The Adult Care and Well Being Overview and Scrutiny Panel met to discuss mental health social care services, NHS continuing healthcare, budget monitoring and performance, and to refresh their work programme. Councillors heard that adult social care was facing financial challenges, with demand-led services increasing and putting pressure on budgets. The panel agreed to scrutinise the Integrated Care Board's (ICB) contribution to continuing healthcare and to schedule a session with partners and the community to discuss how they can support adult social care.

Financial Performance and Budget Monitoring

Richard Stocks, provided an overview of the council's financial position, highlighting a forecast overspend of £7.960 million in adult services. This was primarily driven by increased placement costs, particularly in older people's services, learning disabilities, and physical disabilities.

Key points:

• Older People: A £2.315 million overspend was attributed to rising numbers and costs in residential and nursing care placements.
• Learning Disabilities: A £3.819 million overspend was due to increased client numbers and higher weekly costs in residential care, day care, and supported living¹.
• Physical Disabilities: An £808,000 overspend resulted from increased residential care placement costs.
• Mental Health: A £787,000 overspend was linked to a rise in client numbers, mainly in bed-based care.

Councillor Adrian Hardman raised concerns about the consistent overspend in learning disabilities, questioning whether the council was adequately informed about the number of children transitioning into adult services. Kerry McCrossan, explained that the learning disabilities budget also covered people with neurodiverse needs, and that the Adult Neurodiversity Team (ANT) had worked with around 400 people in the last 18 months. She added that the council had good relationships with children's services and was usually aware of young people transitioning into adult services from the age of 14.

Councillor Andrew Cross asked about high-cost placements, specifically how many individuals had costs exceeding £1 million. Mark Fitton, clarified that he was not aware of any costs reaching that level, but that the council was reviewing placements costing over £4,000 per week (approximately £200,000 per year).

Councillor Richard Morris asked what the panel could do to help get the government to speed up the process of review and legislation to either enable more funding or to legislate more effectively to mitigate the issues that the council was going to be facing with adult social care and children's services. Mark Fitton responded that the council tried to push their concerns through regional perspectives into national Association of Directors of Adult Social Services (ADASS) to ensure that they were aware of the pressures that the council faced.

Overview of Worcestershire Mental Health Social Care Services

Kerry McCrossan, Assistant Director for Adult Social Care, presented an overview of Worcestershire's mental health social care services following the end of the Section 75 agreement² with Herefordshire and Worcestershire Health and Care NHS Trust in 2021. The report highlighted key achievements, challenges, and areas for improvement.

Key achievements:

• Development of hospital social worker roles within mental health inpatient settings, leading to improved discharge planning and reduced reliance on high-cost placements.
• Introduction of a Forensic Social Worker (FSW) role to improve oversight, coordination, and outcomes for individuals subject to forensic mental health pathways.

Key challenges:

• A 94.6% increase in caseloads since April 2021, with the North team seeing a 158% increase and the South team a 57% increase.
• Recruiting and retaining qualified mental health social workers, with competition from the NHS.
• Growth in commissioned services and increased costs, particularly in nursing care.

Councillor Andrew Cross asked about the council's connection with third sector and voluntary organisations such as Worcester Food Bank, St Paul's Hostel and Maggs Day Centre. Aaron Dodd, Head of Service for Mental Health, responded that the mental health services teams had links with regional food banks and third sector organisations, and kept a database of available services.

Councillor Dave Edmonds offered to connect the council with voluntary organisations in Redditch, such as Sandyland Brook.

Update on NHS Continuing Healthcare (CHC)

Kerry McCrossan provided an update on NHS Continuing Healthcare (CHC), explaining that it is a package of ongoing care arranged and funded solely by the NHS where an individual has been assessed and found to have a 'primary health need'. She noted that the council's income from the ICB for CHC had decreased, and that the ICB was introducing new policies and procedures in relation to CHC, including changing the notice period from 28 to 14 days.

Councillor Adrian Hardman expressed concern about the ICB changing the notice period from 28 to 14 days, and Councillor Owen Cleary asked whether NHS colleagues were still pulling the plug and defaulting to continuing healthcare.

Francesca Darby, Head of Service for Learning Disabilities, responded that the council had excellent legal support, but that the process of getting legal support could be lengthy. She added that the council tracked all disputes, and that it was a considerable amount of work for council officers to take part in the disputes.

Councillor Richard Morris asked what the panel could do to help the service more effectively in terms of their delivery. Kerry McCrossan responded that the associate director had talked about joining the panel, and that it was something that could be arranged and invited.

Refresh of the Scrutiny Work Programme 2025-26

The panel discussed and agreed to add the following items to their work programme:

• A session to scrutinise the ICB and their contributions to CHC.
• A session with partners and the community to look at their contributions and support, and if there's anything more that could be leveraged from the community in that aspect.

Councillor Adrian Hardman asked for an update on the Care Quality Commission (CQC) inspection. Mark Fitton responded that the on-site inspection would take place the week commencing 10 November, and that the council would give a leadership presentation to the CQC online on 15 October. He added that the CQC had requested to speak with Councillor Mel Allcott and Councillor Richard Ecock.