living within our means – adult social care john bolton interim executive director

LIVING WITHIN OUR MEANS – ADULT SOCIAL CARE

John BoltonInterim Executive Director

www.walsall.gov.uk

The financial crisis in Walsall Adult Social Care

• We are currently overspending about £4.9 million – and the amount is going up......

• We have to find a further £7 million savings for next year

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www.walsall.gov.uk

The diagnosis

• We have too many people in unfunded posts or things we are doing without proper budget provision

• We have allowed the Dom Care market prices to rise excessively this year - £2.5 million

• We have savings we have not delivered in both mental health and learning disabilities

• We are giving excessive packages of care to some people – long term packages don’t appear to promote independence – the assessment culture

www.walsall.gov.uk

The Solution – for us

• Get the operational model to work– Ensure people get the right help at point of referral –

not rush them into the system– Get the reablement service up to establishment and

delivering 75% of people not needing more care– Get reablement to take more risky cases from hospital– Only use intermediate care beds – get therapies and

social work to support move on– When older people are ill they will probably get better

www.walsall.gov.uk

Continue to find purposeful interventions that promote independence

• In mental health services – recovery model – reduce use of respite and crisis beds

• In learning disability stronger focus on promoting independence – some new ideas

• In Older People with dementia – better evidence base about what works and a more developed care pathway

www.walsall.gov.uk

Some rules

• No manager has any authority to spend money not in their budget – managers must ensure we still meet our employment responsibilities

• Don’t use temporary beds to make an easy solution

• We are exploring high cost packages of care• We are exploring more ways to help people be

creative – what happened to Personal Budgets and new solutions?

• We need a better trained workforce to get this right

www.walsall.gov.uk

Wider engagement with partners

• With whom should we build stronger links?– Neighbourhoods– Voluntary Sector– Health Services– Housing Services

– DISCUSS

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Remember

• We spend about:• £11 million on prevention• £8 million on assessment and care

management staff and support• £10 million on in-house services• £55 million on procured/commissioned

services• From where should we take money?

www.walsall.gov.uk

What are your solutions?

• If you are going to be a manager in adult social care for the next 5 + years these are the issues you will face every day of every year! If you don’t want to or cant do it ……..

• How do you suggest we reduce our £4 million overspend in this year?

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AND NEXT YEAR…..

• Reduced staffing• Reduced budgets• No apprentices, quality team, • New legislation• Challenge of health integration?

• Questions on this?

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What will/should our operating model deliver?

Reduce demand for residential care (older people) by £1/2 million

Reduce demand for domiciliary care (older people) by £1/2 million through reablement

Reduce domiciliary care through introducing time-monitoring scheme – £½ million

Reduce need for some staff/managers at front end

www.walsall.gov.uk

Which other budgets can be reduced?

Review of all staffing to take out 20% of current levels (with “preventive services” protected)

Joint Commissioning Unit 3 posts Mental Health Services 5 posts Access, Assessment & Care Management 29 posts Provider Services (including Quality Team) 11 posts Strategic Development 6 posts

£2 million proposed saving

Where possible using vacancies and voluntary redundancies to achieve reductions.

www.walsall.gov.uk

What can we do differently? Broadway North – close residential unit

Decommission (parts) of Housing 21 Contract

Review Day Care for Adults with LD

Review Extra Care Housing

Review Low Level Commissioned Services

What don't we have to do? Recruitability

Apprenticeships

£2.0 million proposed savings

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What scope for charging?

Impact of social care bill and charging cap

What else can we do?

Review base budget Absorb current costs into new DH grant – spend

on exiting services £1.4 million proposed savings

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• COMMENTS ON SAVINGS

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PEER REVIEW FINDINGS

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Peer Review Findings

• Impressed with operational model and general level of ownership BUT

• Some people don't yet understand it – more to do with longer term teams (incl reviews)

• Would like to see more engagement with staff; stakeholders; voluntary sector; community; users and carers in taking forward

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www.walsall.gov.uk

Peer Review (2)

• Need a medium term financial strategy and a business plan to take forward financial challenges

• Can we deal with increasing pressures and demands of the new Care Bill?

• Can we work closer with Health to find further solutions?

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www.walsall.gov.uk

Some detailed comments

• Financial assessment should not be completed before support plan

• Need more Direct Payments to promote social inclusion especially for carers

• Need stronger links with Area Partnerships• Examine workloads (and efficiency) of

Complex Teams – including waiting lists• Pressures in mental health services

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www.walsall.gov.uk

Conclusions

• New Operating Model the right approach and places the Council in a better position to meet the financial challenges.

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