(Councillor Mahony arrived at this time)

Councillor Aspinall (Cabinet Member for H&ASC) introduced the Performance and Finance reports for Health and Adult Social Care (H&ASC) and highlighted the following points-

a)    The quarterly report provided key performance metrics for H&ASC, which were used operationally and strategically by the Council and its partners to ensure that best outcomes were attained.

Rob Sowden (Senior Performance Advisor) delivered the Quarterly Performance Update for H&ASC, and highlighted the following points-

b)    Demand for the Livewell Southwest Referral Service had remained steady however, ongoing work was being undertaken to reduce waiting times. As of 23 October 2023, waiting lists for ASC support had dropped to 114, and Occupational Therapy waiting lists to 64;

c)    90% of people who were referred into ASC did not require a long-term care package. This was positive, with early support and intervention reducing the need for long term care;

d)    There was an improved position for people waiting for Domiciliary Care, with waiting lists having reduced 85% since January 2023, to 20 people as of 25 October 2023. The average waiting list for October 2023 was 21 people, demonstrating that the increasing demand pressure for Domiciliary Care had started to plateau;

e)    The Independence at Home Service (Reablement Service) had seen an average of 66% of service users discharged with no ongoing needs in 2022/23, which was the best outcome. This had risen to 73% during April and August 2023;

f)     There were ongoing pressures caused by long-term placements into residential and nursing care. Demand for these services continued to grow, with admissions of older people (65+) having increased 57% in 2022/23. This had however, started to slow between June and August 2023;

g)    The number of people receiving Direct Payments was increasing, despite lagging behind regional and national averages. Direct Payments were positive as they allowed people to choose the care they needed, and felt most appropriate. While there had recently been a slight drop in Direct Payments, which would be investigated, yearly averages showed the gap was closing rapidly and on a positive trajectory;

h)    Last year, 97% of Safeguarding cases had seen their outcomes fully or partially achieved. This had risen to 98% in Quarter 1 and 2 of this year;

i)     The number of people experiencing delayed discharges at University Hospitals Plymouth (UHP) had dropped from a daily average of 77 in 2022, to 22 between January and August 2023.

In response to questions from the Committee, it was reported that-

j)     PCC had extended residential and nursing care contracts that were due to expire in December 2023 for 12 months, to allow greater consultation, engagement and learning before the re-commissioning process was launched. Positive work had been undertaken regarding workforce recruitment and retention and while remaining fragile, there were signs of improvement;

k)    PCC staff were due to visit a Care Home which had given notice of closure, and had been regularly engaging and offering support to residents, staff and the contractor to ensure ongoing care provision and reassurance;

l)     It was anticipated that demand for Domiciliary Care, and workforce pressures would increase over the winter period. The current waiting time was approximately 3 weeks however, extra capacity was being secured ahead of the expected winter pressures;

m)  Market Sustainability Plans had been drawn up to increase resilience among providers and the care market across the city, in an attempt transition from reactive, to proactive work;

n)    Plymouth’s shortfall in Direct Payment usage had now closed to around 2-3% behind national averages. It was important that targets were not persused blindly, and that each approach must be appropriate for the individual and their situation;

o)    The Joint Local Plan was due for renewal shortly, and included consideration of care needs when planning future developments and infrastructure. It was important to consider the needs of older people and families when planning future developments;

p)     PCC were currently undertaking a specialist Housing Needs Assessment for adult and children’s social care, aiming to identify specific needs for particular cohorts across the city.

The Committee agreed-

1.    To request that future performance reports contain numerical waiting list data, as opposed to direction of performance;

2.    To note the Quarterly Performance Update for Health and Adult Social Care.

Helen Slater (Lead Accountancy Manager, Finance) introduced the Quarterly Finance Update for Health and Adult Social Care, and highlighted the following points-

q)     Quarter 1 of the H&ASC budget identified a pressure of £1.298 MM. This was primarily driven by demand and cost pressures within care-package budgets. Domiciliary Care faced the highest pressure, largely due to reduced waiting lists and improved capacity to meet demand, followed by Long Stay Nursing, which had seen increased complexity of need driving higher package costs. In total there was a £3.499 MM cost pressure from care packages however, this was offset by additional income from clients, as well as grants/funding such as the Market Sustainability Workforce Fund Grant of £1.9 MM to help plan for winter pressures. There were risks of further growth in these pressures;

r)    Work was ongoing to identify mitigations to these pressures, and ‘deep dives’ into care packages had been undertaken. This included income maximisation initiatives and a revised scheme of delegation, with tighter financial governance;

s)     The service had an in year budget savings target of £3.712 MM, which was reported on track.

In response to questions from the Committee, it was reported that-

t)     Respite figures showed that only 2/3 of the budget had been spent. This was likely due to increased demand on other services such as Short Stay, and inherent unpredictability of demand. 

The Committee agreed-

3.    To note the Quarterly Finance Update for Health and Adult Social Care.