The Committee considered a report of the Director of Adults and Communities, the purpose of which was to advise on the current demand pressures being faced by the Adults and Communities Department and the impact of this demand on the 2021/22 forecast departmental budget outturn. A copy of the report marked ‘Agenda Item 10’, is filed with these minutes.
Arising from discussion the following the points arose:
(i) Regarding the table at paragraph 28 of the report which showed the difference in spend between Leicestershire and comparator authorities on overall expenditure on adult social care and on the amount of spent on older adults, a member commented that Leicestershire had spent considerably less than the other authorities listed on long term care for older adults in 2019/20. In response the Director confirmed that local authority’s expenditure levels largely depended on the level of funding they received. Therefore, this did not mean that the Council was not meeting the care requirements of those with eligible needs, rather that other areas of the country receiving greater levels of funding were in a better position to provide higher levels of funding. Leicestershire had been the lowest spending authority out of 151 councils for that particular area of care for the year 2019/20, but other authorities such as Nottinghamshire and Derbyshire County Councils had received significantly more funding per head of population thus providing them with the ability to spend more. For the year 2020/21, Leicestershire’s position had improved somewhat to 143 out of 151 despite the Council remaining the lowest funded council in England. The funding allocations were determined by a complex formula set up by the National Government which took into account a range of factors such as deprivation and income. Representations previously made by the Council to the National Government had raised the need for fairer funding for Leicestershire.
(ii) A member commented that there could be a difference between providing care in line with statutory responsibility and meeting people’s care needs entirely. It was questioned whether Adult Social Care in Leicestershire should be a higher priority area to receive additional funding. In response it was confirmed that in order for the Department to continue to meet the needs of its service users, a significant amount of growth would be required going into the next financial year.
(iii) With regard to the Department’s performance in recent years, the Director explained that in 2015 the Department had the highest growth requirement outlined in the Council’s Medium Term Financial Strategy of any other Department, but by refocusing its strategies on providing the right outcomes for the right people it had successfully managed the budget each year between 2015 and 2019, significantly reduced its additional growth requirements and even declared an underspend indicating that people’s needs had been met with the budget available at that time. It was confirmed that meeting people’s needs would always be the highest priority, but this needed to be done in the right way to help people live as independently as possible and delay the need for long term care.
(iv) In response to a question as to whether the Council’s strategic aims to support people to live at home for longer affected the statistics shown in the aforementioned table at paragraph 28 of the report, officers undertook to provide an East Midlands comparison of people aged 65+ supported either in the community or in a permanent placement in the next report to the Committee on departmental performance.
(v) In regard to the UK-wide 1.25 per cent Health and Social Care Levy which was due to be introduced from April 2022 to bring forward an additional £12 billion per year for health and social care over the next three years, it was expected that for at least the next two years the majority of the funding would be directed towards the NHS to tackle the backlogs of cases for elective services that had accumulated during the Covid-19 pandemic. It was therefore unlikely that any additional funding from the levy would be received from the National Government for social care until 2023/24 onwards once its plans for reform came into effect.
(vi) The most significant factor that had contributed to the increased demand in social care services in February 2021 referenced in paragraph 8 of the report had been the influx of patients to the Leicester Royal Infirmary who at that time were receiving a record number of patients of around 900 per day into its accident and emergency department. As health and care services worked in an integrated way there had been a knock on effect to local social care services and other services who were also responding to the additional numbers of patients by ensuring the appropriate care packages were put in place for a timely and efficient discharge. Due to the national restrictions that were put in place to stop the spread of Covid and allow hospitals to focus on managing Covid related demand, there had been a delay to the normal winter pressures relating to other illnesses such as the flu that were usually experienced during the months of December and January. The impact of the pandemic requiring hospitals to postpone or cancel elective treatments was also significant and having an ongoing effect on hospitals being able to meet the continuously high level of demand.
(vii) In response to a question the Director confirmed that having fewer self-funding residents being admitted into care homes would have a significant impact on the Council’s budget going forward. Members noted that in terms of the care home placements that the Council funded there were two types of additional payments that the Council could be required to pay. One was a supplementary needs allowance for when a person’s additional needs required them to have a level of care above the standard fee. The second was a local authority assisted funding allocation which came into play when the fee for a care home placement was higher than the fee the Council would ordinarily pay. Since the Covid-19 pandemic the percentage of services users requiring the Council to make an additional payment had doubled from 20% to 40%. This was because care providers had increased their fees for placements to make up for the additional costs they had experienced throughout the pandemic. For example, to meet new requirements brought in by the National Government around workforce and Personal Protective Equipment. Another factor was that care homes were experiencing a higher level of bed vacancies than ever before due to the effects of Covid-19.
(viii) The Committee noted the update and offered its thanks to the staff in the Department for their continued efforts to keep services running and meet service user’s needs despite the significant financial restraints and ongoing challenges being faced.
(a) That the update regarding the current demand pressures on the Adults and Communities Department’s Forecast Budget for 2021/22 be noted.
(b) That the Director be requested to include an East Midlands comparison of people aged 65+ supported either in the community or in a permanent placement in the next performance report to the Committee.