Joint Working in a Cold Climate

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

2. Contents

3. 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

4. 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complex to understand and navigation difficult • People do not understand who pays for what • Changing needs and an outdated model are a bad combination

5. 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

6. Core City Slide • Append 2b council plan

7. 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.

8. 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

9. 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

10. Potential Impact of Year Two • Update from survey

11. Less hindrance to integrate than 2010?Source: NHS/Confed Where Next for Health and Social Care Integration, June 2010

12. 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

13. 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

14. Transformation model for reducing resources Citizen purchased care – own resources Citizen purchased care – state resources Citizen purchased care – own resources Enablement NEEDS Prevention Support and information offer ‘A wider service offer’ MEANS