Adult Social Care and Health 2023-24 budget proposals

This directorate is responsible, under the Care Act 2014, for the health and wellbeing of all adults. This includes all statutory (legal) duties for eligible residents, information and advice for all and the delivery of prevention and early intervention services.

In addition, the directorate has responsibility for supporting those who are homeless. This support includes tenancy support, homeless prevention, admission to temporary housing and all ancillary support services (eg: substance misuse support) and the commissioning and contract management of all external homelessness services.

The main services include:

  • Provision of information and advice through Care Line and other access points.
  • Assessment and Care management in the community and in hospitals including speciality social work mental health teams based in the mental health trust and a specialist autism team. This includes discharging our duty with regard to safeguarding adults.
  • Occupational therapy, including the administration of the disabled facilities grant (DFG) and ancillary support teams.
  • In house provider teams who run our residential hubs, our Home First reablement service and in house day care.
  • The strategic and operational commissioning of all care and homelessness services in the independent and VCSE sectors including contract management.
  • The strategic management of partner relationships, in particular, the NHS.

Financial pressures

Health and social care faces its most challenging time in living memory. An ageing population, austerity and the current cost of living crisis has led to  increasing demand, while costs continue to rise. There are also a number of specific issues exacerbating this position

Social care has been structurally underfunded for 12 years. Annual investment has remained the same since 2011, but there has been on average a 4% increase in demand each year since then. The current funding gap is estimated at £4.5 billion nationally. The removal of the national insurance increase recently has left a lack of clarity over resourcing future funding.

The pandemic has caused significant issues in the NHS including on-going acute bed shortages, staff shortages and significantly increased waiting lists. This in turn has put pressure on social care and in particular hospital discharges. In Liverpool the move to the new Royal Hospital has led to fewer beds and more pressure.

Covid-19 has also had a devastating effect on the care market. There were nearly 50,000 deaths in care homes nationally, plus deaths and illness amongst care staff. At times outbreaks led to a 75% reduction in capacity. Care homes are usually private businesses and these issues have threatened commercial viability. There is also an acute workforce shortage with Skills for Care reporting that there are 165,000 vacancies in care roles nationally. Added to this care homes are particularly sensitive to food and energy inflation. This has led to the Care Quality Commission (CQC) reporting there is now a 40% increase in providers who are at financial risk. Obviously, a decrease in care supply leads to an increase in average costs. Plans for rectifying the funding gap are increasingly threatened by the cost-of-living crisis. This has also seen a significant rise in homelessness and those at risk. The lack of housing in Liverpool exacerbates this. All the above, signals very significant challenges for social care and homeless services and requires the need for different thinking and wholesale transformation.

Approach to savings and transformation

Our transformation programme will follow a holistic, strengths-based approach across health and care. Our focus will be on promoting:

  • Independence
  • Reablement
  • Community and voluntary assets

By doing this we will also achieve a savings target by 2026, while delivering a high performing, good quality service that delivers successful results for Liverpool residents.

Our aim is the same as those our residents would wish for themselves, the right service delivered at the right time, at the best value for money. We will deliver this by achieving the following objectives:

  1. Improve people’s wellbeing and outcomes through promoting independence.
  2. Prevent, reduce and delay demand for formal adult social care support.
  3. Create a financially sustainable adult social care offer.
  4. Establish a positive adult social care culture.

The savings will be delivered by moving away from:

  • An over-reliance on formal council services
  • Over provision of services
  • A culture that promotes long-term involvement

In transforming, our commissioning offer will:

  1. Work with organisations that share our principles and can work innovatively and creatively alongside our operating model.
  2. Increase the resilience of our communities by providing a breadth of options and choices within the community.
  3. Involve a range of stakeholders, including people who use our services and unpaid carers, to shape our commissioning.