Agenda item

Purpose of the item: Scrutiny of the Draft Budget and Medium-Term Financial Strategy.

Witnesses:

Mark Nuti, Cabinet Member for Adults and Health

Sinead Mooney, Cabinet Member for Adults Social Care

David Lewis, Cabinet Member for Finance and Resources.

Nicola Kilvington, Director of Corporate Strategy & Policy, Surrey County Council

Rachel Wigley, Director, Finance Insights & Performance

William House, Strategic Finance Business Partner for Adults, Wellbeing and Health Partnerships

Sarah Kershaw, Strategic Director of Adults, Health, and Wellbeing

Nicola O’Connor, Strategic Finance Business Partner

Paul Richards, Area Director East & Mid Surrey, Adult Social Care (ASC)

Jonathan Lillistone, Assistant Director of Integrated Commissioning

Nikki Roberts, CEO, Surrey Coalition of Disabled People

Key points raised during the discussion:

1. The Cabinet Member for Finance and Resources introduced the Item and provided an overview on the draft budget for 2024/25 and the Medium-Term Financial Strategy (MTFS) for 2028/29.

2. The Chairman questioned if there had been any further opportunities identified to work cooperatively with the borough and district councils to close any budget gaps. The Strategic Director of Adults, Health and Wellbeing explained that the Directorate worked closely with the district and borough councils in delivering care, but there were several financial challenges within some of these councils that increased difficulties in how the Directorate would deliver services in the future, but options to work together more effectively would always be explored. A Member asked if the Directorate was anticipating service withdrawals from borough and district councils. The Cabinet Member for Finance and Resources explained that there could be a risk partners resorting to statutory rather than discretionary services, which could have consequences for the Council. There was currently no direct indication that services would be withdrawn. The Cabinet Member for Adult Social Care highlighted that the Council funded some district and borough council schemes such as ‘meals on wheels’ and the Directorate were committed to continue this.

3. A Member questioned whether the Service was being ambitious enough in extra care housing numbers.The Cabinet Member for Adults Social Care explained the Directorate was bound by the Care Quality Commission (CQC) regulations, which restricts the size, height and density of properties, and number of residents. The Director of Integrated Commissioninghighlighted that the Directorate would avoid introducing risk and officers who were working on the programme had been as ambitious as possible with the number of units. Good progress had been made on Regulation 3 applications, with planning approval on the Guildford site and construction starting in 2024, outline planning approval for three sites in the next part of the programme, and the remaining three sites would be due to come forward for outline planning approval. Overall, this means that the Directorate are at 360 units towards the 725 targets, with further plans in the pipeline to achieve the full target.

Abby King and Robert Evans arrived at 10.32 am.

4. In reference to the Medium-Term Position being uncertain with continued pressures, the Chairman asked what opportunities there were to put in place Transformation programmes, which could alter major cost drivers. The Strategic Director of Adults, Health and Wellbeing explained there were three key focus areas. Customer journey, which involved how ASC would look after residents from the outset, that ensured the Service would be person-centred; market management and commissioning; and how ASC would work with health organisations such as NHS Surrey Heartlands and Frimley Health to maximise the holistic offer to residents and provide a more preventative approach. This involved looking at the Directorate’s current approaches, how they could align it to the three key areas and how they could improve over the next year to help deal with efficiencies and challenges. This would help achieve a move towards prevention and help manage budgets due to a reduced need to intervene, whilst simultaneously delivering the Council’s responsibilities under the Care Act 2014.

5. In reference to the efficiency of changing care models, a Member asked for clarity on the proposed changes to transport in care settings. The Director of Integrated Commissioning explained it linked to the broader transformation and prevention agenda, and the Directorate was looking at community opportunities for everyday living. The Service had seen progress with more people travelling independently, with travel training and different organisational involvement being a key role in this. A wider piece of work with the Freedom to Travel programme, looking at information relevant to Adults Wellbeing and Health Partnerships (AW&HP), is also being undertaken.

6. A Member asked if the move to supported independent living, in extra care, could be accelerated.The Director for Integrated Commissioning explained that these were major programmes and over the next 12 or 18 months, the programme would accelerate. Work had previously been going into the design, planning, preparation, and the securing of the right development partners. The Service would continue to explore opportunities to accelerate delivery as quickly as possible.

7. The Chairman requested more information around technology enabled care, extending its coverage, and increasing the sophistication and range of what was on offer. The Strategic Director for Adults, Health and Wellbeing explained that a lot work had already been done on this in the community and homes, that could be built on further, such as by utilising Artificial Intelligence (A.I.). The Director for Integrated Commissioning expressed that ambition should not be limited around technology enabled care and options were being fully explored. The Director underlined the importance of linking technology with extra care and supported independent living, and technology had been designed into those schemes’ design briefs and it would be an area where collaborative work and integration with health colleagues would be important, such as with NHS Surrey Heartland’s and their virtual wards.

8. A Member raised a concern around the delivery of technology enabled care in rural areas and to people who find technology difficult to manage. The Director of Integrated Commissioning explained that addressing the broader infrastructure and challenges, would be part of any transformation programme. Several technology support schemes had been funded through the ‘Better Care Fund’, which the Service would want to continue alongside any transformation programme. The Cabinet Member for Health, Wellbeing and Public Health expressed that advancement in technology, such as no longer requiring a ‘user’, and A.I., could help certain groups, but stressed the importance of ensuring that the infrastructure would be in place to support it, and that it would be the right thing for the right people. The CEO of the Surrey Coalition of Disabled People highlighted their digital exclusion service, funded by the ‘Better Care Fund’, to teach those excluded how to use technology.

9. A Member asked what the current adult social care staffing situation was in Surrey, what the shortages were, and what plans were in place to mitigate them.The Strategic Director for Adults, Health and Wellbeing explained that staffing shortages were due to a range of factors such as higher housing costs. Commissioners had and would continue to work collaboratively with the provider community, including the Surrey Care Association and NHS partners, to understand the challenges and find ways to address them. The Service had created a joint £6 million workforce innovation fund with NHS Surrey Heartlands, to help solve the challenges of staff shortages. This resulted in workforce projects such as a programme with the Surrey Care Association that would provide an avenue for people to gain an accredited care qualification. The Strategic Director highlighted that competition in pay was also a source of tension. The Cabinet Member for Adult Social Care referred to the Surrey Housing, Homes and Accommodation summit that took place in December 2022, explaining that it identified a need for essential worker housing. This housing strategy would be going to Cabinet and would outline a model to take forward in 2024. The Cabinet Member for Health, Wellbeing and Public Health added that public perception of working in the care system would need to change to help reduce staff shortages.

10. A Member agreed with the Cabinet Member for Health, Wellbeing and Public Health’s point on changing public perception around working in the care sector. The Strategic Director highlighted the health and social care academy jointly run with NHS Surrey Heartlands, along with AW&HP’s own academy, and expressed there would be an opportunity to build more on this and proactively change public perception. This was being explored as part of the transformation programme with a focus on how the Directorate could create career paths to portray the benefits of working in the care sector.

11.  The Member asked for clarity on the number of vacancies, in both Council services and the private sector. The Strategic Director for Adults, Health and Wellbeing informed the committee that, according to the 2022/23 Skills for Care Data, there were 3,800 vacancies across the whole sector. Regarding the Council’s care provision versus private care provision, the Strategic Director explained that conditions and benefit packages for staff are similar across the sector and a shift in it being easier to recruit into the private sector, would not necessarily be seen. The Director of Integrated commissioning added that last year’s ‘Cost of Care’ exercise, allowed the AW&HP to gather details on pay rates and staffing on home care services and care homes, which only highlighted a differential in some senior roles. In the last 12 months the Directorate had seen a significant increase in overseas recruitment which had been an important route in addressing some workforce challenges.

12. A Member referred to the recent announcement made by the Home Secretary on plans to cut net migration, and asked how it would affect the care sector. The Director of Integrated Commissioning explained that the announcement did not apply to exempt professions that would go through the health and social care visa route, and therefore would have an impact on the social care workforce. The condition around bringing family requiring an increased minimum income, could have an impact on the care sector, which was still being investigated and communication was being undertaken with the Surrey Care Association on this.

13. The Chairman questioned if the Directorate was comfortable with the overall current budget position for public health and its future going forwards. The Cabinet Member for Health, Wellbeing and Public Health expressed it would be the second lowest public health budget in the country and were therefore not comfortable with the position but would work with what was received and use it to generate more investment into public health by outside partners and grant funding.

14. A Member commented that the 1.2% increase in the Public Health Grant is capable of being raised and did not cover the inflationary pressures. The Member asked if the Cabinet Member for Health, Wellbeing and Public Health was assisting the Leader of the Council in obtaining further funding for public health. The Cabinet Member for Health, Wellbeing and Public Health confirmed that more funding is constantly challenged for and substantiated that the Council had recently received a £5 million grant from the National Institute for Health and Care Research. The Member asked for clarification on how much of the Public Health Grant is given to AW&HP. The Cabinet Member for Health, Wellbeing and Public Health explained that the public health grant was ring-fenced to be used only for public health matters.

15. A Member asked how budget gaps in Adults Wellbeing and Health Partnerships were to be filled. The Cabinet Member for Adult Social Care highlighted the importance of delivering the transformation programmes and explained that the Directorate must look at demand management, which had increased and continued to rise, as well as consider how it would be managed and what opportunities could be implemented for when people seek support from the Service. There would be several services, such as reablement, where the offers would need to be reviewed to see if it could be improved. The Cabinet Member also underlined an integration programme with NHS Surrey Heartlands and other health partners, which would require collaboration, as the benefits could be significant. Efficiencies around the institutionalised type of care setting were identified, and discussions with providers would start shortly. The Cabinet Member also expressed a need to keep the Service outcome focussed.

Actions/requests for further information:

1. Adults, Wellbeing and Health Partnerships to provide the Skills for Care data, that is split up geographically across Surrey on vacancies in the adults’ social care sector (if possible).

2. The Assistant Director for Integrated Commissioning (ASC) agreed to update the Committee on communication with the Surrey Care Association concerning the announcement by the Home Secretary on migration and the possible impacts it will have on the care sector.

Resolved:

The Adults and Health Select Committee recommends that:

1.    Given the known trends for rising demand for services and rising costs, it is the view of the Select Committee that a major transformation project is needed based around the objective set in Section 2 of the Care Act 2014 of “Preventing needs for care and support "by:

a.    Developing community-based approaches to keeping residents healthy and in their own homes.

b.    Reducing the overall market demand for high-cost care services by refocusing efforts on prevention.

c.    Maximising the use of Technology Enabled Care including making the service available Surrey-wide as soon as possible for both self-funders and Surrey funded service users.

2.    The Committee recommends that the Cabinet Member for Health and Wellbeing and Public Health commits to work with Government and other agencies to raise the image of caring careers and the pay and salaries in the care industry.