Agenda item

Ms Sandra Taylor, the Council’s Corporate Director of Adult Social Care and Health, advised that health and social care services were always challenged and that understanding demographic growth was hard with the level of complexity of residents’ increasing over the last year. Although the total number of services users had not increased very much over the last ten years, the cost of care had increased significantly. The Council had to take proactive steps to manage the available resources to be able to provide and manage a good service at a good unit cost value.

There were challenges in relation to managing demand and pressures. Demand drivers of increased costs included an increase in National Insurance (which would increase again in April 2026). Whilst officers did what they could to maintain fair prices and use brokerage services, they recognised that it was also a challenging time for care providers. Autism had also become an increased driver for services.

Mr Martyn Storey, the Council’s Head of Finance – Adult Social Care, advised that the bottom of Table 2 in the report had showed a £5.4m overspend on adult social care placements in the last year and that the pressure had been mitigated by holding vacancies. Table 5 showed that an £8.2m overspend in total services operating budgets had been forecast at Month 2 and that officers might be in a better position to comment on this at the next meeting.

Members were advised that the combined effect of the living wage and National Insurance increases had increased the wage bill by just under 9%. Although providers with existing care placements understood that the Council was under financial pressure, new placements were costing more.

Concern was expressed that there was always an overspend in social care as forecasting did not appear to be accurate and queried where the analysis was in the report that could give Members confidence in the forecasting. Mr Storey noted that the officers would be able to get better at forecasting by modelling using the data that was available.

Ms Taylor advised that the Council had purchased its own care home to try to manage some of the pressures but that care packages for people with learning disabilities in supported living had the highest costs. These were also often long term costs as these residents tended to be younger when they first needed the support.

The Council had had to look at things differently and work was being undertaken accordingly (although not yet at a stage where it could be reported to Members). Analytics were monitored and all local authorities were required to report annually so Hillingdon was able to benchmark its costs to ensure that the Council was achieving best value. It was agreed that further information on this would be brought to a future meeting.

Members acknowledged the pressure faced by health and social care but noted that the Committee was only being given figures for Month 2 when Cabinet would be considering Month 4 later in the week. A request was also made that, as Members and residents were not necessarily finance experts, an explanation of terminology such as “underlying forecast” be included in all future reports. Mr Matt Davis, the Council’s Director of Strategic and Operational Finance, advised that the underlying forecast was effectively the debits and credits attributed to adult social care. Provisions were, for example, debts that were not collectable. Members were advised that, in 2017, councils had been permitted to use capital receipts for transformation projects that would deliver ongoing reductions in future expenditure.

Mr Storey advised that he was very confident about the figures in the report. They had been build up on a person by person basis but based on dynamic data and a fairly consistent pattern had been developing. There had been no evidence to suggest that it would go out of control.

Members queried the effects that the pandemic continued to have on the provision of health and social care and whether effort was being made to make residents less reliant on social care. Ms Taylor advised that the social care ethos was early intervention. There had been a flattening in the demand for services from older people but a rise in demand from people with mental health issues or learning disabilities. The pandemic had prevented a lot of elective surgery from taking place. While they were waiting for their operations, the condition of these residents might have worsened meaning that they needed social care support before the operation as well as after the operation from which they might take longer to recover. Patients with a learning disability were encouraged to do as much for themselves as possible and a range of interventions were available for those with mental ill health before they came to social care. It was important for the whole system to work together to build resilient communities and prevent things like falls. The early intervention and prevention work undertaken reduced overall costs.

Table 3 showed that £1.2m had been banked in 2024/25. Members queried whether this had been rolled forward from the previous year. Ms Taylor advised that the banked savings in the previous year had been as a result of a budget reduction (with the exception of care diagnostics).

Members were keen that more detailed information be included in future reports. They were asked to provide the Democratic, Civic and Ceremonial Manager with details of the information that they would like included in future budget reports so that it could be collated and sent to Finance.

RESOLVED: That:

1.    the 2024/25 Outturn position be noted;

2.    the 2025/26 Month 2 budget monitoring position be noted;

3.    the Corporate Director of Adult Social Care and Health provide the Committee with further information on benchmarking value for money be brought to a future meeting of the Health and Social Care Select Committee; and

4.    Members send details of the information that they would like included in future budget reports to the Democratic, Civic and Ceremonial Manager to collate and sent to Finance.