Joint Working in a Cold Climate NHS Confed Conference 7th 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 £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

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system complex to understand and navigation difficult People do not understand who pays for what Changing needs and an outdated model are a bad combination

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

Core City Slide

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.

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 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 are interdependent (not exclusively) Use the obvious wins (Kerslake/Glasby) in QIPP

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

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