Agenda item

The Committee considered a report of the Director of Adults and Communities which provided an update on the in-year financial pressures experienced by the Adults and Communities Department, particularly with regard to delivering the Effective Support project and the financial implications arising from this in the future. A copy of the report marked ‘Agenda Item 8’ is filed with these minutes.

The Chairman welcomed the Cabinet Lead Member for Adult Social Care, Mr D W Houseman MBE CC, to the meeting for this and other items. Mr Houseman noted that the savings targets set through the Medium Term Financial Strategy (MTFS) had been challenging and that the Adults and Communities Department needed to be open and realistic with regard to its ability in meeting these targets. Last year the Department had achieved an underspend of £4.55 million, this saving had contributed to the protection of other service areas such as highways maintenance. It was hoped that the Department could meet the savings over the proceeding four years as outlined in the MTFS.

Arising from discussion the following points were raised:-

(i)     The County Council was able to claim VAT back for services it commissioned. These were usually traditional services, such as, those provided by day centres which could be purchased on a large scale. However, where a service user had opted for an individual, tailored package of care, they would be required to pay VAT. Members expressed concern over this arrangement but were advised that the Department of Health had already raised the matter with HM Revenue and Customs. Local authorities had been required to absorb the additional costs into the budget for personalisation;

(ii)    With regard to checks and balances in place for the allocation of personal budgets, it was explained that service users were required to set up a bank account solely for the receipt of their personal budget. Guidance was issued to service users which advised that regular audits of their bank account would be undertaken. Service users were also subject to regular reviews to ensure that funding was being used for the purpose of providing a care package and enabled them to provide feedback. The County Council could not by law access a person’s bank account to remove monies. However, it could obtain access to bank statements and freeze any future funding if it deemed that monies were not being used appropriately. The Committee requested that a report be submitted to a future meeting on the audit and monitoring process for direct cash payments for personal budgets;

(iii)  The Committee queried the circumstances which would lead to the County Council requiring a service user to pay back money that had been issued as part of a personal budget. It was explained that if a service user changed provider to a cheaper service or there was a delay to the start of the care package they could be required to payback any subsequent unused monies to the County Council. The County Council also provided money to be used as a contingency fund in a crisis situation which was rarely used. This provision was to be reviewed. The County Council was also considering whether it should charge for managing personal budgets for service users; 

(iv)  Care reviews took approximately 20 hours to complete, reflecting the increasing complexity of cases. Care packages provided were often jointly agreed between the County Council and NHS and this made it complicated to look at funding streams and translate this into any change to services. Once a care package was in place, a second review would also be carried out to ensure that the service user was in receipt of the best tailored services for their needs. Since the eligibility for service threshold had been raised from moderate to substantial and critical needs this also meant that the majority of cases were more complex than previously;

(v)    The £2.4 million of Health transfer funding agreed with the Clinical Commissioning Groups (CCGs) related to 2013/14. Regular conversations took place between the County Council and CCG’s regarding the ongoing transfer of funds from the CCGs to the County Council;

(vi)  The possibility of identifying savings to offset the £3 million funding gap was being discussed, it was pointed out that such savings needed to be ongoing. The County Council was also seeking a solution corporately to help meet the savings requirements. The savings were challenging but a number of options had been identified to help make up some of the shortfall during 2013/14 and 2014/15.  

RESOLVED:

(a)  That the report be noted;

(b)  That a report on the audit and monitoring process for direct cash payments for personal budgets be submitted to a future meeting of the Committee.