“This is a really tight budget and it’s getting harder to find savings. This is the hardest one so far.”

Those were the words of Jennie Stephens, Devon County Council’s chief officer for adult care and health, at last week’s Health and Adult Care Scrutiny Committee meeting.

This next financial year (20/21) is the first without core government funding. Instead, the new Conservative government has offered a series of one off grants, totalling around a 10 per cent increase.

They were by all accounts better than anticipated but a decade of austerity has taken its toll.

The challenge so far

A massive £272m has been wiped off Devon County Council’s finances during that time. First by the Conservative led coalition and then by the Tory government.

The council has (as have other public sector organisations) been forced to raise council tax considerably, in a miserable scenario whereby local people end up paying more money for fewer services… and the income generated is only a fraction of what has been lost.

A consistent and problematic shortage of paid care workers

At the same time the cost of care is rising, so is demand. And there is a huge and problematic shortage of paid care workers, around 100 across the county.

The staffing picture is toughest in and around Exeter and East Devon, which can be seen in the numbers of people waiting every day to be discharged from the RD&E, but can’t due to the lack of paid carers.

The closure of hundreds of community hospital beds in recent years has made a challenging situation much harder.

Still no sign of the adult social care green paper – years late

And the Conservative government’s inability to grasp the nettle and provide a solution on funding for adult social care, so that people don’t cripple themselves financially trying to care for relatives, is a disgrace.

The adult social care green paper has been promised for years and despite huge assistance and extremely well evidenced proposals from the Local Government Association, the new government shows every sign of batting this problem back to councils. We will see…

As a member of Devon County Council’s Health and Adult Care Scrutiny Committee we scrutinised the adult care and public health budget last Thursday and made recommendations, which will be considered by cabinet.

No confirmation from government what the final funding settlements actually are

Unfortunately, despite the legal requirements for councils to set their budgets by the end of February, ministers haven’t got around to letting them know the funding allocations, so much of the financial planning is guesswork, especially in relation to public health.

The headlines for Devon are as follows:

  • £5m cuts are proposed to the adult social care budget
  • Council tax is proposed to rise by two per cent (all local public sector are organisations are set to raise theirs for the same reasons)
  • The public health budget is not yet confirmed by central government so a precautionary approach is being taken

This means a range of issues for adult social care services, including:

  • The number of older disabled people set to receive in house day opportunities will be reduced by around 70 to 100
  • The number of older people set to receive paid for personal care is set to reduce by over 100 to 2,483
  • Around £400,000 is being saved from the contracts budget

This means a range of issues for public health services, including:

  • Around 140 fewer people with alcohol addictions will be supported
  • The sexual health service is set to move to an appointments only service, although this is not expected to affect the numbers of people who can be seen
  • Insufficient resource for public health nursing, which means the service will be stretched

What are the risks?

There’s a long list of risks in the budget assessment, relating to the shortage of staffing and the increasing cost of and demand for, services.

No deal Brexit and immigration points system is a risk factor

The possibility of a Brexit no deal is a “major risk” to workforce, as is a points based immigration system, as the uncertainty could deter jobs from EU nationals, according to the budget risk assessment.

The council’s official risk register also records the council’s ability to meet its statutory market sufficiency requirement for nursing care, personal care and demand for working aged adults, as “high” or “very high”

Director of public health, Dr Virginia Pearson confirmed that almost none of the public health budget now goes on prevention. Almost all of it now must be spent on treatment.

This directly contradicts the Secretary of State’s claims, who consistently asserts that prevention is a key government priority.

What were the committee’s recommendations?

I asked that the county treasurer’s points relating to requiring a significant increase in government funding, as well as four year settlements were set out as recommendations, as well as highlighting to ministers the dangers of their proposed new immigration policy and a no deal Brexit.

I also proposed that we record our concerns about the cuts in the provision of services for people with alcohol addictions and the late settlement for public health.

Sara Randall Johnson, chair, did not like my recommendation on Brexit and tried to caveat it with there being new employment opportunities for local people. I replied that this was not what our officers had been advising us for many years (staff are not able to be recruited locally) and we should not seek to water down the risks outlined by officers in the budget papers.

She backed down.

The recommendations to cabinet (some to be taken forward at central government level) on the budget paper, are set out below:

RESOLVED that the Budget 2020/21, provisional financial settlement and its impact on spending targets and on the proposed Adult Care and Health Services and Public Health budgets for 2020/21 and the issues and/or observations set out above be noted and the Cabinet meeting on 15th February 2020 be requested to: (a) welcome and support: (i) the 10% increase to the Adult Care and Health budget this year in recognition of the sustained increase in demand; and (ii) thank the Officers for their endeavours in the effective running of the service. (b) record concern and ask (the Cabinet): (i) to satisfy itself that based on the provisional nature of the Public Health settlement that sufficient funds are in place to ameliorate any shortfall in funding and that the budget savings across the Health and Adult Care budget are achievable;

(ii) to call for financial consideration to support the Prevention work made possible through significant partnership arrangements with and between Districts, the third and voluntary sector and the NHS; (iii) ask for greater clarity over the breakdown of figures in the budget papers, for example, opportunities from the Better Care Fund showing the support given to the third sector; and (iv) to put pressure on Central Government to: (A) overhaul the budget setting process for Local Authorities, and move to four-year finance settlements to support financial certainty and longer-term planning; (B) give clarity over settlement figures as soon as possible and in future as far in advance as possible to enable effective service planning; (C) appreciate the insufficient funding to cover prevention and early intervention in substance misuse, particularly alcohol, and specifically ask that in the event there is additional funding in the settlement this be dedicated to prevention work with substance misuse, particularly alcohol;

(D) increase the Public Health Grant to enable a return to a focus on prevention, and (E) account on promises and make it aware of the impact of policies namely: (1) adequately resourcing additional responsibilities that may arise from the Prevention White Paper; and (2) recording concern about the proposed points-based immigration system impact upon recruitment in Health and Adult Care; (F) publish, without further delay, the Green Paper on Adult Social Care

The proposed budget will be finalised and voted on, at the full council meeting on Thursday 20 February.

Here’s the webcast from last week’s meeting, from which you can also pick up the paperwork and individual speakers – https://devoncc.public-i.tv/core/portal/webcast_interactive/451530

NB. I have pointed out to officers that omitted from the minuted recommendations is a no deal Brexit a “major risk” as the risk assessment states.