Adult Social Care

Budget Gap – 5 Year Forecast

Outturn 2014/15 Outturn Comparison 2013/14 & 2014/ /142014/15 Budget£130.5m£132.7m Expenditure£132.7m£133.6m Variation£2.2m o/s£0.9m o/s Outturn for 2014/15 is net of the following additional funding: Section 256£11.4m (£1.5m used against pressures) Winter Resilience£0.8m DTOC Grant£0.5m * These amount to 7% of the Adult Social Care budget (excl LDPS) Main Pressures 14/15 ASC Home Care£0.7m o/s ASC Direct Payments£0.8m o/s LD Residential (External)£1.3m o/s LD Direct Payments£0.9m o/s

Care Act Pressures In conjunction with South West ADASS colleagues we have been modelling the financial effect of the 2016 Care Act changes. These will require refining throughout the summer but the initial findings are as follows £4.3m total additional cost in 15/16 rising to £18.5m in 25/ new over 65 clients in 15/16 rising to 580 in 25/26. Cost ranges from £1.7m to £8.8m 2,700 working age adults receiving additional financial support in 15/16 at a cost of £2.6m. This increases to 3,800 in 25/26 costing £9.7m Unknown number of carers assessments and support packages (census figure is 58,000 people) More work to be done on this and considerable uncertainty regarding population not currently supported financially by Somerset County Council.

Fair Price for Care Current Domiciliary Care Hourly Rate Local Comparator Rates Urban£15.84 p/h£ £17.59 p/h Rural£16.68 p/h£17.65 p/h Current Residential/Nursing Rates Local Comparator Rates Residential£ p/w£398 - £447 p/w SRC£ p/w£487 - £491 p/w Nursing£ p/w£570 - £595 p/w EMI Nursing£ p/w£590 - £633 p/w For comparison the current approach to Continuing Health Care fee levels in Somerset is split across 3 levels: Level 1 - £650 per week Level 2 - £850 per week Level 3 - Individual Fee Agreement

Adult Social Care Year: RESTRICTED Local Authority Bristol Devon Dorset Gloucestershire Plymouth Poole Somerset South Glos Swindon Wiltshire 1C: Proportion of people using social care & carers who receive self-directed support (1a) 90.70%89.90%96.2%84.00%86.00%96.70%23.84%81.80%72.09%93.40% 1C: Proportion of carers who receive self-directed support (1b) 95.50%89.40%45.60%0.00%50.00%52.90%0.00% % 25.90%96.90% 1C: Proportion of people using social care who receive self- directed support through a direct payment (2a) 15.90%33.50%20.0%19.30%29.60%22.90%23.84%28.10%20.28%30.40% 2A: Permanent admissions to nursing care homes for people aged 18-64, per 100,000 population (part 1) A: Permanent admissions to residential care homes for people aged 18-64, per 100,000 population (part 1) A: Permanent admissions to nursing care homes for people aged 65 & over, per 100,000 population (part 2) A: Permanent admissions to residential care homes for people aged 65 & over, per 100,000 population (part 2) E: Proportion of adults with learning disabilities in paid employment 6.30%6.70%4.10%8.30%5.00%5.90%4.25%8.60%4.21%3.70% 1F: Proportion of adults in contact with secondary mental health services in paid employment 6.4% 14.0%5.0% N/A21.6%9.6%12.2% 2C: Delayed transfers of care from hospital which are attributable to adult social care per 100,000 population aged 18 & over (part 2) B: Proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into reablement/rehabilitation services (part 1) 85.0%88.8%86.2%74.7%84.0%93.0%87.9% 93.0%81.2% ADASS SOUTH WEST ADULT SOCIAL CARE IMPROVEMENT PROGRAMME

Adult Social Care Areas of performance concern Personalisation (overall ASCOF 1C figure low) Personalisation (low number of PBs) Personalisation (no carers getting PBs or DPs) New residential and nursing placements high LD clients in paid employment low Delayed Transfers of Care high

Learning Disabilities LD demographic Projected increase in the number of people with a moderate to severe learning disability from

Learning Disabilities Clients in receipt of long term care during the year 2014/15 (SALT definition): AgeResidential & Nursing Community based Total ,1511, & over

Spend v Other Authorities on LD

Learning Disabilities What are we doing to improve? Transition improved via the new strategy (SLT July 2015) Move to social enterprise Dedicated adult social care worker to review day services and move to employment where possible Generic teams to build on existing good practice and innovation Move away from risk aversion and paternalism Enabling people to take risks associated with lifestyle choices Asperger's

Assessments and Reviews Actions being taken to reduce backlogs Embedding new assessment and review processes to ensure optimise use of resources Monitored via “Performance Wednesday” reports QA process in place to ensure meet ASCOF criteria SOMs and team managers taking ownership for removing backlogs against agreed targets Implementation of local assessment “centres/ hubs” in SCC offices  Bridgwater local hub has been operational since 18 th May in Morgan House  ASCWs spend 3 days a week in the hub and see on average 2-3 people a day  Learning to be shared with other areas

Safeguarding YearSafeguarding Concerns received, April - May Number accepted as safeguarding % accepted as safeguarding of total concerns received % %

Safeguarding progress New governance arrangements for SAB Three year strategic plan SAB Board Manager Additional resources from CCG Implementation of MSP Audit system in place Dedicated safeguarding service in place

Deprivation of Liberty Deprivation of Liberty Safeguard (DOLS) is a legal framework within the Mental Capacity Act which authorises the deprivation of liberty of a person in a hospital or care home when the person lacks the capacity to consent to stay and to be subject to continuous supervision and control. When considering a DOLS it is important to remember this affects only individuals that have been formally assessed as lacking mental capacity to make an informed decision. The legal presumption is one of having capacity

Deprivation of Liberty Apps received from carehomesApps received fromhospitalsTotal appsAssessments completedChange of circumstancesprior to assessmentAuthorisations grantedAuthorisations declinedOutstanding applicationsat year end 2013/ /

Strategic Commissioning Reconfiguration to support the transformation, integration and policy change Contract management activity and staff transferred to ASC Operational Commissioning in May  Continuing to work closely with this team and procurement to ensure optimise skill sets by clearly defining roles, responsibilities and handoffs 2 Strategic Commissioning Managers supporting the DASS to deliver strategic agenda  Internal focus to support transformation agenda and meet anticipated future demand profiles  External focus on the integration agenda

Health Integration Joint Commissioning posts for LD and Mental Health Better Care Fund and the role of Health and Wellbeing Board Integrated Outcome Based Commissioning Decision “Health and social care commissioners in Somerset are seeking to move to an outcomes based commissioning (OBC) approach to contracting health and social care services, in an effort to improve outcomes for people in the county whilst promoting greater financial sustainability”

Health Integration Advantages Potential to move money around the whole health and social care system (e.g. from acute hospitals to prevention/social care) Joined up services for people Less duplication of commissioned services/assessments Disadvantages Less control/relinquish SCC budget Potential for model to be led by one LARGE provider Where does safeguarding and children’s services fit given that statutory responsibility remains with LA?

Our vision: “People in Somerset will remain independent for as long as possible because we help their families and communities give them the support they need to reduce the risk of them losing their independence. When people do need care or support this will be through high quality, joined up social care, health and wellbeing services. These should where possible enhance rather than replace their existing informal support networks. People will be in control of the care and support services they receive, so that these are delivered where, when, and by the people they want, and achieve the outcomes that are important for them.”

Managing and Signposting Demand We need to help people to find solutions to their emerging social care needs without their having to become a ‘service user’. A key principle is to respond to needs in the most immediate and proportionate way. What can they do for themselves, with their family, in their community? Good information, advice and signposting is the key to this. Must be more ‘carer aware’, must always consider the potential use

Workforce by September First point of contact, assessment and support planning, safeguarding and quality and community hospital teams all in place By end June all key competencies and skills mapped for each role in the new OD JDs and evaluations for key roles completed by end July Staff and union consultations over July and August New OD in place September Review OD end February 2016 Permanent workforce scoped and costed with plans in place to recruit staff

SUMMARY Budget shortfall  Care Act Pressures  Fair Price for Care Learning Disabilities  Performance in key metrics needs to improve  Actions in place, social enterprise Adult Social Care  Assessments and reviews backlogs being addressed  Safeguarding is improving  DoLs - pressure  Mental Health service issues  Parity with Children's services and corporate risk Strategic Commissioning  - Supporting the transformation agenda