SUPPORTING PEOPLE TO LIVE AND DIE WELL EAST MIDLANDS REGIONAL OVERVIEW 11 JANUARY 2011 MICK CONNELL DIRECTOR OF ADULTS AND COMMUNITIES

Key issues and concerns and end of life care Context Personalisation Partnership Efficiency The Challenge Ahead

Context Coalition Government Massive Changes: Localism NHS White Paper Big Society Financial Climate What does it all mean for us?

Personalisation in Leicestershire Putting People First (PPF) Self-Directed Support

Adult Social Care Service New Customer Pathway Community Adult Social Care Service Advice & Information Prevention & Early Intervention Customer Service Centre Re- ablement RAS  Support Plan Personal Budget Review Support in place. Live your life. Outcomes met

PPF is everyone’s business Transport Volunteering Social Inclusion Community development Creative provider services Information and advice access points Regeneration and social enterprises Transitions

Think Local, Act Personal Next steps for Transforming Adult Social Care (PPF2): A proposed sector-wide commitment to moving forward with personalisation and community based support Building on progress, recognising the new political and financial climate A vision for Adult Social Care: Capable communities and active citizens The 7 P’s – key principles for a modern system of social care

Encouraging continued reform Personalised care and support (direct payments is the preferred delivery model for most) Preventative, community-based approaches Integrated service delivery Supporting the continuation of individuals, families and communities Reducing the need for acute health care and support Reducing duplication and improving outcomes

Partnership “shifting the power from the state to the people, where people, in their every day lives, in their homes, in their neighbourhood, in their work place ….. don’t always turn to official, local authorities or central government for answers to the problems they face”. (David Cameron July 2010) Continuation of Putting People First - Capable communities and active citizens Principles extended to the NHS – “No decision about me without me” Collaboration and strong partnership horizontally and vertically At the same time government wants to curb local government spending and the expectation is for councils to comply with the policy and the requirements to reduce overall public expenditure.

Key elements of the Adult Social Care Vision and NHS Equity and Excellence: Liberating the NHS Key Principles Adult Social Care Vision Partnership Prevention Personalisation Plurality Protection Productivity People Key Values Principles for the NHS Putting Patients and public first Improving healthcare outcomes Autonomy, accountability and democratic legitimacy Cutting bureaucracy and improving efficiency

Direction of travel for Adult Social Care and the NHS Adult Social Care Vision Breaking down barriers Extending roll out of personal budgets Increasing use of direct payments Making services more personalised and more preventative Focused on outcome Devolving power to frontline workers and carers Stable financial base for next 4 years Equity and excellence: Liberating the NHS Is centred on patients and carers Achieves quality and outcomes Refuses to tolerate unsafe and substandard care Reduces inequalities in care Puts clinicians in the driving seat and sets hospital and providers free to innovate and adopt best practice Is transparent and accountable for quality Citizens have a greater say in how the NHS is run Is efficient and dynamic with reduced bureaucracy nationally, regionally and locally

Implications for Adult Social Care Challenges Continuous and rapid change for next 3 years NHS and Adult Social Care required to achieve unprecedented efficiency gains despite increase and growth in funding Invest in Prevention – identify models to suit all groups Meeting needs and addressing inequalities GPs responsible for commissioning majority of services New governance arrangements for Health and Wellbeing Boards Capacity building, culture shift and embedding the new structure Opportunities Leadership role for Adult Social Care at all levels Ambition to increase quality through implementing best practice and increase options for prevention Integrated re-ablement with investment for NHS long term conditions and improved responses to hospital discharge Increase profile for public health ASC will have major role for integration both in commissioning and service Better intelligence on needs (JSNA/mortality profiles)

Efficiency It’s grim! Some councils are affected more than others Maximise efficiency in any way possible Service reductions are inevitable A new, more sustainable model is needed: state and individual new funding arrangements for social care

Population Still growing Growing ever older and more diverse 65+ Generation have £1trn of assets - in 2020 their assets will exceed GDP and exceed national debt Adults with complex needs are fastest growing and highest demand client group for care and support - they have few assets Inequality of health, wealth and opportunity widening

Health and Social Care Putting People First - delivering but is it enough? National Care Service - is there political will for a step change? Integration - why this time? Quality and innovation - can commissioning deliver?

Transformation How far / How fast? National / Local Putting People First Personal budgets Self Assessment Independence at home Shift from day and residential services Prevention and re-ablement National Care Service Prevention and reablement One assessment One service One budget All pay/some pay? Pay now/pay later? How far / How fast? National / Local

3 stages 2009 2014 … Efficiency System Reform Manage Impact Maximise efficiency Speed up reform Squeeze costs Make case for Radical change Deliver system Change Health Local Government Total Place New Offer Commercial options Political repositioning Either … -Implement new Offer and funding Model or .. Reduce core Services and manage Community impact

Common efficiency priorities Review eligibility, high cost placements and Resource Allocation System [how much does each individual get?] Review, rationalise or reduce residential homes and day services (including supported employment) [closing high cost, inflexible, in-house services] Reduce overheads through management restructures, customer centres, higher productivity assessment and care management [organising a lower cost system] Stopping or reducing uplifts to providers and voluntary organisations [passing efficiency targets on to the market and partners]

The Future: Adult Social Care rising to the challenge

Key issues Build a sustainable model Empower individuals Supporting carers and families Cradle to grave Getting the culture right Reflecting diversity Skilling up our workforce Integrated approaches Working together Having confidence in ourselves

and don’t forget TRUST and OPTIMISM