Joint Working in a Cold Climate

NHS Confed Conference7th July 2011

Peter HayADASS President

Contents

Social Care – the long big gap

• 1999 Royal Commission

• 2006 Kings Fund Wanless Report

• 2008 HM Govt. “Why England Needs a New Care and Support System” estimates a £6bn gap over the next 20 years.

• 2011/12 ADASS finds whatever the gap, a further £1bn is the reduction from councils

• 2012/14 ADASS estimates a further £1bn

Reform isn’t just resources

• Fewer people received help whilst resources increased and eligibility stayed fixed

• People find the care system complex to understand and navigation difficult

• People do not understand who pays for what

• Changing needs and an outdated model are a bad combination

Spending review impact

Protecting health and education spending mean a significant reduction in funding for local government.

This is with £1bn transferred from NHS in the bottom line

8

Core City Slide

• Append 2b council plan

ADASS Budget Survey – May ‘11

• Councils are reducing their budgets for adult social care by £991M, representing a 6.9% reduction against a 10% reduction in overall spending by councils.

• Councils are reducing by £169M their spend on Supporting People.

• 13% of councils are changing their FACS criteria. There are now 78% councils at Substantial in 11/12 compared to 70% in 10/11 and 4% at critical only.

• 79% councils have frozen or increased fees to providers.

• £425m of demographic pressures were identified with 41% of councils fully funding these pressures.

ADASS Survey – joint monies

• The full amount of the reablement resources has been identified with strong levels of agreement with the NHS on areas of spend.

• 95% of the Winter Pressure allocation was identified, with 89% of councils reporting agreement on how this allocation will be spent.

• The full year NHS Transfer (total of £650k?) is still to be determined with 57% not yet agreed

• Carer’s money – more importantly- strategies appears slow to impact

Consequences showing in Year One

• Instability to the already long unstable care system

• Blaming cuts misses the gaps!• Plenty of challenge – post Birmingham

ADASS survey shows 20 councils with JR challenges to budget (eligibility, fees and )

• Move to Clusters means that radical changes for enablement, QIPP etc are probably slow off the mark

Potential Impact of Year Two

• Update from survey

Less hindrance to integrate than 2010?

Source: NHS/Confed Where Next for Health and Social Care Integration, June 2010

Performance Regimes

Financial pressures

Organisational complexity

Changing leadership

Financial complexity

Cold Climate Consequence

• Money will get worse before it gets better

• Dilnot proposals for reform and resources

• The unintended Dilnot/Gloucester trap – eligibility frozen whilst it is the only legal tap on resource

• Local reforms slow off the ground?

• Known hindrances appear to have strengthened

How do we warm up?

• Prepare for worse to come

• Quickly make up ground for transformation of health and care

• Ensure together we get Dilnot addressed

• Recognise that great health and care are interdependent (not exclusively)

• Use the obvious wins (Kerslake/Glasby) in QIPP

Citizen purchased care – own resources

MEANS

NEEDS Enablement

Support and information offer

Citizen purchased care – state resources

Prevention

Citizen purchased care – own resources

Transformation model for reducing resources

‘A wider service offer’