Officers will be in
attendance to provide the scrutiny panel with a general overview and
introduction to the topic.
The investigation will
focus on matters including:
·
The impact of increased costs on care home and home
care provision;
·
Government funding and the impact of increased
costs on Adult Social Care funding / budgets; and
·
The impact of winter pressures.
The panel will be asked to consider the information provided and next
steps for the review.
Minutes:
It was agreed at the last panel meeting that
an additional topic would be added to the work programme, i.e. ‘The Impact of
the Energy and Cost of Living Crises on Caring for Vulnerable Adults’. The Overview and Scrutiny Board had
subsequently approved the addition of this item at its meeting on 21 September
2022 (as part of the Scrutiny Chairs Update).
The Director of Adult Social Care and Health
Integration and the Head of Strategic Commissioning and Procurement were
present at the meeting to deliver a presentation to Members. The information was presented in two
parts. The first part focused on ‘The
Cost of Living Impacts on Adult Social Care’, and the second part focused on
the risks and potential impact of the crises on both Adult Social Care and the
wider directorates of the Council.
In terms of ‘The Cost of Living Impacts on
Adult Social Care’, the following matters were raised:
-
By way
of background, Members were advised that some of the issues experienced had
recently been addressed by the government’s Mini-Budget, which was delivered on
23 September 2022. However, some
independent sector organisations that delivered services to vulnerable adults,
and who continued to face pressures, had verbalised these to officers within
Adult Social Care.
-
Homecare
consisted of domiciliary care providers delivering services in clients’ own
homes and in residential care settings.
Supported Living and Extra-Care Housing facilities were predominantly
shared housing with care providers visiting; residents had their own tenancies
in place and therefore faced the same pressures as other Middlesbrough
residents, i.e. increased bills. Mention
was made of the Welfare Strategy discussed at the last panel meeting in
assisting support recipients.
-
In
terms of current issues being faced by providers, these were identified as
follows:
Homecare
-
A
number of external factors had caused significant issues in respect of fuel,
which had created an almost ‘perfect storm’.
In terms of the pandemic, the price of crude oil had fluctuated around
the lockdown periods, and demand changed as businesses closed and then
reopened. Reference was made to the
ongoing war in Ukraine, and the decreasing value of the pound versus the (oil
costed) dollar.
-
Adult
Social Care had five approved business providers for the delivery of
domiciliary care; approximately 13,000 hours of homecare was commissioned per
week. An element of this was delivered
by local staff able to walk and cycle to their clients’ homes, however, due to
workforce pressures, there was an increasing reliance on drivers. The viability of care work had decreased for
many people, predominantly due to the rise in the cost of living and competition
from other industry recruiters, such as retail.
It was indicated that a wider strategy around recruitment was required,
as it was difficult to compete with organisations paying a higher wage.
-
In the
period December 2021 to August 2022, fuel had increased by 26%. When tendering for homecare contracts,
providers needed to consider care workers’ hourly rate, which took into account
insurance, registration fees, mileage fees, etc. As a portion of the hourly rate was for
mileage, and to try and maintain stability in the workforce, officers
facilitated an additional fuel payment tracked against fuel prices. A temporary (three-month) increase of 26p was
subsequently applied to mileage payments.
The estimated cost of this for the three months was £26,300, which was
dependant on the number of hours of care delivered. Adult Social Care would continue to track the
wholesale fuel price levels and review the baseline in three months’ time.
-
It was
indicated that during school holidays and winter periods, it was difficult to
recruit/retain homecare workers.
However, it was highlighted that Middlesbrough was faring far better
than other areas, as some currently had a waiting list of 200 packages;
Middlesbrough did not operate a waiting list.
It was emphasised that the reason for this was the excellent work of the
Commissioning Team, and the relationships that had been built with
partners. The significant issues being
experienced by other authorities fed into other areas such as hospital
discharge, and therefore Middlesbrough’s position was especially positive.
Residential Care
-
It was
explained that care homes usually obtained energy supply under fixed rate
deals. Some of these terms may have been
for three years-plus, others to the end of 2023. Some care homes were fixed until
February/March 2023 and were already approaching Adult Social Care and
verbalising concerns.
-
Care
homes worked with brokers to identify deals.
The issue creating concern was that although the Government had capped
KWPH rates for businesses, standing charges had not been capped.
-
In
terms of potential increases, as an example comparison, one care home had
advised that the cost of gas (KWPH) in October 2021 was £2.16, and £22.6 KWPH
(a ten-fold increase) in mid-September 2022.
In terms of electricity, in February 2021 this was 15.68 KWPH, and 71.8
KWPH in mid-September 2022. Cost-wise,
for a typical 32 bed care home, this would equate to an increase from £20,000
to £160,000 per annum, or equivalent to an £85 per week, per resident, increase
in fees (£3.5m).
-
It was
indicated that the energy price cap had not filtered through to brokers as of
yet, and the figures provided were pre Mini-Budget. Care homes had no choice in whether to switch
on their gas and electricity as they needed to keep residents warm, and
therefore exactly what this would entail for those approaching the end of fixed
rate deals remained to be seen.
-
From
the Council’s perspective, in April 2022 the authority gave providers a highest
ever inflation award of 9%, which was the highest in the North East and did
provide much needed assistance.
-
At
present, there had been no further support packages announced from the
government for additional energy pressures for the vulnerable sector, other
than the package announced in the Mini-Budget.
Supported Living / Extra Care Housing
Facilities
-
As
tenants held individual contracts with energy suppliers, the increased bills
being seen by all domestic households were being experienced by residents in
these properties too.
Across the board, another pressing issue
reported by providers concerned insurance premiums, which had increased
significantly in the aftermath of COVID-19.
In some cases, providers could not acquire insurance.
After concluding
this part of the presentation, the officers responded to several queries from
Members. The following information was
provided in response:
The second part of
the presentation focused on the risks and potential impact of the cost of
living and energy crises on both Adult Social Care and the wider directorates
of the Council.
By way of
background, like most Local Authorities in the area, the Council was building a
plan to support vulnerable individuals at a time when finances had never been
more challenging. A Wider Leadership
Management Team (WLMT) session had been held for the individual directorates to
come together and coordinate the response to the cost of living crisis. The following matters, as discussed at the WLMT
session, were detailed to the panel:
-
Regarding
potential risks, the cost of living crisis could adversely impact by increasing
demand for services, and increase the cost of delivering services (inflation,
pay award and utility costs). If these
risks were not mitigated, the following may occur:
§
Increased
number of children living in poverty;
§
Increase
in the number of children needing to be cared for by the Council;
§
Increased
suicide rates and increased demand for Mental Health services (potentially more
so as a consequence of this than from COVID-19 and the associated
isolation/pressures);
§
Increased
volume of domestic abuse incidents;
§
An
Increase in alcohol and substance abuse;
§
Additional
pressures on the voluntary sector and reduced services from them (the Council
needed to consider how it worked to support the VCS in order for the VCS to
provide reciprocal support to the Council);
§
More
hospital and care home admissions from people unable to remain safely in their
homes;
§
An
increase in household debt and reduced ability of the population to spend money
in leisure and entertainment sectors could see the town centre collapse and
reduce business rates; and
§
Care
providers’ increased costs put care provision at risk.
-
In
terms of the impact to date within Adult Social Care, the following was
highlighted:
§
Access Team – no increased
referral rate but an increase in individuals presenting with issues relating to
poverty/food parcels was anticipated.
Reference was made to Staying Included groups, which were a legacy of
Ageing Better Middlesbrough. More people
had been attending sessions to keep warm and have a hot drink.
§
Mental Health Teams – no obvious impact
on referral rates; increased anxiety regarding inflation/costs being
observed.
§
Housing Support/Homelessness – not
seeing impact on presentations yet but increased calls around anxiety on
housing security. An increase in
presentations in 3 to 4 months’ time was anticipated.
§
Domestic Abuse – no obvious increase
in referral rates, but an increase in the number of victims reporting as
“hungry” at point of presentation.
§
Prevention Services – increased use of
Staying Included groups.
-
Regarding
action currently underway, work was taking place within individual
directorates, as follows:
§
Adult
Social Care: “Winter Warmth” activities/campaigns. It was explained that heaters had been issued
previously, but whether this was appropriate this year given the rising cost of
energy had been considered. Mention was
made of heated blankets, which were less expensive to operate. Clothing and accessories, such as hats,
gloves, fleeces, jumpers, etc. would be provided, and funding to increase
supplies this year was being identified.
§
Public
Health: working to identify people who may have struggled to afford to heat
their home and were vulnerable to adverse effects of low temperatures on their
health, and develop a plan to support.
§
Children’s
Services: looking to identify people at particular risk of heat or eat known to
the Early Help team to identify those at risk and put in place plans to support
them.
§
Finance
and Governance: review of the Medium Term Financial Plan and taking action to
sustain Council funds to support people.
§
Finance
and Governance: review of organisational savings to mitigate the mid-year
impacts of inflation.
§
A range
of government interventions were being announced and the Council was
responding/delivering as required.
-
In
addition to action being taken specifically by Middlesbrough Council, a
multi-agency task sponsored by the Health and Wellbeing Board was also
currently underway. A task and finish
group was looking at vulnerable risk groups to identify who was most at risk of
harm from a cold house; what the local support offer was; and the ways in which
the demand could be connected to the offer in order to minimise risk to
health. The project would triangulate
and coordinate NHS and Adult Social Care information to provide appropriate
support by ensuring that those requiring support were successfully linked to
services.
Following conclusion of the presentation,
Members asked a series of questions of the officers; the following matters were
considered:
-
In
terms of identifying vulnerable people, this was a significant challenge and it
was indicated that not every vulnerable individual would be identified. Appropriate ways to communicate with the
cohort were currently being devised. Consideration
was given to the various facets and challenges involved, and the role of the
Voluntary and Community Sector (VCS) in assisting with this. However, the VCS too were significantly under
resourced, with volunteers impacted by the cost of living and therefore not
always able to make themselves available.
-
A
Member congratulated the team at looking at both the strategic and practical
levels associated with this, but expressed significant concern in terms of the
projected increases in some areas, with no real hope of an early
resolution. It was felt that national
change was possible and needed to be actively pursued. Locally, deficits were being faced and the
Member wished to see a way of committing to the future support of the teams and
to the retention of preventative services, including the VCS. In response, reference was made to the
statutory duty to support those accessing such services as Mental Health;
Council funding and impending budgetary challenges; the differences between the
VCS and prevention services; the national recruitment crisis facing Adult
Social Care; and current vacancies that existed within teams.
-
Members
wished to convey their gratitude to all of the teams for working through such
very challenging times, and felt reassured that matters were being actively
considered.
In terms of next steps, the panel felt that,
having received the information, it would be more appropriate to revisit this
topic for periodic updates, rather than as a short-term scrutiny
investigation. The following suggestions
were made and subsequently agreed by the panel:
The Chair thanked the officers for their
attendance and contributions to the meeting.
AGREED: