASCH restructure’ on page 59 under ‘Transformation & Efficiency’ savings meant for Kent residents. Mr Watkins said it relates to the shifting of care support from a county-wide offer to a community-level offer. There were now 24 community teams that enabled local expertise and it was noted that the wider service redesign includes technology and enablement. Mr Watkins said that Technology Enhanced Lives would launch this week where residents could be supported at home through technology and equipment rather than in residential care homes. Mark Albiston said this was part of the approach to reshape the front door of care with an early intervention and preventative offer as the new model for social care going forward. Mr Smith noted that it was hard to cover all the details in a summary document. Mr Smith reiterated the ongoing work to change from a traditional care model to a robust community-facing preventative offer. To do this the team were looking to implement Joint Community Teams with NHS partners to support people in the community before they reach the eligibility standard for Social Care. It was said that these teams were not in place yet but the foundations had been put in place over the past 12 months. Mr Smith noted that new models of care featured highly in Securing Kent’s Future.  

5. In response to the previous answers, a Member raised a concern that not enough information or detail had been provided to the committee to allow them to make an informed decision. It was said that the next time the report comes to the committee, further information on the impact of savings on the services provided and Kent residents would be required. 

6. A Member asked the following questions about the impact of the proposed budget on the provision of Adult Social Care services. 

A.    It was asked how the budget aim to negotiate a 5% reduction in expenditure for the Older People's Residential & Nursing contract and the Care & Support in the Home contract was feasible without negatively affecting the delivery of these statutory services given the context of the cost-of-living crisis and the need for staff to get a pay rise. 

B.    A concern was raised about cuts to the expenditure for voluntary services, which provided vital support for numerous residents and held up statutory services, it was asked how the Council planning was on supporting those who may struggle to access services that they were entitled to. 

C.   It was said that numerous suppliers were unaware if their contracts with the Council would be extended beyond the current end date of March 2024. This undermined the ability of these services to forward plans and were losing staff as a result. The situation would negatively impact their future ability to provide services for the local communities they support.  

Mr Watkins said that they were working closely with suppliers and partners, which was key to achieving their transformation and efficiency aims. It was noted that the negotiation on the two contracts mentioned would be achieved through a new approach delivered under the recently appointed Director of Strategic Commissioning, Richard Ellis, to support a strategic approach to residential care, service commissioning and stakeholder engagement. The aim would be to achieve a win-win for both the Council and its partners. Mr Watkins also said that there had been reductions in the grant for voluntary sector services but there was also an effort to reconfigure the services to meet obligations efficiently and effectively for service users. Mr Mitchell said that they were engaging with voluntary sector organisations about the approach from April 2024, this was currently going through internal governance and the outcome would be shared with those organisations soon.      

7.    A Member said that adequate information had not been provided to Members before today’s discussion. It was also noted that making these budget decisions before engaging with partners and service providers, such as care homes, was of concern as any reduction in contract values could have negative knock-on impacts on staff, service users and the overall quality of support. The Chair noted that at this time no final decisions would be made more information could be provided between now and the Budget County Council in February 2024. Mr Smith said that there would be now system-wide reduction in contract values, going forward some might constrict and others expand to strategically meet the needs of residents. Mr Smith noted that this was about moving from a contract and procurement relationship with the sector to one focused on partnerships.    

8.    A Member said that the move to an increasingly digital offer would potentially leave some people behind who lacked digital skills or an internet connection. It was said that this could lead to an increased risk of social isolation for vulnerable people. It was also asked if there was a plan b if the assumed reduction in costs was not achieved when negotiating contracts. 

In response to this question, it was said:

(a) Mr Watkins said that the document would be too long if all the details were  included but there would be more information provided in January and at the February full Council meeting, an additional meeting could be arranged to discuss this further if Members requested to. Mr Watkins noted that the Member was referring to the ‘Making a Difference Every Day Strategy’ which was coproduced with residents who wanted to limit the amount of time spent in a care home. The use of technology would help residents live independent lives for longer, support care workers and would not reduce the level of care residents received. The technology covered a range of devices, such as sensors, several of these would not require the residents themselves to have digital skills but social workers would be trained to be more digitally adept to understand the data provided by these devices. Mr Watkins said that any reductions in contract values would reshape how services were delivered but would not reduce the standard of care. The Council would meet its statutory obligation to meet the care needs of eligible adults. Mr Watkins also noted that the financial plans had been rigorously assessed before being brought to the committee. 

(b) Mark Albiston said that no one answer would fit all the 16,000 people who currently receive a funded care package in Kent but that all decisions on support would follow a lawful assessment and no decisions would be made to bring the Social Care team or the Council into disrepute. The redesign focused on reducing reliance on residential care homes and providing support to residents within their own homes, which people in Kent and nationally have said they want. Technology would support the achievement of this aim and reduce barriers to the provision of at-home care. 

(c) Mr Smith said that the proposals made in the budget and ongoing plans for the future of Adult Social Care in Kent followed tried and tested methods. Mr Smith noted that due to demographic changes and more complex health challenges adult social care provision would be very difficult without a long-term funded solution for adult social care and children’s services. 

9.     A Member asked if the Council were of the assumption that care homes were inefficient by running with spare capacity and if these proposals were proved effective why were they not implemented in the years previously. Mr Watkins said all organisations were more innovative when under the most amount of pressure. Mr Watkins noted that not all care homes had spare capacity and that some care homes outside the current framework could join to increase overall capacity. 

10. It was said by a Member that if residents were to stay in their home longer they required support from the local community services. It was noted that Community Hubs were uncertain about the future funding to be received from Kent County Council (KCC) and that without such services home care would be more difficult. Mr Watkins invited Members to share concerns if a Community Hub in their division was in trouble and his team would reach out to them to help resolve any difficulties.

11.A Member said that the highest risk identified in the risk register was an unsustainable market and that entering into a negotiation to achieve a 5% cut was unwise. The Member requested further information on this at the next meeting. Mr Watkins said that this was noted and would put together a briefing note on this area for the January committee meeting. 

12. A Member asked how quickly they could be expected to see any of the results or financial benefits of the changes proposed for Adult Social Care services going forward Mr Smith noted that due to the current financial climate, this year and the next would be very difficult. Mr Smith said that the Adult Social Care Awards had recently recognised some of the great work by frontline staff. It was said the new strategic commissioning strategy would be about working in partnership with businesses and in-house services to discuss how best to deliver the new model of care.

13. RESOLVED the Adult Social Care Cabinet Committee agreed to:

i.      Note the initial draft capital and revenue budgets including responses to consultation.

2. Suggest any changes which should be made to the section of the budget related to the Cabinet Committee’s portfolio area before the draft is considered by the Cabinet on 25th January 2024 and presented to the Full County Council on 19th February 2024.