Efficiency in social care - what are the options? Sally Warren, Deputy Director, Social Care Strategic Policy and Finance

Setting the scene The Spending Review Framework stated: Reducing the budget deficit is the most urgent issue facing Britain. According to the International Monetary Fund (IMF), the UK has the highest budget deficit in the G7 and G20. That the bulk of the deficit reduction will be achieved through reductions in spending rather than increased taxes.

Ensuring value for money In light of the current fiscal context, there will be a strong emphasis on achieving value for money. The Department has been working in conjunction with ADASS, LGA and others from the sector to consider what efficiency opportunities exist over the upcoming SR period. We think efficiency opportunities can be grouped under three headings.

Efficiency opportunities Helping people to stay independent for as long as possible, through the roll out of targeted prevention and early intervention services Ensuring that people receive care and support in the most appropriate and cost effective way to meet their outcomes, through the roll out of personal budgets, effective community support services Maximising spend on frontline services, by reducing back office spending, reforming procurement practices and streamlining assessment and care management processes.

Opportunity 1: Helping people to stay independent for as long as possible Homecare re-ablement –Evidence suggests that over 50 per cent of people who went through a re-ablement package needed no immediate care package, and 36 to 48 per cent continued to have no ongoing care package after two years. Crisis or rapid response services –crisis response services can save money across the health and social care system by reducing ambulance call-outs, unnecessary admission to hospital, and unplanned entry to residential care.

Opportunity 2: Ensuring that people receive care and support in the most appropriate and cost effective way to meet their outcomes Reducing spending on residential care for reinvestment in other services –Spending on residential care varies from 30% to 70% of LA spending on older people; for those with learning disabilities the proportion spent on residential care varies from 12% to 80%. Assistive Technology –CSED evidence suggests possible savings of 1.5% per annum of total home and residential care through integrated telecare. Personal budgets –Early evidence suggests that, for some people, personal budgets can be more cost effective than traditional services.

Opportunity 3: Maximising spend on frontline services Getting the best value from services –separating responsibility for commissioning and providing services; reducing proportion of spend on in-house provision. Streamlining of administrative functions –Reducing back office spend will free up resources which can be redirected to front line services. –Streamlining assessment and care management systems, following introduction of resource allocation systems.

Collaborative working This challenging fiscal climate means it is more important than ever that social care and health break down the barriers between the two systems and look at the health and care economy as a whole. For example, the new responsibility for acute trusts to pay for post-discharge care provides an opportunity to develop capacity and quality of re-ablement services.

Delivery Strategy CSED will end in March 2011 DH will bring people together to discuss the most appropriate business model to support the delivery of transformation and efficiency. Key principles : –Sector led –Localism agenda Draft Structural Reform Plan commits DH to: –Work with the sector to disseminate best practice in efficiency and effectiveness –Create the necessary support tools to achieve best practice at a local level

Process and Next Steps Publication of the Spending Review 20 October 2010 Launch of the vision November 2010