Agenda item

Ms Sandra Taylor, Corporate Director of Adult Social Care and Health, advised that the Council’s other Select Committees had discussed the information that they would like to receive at future meetings in relation to the budget.  A report had been circulated which provided information about the spend and activity within the services provided within the Committee’s remit as well as how the budget would be set.  Ms Taylor noted that the Council was about to close last year’s budget and she would report on the outturn at the Committee’s June meeting. 

Members were advised that the Council worked on a forecasting model which was based on demographic growth, costs, etc.  Since the pandemic, it had become difficult to forecast as the pressure on services had increased so the Council was unable to predict who would want to use its services or when. 

Ms Taylor noted that inner London boroughs were placing residents in Hillingdon care homes (an outer London borough) which created challenges in the care market and with the cost of care locally.  The impact of the increase in employers’ national insurance contributions and national living wage had meant that social care providers had been asking for significant increases in fees.  However, the Council already paid a fair rate for care which had been driven by market forces / demand. 

The Council had been prudent in creating its own care home places and Ms Taylor hoped to be able to go into more detail about this at the meeting on 19 June 2025 as well as the operating model for the future care of Hillingdon residents.  It was important that the Council was able to place residents locally in Hillingdon. 

There were a large number of care providers in Hillingdon (the Borough had the highest number of care home places in London).  The price of care used to be determined by the West London Framework but the Framework fell apart during the pandemic and providers no longer had the appetite for it.  As Hillingdon was an outer London borough and had a lower price per bed, around 50% of care home beds locally were occupied by people from outside of the Borough.

Ms Taylor advised that the savings target for her Directorate needed to address costs in relation to staff and care provision.  To achieve this, she had been working with providers and the Association of Directors of Adult Social Services (ADASS) on how this could best be achieved.  Hillingdon adult social care had had some positive outcomes in relation to low spend, providing excellent value for money per head of population.  The reablement services in Hillingdon had been provided at low cost, with 90% of service users needing no ongoing care needs.  However, further efficiencies were still needed. 

Members were advised that the Council had reduced the amount of agency staff being used but that it still had a statutory duty to provide services.  As such, the Council would not be able to go over and above all of the time but still needed to meet demand in a safe way that did not negatively affect the ‘Good’ CQC rating that the service had achieved.  Ms Taylor advised that budget managers monitored and managed monthly income and expenditure reports on the finance system.  These reports were available weekly if required and provided a RAG rating for each quarter to see how the Directorate was doing.  If the savings were not achieved as expected, action would need to be taken to find the savings elsewhere. 

At the meeting on 19 June 2025, Members would receive information about projects that had started.  Consideration would also need to be given to how the Directorate’s £7m savings target would be achieved whilst also accommodating £5m of growth to cover the increased demand for adult social care and public health services. 

Mr Martyn Storey, the Council’s Head of Finance – Adult Social Care, advised that the 2024/25 accounts were currently being closed.  The staffing spend was very detailed and even more detailed information was available.  The risk of slippage, and actual slippage, would need to be monitored.  Increasing internal capacity would help but there were associated risks. 

It was noted that specific scrutiny training was being organised for Members in late May / early June 2025 for them to be able to scrutinise the budgets within their Committee’s remit.  The Chair requested that a specific section on scrutinising health and social care budgets be included in the training. 

Members queried whether the announcement earlier this year that the North West London Integrated Care Board (NWL ICB) would need to reduce its costs by 50% would impact on adult social care in Hillingdon.  Ms Taylor advised that this would have an impact as the NWL ICB directly commissioned services that benefitted Hillingdon residents.  With regards to the Better Care Fund, the NWL ICB financial challenges meant that changes had been proposed in relation to the additional funding.  If changes were made to the wider system, they would likely impact on Hillingdon’s social care services.  As such, it would be important to retain ‘place’ integrity.  The BCF Plan had not yet been signed off so a better discussion about the issue would be possible at the meeting on 19 June 2025. 

Members asked that the budget reports received by the Committee identify spend on statutory responsibilities and discretionary spend along with how the statutory duties were delivered (or how they could be delivered differently).  Ms Taylor advised that it was not always that straight forward.  Mr Storey explained that, for example, the Care Act placed a statutory duty on local authorities to provide preventative services which, of themselves, were not statutory services. 

It was suggested that a key be included on future reports to highlight which figures were income and which were expenditure.  Members also asked that the information be broken down by statutory and discretionary spend.  Ms Taylor noted that there had been some challenges with regard to the Oracle system and a task force had been working on it to ensure that it was ready for June 2025.  The actuals and outturn were needed and the staff structure changes that were made last year needed to be reflected in the system.

There had been a significant improvement in the data that was available over the last year which gave officers better tools for forecasting.  Working through the budget, the biggest expenditure had been in relation to placements so growth against the number of people who would draw against this budget needed to be monitored closely.  The numbers needed to be stabilised as growth had been higher in the last year. 

Members queried where budget transfers were coming from.  It was recognised that slippage into next year’s budget was not an option.  Adult social care was the highest spending Directorate in the whole of the Council and continued to be a huge challenge. 

Ms Taylor noted that there had been a five year plan to improve elective surgery performance post pandemic.  There had been some positive implications in adult social care from this push (reduced demand for services from this cohort) as action was being taken to drive early intervention and prevention. 

RESOLVED:  That:

1.    Ms Sandra Taylor attend the next meeting on 19 June 2025 to provide Members with an update on the budget and other information as agreed during the meeting; and

2.    the discussion be noted.