Agenda and minutes

An apology for absence was received from Councillor B. Davies.

There were no declarations of personal interest or of any prohibited party whips.

The Chair advised that no public questions had been received.

The Committee considered the Revenue and Capital Budget Monitoring Report in relation to the Health & Social Services, which provided an update on the latest budgetary position as at 31^st October, 2023 in respect of the 2023/24 financial year.

The Health & Social Services was forecasting an overspend of £9,740k on the revenue budget. The main variances on capital schemes indicated a forecasted variance of -£49k against a net budget of £1,906k on social care projects, and a -£184k variance against the Children Services projects net budget of £517k.

Cabinet Member for Resources highlighted that the forecast budget overspend on Children’s Services was an area of significant concern to the corporate budget position and in recognising this a working group had been set up to investigate and identify corrective action where possible.

A number of questions were raised to which officers responded. The main matters were as follows:

• Concern was expressed regarding the excessive cost of agency staff in residential homes and it was asked what safeguards were in place to ensure the reliance on agency staff would not be the same in the next financial year. Officers advised that a working group had been set up to help gain an understanding of the work demands. It was hoped that an improvement in the  financial position would be evident in the next monitoring report. Work had been undertaken to establish an in-house flexible pool of casual staff and if successful would reduce the reliance on agency staff.
• In response to concerns regarding the overspend of £9.7m and what the likely position would be at year end, the Committee was advised that while the figure was concerning it was for the departments within the remit of this Committee and that corporately the forecast was lower due to the underspend in the Chief Executive and Corporate Services Departments. It was also noted that there was an underspend position in respect of Capital Charges. Once again, the Committee was reminded that the monitoring work addressed the ‘actual performance’ based on data up to the end of October and that the accountants worked closely with all the service departments to review the trends and areas of overspend. It was stated that the increase in the use of agency staff had been identified as part of the monitoring process and had highlighted that unless corrective actions were put in place the financial position would deteriorate further.
• In reference to Appendix B, it was asked what the ‘alternative ways of working’ meant. Officers stated that recently Welsh Government had consulted on a rebalancing care and support white paper which considered how commissioning was undertaken with a greater emphasis on mitigating against market failures. An example of this would be the development of more in-house capacity with a specific example of Plas Y Bryn care home which closed last year and was subsequently bought by the Local Authority. It was also stated that there was an ambition to develop in-house children’s facilities to mitigate against the excessive cost  ...  view the full minutes text for item 4.

The Committee considered the Council’s Revenue Budget Strategy 2024/25 to 2026/27 which provided a current view of the revenue budget for 2024/25 together with indicative figures for the 2025/26 and 2026/27 financial years. The report was based on officers’ projections of spending requirements and took account of the provisional settlement issued by Welsh Government on 20th December 2023 - the latest date this had ever been provided.

It was emphasised that whilst significant work had already been undertaken in preparing the budget, the report represented an initial position statement which would be updated following the consultation process. Accordingly, Members were reminded that the report had been considered by the Cabinet at its meeting on 15th January 2024 and members of the Committee had attended recent consultation events which had provided an opportunity to analyse and seek clarification on various aspects of the budget.

The Committee was advised that the final settlement was expected to be published by Welsh Government on 27^th February 2024 alongside the Welsh Government budget, the day before full council meets to agree the final budget.

The report indicated that no funding had been allocated for either Teachers’ or Firefighters’ pension increases, as this mechanism had not yet been worked through between Westminster and Welsh Government. Whilst this was assumed to be a nil impact on the funding position, this was considered a significant risk until formally confirmed, with a value of c. £4m.

The Ministers letter stated that all available funding had been provided, and Local Authorities “must therefore accommodate” costs such as the September 2024 Teachers pay deal, although there was no clarity on what has been assumed.

Members were reminded that no additional funding had been provided to meet the budget shortfall going forward as a result of either the uplift in Teachers pay (set by Welsh Government), nor the 2023 NJC pay award (set by national pay bargaining). Welsh Government recognised that this was the most challenging settlement since devolution.

The Cabinet Member for Resources advised that Wales was to receive an extra £25m for public services off the back of the boost received by English councils aimed to tackle their cash crisis. It was hoped that some of this additional funding would be distributed to Local Authorities.

The Committee thereupon considered the following detailed budget information appended to the Strategy, relevant to its remit:-

·         Appendix A(i) – Efficiency summary for Health and Social Services

·         Appendix A(ii) – Growth Pressures summary for Health & Social Services

·         Appendix B – Budget monitoring report for Health and Social Services

·         Appendix C – Charging Digest for Health and Social Services

Several questions were raised to which officers responded. The main matters were as follows:

• In response to a query regarding the £2m drawn from reserves for Children Services, assurance was provided that it was correct to apply this funding and that it was anticipated that the introduction of in-house facilities would result in the reduction for the need to go market for 3^rd party placements.  ...  view the full minutes text for item 5.

The Committee considered a report that provided a position statement on Integration of Health & Social Care in Carmarthenshire and specifically,

an update with regards to specific priorities which were set out to deliver on a community care system for Carmarthenshire.

Following a presentation to Scrutiny Committee at its June 2023 meeting, members agreed to support the development of a plan building on a range of initiatives. This plan was to address the complex and multiple needs of the patients rather than the capabilities of the current provider landscape. It would consider both immediate impacts that changes could make as well as setting out a model that would meet medium and long-term demand of the frail and elderly.

Members noted that work in Integration between Health and Social Care had been focussed on delivery on the frontline of seamless services to the public. Progress on wider strategic integration had not been what was envisaged last year. Significant financial pressures, changes at Chief Executive level and a reorganisation within Health made further progress in strategically integrating the Local Authority and the Health Board unlikely in the short to medium term.

The Chair welcomed to the meeting from Hywel Dda UHB Dr Sioned Richards (GP Lead, Carmarthenshire Intermediate Care) and Indeg Jameson (Acute Response Team Physiotherapist) who provided the Committee with an update and presentation on the integrated work that was being undertaken within Carmarthenshire’s Eastgate Hub. The Committee was advised that the multi-disciplinary team had a shared vision and goal to support people in their homes and to prevent admissions. Referrals were received from hospitals, community, and GPs. The integrated way of working resulted in patients receiving the most appropriate level of care.

A number of questions were raised to which officers responded. The main matters were as follows:

• In response to a query regarding the model and the challenges of linking with GPs, it was advised that the model was working well however minor adjustments were needed such as an increase in the number of carers. It was stated that the team was in place to provide rehabilitation to help people maintain their independence and not to deliver long term care.
• When asked if a similar model was in place elsewhere it was stated that the model had been duplicated by other authorities and that the model had been recognised as best practice.  It had also received awards in recognition of its success.
• In response to concerns raised regarding the use of beds at Ty Pili Pala and the disparity of the length of bed stays at Llandovery and Amman Valley, the Committee was advised that the community hospitals received patients that required a longer term of stay as they would usually require packages of care. It was noted that significant work was being undertaken on how to better utilise these beds.
• In response to concern raised regarding work on the strategic integration between Health and Social Care, the Committee was advised due to significant financial pressures, changes at Chief  ...  view the full minutes text for item 6.

Officers and Committee Members advised that they needed to leave the meeting due to prior commitments.

UNANIMOUSLY RESOLVED that the report be deferred to the next scheduled meeting on the 21^st March 2024 .

Officers and Committee Members advised that they needed to leave the meeting due to prior commitments.

UNANIMOUSLY RESOLVED that the report be deferred to the next scheduled meeting on the 21^st March 2024 .

The Committee received an explanation for the non-submission of the following scrutiny reports. 

·         10 Year Social Services Strategy

·         Children’s Services Budget Group Report

The Committee re-iterated their concern regarding the non-submission of the Children’s Services Budget Group Report but noted that some information had been provided through the Budget Consultation process.

RESOLVED that the explanation for the non-submission be noted.

The Committee advised that if possible, they would like to consider the Regional Safeguarding Annual Report at the next meeting. 

RESOLVED that the list of forthcoming items to be considered at the next scheduled meeting on the 21^st March 2024 be noted.

UNANAMOUSLY RESOLVED that the minutes of the meeting of the Committee held on the 18^th December, 2023 be signed as a correct record.