Health and Adult Social Care in

Walsall

May 2014

Working Together in the

Age of Austerity

A bit of background

• Walsall: ranked 30 / 326 LAs on indices of multiple deprivation.

• Issues: deprivation, educational attainment, poor health, diversity and inequality.

• Health and social care economy:

– Walsall Healthcare NHS Trust.

– Walsall Council Social Care (80% commissioned).

– Walsall Clinical Commissioning Group.

– Dudley & Walsall Mental Health NHS Trust.

Our shared financial challenge

• Walsall Adult Social Care:

– £14m savings delivered over last 3 years.

– 14/15 £63m net budget after £11m reduction.

– 2015/16: tbc but further reduction necessary.

• Walsall Healthcare NHS Trust:

– £230m turnover.

– c. £40m savings delivered in last 4 years.

– c. £50m needed in next 5 years.

The burning platform

• Large increases in emergency admissions to hospital (>20% in last 2 years. NB. Stafford).

• Hospital bed occupancy >95%.

• Pressure on discharge and intermediate care: +1 day av LOS in last 3-4 months.

• Rising readmissions: 14% up to 16% in last year

• Over-reliance on nursing and residential home care for step down

• Insufficient capacity in health and social care market for care at home (1 week in April 120 clinically stable patients)

Our approach

• Renewed commitment to work together.

• Investment in community

– CCG investment in community health services

– Social care investment in reablement, home care

– Review of urgent care and walk in centres

• Locality-based multi-disciplinary teams.

• Improving intermediate care.

• Reduced reliance on institutional care through targeted and joint early intervention

Prognosis . . .

• Some early signs of progress:

– Impact of reablement for “simple” discharges.

– 200 high users referred to community matrons and 60% not readmitted since.

– Rise in emergency admissions halted.

– Increased end of life care in community.

• But lots still to do:

– Hospital capacity pressures.

– Co-ordination and capacity in the community.

– Managing the most vulnerable better.

Issues and next steps

• Austerity – 60% public sector reductions

still to come.

• Better Care Fund – national policy vs local

implementation.

• Integration – how far do we go?

• Institutional impact – FT application.

• Non-statutory players – community groups

and voluntary sector.