Archived decisions
HAMPSHIRE COUNTY COUNCIL
Decision Report
Decision Maker: |
Executive Member for Adult Social Care | ||||
Date of Decision: |
24 July 2009 | ||||
Decision Title: |
Final Accounts and Performance 2008/09 and Budget and Performance Monitoring 2009/10 - period 01/04/2009 to 31/05/09 | ||||
Decision Reference: |
823 | ||||
Report From: |
Report of the County Treasurer and Director of Adult Services | ||||
Contact name: |
Erica Meadus, Head of Finance, Adult Services Adrian Thorne, Assistant Director, Performance and Business Management | ||||
Tel: |
(01962) 846195 (01962) 847259 |
Email: |
|||
1. Executive Summary
1.1 The purpose of this report is to explain the revenue and capital final accounts position and the performance results for 2008/09. It seeks approval to transfer the revenue carry forward underspend to the capital programme for 2009/10 and reports the results of budget and performance monitoring for the first two months of 2009/10.
1.2 Final accounts for 2008/09 show a revenue underspend of £495,000. The Policy & Resources Executive Member decision on 19 May 2009 has already approved 50% carry forward to 2009/10 and 50% carry forward two years to 2011/12. It is recommended that the carry forward 50% (£247,500), of the 2008/09 underspend to 2009/10 be transferred to capital to support the continued integration of the Learning Disabilities services of Hampshire County Council and Hampshire Partnership Foundation Trust. The remaining 50% will be carried forward to 2011/12 to support budget pressures in line with the cabinet report.
1.3 The Performance results were submitted to the Care Quality Commission (CQC) on 18 June 2009 and are subject to confirmation by the CQC in November 2009. After this date it will be possible to carry out analysis of our performance in comparison to other councils.
1.4 The first two months of 2009/10, show a balanced budget position with the forecast outturn in line with budget.
1.5 To reflect the increasing impact of personalisation and of people living in their own homes for longer, approval is requested to allocate £3.5m from OP/PD purchased nursing (£2.5m) and residential care budgets ( £1.0m) to domiciliary care (£2.8m) and Direct Payments budgets ( £0.7m). More details are in Appendix 3.
1.6 The report includes the 2009/10 capital programme proposals. This incorporates reallocation of £960,000, the investment of £500,000 in improvements to older people's homes, investment of £1.2m in extra care housing and a further £1.2m in the Common Assessment Framework (CAF). The CAF proposals include four full time equivalent (fte) temporary posts to be funded by grant.
1.7 The report notes the transfer by the TUPE (Transfer of Undertakings Protection of Employment) regulations of a Domestic Abuse Co-ordinator fully funded from external sources.
1.8 This is the first report to integrate both financial, performance and workforce results and it is intended to further develop the presentation for the next report to the Executive Member in October 2009.
1.9 The report notes that the maximum weekly charge is the equivalent of the Hampshire rate for residential care for Elderly Very Dependent clients with Dementia and for 2009 /10 this rate is £435.82 per week.
2. Overview of Final Accounts , Performance and Workforce 2008/09
2.1 The final accounts for 2008/09 resulted in a revenue underspend of £495,000. This represents just 0.2% of the revised revenue cash limit of £283m and is a significant achievement against a background of increased client activity over the year. Table 1 below sets out the overall position for each care group in line with the requirements of the CIPFA Best Value Accounting Code of Practice.
Table 1 | ||||
Cash limited Expenditure |
Adjusted revised estimate 2008/09 (£000) |
Actual 2008/09 (£000) |
Variation Over (+)/Under (-) Spend | |
£'000 |
% | |||
Service strategy and regulation |
865 |
825 |
-40 |
-4.6 |
Older people (age 65 or over) including mentally ill |
140,399 |
138,326 |
-2,073 |
-1.5 |
Adults under 65 years with physical or sensory impairment |
27,882 |
28,822 |
940 |
3.4 |
Adults under 65 years with learning disabilities |
64,878 |
65,184 |
306 |
0.5 |
Adults under 65 years with mental health needs |
14,469 |
14,802 |
333 |
2.3 |
Other Adult Services |
3,042 |
2,975 |
-67 |
-2.2 |
Supported employment |
544 |
673 |
129 |
23.7 |
Supporting people |
30,577 |
30,558 |
-19 |
-0.1 |
Unapportionable overheads |
342 |
338 |
-4 |
-1.2 |
Grand Total |
282,998 |
282,503 |
-495 |
-0.2 |
2.2 The largest contribution to the 0.2% underspend was from older people which offset overspends in other care groups, particularly physical disabilities.
2.3 Older people achieved savings within purchased services (domiciliary residential and nursing), partially offset by the requirement to ensure that in-house nursing and residential units were staffed appropriately for higher dependency clients, leading to an overspend on salary budgets. Overall this resulted in an underspend of £2.1m.
2.4 Planned performance improvements in this area resulted in the number of older people needing to be admitted to care homes falling from 74.7 to 72.5 per 10,000 population. The underspend in older people purchased services enabled pressures in other areas to be met and for help to live at home performance targets for this care group to be achieved. An additional 358 older people were supported to live at home, representing a 1.9% increase, however population growth was 2% resulting in a slight drop in performance equivalent to 0.1 per 1,000 people.
2.5 For physical disabilities the overall overspend was £940,000 which was primarily the result of planned additional spend on equipment and sensory rooms. This was largely related to increased demand for essential items sourced through the Integrated Joint Equipment Store (ICES) to support people living at home.
2.6 At the end of 2008/09 4,847 physical disabilities clients were helped to live at home, an increase of 131 on the previous year. This represents an improvement in performance, as 6.2 people per 10,000 population were helped to live at home in 2008/09, compared to 6.1 in the previous year.
2.7 For learning disabilities the overall overspend for the year was £306,000, which included provision for ordinary residence of £850,000. Purchased client numbers increased by 194 in 2008/09 at a gross annual cost of £1.1m. The increase was predominantly in community based services. However, this cost was offset by in-house day care transport costs being lower than expected and receiving additional continuing health care funding.
2.8 Performance in the Learning Disabilities care group was sustained at 2007/08 levels with 2.8 adults per 1,000 population supported at home.
2.9 Progress was made on service integration with the Health Service. There are now eight joint teams successfully operating together. Two teams are already co-located and the intention is for the remaining six to be co-located during 2009/10. It is intended to support the co-location using the carry forward from 2008/09.
2.10 Agreement was reached on the transfer of commissioning responsibility from the Hampshire Primary Care Trust (HPCT) to Hampshire County Council which will result in a £30m transfer from HPCT in 2009/10. This figure was approved by the Executive Member on 26th June 2009.
2.11 Mental Health Services have reported a £333,000 overspend (2.3%) primarily due to a provision for a client which under the Mental Health Act section 117 became the responsibility of the Council and will result in a backdated reimbursement of client contributions.
2.12 Supported employment have reported a £129,000 overspend principally due to additional resource allocated to fast-track new services to improve the prospects of people with a learning disability in gaining meaningful and paid employment. Performance has improved with the number of adults helped into employment increasing from 94 to 347.
2.13 Overall, the final accounts for 2008/09 show a revenue underspend of £495,000. It is proposed to carry forward 50% (£247,500), of the 2008/09 underspend to 2009/10 to support the continued integration of the Learning Disabilities services of Hampshire County Council and Hampshire Partnership Foundation Trust. The remaining 50% is to be carried forward two years to 2011/12 to support budget pressures.
2.14 The Capital Programme for 2008/09 was £10.6m and schemes to the value of £4.8m were started in the year. This includes £2.9m investment in Extra-Care Housing which at year end had delivered an extra 244 places, exceeding the performance target of 200. Approval is being sought from Cabinet to carry forward schemes to the value of £5.8m to start in 2009/10. The re-scheduling of the 2008/09 programme was due to delays on projects, technical resource constraints and also future pressures on capital resources required for investment in older peoples homes, extra care housing and IT.
2.15 There are 11 main partnerships the department is actively involved in. A progress update is given in Appendix 1(e).
2.16 The Department's performance is improving strongly and it has made good progress in all its priorities, including areas for improvement. Client numbers are increasing and peoples independence improving. There are more clients at home now with complex needs. The Department has successfully delivered Value for Money to Hampshire residents with £19.7m efficiencies over the previous two years, plus a further £8.3m in 2008/09. This will continue with £8.3m efficiency improvements planned for 2009/10. All efficiency savings have been reinvested back into transforming social care services.
2.17 A top performer in commissioning and use of resources; and including users in all aspects of service delivery and community involvement, the department has also received national `excellent' accreditation for `Supporting People' housing related support; and for `Shared Lives' which arranges family placement for vulnerable people. Future budgets include £3.9m carried forward from 2008/09 for the Supporting People partnership with £2.2m for 2010/11 and £1.7m for 2011/12 to enable planned spending and resources to be matched.
2.18 The Self Assessment Survey (May 2009) indicates the Department is on track to retain its 2008 performance judgements which the Care Quality Commission will formally announce in November 2009. There will be no Star rating this year though the judgement will directly contribute to the Comprehensive Area Assessment (CAA) both for the County Council organisational assessment and for the wider Hampshire (as a place in which to live) assessment.
2.19 The Personal Social Services Expenditure Return (PSS EX1) was submitted on 10 July 2009. This return provides analysis of expenditure, activity, and unit cost calculations. The impact of a change in accounting treatment and property valuations in the current economic climate has meant significant increases in capital charges. Whilst not included in operational budgets, this will impact on unit cost comparisons with other authorities for in-house residential and nursing homes.
2.20 A more detailed analysis of the Department's finance and performance in 2008/09 is set out in the following appendices:
· 1 2008/09 Revenue Expenditure under service control
· 1(a) Construction of the 2008/09 cash limit
· 1(b) Final Accounts - Summary of 2008/09 revenue expenditure
· 1(c) Analysis of 2008/09 cash limited revenue expenditure over services
· 1(d) Major variations in 2008/09 cash limited expenditure
· 1(e) Partnerships progress
· 1(f) Efficiency savings
· 1(g) Performance commentary
· 1(h) Value for money scorecard
· 2 2008/09 Capital Expenditure
· 2(a)Capital expenditure 2008/09
3 2009/10 Budget and Performance Strategy
Revenue Budget Strategy
3.1 A budget strategy was agreed as part of the budget setting process in February. Within the budget for 2009/10 are growth pressures of £18.5m, which are funded from:
· redeployment of resources of £8.3m
· extra guideline growth of £6.7m
· planned carry forward £3.5m 1
3.2 The budget strategy for 2009/10 takes account of in-year implementation and development of many of the Hampshire model's proposals, including, for example, self directed support, early intervention and prevention, and the further development of business processes linked to Hantsdirect.
3.3 A programme implementation plan is being formulated for the Hampshire model, which sets out the detailed transition activities, long term objectives, timescales and communications plan. This will enable successful delivery of the proposed model over an agreed timescale, within agreed budgets and meeting performance standards as required. To ensure an effective implementation of the Hampshire model for service users and providers, experience from other major projects, including the Self Directed Support Phase 1 work in Basingstoke has shown that timescales need to be realistic for them to have sustainable outcomes.
3.4 The approved budget includes 138.5 additional full time equivalent staff to support the strategic direction of the department and enhance capacity to deliver safe and secure services, new work requirements and increased volumes during the period of transformation.
3.5 Since the budget was approved, further grant funding of £246,000 has been identified for six new posts. These increase the workforce budget average numbers from 3,429 full-time equivalents to 3,435 full-time equivalents.
· Hampshire was successful in obtaining government grant for the Common Assessment Framework. This pilot will require a further four full time equivalent staff in its first year reducing to two in its second year, all positions will be temporary contracts.
· One domestic abuse co-ordinator permanent post has transferred from the Hampton trust, a voluntary organisation and will be funded from external funding under the Transfer of Undertakings Protection of Employment (TUPE) regulations.
· One Deprivation of Liberties Safeguards permanent post will be funded from Mental Capacity grant.
Capital Budget strategy
3.6 The total capital cash limit for 2009/10 is £11.8m. This includes £1.7m transferred from revenue, £1.2m grant for Common Assessment Framework and £5.8m carried forward from 2008/09. It is proposed to transfer to capital the 50% (£247,500), of the 2008/09 carry forward underspend to support the continued integration of the Learning Disabilities services of Hampshire County Council and Hampshire Partnership Foundation Trust.
3.7 The detailed scheme list within the capital programme includes proposals to reallocate £960,000 existing resource, to spend the transferred £1.7m additional resource on improvements to older peoples homes (£500,000) invest in extra care housing (£1.2m).The programme is summarised in Table 2 below.
Table 22 |
|
Capital Programme 2009/2010 - Position as at - |
May |
Resources |
£'000s |
2009/2010 Capital Programme |
2,884 |
Balance of Cash Limit brought forward from 2008/2009 |
5,785 |
Capital Receipts |
28 |
Revenue Contribution to Capital Programme already agreed3 |
1,700 |
Revenue Contribution to Capital Programme - to be agreed |
248 |
Common Assessment Framework Grant |
1,200 |
Capital Cash Limit 2009/2010 |
11,845 |
Schemes committed (at contract prices) |
4,010 |
Schemes not yet committed (at latest approved prices) |
7,835 |
Total schemes |
11,845 |
3.8 It should be noted that the capital programme may be under pressure in 2010/11 and 2011/12 to resource delivery of £3.7m transition capital infrastructure (including SDS and Crisis care) but efforts will be made to meet this within the existing budget.
3.9 More details of the proposed capital programme are set out in Appendix 4.
Performance strategy
3.10 The performance strategy for the department is one of incremental improvement that is affordable within budget and is in those areas identified as local priorities. For 2009/10 these include Self Directed Support, Safeguarding and the development of advice, information as part of the universal offer and commissioning services that support reablement and independence.
3.11 Informed by Driving Success, the Council's corporate performance management framework, strategic priorities for the department include the Corporate Improvement Plan, delivering Value for Money and the Local Area Agreement targets for theme F Health and Wellbeing to reduce health inequalities, promote good health through exercise, less smoking and sensible drinking of alcohol, reducing emergency hospital admissions and support to older people to maintain independent living, through initiatives such as the Community Innovations Teams.
Risks and Challenges
3.12 The departmental management team have recently undertaken a strategic review of risks in relation to the Hampshire model, the wider transformation programme and ensuring `business as usual' is safe and secure. There may be a need to use some of the contingency if required to offset potential cost pressure.
3.13 It has identified the following key strategic risks which are being managed across the department:
_ Safeguarding
_ Organisational and workforce planning
_ Performance Management
_ Partnership working - commissioning
_ Partnership working - operations
_ Resource management
_ Health and safety management
_ Business transformation
_ Demographic change
_ Business continuity
_ Customer care and communications
_ Information systems and infrastructure
3.14 Next year, 2010/11, will be the final year of the government's current spending plan. The content of the next 3 year Comprehensive Spending Review is unknown but further pressures can be expected.
3.15 The Government's green paper on the future of Adult Services was published on 14 July 2009, at the time of writing this report the contents have yet to be analysed.
Maximum weekly charge for non residential care
3.16 Following the decision at the May 2006 Executive Member for Adult Social Care decision day, the maximum weekly charge is the equivalent of the Hampshire rate for residential care Elderly Residential Very Dependent with Dementia. This is to inform the Executive Member that for 2009 /10 this rate will be £435. 82 per week This represents an uplift of 2.5% on the 2008/2009 rate of £415.03 per week
4. Budget, performance and workforce monitoring for the first two months of 2009/10.
2009/10 Revenue Budget position
4.1 This is the first budget monitoring report for 2009/10, and is based on data to the end of May. The headlines are shown in Table 3 below and show a balanced budget position. This needs to be treated with some caution at this early stage of the year. Potential risks have been identified and plans are in place to ensure the outturn comes in on budget.
Table 3 | ||||
Client Group |
Adjusted P2 Cash Limit 2009/10 (£000) |
Projected Spend (to 31/03/10) (£000) |
Variation Over/(Under) Spend | |
£'000 |
% | |||
Director and Performance & Business Management |
24,918 |
24,918 |
- |
- |
Commissioning and Partnerships |
46,895 |
46,895 |
- |
- |
Older People / Physical Disability |
159,690 |
159,690 |
- |
- |
Learning disability |
61,123 |
61,123 |
- |
- |
Mental Health |
10,293 |
10,293 |
- |
- |
Contingency & Centrally Held |
2,677 |
2,677 |
||
Grand Total |
305,596 |
305,596 |
- |
- |
Note: The table above analyses the budget in terms of management responsibility and is not, therefore, the same as the presentation used in the budget book, which follows the external reporting requirements of CIPFA's best value accounting code of practice. More detailed information is given in Appendix 3.
4.2 The main factors impacting on the 2009/10 revenue budget following the closing of the 2008/09 accounts are the carry forward of grants, 50% share of the 2008/09 underspend, which were approved by the Policy & Resources Executive Member on 19 May 2009 and new grants announced since the budget was set.
4.3 Overall, there has been a net increase of £756,000 to the cash limit. The movement in the cash limit is set out below:
£'000 | |
Budget as per Budget Book 2009/2010 |
304,840 |
50% of £495,000 underspend (one-off)4 |
248 |
Transfer to capital of 50% of £495,000 |
-248 |
Campus closure grant4 |
222 |
Invest to Save4 |
90 |
Stroke grant4 |
120 |
New grants |
272 |
Technical adjustments |
52 |
Cash limit as at 24 July 2009 |
305,596 |
4.4 The 2009/10 contingency is £1.9m, after utilising £3.5m of planned carried forward monies (£3.9m) from 2008/09 to meet the budget shortfall of £3.5m, and it has been out turned to budget at this stage, although none of it has been committed.
The contingency is made up of:
Contingency in the base budget £1.4m
Savings and contingency funding to be identified -£3.5m
Planned carry forward from 2008/09 (one off) 5 £3.8m
Total contingency after carry forward addition £1.7m
Contingency for specific pressures (section 117) £0.2m
Total contingency (included in Table 3) £1.9m
4.5 OP/PD purchased services are overall showing a balanced budget, however, Personalisation and the trend of clients choosing to direct their own care and/or live at home as an alternative to residential care, has resulted in a shift in spend of £3.5m to domiciliary care and Direct payments which will be offset by reductions of £3.5m on more traditional residential models of care. Budget realignments are recommended for approval to reflect this.
4.6 Grants carried forward are:
· £90,000 Invest to Save
· £120,000 Stroke Assistance
· £222,000 Learning disability Campus Closure
4.7 The £90,000 Invest to Save is the balance from the £139,000 scheme which enhances the transition service and supports continuing health care applications. (In 2008/09 £49,000 was spent on this scheme). There will be a one-off cash limit increase of £90,000 in 2009/10 and then the full scheme cost will be repaid by a one-off reduction in 2010/11 of £139,000.
4.8 Other grants carried forward are £120,000 for continuation of the strategy to provide comprehensive access to stroke support groups across the county and £222,000 for continuation of the Learning Disability campus closure programme.
4.9 It is noted that the DAAT Partnerships carried forward £750,527 to 2009/10 from its 2008/09 allocation as part of its medium term financial strategy to cover planned reductions in government grant. However, as this is a Partnership funded through grant received directly by the Primary Care Trust it does not form part of the Adult Services cash limit.
4.10 Further details of the overall revenue position and projected outturn for 2009/10 are set out in Appendix 3:
· Appendix 3 2009/10 Overall Revenue Budget Strategy and projected outturn
· 3(a) Comparison of period 2 projected outturn with latest cash limit
· 3(b) 2009/10 Government grants
· 3(c) Client Activity
· 3(d) Staffing update
5. Recommendations
5.1 That the final accounts and performance achievements for 2008/09 be noted as set out in paragraphs 2.1 to 2.20 on pages 2 to 6 and Appendices 1 and 2 on pages 16 to 37.
5.2 That the current budget position as at period 2 for 2009/10 be noted as set out in paragraphs 4.1 to 4.10 on pages 9 to 12 and Appendix 3 on pages 38 - 54.
5.3 That £247,500, (50%) of the 2008/09 revenue underspend carried forward to 2009/10, in line with the the Policy & Resources Executive Member decision on 19 May 2009, be transferred to 2009/10 capital for the co-location of learning disability and Health teams arising from the learning disabilities integration with Health.
5.4 That the 2009/10 capital programme proposals for reallocation of £960,000, for investment of £500,000 in improvements to older peoples homes, for £1.2m investment in extra care housing and £1.2m investment in the Common Assessment Framework be approved as set out in Appendix 4.
5.5 That the maximum weekly charge of £435.82 for 2009/10 for non-residential care be approved.
5.6 That the following budget virements be approved: allocate £3.5m from OP/PD purchased nursing (£2.5m) and residential care budgets (£1.0m) to domiciliary care (£2.8m) and Direct Payments budgets (£0.7m).
5.7 That approval be given for the following additional posts which are funded from grants or other external sources. These increase the workforce budget average numbers from 3,429 full-time equivalent posts to 3,435 full time equivalent posts:
· Four Comprehensive Assessment framework full-time equivalent temporary staff -funded from Comprehensive Assessment Framework grant
· One domestic abuse co-ordinator permanent post - funded from external sources under the Transfer of Undertakings Protection of Employment (TUPE) regulations.
· One Deprivation of Liberties Safeguards permanent post - funded from Mental Capacity grant , as reported to Executive Member in March 2009.
CORPORATE OR LEGAL INFORMATION:
Links to the Corporate Strategy
Hampshire safer and more secure for all: |
yes |
Corporate Business plan link number (if appropriate): | |
Maximising well-being: |
yes |
Corporate Business plan link number (if appropriate): | |
Enhancing our quality of place: |
no |
Corporate Business plan link number (if appropriate): | |
Section 100 D - Local Government Act 1972 - background documents | |
The following documents discuss facts or matters on which this report, or an important part of it, is based and have been relied upon to a material extent in the preparation of this report. (NB: the list excludes published works and any documents which disclose exempt or confidential information as defined in the Act.) | |
Document |
Location |
IMPACT ASSESSMENTS:
1. Equalities Impact Assessment:
1.1. The Department's budget and performance strategies are developed in accordance with the Council's Equalities Policy and target the most vulnerable in society.
1.2. How budgets are used have a significant impact on the most excluded. The operational directors have lead responsibility to ensure that impact assessments take account of the needs of these groups. The head of finance is a member of the Departmental management team, and part of her role is contribute to these impact assessments. This budget monitoring report provides information on the progress of spending plans of the Directorate and will contribute to better outcomes for all.
2. Impact on Crime and Disorder:
The County Council has a legal obligation under Section 17 of the Crime and Disorder Act 1998 to consider the impact of all the decisions it makes on the prevention of crime. The proposals in this report have no proven impact on the prevention of crime.
3. Climate Change:
a) How does what is being proposed impact on our carbon footprint / energy consumption?
All relevant developments within the revenue budget and capital programme are subject to specific, detailed assessments. Energy conservation, and where applicable enhancing biodiversity, are priorities for all major building schemes and the revenue budget includes an allocation to specifically encourage sustainability initiatives.
b) How does what is being proposed consider the need to adapt to climate change, and be resilient to its longer term impacts?
Where appropriate capital schemes are planned with adaptation to climate change in mind, such as the inclusion of passive cooling through building design, rain-water and grey-water harvesting, drought resistant planting etc.
APPENDICES
Page Number | ||
1 2008/09 Revenue Expenditure under service control |
16 - 20 | |
1(a) |
Construction of the 2008/09 cash limit |
21 - 22 |
1(b) Final Accounts - Summary of 2008/09 revenue expenditure |
23 | |
1(c) |
Analysis of 2008/09 cash limited revenue expenditure |
24 - 25 |
over services |
||
1(d) |
Major variations in 2008/09 cash limited expenditure |
26 |
1(e) |
Partnerships progress |
27 - 29 |
1(f) |
Efficiency savings |
30 |
1(g) |
Performance commentary |
31 - 32 |
1(h) |
Value for money scorecard |
33 |
2 |
2008/09 Capital Expenditure |
34 - 35 |
2(a) |
Capital expenditure 2008/09 |
36 - 37 |
3 |
2009/10 Overall Revenue Budget Strategy and projected |
38 - 43 |
outturn |
||
3(a) |
Comparison of period 2 projected outturn with latest cashlimit 44 | |
3(b) |
2009/10 Government grants |
45 - 47 |
3(c) |
Client Activity |
48 - 53 |
3(d) |
Staffing Update |
54 |
4 |
2009/10 Capital Programme Position |
55 |
4(a) |
2009/10 Capital Programme Position |
56 |
Appendix 1
2008/09 revenue expenditure under the Service's control
1 Revenue expenditure under the Service's direct control was subject to a cash limit. For 2008/09 the adjusted amount is £282.998m as set out in Appendix 1(a).
2 The final outturn was £495,000 less than the cash limit.
3 The final position for 2008/09 compared to the outturns for the previous three years is shown in the table below. There has been improved control of the department's resources to meet outcomes for the citizens of Hampshire.
Variations from Revised Budget | ||
£'000 |
% | |
2005/06 |
+11,124 |
+4.5 |
2006/07 |
+7,494 |
+2.9 |
2007/08 |
-1,865 |
-0.7 |
2008/09 |
-495 |
-0.2 |
4 The table below shows the overall outturn position and the following paragraphs briefly describe some of the more significant variances across each client group since the revised budget was prepared in November.
Cash limited Expenditure |
Adjusted revised estimate 2008/09 (£000) |
Actual 2008/09 (£000) |
Variation Over (+)/Under (-) Spend | |
£'000 |
% | |||
Service strategy and regulation |
865 |
825 |
-40 |
-4.6 |
Older people (age 65 or over) including mentally ill |
140,399 |
138,326 |
-2,073 |
-1.5 |
Adults under 65 years with physical or sensory impairment |
27,882 |
28,822 |
940 |
3.4 |
Adults under 65 years with learning disabilities |
64,878 |
65,184 |
306 |
0.5 |
Adults under 65 years with mental health needs |
14,469 |
14,802 |
333 |
2.3 |
Other Adult Services |
3,042 |
2,975 |
-67 |
-2.2 |
Supported employment |
544 |
673 |
129 |
23.7 |
Supporting people |
30,577 |
30,558 |
-19 |
-0.1 |
Unapportionable overheads |
342 |
338 |
-4 |
-1.2 |
Grand Total |
282,998 |
282,503 |
-495 |
-0.2 |
Older people -£2.07m underspend (-1.5%)
5 Older people achieved savings within purchased services (domiciliary residential and nursing), this was offset by the requirement to ensure that in-house nursing and residential units were staffed appropriately for higher dependency clients, leading to an overspend on salary budgets. Overall this resulted in an underspend of £2.1m.
6 Efforts are continuing to manage down dependency levels and improve staff retention to reduce costs. This has been effective in 2008/09 with staff turnover in residential homes reducing from 23% in 2007/08 to 16% in 2008/09. Although this was still higher than the department average.
7 The underspend in purchased residential and nursing care was mainly due to improvements in securing Continuing Health Care funding including the backdating of claims. The underspend in purchased domiciliary care was mainly due to additional non-residential charging (NRC) income and the success of the community response team in re-abling clients. There has also been the continuation of tight vacancy management in assessment & care management and in-house home care.
8 Planned performance improvements in this area resulted in the number of older people needing to be admitted to care homes falling from 74.7 to 72.5 per 10,000 population. The underspend enabled pressures in other areas to be met, particularly services for people with physical disabilities (£940,000 overspend), and for help to live at home performance targets for this care group to be achieved. An additional 358 older people were supported to live at home, representing a 1.9% increase, however population growth was 2% resulting in a slight drop in performance equivalent to 0.1 per 1,000 people.
9 Management action has been targeted at increasing direct payment client activity to meet performance targets, and despite year end activity levels being still below planned levels, there has been a steady growth in numbers and value over the year.
10 In 2008/09 the number of older people using Direct Payments during the year almost doubled, from 506 in 2007/08 to 950, accounting for 53% of all the DP clients. In 2007/08 52% of the DP's received by older people had a value less than £200. In 2008/09 this had improved with 70% of clients receiving between £200 - £500.
Adults with a physical or sensory impairment +£940,000 overspend (+3.4%)
11 The primary reason for the overspend was a planned additional spend of £780,000 on equipment. This was as a result of focusing resources where a little bit of help can make a difference in supporting people to live at home. This was largely related to increased demand for essential items sourced through the Integrated Joint Equipment Store (ICES) to support people living at home, helping to improve the department's performance.
12 In 2008/09 the ICES delivered over 20,000 more items of equipment than in the previous year, taking the total to over 70,000; delivering on average 94.5% of items within 7 working days. There was also pressure on domiciliary care due to additional demand (client numbers increased by 57 (8%) over the year) and residential care due to increased level of need.
13 In relation to Direct Payments whilst the number of clients remained at a similar level to the previous year, at around 470, the value of DP increased. In 2007/08 56% of all the DP's issued to PD clients had an annual value greater than £5,000, in 2008/09 this had increased to 61% of clients. The percentage of people receiving between £2,000-£5,000 also increased from 17% to 20%.
Adults with learning disabilities +£306,000 overspend (+0.5%)
14 The underlying £0.5m underspend for the year moved to a £0.3m overspend only as a result of ordinary residence provision made at the end of the year for 21 likely claims (£0.8m). The other main factors contributing to the overall year end position are summarised below:
· Purchased client numbers overall increased in year by 194 (costing £1.1m) with the increases predominantly relating to community based services offset by a reduction in high cost residential client numbers (saving £0.6m) to give a net overspend of £0.5m.
· Additional continuing health care income of £0.5m. This was largely facilitated by the expert advice and support from two continuing health care posts funded by the Invest to Save budget.
· Underspend of £1.1m in in-house day care, as a result of vacancy management and lower than expected transport costs for clients.
· Overspend of £0.6m in in-house residential and domiciliary care reflecting the maximisation of the in-house residential capacity for clients with higher support needs who would normally have needed to have gone to more expensive purchased care packages.
15 Performance in this care group was sustained at 2007/08 levels with 2.8 adults per 1,000 populated supported at home.
16 The number of LD clients receiving a direct payment increased by 25% in 2008/09 from 198 in 2007/08 to 247 in 2008/09. In addition to this increase in client numbers the value of DP's also increased, with 49% of people receiving more than £5,000 over the year in 2008/09, compared to 45% in 2007/08.
17 In 2008/09 the number of clients aged under 65 admitted into permanent care reduced by 2.8% from 107 new admissions in 2007/08 to 104 in 2008/09. Against population this represents a 8% decrease in the number of new admissions of 18-64 years per 1,000 population, as measured by C73, as performance improved from 1.47 to 1.34 admission per 1,000 population.
Adults with mental health needs +£333,000 overspend (+2.3%)
18 Mental Health Services have reported a £333,000 overspend (2.3%) primarily due to a provision for a client which under the Mental Health Act section 117 became the responsibility of the Council and will result in a backdated reimbursement of client contributions.
Other services +£62,000 overspend (+1.7%)
19 The overspend was principally due to additional resource allocated to supported employment to fast-track new services to improve the prospects of people with a learning disability in gaining meaningful and paid employment. This reflects corporate and national priorities.
20 Of note is the improved performance with regard to the number of adults with learning disabilities helped into employment which increased from 94 to 347.
Variations in non-cash limited expenditure
21 The variations in non cash limited expenditure budgets explained in the next paragraph have no impact on Adult Services cash limited operational budgets.
22 The increased cost of office accommodation (included within central support services) and increased capital charges, arise from writing down the value of County Council owned land and buildings to reflect the general fall in land and property values in the economy. In accordance with standard accounting practice, this reduction can be charged to the asset revaluation reserve in the balance sheet if there are previous valuation gains to generate a sufficient reserve. However, because this accounting policy was introduced in Local Government in April 2007, there has been insufficient time to generate a sufficient reserve and so the reduction must be charged to service revenue accounts. However, as has always been the case for capital charges, they do not impact on the charge to the council tax payer. This technical accounting adjustment has no impact on Adult Services operational spending.
23 The above technical change on capital charges impacts on the PSS EX1. For example, for Hampshire Older People in-house residential homes, gross expenditure excluding capital charges increased by 3.3% from 2007/08 to 2008/09. If capital charges are included, the increase rises to 20%. Similarly, after taking account of client activity, the unit cost increase without capital charges is 8.5% and with capital charges 26%.
Appendix 1(a)
Adult Services
Revenue Expenditure 2008/09
Construction of cash limit
1 In the revised budget revenue expenditure under the service's direct control was subject to a cash limit set by Cabinet of £285.070m. Business rates were an exception because the level of business rates on the County Council's own properties could not be determined precisely when the revenue budget was set. As a result of revaluations actual expenditure on rates is £7,000 higher than was provided for in the revised budget and the cash limit has been adjusted accordingly. The calculation is shown in Table 4.
2 Further adjustments to the cash limit have also been made for:
£'000 | ||
Changes in Government Grants: |
||
Homeworkers |
-1 | |
Stroke care for Adults in the community |
-120 | |
Learning Disability Campus closure |
-222 | |
-343 | ||
Virements across Services |
||
Invest to save grant |
-90 | |
Funding contribution to Ashburton Court |
-226 | |
Transfer to Culture Communities & Rural Affairs |
-125 | |
-441 | ||
Inclusive Pay |
200 | |
Pay & Benefits Appeals |
205 | |
Winter Pressures targeted savings |
-1,700 | |
3 The adjustments referred to above are incorporated in the table below which summarises the position for the service in the year:
Table 4 2008/09 Cashlimit |
£'000 |
£'000 |
Revised cash limit for 2008/09 |
285,070 | |
Increase for the higher level of business rates payable |
7 |
|
Variation in government grants |
-343 |
|
Virements across Services |
-441 |
|
Inclusive pay |
200 |
|
Pay & Benefits Appeals |
205 |
|
Winter Pressures targeted savings |
-1,700 |
|
-2,072 | ||
Amended cash limit |
282,998 | |
Net expenditure |
282,503 | |
Net underspending against Service's controllable expenditure. |
-495 | |
Appendix 1(b)
Adult Services
Final Accounts 2008/09
Summary of Revenue Expenditure
(1) |
(2) |
(3) |
|||
Adjusted revised estimate |
Actual 2008/09 |
Variation (Col 2 - Col 1) |
|||
£'000 |
£'000 |
£'000 |
% | ||
Cash limited expenditure |
282,998 |
282,503 |
-495 |
-0.2 | |
Capital charges |
2,075 |
20,832 |
18,757 |
904.0 | |
Other expenditure which is controlled centrally by Policy and Resources and recharged to this service |
|
|
|
| |
- repair and maintenance of buildings |
1,515 |
1,199 |
-316 |
-20.9 | |
- central support services |
8,609 |
12,316 |
3,707 |
43.1 | |
295,197 |
316,850 |
21,653 |
7.3 | ||
- adjustment for pension costs |
-3,270 |
-2,889 |
381 |
-11.7 | |
Expenditure controlled by this committee recharged to Policy and Resources committee: |
|||||
- corporate and democratic core |
-201 |
-201 |
- |
- | |
Net expenditure before grant |
291,726 |
313,760 |
22,034 |
7.6 | |
Government grants: |
|||||
Homeworkers |
1 |
1 |
- |
||
National training strategy |
246 |
246 |
- |
||
AIDS support |
190 |
190 |
- |
||
Mental health |
45 |
45 |
- |
||
Supporting people |
2,684 |
2,684 |
- |
||
Invest to save |
240 |
240 |
- |
||
Preserved rights |
500 |
500 |
- |
||
Carers grant |
298 |
298 |
- |
||
Social Care Reform Grant |
1,537 |
1,537 |
- |
||
Learning Disability Campus Closure |
666 |
666 |
- |
||
Stroke Care for Adults in the Community |
25 |
25 |
- |
||
Total net expenditure |
285,294 |
307,328 |
22,034 |
7.7 | |
Reconciliation with total net expenditure in the budget book: |
|||||
Net expenditure (on page B3 of the budget book) |
287,023 |
||||
Adjustments |
|||||
Virements across Services |
-441 |
||||
Decrease for higher level of business rates |
7 |
||||
Inclusive pay |
200 |
||||
Pay and benefits |
205 |
||||
Winter Pressures targeted savings |
-1,700 |
||||
285,294 |
|||||
Appendix 1(c)
Adult services
Revenue Expenditure 2008/09
Analysis of cash limited revenue expenditure over services
(1) |
(2) |
(3) |
|||
Adjusted revised estimate |
Actual 2008/09 |
Variation (Col 2 - Col 1) |
|||
£'000 |
£'000 |
£'000 |
% | ||
Cash limit expenditure |
|||||
Service Strategy and Regulation |
865 |
825 |
-40 |
-4.6 | |
Older people (aged 65 or over) including older mentally ill |
|||||
Assessment and care management |
19,957 |
19,124 |
-833 |
-4.2 | |
Net costs of services |
120,442 |
119,202 |
-1,240 |
-1.0 | |
140,399 |
138,326 |
-2,073 |
-1.5 | ||
Adults under 65 years with physical or sensory impairment |
|||||
Assessment and care management |
6,710 |
6,797 |
87 |
1.3 | |
Net costs of services |
21,172 |
22,025 |
853 |
4.0 | |
27,882 |
28,822 |
940 |
3.4 | ||
Adults under 65 years with learning disabilities |
|||||
Assessment and care management |
4,254 |
4,108 |
-146 |
-3.4 | |
Net costs of services |
60,624 |
61,076 |
452 |
0.7 | |
64,878 |
65,184 |
306 |
0.5 | ||
Adults under 65 years with mental health needs |
|||||
Assessment and care management |
6,744 |
6,884 |
140 |
2.1 | |
Net costs of services |
7,725 |
7,918 |
193 |
2.5 | |
14,469 |
14,802 |
333 |
2.3 | ||
Other adult services |
|||||
Assessment and care management |
402 |
408 |
6 |
1.5 | |
Net costs of services |
2,640 |
2,567 |
-73 |
-2.8 | |
3,042 |
2,975 |
-67 |
-2.2 | ||
Supported employment |
|||||
Net costs of services |
544 |
673 |
129 |
23.7 | |
(1) |
(2) |
(3) |
||||||||
Adjusted revised estimate |
Actual 2008/09 |
Variation (Col 2 - Col 1) |
||||||||
£'000 |
£'000 |
£'000 |
% |
|||||||
Supporting people |
||||||||||
Net costs of services |
30,577 |
30,558 |
-19 |
-0.1 | ||||||
Unapportionable overheads |
||||||||||
Compensatory added years |
342 |
338 |
-4 |
-1.2 | ||||||
Net cash limited expenditure |
282,998 |
282,503 |
-495 |
-0.2 | ||||||
Appendix 1(d)
Adult Services
Revenue Expenditure 2008/09
Major variations in cash limited expenditure - underspending of £0.495m.
Budget heading |
Variation over(+)/ under(-) |
Adjusted cash limit |
Reason |
£'000 |
£'000 |
||
Service strategy and regulation Older people (aged 65 or over) |
-40 -2,073 |
865 140,399 |
Part year savings on new complaints regulations process. Secured more Continuing Health Care than planned, particularly with the backdating of claims, higher than budgeted NRC income and tight vacancy management in assessment & care management and in-house home care. |
Adults under 65 years with a physical or sensory impairment |
940 |
27,882 |
Planned additional spend on equipment and sensory rooms. |
Adults under 65 years with a learning disability |
306 |
64,878 |
Focussed demand management contained the operational pressures within the overall budget. The overspend reflects the £850,000 provision made in relation to a number of Ordinary Residence clients |
Adults under 65 years with mental health needs |
333 |
14,469 |
Focussed demand management contained the operational pressures within the overall budget. The overspend reflects the £475,000 provision in relation to the repayment of a number of years of client contributions to a client who has Section 117 status. |
Other services |
62 |
3,586 |
Additional resource was allocated to supported employment to fast-track new services to improve people's prospects of gaining meaningful and paid employment reflecting corporate and national priorities |
Appendix 1(e)
Adult Services
Key Statutory Partnerships - Progress
1 Hampshire Partnership Foundation Trust integrated mental health and substance misuse services
The objective of this partnership is to work together to provide modern health and social care mental health resources (circa £8.3m) that meet the needs of adults with severe mental health problems and promote their independence. Currently the Section 31 agreement is being refreshed and will be prepared under the Section 75 guidelines. A final draft, which will need to be formally signed off by both parties, is nearing completion.
2 Surrey & Borders Trust integrated mental health and substance misuse services
The objective of this partnership is to work together to provide modern health and social care mental health resources (circa £1.4m) that meet the needs of adults with severe mental health problems and promote their independence. Currently the Section 31 agreement is being refreshed and will be prepared under the Section 75 guidelines.
3 Portsmouth City mental health integrated substance misuse services The County have a S31 Agreement (circa £0.15m) with the Portsmouth City Primary Care Trust (PCPCT) to integrate social care with their tier 3 health teams to provide substance misuse services to the Fareham and Gosport and the Havant, Hayling Island and Petersfield areas of Hampshire. As with the agreement with Hampshire partnership Foundation Trust (HPFT) and Surrey and Borders Foundation Trust (SABFT), the PCPCT have responsibility for managing this service and it is covered by the review mentioned below.
4 Mental health Section 75 pooled funds with Hampshire PCT
There is a small Pooled Fund agreement (circa £0.9m) in place for some services in Mid Hampshire which were previously commissioned by NHS Hampshire. This arrangement has enabled services funded through the agreement to be redesigned leading to improvements in service delivery and efficiency savings. It is proposed to extend this agreement to include all mental health community support services which are block purchased from the third sector. This will enable the Council and NHS Hampshire to work together to review and improve purchased services to ensure that these meet future needs and deliver best value. A project plan is currently being drafted with NHS Hampshire.
5 Drug and Alcohol Action Team
The Hampshire Drug & Alcohol Action Team (DAAT) is a multi-agency partnership, responsible for the local implementation of the Government's ten year drug strategy 2008-2018 with an annual grant budget of £6.6m.
A countywide strategic review of substance misuse services was launched during July 2008 and a formal consultation process, based upon a strategic review information pack took place between 2 October 2008 and 2 January 2009. The desired outcome of the review process is to deliver the best possible configuration of drug and alcohol services in the county. These services will be effectively commissioned, properly contracted and monitored to meet needs and targets, and will be affordable within the available budget.
Following consultation, and as reported to the Executive Member on 26 June 2009 further work has been undertaken to develop the service delivery model for the Hampshire treatment system, clarify care pathways and describe the treatment journey; and to progress the proposals for joint commissioning and the appropriate administrative, governance and accountability arrangements to support these processes.
6 Health & Wellbeing Partnership Board
The Board brings together representatives from each district council, the PCT and the County Council. It met for the first time in June 2008. It has developed a work programme, including taking the lead on the delivery of the Local Area Agreement Theme F (Health & Wellbeing); adopted the Older People's Wellbeing Strategy; and is currently developing a Hampshire-wide Health & Wellbeing Strategy, which goes out to a 12-week consultation in June 2009.
7 Hampshire Integrated Community Equipment Service s75
This service provides equipment to disabled adults and children, as well as frail and elderly people, to help people remain in their own homes or in community-based settings for as long as possible. The section 75 Partnership Agreement covering the £3.5m combined budget has been endorsed by the Executive Member for Adult Social Care and is awaiting formal sign-off by the PCT. The HICES Board has been reconstituted and has introduced a robust performance monitoring regime. The service improved its performance last year, achieving 95% (against a target of 94.1%) for the percentage of items of equipment and adaptations delivered in 7 working days.
8 Learning disability s256 and budget transfer
Responsibility for commissioning social care for adults with a learning disability transferred from the NHS to Local Authorities from April 2009. This transfer had to be in the form of a local agreement for two years, 2009/10 and 2010/11. A comprehensive process has been undertaken in Hampshire to identify and verify all relevant funding for transfer. Extensive negotiations have taken place both with NHS Hampshire and the relevant provider organisations. As set out in the report to Executive Member on 26 June 2009, the agreement is for a transfer of £29,503,437 for 2009/10 and £30,241,023 for 2010/11 from Hampshire NHS to Hampshire County Council to support the transfer in responsibility for commissioning social care for adults with a learning disability. After this time, funding will be allocated to Local Authorities directly from the Department of Health according to a national funding formula. This formula has not yet been announced. The transfer will be supported by new contractual arrangements through the single tender process and a revised legal agreement in the form of the s256 Memorandum of Understanding.
9 Learning Disability Integrated Teams
This partnership of Hampshire County Council Adult Services and Hampshire Partnership Trust has been working together to bring together a joint integrated Learning Disability service, to deliver improved services to service users and their carers. There is now a single learning disability service, under the management of a Head of Service, hosted within Hampshire County Council. There are 5 new service areas each managed by a Locality Service Manager. Each area has within it Integrated Community Teams. These 8 new teams comprise those staff previously located in Hampshire Partnership Trust Community Learning Disability Teams and Hampshire County Council Care Management Teams. The management arrangements for the Integrated Service (circa £6m) will be covered by a Section 75 Partnership Agreement which is approaching its final draft.
In addition, each service management area will manage local Hampshire County Council in-house day services. Hampshire County Council's in-house residential services will be part of the overall service, but will remain discretely managed by a Residential Service Manager.
10 Nursing homes s31
The current S31 agreement was put in place for the ENHANCE nursing homes and was signed by the original 7 primary care trusts in Hampshire. The key benefits are that it allows Hampshire County Council to employ nurses by the NHS passing the authority to do this over to Adult Services. It also specifies that priority for admissions to the nursing homes should be for people with a Hampshire address or registered with a GP who covers NHS Hampshire. During 2008/09 no significant changes have occurred within the partnership.
11 Supporting People County Core Group
This group is comprised of representatives from each district or borough council, the County Council, Health and Probation. Together they have the ultimate responsibility for agreeing the Hampshire-wide Supporting People (SP) Policy, Strategy and Implementation of the programme for the £30m annual grant. The strategic review of Older Persons services saw the completion of this programme, and following widespread consultation saw extensive remodeling of services for Older People. This has resulted in more flexible services available to a wider range of clients, all clearly focused on meeting Local Area Agreement objectives. SP also took part in a Department of Communities and Local Government (CLG) Pathfinder exercise to test proposals for including SP funding into the Area Based Grant, allowing funding to be used more flexibly. The programme remains on target with regard to delivering on its current three-year financial strategy.
Appendix 1(f)
Adult Services
2008/09 Efficiency Savings
Budget heading |
Planned savings per budget |
Actual savings achieved |
Variance |
Comments |
|
|
|
|
|
Service strategy and regulation |
0 |
0 |
|
|
Older people (aged 65 or over) including older mentally ill |
(3,952) |
(5,102) |
(1,150) |
Primarily the overachievement of OP/PD CHC targets due to backdated receipts, plus additional savings from the Home Care Modernisation programme due to delays in recruiting to the new structure |
Adults under 65 years with a physical or sensory impairment |
(651) |
(651) |
0 |
|
Adults under 65 years with a learning disability |
(1,751) |
(2,134) |
(383) |
Overachievement of LD CHC targets, due to backdated receipts. |
Adults under 65 years with mental health needs |
(386) |
(386) |
0 |
|
Other adult services |
(34) |
(34) |
0 |
|
Total savings |
(6,774) |
(8,307) |
(1,533) |
3% of cash limited expenditure |
Appendix 1(g)
Adult Services
Performance Commentary
1 Good progress is being made in delivering the Corporate Improvement Plan, with the target for Extra-care housing having been exceeded. The Hampshire Model for Personalisation is already achieving better outcomes for people, notably those who are part of the Self-Directed Support programme in Basingstoke. Learning from evaluation and user experience is shaping the longer term plan to deliver sustainable improvements for vulnerable adults.
2 Adult Services has direct responsibility for delivering 11 of the National Indicator Set (NIS) and monitors an additional 25 to which it contributes or has an interest. While still `early days' for many of the NIS, we have built up a good knowledge of local performance where it is possible to do so. Indications are that compared to other county councils, we continue to perform well across adult social care indicators, notably having slightly exceeded our Direct Payments target.
3 There is also evidence that the Local Area Agreement is targeting those wider `health and wellbeing' indicators presenting the greatest challenges in the local population, though there remains much work to do, including in the area of tackling health inequalities. The Health and Wellbeing Partnership Board has agreed priorities for action, these are to stem, in the face of significant population growth, the rise in the number of emergency beds days used across Hampshire; and to address health inequalities in two target areas - smoking cessation and alcohol abuse.
4 Strategic and local partnerships with Health are good and improving and have delivered improved outcomes for people discharged from hospital and those entitled to continuing healthcare. Further improvement to prevent admissions and reduce the use of emergency beds is a specific priority for the Hampshire Model and LAA Health & wellbeing theme.
5 The continued success of Council strategies focused on reablement, has seen a reduction in admissions of older people to residential and nursing care and more older people with intensive care needs supported at home, despite an increasing elderly and frail population. Promotion of Direct Payments is enabling service users to regain control of their lives, with support to achieve personal outcomes in imaginative and creative ways. Supporting risk taking is a challenge in terms of the Councils duty of care and is being addressed as part of the Self Directed Support programme. The number of people with learning disabilities helped into employment has increased from 94 to 347 in the last year and is a significant achievement in times of economic recession.
6 Work with providers through the Contracts Quality Monitoring Framework, which gives front line staff `real time' information, is proving effective in addressing quality, safeguarding concerns and improving outcomes for individuals. Increased investment in safeguarding and awareness raising across the Council and its partners has seen the number of referrals increase. Strengths in safeguarding include prompt response to referrals and the quality of case work under very difficult and sensitive circumstances. A challenge is to ensure that appropriate referrals are received from partner agencies and work is underway to address this.
Appendix 1(h)
Adult Services Value for Money Scorecard 2008/09
Adult Services provides information and advice to people at a vulnerable time in their lives. It commissions and delivers services to those assessed as being in `substantial' or `critical' need. Charges are made for services, dependent on individual's ability to pay. A key aim of the service is to help people remain independent and in their own home, avoiding the need for residential, nursing or hospital care wherever possible.
Adult Services has sustained three star top performance. It has successfully delivered efficiency and improvements to the value of £19.7million in the last two financial years, plus an estimated £7.8million cashable savings in 2008/09, with £8.3million planned in 2009/10.
Performance Measure |
2006/07 |
2007/08 |
2008/09 |
Plan |
Economy - the price paid for what goes into providing a service | ||||
B12 Unit Cost of intensive care |
£581 |
£583 |
£651 |
£598 |
B17 Unit cost of home care |
£14.50 |
£14.10 |
£14.40 |
£14.5 |
Efficiency - how much you get out in relation to what is put in | ||||
C32 Older People helped to live at home per 1,000 population |
83 |
84 |
84.2 |
85 |
C30 People with LD helped to live at home per 1,000 population |
2.7 |
2.8 |
2.8 |
2.9 |
C29 People with PD helped to live at home per 1,000 population |
5.9 |
6.1 |
6.2 |
6.2 |
C31 People with MH helped to live at home per 1,000 population |
10.8 |
Definition changed in 2008/09 | ||
NI 136 All adults supported to live independently through Adult Services per 100,000 population |
4,808 |
5,176 |
5,421 |
New approach - No target set. |
Effectiveness - the impact achieved | ||||
C72 (Reducing) Admissions to res care 65yrs plus per 10,000 population |
78 |
74.7 |
72.5 |
73 |
C73 (Reducing) Admissions to res care younger adults per 10,000 population |
1.6 |
1.4 |
1.3 |
1.3 |
NI 132 People who wait less than 4 weeks for an assessment (all ages) |
84% |
85% |
87% |
New approach - No target set. |
NI 133 People who wait less than 4 weeks for a service (aged 65 and over) |
89% |
89% |
90% |
90% |
D41 Delayed Transfers of Care (acute hospitals only) |
38 |
28.2 |
29.2 |
27.5 |
NI 131 Delayed Transfers of Care (all hospitals) |
8.6 |
16.77 |
14.1 |
Definition changed in 2008/09 |
Local PI User Satisfaction (annual survey) |
83% |
83% |
87% |
85% |
Supporting People: This programme is designed to give vulnerable people the opportunity to improve their quality of life by helping them to establish or maintain independent living in a stable home environment.
Performance Measure |
2006/07 |
2007/08 |
2008/09 |
Plan |
Economy - the price paid for what goes into providing a service | ||||
Supporting People |
£31.3m |
£30.9m |
£30.6m |
|
Effectiveness - the impact achieved | ||||
NI 141: % of vulnerable people achieving independent living |
Reliable data not available |
71.90% Q4 |
79.78 Q4 |
|
NI 142: % of vulnerable people who are supported to maintain independent living |
97.99% Q4 |
98.05% Q4 |
99.13% Q4 |
99.0% |
Appendix 2
2008/09 Capital expenditure
1 In December 2006 cabinet approved the adult services strategy to increase the availability of Extra-care housing where the department has sole nomination rights. This will enable the department to provide care at home for the physically frail who might previously have had little choice but to enter residential care.
In 2008/09 we provided 244 enhanced scheme units to create extra- care beds. By 2013 we will have added a further 240 new build extra- care units. In addition, we currently provide 1,192 beds comprising 692 residential and 500 nursing in-house beds. This compares to 942 beds in 2003.
The development of new build Extra Care schemes is progressing well, with new build projects progressing in Gosport, Basingstoke (Brighton Hill), Fleet and Andover. We are also progressing seven enhanced sheltered housing schemes in Fareham, Andover, Basingstoke, Aldershot, Eastleigh, Lymington and Denmead. This is a key programme in the development of the market to meet future aspirations to support people to remain independent in their own homes.
In February 2009 capital works were completed on Bishops Waltham House, a building that provides residential care for up to 36 older people at any one time. The scheme involved internal refurbishment, reconfiguration, minor alterations and improvements to the facilities, to enhance the quality of place and improve safety for residents and staff at the Home. The capital works were completed in February 2009 at a cost of £830,500.
The outturn for 2008/09 is set out below with details of the total resources and of the individual schemes started/completed in the year appearing in Appendix 2(a).
£'000 | |
Total resources |
10,571 |
Value of schemes started/completed in 2008/09 |
4,786 |
Balance of Cash Limit |
5,785 |
2 The total programme limit for 2008/09 amounted to £10.6m and schemes to the value of £4.8m were committed in the year. Schemes to the value of £5.8m are to be carried forward to 2009/10.
3 Schemes not started in 2008/09 and to be carried forward to 2009/10 include the balance of minor works in residential and day care premises, furniture and equipment, and improvements to residential homes. The list of schemes started and proposed for carry forward are included in Appendix 2(a).
4 In accordance with the County Council's Financial Procedures, the final costs of capital schemes controlled on an expenditure basis completed in 2008/09 are listed in Appendix 2(a). "Completed" in this context means when the final payment has been made. Some of these schemes may have been in operation prior to April 2008, but the final payment was only made in 2008/09. The final cost of the schemes completed in 2008/09 is £4.8m.
Appendix 2(a)
Adult Services
Capital Expenditure 2008/09
£'000 | |||||||
1 |
Construction of total resources |
||||||
Original programme limit per 2008/09 budget book |
2,576 | ||||||
Cash limit brought forward from 2007/08 |
3,802 | ||||||
Share of 2007/08 capital receipts |
320 | ||||||
Extra Care Housing Grant |
1,592 | ||||||
Social Care Infrastructure Grant |
281 | ||||||
Revenue underspending from 2007/08 transferred to capital |
2,000 | ||||||
10,571 | |||||||
2 |
Schemes committed during 2008/09 |
||||||
Furniture and equipment in Residential and Day care Premises |
221 | ||||||
Minor works in Residential and Day care Premises |
683 | ||||||
Fire precautions/improvements in OP Homes |
666 | ||||||
Extra Care Housing Grant |
1,592 | ||||||
Extra Care Housing Local Resource |
1,350 | ||||||
Improving the Care Homes Environment |
263 | ||||||
Information Management Grant |
11 | ||||||
Total schemes committed during 2008/09 |
4,786 | ||||||
3 |
Schemes carried forward, to be approved by the Cabinet to start in 2009/10 |
||||||
a) Schemes controlled on a starts basis: |
|||||||
Minor Works in Residential and Day Care Premises |
380 | ||||||
Furniture and Equipment in Residential and Day Care Premises |
394 | ||||||
Furniture and Equipment in Office Bases |
275 | ||||||
OP Homes Fire precautions/Improvements |
1,627 | ||||||
b) Schemes controlled on an expenditure basis - adjustment for variation between planned and actual expenditure: |
|||||||
Mental Health Supported Capital Expenditure (Revenue) |
432 | ||||||
Mental Health Grants |
291 | ||||||
Information Management System |
137 | ||||||
Extra Care Supported Housing |
402 | ||||||
Community Equipment Stock |
300 | ||||||
IT Equipment |
188 | ||||||
IT Projects |
960 | ||||||
Social Care Infrastructure grant |
281 | ||||||
Improving the Care Homes Environment |
118 | ||||||
Total |
5,785 | ||||||
4 |
Summary of 2008/09 capital programme: |
||||||
Total resources |
10,571 | ||||||
Schemes committed during 2008/09 |
4,786 | ||||||
Balance of cash limit as 31 March 2009 |
5,785 | ||||||
Schemes carried forward to 2009/10 |
-5,785 | ||||||
Net balance of cash limit remaining to meet inflation costs |
- | ||||||
Cash limit carried forward to 2009/10 |
5,785 | ||||||
5 |
Costs of capital schemes completed/started in 2008/09 |
||||||
Scheme |
Final cost |
Funded from external contributions |
Net cost chargeable to capital cash limit |
Latest approved cost |
Variation | ||
Completed projects: |
£'000 |
£'000 |
£'000 |
£'000 |
£'000 | ||
Improving the care homes environment |
263 |
263 |
263 |
0 | |||
Information Management Grant |
11 |
11 |
11 |
0 | |||
Sub-total |
274 |
274 |
274 |
0 | |||
Starts and block schemes |
|||||||
Furniture and equipment in residential and day centres |
221 |
221 |
221 |
0 | |||
Fire precautions and improvements in OPH |
666 |
666 |
666 |
0 | |||
Extra care housing grant |
1,592 |
1,592 |
1,592 |
0 | |||
Extra care local resource |
1,350 |
1,350 |
1,350 |
0 | |||
Minor Works |
683 |
683 |
683 |
0 | |||
Sub-total |
4,512 |
4,512 |
4,512 |
0 | |||
Total |
4,786 |
4,786 |
4,786 |
0 | |||
Appendix 3
2009/10 Overall Revenue Budget strategy and projected outturn
Budget Strategy
1 The budget strategy for 2009/10 takes account of partial in year implementation of many of the Hampshire model's proposals, including for example self directed support, early intervention and prevention, and the further development of business processes linked to Hantsdirect.
2 A long term implementation plan with detailed transition activities, longer term changes, timescales, and implementation dates and communications plan is being formulated. This will enable successful delivery of the proposed model over an agreed timescale, within agreed budgets and meeting performance standards as required. Experience from other major projects, including the Phase 1 work in Basingstoke has shown that the roll out of change that impacts on service users and the market, need a longer implementation timescale for them to have sustainable outcomes. The Transformation programme includes:
· The Hampshire Model
o Universal Offer
o Free Crisis Care
o Self Directed Support
o Carers
o User led initiatives
o Market development
· Learning Disability integration
· NHS transfer of LD Services
· Extra Care
· HantsDirect
· Common Assessment Framework
· Care Governance
· Safeguarding (Performance Data)
The budget is constructed at the cash limit and allows for:
Category |
£m |
Pressures |
18.5 |
Savings |
(8.3) |
Net Growth |
10.2 |
5.4% Cash Increase |
(6.7) |
Further savings to be identified * |
(3.5) |
Balance |
0 |
* This shortfall for 2009/10 has now been covered by planned carry forward from 2008/09 of £3.5m. Further savings will be required for 2010/11 onwards.
3 The report for the first two months of this financial year shows the projected outturn to be in line with the budget. The current cash limit amounts £305.6m. There has been a net increase of £756,000 to the cash limit. The movement in the cash limit is set out in the table below:
£ m | |
Budget as per Budget Book 2009/2010 |
304.840 |
50% of £495,000 underspend (one-off)* |
0.248 |
Transfer to capital of 50% of £495,000 |
-0.248 |
Campus closure grant |
0.222 |
Invest to Save |
0.090 |
Stroke grant |
0.120 |
New grants |
0.272 |
Technical adjustments |
0.052 |
Cash limit as at 24 July 2009 |
305.596 |
* as approved by the Policy & Resources Executive Member decision on 19 May 2009.
4 This is the first budget monitoring for 2009/10 and needs to be treated with some caution at this early stage of the year with only two months spending incurred. Potential risks have been identified and plans are in place to ensure the outturn comes in on budget.
5 The overall position by business group may be summarised as follows:
Client Group |
Adjusted P2 Cash Limit 2009/10 (£000) |
Projected Spend (to 31/03/10) (£000) |
Variation Over/(Under) Spend | |
£'000 |
% | |||
Director and Performance & Business Management |
24,918 |
24,918 |
- |
- |
Commissioning and Partnerships |
46,895 |
46,895 |
- |
- |
Older People / Physical Disability |
159,690 |
159,690 |
- |
- |
Learning disability |
61,123 |
61,123 |
- |
- |
Mental Health |
10,293 |
10,293 |
- |
- |
Contingency & Centrally Held |
2,677 |
2,677 |
- |
- |
Grand Total |
305,596 |
305,596 |
- |
- |
Note: The table above analyses the budget in terms of management responsibility and is not, therefore, the same as the presentation used in the budget book, which follows the external reporting requirements of CIPFA's best value accounting code of practice. More detailed information is given in Appendix 3(a).
6 The Director, Performance & Business Management projection is in line with the budget. Should cost pressures arise in the year management action will be taken to contain these within budget.
7 Commissioning and Partnerships is forecasting a balanced budget position across the client groups.
In April 2006 Hampshire County Council and the eleven District Councils in partnership signed up to Target 14 of the Local Public Service Agreement 2 (LPSA2), which set a target of 264 people to be housed over the three year period April 2006 to April 2009. Having achieved this stretch target in the specified time period the partnership will receive £1.8m Reward Grant, of which £0.3m will come to Hampshire County Council. This is ring fenced for the purpose of housing for people with assessed care needs and will be received as a mixture of capital and revenue across 2009/10 and 2010/11. The split between capital and revenue will be determined following ongoing negotiations with the District Councils and will be confirmed in a future report.
8 Within Older People and Physical Disability there are net pressures of £1.1m offset by contingencies resulting in a balanced position as summarised below and explained in the following paragraphs.
In-house Services are currently projecting an overspend of £1.2m, primarily staffing costs due to high levels of vacancies, staff turnover and sickness, covered by using overtime and agency staff to ensure safe staffing levels are maintained.
Action: Budget surgeries have been held with all Service Managers and Unit Managers to develop financial recovery plans for each unit, including:
· work force plans and recruitment strategies are being developed to take advantage of the current economic climate
· the findings from the recent review of rosters will be implemented to make more efficient use of available care hours
· and there will be phased recruitment to the new domestic posts approved in the 2009/10 budget process.
Senior management will consolidate these into an overall financial recovery plan aimed to deliver a balanced budget.
Purchased Services are overall showing a balanced budget, however, Personalisation and the trend of clients choosing to direct their own care and/or live at home as an alternative to residential care, has resulted in a shift in spend of £3.5m to domiciliary care and Direct payments which will be offset by reductions of £3.5m on more traditional residential models of care.
Action: Realignment virements are being proposed as explained in para. 13 in appendix 3 below.
Due to changes made to how income is allocated to budgets, and the overachievement of NRC income targets in 2008/09, income budgets were increased in 2009/10 to more accurately reflect anticipated levels of income. This will be tightly monitored over the year, to track any potential impact on income of the current economic climate.
Additionally, new DOH guidance on the 12 week property disregard, clarifies that the scheme is available to clients from when they are first known to HCC, not from when they first receive residential care. This subtle distinction increases the number of clients who could be eligible and therefore could potentially impact upon income received under Charging for residential accommodation guide (CRAG). However, it is not possible to quantitatively predict the impact at this stage.
9 The Learning Disability sector is showing a balanced budget as at period 2. There are, nevertheless, a number of areas of high risk that will need to be closely managed and monitoring over the coming months.
Ordinary Residence: There has been increased activity from Other Local Authorities (OLAs) looking to reclaim Ordinary Residence costs for clients who have taken out a tenancy in Hampshire. Costs incurred of £200,000 have been absorbed by the £850,000 provided for in the 2008/09 accounts. However, there is potential for more and larger claims to be made.
Action: The Head of the Integrated Learning Disability Service is working closely with Legal Services to ensure that all cases are robustly challenged and that all cases that Hampshire County Council can pursue from OLAs are followed up.
Supporting People Savings: There are £965,000 savings required from the reinvestment fund set aside by Supporting People for Adult Services as part of the Support People Strategic Review of Learning Disability Sector. Details on how the investment fund can be utilised needs to be agreed with the County Core Group, the partnership board for Supporting People.
Action: The Head of the Integrated Learning Disability Service and the Assistant Director for Business and Performance are working closely with Supporting People to maximise the effectiveness of the reinvestment fund.
Continuing Health Care: Included in the budget for transition clients is a £1m provision for reductions in the gross cost of the transition clients. This is largely to be sourced from achieving Continuing Health Care income for qualifying clients. There is currently a backlog of some 100 cases awaiting ratification by Hampshire Primary Care Trust (PCT) which represents a potential income of £1.5m. Delays in achieving the resolution of these cases could affect the achievement of this target.
Action: The Head of the Integrated Learning Disability Service and the Departmental Lead for Continuing Health Care are planning to divert additional resources to this issue to speed up the resolution of these cases.
Updates on these areas will be given in future reports.
10 Mental Health-Operations are forecasting a balanced budget at this stage. This is mainly the result of ongoing strong management action around the containment of the number of residential placements, which has reduced by 5 since the budget was set.
Contingency
11 The contingency is made up of:
o Contingency in the base budget £1.4m
o Savings and contingency funding to be identified -£3.5m
o Planned carry forward from 2008/09 (one off) £3.8m
-------
o Total contingency after carry forward addition £1.7m
o Contingency for specific pressures £0.2m
(e.g. section 117 etc)
--------
o Total in table in para 5 above £1.9m
--------
12 At this stage of the year the contingency needs to be kept intact to cover winter or operational or transitional pressures which may occur as the year progresses.
13 Realignment Virements
As described in para. 8 in appendix 3 above, Personalisation and the trend of clients living in their own homes has had a much bigger impact on OP/PD spending patterns than originally provided for in the budgets. It is proposed to allocate £3.5m from OP/PD purchased nursing (£2.5m) and residential care budgets (£1.0m) to domiciliary care (£2.8m) and Direct Payments budgets (£0.7m).
Supporting People
14 Supporting People is showing a balanced position as the end of May. This includes the £3.9m that was carried forward from the underspend on its grant from 2008/09.
Currently the service is on course to meet its three-year financial strategy which is to use this carry forward to underwrite the fact that for 2009/10 the grant has been held at 2008/09 levels (£31m) and will decrease by £894,000 in 2010/11. This will allow it time to review its contracts so by the end of March 2010 it will be in a balanced financial position.
It is planned that the ring fence around the supporting people grant will be removed in April 2010 when it becomes part of Area Based Grant (ABG). At this stage it is not anticipated that the Supporting People grant will be cut further in the next Comprehensive Spending Review. Nevertheless, funding continuing at the existing level is at risk and future planning will take this into account. Any announcements from central government will be closely monitored by the Supporting People team.
Drug and Alcohol Action Team
15 For the end of May DAAT is reporting a balanced outturn forecast. This includes the £750,000 carried forward from the underspend in the 2008/09 grant. As described in the paper on the Strategic Review of Substance Misuse that went to Executive Member on 26th June 2009 the intention is to utilise the carry forward to compensate in the short term for the £647,961 reduction in grant funding from 2008/09 to 2010/11. As part of the short term financial strategy it is anticipated that there will be £0.5m underspend in 2009/10 which will be carried forward to the following financial year to offset the reduction in grant funding. It is anticipated that through the re-commissioning of services that will take place as part of the next stage of the Strategic Review that the service will achieve a sustainable balanced budget position by the end of March 2011.
In the Adult Services budget preparation for 2009/10 there was a budget bid for £102,000 to compensate for the anticipated decrease in grant funding from other partner organisations. As that decrease has not materialised the £102,000 will not be required for 2009/10. However, as set out in the Executive Member paper it is intended that this sum be carried to 2010/11 to support the medium term financial plan described above.
Other Factors
16 In addition the following factors need consideration.
17 Outstanding debt relating to client contributions being actively managed by the Write Off Panel totals £589,000 of which £157,000 is at risk of being taken to the write-off panel for further consideration. To date there are no proposed write-off over the £5,000 limit that require formal write off by the Executive Member. Debts written-off so far this year under £5,000 are £18,863.
18 Outstanding debt from other local authorities and Health has decreased from £237,000 to £149,000 between end of March and end of May 2009. It is all anticipated to be recovered.
19 There is a continuing risk around ordinary residence. Hampshire is a net importer of residents in residential care funded by other local authorities. It is probable Hampshire will have to pick up the costs of those clients placed by another authority in a Hampshire home which subsequently de-registers. The current risk was assessed at £850,000 and provided for in the 2008/09 accounts. These risks will be continually monitored and reported on when the position is clearer.
Appendix 3(a) Comparison of Period 2 Projected Outturn with the latest Cash Limit
|
|
Provisional Cash Limit Adjustments |
|||||||||||||
Client Group |
Original P2 Cash Limit 2009/10 (£000) |
50% of £495k underspend (one-off) (£000) |
Transfer to capital of 50% of £495k (£000) |
08/09 Grants carry forwards (£000) |
New Grants (£000) |
Technical Adjust. (£000) |
Adjusted P2 Cash Limit 2009/10 (£000) |
Total Actuals as at 31/05/09 (£000) |
Projected Spend (to 31/03/10) (£000) |
Variation Over/(Under) Spend | |||||
£'000 |
% | ||||||||||||||
|
|
|
|
|
|
|
|
|
|
| |||||
Director (inc Director, Director's Office, Admin, Comms & Complaints) |
1,024 |
- |
- |
- |
- |
- |
1,024 |
(58) |
1,024 |
- |
- | ||||
Performance and Business Management |
23,863 |
- |
- |
- |
- |
31 |
23,894 |
1,484 |
23,894 |
- |
- | ||||
Commissioning and Partnerships |
46,159 |
- |
- |
432 |
272 |
32 |
46,895 |
10,193 |
46,895 |
- |
- | ||||
Older People / Physical Disability |
159,690 |
- |
- |
- |
- |
- |
159,690 |
22,456 |
159,690 |
- |
- | ||||
Learning Disability |
61,123 |
- |
- |
- |
- |
- |
61,123 |
5,362 |
61,123 |
- |
- | ||||
Mental Health |
10,293 |
- |
- |
- |
- |
- |
10,293 |
1,316 |
10,293 |
- |
- | ||||
Centrally Held |
2,688 |
248 |
(248) |
- |
- |
(11) |
2,677 |
(1,218) |
2,677 |
- |
- | ||||
Grand Total |
304,840 |
248 |
(248) |
432 |
272 |
52 |
305,596 |
39,535 |
305,596 |
- |
- | ||||
2009/10 Government Grants Appendix 3(b)
1 The 2009/10 government grants allocation of £53.148m for the service is summarised in this appendix.
2 This is the second year of the Social Care Reform grant introduced for a period of three years, to promote inclusion in communities. The grant is £3.6m in 2009/10 (£1.5m in 2008/09) and £4.5m in 2010/11 and is being used to implement the personalisation agenda, including Self Directed Support (SDS). The ultimate aim is to empower individuals who are in need of support in the definition and purchase of services they need for their well being. The grant is to pay for the costs of the transformation required including Self Directed Support, not for operations. The future of the funding beyond the 3 year period is uncertain.
The 2009/10 grant has been allocated as follows:
Use of funding |
£'000 |
Self Directed Support |
1,664 |
Care Choice |
348 |
Community Innovations |
960 |
Integrated LD Teams |
250 |
Swift upgrade |
45 |
Training |
50 |
Time to think |
250 |
Carebrokers |
51 |
Total |
3,618 |
3 This is also the second year of the LD campus reprovision grant. The total available is £1.967m plus £222,000 carry forward and has been allocated as follows:
Use of funding |
£'000 |
Person Centred Planning including working with families |
168 |
Care Management |
438 |
Housing related work |
678 |
Support for Health Action Planning |
200 |
Workforce development and training |
150 |
Support and advocacy |
415 |
Support for more inclusive community based activities |
100 |
Support to help people get into employment |
40 |
Total * |
2,189 |
* includes £222,000 carry forward per para 4 in appendix 3(b) below
4 The Policy & Resources Executive Member decision on 19 May 2009 has already approved the carry forward of unspent government grant of £432,000 as follows:
· £222,000 Learning Disability Campus Closure
· £120,000 Stroke Care for adults in the community
· £90,000 Invest to Save
5 It has recently been announced that HIV aids support grant will increase by £103,000. This addition will be reflected in the next monitoring report.
|
Variations |
| |
Grants 2008/09 £'000 |
Existing Grants £'000 |
Grants 2009/10 £'000 | |
Specific Grants |
|
| |
Stroke Carers |
|
145 |
145 |
HIV/Aids Support |
133 |
|
133 |
Homeworker's scheme |
2 |
|
2 |
Social Care Reform |
1,537 |
2,081 |
3,618 |
Invest to Save |
240 |
|
240 |
Learning Disabilities Campus Programme |
|
1,967 |
1,967 |
Handy Person |
|
150 |
150 |
Total Specific Grants excl Supporting People |
1,912 |
4,343 |
6,255 |
Supporting People Care Grant |
31,010 |
|
31,010 |
Total Specific Grants inc Supporting People |
32,922 |
4,343 |
37,265 |
Area Based Grants |
|
|
|
Adult Services |
|
|
|
Mental Health Grant |
2,230 |
111 |
2,341 |
Drug Action Team |
103 |
|
103 |
Young People Substance Misuse |
|
210 |
210 |
Additional Young People Substance Misuse |
|
154 |
154 |
Adult Social Care Workforce (was NTS/HR) |
1,879 |
87 |
1,966 |
Carers Grant |
3,278 |
250 |
3,528 |
Preserved Rights |
5,756 |
(262) |
5,494 |
IMCA & IMCAS Mental Capacity Grant |
433 |
116 |
549 |
Supporting People Admin |
779 |
(61) |
718 |
Learning Disability Development Fund |
699 |
(1) |
698 |
Total Adults Area based Grants |
15,157 |
604 |
15,761 |
Policy & Resources Area Based Grants |
|
|
|
Safe & Strong Communities |
|
122 |
122 |
Total Area based Grants |
15,157 |
726 |
15,883 |
|
|
|
|
Total Grants inc Supporting People |
48,079 |
5,069 |
53,148 |
Increase between 08/09 & 09/10 |
|
|
5,069 |
2009/10 Client activity Appendix 3(c)
1 The current client activity is currently 510 higher than the budgeted level. The significant variances are:
· Domiciliary care 461 above budgeted level, reflecting Personalisation and clients choosing to live in their own homes.
· Day care 122 below budgeted level, primarily OP clients, which is reflected by a small underspend on this care type.
· Direct Payments 65 above budgeted level. The SDS Phase 1 in Basingstoke and County wide management action to increase take up of Direct Payments to promote personalisation and meet performance targets, has resulted in the targeted client activity being exceeded.
The movement in the individual client groups is summarised below and detailed in the following tables. The budget activity below will be adjusted in the next report to reflect the movement of funding recommended in this report. Activity levels here are presented using more accurate "Average weekly cost" data basis which supersedes the Client Management Activity (CMA) data set used in previous client activity reports.
(Client Group Activity by Care Type and by External & Internal Provider) | |||||||||||||||||||||||||
|
|
|
|
|
Movement Between Budgeted 0910 & May 09 |
||||||||||||||||||||
Care Type |
Budgeted 0910 |
Apr-09 |
May-09 |
|
|||||||||||||||||||||
Nursing Care - External |
1394 |
1,514 |
1,504 |
|
110 |
||||||||||||||||||||
Nursing Care - In-house |
465 |
392 |
378 |
|
-87 |
||||||||||||||||||||
sub-total Nursing Care |
1859 |
1,906 |
1,882 |
|
23 |
||||||||||||||||||||
Residential Care - External |
2648 |
2,710 |
2,671 |
|
23 |
||||||||||||||||||||
Residential Care - In-house |
761 |
819 |
793 |
|
32 |
||||||||||||||||||||
sub-total Residential Care |
3409 |
3,529 |
3,464 |
|
55 |
||||||||||||||||||||
Domiciliary Care - External |
6626 |
7,290 |
7,238 |
|
612 |
||||||||||||||||||||
Domiciliary Care - In-house |
689 |
530 |
538 |
|
-151 |
||||||||||||||||||||
sub-total Domiciliary Care |
7315 |
7,820 |
7,776 |
|
461 |
||||||||||||||||||||
Day Care - External |
2185 |
1,966 |
1,919 |
|
-266 |
||||||||||||||||||||
Day Care - In-house |
1442 |
1,594 |
1,586 |
|
144 |
||||||||||||||||||||
sub-total Day Care |
3627 |
3,560 |
3,505 |
|
-122 |
||||||||||||||||||||
Direct Payments - External |
853 |
891 |
918 |
|
65 |
||||||||||||||||||||
Direct Payments - In-house |
|
0 |
0 |
|
0 |
||||||||||||||||||||
sub-total Direct Payments |
853 |
891 |
918 |
|
65 |
||||||||||||||||||||
Other - External |
0 |
86 |
28 |
|
28 |
||||||||||||||||||||
Other - In-house |
0 |
0 |
0 |
|
0 |
||||||||||||||||||||
sub-total Other |
0 |
86 |
28 |
|
28 |
||||||||||||||||||||
Grand Total |
17,063 |
17,792 |
17,573 |
|
510 |
||||||||||||||||||||
Client Group Activity Analysis by Care Type | ||||||||||||||||||||||||
Older People |
|
|
|
Movement Between Budgeted 0910 & May 09 |
||||||||||||||||||||
Care Type |
Budgeted 0910 |
Apr-09 |
May-09 |
|||||||||||||||||||||
Nursing Care |
1,732 |
1,778 |
1,755 |
23 |
||||||||||||||||||||
Residential Care |
2,286 |
2,444 |
2,396 |
110 |
||||||||||||||||||||
Domiciliary Care |
5,273 |
5,682 |
5,708 |
435 |
||||||||||||||||||||
Day Care |
1,849 |
1,645 |
1,585 |
-264 |
||||||||||||||||||||
Direct Payments |
245 |
206 |
219 |
-26 |
||||||||||||||||||||
Other |
0 |
3 |
0 |
0 |
||||||||||||||||||||
Total |
11,385 |
11,758 |
11,663 |
278 |
||||||||||||||||||||
Physical Disabilities |
|
|
|
Movement Between Budgeted 0910 & May 09 |
||||||||||||||||||||
Care Type |
Budgeted 0910 |
Apr-09 |
May-09 |
|||||||||||||||||||||
Nursing Care |
94 |
90 |
87 |
-7 |
||||||||||||||||||||
Residential Care |
122 |
129 |
130 |
8 |
||||||||||||||||||||
Domiciliary Care |
675 |
817 |
801 |
126 |
||||||||||||||||||||
Day Care |
346 |
334 |
328 |
-18 |
||||||||||||||||||||
Direct Payments |
392 |
420 |
427 |
35 |
||||||||||||||||||||
Other |
0 |
6 |
0 |
0 |
||||||||||||||||||||
Total |
1,629 |
1,796 |
1,773 |
144 |
||||||||||||||||||||
Learning Disabilities |
|
|
|
Movement Between Budgeted 0910 & May 09 |
||||||||||||||||||||
Care Type |
Budgeted 0910 |
Apr-09 |
May-09 |
|||||||||||||||||||||
Nursing Care |
19 |
25 |
27 |
8 |
||||||||||||||||||||
Residential Care |
885 |
859 |
843 |
-42 |
||||||||||||||||||||
Domiciliary Care |
1,096 |
1,047 |
996 |
-100 |
||||||||||||||||||||
Day Care |
1,232 |
1,259 |
1,259 |
27 |
||||||||||||||||||||
Direct Payments |
192 |
244 |
250 |
58 |
||||||||||||||||||||
Other |
0 |
51 |
0 |
0 |
||||||||||||||||||||
Total |
3,424 |
3,485 |
3,375 |
|
-49 |
|||||||||||||||||||
Mental Health |
|
|
|
Movement Between Budgeted 0910 & May 09 |
||||||||||||||||||||
Care Type |
Budgeted 0910 |
Apr-09 |
May-09 |
|||||||||||||||||||||
Nursing Care |
14 |
13 |
13 |
-1 |
||||||||||||||||||||
Residential Care |
116 |
97 |
95 |
-21 |
||||||||||||||||||||
Domiciliary Care |
271 |
274 |
271 |
0 |
||||||||||||||||||||
Day Care |
200 |
322 |
333 |
133 |
||||||||||||||||||||
Direct Payments |
24 |
21 |
22 |
-2 |
||||||||||||||||||||
Other |
0 |
26 |
28 |
28 |
||||||||||||||||||||
Total |
625 |
753 |
762 |
137 |
||||||||||||||||||||
|
|
|||||||||||||||||||||||
Grand Total |
17,063 |
17,792 |
17,573 |
510 |
(Client Group Activity by Care Type and by External & Internal Provider) | |||||||||||||||||||||||||||
Provider |
Care Type |
Budgeted 0910 |
Apr-09 |
May-09 |
Movement b/w Budgeted 0910 & May 09 |
||||||||||||||||||||||
|
OLDER PEOPLE |
|
|
||||||||||||||||||||||||
External |
Nursing |
1,267 |
1,386 |
1,377 |
110 |
||||||||||||||||||||||
|
Residential |
1,607 |
1,735 |
1,700 |
93 |
||||||||||||||||||||||
|
Dom Care |
4,715 |
5,253 |
5,265 |
550 |
||||||||||||||||||||||
|
Day Care |
1,306 |
1,121 |
1,069 |
-237 |
||||||||||||||||||||||
|
Direct Payment |
245 |
206 |
219 |
-26 |
||||||||||||||||||||||
|
Other |
0 |
3 |
0 |
0 |
||||||||||||||||||||||
|
Total External |
9,140 |
9,704 |
9,630 |
490 |
||||||||||||||||||||||
Inhouse |
Nursing |
465 |
392 |
378 |
-87 |
||||||||||||||||||||||
|
Residential |
679 |
709 |
696 |
17 |
||||||||||||||||||||||
|
Dom Care |
558 |
429 |
443 |
-115 |
||||||||||||||||||||||
|
Day Care |
543 |
524 |
516 |
-27 |
||||||||||||||||||||||
|
Other |
0 |
0 |
0 |
0 |
||||||||||||||||||||||
|
Total Inhouse |
2,245 |
2,054 |
2,033 |
-212 |
||||||||||||||||||||||
|
OP TOTAL |
11,385 |
11,758 |
11,663 |
278 |
||||||||||||||||||||||
Provider |
Care Type |
Budgeted 0910 |
Apr-09 |
May-09 |
Movement b/w Budgeted 0910 & May 09 |
||||||||||||||||||||||
PHYSICAL DISABILITY |
|
|
|||||||||||||||||||||||||
External |
Nursing |
94 |
90 |
87 |
-7 |
||||||||||||||||||||||
|
Residential |
103 |
104 |
104 |
1 |
||||||||||||||||||||||
|
Dom Care |
620 |
792 |
780 |
160 |
||||||||||||||||||||||
|
Day Care |
196 |
193 |
186 |
-10 |
||||||||||||||||||||||
|
Direct Payment |
392 |
420 |
427 |
35 |
||||||||||||||||||||||
|
Other |
0 |
6 |
0 |
0 |
||||||||||||||||||||||
|
Total External |
1,405 |
1,605 |
1,584 |
179 |
||||||||||||||||||||||
Inhouse |
Residential |
19 |
25 |
26 |
7 |
||||||||||||||||||||||
|
Dom Care |
55 |
25 |
21 |
-34 |
||||||||||||||||||||||
|
Day Care |
150 |
141 |
142 |
-8 |
||||||||||||||||||||||
|
Other |
0 |
0 |
0 |
0 |
||||||||||||||||||||||
|
Total Inhouse |
224 |
191 |
189 |
-35 |
||||||||||||||||||||||
|
PD TOTAL |
1,629 |
1,796 |
1,773 |
144 |
||||||||||||||||||||||
Provider |
Care Type |
Budgeted 0910 |
Apr-09 |
May-09 |
Movement b/w Budgeted 0910 & May 09 |
||||||||||||||||||||||
LEARNING DISABILITIES |
|
|
|||||||||||||||||||||||||
External |
Nursing |
19 |
25 |
27 |
8 |
||||||||||||||||||||||
|
Residential |
822 |
774 |
772 |
-50 |
||||||||||||||||||||||
|
Dom Care |
1,091 |
1,041 |
991 |
-100 |
||||||||||||||||||||||
|
Day Care |
483 |
458 |
458 |
-25 |
||||||||||||||||||||||
|
Direct Payment |
192 |
244 |
250 |
58 |
||||||||||||||||||||||
|
Other |
0 |
51 |
0 |
0 |
||||||||||||||||||||||
|
Total External |
2,607 |
2,593 |
2,498 |
-109 |
||||||||||||||||||||||
Inhouse |
Residential |
63 |
85 |
71 |
8 |
||||||||||||||||||||||
|
Dom Care |
5 |
6 |
5 |
0 |
||||||||||||||||||||||
|
Day Care |
749 |
801 |
801 |
52 |
||||||||||||||||||||||
|
Other |
0 |
0 |
0 |
0 |
||||||||||||||||||||||
|
Total Inhouse |
817 |
892 |
877 |
60 |
||||||||||||||||||||||
|
LD TOTAL |
3,424 |
3,485 |
3,375 |
|
-49 |
|||||||||||||||||||||
Provider |
Care Type |
Budgeted 0910 |
Apr-09 |
May-09 |
Movement b/w Budgeted 0910 & May 09 |
||||||||||||||||||||||
MENTAL HEALTH |
|
|
|||||||||||||||||||||||||
External |
Nursing |
14 |
13 |
13 |
-1 |
||||||||||||||||||||||
|
Residential |
116 |
97 |
95 |
-21 |
||||||||||||||||||||||
|
Dom Care |
200 |
204 |
202 |
2 |
||||||||||||||||||||||
|
Day Care |
200 |
194 |
206 |
6 |
||||||||||||||||||||||
|
Direct Payment |
24 |
21 |
22 |
-2 |
||||||||||||||||||||||
|
Other |
0 |
26 |
28 |
28 |
||||||||||||||||||||||
|
Total External |
554 |
555 |
566 |
12 |
||||||||||||||||||||||
Inhouse |
Dom Care |
71 |
70 |
69 |
-2 |
||||||||||||||||||||||
|
Day Care |
0 |
128 |
127 |
127 |
||||||||||||||||||||||
|
Other |
0 |
0 |
0 |
0 |
||||||||||||||||||||||
|
Total Inhouse |
71 |
198 |
196 |
125 |
||||||||||||||||||||||
|
MH TOTAL |
625 |
753 |
762 |
137 |
||||||||||||||||||||||
GRAND TOTAL |
17,063 |
17,792 |
17,573 |
510 |
|||||||||||||||||||||||
Appendix 3(d)
2009/10 Staffing update
The summary table below monitors the progress of recruiting additional staff as at the end of May 2009 compared with additional provision in the budget.
Additional Staff for 2009/10 |
Budget (fte) |
Recruited (fte) |
Funding source |
Workforce plan increase agreed 1.10.08 |
32 |
5 |
Budget |
New Posts in 2009/10 Budget |
|||
Dependency and demographic growth |
18.6 |
5.3 |
Budget |
Transformation growth |
9.3 |
0.8 |
Budget |
Safe and secure growth |
8.5 |
3 |
Budget |
Other operational pressures |
22.5 |
0.5 |
Budget |
Efficiency savings |
(5.4) |
(4) |
Budget |
Social care reform grant |
30 |
16 |
Grant |
LD campus reprovision grant |
21 |
8 |
Grant |
Stroke Carers grant |
2 |
2 |
Grant |
Subtotal budget provision |
138.5 |
36.6 |
|
Additional posts |
|||
Common Assessment Framework |
4 |
- |
Grant |
Domestic Abuse Co-ordinator |
1 |
1 |
External |
Deprivation of Liberties Safeguarding |
1 |
1 |
Grant |
Subtotal |
6 |
2 |
|
Total additional posts |
144.5 |
38.6 |
Appendix 4
2009/10 Capital Programme Position
1 The total capital cash limit for 2009/10 is £11.845m as set out in the table below. This includes £5.8m carried forward from the 2008/09 programme and £247,500 50% underspend transferred from revenue (to be agreed by Cabinet), and £1.7m carried forward from 2008/09 revenue, already agreed by Cabinet. The re-scheduling of the 2008/09 programme was due to delays on projects, technical resource constraints and also future pressures on capital resources required for investment in older peoples homes, extra care housing and IT.
2 The £247,500 50% underspend transferred from revenue is planned to be spent on integrated service bases for the integrated Learning Disability team.
3 The capital programme position is summarised below. It includes proposals to redirect £960,000 existing resources to essential improvements and fire precautions at older people homes. The £1.7m planned transfer from revenue at the end of 2008/09 will be enable a further £500,000 to be invested in improvements to older peoples homes and £1.2m to be invested in Extra Care Housing. The programme includes £1.2m grant for the Common Assessment Framework pilot which is a two year programme with a further £1.6m grant due in 2010/11. More details are in Appendix 4(a).
4 It should be noted that the capital programme will be under pressure in 2010/11 and 2011/12 and will require additional resource to deliver transition capital infrastructure. Predicted shortfalls are £1.3m in 2010/11 and £0.3m in 2011/12.
Capital Programme 2009/10 - Position as at - |
May |
Resources |
£'000s |
2009/10 Capital Programme |
2,884 |
Balance of Cash Limit brought forward from 2008/09 |
5,785 |
Capital Receipts |
28 |
Revenue Contribution to Capital Programme already agreed* |
1,700 |
Revenue Contribution to Capital Programme - to be agreed |
248 |
Common Assessment Framework Grant |
1,200 |
Capital Cash Limit 2009/10 |
11,845 |
Schemes committed (at contract prices) |
4,010 |
Schemes not yet committed (at latest approved prices) |
7,835 |
Total schemes |
11,845 |
*Carried forward from 2008/09 revenue
Summary of 2009/10 Capital Programme Position Appendix 4(a)
Capital Programme 2009/10 - Position as at - |
May |
Resources |
£'000s |
2009/10 Capital Programme |
2,884 |
Balance of Cash Limit brought forward from 2008/09 |
5,785 |
Capital Receipts |
28 |
Revenue Contribution to Capital Programme - already agreed |
1,700 |
Revenue Contribution to Capital Programme - to be agreed |
248 |
Common Assessment Framework |
1,200 |
Capital Cash Limit 2009/10 |
11,845 |
Schemes committed (at contract prices) |
|
Furniture and Equipment in Residential and Day Care Premises |
116 |
Minor Works in Residential and Day Care Premises |
95 |
Furniture and Equipment in Office Bases |
32 |
OPH Fire precautions / Improvements |
1,934 |
IT Equipment |
24 |
IT Projects |
154 |
Common Assessment Framework Pilot |
63 |
Extra Care Housing Grant |
1,592 |
Sub-Total |
4,010 |
Schemes not yet committed (at latest approved prices) |
|
Furniture and Equipment in Residential and Day Care Premises |
96 |
Minor Works in Residential and Day Care Premises |
459 |
Furniture and Equipment in Office Bases |
68 |
OPH Fire precautions / Improvements |
1,344 |
Community Equipment Stock |
67 |
IT Equipment |
216 |
IT Projects |
806 |
MH (SCE) Infrastructure and systems |
432 |
Social Care Infrastructure Grant ( formerly Information Management Grant) |
719 |
Common Assessment Framework Pilot |
1,137 |
MH Grants |
582 |
Extra Care Housing (Local resource) |
1,661 |
LD Integration bases |
248 |
Sub-Total |
7,835 |
Total schemes |
11,845 |