Agenda item

Key background documents for this item are:

1. Medium Term Financial Plan and Capital Strategy, as considered at the 31 October Full Council

ModernGov - bristol.gov.uk

2. Previous Resources Scrutiny/Finance Task Group comments as submitted to the 31 October Full Council

FTG submission for Full Council - 31 Oct 23.pdf (bristol.gov.uk)

3. Budget 2024-25 consultation as published on the Ask Bristol consultation and engagement hub

https://www.ask.bristol.gov.uk/budget-2024-25

In this session, the Resources Scrutiny Commission will consider the following issues:

a. Transformation programme (up to 60 minutes)

Update and opportunity for questioning on delivery of the ‘top 4’ transformation programme.

Key reference document: update report submitted to the Overview and Scrutiny Management Board on 4 December 2023

https://democracy.bristol.gov.uk/documents/s90216/Transformation%20Portfolio.pdf

b. Children and Education & Adult Social Care (up to 60 minutes)

Budget proposal reference points:

- Relevant shortlisted Invest to Save (capital) proposals

- Adult social care budget proposals as included in list of 25 budget proposals

Key questions/areas of scrutiny interest as identified in advance of this meeting by Resources Scrutiny members:

1. What is the confidence level around actual delivery of each of these proposals, and how will this be tracked?

2. Can these measures be taken whilst also ensuring individuals still receive the care they need?

a. Transformation Programme

Officers presented a slide-deck overview/update of the transformation portfolio of the “Top 4” programmes (Adult Social Care; ‘Our Families’ (Children and Education); Council’s property estate; Temporary Accommodation) underway across the Council, as previously discussed by the Overview and Scrutiny Management Board on 4 December.

Summary of key points highlighted:

1. Context under which the Transformation programme was being taken forward:

- The Council continued to face a range of very significant financial challenges, as identified in the Medium Term Financial Plan, including required General Fund savings of £37m in 2023/24, with additional in-year risks and budget pressures. The four programmes accounted for 62% of the £37m savings required in the current financial year.

- The Council also faced unsustainable demand for some services, which was a further key driver for transformation.

2. The Adult Social Care programme was developing a sustainable model of care that built on community assets and would improve outcomes whilst delivering within budget as part of a financially stable corporate position.  The programme was being taken forward at pace in partnership with Peopletoo as the Council’s delivery partner.

3. The Our Families programme involved designing effective and sustainable services with, and for, children, young people and families; efficiency of delivery would improve as a result through a whole system change.  Key elements of the programme included introducing a new operating model, improved demand management and specific interventions around home-to-school transport, cost of placements and increasing the number of foster carers.  

4. The Property programme would deliver revenue savings and capital receipts (generated through the capital disposal programme) by reducing the size of the Council’s property estate and maximising utilisation of retained sites. The programme would also implement a corporate landlord model to enable sustainable management of the estate in the long-term.  In addition, the programme would examine which properties within the estate could be utilised to support the Our Families and Adult Social Care programmes.

5. The Temporary Accommodation programme would address the subsidy loss caused by the increase in homelessness that had been experienced.  The reduction in subsidy loss would enable a balanced budget, contributing to the Council’s financial sustainability.

The programme would also deliver an increase in supported housing from registered providers, so that more people could be placed in accommodation meeting their support

needs; it would also secure more suitable temporary and emergency accommodation for those who need it, reducing reliance on the use of hotels.  Other, new sources of funding were being examined, with a view to bringing forward additional capacity for a longer-term solution.

6. In terms of assurance, particularly around benefits realisation, progress on the top 4 programme had been independently reviewed by PWC; their report had now been received and would be key in building the next iteration of the transformation work.

Summary of main points raised/noted in discussion of this item:

1. A number of questions were asked around the confidence levels in terms of the achievability of the top 4 programme, particularly in terms of savings required in 2023/24, bearing in mind that some of the challenges being tackled had been faced by the Council for a number of years.  In response, the following was noted:

a. The Cabinet, in June 2023 had approved specific funding to support the additional capacity required to deliver the top 4 programme. 

b. It was acknowledged that there had been previous, and in some cases over-aspirational attempts to resolve some of the issues that were now being tackled through the programme.  In tandem with the additional funded capacity, there was corporate recognition of the imperative need to also deliver associated long-term organisational culture change whilst also delivering step-changes across the programme.

2. In relation to Adult Social Care, there was a recognition that previously, to an extent, significant resource had been committed to doing the wrong thing as well as possible.  Working with Peopletoo as a full delivery partner providing additional capacity, the focus now was on identifying the most appropriate transformative actions to take forward at pace, in conjunction with Adult Social Care partners.

3. It was noted that the Adult Social Care programme was being taken forward in the context of a 3.9% increase in demand, i.e. new service users.  Progress was being made and was evidenced through a joined-up approach between partners across the programme; for example, 45 individuals had been able to access a home of their own this year as an alternative to supported accommodation - these were ‘win, win’ scenarios in that better outcomes were achieved for the individuals concerned whilst also reducing Council costs. Every effort was also being made to develop locally based placements, to reduce reliance on more expensive ‘out-of-area’ placements.  Stretch targets were in place to ensure momentum in driving change.

4. In response to questions, it was noted that Peopletoo had recommended the development of an effective communications plan to explain the work being undertaken to service users.  In consulting, for example in relation to the Fair and Affordable Care policy, the importance of securing detailed insight from service users was recognised - careful efforts had been made to engage through the Disability Equality Mayoral Commission; the consultation timeline had been extended to enable more views to be heard and an easy-read online survey was also available.  Work on the new target operating model would also be informed by discussions with service users in the spirit of co-production, although, in terms of managing expectations, care was also being taken to explain clearly the financial context and limits within which the Council was operating.

5. Also in relation to Adult Social Care transformation, it was noted that best practice was being examined in relation to the programme, across a wide range of networks, including the Local Government Association, Association of Directors of Adult Social Services and though peer links across the South West Councils Adult Social Care lead members network.

6. It was noted that, at the national level, the highest performing councils in relation to Adult Social Care were not the most expensive in terms of service cost.  The key challenge faced by the Council was to deliver the best possible service within the funding envelope available.  This included addressing care sector workforce shortage issues - a number of initiatives had been taken including signing up to the UNISON ethical care charter, thus supporting a range of commitments to protect the rights and wellbeing of home care workers, with a view to assisting stability in the home care workforce.

7. In discussion, whilst noting the importance of delivering cost-effective, value-for-money services, a number of members commented that it was also important to seek to deliver the services people need and to assure the quality of the services that are provided.  In terms of assurance, it was noted that Adult Social Care services nationally would face increased scrutiny through inspections to be carried out by the Care Quality Commission.

8. In response to questions about the Our Families programme, the following was noted:

a. The work and activity being taken forward was being led and overseen by a very experienced consultant, as Director of the programme.

b. Key areas of improvement included:

- Ongoing careful engagement with service users and parents/carers.

- Utilising technology/digital opportunities to best effect, e.g. to improve SEND related services.

- Developing the in-house, local placement offer (including ‘investing to save’ opportunities to provide local children’s homes) to reduce reliance on more expensive ‘out-of-area’ placements.

- Challenging providers on costs and where necessary re-negotiating particular contracts to secure best value.

- Redesigning the approach to home-to-school transport; this may involve setting up a fleet of mini-buses (which could potentially be in-house or through a hybrid model developed with a voluntary/community/social enterprise partner) to drive pupils to school as an alternative to the spend on taxis for home-to-school transport.

- A drive to recruit significantly more foster carers, and where appropriate to consider additional, innovative approaches, e.g. in some cases, it may be appropriate to provide financial assistance to foster carers/prospective adopters to enable a home extension, or a larger vehicle to be provided, where it was clear that long-term value for money through that additional investment could be assured.

9. In relation to the Property programme, a question was raised about plans for those properties within the Council’s estate which were partly or completely unused, e.g. Ashton Court mansion, and office accommodation at the Corn Exchange.  It was noted that all appropriate opportunities to either dispose of, or realise an income from unused properties

were being considered as a priority within the programme as it was recognised that it was unsatisfactory for properties to be kept empty/vacant.

10. It was noted that the external validation undertaken by PWC was seen as critical in securing assurance about the effectiveness and pace of delivery of the programme and in ensuring confidence around the Council securing an appropriate level of return on its investment in the programme as approved by the Cabinet.  It was also noted that in the coming months, the Chief Executive would be sharing a proposition for a new operating model for the Council with party group leaders.

11. The Director: Finance commented that it was important to recognise that Children and Education, Adult Care and Housing services now accounted for a very significant proportion of the Council’s overall budget (approx. 80 per cent of the current net service budget).  Delivery of the transformation programme was essential but would likely require future radical/difficult decisions to be progressed, for example in terms of establishing new operating models and renegotiating certain contracts, especially given the range of factors that were not wholly within the Council’s control, including demand for services and market conditions.  It was noted that the delivery of the programme would be an ongoing issue to be faced under the committee governance system that would take effect from May 2024.

b. Children and Education & Adult Social Care budget proposals

Summary of main points raised/noted in discussion of this item:

1. There was a discussion around the confidence level of delivering budget proposals in the year ahead:

- It was noted that in relation to the Our Families programme, robust financial target monitoring was in place.  It was also noted that the programme would bring non-financial benefits.

- In relation to the Adult Social Care programme, it was noted that with Peopletoo fully on board as the delivery partner with a proven track record, there was confidence around improved performance in achieving savings in comparison with previous years. It was noted that in relation to complex care cases, additional capacity was now in place to review individual care needs at a suitable point, e.g. the aim was to carry out care reviews within approx. 12 weeks of an individual leaving hospital, to specifically avoid ongoing ‘over prescription’ of care needs (and the related costs) being in place for too long a period. 

2. In terms of maintaining staff capacity, care would be taken, for example in any future recruitment freeze, to ensure that certain categories of Adult Social care employee were ‘exempted’ so that recruitment could continue for essential, cost-effective posts.  As far as possible, recruitment aimed to ‘future proof’ service capacity.

3. There was a discussion around the importance of continuing to maximise the use of technology to improve efficiency and effectiveness of services, and how this linked in with the Council’s broader Digital Transformation Programme:

a. It was noted that, at the corporate level, a data academy was being re-launched; through this, staff were being offered the opportunity to gain confidence and skills to navigate and utilise the data landscape more effectively.

b. It was noted that, in liaison with city partners, opportunities around the use of technology and Artificial Intelligence (AI) to improve service effectiveness would continue to be considered in the years to come, to include examining and learning from best practice elsewhere.  It was also noted that in taking forward appropriate opportunities using AI, related ethical considerations (e.g. around systemic bias) would need to be worked through carefully alongside policy and governance implications and any required safeguards/ assurance framework.

4. In terms of the proposals around reducing the average cost of placements in children’s homes, it was noted that further granular detail could be provided to members to assist future scrutiny.

At the conclusion of the meeting, the Chair thanked members and officers for their participation across both of these budget scrutiny sessions.

The meeting finished at 11.57 p.m.