Solace Summit 2014The integration challenge:

health and social care

David Pearson President of the Association of Directors of Adult

Social Services (ADASS)

Corporate Director, Adult Social Care, Health and Public Protection, Nottinghamshire County

Council

The Challenges

• Changing nature of the task for the health service, episodic treatments to helping to support people with long term conditions

• We all enjoy the benefits of longevity but are reluctant to pay for some of the costs

• Numbers aged over 80 set to double by 2037• Growth in working age adults with disabilities

requiring care and extensive levels of care• Examples of very poor quality care• Concern about the status of social care

commissioning and the workforce, low wages and zero hour contracts

The Challenges (Cont’d)• Concern about the sustainability of social care given

the level of reductions• Invest sufficiently in the system to ensure that

principles and requirements of the Care Act are met• Ensure that other public services, voluntary,

community in the sector and business are equal partners

• Change expectations and culture in local communities

• A national and local system• Different cultures and expectations

• Pioneers• Further development of the Better Care Fund• Integrated Personal Commissioning • Pooled budgets for health and social care by 2018• A national Health and Care Service • Commissioning at a local level – enhanced role for

Health and Wellbeing Boards• Make social care free at the point of delivery or at

least some of it• Recognise that expenditure, as a % of GDP, will rise

(Barker Commission)

Some of the ideas

• Two questions - how much and how?• Adequacy of funding is a significant issue• Health “protected” but needs growing – concern about viability

of some hospitals• ADASS Budget survey 2014:

£3.5bn reduction since 2010 26% savings in social care Directors worried that:

o Fewer people who need support are receiving ito Councils subject to legal challenge on level of service and

paymentso Providers of care in financial difficultyo NHS under more pressureo Directors concerned that the quality of life and the quality of

care will deteriorate

The Funding challenge

What are we trying to achieve?

Key Principles

Health and wellbeing of individuals and carers Continued move towards personalisation of services

enshrined in Personal Budgets, Direct Payments and co-produced assessment and commissioning

Joining up services with Health and Care and other public services

Creating communities and businesses that are sensitive and supportive through social action in neighbourhoods and communities

The approach

Good advice and information Prevention and early intervention and helping people

in crisis Assessment of health and care needs and outcomes

and support planning Providing a personal budget, through a managed

budget or direct payment Building community capacity

Shaped locally?

• Local democratic accountability and co-ordination• Personalised services based on needs and outcomes

as personal budgets• System leadership through Health and Wellbeing

Boards• Ability to lead and co-ordinate broader public

services e.g. housing, voluntary and community services and business

• Sensitivity to local need• Building on the strengths of communities and

neighbourhoods• The role of central government is to be clear about

policy and performance requirements and to ensure resources match the ambition

Why personalisation ?

• Joint project between Nottinghamshire County Council and Alzheimer’s Society to promote use of Personal Budgets for people with dementia. This showed that:

Personal Budgets for people with dementia can be very cost effective. Case studies evidence that people with dementia and other health conditions can live in the community with the right support, at comparable or less cost than in residential care 

Factors that make community and home based support effective in maintaining people with dementia at home - reliability, continuity of carers, trust and consistency.

Mrs K is 84 years old, has been diagnosed with dementia and has a range of other health problems. Following a fall she was admitted to hospital and from there to a step up bed in a care home and was at risk of remaining in long term residential care.  With input from the Short Term Assessment and Reablement Team brokerage, her husband chose one of three agencies that expressed an ability to offer home based support to Mrs K on her discharge. Mrs. K was discharged home with a direct payment with her husband acting as her Suitable Person. The care agency Mr K chose provides daily support mornings and evenings. Total cost of direct payment £147 per week

Ring-fenced budget(s), which is singly commissioned

• A single budget for health and social care or aligned?

• Routed through Health and Wellbeing Boards• Based around principles of wellbeing and

personalised approaches• Maximum flexibility to allow funding to be used to

secure best possible shared outcomes• Needs to focus on prevention, community based

activity, joined up across the local area

ADASS Business Unit Local Government House

Smith Square London SW1P 3HZ

Tel: 020 7072 7433Fax: 020 7863 9133

EMAIL: team@adass.org.uk WEB: www.adass.org.uk