The Sub-Committee received a presentation which highlighted (i) the overall budget for adult social care; (ii) the position at month 6 of the 2021/22 financial year; (iii) delivery of savings; and (iv) pressures/risks going forward and the approach to managing these.  A summary of the questions raised by the Sub-Committee and feedback given is summarised below:

The Sub-Committee

v  Agreed that the quality, reliability, and effectiveness of our adult social care system depends on a workforce that feels valued, supported, and encouraged to be the best. 

v  Commented that this support will need to be focused on levelling up the knowledge, skills, and experience of care colleagues across the sector through the establishment of a new knowledge and skills framework, promoting varied careers pathways, and making the most of any investment in learning and development.

v  Noted that patients can defer their operation whilst remaining on the waiting list for treatment, although until now there has been no systematic way of capturing that a patient has chosen to defer treatment (e.g. concerns about COVID-19).

v  Noted that the Department of Health and Social Care will be publishing a White Paper to improve health and social care for all and that the Council and its partners will continue to work with the Department of Health and Social Care and NHS England as they produce further guidance and support to facilitate the changes envisaged by this bill. Accordingly, Members indicated that they wanted to receive details of any risks envisaged to the delivery of  services to residents from the health and care Bill.

v  Requested a clear outline of process of appeals and fair process for panels and appeals e.g. the scope for a residents’ voice within the debt recovery panels and if individuals might be able to attend their panel meetings.

v  Noted the impacts of Covid on people's physical and mental well-being which can manifest through an impact on their needs for care and support.

v  Acknowledged that carers have also been adversely impacted during the pandemic in several ways and therefore the support that they may have been offered may not been available during significant periods of time through the period of the pandemic and therefore for several reasons people’s needs have become more complex because of that.  In addition, the Borough must work out a whole range of financial implications that are going to start to have an impact and that work has only just started as the Government is due to make further announcements that will provide more details.

v  Noted that from October 2023 the (i) Government will introduce a new £86,000 cap on the amount anyone in England will need to spend on their personal care over their lifetime, (ii) upper capital limit (UCL), the point at which people become eligible to receive some financial support from their local authority, will rise to £100,000 from the current £23,250, and (iii) lower capital limit (LCL), the threshold below which people will not have to pay anything for their care from their assets will increase to £20,000 from £14,250.

v  Observed that adult social care covers a wide range of activities to help people who are older or living with disability or physical or mental illness live independently and stay well and safe. It can include ‘personal care,’ such as support for washing, dressing, and getting out of bed in the morning, as well as wider support to help people stay active and engaged in their communities.

v  Noted that social care includes support in people’s own homes (home care or ‘domiciliary care’); support in day centres; care provided by care homes and nursing homes (‘residential care’); ‘reablement’ services to help people regain independence; providing aids and adaptations for people’s homes; providing information and advice; and providing support for family carers.

v  Noted concerns raised by clients e.g., where they felt that specific situations had not been considered, assessed contributions towards support; or that they felt that they should be able to represent themselves within the appeals process.

v  Agreed that it is very important to ensure that as part of the financial assessment process that LBTH determines how many, if any, people are able to afford to contribute towards the cost of their care and in doing so that LBTH also takes into consideration disability related expenditure so that they can be assured that additional expenditure that the individual may experience as a result arising from their disability.

v  Noted that the LBTH financial assessment team sends information to clients, which outlines a breakdown of how their charge has been calculated, and that they do have the opportunity to work with the financial assessment team if they feel that there are any in accuracies within that, or if indeed they feel that they have any disability related expenditure that has not been considered.

v  Was advised that clients can adjust their weekly assessed contribution and whilst there is not a panel for them to approach as such, they can make their concerns known about whether they feel that there are any in accuracies and LBTH has a duty to make sure that their clients are supported to access appropriate advice and information to fully understand the circumstances associated with their charges and what that means for them, and if they need to seek independent financial advice.

v  Stated that it is important to ensure that the residents voice is heard within the process and whilst for most of the cases there is a good understanding of the process.  Members wanted to know that about any process by which the Council will review these cases as going forward there will more of these individualized plans.

v  Noted that within Adult Social Care there was an appetite reflect on the issues raised by the Sub-Committee and to ensure that there is a fair and equitable process co-produced in partnership with clients and that there is an understanding of the importance user’s voice.

v  Agreed that it would be helpful to involved in any future discussions with clients; council officers and those support groups such as the Patient Welfare Association who have been working very closely with both the Royal London and Mile End.

Following a full and wide-ranging discussion, the Chair thanked all those Committee Members in attendance together with (i) Katie O'Driscoll, (ii) Denise Radley, (iii) Sima Khiroya for their contributions to the discussions on this important issue especially when it is such a busy time budget wise.