Adult Social Care 6 Monthly Update
Renfrewshire Council · 18 September 2024
Back to Leadership Board — 18 September 2024 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: 18 September 2024 ___________________________________________________________________ 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 Management Report 2023/24 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; • Note that the next six-monthly update report will be presented to the Leadership Board in February 2025. _________________________________________________________ 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: • Social work services for adults and older people;
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• 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), 6 monthly updates are also provided 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 4.1 Renfrewshire IJB’s Annual Performance Report 2023-24 provides a comprehensive reflection on the HSCP’s performance against local and national performance indicators. A summary of the 2023/24 year-end status of the IJB’s full 48 performance indicators is provided in the table below. Performance Indicator Status 2023/24 Target achieved 12 Warning (less than 10% variance of target) 9 Alert (more than 10% variance of target) 7 Data only (no target) 20 4.2 Of the seven indicators that are red alerts, two relate to adult services – • Sickness absence rate for HSCP Adult Social Work staff (work-days lost per FTE – this remains a challenge and work continues across the Partnership and is monitored regularly by the Senior Management Team. Ongoing activities to address current absence rates include HR support and training; the
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identification of areas requiring additional support and guidance; and the establishment of the new Staff Health and Wellbeing Group. • Number of new Adult Carers supported by Renfrewshire Carers Centre - while the number of new adult carers supported has decreased this year, it is still a significant increase on the 3-year average pre-pandemic. Work continues to identify new carers with a programme of awareness sessions and workshops ongoing, including training for individuals who would like to become Carer Community Champions. A significant improvement in the uptake of adult carer support plans also suggests support is being strengthened. 4.3 Following the IJB’s agreement in September 2023 to make changes to the performance scorecard, a corresponding revised scorecard was also approved by Leadership Board in February 2024, ensuring that social care indicators were more reflective of the breadth of activity across the Partnership. 5. Adult Social Work Performance Overview 5.1 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. 5.2 In addition to internal scrutiny, performance is reported at all IJB meetings, with the Scorecard presented twice-yearly providing a detailed picture of what is working well, current challenges and intended remedial action where necessary. 5.3 The Scorecard includes adult social care indicators alongside a variety of both local and national health service indicators. As detailed in Section 4, the suite of adult social care indicators has been reviewed and the revised Scorecard for this Board was approved in February 2024. 5.4 There are now 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 1 Warning (less than 10% variance of target) 0 Alert (more than 10% variance of target) 1 Data only (no target) 17
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6. Key Activities 6.1 A summary of the key activities undertaken during the last six months related to the delegated services is detailed in the section below. Winter Pressures 6.2 As previously reported to Leadership Board, each year, Renfrewshire HSCP develops plans to ensure the resilience of critical services over the winter period. The planning process for winter 2023/24 was undertaken across all HSCP internal and hosted services and, looking forward, the same is being undertaken for 2024/25. This also feeds into the national approach, where a Winter Plan for Health and Social Care services is again being developed. 6.3 The HSCP will submit its winter plan for 2024/25 to the IJB at its next meeting (the IJB will consider a proposal to move its November meeting to 13 December 2024). The key priorities for this year’s plan will be reviewed but are anticipated to include those priorities identified for last winter: • Vaccination programmes - protecting our staff and the public by delivering the required seasonal vaccination programmes; Flu and COVID Booster as set out by national guidelines. • Operational resilience - embedding our frameworks, policies and plans to support service resilience and the prioritisation of emergency and critical services, whilst maintaining the delivery of other essential services. This includes a continued focus on the HSCP’s ‘Data Resilience’ plans. • Surveillance and response - surveying our environment and stay abreast of how our services are performing for our service users, taking note of any lessons learned and amending our policy and practice as required to sustain service levels. • Supporting the public - continuing to access required services, addressing their critical and essential needs and supporting residents to remain safe and well. • Supporting our partner organisations – taking steps to prepare for winter and collaborate on necessary solutions for the benefit of residents. • Enabling and optimising existing infrastructure - delivering, championing, and optimising the use of appropriate infrastructure across the Partnership, with our partners, to underpin the successful delivery of our plans. • Festive period planning - adequately understanding the needs of services during the festive period and planning appropriately to maintain and manage service levels and any potential disruption. • Workforce planning / staffing - ensuring we deliver the right balance of annual leave and staffing across services to maintain service levels throughout the winter period. Ensuring we support the health and wellbeing of colleagues so they remain well and are able to undertake their roles during potentially challenging winter conditions. Delayed discharge 6.4 Aligned to the local and national work on developing a Winter Plan, there continues to be a strong focus on delayed discharge, with the Scottish Government highlighting this as a key priority and local and national government working together on a ‘Joint Mission’ to reduce delayed discharge.
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6.5 Renfrewshire was the highest performing HSCP in Scotland in respect to ‘standard’ delayed discharge for the financial year April 2023 to March 2024, for the second year running. In the period April to June 2024, the HSCP has remained the highest performing HSCP for standard delays and the fifth highest performing HSCP for ‘Code 9’ delays, an improvement on 9th position in 2023/24. Examples of Code 9 delays include Adults with Incapacity (AWI) undergoing a Guardianship process; patients delayed awaiting availability of a place in a specialist facility where no facilities exist, and an interim move would be inappropriate; patients delayed due to infection control measures; and other patients for whom an interim move is not possible or reasonable. Despite this sustained performance, delayed discharge and participation in the national Collaborative Response and Assurance Group remains a priority for the HSCP. National Care Service 6.6 The Scottish Government continue to progress required legislation to facilitate the creation of a National Care Service (NCS). Since the previous update to Leadership Board, the NCS Bill has moved to stage 2 and a range of amendments were accepted at stage 1 which have resulted in some issues being raised within local government (noted below). 6.7 Currently the Bill is open to a Call for Views, with a separate paper on this Board’s agenda outlining a proposed Council response to this. 6.8 On behalf of all local authorities, COSLA continues to lobby around the NCS, particularly on issues of shared accountability, the position of children’s and justice social work and the wider delegation of local authorities’ services and functions. Engagement with the Scottish Government continues at a national level and through the professional bodies of which many Renfrewshire Council and HSCP officers are members. Sustainable Futures Programme 6.9 As previously reported to Leadership Board, the Sustainable Futures Programme (SFP) aims to identify and develop options, subject to the IJB’s agreement, to address the financial challenges facing the IJB. For 2024/25 the estimated net funding gap was £10.7m. This is a recurring gap which will be mitigated this year through a range of measures including the use of reserves, planned/assumed savings, and a temporary reduction in employer pensions contribution due to higher-than-expected returns on investment by Strathclyde Pension Fund. 6.10 A full update on the SFP was reported to the IJB in June, noting that £2.769m savings have been approved from overall proposals of £3.399m considered. 6.11 Other areas which may deliver savings or increase income have been identified for further exploration and include – the review of the non-residential charging policy; review of soft facilities management arrangements; and the eligibility criteria and assessment and support planning processes. 6.12 Key risks and challenges for the programme have also been identified and continue to be monitored and mitigated where possible. These include but are not limited to – the risk of not agreeing the required savings; impact of external factors on activities and timescales; ongoing capacity constraints across the
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workforce; and balancing statutory provision alongside equalities considerations. 6.13 The programme continues and at its September meeting the IJB will consider proposals for progressing the programme through the remainder of the financial year. This will consider the approach to identifying and engaging upon further savings proposals to address the estimated recurring funding gap of circa £22.9m in 2025/26. Utilising remaining earmarked and general reserves, alongside an additional year of reduced employer pensions contribution, there is a projected remaining funding gap of £11.8m for 2025/26 for which additional mitigating measures must be identified. HSCP Strategic Plan 6.14 Renfrewshire’s IJB has a statutory requirement to produce a Strategic Plan on how the delegated community health and social care functions are planned and delivered. The IJB’s current plan, for 2022-25, was approved in March 2022. 6.15 At the June meeting, the IJB agreed that the current Strategic Plan would be reviewed at this point and extended for two years to summer 2027. This view was taken given the current strategic direction was evidence-based and remains relevant, it also allows organisational capacity to focus on delivering the Sustainable Futures Programme as outlined above, alongside continued changing national policy context including the development of the National Care Service agenda. 6.16 The review will include any revisions to the strategic objectives and analysis of the census data and Renfrewshire’s Health and Wellbeing Survey. Consultation and engagement with key stakeholders will also be undertaken. Drug related deaths 6.17 On 20 August, the National Records of Scotland (NRS) published their ‘Drug Related Deaths in Scotland’ report for 2023. Sadly, in Renfrewshire, there were 44 drug-related deaths in 2023. This is an increase from 39 in 2022. Renfrewshire had the seventh highest rate of deaths per 100,000 population (2019-2023) at 27.5 and above the Scottish average of 23.6. This is similar to the previous 5-year rate where Renfrewshire had also had the seventh highest rate of deaths at 28.9. 6.18 In terms of the type of drug, analysis at the NHS Greater Glasgow and Clyde level showed that opiates or opioids continued to be present in 82% of drug related deaths, with heroin/morphine implicated in 33%. Buprenorphine was implicated in 7% of all cases. Codeine (4%) and Dihydrocodeine (9%) were implicated to a much lesser degree. Methadone was implicated in 46% of all deaths, this is consistent with 45% in 2022. The incidence of Cocaine deaths in 2023 has increased by 12% (29% in 2022 versus 41% in 2023). They are now found in two of every five deaths and are at the highest levels found in the last 5 years. There were small or no changes in the incidence of deaths involving Ecstasy (2%), Amphetamine (3%) or those involving Alcohol (8%). In addition, deaths where an underlying health condition is also implied have also increased in 2023 meaning 2 in every 5 deaths has one present (44.2%). 6.19 In terms of demographics, analysis at the NHS Greater Glasgow and Clyde level showed that while male deaths continue to outnumber female deaths 2:1,
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in 2023 there was an overall increase in deaths but in contrast to 2022, there was a marked difference between the sexes (23.4 in males; 7.4 in females) indicating that much of the increase in 2023 has been in male deaths. In 2023, the most common age range when someone died was aged 45-54, and the median was 46. As in previous years the majority of those who died lived in the poorest communities within the Health Board areas (68.6%; SIMD Quintile 1) with just under one-third (32.3%) living in the 5% poorest communities. 6.20 Renfrewshire Alcohol and Drug Partnership (ADP) has continued to work to address the National Drug Related Death crisis through a range of action plans aligned to the Drug Death Taskforce and Scottish Government Drug Mission Action Plan. This will assist the ADP in ensuring a whole systems approach is progressed in Renfrewshire with the key aim of reducing the number of drug related deaths. 6.21 To gain a clear understanding of the needs and challenges experienced within Renfrewshire the ADP has recently commissioned a comprehensive needs assessment. The needs assessment will aim to provide a detailed analysis of current and future needs in both children and adults to inform the ADP’s commissioning intentions and to refresh priorities within an updated Strategic Plan for the Alcohol and Drug Partnership. 6.22 Operationally, Renfrewshire’s Alcohol and Drug Recovery Services consistently meet the national waiting times target ensuring timeous access to treatment and care and are currently sitting at 98.6% (Jan – March 2024). Renfrewshire’s Alcohol and Drugs Change Programme 6.23 The delivery of Renfrewshire’s Alcohol and Drugs Change Programme continues to progress, and is now in its final stages, with a number of projects now concluded, and others being mainstreamed within existing services. A number of projects continue to be delivered, including the My Life Ahead (MyLA) project, which supports people to sustain settled housing, and the Safeguarding Vulnerable Young People project, which provides additional pastoral support for a group of young people in a local school. New, interactive Stigma Awareness training resources have been developed by ‘I Am Me’ this year, aiming to improve the understanding, awareness, and confidence of the workforce in relation to stigmatising language around alcohol and drugs, and the impact of stigma on individuals and communities. The resources are currently being finalised, with communications and development plans being prepared. Adult Support and Protection (ASP) 6.24 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. 6.25 The volume of adult protection work in Renfrewshire continues to increase, and in 2023/24 we received 1,527 adult protection referrals, in comparison to 1,314 for 2022/23. There were 92 Adult Support and Protection (ASP) Investigations completed during the period 2023/24, compared to previous end of year reporting of 98 during 2022/23.
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6.26 The location of the principal harm, which resulted in an investigation taking place, remains the adult’s own home, with 626 investigations having been conducted. Physical harm remains the well-established primary type of harm reported. Worthy of note that psychological, self-harm and financial harm all have significant numbers confirming the range of issues. Analysis has shown that physical, psychological, and financial harm invariably involve close relatives, friends, and carers. Although all client groups are at risk of harm, those at a higher risk are individuals with dementia, poor mental health and those with a learning disability. 6.27 In 2023/24 RAPC continued to implemented the revisions for the Scottish Government’s revised Code of Practice for ASP including: • More detail about the three-point criteria • Clarification on capacity and consent • Emphasis on the duty to refer and co-operate in inquiries • Clarification regarding information sharing expectations • Clarification of relationship - inquiries and investigations • New sections on referrals and related matters • Further detail and clarification on visits and interviews • New chapter on assessing and managing risk including case reviews and large scale investigations • New section on chronologies Renfrewshire continues to be represented at four national implementation subgroups: chronologies; self evaluation; advocacy, voice of the service user/carer, trauma informed approach; and inquiry, investigative powers, role of the council officer. As part of the phased approach to implementation, a series of briefings have been rolled out to staff. International Recruitment Pilot: Care At Home 6.28 The HSCP and Renfrewshire Council have been participating together in a Scottish Government and NHS Education for Scotland-led Adult Social Care International Recruitment Programme Pilot, a grant funded project which has been ongoing since Autumn 2023. The aim of the project is to test approaches which can help address the recruitment challenges facing Adult Social Care nationally and Renfrewshire’s pilot models a process for recruiting to posts directly from overseas, where shortages in the resident UK labour market are impacting on our ability to recruit to these vacant posts. 6.29 Four people have been permanently recruited to Renfrewshire’s Care at Home service and have been settling into their new surroundings while undertaking induction and onboarding. A buddy scheme with additional support provided via local community support networks has also been put in place, alongside pastoral support to minimise the impact of social isolation and the psychological impact of migration.
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Adult Support and Protection: Planned Inspection 6.30 Adult Support and Protection arrangements were subject to a joint inspection in March 2020, however due to the Covid-19 pandemic, the full inspection was unable to be completed at that time. An action plan reflecting findings was developed and agreed with the inspection team, but a full inspection report was not completed. 6.31 Reflecting this context, the HSCP has been progressing discussions with the joint inspection team regarding the options and approach for a follow up to the incomplete inspection. This is expected to commence in January 2025 and will not be a full inspection but will include a review of progress made in the Renfrewshire partnership area since 2020, alongside a survey of local staff. 6.32. Multi-agency preparation has begun across the HSCP and with wider partners to progress key actions necessary in preparation for the inspection activity. Review of Social Work Governance and Assurance 6.33 In July, the Care Inspectorate launched a national review of social work governance and assurance within Scotland and the HSCP is actively participating in the review. The purpose of the review is to add to the understanding of the role, remit, effectiveness, and the current challenges facing social work services. The aim is to gain a national overview of approaches to ensuring governance and assurance arrangements are in place to provide public assurance that social work duties are being appropriately discharged. 6.34 This review will also explore how staff are supported to conduct their roles and identify concerns to be addressed. The review will also consider the extent to which social work leaders meaningfully influence decision making and have strategic oversight of significant risk relating to key areas of legislative responsibility. The review will span the full range of social work, including adults, children, and justice. 6.35. Although the scope of the review has been designed to be relative to the current pressures being experienced by the sector, it will have an impact on those leading and working across social work services at a time of increased demand and pressures across our services. The review will conclude in December 2024. A national report will be published on 17 March 2025 and a local staff survey report provided to each area after publication. 7. Next Steps 7.1 The next performance report on delegated Adult Social Care functions will be reported to the Leadership Board in February 2025. ___________________________________________________________________ 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
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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 – The Sustainable Futures Programme is currently underway and could potentially have an impact following its conclusion. Section 6 includes an update on the international recruitment pilot. 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. Children’s Rights – while the content of this update predominantly focuses on adult services, the scorecard includes one indicator in relation to children. 14. Climate Risk – The HSCP is committed to tackling the climate emergency and actively participates in Renfrewshire’s Plan for Net Zero. _________________________________________________________ List of Background Papers Adult Social Care: 6 Monthly Update, Leadership Board, February 2024 ___________________________________________________________________ Author: Pauline Moss, Strategy, Policy and Insight Manager Pauline.moss@renfrewshire.gov.uk
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Appendix 1 Performance Indicators The 19 adult social care services’ indicators in the updated scorecard are as follows: Performance Indicator Status No. Target achieved 1 Warning (less than 10% variance of target) 0 Alert (more than 10% variance of target) 1 N/A Not applicable require year end figure 0 Data only 17 Status Direction of Travel Performance Indicator 20/21 Value 21/22 Value 22/23 Value 23/24 Value Target Sickness absence rate for HSCP Adult Social Work staff (work days lost per FTE) 13.50 17.79 21.94 19.51 15.3 Explanation for red status: Sickness absence remains challenging for the Partnership. There has been a slight improvement in performance compared with last year but performance remains well above target. Ongoing activities to address absence include HR support and training; identification of areas requiring additional support and guidance; and Staff Health and Wellbeing Group established, promoting health improvement activities and support. Number of adult support plans completed for carers (age 18+) (Renfrewshire Carers Centre) 86 148 203 376 242 Direction of Travel Improvement Deterioration Same as previous reporting period
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Data Only Indicators Performance Indicator 20/21 Value 21/22 Value 22/23 Value 23/24 Value Number of adult support plans completed with carers by the HSCP (age 18+) From 2021/22 onwards 40 25 192 Total Mental Health Officer service activity 627 1,222 1,362 1,499 Number of Chief Social Worker Guardianships (as at position) 115 125 132 124 Number of Private Guardianship Applications Only 2022/23 onwards 158 126 Population of clients receiving Telecare (75+) - Rate per 1,000 Only 2022/23 onwards 61 40 Population of clients receiving Telecare (all ages) Rate per 1,000 Only 2022/23 onwards 4.2 4.8 Number of people accessing Community Alarms (all ages) Only 2022/23 onwards 2,791 3,767 Number of people accessing Community Alarms (75+) Only 2022/23 onwards 2,121 2,827 Balance of Care: Home Care - Total number of open community placements versus open residential placements for 65+ Only 2022/23 onwards 1,554 (61.5%) 1,786 (64%) Balance of Care: Home Care - total number of hours per week provided for clients receiving personal care versus non-personal care Only 2022/23 onwards PC: 14,699 NPC: 318 PC: 18,521 NPC: 375.5
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Performance Indicator 20/21 Value 21/22 Value 22/23 Value 23/24 Value Percentage of Adult Support and Protection referrals where investigatory powers are used From 2023/24 only 43% Number of Adult Protection contacts (including AWC) received 3,487 4,263 4,123 4,078 Percentage of Children registered in this period who have previously been on the Child Protection Register in the last two years From 2022/23 onwards 4.8% 11.1% Number of Adult Support and Protection referrals (please see source below for 2023/24) From 2021/22 onwards 1,068 1,314 1,527 Mental Welfare Commission for Scotland Reported by source from 2023/24 onwards 0 Care Inspectorate 32 Healthcare Improvement Scotland 0 Office of the Public Guardian 6 Police Scotland 294 NHS 24 24 NHS Primary Care 44 NHS Acute Services 72 NHS Specialist Drug and Alcohol Services 2 Community Health Services 11
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Performance Indicator 20/21 Value 21/22 Value 22/23 Value 23/24 Value Mental Health Services – Hospital and Community Reported by source from 2023/24 onwards 49 Other Health (Public, Private and Prison) 5 Social Work Adults (inc Mental Health Officers) 143 Social Work Children and Families 12 Scottish Ambulance Service 8 Scottish Fire and Rescue 72 Scottish Prison Service 0 Care Home 370 Care at Home Provider 183 Housing 120 Education 1 Other Child Protection Service 0 Self (Adult at Risk) 6 Unpaid Carer 1 Friend, Relative, Neighbour (not an unpaid carer) 21 Other Member of the Public 1 Third Sector Organisation 17
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Performance Indicator 20/21 Value 21/22 Value 22/23 Value 23/24 Value Financial Institution Reported by source from 2023/24 onwards 0 Anonymous 2 Other 31 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) £27.32 £ 28.04 £ 27.38 £28.70 Direct payment spend on adults 18+ as a % of total social work spend on adults 18+ 4.1% 4.5% 4.8% 4.7% Net residential costs per week for older persons (over 65) £392 £494 £502 £526