Setting the scene - Adult Social Care in a changing landscape
The demand for Adult Social Care rises every year as people live longer and there are more people living longer with more complex needs.
The illustrations on the next few pages give you an indication of the position for Adult Social Care during 2020/21 in respect of:
- Budget – Money Matters
- Activity – Facts and Figures
- Demographic – The people who come to use for support
- Our Workforce - The people that provide support where required
The Council is a large organisation spending a net £238.4m on revenue activity during 2020/21. The gross Adult Social Care spend in 2019/20 minus citizen’s and other contributions was £103.2m as shown below. This includes £7.8m of additional resources provided to support the care market during the pandemic.
Budget - Money Matters
2020/21 Adult Social Care spend £103.2m.
This compares to a spend of £95m in 2019/20. The largest element of the increase relates to spend on people (provision of services).
- £79.5m spent on people
- £17.1m spent on community assessment and overheads
- £6.1m spent on central recharges
- £0.3m spent on transport
- £0.2m sent on other
2020/21 spend on people (£79.5m)
The ‘Spend on People’ referred to in the above chart has increased from £70.4m in 2019/20. £7.8m of that increase relates to the additional support to providers referenced above. ‘Spend on People’ is money spent directly on the following services.
- £21.9m spent on homecare
- £21.8m spent on residential
- £9m spent on Direct Payments
- £7.8m spent on COVID
- £6.6m spent on housing with care
- £6.1m spent on nursing
- £2.4m spent on day opportunities
- £2.4m spent on supported living
- £1.1m spent on equipment and adaptions
- £0.4m spent on individual services funds
How do we compare?
Coventry still continues to be a comparatively low spending local authority per 100,000 population. In recent years we know that Coventry demonstrates comparatively low spending as a local authority per 100,000 population. The Local Government Association publish information about spend later on in the year.
Activity - Facts and figures
COVID-19 and the country’s response to the pandemic, with national lockdowns and limited family contact impacted on the activity of Adult Social Care, those accessing our support and how we needed to work. We don’t know what the future holds but as a consequence of the pandemic we are starting to see more demand associated with mental health and wellbeing.
People receiving support
Adult Social Care receives a large volume of requests for support on a day-to-day basis. Our aim is to maximise people’s independence and support people in the least intrusive way.
- 9,902 new requests for support (a small decrease on last year’s figures of 10,534).
- 5% of requests resulted in a long-term service decrease from last year’s 7%) received low level support (increase from last year’s 25%).
- 34% received low-level support (increases from last years 25%).
- 30% received a short-term service to promote independence (increase from last year’s 21%) Adult Social Care receive a large volume of requests for support on a day-to-day basis.
- 4,529 people received long term support during the year (an increase of 1.7% from last year’s 4453).
- 1,430 received a planned or unplanned review throughout the year.
- 23 people transitioned from Children’s Services to Adult Social Care compared to 44 last year.
Carers receiving an assessment
Adult Social Care has equal responsibility for anyone providing unpaid care within the city. Anyone providing necessary care to another adult is entitled to a carer’s assessment:
- 588 carers had their needs assessed of which 286 received a separate assessment
- 802 carers received formal support
How do we compare?
CQC Local Area Analysis data suggests in Coventry, compared to other local authorities that have similar populations, that we think of other solutions first, signposting to universal services and other community support rather than looking at traditional models of support.
In comparison to other local authorities Coventry continues to have;
- Low rates of new requests for Adult Social Care, with an average of 27 a day compared to the national average of 35 in 19/20
- A lower rate of new requests for Adult Social Care support going straight into an ongoing long-term service than comparators
- A higher proportion of new requests for people aged 65+ going on to receive short term support to maximise independence than comparators
- Continued lower rate of people receiving long term support per 100,000 population compared with our comparators
Safeguarding
Protecting adults to live in safety, free from abuse and neglect is a core duty of Adult Social Care. The rising rate of safeguarding concerns reported suggests people know how to report abuse and we are addressing concerns without the need for an enquiry or investigation.
2020/21 Safeguarding Information:
- 4,321 safeguarding concerns received, a 2% decrease from the previous year
- 508 completed safeguarding enquiries were undertaken in the year compared to 563 in the previous year
- 11% the rate of concerns that led to an enquiry was down from 12% last year
- 423 people (83%) were asked about their outcomes, an increase from 80% of people asked last year
- 493 safeguarding enquiries, a 7% decrease from the previous year
- 93% of people reported fully achieved/partially achieved outcomes compared to 95% last year
We continue to closely monitor all our activity and use ‘sampling’ audits and develop improvement plans when we need to look into our approaches in more depth.
How do we compare?
Coventry has a higher rate of concerns per100,000 population than comparators. In 2020/21 1481 compared to the average rate in England (2019/20) of 938 - but thorough initial enquiries address these sooner without the need for a full enquiry. 2020/21 comparator data is due to be published in November 2021 on the NHS Digital Adult Social Care Analytical Hub.
Deprivation of Liberty Safeguards (DoLS)
The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. The safeguards aim to make sure that people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom.
- There has been a 1% (13) reduction in the number of applications from 2250 in 2019/20 to 2237 in 2020/21
- 349 (16%) are in due process compared with 254 (11%) in 2019/20
- In 2020/21 there were 1889 applications completed which is a 5% decrease from 1,996 in 2020/21
- There was an increase of applications granted after six months of being received from 22 (3%) in 2019/20 to 37 (4%) in 2020/21
How do we compare?
Comparator information will be published at the end of 2021 however we know from last year that Coventry continues to have a higher proportion of applications and completes a higher proportion of assessments per 100,000 than our comparators. As a
result of this Coventry has a lower rate of applications not completed than our comparators.
Our work during the year was impacted as a result of the pandemic due to reduced staffing capacity and assessments taking longer to complete. Liberty Protection Safeguards are due to replace DoLS in April 2022 for which the service is actively preparing.
Demographic
Coventry’s population is growing, changing and increasingly diverse.
- Coventry is home to 379,387 residents (mid 2020 est).
- Population growth is still amongst the top 10% of local authority areas but has stabilised (growing by 2.1%).
- Highest growth in the population is amongst the young working aged adult population.
- 13.31% of the population is 65+ but this is expected to grow and accelerate in the next 10-15 years
- Life expectancy in Coventry remains consistently below England, but healthy life expectancy is similar to England.
- Health outcomes are worse in the most deprived areas, where people not only live shorter lives, but spend a bigger portion of their years in poor health, and are more likely to die of preventable causes
National data suggests that between 2015-2017 and 2017-2019, life expectancy between the richer and poorer increased further. In particular, there was a decrease in life expectancy for females in poorer areas - resulting in a widening of inequality in the life expectancy gap among females (7.4 years). Although, the gap for males (9.4 years) remains larger.
Early mortality ( less than 75 years) is worse than average for males and females for cardiovascular, cancer, respiratory diseases and communicable diseases. For liver disease in men, it is also worse that the national figure.
Our workforce
- 928 internal
- 83% female staff
- 17% female staff
- Average age of workforce 47.5 years
- 50% workforce aged over 50
- 69% workforce is white
- Vacancy rate is 9% compared to 6% nationally
- 19% of workforce is BAME up 2% from last year
- Leaver rate is 9% (83 people)
- New starter rate is 15% (141 people)
- The wider Adult Social Care workforce in Coventry amounts to 9,600 jobs which includes staff working in 177 CQC registered establishments