Update on: The Surrey LD Leadership Forum The Market Development Group The L&B Cost of Care Project David Holmes Ashcroft/SCA/SLDLF 28 February 2013

SLDLF activities Regular SLDLF meetings and discussions Analysis of SCC budgets Assessment of impacts on sector Meeting with Sarah Mitchell and Anne Butler LD Market Development Group MDG project workstreams Presentation to Adult Social Care Select Committee Meeting with Sally Marks, Chair of ASC Select Committee Meeting with David McNulty, CEO of SCC

Market Development Group Workstreams 1. Cost of Care To establish the true costs of care being incurred by providers of residential care and supported living in Surrey Jo Poynter 2. Market EfficiencyMark Packer To create a dynamic culture and a robust process where providers and SCC work together to produce improved outcomes and value for money by: The strategic configuration and management of resources Increased cooperation over market efficiency and the use of shared services Use of technology Exploring opportunities for partnership working 3. Market ImpactAndrew Price/David Holmes To ensure that the Surrey market for LD care and support services is able to deliver services of appropriate quality to people with assessed needs in the long term. Identify the range of policy, regulatory and economic drivers of change Assess the likely impact of each of the key drivers on the market. Mitigate negative market impacts as appropriate

The L&B Cost of Care Project – Objectives Overall Objective To establish the true costs of care being incurred by providers of residential care and supported living in Surrey Subsidiary Objectives To understand the relative costs of different housing settings, including residential homes of different sizes To understand different unit costs for people with different levels of requirement To consider the accuracy of current fees To provide a basis for calculating sustainable cost and fee levels in the future To provide benchmarks to help providers operate economically and efficiently

The L&B Cost of Care Project: Key finding 1 – What Residential Care costs in Surrey

The L&B Cost of Care Project: Key finding 2 – What Supported Living costs in Surrey

The L&B Cost of Care Project: Key finding 3 – Profitability of services Residential careSupported living Average loss = 8.1% Average profit = 0.4% “The fact that the average level of mark-up is negative when most providers need a certain minimum mark-up to continue in business is a cause for concern” Underfunding on basis of 10% mark-up: 18.1%9.6% “At face value this seems slightly less an adverse overall situation than in residential care”

The Challenge for Surrey LD Providers and SCC Challenge: Close the funding gap Future SCC LD Budget = Future cost of provision (in future structure) Current cost of LD services 2012 L&B Cost of Care project determined that, on average, service costs significantly exceed fees. Current SCC LD budget The challenge for Surrey LD Providers and SCC is: How to eliminate the funding gap in the provision LD services whilst meeting demanding budgetary targets, but without resorting to unacceptable cuts to services and quality. This requires Providers and SCC to work innovatively and flexibly in true partnership. CDH, 4/2/13

Objective 1: Reduce the cost of LD provision in Surrey (without impacting quality) RequirementActions identified/underway Improve Provider cost- effectiveness Provider guidance produced by SCA Benchmarking to optimise purchasing Sector optimisation, to include shared services and joint working MDG project underway, led by MP Market process efficiency (to eliminate waste from the social care market not working efficiently) Requirement for project to ensure market processes working efficiently (eg sourcing services, development of new services according to need) Provider consolidationMDG project proposed Re-assessmentSCC re-assessing, starting out-of-county. To include provider re- assessment and re-costing based on L&B benchmarks Prioritise personalisationPrioritise Personalisation where cost to SCC will be reduced Maximise social capitalPrioritise cases where social capital will deliver best outcomes & savings Ablement and re-ablementPrioritise support for people for whom ablement or re-ablement will improve outcomes and deliver savings Maximise income from other sources To be delivered, in part, by personalisation

RequirementActions identified/underway Monitor funding gapRequirement for process to measure Research long-term impact of funding constraints and other pressures MDG project underway, led by AP and DH Secure inflationary uplifts to prevent further erosion and build momentum Providers seeking to influence decision-makers (alongside users and carers) Obtain a larger slice of the SCC pie for LD (ideally ring-fencing LD funding) Providers seeking to influence decision-makers (alongside users and carers) Ensure demographic growth properly funded Providers seeking to influence decision-makers (alongside users and carers) Objective 2: Increase the SCC LD budget (and ensure it is spent wisely)