Agenda item

Recommendations and comments

Response

1. Having considered the contents of Business Planning and Medium-Term Financial Strategy 2024-2030 Report attached at Annex A (noting the remaining budget gap for 2024/25) had the following specific concerns and made the following recommendations for Cabinet to examine:

Considered by Cabinet as set out below.

2. Notes that any changes made in the Autumn Statement on 22 November 2023 that impact the MTFS may be incorporated into the paper presented to Cabinet on 12 December 2023.

All changes have been incorporated into the Cabinet report on this agenda for Business Planning 2024-2030 and In-Year Budget Management 2023/24.

3. Noting that the proposed budget relied on Community infrastructure Levy (CIL) to fund some revenue expenditure, noted that legal advice had been requested on the use of CIL as set out in the budget proposals.

Conversations are progressing with legal, and assurance will be provided ahead of the Cabinet meeting in February 2024.

4. The Committee, being concerned about the level of NHS debt to the Council, recommends that Cabinet carry out its best endeavours to retrieve these monies and report progress back to the Overview and Scrutiny Committee.

A project management approach is being taken to interactions with health, which includes debt but also wider discussions on income expectations. Scoping of the challenge has been carried out and the work will focus on three areas – Historic Debt Review, Invoicing Processes, Processes for Agreeing Funding.

Officers have supplied the North Central London Integrated Care Board (ICB) with the relevant information and evidence about the debt, and the issue of the outstanding debt will be escalated to the NCL ICB chief executive for urgent attention.

There is also work that has been kicked off at a subregional level to get visibility of levels of funding across the subregion.

The S151 officer is working on this issue with the four other north central London councils, to which the ICB is also a debtor. 

A dedicated project is being established as part of the council wide transformation programme to create improvement in the longer term on ICB debt to the council. 

5. That Cabinet considers writing to the three local Members of Parliament to ask them to lobby the Secretary of State for Health to pay outstanding debts to the Council.

This will be addressed as part of the debt project set out above.

6. The Committee, having sought clarification on the saving of £500,000 on adults with mental health needs, is concerned that Cabinet may need assurance on these savings proposals given the level of need within this area.

This is part of continuing work to look at increasing independence and, if appropriate, for people to be supported with less intensive forms of support for their eligible social care needs.

This is done through intensive work by the social care practitioner with the person drawing on care & support.

This programme has been in operation for a number of years and it has consistently supported individuals to achieve greater independence and deliver planned savings.

Note: the savings relate to social care needs. They do not alter any NHS mental health or general health services being provided to the individual.

7. The Committee further noting the expenditure within the budget that assumes funding coming in from the NHS, including £1 million in Continuing Health Care and £10 million in outstanding debt, recommends that Cabinet:

a. Explore the fiscal relationship with the NHS as far as is practically possible.
b. Consider the reality of transfer of funds from NHS and evaluate the likelihood of this money being received and the impact should the funding not materialise,
c. Look at it in the aggregate (money coming from the NHS and money going to the NHS) to decide if it is feasible.

a.     This is being done as part of the project referred to under Recommendation 4.

b.     This is also being done as part of the project referred to under Recommendation 4. In reference to the CHC – Continuing healthcare – this is a national entitlement for those residents whose needs meet the criteria. CHC is free at the point of delivery like other NHS services.  The council has invested in training and support for social workers to enable them to refer and support residents with appropriate needs through the process so they can secure the support through the NHS that they are entitled to. In 2023-24, the council has secured an additional £1.1M of CHC funding for residents and the plans for 204-25 have been carefully developed.

c.     The Executive Director of Resources & Strategy, and the Executive Directors for Adults and Children Services will examine this and report back.

8. The Committee having expressed concern about ‘Adults 27’, given that it is the largest saving and will require £3 million savings per year, recommend that more detail be provided about how this saving will be achieved, and request that Cabinet reconsider the saving to determine if it is achievable to save these significant sums of money within the time frame.

The saving is about developing a long-term transformation programme which focuses on reducing admissions to acute hospital and reducing levels of hospital discharge, transforming our approach to our front door, our preventative offer, what we can do with the VCSF, what we can do with housing on developing lower cost provision for younger adults, how we commission more cost effective services from providers, and pushing the digital agenda further and more. It is a big saving and will require some investment to deliver.

The saving is proposed from 2026-30 – so this is long-term budget and service planning.

A lot of work has already gone into identifying how the saving can be delivered and detailed planning for delivery is taking place.

It involves cross council work on customer access, customer journeys and maximising digital solutions will support the scoping of new opportunities to reduce demand pressures on adult social care by supporting people to remain well and to live independently in the community for longer. 

This has been informed by the work of Triple Value Impact who have been working with the council on digital and technology approaches that have a positive financial impact on council expenditure.

This work is longer term in its impact and is being progressed by the corporate transformation programme. It will involve using technology to seek to identify people who may develop care & support needs and intervene early so that those needs are prevented from developing. It will involve greater use of tech & remote monitoring in existing home care packages, so that people stay more independent and stay safe in their own homes, and, as a result, care hours can be reduced or avoided.

Updated on this will be brought to Cabinet in due course.

9. The Committee, noting that Barnet has one the highest hospital discharge rates in London and the associated costs, recommend that Cabinet Member for Adults & Health jointly with the Chair of the Adults & Health Overview and Scrutiny Committee Sub-Committee write and call on the Government and North Central London Integrated Care Board to provide extra funding for people as they are discharged from hospital and need additional support to return home and main independence.

This is being co-ordinated.

10. That Cabinet give further consideration when savings are moved from the revenue to the capital budget to ensure this is an appropriate action to undertake (capitalisation of spending which could include borrowing).

This is undertaken as part of discussions with the capital team and auditors.

11. The Committee supports the use of new technology which may enable more citizens to be more independent and thereby not need intervention so ultimately produce savings be explored.

We are grateful for this support by the O&S Committee.

A number of the savings proposals are predicated on this – including Adults 27 as stated already.

12. The Committee noted that there was a new model under SSR7 (New operating model aligned to newly defined priorities in the Community Safety team) and questioned how savings would be achieved.

After 18 months of operating the new team model and delivering the new priorities, we feel that we are in a good place to be able to review things to ensure effective, efficient and best use of our resources. We will be reviewing staff workloads and types of cases, to ensure the team is best placed to deliver the ongoing priorities, which will still include, hubs, ward walks, visible presence as well as dealing with ASB and Environmental Crime. The exact operating model is not yet finalised and will be subject to HR, Union and Staff consultation before it is implemented.