Adult Social Care 6 Monthly Update
Renfrewshire Council · 20 September 2023
Back to Leadership Board — 20 September 2023 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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___________________________________________________________________ To: Leadership Board On: 20 September 2023 ___________________________________________________________________ Report by: Chief Officer, Renfrewshire Health and Social Care Partnership ___________________________________________________________________ Heading: Adult Social Care: 6 Monthly Update ___________________________________________________________________ 1. Summary 1.1 Adult Social Work Services were delegated to Renfrewshire Integration Joint Board (IJB) on 1 April 2016. These services are managed through the Health and Social Care Partnership (HSCP). 1.2 This 6-monthly update report to Leadership Board, together with Renfrewshire’s Integration Joint Board Annual Performance Report 2022/23 provides an overview of adult social care activity and performance. ___________________________________________________________________ 2. Recommendations 2.1 It is recommended that members note: • the contents of this report updating activity and performance of adult social work services delegated to the IJB; • that a revised suite of adult social care performance indictors will be submitted to a future meeting of this Board for approval; and • that the next six-monthly update report for April to September 2023 will be presented to the Leadership Board in February 2024. _________________________________________________________ 3. Background 3.1 The list of functions that must be delegated by the Local Authority to the IJB is set out in the Public Bodies (Joint Working) (Prescribed Local Authority Functions, etc) (Scotland) Regulations 2014, and is noted in Annex 2, part 1 of Renfrewshire’s Integration Scheme. These include:
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• Social work services for adults and older people; • Services and support for adults with physical disabilities and learning disabilities; • Mental health services; • Drug and alcohol services; • Adult protection and domestic abuse; • Carers’ support services; • Community care assessment teams; • Support services; • Care home services; • Adult placement services; • Health improvement services; • Aspects of housing support; • Day services; • Respite provision; • Occupational therapy services; and • Reablement services, equipment, and telecare. 3.2 Whilst regular reporting in relation to these services is provided to the Integration Joint Board (IJB), it was previously agreed that 6 monthly updates would also be presented to the Leadership Board. This ensures oversight of the key activities and wider context relating to the delivery of these services. 4. Renfrewshire IJB’s Annual Performance Report 2022/23 4.1 Renfrewshire IJB’s Annual Performance Report 2022/23 provides a comprehensive reflection on the HSCP’s performance against agreed local and national performance indicators and in delivering the commitments set out within year one of the IJB Strategic Plan 2022-25. 4.2 While 2022/23 has been another challenging year, overall performance has improved when compared with 2021/22. At the financial year end 2022/23, the HSCP performance scorecard showed an improved position compared to 2021/22, the table below highlights: indicators with red status reduced by one, amber reduced by four and green increased from 16 to 22. The full Scorecard is included at Appendix 1 within the Annual Performance Report 2022/23 and a detailed section of Council delegated indicators are included in Appendix 1 of this report. Performance Indicator Status 2021/22 2022/23 Target achieved 16 22 Warning (less than 10% variance of target) 10 6 Alert (more than 10% variance of target) 13 12 Data only 18 11
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5. Key Activities 5.1 A summary of the key activities undertaken during 2022/23 related to the delegated services are detailed in the section below. Winter Pressures 5.2 As previously reported, the Winter Plan 2022/23 was approved by Renfrewshire’s IJB on 25 November 2022. Each year, Renfrewshire HSCP develops plans to ensure the resilience of critical services over the winter period. The planning process for winter 2022/23 was undertaken across all HSCP internal and hosted services. 5.3 The key priorities over the winter were as follows: • Deliver the seasonal vaccination programmes; Flu and COVID Booster; • Embed frameworks, policies and plans to support service resilience and the prioritisation of emergency and critical services, whilst maintaining the delivery of other essential services; • Develop ‘Data Resilience’ plans to ensure that services were prepared for any potential loss of systems, network or power for a period of one week; • Continue to survey the environment and stay abreast of how services were performing for service users, amending policy and practice to sustain service levels; • Support the public to continue to access services, addressing their critical and essential needs and supporting residents to remain safe and well; • Support partner organisations to take steps to prepare for winter and collaborate on necessary solutions for the benefit of residents; • Deliver, champion and optimise the use of appropriate infrastructure across the partnership, to underpin the successful delivery of our plans; • Understand the needs of services through the festive period and plan appropriately to maintain and manage service levels and any potential disruption; • Deliver the right balance of annual leave and staffing across services to maintain service levels throughout the winter period; and • Support the health and wellbeing of staff so that they remain well and are able to undertake their roles through challenging winter conditions. 5.4 Additional winter funding was secured from the Scottish Government to create additional posts across a range of services, of which 45.84 FTE posts were successfully recruited to. Care Homes 5.5 Enhanced clinical and care oversight arrangements for care homes were put in place early in the pandemic to support care home staff to keep residents safe. The guidance required that clinical and care professionals at NHS boards and local authorities will have a leading role in the oversight for care homes in their area. There has been considerable learning and examples of excellent partnership working during this time.
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5.6 On 19 December 2022, the Chief Social Work Advisor and the Chief Nurse set out recommendations for new arrangements to provide continuing enhanced support to adult and older people’s care homes in Scotland. The recommendations have since been adopted in Renfrewshire and a Collaborative Care Home Support Team is in place. Local strategic oversight of these arrangements continues to be provided by the COG who regularly monitored performance, scrutinise reports and establish special meetings of the group, as and when required. 5.7 During 2022/23, unannounced inspections were undertaken by the Care Inspectorate at Montrose and Renfrew care homes which are operated by the HSCP. The Inspection Teams looked at a selection of the quality indicators which are based on the intelligence they hold about the service, and any risk factors that they may have identified. The evaluations provided to the care homes is as follows: Montrose Care Home How well do we support people's wellbeing? 4 - Good People's health and wellbeing benefits from their care and support 5 - Very Good People experience meaningful contact that meets their outcomes, needs and wishes 5 - Very Good People's health and wellbeing benefits from safe infection prevention and control practice and procedure 4 - Good How good is our leadership? 4 - Good Quality assurance and improvement is led well 4 - Good Renfrew Care Home How well do we support people's wellbeing? 4 - Good People experience compassion, dignity and respect 4 - Good People experience meaningful contact that meets their outcomes, needs and wishes 5 - Very Good People's health and wellbeing benefits from safe infection prevention and control practice and procedure 4 - Good How good is our leadership? 4 - Good Quality assurance and improvement is led well 4 - Good Care at Home 5.8 Although our Care at Home services faced significant challenges, the HSCP were able to continue to support existing vulnerable service users whilst remaining responsive to the safe and timely discharge of patients from hospital. Renfrewshire was the highest performing HSCP in Scotland at March 2023 for standard bed days lost to delayed discharge.
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5.9 On 14 September 2022, the Care Inspectorate concluded an unannounced inspection of the Renfrewshire Care at Home Service. Unfortunately, the inspection highlighted some areas of concern which resulted in the grades provided in the table below. The HSCP immediately established a working group to expedite implementing the necessary requirements and improvements identified within the report. A follow-up visit was undertaken by the Care Inspectorate between 28 November 2022 and 1 December 2022 and resulted in the positive re-evaluation of the grades below. Quality Indicator 14 September 2022 1 December 2022 How well do we support people's wellbeing? 2 - Weak 4 - Good People experience compassion, dignity and respect 3 - Adequate 4 – Good People experience meaningful contact that meets their outcomes, needs and wishes 2 - Weak 4 - Good People's health and wellbeing benefits from safe infection prevention and control, practice and procedure 2 - Weak 4 - Good How good is our leadership? 3 - Adequate Not assessed Quality assurance and improvement is led well 3 - Adequate Not assessed The Inspection team also highlighted the following key messages: • People told us they were treated with kindness, compassion and dignity. • The provider had implemented personal plans for people using the service. • The provider had completed medication assessments and created medication plans for people using the service. • Infection Prevention and Control policy and practice had improved since the last inspection. Home First Response Service 5.10 The Home First Response Service, which was launched in November 2022, sees patients who would otherwise potentially spend long periods in hospital, receive a tailored care plan, which can be delivered in a home or community environment. The service is particularly helpful to elderly patients, where treatment at home provides significant benefits – increasing recovery time, preserving mobility and reducing the chance of delirium. Specially trained HSCP staff have been embedded alongside acute frailty teams at the Royal Alexandra Hospital to help limit admissions, improve early discharges and support anticipatory care planning.
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Day Centres and Respite Services 5.11 Day centres and respite services have continued to provide support to those in greatest need. Work is underway to develop day opportunities and explore wider, flexible community-based models which, where appropriate for each person, provide additional choice beyond existing services and support innovative use of our buildings. This work will be captured within the scope of the HSCP’s Sustainable Futures programme from June 2023 onwards. Carers 5.12 As members are aware, a co-produced Unpaid Carers' Strategy 2022-25 was published which reaffirms the value we place on unpaid carers and the contribution they make to the wider community of Renfrewshire. It sets out a commitment to unpaid carers, by prioritising a preventive approach to supporting them and building carer friendly communities across Renfrewshire. Our aim is to help them to remain in their caring roles and to manage their own health and wellbeing alongside their caring responsibilities. 5.13 In support, a Carers Partnership Officer funded by the HSCP has been recruited by Renfrewshire Carers Centre, to help identify carers and promote a wide-reaching awareness and development programme. This links with services, acute and community health partners, the voluntary sector and communities to ensure that unpaid carers can access the support they need. The work resulted in the highest number of completed adult carer support plans and the highest number of new unpaid carers accessing support since the HSCP began recording this data. The HSCP recently agreed a new three-year contract with Renfrewshire Carers Centre to continue this work. Adult Support and Protection (ASP) 5.14 Some people may find it more difficult to keep themselves safe and might need help and support to look after themselves. Renfrewshire Adult Protection Committee (RAPC) continues to oversee the effectiveness of our adult protection practice. During the reporting period, RAPC has been working towards implementing the revisions for the Scottish Government’s revised Code of Practice for ASP. Given the significance of the Code of Practice an action plan has been develop and there will be a phased approach to implementation. To ensure staff are engaged throughout the process, a series of briefings has already begun. 5.15 The Institute for Research and Innovation in Social Services (IRISS) was commissioned by the Scottish Government, to design a minimum data set that works both locally and nationally to generate meaningful and comparable data. Renfrewshire HSCP was identified at an early stage to become a learning partner and help develop the new data set that better reflects the whole ASP journey. The new national minimum dataset has been designed, tested and rolled out across Scotland. 5.16 During Adult Support and Protection Day on 20 February 2023, our local communications reflected the national key message of Seen Something, Say Something. In addition, a spotlight on neglect and self-neglect were issued.
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The RAPC Twitter feed was also used to disseminate this material, to carry the same key messages to members of the public. Alcohol and Drugs Recovery 5.17 Following the Alcohol and Drugs Commission’s final report in December 2020, partners have prioritised a range of actions in response to the key recommendations, as well as establishing a Programme Board to drive the local response, ensuring that all partners work together, join up service developments, and maximise the resources available. Key developments in projects progressed over the year include: • Harm Reduction Response Team (HaRRT) - The Service is delivered through a mobile unit, which has been situated in specific areas in relation to near fatal overdoses and suspected drug deaths postcode data. Launching in early summer 2022, around 153 clients were supported by the service throughout 2022. • MYLA (MyLifeAhead) – This housing-led project offers supports to households in Renfrewshire, whose life is being affected by alcohol/drugs, and builds on the concept that in order to have good health, you need to have a good, settled home. Launching in May 2022, the project is already supporting 26 service users, with referrals coming from a broad range of services/agencies. • FIRST Crisis - This project involves extending the current out of hours crisis support service provided by RAMH to include support in relation to alcohol and drugs. The Service operates between 9am-8pm Monday- Friday and 9-5pm Saturday/Sunday and public holidays, predominantly through telephone support. Launching in April 2022, 171 clients were supported by the service throughout 2022. • Building Based Services - In response to identified issues with the environment at the Back Sneddon Street Service, the HSCP are reviewing accommodation requirements and the findings will used to inform a Property Strategy. The HSCP are also considering expanding the use of space in other buildings across Renfrewshire to support a shift to a more community-based model, for example more clinical space has been agreed for ADRS use in areas such as Johnstone and Renfrew. • Hidden Harm - Independent research was commissioned to better understand the level of hidden harm from alcohol and drugs in Renfrewshire. This was completed by We are With You and the findings from this research have been shared and discussed with partners. • Mental Health Support for Children and Young People - The Youth Health and Wellbeing Service began in mid-September 2022 and provides drop-in facilities for young people who require access to both health and wellbeing support direct from health professionals. A second phase of the approach involves undertaking targeted work in specific schools experiencing very complex needs. • Alcohol Policy - A partnership officer has been recruited to drive policy change across Renfrewshire. Actions over the last year include: continuing to support the Licensing Forum, as well as community councils around their role in the licensing process and for the Licensing Statement Review; and, supporting Council HR colleagues in developing a Workplace Alcohol and
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Substance Policy, as well as supporting a review of similar policies in West College Scotland. • Enhanced Education and Training Across Educational Establishments - The ‘Alcohol and Substance Awareness Education’ pack, including nursery, primary, and secondary resources, has been produced with Renfrewshire Children’s Services, Teachers, Police Scotland, NHS, Renfrewshire HSCP and, most importantly, children, young people, and those who have lived experience of drug and alcohol use. Since its launch in August 2022, the programme has been accessed by over 400 Renfrewshire teachers. • Family Support Review - An independent review of existing family support provision Renfrewshire has been carried out, engaging with local families and frontline staff to assess where possible gaps in provision exist, and making recommendations on how to address these. • Recovery Change Fund - The aim of the Recovery Change Fund is to support the development of local groups and organisations which provide social connection and support recovery in Renfrewshire. • Connected and Caring Renfrewshire – The Scottish Recovery Consortium (SRC), working in partnership with colleagues in CIRCLE, delivered a programme of events and activities throughout 2022 including the 2022 Recovery Walk Scotland, which took place in Paisley on 24 September. The Programme is joint funded by the ADP and the Alcohol and Drugs Change Programme. • Peer Worker Model - The model delivers a core programme of activities and is developing links for future implementation. Current service provision includes activities such as a book group, gardening group, focus group, football, drama etc. The Coordinator and workers played a key role in the Connected and Caring Renfrewshire programme and its development and delivery, including holding a Listening Event. • Stigma/Language Matters – High level themes and initial actions have been identified, including supporting staff to understand the power of language, be confident in their use of language, and to challenge stigma by speaking up when people make negative or wrong comments; and supporting national campaigns to help people in Renfrewshire understand the power and impact of language. A review of the resources required to deliver this project is currently underway, exploring the potential to engage a partner to undertake this work. 5.18 Renfrewshire Alcohol and Drug Partnership (ADP) has key responsibility for implementing the National Policy Framework and driving forward local action to reduce the use of and harm from alcohol and drugs. A summary of the key activities undertaken during the reporting period include: • An enhanced drug death review process was set up, including the formation of a Renfrewshire multiagency Drug Death Review Group which aims to identify trends, risk factors, and recognise areas of focus for prevention. • A multiagency Naloxone Delivery Group has been established with the goal of expanding Naloxone availability throughout Renfrewshire. The distribution of Naloxone continues to target those most at risk of overdose through
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supply by local services including ADRS, CIRCLE, HaRRT, the Overdose Response Team, pharmacies, and needle exchanges. • Drug Death Reflective sessions were held for ADRS staff throughout April 2022. The purpose of these sessions was to learn how ADRS staff can be better supported in the event that someone on their caseload dies. A subsequent report capturing staff insights, and an action plan to drive change was implemented. • The Drug Death Prevention Group continued to drive forward and implement actions identified within the Preventing Drug Deaths in Renfrewshire Action Plan. This has been updated following a development session with group members, facilitated by Scottish Drugs Forum, as well as the recommendations and strategies including the Drug Death Task Force Final Report. • The Renfrewshire Lived Experience Forum held its first meeting in December 2022 and continues to meet on a monthly basis. Members of the community with lived and living experience of alcohol and drug use, for either themselves or a family member, are invited to learn more about how they have the ability to influence change in Renfrewshire. The purpose of the group is to give members the opportunity to share their views and experiences to help inform the work of the ADP and in turn improve services. • A Family Support Recovery Worker was recruited, in partnership with Barnardo’s. Their role will has been to establish a network of support for people in Renfrewshire who are impacted by a loved one’s drug or alcohol use. 6. National Care Service 6.1 The National Care Service (Scotland) Bill was introduced by the Scottish Government in June 2022 with the intention of reforming how social care, social work and community health services are delivered in Scotland. It has been described by the Scottish Government as the most significant reform to public services since the creation of the NHS. 6.2 The proposal to create a National Care Service was based on the recommendations made by the Independent Review of Adult Social Care, led by Derek Feeley. One of the recommendations called for increased national oversight of adult social care in response to challenges that were highlighted during the coronavirus pandemic. The Scottish Government’s intention is to ‘co- design’ these details alongside people who use and work in social care. 6.3 On 7 June 2023, the Scottish Parliament agreed a further delay to Stage 1 scrutiny of the NCS Bill, which will now be completed by 31 January 2024. 6.4 Following this, on 12 July 2023, the Scottish Government announced that an initial agreement has been reached with local government and the NHS regarding the accountability arrangements for the NCS. The agreement aims to establish responsibility for people’s care once the NCS is established. A summary of the key points from the agreement include: • Overall legal accountability will be shared between Scottish Government, the NHS and local government;
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• Staff will continue to be employed by local authorities, and councils will still be responsible for assets like buildings and the delivery of services; and • New governance arrangements will be introduced to ensure consistently high levels of service across the country, while building the flexibility to meet varying community needs at a local level. 6.5 The detail of how this will work at a local level will be developed in the coming months and this will help inform what the implications will be for Renfrewshire. The recent steps to involve local government more fully in the development is welcomed as is the clarity around staff, assets and service delivery. 7. Adult Social Work Performance Overview 7.1 Adult Social Work Services are managed and monitored via regular internal HSCP professional governance and operational management arrangements, including meetings, case management, and regular service and case reviews. These meetings involving Heads of Service and Service Managers cover a variety of local and national strategic and operational indicators. They allow Managers to scrutinise and discuss performance data, agree remedial action, timescales for improvement, and consider future challenges which may affect services, to allow planned actions and mitigation where appropriate. 7.2 In addition to internal scrutiny, performance is reported at all IJB meetings, with the scorecard presented twice-yearly. The report charts data for the last three years and, where possible, associated targets, the ‘performance direction of travel’ and whether the indicator is currently on track to meet target. The reports provide a detailed picture of what is working well, current challenges and intended remedial action where necessary. 7.3 The scorecard includes adult social care indicators alongside a variety of both local and national health service indicators. The suite of adult social care indicators is currently being reviewed and on completion, a revised 2024/25 scorecard for this Board will be developed and submitted for approval. 7.4 There are 19 adult social care indicators, details of the performance are provided in Appendix 1, however a summary is included in the table below. Performance Indicator Status No. Target achieved 2 Warning 1 Alert 1 Data only 15 7.5 The rate of sickness absence for HSCP adult social work staff remains as a red alert. Addressing absence management and supporting employees to return to work is a key priority for the HSCP Senior Management Team. In collaboration with the Council’s HR and Organisational Development, a streamlined process for absence management is being rolled out using the Business World system and additional supporting attendance training is being provided to managers. In
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addition, health improvement activities and support through Healthy Working Lives is also ongoing to help raise employee awareness of health issues. 8. Next Steps 8.1 The next performance report on delegated Adult Social Care functions will be reported to the Leadership Board on 21 February 2024. ___________________________________________________________________ Implications of the Report 1. Financial – Although there are no direct costs associated with this report, the IJB is operating in an increasingly challenging environment with increases in both the level of demand and service delivery costs. The Sustainable Futures Programme has been established and will aim to deliver best value by modernising services as well as identifying savings to reduce the financial gap in a sustainable way and where feasible with the least possible impact. 2. HR & Organisational Development – Published in November 2022, Renfrewshire IJB’s Workforce Plan 2022-25 aims to ensure the Partnership has a workforce fit for purpose and enabled to deliver the current and future needs of those who rely on our services. 3. Community/Council Planning – none 4. Legal – none. 5. Property/Assets – none 6. Information Technology – none 7. Equality & Human Rights The Recommendations contained within this report have been assessed in relation to their impact on equalities and human rights. No negative impacts on equality groups or potential for infringement of individuals’ human rights have been identified arising from the recommendations contained in the report because it is for noting only. If required following implementation, the actual impact of the recommendations and the mitigating actions will be reviewed and monitored, and the results of the assessment will be published on the Council’s website. 8. Health & Safety – none 9. Procurement – none 10. Risk – none 11. Privacy Impact – none 12. Cosla Policy Position – none. 13. Climate Risk – The HSCP is committed to tackling the climate emergency and actively participates in Renfrewshire’s Plan for Net Zero.
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_________________________________________________________ List of Background Papers None ___________________________________________________________________ Authors: Yvonne Farquhar, Service Planning and Policy Development Manager, Chief Executive’s Service yvonne.farquhar@renfrewshire.gov.uk
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Appendix 1 Performance Indicators The 19 adult social care services’ indicators are as follows: Performance Indicator Status No. Target achieved 2 Warning (less than 10% variance of target) 1 Alert (more than 10% variance of target) 1 Data only 15 Status Direction of Travel Performance Indicator 19/20 Value 20/21 Value 21/22 Value 22/23 Value Target Percentage of clients accessing out of hours home care services (65+) 90% 90% 90% 92% 85% Average number of clients on the Occupational Therapy waiting list 315 159 143 226 350 Percentage of long-term care clients receiving intensive home care 27% 29% 29% 28% 30% Sickness absence rate for HSCP Adult Social Work staff (work days lost per FTE) 18.08 13.50 17.79 21.86 15.3 days Explanation for red status: Addressing absence management and supporting employees to return to work is a key priority for the HSCP Senior Management Team. In collaboration with the Council’s HR and Organisational Development, a streamlined process for absence management is being rolled out using the Business World system and additional supporting attendance training will be provided to managers. In addition, health improvement activities and support through Healthy Working Lives is also ongoing to help raise employee awareness of health issues. Direction of Travel Improvement Deterioration Same as previous reporting period
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Data Only Indicators Performance Indicator 19/20 Value 20/21 Value 21/22 Value 22/23 Value Homecare hours provided - rate per 1,000 population aged 65+ 414 390 411 444 Percentage of homecare clients aged 65+ receiving personal care 99% 99% 99% 99% Population of clients receiving telecare (75+) - Rate per 1,000 (2022/23 includes all telecare, previous years included enhanced alarms only) 50 46 58 140 Percentage of routine OT referrals allocated within 9 weeks 42% 41% 68% 92% Number of adult carer support plans completed for carers (age 18+) (Renfrewshire Carers Centre only, does not include the number for HSCP) 162 86 148 203 Number of adult carer support plans declined by carers (age 18+) (Renfrewshire Carers Centre only, does not include the number for HSCP) 34 51 36 223 Number of young carers' statements completed 68 49 27 49 Number of Adult Protection contacts (including AWC) received 3,106 3,487 4,263 4,123 Total Mental Health Officer service activity 683 627 1,222 1,362 Number of Chief Social Worker Guardianships (as at position) 110 115 125 132 Percentage of children registered in this period who have previously been on the Child Protection Register 11% 29% 30.4% 9.52% No. of SW employees, in the MTIPD process, with a completed IDP 909 1,000 People, Performance and Talent Policy is currently being reviewed and a new indicator will be developed.
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Local Government Benchmarking Framework Performance Indicator 19/20 Value 20/21 Value 21/22 Value 22/23 Value Care at Home costs per hour (65 and over) £26.40 £23.05 £25.67 Information from LGBF - available 2024 Direct payment spend on adults 18+ as a % of total social work spend on adults 18+ 5.88% 4.05% 4.8% Information from LGBF - available 2024 Net residential costs per week for older persons (over 65) £298 £277 £633 Information from LGBF - available 2024