`AGENDA ITEM 6

BOROUGH OF POOLE

CABINET

5 SEPTEMBER 2006

FINANCIAL ISSUES FACING LEARNING DISABILITY SERVICE: REPORT OF THE PORTFOLIO HOLDER FOR HOUSING AREAS INCLUDING AFFORDING HOUSING AND “SCHOOLS FOR THE FUTURE”

1. /

PURPOSE OF REPORT

1.1 /

To update Cabinet on financial issues facing learning disability services and to seek approval for a market testing exercise in respect to directly managed supported living services.

2. /

DECISIONS REQUIRED

2.1 /

Cabinet is requested to approve a market testing exercise in respect of supported living services provided from Christopher Crescent and Ashmore House.

3. /

INTRODUCTION

3.1 /

At its meeting on 20 July 2006, the Community Support Overview Group received a report on learning disability finances from the Head of the Adult Social Care and Well-being Unit. Recommendations from this meeting are reproduced here for information.

3.1.1 /

The Community Support Overview Group notes the financial issues within the report submitted by the Head of Social Care and Well-being which shows that demand projections would lead to an estimated budget increase of £2,018,940 (33%) over the next five years (cumulative increase not per annum) and these issues be referred to Cabinet for further consideration.

3.1.2 /

The Overview Groups notes that the Council’s medium term financial planning provides for additional funding for learning disability services within the same five year period of £1,200,000 leaving a currently unfunded “gap” of £818,940 and officers be asked to develop options to bridge this unfunded gap.

3.1.3 /

Cabinet are asked to approve a market testing exercise in respect of supported living services provided from Christopher Crescent and Ashmore House and

3.1.4 /

An update report be submitted to this Overview Group in November 2006 containing results and recommendations following the market testing exercise, for supported living and other options to bridge the unfunded gap in the medium term financial plan.

4. /

BACKGROUND

4.1 / Total budgeted expenditure for 2006/07 for learning disability services is £7,370,428.
4.2 / The report to Overview Group (Appendix One) highlighted a number of challenges within the service. Detailed analysis of which lead to the requirement for the additional £2,018,940 of expenditure identified over the next five years, as follows:
·  NHS patient transfer to Social Care - £500,000;
·  Supported living increased availability - £918,940;
·  Residential care increased availability - £600,000.
The Council’s current medium term financial plan provided £1.2m over the same five year period leaving an unfunded gap of £818,940.
5. / SUPPORTED LIVING SERVICES
5.1 / Services provided at Christopher Crescent and Ashmore House (35 tenants) are jointly funded from the Adult Social Care and Well-being Unit base budget (£689,000) and by the supporting people programme (£686,000). Gross expenditure on supported living in these facilities is budgeted at £1,375,000 for this financial year. This equates to an average unit cost per week of £746 per person. Currently, the costs are considerably higher than they might otherwise be if both housing support and care services were jointly commissioned. A complicated factor is that in these two schemes the ASCWB is both commissioner and provider of services.
5.2 / Recent negotiations with independent providers for other supported living schemes where care and support are provided by voluntary sector organisations has reduced the unit cost for the next financial year 2007/08 to an average of £570 per week.
5.3 / In order to ensure that the current directly managed supported living services continue to improve and are commissioned efficiently it is proposed to subject them to a market testing exercise as a first step to determining whether outsourcing could lead to improved services and greater efficiency. This will be a complicated exercise as there are potentially a number of legislative issues. These relate to the ongoing status of some parts of this service which may require registration under care homes legislation (which would lead to the loss of the supporting people grant). All current service users have legal tenancy rights. The majority of people supported have multiple and complex needs.
5.4 / All current service users living within supported living have a legal right to chose their domiciliary care provider, however, this right has not been exercised. This fact will need to be borne in mind in any market testing exercise but does not detract from the need to ensure all services, whether commissioned or directly provided, provide the best quality at the most efficient price.
5.5 / Given the vulnerability of service users within Christopher Crescent and Ashmore House and the need to minimise potential insecurity for employees it is recommended that the Market testing exercise be undertaken as a matter of priority. Cabinet are consequently asked to approve this course of action.

Background papers

Report to Community Support Overview Group 20 July 2006 (attached)

Contact Officer

Charlie Sheldrick, Head of Adult Social Care and Well-being Unit

Telephone 261030

Portfolio Holder

Cllr Elaine Atkinson

Telephone 633043


BOROUGH OF POOLE

COMMUNITY SUPPORT OVERVIEW GROUP

20 JULY 2006

REPORT OF HEAD OF SOCIAL CARE AND WELL-BEING UNIT ON FINANCIAL ISSUES FACING LEARNING DISABILITY SERVICES

1. /

PURPOSE OF REPORT

1.1 / To advise and seek Member’s views on current and future services for people with a learning disability, with particular reference to financial issues.
2. /

RECOMMENDATIONS

2.1 /

Members are asked to note the financial issues within this report which shows that demand projections will lead to an estimated budget increase of £2,018,940 (33%) over the next five years. (Cumulative increase not per annum) and to refer these issues to Cabinet for further consideration.

2.2 /

Members are also asked to note that the Council’s Medium Term Financial Plan (MTFP) provides for additional funding for learning disability services over the same five year period of £1,200,0000 leaving a currently un-funded ‘gap’ of £818,940. Officers will develop options to bridge this un-funded ‘gap’.

2.3 /

Cabinet be asked to approve a market testing exercise in respect of supported living services provided from Christopher Crescent and Ashmore House.

2.4 /

Members receive an update report in November 2006 containing results and recommendations following the market testing exercise for supported living and other options to bridge the un-funded gap in the MTFP.

3. /

INTRODUCTION

3.1 /

A survey conducted by the Association of Directors of Social Services last year confirmed that 63% of local authorities in England are projecting overspends on services for people with a learning disability. Poole is amongst this number. Within the Council’s MTFP is provision for a £240,000 (4%) increase above inflation per annum. Detailed demand projections which have recently been completed suggest that this sum will be insufficient to meet demand unless significant efficiencies are made.

3.2 /

Within Poole there are known to be 591 people with a learning disability aged 18-64. This number includes 55 individuals for whom Social Services has no financial responsibility as they originate from elsewhere. 326 individuals are in receipt of Council funded services.

3.3 /

The net budget for 2006/07 is £6,110,000. In addition, a further £1,260,428 of Supporting People Programme grant is spent on people with a learning disability for whom Poole has responsibility resulting in a total of £7,370,428 expenditure on 326 individuals. Expressed as expenditure per head per week the sum is £434.78. The latest figures produced by CIPFA (2004/05) based on actual local authority spending shows Poole to be the second lowest spender within our unitary authority family group.

4. /

CURRENT PROFILE OF SERVICES

4.1 /

Many people with a learning disability living in Poole are in receipt of more than one service. For example, people accommodated in supported living may also be accessing day services and/or be involved in voluntary work. The following provides an overview of current provision:

·  326 people receiving Council funded services;

·  41 people live in residential care (13 in homes outside Dorset);

·  60 people have profound multiple learning disabilities;

·  70 people are in paid work;

·  85 people are involved in voluntary work;

·  77 people engaged in work preparation;

·  140 people spend one or more days, accessing day services or day opportunities arranged from Sea View;

·  116 people are in supported living;

·  140 people live with family carers;

·  20 people live with older carers aged 65+;

·  55 people are in receipt of direct payments and purchase their own care and support;

·  9 people receiving services are from minority ethnic groups.

5. /

SIGNIFICANT CHALLENGES

5.1
5.1.1
5.1.2 / People living in NHS accommodation
27 people living in NHS patient accommodation within Poole are Poole residents and as such are eligible for a full community care assessment and services stemming from this. The government require all locally based NHS accommodation based provision to be closed by 2010. The implications of this are that the local authority is expected to re-provide community based services for these individuals. Achieving this presents a major financial challenge as current NHS expenditure, which would be transferred, is significantly below that required to provide individual community based services which are now the norm for the majority of people.
The estimated shortfall within Poole is in the region of £500,000. We share this issue in common to our neighbouring local authorities of Dorset and Bournemouth and have agreed collectively with them and Dorset Healthcare NHS Trust to jointly fund a project which will identify accurate costs to meet the needs of people currently supported by the NHS. Poole will host the Programme Manager for this project. There is a clear need to secure significant new resources in order to achieve the changes required by 2010.
5.2
5.2.1
5.2.2 /

Supported Living Services and Supporting People Grant

The separate commissioning costs at Christopher Crescent and Ashmore of housing related support from the supporting people programme of £686,000 when added to the commissioned service costs by the Adult Social Care and Well-being Unit of £689,000 for care services results in gross expenditure on supported living in these facilities of £1,375,000. This equates to a unit cost of £746 per person per week.[£345 housing related support and £401 care support] Whilst many of those supported have high levels of need it is recognised that current unit costs are considerably higher than they might otherwise be if both housing support and care services were jointly commissioned. An added complication within the current arrangements is that the ASCWB Unit is both commissioner and provider of care services at these two facilities.

Work has already been undertaken by the supporting people team to reduce costs of supported living services provided by independent providers. Within the independent sector, average weekly costs for housing related support are only £3 more (£348) than at Christopher Crescent and Ashmore but are distorted by two very high cost providers. Actions to achieve efficiencies have resulted in these two providers being notified of substantial reductions from 2007/08 in their SP grant. The net efficiencies which will be achieved within the supporting people grant as a result of this are £287,000 (this sum will not be available for reinvestment within LD services). Revised estimates for weekly costs within the independent sector suggest a figure of £190 per individual per week. This figure does not include care costs which are currently separately commissioned. This will result in pressure to reduce the cost of housing related support in the Borough’s own schemes. In order to address this it is proposed subject to Member agreement to undertake a jointly commissioned market testing exercise to determine whether better value can be delivered at Christopher Crescent and Ashmore.

5.2.3 /

Projected demand suggests an increasing need for supported living services. Notwithstanding planned and potential efficiencies, these services will struggle to meet demand within existing budgets. In relation to the Supporting People Programme, the Government is consulting on proposals which could result in a substantial loss of grant to Poole over the coming years with the worst case scenario being in the order of a loss of 50% of current funding. The Government is currently indicating that it will publish its decision on future funding of the Supporting People Programme in summer 2006. Further as the Audit Commission’s Supporting people Programme Inspection in 2005 highlighted, the proportion of SP spent on Learning Disability Services in Poole is 45% of the total funding available with the national average being 25%. Detailed work is being undertaken to develop a Five Year Strategy for the Supporting People Programme which assesses the local needs of all 21 need groups catered for in the Supporting People Programme and makes clear decisions on the priority needs to be met between as well as within need groups. In this context it is probably prudent to assume that additional monies will not be available for new Learning Disability Services from Supporting People funding in the coming years.

5.2.4 /

It is estimated that to keep pace with demand the number of supported living tenancies available will need to increase from the current 116 to 147 by 2010/11. Based on an estimated cost of £570 per place the amount required will be an addition £918,940 in 2010/11. Some of these costs may be mitigated by savings in existing services and through re-commissioning. However, it is not possible to predict with any degree of accuracy what these savings might be.

5.3 /

Residential Care

5.3.1 /

Excluding those currently accommodated by the NHS there are 41 people (11% of LD service users) living in residential care. The costs of this care in 2006/07 have been budgeted at £1,994,000 (33% of the net budget). The amount spent on residential care has been increasing year on year and this year’s figure represents a 32% (£484,000) increase on the previous year. Largely due to the costs associated with the significant and complex needs of two individuals who require residential care. Subject to supported living services expanding the increasing number of people requiring residential care is likely to be modest and it is estimated that six more beds will be required by 2010/11. The average cost of a residential care bed (high dependency) is £1,920 per week. A further six placements represents an anticipated additional budget pressure of £600,000 in 2010/11 based on today’s prices.