East Sussex funding gap: Have your say on the Mental Health Community Outreach Service

Our funding gap

East Sussex County Council (the Council) has a net budget of £538.1 million for the year from April 2024 to March 2025. Our net budget is the money we have to spend which is financed by business rates, council tax receipts and the revenue support grant we get from the national government.

We expect our net budget for next year to be a similar amount. This means that we are facing a financial gap of £55 million for 2025/26. The financial gap is the difference between the funding available and the cost of keeping services at their present level.

Most local authorities are facing similar pressures. We face this gap even though we are a well-run and efficient council which has saved £140 million since 2010 and found new ways to work effectively through difficult times. Unfortunately, the cost pressures we face now are so great that efficiency alone is not enough and the limited reserves of money we have available would not be enough to meet the financial gap. Most importantly, reserves can only be spent once and could not repeatedly fill the financial gap which councils face every year. It is also not possible to close the whole gap by raising council tax as the increase that would be required is beyond the limit set by national Government.

We are legally obliged to close the financial gap and balance our budget. This means that some tough decisions will have to be made and reduced services are possible in all areas. When making these decisions, our priority will be to maintain protection and support, wherever possible, for the most vulnerable people in our community.

There is more information about why we have to make savings and what we are doing to highlight the issues local authorities face with the national Government on our website at https://www.eastsussex.gov.uk/your-council/finance/east-sussex-our-funding-gap.

Social care support

Adult Social Care and Health is a department of East Sussex County Council. We work with people aged 18 and over who live in East Sussex. We help people live healthy and independent lives, whatever that may look like for them. We look at people's strengths, capabilities, support network, community and difficulties and work with them to find solutions.

The Council has a legal duty to provide social care support to those who are eligible. About three quarters of the East Sussex budget goes on providing social care for children and adults, with adult social care accounting for nearly half of the budget (48%). Care and support for adults is not free and we charge for most of our services. The amount people pay depends on their financial situation, but most people have to pay something towards their care, with the remaining costs paid by the Council.

Nationally, social care is under pressure due to a combination of demographic, financial, and systemic factors. East Sussex is no stranger to this, facing unique challenges which impact on the need for support and services in the county. Around 25% of the East Sussex population is over 65 compared to a national figure of 18%, average wages remain lower than the national average and 30,000 people in the county are living in some of the most deprived areas of England. We have also seen a 40% increase in the average weekly cost of providing care in East Sussex since 2020.

As people live longer, they may require care and support for longer, and their care and support needs are likely to become more complex over time. There is also evidence that the cost of living challenges have increased demand for care, as well as making people less able to afford their contribution towards the cost of care.

As social care is such a large part of the Council’s budget, we will need to make savings to services in this area too. Reduced services are likely, and we will need to review staff numbers, but the amount we need to save can’t be achieved through reducing the workforce alone.

Developing the savings proposals

Given the financial gap we are facing, we know it is impossible to avoid some of our residents being negatively affected by the difficult decisions that we need to make. We have tried our best to identify proposed savings that would have the least possible impact on people’s care and wellbeing.

We know too that many of our external partners in the NHS, local authorities, providers and the voluntary, community and social enterprise sector (VCSE) are experiencing their own pressures in terms of demand for services and funding challenges. Where we can, we’ve tried to take that into account in looking for savings.

Our priority in Adult Social Care and Health is to meet our legal duties under the Care Act. To help us to do this, we have identified funding areas that we think need to be protected when we are looking at savings options.

The priority funding areas are:

• Community care budget: This budget covers the cost of care that is provided to adults who are eligible for social care support because of a disability or health condition. This budget is already under pressure because more people need our help, the cost of providing care is increasing, and our residents are increasingly struggling to pay their contribution towards the cost of care.

• Carers: As well as protecting the budget for community care which funds support for people who are eligible for social care support, we have tried to protect the direct support we provide to unpaid carers who are looking after their family members and friends. This is because carers play an invaluable role in meeting care and support needs for so many residents and reduce the amount of support residents need from other services.

• Voluntary and community enterprise sector (VCSE): These organisations make a huge contribution to preventing, reducing and delaying the need for care and support from the community care budget. For this reason, we want to protect the funding that we provide to support this sector as far as possible, particularly where we can demonstrate that services are supporting our statutory duties and other priority funding areas.

• Frontline workers: We need to ensure we have enough social work staff and occupational therapy workers to carry out assessments and put care and support in place. We also need to retain enough financial assessment staff to ensure we are funding those who are most in need and that people pay the correct contribution.

• Care market: We need to ensure we retain enough staff so that we can support the care market and ensure we have a good supply of services that deliver the best value.

How the service works now

The Mental Health Community Outreach Service is run by the Council. It is a short-term service, operating seven days a week. It offers support for up to four weeks to a maximum of 15 people at any one time. The service has seven members of staff, who are employed by the Council.

People are typically referred to the service by the Council’s Health and Social Care Connect contact centre, or by health professionals such as GPs and community nurses. They can also be referred to the service by other adult social care teams.

The service offers therapeutic interventions, such as assessment and support planning, to people with mental health needs living in the community. This includes older people with depression and/or anxiety, mild cognitive impairment, and dementia.

The staff carry out home visits to people, where they carry out assessments on topics like mobility, equipment, mental health and wellbeing. Through support planning, they then help people to identify ways of completing everyday tasks that they may be finding

challenging due to their mental health needs. The service also provides support and advice for carers.

The aim of the service is to:

• promote faster recovery from illness,
• support people to get home from hospital,
• prevent unnecessary hospital or care home admissions,
• maximise independent living at home,
• provide support for carers and allow them to continue in their caring role,
• identify any care and support needs the client has through a range of assessments, and
• support people to access and engage with other community support and activities.

The service supported 118 people between April 2023 and March 2024.

What we are proposing to change

We are proposing to stop providing the Mental Health Community Outreach Service. As the service is a short-term one, people already using it wouldn’t be affected by the change. If the proposal was agreed, we would stop accepting new referrals from February and the service would cease from April 2025.

There would still be support available to this group of people, but it would be provided by other Adult Social Care teams instead. As an alternative, people would be able to access other services such as occupational therapy, community mental health teams, the carer’s breaks team, and the mental health bedded service at Milton Grange in Eastbourne.

Why we are proposing this saving

While we recognise the importance of this service, the budget pressures we face mean that we have to make difficult decisions about how we spend our money. The support provided by the outreach service is available from other teams and it is therefore hard to justify providing this additional home-based service.

How people and organisations would be affected

People who are already using this service would not be affected by the proposal. Those who need the sort of support it offers in future would need to access our universal services.

The outreach service is able to see most people referred to it within a week. The alternative services people would need to access if it stopped are unlikely to be able to see people so quickly.

This would mean people face longer waits for support. It may also mean that they have to get the information and advice they need from multiple services, instead of one person. These other services may not have the same specialist knowledge as the outreach service. All of this may affect clients’ and carers’ experiences of accessing support.

One of the aims of the service is to help get people home from hospital and prevent unnecessary admissions to the hospital. Stopping providing this service could mean that more people with mental health needs stay in hospital longer than needed. It could also result in some additional admissions to hospital, although it is hard to determine the likelihood of this at this stage.