Archived decisions

HAMPSHIRE COUNTY COUNCIL

Decision Report

1. Executive Summary

1.1. The purpose of this paper is to inform the Executive Member for Adult Social Care of the budget forecast outturn position and associated performance improvements as at the end of September 2009 as well as an update on the 2008/11 Workforce Plan.

1.2. This paper:

· Explains the movement in forecast outturn between the 31 July 2009 (period 4: +£2.1m pressure) and 30 September 2009 (period 6: +£1.4m pressure), a reduction of £0.7m, and the reasons for areas of potential pressure and under-spend.

· Explains the management actions put in place to ensure that the service continues to provide effective front-line services to our clients within our resources.

· Identifies the performance achievements that the budget has supported during this period.

· Reports the progress in appointing to new posts as identified in the budget report to Executive Member for 2009/10¹.

· Identifies any financial or performance risks that may impact on Adult Services over the remaining financial year.

· Seeks approval of realignment virements as described in section 9.

· Updates the Executive Member on the 2008/11 Workforce Plan.

2. Introduction

2.1. This report provides an update on the budget position as at the end of September 2009 and gives an update on the key external and internal pressures and the management action that is being taken to achieve a balanced budget in 2009/10 and to facilitate a sustainable budget position for future years. Further information is set out in Sections 3 to 5.

2.2. This is the third monitoring report for 2009/10 and is based on data to the end of September (Period 6). The second budget monitoring report was presented to the Executive Member on 9 October 2009 (Period 4). This report highlights the movement on the 2009/10 revenue budget from a pressure of £2.1m in period 4 to a pressure of £1.4m in period 6, a reduction of £0.7m.

2.3. Although this figure in isolation is manageable the potential trends which some of the pressures could follow would potentially lead to medium and longer term pressures on the budget, particularly in future financial years when the full year effects occur.

2.4. The department is continuing to monitor progress on management action very closely to manage the budget in line with the cash limit in the current financial year as well as preparing to manage the likely additional pressure in future financial years.

2.5. These pressures are being exerted from both external and internal sources. The external pressures are ones which the service will have less direct control over and remain as demography and complexity, ordinary residence and continuing health care.

2.6. Performance targets have now been reviewed and revised by the Departmental Management Team (DMT) for 2009/10, where appropriate, to take into account the performance of comparator councils in 2008/09, whilst ensuring improvement is within budget. Further information is contained in section 12. An area of medium risk is national indicator NI 130 Self Directed Support, which includes Individual Budgets and Direct Payments. Incremental improvement will be achieved in 2009/10, with significant improvements planned as part of the roll out of Self Directed Support in 2010/11.

3. External pressures

Demography and Complexity

3.1. As at the end of September 2009 the number of client care packages is 17,931, a growth of 868 (5.1%) above the budget. Although there is a slight decrease in the domiciliary care packages overall the net number of client care packages has increased by 6 new client care packages between period 4 and 6. Further detail is shown in Appendix 7.

3.2. This is potentially the area of greatest concern because on the basis of numbers of clients we are supporting to date we have already used the additional monies provided for in the budget for demography.

3.3. Complexity is continuing to increase across all care types. People are living longer with more complex needs putting pressure on operational budgets for our current service users across all client groups. This can be evidenced in the increasing average cost per client and reduced attrition rates. The rate of attrition for clients since March 2009 has been lower than previously, which compounds the increase in number of clients joining the service leading to unforeseen demographic growth and pressures on 2009/10 and 2010/11 budget settlement.

3.4. As the demographic pressures and complexity increase there is a corresponding increase in the number of reported safeguarding incidents (see section 5.3 in appendix 5 for an update on current position).

Ordinary Residence

3.5. Under current rules, the deregistration from residential care to supported living model changes the place of ordinary residence for the residents from their home county to the county where the person is located.

3.6. As reported in Period 4, Hampshire is pursuing cases where we have placed clients in homes within other authorities' boundaries that have then deregistered: this will offset the costs. However, it is anticipated that there will be more clients placed in Hampshire by other local authorities than those placed in other local authorities by Hampshire. Ongoing commitments are shown below:

· Current net impact on the budget £500,000 (previously £358,000)

· Potential additional future net impact £254,000 (previously £567,000)

· Total impact £754,000 (previously £925,000)

3.7. The total impact indicates a reduction of £171,000 on the £925,000 reported in Period 4 and brings the pressure within the one off provision of £850,000 to cover potential costs. This is due to concerted efforts to ensure that the Council is claiming for clients it is currently supporting that should have Ordinary Residence status in another Local Authority.

Continuing Health Care

3.8. NHS Hampshire currently have a backlog of cases lodged with them awaiting continuing health care assessments or decisions. In the period 4 report a potential total income from continuing health care of £1.5m was identified. Of this total £1m was deemed as fully achievable in 2009/10. To date £300,000 has been secured leaving a balance of £1.2m, of which it is expected £0.7m will be achieved. This is included in the forecast outturn. However, it is judged that £0.5m is at risk of not being achieved. The longer these cases are delayed the more the financial pressure will increase for the County Council.

3.9. The department is continuing to work with NHS Hampshire. Discussions should be aided by the recent publication by the Department of Health of new guidance on Continuing Health Care that clarifies the responsibilities of Health and Local Authorities with effect from October 2009.

3.10. Discussions with NHS Hampshire are also taking place to update the local protocol around dispute resolution. The aim is to streamline the process so that disputes are resolved more quickly. An update on the progress on the protocol will be given in future reports.

4. Internal pressures

4.1. Internal pressures are those which can be managed directly within the department.

4.2. Localised pressures have been identified in the North East of the County and new processes have been developed to mitigate these pressures.

5. Actions being taken to resolve the position

Targeted Vacancy Management

5.1. The targeting of vacancy management will take into account the implementation of the Hampshire Model and will fully support existing front line services so there is no impact on service users.

5.2. As a result of an extensive review of new posts agreed in the 2009/10 budget savings of £625,000 are included in the outturn in relation to targeted deferment of non-critical posts.

Use of grants

5.3. The department currently receives £53.7m in grants. The majority of these grants are being forecast to be fully spent, work is on-going to identify what is uncommitted, this remaining unspent portion of the grant could be held and used to offset the budget pressures. Work is ongoing to review grant conditions to identify rules around flexibilities.

5.4. Supporting People (SP); The SP grant outturn has been amended to reflect the January 2009 Budget Report that carried forward the £3.9m SP underspend in 2008/09 partly to 2010/11 (£2.2m) with the balance of £1.7m being released in 2011/12. Thus, none of the £3.9m underspend from 2008/09 appears in the 2009/10 cash limit.

Corporate Finance has agreed that the £3.9m from 2008/09 can be re-profiled. This will be reviewed in light of the financial strategy due to be approved by the County Core Group for SP in January 2010.

Further use of contingencies

5.5. After allowing £750,000 for winter pressures £2.9m remains as unallocated contingency which is available to be used against operational pressures.

6. Future Budget Strategy 2009/10

6.1. The three key external pressures of demography and complexity, ordinary residence and Continuing Health Care continue to place the department under pressure. The largest concern is around demography and complexity in particular domiciliary care and the impact this will have not only on the current but also on future financial years. The department is currently projecting a potential pressure of £1.4m. However, management action is already under way to address that position.

6.2. This approach to the budget is supported by the performance strategy to plan for and achieve incremental improvements that benefit Hampshire residents. This means the department will continue to perform well in delivering good outcomes compared to its comparators, but does mean it may not feature in the top quartile for all national indicators. The need to balance budget and performance remains a key challenge for the department, whilst meeting the needs of the population of Hampshire.

7. Movement in cash limit

7.1. This period the cash limit has remained at £305.7m, although there has been two small adjustments as shown below.

8. Movement in forecast outturn

8.1. Table 1 below sets out the movement in the forecast outturn between 31 July 2009 and 30 September 2009 for each care group.

8.2. Over this period the forecast outturn has decreased from a potential pressure of £2.1m to a potential pressure of £1.4m. The reasons for the movement in each of the care groups are explained in the paragraphs below.

Performance and business management

8.3. The Performance and Business Management position is currently showing a £573,000 under-spend an improvement of £635,000 over the period 4 position of £62,000 pressure. This has been achievable through rigorous scrutiny of all budgets, particularly those of projects, and a slowing of any recruitment process not affecting front-line service delivery.

8.4. In 2009/10 the office moves to the new Elizabeth II complex were planned and budget provision of £451,000 was created to allow for costs relating to this. Whilst costs cannot be fully finalised at this stage a saving of £182,000 is forecast on this budget.

8.5. The Care Choice project budget of £398,000 within the Information Services Department whilst still continuing will not be completed in this financial year, resulting in a saving of £248,000.

8.6. The Self Directed Support budget which is funded from the Social Care Reform Grant (SCRG) is showing a £296,000 under-spend due to phased recruitment. This is offset by other required expenditure also funded from SCRG of £193,000.

8.7. These savings are partially offset by pressures within the County Treasurer's recharge and Capital Resources.

Older people and Physical Disability

8.8. Older people and physical disabilities are showing a movement of £232,000 on period 4.

8.9. Table 2 sets out the movement between period 4 and period 6 for each of the care types.

Operations Director residential and nursing

8.10. As a result of an excellent progress against management action it is anticipated that the budget will be balanced by the end of the year.

Older People and Physical Disabilities

8.11. The impact of increasing demographic pressures, rising complexity and higher average cost per client (especially in the north of the county) are all contributing towards the pressure on purchased services, in particular purchased domiciliary care.

8.12. This has led to a £1.9m pressure in period 6. The focus on allowing clients to live at home is resulting in some very high cost domiciliary care packages significantly above the average cost of residential care.

8.13. This pressure mainly relates to purchased home care (£2.5m), Direct Payments (£393,000) and assessment and care management (£333,000).

8.14. Assessment and care management is reduced by £330,000 as compared to period 4 by vacancy management and lower than budgeted pay award.

8.15. Since period 4 the number of older people helped to live at home per 1,000 population, as measured by C32, has increased by 0.3 with 84.8 older people being supported in period 6.

8.16. Pressure in these areas is offset by under spends mainly in purchased residential (£840,000), purchased day care (£256,000) and in-house home care (£426,000).

8.17. In period 5 virements were completed to move £1.9m from purchased nursing and £1.0m from purchased residential to increase the Direct Payments budgets by £0.5m and the purchased domiciliary budgets by £2.4m, as agreed in the period 2 report to Executive Member.

8.18. Action: A financial focus has been developed across the department to balance the budget and a recovery plan is now in place.

8.19. Action: All high cost placements (beginning with the 50 highest value) are being investigated to enable team and service managers to review for any possibility of Continuing Health Care or Reprovisioning.

Learning Disability

8.20. Learning Disabilities has remained constant with a pressure of £529,000 in period 6. Table 3 below sets out the movement between period 4 and period 6 for each of the care types.

8.21. Within the care types the main movement relates to increases in purchased home care (+£1,4m) and direct payments (+£199,000), offset by reductions in purchased residential care of (-£546,000), day care of (-£392,000) and other care of (-£410,000).

8.22. The movement in purchased home care, is primarily due to increasing complexity of needs which impacts on unit costs and when combined with people living longer is creating budgetary pressure.

8.23. The increase in the forecast residential under-spend is largely the result of additional continuing health care income (£445,000).

8.24. Direct payments has shown an increase of 30 client care packages at an additional cost of £199,000. This is supporting NI 130 which measures the number of people receiving direct payments over a rolling year. Since period 4 there has been a 9.7% increase in the number of LD clients in receipt of a direct payment.

8.25. Performance improvement is planned to keep pace with demography and is on target to achieve 2.8 per 10,000 people helped to live at home. Performance currently stands at 2.74.

8.26. There are two significant risks, ordinary residence and additional savings from Continuing Health Care. These are covered in more detail in Appendix 5.

Mental Health

8.27. The mental health forecast has not moved since period 4, remaining at a predicted £71,000 over spend. This mostly relates to purchased domiciliary care pressures where the average cost of packages has increased to 14% more than budgeted. There is also pressure on the residential care budgets in the North East of the county.

8.28. Action: As outlined in the Period 4 report, reviewing of high cost placements and tightening of scrutiny of cases appearing at the County Panel for Mental Health are being implemented.

8.29. There are two significant risks, provider dispute and Section 117. These are covered in more detail in paragraphs 13.1 and 13.2.

9. Realignment Virements

9.1. Approval is requested for the following virements required to realign budgets to reflect specific service needs.

Ageless Service 

9.2. Permanent virements totalling £348,000 from Learning Disability to Older People (residential care £308,000 and domiciliary care £40,000) for clients who have reached the age of 65 years.

Future Builders Project

9.3. Temporary virement of £230,000 from purchased domiciliary care to in-house domiciliary care to cover the costs of an innovative supporting living project for three Learning Disability clients coming through transition from Children's Services.  

Invest to Save

9.4. Temporary virement transferring £45,000 from a non-pay contingency to staff costs in relation to the Transition Team Manager post that was funded in 2009/10 from the Corporate Invest to Save fund. Ongoing funding for this post has been included in the budget preparation for 2010/11. 

Independent Mental Capacity Advocacy Service

9.5. Temporary virement transferring £48,500 from a non-pay code to a salary code in relation to the Mental Capacity Act Development Manager post, which is funded from the Independent Mental Capacity Advocacy Grant.

Older Person's/ Physical Disabilities (OP/PD)

9.6. Permanent virement totalling £535,000 within staffing budgets to reflect the combined OP/PD teams.

9.7. Permanent virement of £92,000 from in-house equipment & adaptations to staffing to more accurately reflect a recharge to Health for the Technicians service

9.8. Permanent virement of £153,000 from Management & Support within Older Persons/Physical Disabilities and Commissioning and Partnerships to Management & Support Mental Health for the Safeguarding Professional Leads.

10. Progress on recruitment

10.1. The department continues to monitor the overall headcount, as at the end of September 2009 a total of 116.4 FTE have been appointed. Of these 67.1 FTE relate to the new posts identified in the 2009/10 budget report. 26.3 FTE vacancies in in-house services have been recruited in order to maintain safe staffing levels and as part of a strategy to reduce agency usage.

10.2. Staff sickness levels are monitored monthly. The percentage of time lost due to sickness between period 4 and period 6 reduced by 0.7% to 4.99%.

11. Workforce Planning

11.1. In 2008 Adult Services DMT, following a briefing of the Executive Member, adopted a Workforce Plan for 2008/9 which also looked forward to the period 2009/10 to 2010/11. The plan supported the directorate service plans and is in turn supported by the Learning and Development Plan and aligned with the departmental budget.

11.2. Whilst the plan remains largely intact it has now been refreshed to reflect the work undertaken to implement the Hampshire Model Year One and the planned transformation agenda into 2010/11. The refreshed plan is contained in Appendix 8.

11.3. It is requested that the Executive Member approve the Workforce Plan for period 2008 to 2011.

12. Performance³

12.1. The new National Indicator Set (NIS) of around 189 indicators seeks to measure a broad range of public sector performance at many levels - county, district and organisational. They also vary from measures of longer term strategic intent, such as reducing health inequalities, to specific measures of business activity such as waiting times for services. Many NIS are not `owned' by the County Council, but by partner organisations; with several NIS results collated and reported by national bodies on behalf of government.

Adult Services Performance Priorities 2009/10

12.2. Priorities for `stretched' improvement are those NIS which are included in the Local Area Agreement (LAA), in particular Theme F (Health and Wellbeing) which Adult Services lead in partnership with NHS Hampshire. The Theme F targets are set out in Appendix 6. The department has also set incremental improvement targets for each of the NIS for which it has a direct delivery responsibility; and NI 131 Delayed Transfers of Care, which is a joint health and social care indicator. These are also set out in Appendix 6. The department's Performance Management Steering Group, chaired by the Assistant Director, Performance and Business Management is responsible for monitoring performance, identifying risk and agreeing action.

12.3. An area of medium risk is national indicator NI 130 Self Directed Support, which includes Direct Payments. Current performance in this area is below that of other councils, but additional evidence has enabled the Care Quality Commission to acknowledge the county-wide roll out of SDS in 2010/11. Target setting for 2010/11 is being integrated into the budget planning process.

Targets for 2009/10

12.4. A number of the NIS for adult social care are based on measures of volume which has financial implications for the Council. The performance strategy for the department is to set targets which demonstrate incremental improvement and as a minimum, keep pace with demographic growth planned through the budget setting process.

12.5. Performance targets have been set with partners for the LAA and are included in the table shown in Appendix 6. Targets for the NIS that are the delivery responsibility of Adult Services have been set by DMT for 2009/10 to take into account the performance of comparator councils in 2008/09, whilst ensuring improvement is within budget. An `internal target' for Delayed Transfers of Care has also been set by DMT pending formal agreement with the PCT.

Current performance

12.6. Performance in the key adult social care NIS continued to improve between period 4 and period 6. The number of clients receiving a direct payment or individualised budget, as measured by NI 130, increased by 8.3%. The average number of people delayed being transferred from hospital, (NI 131) reduced to 12.1 per week, from 12.4 in Period 4. Waiting times for services (NI 133) improved with 85.2% of all new clients receiving a service within 28 days in Period 6, compared to 82.2% in Period 4. The number of people being supported to live independently by Adult Services has also increased from 4,994 per 100,000 population to 5,007. Appendix 6 summaries performance and targets for the LAA Theme F Health and Wellbeing NIS and the NIS reported directly by Adult Services.

12.7. A monthly briefing on Internal Audit reports is taken to the Performance Management Steering group, DMT and DMT/Executive Member meetings. In the last month, there have been four internal audit reports. A number of issues have been identified and have been responded to by managers, particularly in relation to Direct Payments. The actions resulting from the responses will be monitored by the Adult Services Quality and Audit team and the Devolved Finance Unit (DFU) Compliance and Performance team. Criminal Records Bureau checking for agency workers in units continues to be monitored on a monthly basis by service managers.

13. New Budget and performance risks since the last report to Executive Member (9th October 2009 )

Mental Health Invoice Dispute

13.1. There is a dispute with a provider in relation to arrears in the order of £165,000. This matter is being investigated by service managers and progress will be reported in future reports. Currently no provision has been included in the outturn for this risk.

Mental Health S117 Arrears

13.2. Under Section 117 of the National Health Service Act (2006) the Council remains liable for the aftercare costs of client once they have been discharged from being detained after being sectioned under the Mental Health Act. The Mental Health service currently has a client who may have paid for care that should have been borne the Council. The cost of this care amounts to £102,000 to date with ongoing costs of £20,000 per annum. This is being investigated by service managers. Currently this risk is not included in the Mental Health outturn. Progress on this risk will be reported in future reports.

Self Directed Support (SDS)

13.3. The largest risks to the success of SDS are:

· Unforeseen impacts on the budget

· The manual nature of the performance information and the still relatively small sample that is being used to generate analysis.

13.4. The mitigating factors to the SDS risks are:

· The willingness to halt the roll-out process if it becomes apparent that problems are developing.

· The recognition of the above risks and development of clear training programmes specifically to support the roll-out.

· Development of tactical tools to bring some systems support to a manual recording process.

Direct Payments Risk

13.5. It is essential that the expected growth in the direct payments budget needs to be met by a commensurate reduction in other care budgets. Carrying an increased level of direct payments without a commensurate reduction in domiciliary care, day care and residential care spend is unsustainable. This will be monitored carefully.

Performance risks

13.6. Risks to performance are in those areas where increased volume is regarded as improvement; and competition from Councils with higher levels of deprivation and funding. All performance targets for 2009/10 have been set to be achieved within the current budget. Period 6 has seen continued growth in performance especially direct payments and `help to live at home' indicators, but this has corresponded with pressures on these budgets. The impact on future performance will need to be considered when developing action plans to address the pressure.

13.7. Updates on the key risks mentioned in the period 4 report are provided in Appendix 5.

14. Hampshire model

14.1. Work continues around the implementation plan for the Hampshire Model. There is a risk that the impact of the economic climate on Hampshire County Council budgets in future years could lead to delays in implementing the Hampshire Model within the 3 year time plan.

14.2. Progress is continuing on all work streams; with DMT giving priority to Free Crisis Care (FCC), Learning Disabilities Transformation (LDT), Market Development (MD) and Self Directed Support (SDS). As these are seen as the key drivers for ensuring personalisation is a success, it is intended that work in these areas will facilitate development of the other work streams.

14.3. Funding of £3.3m has been identified from the Social Care Reform Grant (SCRG) and currently this is supporting the implementation of a number of projects:

· Self Directed Support

· Community innovation teams

· Time to think beds

· Care choice - website for self funders

· Learning disability integration

· Integrated Community Equipment store (ICES) system replacement

· Front line staff development and training

14.4. Standardised budget monitoring of Hampshire Model projects began in period 5, and this, coupled with budget preparation, is developing a much clearer understanding and monitoring of costs and budgets. These apparent changes are not a risk at present because the impact is purely on the costs reflected in the project plans rather than the projections in the financial system.

14.5. As expected, planned costs have fallen in Period 6 and are likely to fall again in Period 7 as the project managers develop their plans for this financial year. Total spend to date is £1.6m (£1.5m against revenue and £0.1m against capital). These lower costs are reflected in the outturn and extra attention is being paid to those forecasts where the actuals appear very low in comparison.

15. Client Care Packages Analysis

15.1. Activity levels here are presented using the "Average weekly cost" data source from SWIFT. This method counts some clients more than once if the client receives more than one type of care.

15.2. The current client care packages are at present 868 above budgeted level. The significant variances are:

· Domiciliary care 628 above budgeted level, reflecting Personalisation and clients choosing to live in their own homes.

· Day Care 211 below budgeted level, primarily older person's services clients, which is reflected by a small under spend on this care type.

· Direct Payments 206 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.

15.3. Overall movement in client care packages is only an increase of 6 from period 4, though this is the net of the number of packages that ceased or new packages started during the period.

15.4. The movement in the individual client groups is summarised in Table 4 below and further detail can be seen in Appendix 7.

16. 2009/10 Capital Programme Position

16.1. The total capital cash limit for 2009/10 is £11.8m. This includes £1.9m transferred from revenue, and £5.8m carried forward from 2008/09, as agreed by Cabinet. An additional grant has been awarded for Common Assessment Framework £1.2m which is included within the £11.8m cash limit.

16.2. The Capital programme position is summarised in Table 5 below. The capital programme is currently 61% planned as at the end of period 6. The summary shows a significant commitment for investment in Older Peoples Homes (OPH) Improvements, Extra Care Housing and the Common Assessment Framework.

Older People Homes (OPH):

16.3. 2009/10 is the final year of the four year Capital Strategy, approved by Cabinet in July 2006, which has seen investment of over £12m in Adult Social Care facilities. A primary focus of the strategy has been the continued modernisation of the older persons' residential estate. Expenditure on minor improvement works and the upgrading of furniture and equipment across the estate also continues, as does the programme for the establishment of joint learning disability management team bases with the Hampshire (NHS) Partnership Trust.

16.4. Whilst the programme to modernise the County Council's older persons' homes is now well advanced, it is not yet complete and a further investment strategy to achieve that, together with the modernisation of facilities for other service-user groups will be brought forward in as part of the budget setting process, in conjunction with Property, Business and Regulatory Services.

Extra Care Housing:

16.5. The major development at Brighton Hill, Basingstoke is progressing on target. Progress is also being made on new sites with Executive Member approval (Extra-Care Housing Capital Funding report November 2009) to invest £0.45m for a development in Andover and another £0.45m for a development in Fleet.

Common Assessment Framework:

16.6. Work started in April on the Department of Health grant funded Common Assessment Framework for Adults demonstrator site. Initial phases of this two year programme are looking at analysis of the business process with development of the IT solutions planned towards the end of the financial year.

Other:

16.7. Investment in IT projects continues to strengthen existing systems. SWIFT is being worked on including the upgrade to the latest version of the application. Tools are being developed to sit alongside SWIFT to support the requirements for the rollout of SDS. Other IT projects include investment to support Hampshire Workstyle, improved monitoring of carers in Community Response Teams and enhanced online information regarding care needs through the Care choice project.

17. Recommendations

17.1. It is recommended that

· The forecast position as at the end of September 2009 be noted (paragraph 2.2)

· The external and internal pressures identified in the report are noted (sections 3 and 4)

· The Performance and Human Resource results as detailed in the report are noted (sections 10 and 12)

· The Hampshire Model budget monitoring update is noted (section 14)

· The capital programme position as at the end of September 2009 be noted (section 16)

· The realignment virements be approved as explained in section 9

· The update on the 2008/11 Workforce Plan is noted (section 11)

Appendices - Executive Member Decision day

Appendix 1 - Income Monitoring

Appendix 2 - Debt Monitoring

Appendix 3 - Grants Analysis

Appendix 4 - Drug and Alcohol Action Team

Appendix 5 - Budget and Performance Risk Updates (Updates to Period 4)

Appendix 6 - Performance

Appendix 7 - Client Care Packages Analysis

Appendix 8 - Workforce Plan 2008/11

CORPORATE OR LEGAL INFORMATION:

Links to the Corporate Strategy

IMPACT ASSESSMENTS:

1. Equalities Impact Assessment:

a) The Department's budget and performance strategies are developed in accordance with the Council's Equalities Policy and target the most vulnerable in society.

b) 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:

a) 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.

Appendix 1 - Income monitoring

1. Income Monitoring

1.1. There is potential for the current economic climate to impact on the ability of service users to contribute towards their care. As the income received from service users offsets the cost of care, any reduction in income will impact on the overall budget position.

1.2. As at the end of September 2009 the department is forecast to exceed the income target by £2.8m, this includes any debts that may be written off via the debt write off process.

1.3. Table 6 provides a high level summary of the overall position, a detailed breakdown of the sources can be found in Table 7.

Table 6 - Summary of budget including income
	Budget	Forecast	Variation
	£,000	£,000	£,000
Gross expenditure	395,282	399,433	4,151
Income	(89,604)	(92,364)	(2,760)
Net position	305,678	307,069	1,391

1.4. The movement in income projection since period 4 is partially due to virements that were implemented to realign income budgets in period 5. Other impacts on the income budgets this period include work the DFU have been undertaking to increase the number of breaks in care recorded within SWIFT (e.g. when care is cancelled for a client's hospital stay), and a thorough review of orders to ensure the forecast is as accurate as possible.

1.5. The review of orders caused a significant increase in the number of client deaths recording during September, 41% of which related to prior periods.

1.6. Action: Work is ongoing to understand the impact of the policy of keeping people in their own home for longer will have on income budgets. This is part of a wider project and a high level summary is going to the Personalisation Board, as wider potential impact on the Hampshire Model.

1.7. The number of service users in Basingstoke who have migrated to Self Directed Support (SDS) has increased and the move is towards the provision of either domiciliary care or a direct payment. There was potential for income to be reduced, as it is not as clear with a direct payment which elements relate to support work and day care (which are non-chargeable). Analysis undertaken to examine the impact that the shift in the provisions has on income, has identified that any reduction is not directly related to SDS, but Basingstoke has seen a decrease in percentage income as compared to other areas. Further analysis and monitoring is ongoing.

1.8. Further income analysis by client groups is shown in table 8 below.

Table 8- Breakdown of income by client group.

1.9.

Appendix 2 - Debt monitoring

2. Debt Monitoring

2.1. The Write Off Panel is currently managing outstanding debt relating to client contributions to the value of £620,000 (previously reported £586,000), of which £157,000 is at high risk of being written off.

2.2. As at the 30 July there were four debts over £5,000 totalling £35,582 requiring formal write off requiring formal write off by the Executive Member. As at 30 September this has remained unchanged.

2.3. So far this year 226 debts with an individual value under £5,000 have been written off, totalling £118,916, an increase of £59,539 on period 4.

2.4. The year to date figure for all debts suggests a projected annual total of £273,415 which is showing a decrease on the 2008/09 figure of £340,100. The number of write offs is increasing, but there is no indication that this is due to the economic climate.

2.5. The Table 9 below gives an indicative position based on information as at the end of period 6, including any debts that have yet to receive formal write off.

Table 9 - Forecast debt write off position as at period 6
	Income Budget	Target as % of actual	Target	Forecast	Forecast percentage
	£000s	%	£000s	£000s	%
Residential5	37,806	0.4	151.2	229.1	0.61%
Non-Residential	7,467	0.5	37.3	44.3	0.59%
TOTAL	45,273	0.42	188.5	273.4	0.60%

2.6. The final position regarding the percentage of income written off as bad debt in 2008/09 was 0.7% and we are currently predicting that forecast write offs will be 0.6% of the overall income budget. Whilst this is a marked increase over and above the target of 0.42%, it is lower than 2008/09. The forecast extrapolates the debts written off to date over a 12 month period. As there isn't a regular pattern to debts write offs, the forecast should still be treated with an element of caution at this stage of the year.

2.7. A Debt Protocols document is being finalised and will shortly be added to the County Treasurer's Hantsnet page. The document will highlight key actions and responsibilities for all staff to help ensure that all income to the Council is collected promptly and to try to minimise the risk of potential write off. In addition there has recently been a Business Process Initiative project on the Income and Debtors Group. Recommendations from that project may impact on debt collection processes.

2.8. The value and number of the write offs will continue to be monitored and if required a request to increase the targets will be made to the Executive Member in the end of year Irrecoverable Debt paper.

Appendix 3 - Grants Analysis

3. Grants Analysis

3.1. The total grants available to Adult Services for 2009/10 total £53.7m, these are summarised below.

3.2 Whilst the majority of grants are projecting to be fully utilised, one grant (Campus Closure Grant) is predicting planned under-spend and four (Social Care Reform Grant, HIV, Homeworkers and Carers Grant) are predicting unplanned under-spends. The majority of the under-spend relates to:

· Learning Disabilities Campus Programme grant; planning to carry forward up to 25% of the total grant (£0.5m). This is a reduction on the previous report reflecting confirmation of the amount allocated out of the Grant that NHS Hampshire are planning to spend on the South West and South East closure projects.

· Social Care Reform Grant (SCRG); showing an under-spend of £925,000. This is due to staff turnover and slippage to SDS programme (i.e. some work done more efficiently e.g. projects combined under one manager, etc) and Community Innovations Team slower than expected recruitment to posts.

3.3 Supporting people;

The profiling of the £3.9m carry forward from 2008/09 has been amended to reflect the January 2009 Budget Report: £2.2m in 2010/11 and £1.9m in 2011/12. Thus, none of the carry forward was included in the 2009/10 cash limit.

The grants monitor now reflects balanced outturn position. Corporate Finance has agreed that if there is an in-year pressure in the Supporting People programme that the 2008/09 carry forward can be re-profiled in 2009/10 to show a balanced outturn position.

3.4 Action: In light of the risks identified within this report expenditure on grants is being monitored carefully to identify if there is any potential within the criteria to utilise any under-spend to offset any pressures elsewhere.

Appendix 4 - Drug and Alcohol Team

4. Drug and Alcohol Team (DAAT)

4.1. As reported in Period 4 the DAAT is planning an underspend in 2009/10 to mitigate the reduction in funding in 2010/11. The total Pooled Treatment Budget managed by DAAT is now forecasting a planned under spend of £807,800 an increase of £215,000 on the £592,700 previously reported to Executive Member (26th June 2009).

4.2. This additional underspend will be used to fund additional costs in 2010/11 in relation to maintaining the current contracts for longer than expected following a delay in the tendering of the new Substance Misuse system as well as other associated commissioning costs.

4.3. DAAT performance results for 2008/09 show the total numbers in effective treatment have over achieved the target of 1,655 by 57 (4%). Performance results for 2009/10 show that the DAAT has continued to out perform the target in quarter one.

Appendix 5 - Budget and performance risks (update to period 4)

5. Budget and performance risks

5.1. A number of risks were identified as part of the budget report to Executive Member in January 2009. Some of the risks have been revisited as part of this report.

5.2. Specific risks identified as part of period 6 budget monitoring process are covered below

Safeguarding

5.3. Safeguarding pressures especially in external homes where there is the potential to re-house service users are continuing to be a challenge. The number of safeguarding incidents reported for the 12 months to September 2009 totals 1,116.

Older Persons and Physical Disability

5.4. Previously it was reported there was a potential risk of a pressure of £1.2m for OP/PD in-house services, but that management action reduced this down to £722,000 in period 4. A workshop with In-house Service Managers has resulted in a financial focus plan being developed which includes an agency reduction strategy. As at the end of period six the action plan has contributed to further reducing this risk to £231,000 a reduction of £491,000. Due to the progress made to date this risk is not included in the forecast position for period six as it is assumed that the budget will be balanced by the end of the year.

5.5. Management action examining high cost placements and understanding the reasons for "hot spots" of high costs around the county has helped to manage this risk down and average weekly cost has stabilised.

5.6. The economic position is potentially having an impact on staff turnover savings which would normally occur between a member of staff leaving and being replaced. The annual target is a 5% saving, whilst there is some concern that this is not going to be met, vacancy management is being implemented across the service, though in such a way that it does not impact on front-line services.

Learning Disability

Pressures from re-tendering supporting people contracts

5.7. In period 4, £200,000 was included in the outturn for a risk relating to the strategic review of learning disability services by Supporting People. Work in ongoing by the learning disability and Supporting People teams to reduce this risk. Updates will be given in future reports.

Ordinary residence

5.8. As previously reported in Period 4 a net one-off provision for £850,000 was made at the end of 2008/09 for clients that were potentially going to become an ongoing responsibility of Hampshire County Council or that Adult Services was pursuing with other authorities.

5.9. Since the previous report the only significant movement has been an increase of three in the number of claims being made by the Council for clients who are judged to have gained Ordinary Residence status in another Local Authority.

5.10. Nevertheless, there still remains a risk that this may not cover the full amount.

5.11. Action: The Head of the Integrated Learning Disability Service is continuing to work closely with Legal Services to ensure that all cases raised against Hampshire are robustly challenged and that all potential cases that could result in a saving to Hampshire are vigorously followed through. Ongoing cost will be considered in 2010/11 budget preparation.

5.12. Table 11 summarises the current position as at the end of September.

Table 11	Ordinary Residence forecast as at the end of September 2009
		Total Actual	2009/10 Commitments	Total Forecast	No. of clients
		£	£	£
Costs of service users now the responsibility of Hampshire		983,192	425,382	1,408,574	27
Successful cases (savings and income)		(483,056)	(171,858)	(654,914)	18
Net pressure/(savings)		500,136	253,524	753,660

5.13. This reflects a reduction in the pressure of £171,354 against the position reported in Period 4 due to the three additional cases being pursued by the Council with other Local Authorities.

5.14. Action: There is no certainty that the department will incur the costs or savings in 2009/10 and they are not included in the forecast outturn. Only those costs that have been agreed (actual column) are included. The risk is monitored on a monthly basis and should there be any change in the risk then the position will be reviewed.

Continuing Health care

5.15. In the period 4 report a potential total income from continuing health care of £1.5m was identified, of which £1m was deemed as achievable in 2009/10. The £0.5m is at risk of not being achieved. To date £0.3 has been achieved against the £1m. The £0.7m balance has been included in the outturn. Discussions have taken place between the Director of Adult Services and the NHS Hampshire's Chief Executive. NHS Hampshire has shared its list of cases. From this sixteen cases have been identified as priority cases for the central Continuing Health Care team due to delays or issues in the assessment. An update on the priority cases will be given in future reports.

Table 12	Continuing Health Care forecast as at the end of September 2009
		Period 6	Period 4	Movement
		£000s	£000s	£000s
Estimate of total potential reimbursement from continuing health care		1,500	1,500	0
Actual continuing health care secured and included in the outturn		(300)	0	(300)
Outstanding continuing health care		1,200	1,500

.

Appendix 6 - Performance

Local Area Agreement Theme F Health and Wellbeing

NIS for which Adult Services has a direct delivery responsibility

Appendix 7

Client Care Packages Analysis by Care Type

Activity levels here are presented using "Average weekly cost" data source. This method counts some clients more than once if the client receives more than one type of care.

Client Care Packages by Care Type and by External & Internal Provider

Activity levels here are presented using "Average weekly cost" data source. This method counts some clients more than once if the client receives more than one type of care.