The Health and Social Services Scrutiny Committee met on Thursday 28 November 2024 to review the council's financial performance, discuss the domiciliary care sector, and consider strategies for dementia care and early help. The committee received updates on the significant overspend within the Health and Social Services revenue budget, heard about improvements in domiciliary care provision despite ongoing workforce challenges, and reviewed progress on the development of a new Prevention Strategy and the implementation of the regional Dementia Strategy.

Revenue and Capital Budget Monitoring Report 2024/25

The committee received an update on the budgetary position for Health and Social Services as of 31 August 2024, which indicated a projected overspend of £7,025,000 on the revenue budget. This overspend is primarily attributed to increased costs in Children's Services, particularly in commissioning and social work, and in residential settings due to the need for specialist agency staff. Capital schemes showed a forecasted variance of £14,000 against the approved budget for Children's Services projects.

The report detailed significant variances across various service areas. For instance, Older People's services were forecasting an overspend of £1,599,000, with notable pressures in private home care and residential care homes due to increased overtime, casual, and agency costs. Children's Services were projecting an overspend of £4,336,000, with substantial increases in commissioning and social work, residential settings, and commissioned placements driven by increased demand, complexity of cases, and the need for specialist agency support.

Savings monitoring for 2024/25 indicated a forecast of £2,193,000 in managerial savings against a target of £2,443,000, meaning £250,000 was off target. The report highlighted that no policy savings had been put forward for 2024/25.

Domiciliary Care Performance Update

An update on domiciliary care performance for Q1 and Q2 of 2024/25 indicated an improvement across key metrics, with commissioned hours returning close to pre-pandemic levels. The number of hours commissioned for domiciliary care had shown a gradual increase since January 2023, attributed to the re-launch of the Domiciliary Care framework and additional provider capacity. However, ongoing recruitment and retention challenges within the sector persist.

The number of people waiting for domiciliary care showed an improving trend, with a significant decline since August 2023. This was linked to the re-launch of the framework, the introduction of the Community Assessment Service, and the Home First approach. Despite these positive trends, there remained a significant amount of unmet need that required monitoring to ensure the safety of those waiting for care.

The report also noted that the in-house home care service provided approximately 37% of the overall domiciliary care market, with an aspiration to grow this to 50% over the next year to enhance market resilience. Strategies to mitigate risks included regular reviews of existing care packages, the use of the releasing time to care methodology, and a weekly meeting to review long hospital waits. The financial implications of the growth in commissioned hours were projected to be approximately £0.8 million for the first six months of 2024-2025.

Prevention Strategy for Carmarthenshire

The committee received an update on the development of a Prevention Strategy for Carmarthenshire, titled 'Living Well in Carmarthenshire'. This strategy is being developed to address the need for a more updated approach to prevention, building on a previous strategy from 2016. The development is being guided by a Regional Preventions Board and a local Prevention Group.

Key opportunities identified for the strategy include improving access to information and advice, empowering the public in their health and wellbeing, using data to inform prevention approaches, harnessing available resources, and collaborating across local authority, health, and third sectors. The strategy is in advanced stages of development, with public engagement underway through 'Living Well Events' and online surveys. The final strategy is scheduled for approval through council governance structures in early 2025.

Interim Report on the Implementation of the Dementia Strategy and a Position Statement Regarding Dementia Care in Carmarthenshire

The committee received an interim report on the implementation of the West Wales Regional Dementia Strategy and a position statement on dementia care in Carmarthenshire. The strategy, finalised in April 2022, aims to Support each person to live well and independently with dementia for as long as possible and focuses on streamlining pathways and placing individuals with dementia and their carers at the centre of service provision.

The report outlined the demographic context, highlighting projected increases in the over-65 population and a significant rise in the number of people aged 85 and over, leading to an expected increase in the number of people living with dementia in Carmarthenshire by 2040. The implementation of the strategy is overseen by the West Wales Regional Dementia Steering Group, which has established workstreams focusing on community engagement, dementia wellbeing services, and workforce development.

A position statement on dementia care in Carmarthenshire indicated that dementia care is prioritised across various service areas. The report detailed a range of community, core, and commissioned services available, including those provided by Delta Wellbeing, Carmarthenshire Carers Information Service, Delta Connect, Age Cymru Dementia Connectors, and the Admiral Nurse Team. The report also highlighted the role of primary care and the Memory Assessment Service in diagnosis and early intervention.

Early Help Strategy

The committee reviewed the draft Early Help Strategy for Carmarthenshire, which aims to establish a common understanding of Early Help and ensure families receive accessible, co-ordinated support. The strategy emphasizes a collaborative approach, focusing on providing the Right Help at the Right Time and in the Right Way for Families. This approach aims to prevent problems from escalating and reduce the need for statutory intervention.

The strategy acknowledges the increased and changed demand on Children and Families Services and is a vital part of their transformation. It outlines objectives to reach families earlier, improve outcomes, deliver more seamless services, support lead professionals, and reduce the number of children requiring statutory intervention. Key next steps include developing Early Help Hubs, strengthening links with school clusters, and creating step-up and step-down processes between teams.

Explanation for Non-Submission of Scrutiny Report

The committee received explanations for the non-submission of several scrutiny reports. The Youth Justice Plan was delayed due to the Carmarthenshire Youth Justice Team's participation in a pilot inspection. An update on the Loneliness Task and Finish Actions was noted as completed, with an update on the Prevention Strategy being presented at the current meeting. The Llesiant/Delta Annual Report Update and the Early Help Strategy update were also noted as being rescheduled.

Forthcoming Items

The committee noted the list of forthcoming items for the next meeting on 3 February 2025. These included Budget Monitoring (April-October), the Revenue Budget Consultation for 2025/26 to 2027/28, an update on Children & Families Services, a progress update against Cabinet Visions and Actions, the Q2 Performance Management Report, the Youth Justice Plan, and the Domiciliary Care Performance Update. The committee also reviewed its Forward Work Plan for 2024/25 and the Cabinet's Forward Work Plan.