Vision for adult social care in a connected world Linda Sanders ADASS National Lead, Assistive Technology Strategic Director for People City of Wolverhampton Council 18th October 2016 Old title: Are we connecting the right social care services in the community to get more integrated working?

The Association of Directors of Adult Social Services Association of Directors of Adults Social Services is a charity. Our objectives include: Furthering comprehensive, equitable, social policies and plans which reflect and shape the economic and social environment of the time Furthering the interests of those who need social care services regardless of their backgrounds and status and Promoting high standards of social care services

Vision for people in our communities… Asset-based approach – individuals and communities Higher expectations – “I want a life not a service.”

Where we are now… 23% of UK population projected to be 65+ by 2034 Unpaid care provided by friends and family to ill, frail or disabled relatives is worth £119 million every year More than 15.4 million people in England live with a long-term condition. Expected to rise to 18 million by 2025 23% of UK population projected to be 65+ by 2034 Up to 1 in 3 (3.4 million) 65+ in UK suffer a fall, costs NHS about £4.6 million a day Adult Social Care budgets reduced by 31% in past five years 1 in 6 people over the age of 80 is affected by dementia Best Practice and national policy post-Winterborne – better community support employment for people with disabilities: WM Combined Authorities on mental health Social care and health integration

ADASS Budget Survey 2016 Adult Social Care Budgets 2015/16: ASC Gross Budget 15/16 £19.6bn ASC Net Budget 15/16 £13.65bn ASC Net Budget 15/16 Outturn £13.82bn Variance £168m overspend ASC Gross Budget 16/17 £19.7bn ASC Net Budget 16/17 £13.82bn % change in ASC Net Budget between 15/16 and 16/17 +1.2% % ASC Net Budget 16/17 of 16/17 Council Net Budget 35.6% To maintain last year’s levels of service would require more than £1.1bn more. (i.e. demography, NLW, DOLS) This year’s budgets have only increased slightly though, by £170m and there is wide variation (70 councils reported a reduction): The precept was raised by most and overall came to £380m. However, it raises least in areas with the greatest need for social care Councils continue to try to protect spend on older and disabled people despite reductions in central grant. ASC this year, like the last 2 years, accounts for 35% of total council spend. Overspends last year were met from reserves or through cutting other services. 3% increase in older population, but no increase in the numbers of older people actually receiving services in 15/16 At least 39% of this year’s savings will come from cutting services, reducing the personal budgets of people who receive care and support, or other service reductions Adult Social Care planned savings for 2016/17 are £941m (8% of the net Adult Social Care budget and 29% of total council savings). Directors’ confidence in making these savings is falling: last year 45% of directors were fully confident planned savings would be met. This year it is just 31%. It reduces to 6% for 2017/18. Applications for DoLS have risen more than tenfold and 2015/16 saw the first full year of the Care Act. Only 36% of directors are fully confident of being able to deliver all of their statutory duties this year, falling considerably to just 8% who think they can do so next year.

ADASS Budget Survey 2016 National Living Wage - calculated at over £600m. (The precept raises less than two thirds of this.) 82% of councils increased fees to providers: nearly a quarter by more than 5%. Nevertheless, 80% of Directors report that providers in their area are facing financial difficulties now. Care Act money / grants) now part of revenue support grant Distributional impact: settlements have hit those most deprived hardest Substantial BCF funding doesn’t kick in until the end of the parliament The acute NHS is struggling and the reduction in social, primary, mental health and community services means that is endlessly compounded. Transformation is essential for survival .

ADASS Budget Survey 2016 Councils spending 4% less on prevention than 14/15. They need to balance: prioritising statutory duties for those with greatest needs and investing in services to prevent / reduce need “We are at the tipping point where social care is in jeopardy and this impacts on the millions of people needing care and support and the staff who care for them.” “The whole sector, including senior leaders from the NHS, local government and the independent sector, are united in recognising the importance of an adequately funded social care system in promoting the country’s wellbeing and ensuring the right care is available. More people work in adult social care than in the NHS and they make a positive difference every minute of every day”.

So what can we do?

LEAD

What we are doing… Two most important routes for savings identified by ADASS in the 2016 Budget Survey: integration of social care and health increased prevention

Social care and health integration Background Documents - NHS Five Year Forward View ADASS/LGA/NHS Confed - Stepping up to the place - The key to successful health and care integration Kings Fund - Place-based systems of care Key messages: One size doesn’t fit all Various models e.g. accountable care organisations. Draws on international experience. Sustainability and Transformation Plans process

Key Aims and Objectives for the Black Country STP Improving Maternity & Infant Health Strengthening Efficiency Transforming Mental Health & Learning Disability Managing Demand Reshaping our Commioning Approach Workforce Estates Estates Reshaping Commissioning Improved Patient Outcomes Increased Patient Satisfaction

Positioning technology correctly is crucial Prevention Positioning technology correctly is crucial Majority of those surveyed see technology playing a key role in maintaining their independence, remaining in their own home for longer and that the technology itself is ever easier to use

Choice and control – not one size fits all Prevention: Choice and control – not one size fits all Concern for around half of those surveyed that too much technology could reduce everyday interaction and will not strengthen community spirit

Sustainable Workforce Workforce to grow by 0.5m by 2020 Leadership and support Pay, skills and careers New Roles and Models of Care Recognition: promoting Social Work and Social Care Sustainability is a good word to describe our aspirations. Firstly, it can be applied to workforce: our plans won’t work without them - trained, committed and ready to work with citizens, building on the assets they and their community bring. We need to understand the value of our sector and recently in the City of Wolverhampton we did some work with Skills for Care to understand our contribution to the local economy – ASC contributes £250m locally.

Sustainable Markets Fair Price of Care & Open Book approaches Market Shaping and Continuity Planning Call to Government to fund ASC Secondly, we need to ensure that our Markets are sustainable. Shaping the Market is a requirement of the Care Act. We are working collectively to shape our markets and we need to ensure they have a wide offer including assistive technologies as part of the offer. Individuals, communities, providers of services need to understand the context we’re working in and our practices need to change so that we build on the confidence and trust we have developed and address the need for trust where it is absent. Call for sustainable funding is part of this.

Sustainable Quality Quality is not compromised for any other priorities Collaborative & transparent approach across commissioners, regulators, providers and individuals All services are good enough to cause no harm Thirdly, we need to ensure that the quality of our services across the board is sustainable. Our work is all about improving the experience of people. They need better information to understand the decisions they can make and we have example of ways in which we all do that through internet-based information directories and the like. And everyone with an interest in this area needs to collaborate – we are all working for the same people in the same society.

Sustainable People, Places and Communities