SOCIAL CARE & HEALTH SCRUTINY COMMITTEE
12th DECEMBER 2013
NOTE: THESE MINUTES ARE SUBJECT TO CONFIRMATION BY THE COMMITTEE AT ITS NEXT MEETING)
Councillor E. Dole (Chair)
Councillors: S.M. Caiach, S.L. Davies, E. Morgan, B.A.L. Roberts, G. Thomas, S.E. Thomas, J.S. Williams
Councillor A.P. Cooper – Substitute for Councillor J Williams
Councillor I.J. Jackson - Substitute for Councillor A.James
Councillor D.M. Jenkins – Substitute for Councillor T.T. Defis
Councillor D.W.H. Richards – Substiture for Councillor W.D. Thomas
Councillor T. Theophilus – Substitute for Councillor I. W. Davies
Also in attendance:
Councillor J. Tremlett – Executive Board Member (Social Care & Health)
Also in attendance as observers:
Miss A.H. Davies (student)
Mr W.H.C Isenschmid (student)
The following officers were in attendance:
Mr. R. Jones – Director of Resources
Mr. B. McLernon – Director of Social Care, Health & Housing
Mr. D. Eldred – Group Accountant
Mrs. C. Reynolds – Senior Consultant
Venue: Chamber, County Hall, Carmarthen, 10:00am – 12:50pm
1. APOLOGIES FOR ABSENCE & PERSONAL MATTERS
Apologies for absence were received from Councillors T. Bowen; I.W. Davies; T.T. Defis; A. James; W.D. Thomas, J. Williams
The Committee took the opportunity to congratulate the following officers in terms of their recent successes at the BASW Cymru Awards:
● Adele Eaton-Brown for achieving a Certificate of Achievement – Spirit of Social Work Category.
● Elen Harries – Innovative Social Work Category
● Llanelli Community Resource Team – Certificate of Achievement – Social Work Team Category
UNANIMOUSLY RESOLVED that the Committee’s congratulations be forwarded to the officers concerned.
2. DECLARATIONS OF PERSONAL INTEREST
Nature of Interest
4. Revenue Budget Strategy Consultation 2014/15 to 2016/17
Mothere is a Blue Badge holder
4. Revenue Budget Strategy Consultation 2014/15 to 2016/17
Carer for her mother-in-law who has dementia and is in receipt of domiciliary care services.
3. DECLARATION OF PROHIBITED PARTY WHIPS
There were no declarations of prohibited party whips.
4. REVENUE BUDGET STRATEGY CONSULTATION 2014/15 TO 2016/17
[Councillor S. Caiach declared an interest in that her mother is a Blue Badge holder; Councillor J.S. Williams declared an interest in that she is a carer for her mother in law who has dementia and is in receipt of domiciliary care services]
The Committee considered the Revenue Budget Strategy 2014/15 to 2016/17, which had been presented to the Executive Board on the 18th November 2013. The Committee noted that the report was based on officers’ projections of spend for the forthcoming year and that it took into account the provisional settlement that was issued by the Welsh Government (WG) on the 16th October 2013. The report also provided the Committee with an overview of budgetary pressures facing the Council as well as the efficiencies that had been identified to date.
The Committee discussed Appendix A: Revenue Budget Strategy 2014/15 – 2016/17; reference was made to the section 4.5 “Earmarked Reserves” and in particular the nature of the reserves included in the “Other” category. The Director of Resources informed the Committee that the main components were:
● Job Evaluation Costs - £5m
● Fleet Management Reserves - £2m
● SAVIX (Symons Value Institutional) Fund repayments - £0.5m
● Departmental reserves – approximately £900k
Responding to a question the Director confirmed that the cap on charging for social care services introduced by the Welsh Government last year was under review and whilst there were no details currently available there was a suggestion it may be increased in line with inflation.
The Committee went on to discuss Appendix A(i) – Revenue Pressures and noted that the Adult Social Care service had received no additional budget to meet the expected growth in demand for 2014/15 – this amounted to approximately £3.9m. Added to the overspend currently projected for the current year and the requirement to deliver efficiency savings the Service was facing an £8 to £9m shortfall. The Committee expressed concerns at the fact that service pressures identified by the Department were not being recognised in terms of the overall budget strategy, particularly as it was unlikely demand would decrease going forward.
The Committee noted that the Older People service was now the largest area of overspend in terms of Adult Social Care and in response to a question the Director confirmed that this was primarily attributable to increasing demand and the complexity of the care plans required to support people to live independently at home.
The Committee discussed Appendix A(ii) – Efficiency Proposals. Concern was expressed in relation to the intention to reduce grants whilst expecting the 3rd sector to increase its role in delivering support services. The Director explained that there was a need to ensure value for money when commissioning services from the 3rd sector and that he had recently held a very positive meeting with the sector to discuss its role in delivering services more cost effectively. He added that it would also provide opportunities for organisations to work collaboratively and more creatively going forward.
In terms of residential care the Committee noted that 49% of the Adult Social Care budget was currently spent providing this service. However, there were high levels of vacancies within the Council run care homes - currently between 26 and 30 vacant places, which in effect equated to one residential care home.
The Committee discussed the reconfiguration proposals for St Paul’s in Llanelli and was informed that there were currently 7 permanent residents living there and that it was also being used to provide step down support and respite care. In response to a question the Director confirmed that the unit cost of a bed at St Paul’s would normally be £619 per week - compared to £448 for a bed in the independent sector – however, because of the current low occupancy the actual cost to the Council was £795 per week. Reconfiguration would allow more efficient use of this money which would help to support additional care packages. In response to a follow up question the Director of Resources confirmed that the weekly unit cost figure did not include any corporate overheads such as payroll admin costs.
The Committee queried where the permanent residents would live if the proposals to reconfigure were agreed by the Executive Board. The Director explained that individual discussions would need to take place with the residents and their families but that there was capacity for all 7 residents to be accommodated within a Local Authority run residential care home in the Llanelli area – if that was what met the needs of the resident. He added that some may decide to move closer to family members whilst others may require nursing care. This principle would also apply to residents living in the Glanmarlais and Tegfan residential care homes in the Ammanford area, where the proposal to close one of the homes was being brought forward to facilitate the development of the new Extra Care Scheme. The Director added that a similar approach had been taken in the Carmarthen area where his team of experienced staff had ensured a smooth transition for all the residents.
The Committee went on to discuss the proposal to transfer all remaining in house long term domiciliary care to either a Local Authority arms length trading company, social enterprise operation or the independent sector, and noted that the in house provision was costing £5 per hour more than independent sector provision. Concern was expressed about the risks associated with (for example) the new provider going out of business. The Director stated that it would be important to commission services from a variety of providers who worked collaboratively and not in competition with each other. Ongoing meetings were being held with the in house and independent providers to discuss training, standards, recruitment practices, rotas and collaboration. In response to a question he confirmed that if the proposal was endorsed any existing staff would be transferred to the new arrangement and that TUPE - Transfer of Undertakings (Protection of Employment) - Regulations would apply. Some members of the Committee expressed a preference for the arms length company option as opposed to transferring all the business to the independent sector. There was a feeling that the local authority would be able to retain an element of control in terms of service quality. The Committee also expressed some concern about the impact any changes in the economy might have on the independent sector – particularly any future increase in interest rates, given that many may have borrowed money to support the development of their business.
The Committee went on to query how an arm’s length company would save money given that the high in house cost was primarily attributable to the Council’s employment terms and conditions. The Director of Resources explained that although staff would be transferred under the TUPE arrangements and so their existing terms and conditions would be protected, the savings would be achieved when new care workers were recruited – as it was likely that these staff would be appointed on new terms and conditions. He added that much work would need to be done before any changes took place and that the bulk of the savings would not be achieved until years 2 and 3.
The Committee went on discuss the proposals for Day Centres and queried whether there was capacity within the 3rd sector to provide some of the lower level support required. The Director stated that the lunch clubs, day clubs and meals on wheels provision were good examples where the 3rd sector had not only stepped in to provide the service but had actually improved the quality of what was being provided. He acknowledged that there would be challenges but there were also opportunities to make better use of the resources available and improve the quality of service provision.
The Committee briefly discussed the Blue Badge scheme and acknowledged that work was underway to improve the efficiency of the current process, however the suggestion was made in relation to the review period and whether or not this could be extended for older people (for example 80 years and over).
The Committee went on to discuss Appendix C – Charging Digest – Social Services and noted that Ceredigion County Council, for example, was now considering recovering the total costs of providing meals, which would mean an increase to £5 per meal. The Director of Resources added that in the future there would be a need for Carmarthenshire to consider whether service users should pay more for the services they received. The Committee acknowledged this and suggested that, to maximise the current potential income, the unit charge be rounded up to the nearest pound wherever possible.
In conclusion the Committee expressed concerns about reducing the social care budget year on year given that the demand for these services would inevitably rise given the demographic trends. The Director acknowledged that there would come a point where there would be no scope to generate further efficiencies, however Carmarthenshire was better placed than many other Welsh Authorities and that the need to collaborate with other providers was now critical if the Council was to maintain services going forward. Strong political support was now required to realise the benefits available.
UNANIMOUSLY RESOLVED that:
4.1 the report be received noted
4.2 the Committee’s concerns relating to the service pressures not being recognised in the budget be conveyed to the Executive Board
4.3 the proposals for delivery of efficiency savings for the health and social care service areas identified in Appendix A(ii) be noted subject to the concerns expressed by the Committee.
4.4 the Charging Digest for Social Services for 2014/15 be endorsed and consideration be given to rounding the unit charge up to the nearest pound wherever possible.
4.5 the unit charge be rounded up to the nearest pound wherever possible.
5. FIVE YEAR CAPITAL PROGRAMME 2014/15 TO 2018/19
The Committee considered the Five Year Capital Programme report, which provided an initial view of the five year Capital Programme 2014/15 to 2018/19.
The following issues were discussed during consideration of the report:
The Committee queried whether building new facilities should be a priority for the Council given the current budget situation. The Director of Resources reminded the Committee that the bulk of the capital programme was being used to modernise schools, which was seen as the key priority for the Council.
In response to a question he added that the grants drawn down to support capital projects could not be used to subsidise the revenue budget.
The capital receipts target was referred to and the Committee queried how achievable the target was. The Director of resources stated that the £1.5m target was challenging however, with political support, he was confident that it could be achieved.
UNANIMOUSLY RESOLVED that the 5 Year Capital Programme for Health & Social Care Services be endorsed.
6. FORTHCOMING ITEMS
The Committee was provided with a list of forthcoming items scheduled to be considered at the meeting to be held on the 17th January 2014.
UNANIMOUSLY RESOLVED that the items be endorsed.