Joint Working in a Cold Climate NHS Confed

Joint Working in a Cold Climate NHS Confed Conference 7 th July 2011 Peter Hay ADASS President

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 £ 6 bn gap over the next 20 years. • 2011/12 ADASS finds whatever the gap, a further £ 1 bn is the reduction from councils • 2012/14 ADASS estimates a further £ 1 bn

Reform isn’t just resources • Fewer people received help whilst resources increased and eligibility stayed fixed • People find the care system complex to understand navigation difficult • People do not understand who pays for what • Changing needs and an outdated model are a bad combination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 £ 1 bn transferred from NHS in the bottom line

Core City Slide

ADASS Budget Survey – May ‘ 11 • Councils are reducing their budgets for adult social care by £ 991 M, representing a 6. 9% reduction against a 10% reduction in overall spending by councils. • Councils are reducing by £ 169 M 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. • £ 425 m 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 £ 650 k? ) is still to be determined with 57% not yet agree. • 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 and care fees top issues) • Move to Clusters means that radical changes for enablement, QIPP etc are probably slow off the mark

Potential Impact of Year Two • Initial indications suggest slightly higher reduction – but substantial variation. • High level of confidence re transfer monies. • Greater radicalism on enablement & not there yet on carers strategies.

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? • Strengthen locally – sorting out the architecture quickly! • 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 interdependent (not exclusively) • Use the obvious wins (Kerslake/Glasby) in QIPP

A new model of care and public health NEEDS Citizen purchased care – state resources Citizen purchased care – own resources Enablement Prevention Support and information offer ‘A wider service offer’ MEANS

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