The Adult Care and Well Being Overview and Scrutiny Panel met to discuss the future location of residential replacement care for adults with learning disabilities, and to review performance and budget monitoring for 2024/25. The panel agreed to further scrutinise the costings of the residential replacement care provision, and made suggestions for topics to be covered in future meetings, including continuing healthcare, mental health services, and hospital discharge pathways.

Residential Replacement Care Provision for Adults with Learning Disabilities

The panel discussed a proposal to relocate residential replacement care services for adults with learning disabilities. The proposal involves moving services from Worth Crescent in Stourport, and Pershore Short Breaks to Greenhill Lodge in Worcester.

Hannah Perrott, Assistant Director for Communities and Provider Services, presented the findings of a public consultation on the proposal, which ran from 27 January to 21 April. The consultation considered four options:

• Option 1: Remain in the current locations.
• Option 2: Consolidate both locations into Greenhill Lodge.
• Option 3: Consolidate Worth Crescent into Pershore and renovate Pershore to increase available beds.
• Option 4: Externalise the provision.

The consultation found that there was no massive dissent to the proposals, particularly at Worth Crescent, where carers recognised that the building is dated and not conducive to meeting individuals' needs. However, the main concerns raised were how the transition would be managed, how staff would be supported, and how transport would be provided.

Ms Perrott also presented a market engagement exercise that sought to externalise the provision (Option 4). Six providers responded, but there was not enough detail to identify potential costs, and the providers would need a property to deliver from, which could not be guaranteed. As such, this option was not pursued.

The preferred option was to consolidate both Worth Crescent and Pershore into Greenhill Lodge (Option 2), as this was the cheapest option overall and presented a bigger opportunity to obtain capital receipts through the sale of surplus buildings. The refurbishment costs for Greenhill Lodge were estimated at £550,000.

Ms Perrott also noted that there was an option to relocate the internal day service provision from Worcester Resource Centre into Greenhill Lodge, which would strengthen the business case and maximise the use of available space. This would be subject to further public consultation.

Councillor Hardman raised concerns that the paper concentrated very much on the council's views of things, and that he did not hear much of the voice of the users of the service in the papers. He also raised concerns about transport costs, and the impact on staff consistency. Mark Fitton, Strategic Director for Adults and Communities, responded that the council had engaged with carers of users, and tried to take into account any concerns that they have.

Councillor Leacock said that she was concerned that Worth Crescent was still being used, as it was in a very bad state and had asbestos under the floor.

The panel agreed to further scrutinise the costings of the proposal, and to receive further information on the asbestos surveys at Worth Crescent and Pershore.

Performance and 2024/25 Draft Year-End Budget Monitoring

Katie Stallard presented a report on performance information for Quarter 4 (January to March 2025). The report covered five key performance indicators (KPIs):

• Admissions to permanent care per 100,000 (18-64) - rated red.
• Admissions to permanent care per 100,000 (65+) - rated green.
• Outcomes of short-term services - rated amber.
• People aged 65+ at home following rehabilitation - rated amber.
• Annual care package reviews completed - rated red.

Ms Stallard noted that Worcestershire was still performing well against its comparators in other areas.

Councillor Morris asked whether the target for annual care package reviews should be lowered, as it was a very stretching target. Mr Fitton responded that it was a stretched target, but that Worcestershire was probably the best performer in the West Midlands in terms of the percentage of people who receive an annual review.

Councillor Cross was troubled by the shape of the graph for annual care package reviews, and asked whether the council was fully satisfied that it was turning this around and that it was on the right track now. Mr Fitton responded that the fluctuations in performance were due to the demand for the service and where the council had to prioritise its resources.

Councillor Shaw asked about the increase in admissions to permanent care for the 18-64 age range. Mr Fitton responded that this was due to the increasing complexity of needs of people transitioning from children's to adult services, and that the council was continuing to scrutinise these requests.

Richard Stocks presented a report on the 2024/25 draft year-end budget monitoring. He reported that the council had an overspend of £6.2 million on a £433.4 million net budget, after using £7.9 million of budgeted reserves. The overspends were in demand-led areas, such as adult social care, children's social care, and home to school transport.

Mr Stocks noted that the adult services had an overspend of £4.1 million, with the most significant variances relating to the costs of placements. He also noted that there had been an increase in debt write-offs within the older people market.

Councillor Shaw asked about the debt write-offs, and whether these were people who had no assets at all that could be claimed later on. Mr Fitton responded that a lot of the debt that the council sees is particularly around where people are receiving domiciliary care, and some people refuse to pay for their care. He said that the council is unable to withdraw care where people refuse to pay for it.

Councillor Hardman requested a table that explained where the sources of funding were coming from, including the social care grant and grants from the Integrated Care Board (ICB). He also expressed concern that the government was going to give the council a three-year settlement, which would leave very little room for manoeuvre.

Work Programme

The panel discussed its work programme for 2025/26, and agreed to include the following items:

• Continuing healthcare.
• Mental health services.
• Supply of services.
• Contracts awarded to providers of domiciliary care services.
• Care package review backlogs.
• Disabled facilities grants.
• Safeguarding.
• Hospital discharge pathways (jointly with the Health Overview and Scrutiny Committee (HOSC)).

Councillor Hardman also raised concerns about the backlog in Deprivation of Liberty Safeguards (DoLS) applications.