1. Better Care Fund & Protection of Social Care Scrutiny Committee 2 nd July 2015

2. Impact of financial constraints on ACS £m2010/112011/122012/132013/142014/152015/16Change over 6 yrs Published Budget 199.1190.2183.3198.1201.7204.15.03% Comparable Budget 199.1190.2183.3183.4182.8182.6-16.5-8% RPI inflated comparison 199.1208.6215.1220.9224.5226.727.614% CPI inflated comparison 199.1207.4213.1217.3218.4218.619.510% The comparable net budget has fallen by 8% over the last 6 years despite demographic and inflationary challenges. The gross budget has not significantly changed (prior to the Care Act) but this has been boosted both by reserve funding and by Health funding, however it remains a real terms decrease because of the effect of inflation. In order to fund inflation and demand year on year, significant levels of savings have been required – see next slide.

3. ACS Savings: 6 Year View 2011/12 2012/13 2013/14 2010/11 Savings £3.4m 2010/11 Cumulative Saving £3.4m £15.8m £28.3m £38.2m £48.4m 2011/12 Savings £12.4m 2010/11 Savings £3.4m 2012/13 Savings £12.5m 2010/11 Savings £3.4m 2011/12 Savings £12.4m 2013/14 Savings £9.9m 2010/11 Savings £3.4m 2011/12 Savings £12.4m 2012/13 Savings £12.5m 2014/15 2010/11 Savings £3.4m 2011/12 Savings £12.4m 2012/13 Savings £12.5m 2013/14 Savings £9.9m 2014/15 Savings £10.2m Outturn: Underspend £1.5m (0.8%) Outturn: Overspend £1.5m (0.7%) Outturn: On Budget Outturn: Underspend £4.2m (2.2%) Outturn: Overspend £1.6m (0.8%)  ACS has a successful record of delivering on savings but this is becoming increasingly difficult. 2010/11 Savings £3.4m 2011/12 Savings £12.4m 2012/13 Savings £12.5m 2013/14 Savings £9.9m 2014/15 Savings £10.2m 2015/16 Savings £10.6m £59.0m 2015/16

4. Protection of Social Care – Health Sector Funding of ACS 2011/122012/13 2013/14 S256 transfer from PCT’s £2.2m 2010/11 S256 transfer from PCT’s £8.8m S256 transfer from PCT’s £8.5m S256 transfer from NHS England £11.7m 2014/15 S256 transfer from NHS England £14.9m Better Care Fund transfer from CCG’s £16.7m (£14.9m S256 + £1.8m care act) 2015/16 4  Funding received by Health has helped to offset savings by funding ACS services. Better Care Fund Additional transfer £5.4m  The Better Care Fund in 15/16 provides some guaranteed funding transfers but also a potential further £5.4m of CCG savings from joint working which will contribute directly to ACS savings.

5. 2016-18 Position for ACS 5 Current savings proposals of £23.3m The above does not include any additional savings required to meet the current gap in the overall SCC position. It does include further HASCI savings to take the total savings required to be passed over from the CCG’s (over and above the former section 256 & care act funding) to £10m. 2010/11 Savings £3.4m 2011/12 Savings £12.4m 2012/13 Savings £12.5m 2013/14 Savings £9.9m 2014/15 Savings £10.2m 2016/17 & 2017/18 Savings £23.3m Cumulative £82.3m Better Care Fund transfer from CCG’s £16.7m (£14.9m S256 + £1.8m care act) + inflation Better Care Fund Additional transfer £10m

6. Better Care Fund and the Health and Care Review Carl Goulton Chief Finance Officer Ipswich & East Suffolk CCG West Suffolk CCG

7. Health and Care Review Ipswich and East Suffolk CCG and West Suffolk CCG working in partnership with Suffolk County Council, providers and other system partners Agreed model for delivery of integrated health and care Early adopter sites – Connect Sudbury – Connect East Ipswich Early discussions re Integrated Care Organisations System-wide activity and financial pressures Ipswich & East Suffolk CCG West Suffolk CCG

8. 2015/16 projection (estimates) Notes Ipswich HospitalDeficit - £20mAfter delivery of CIPs West Suffolk HospitalDeficit - £ 6mAfter delivery of CIPs Addenbrooke’s HospitalDeficit - £ 40mAfter delivery of CIPs Norfolk and Suffolk Foundation TrustDeficit - £ 8mAfter delivery of CIPs Suffolk Community ServicesIn procurement, additional investment required Ipswich and East Suffolk CCGAllocation £442m No in year surplus Savings required £10m Month 1 £0.3m Adverse to plan West Suffolk CCGAllocation £284m No in year surplus Savings required £12m Month 1 £0.5m Adverse to plan Financial Context Providers and commissioners are facing significant financial challenges Ipswich & East Suffolk CCG West Suffolk CCG

9. No additional KPIs agreed to support increased transfer £3m Ipswich & East Suffolk CCG West Suffolk CCG The financial commitment to ACS has risen year on year £17m transfer to SCC protect social care £20m direct CCG spend

10. Health and Care Review – savings not quantified – Early adopter sites – Connect Sudbury and Connect East Ipswich Reduction in emergency admissions - target £1.1m – Target reduction 3.5%, £1.1m – Q4 vs baseline +2.7% (IESCCG/WSCCG +4.5%) Savings initiatives from joint working – target £2.2m – Joint procurement of domiciliary care – contract commences September - part year savings expected, £ to be quantified – Joint procurement of nursing home care – ongoing – part year savings expected, £ to be quantified – Areas identified, no savings expected in 2015/16 Integrated Rehab and Reablement Back office savings Community Equipment Service Savings Initiatives Ipswich & East Suffolk CCG West Suffolk CCG

11. Better Health, Better Care, Better Value An Integrated Approach to System Transformation Cath Gorman Director of Quality & Safety

12. Better Health, Better Care, Better Value An Integrated Approach to System Transformation Great Yarmouth & Waveney – Strong ethos of partnership and integration All commissioners have signed up to Integrated Care System Great Yarmouth & Waveney – discrete health and social care system Great Yarmouth & Waveney is managing demand well – JPUH emergency admissions in 2014/15 were 1% less than 2013/14 Lowestoft Out of Hospital Team is a major contributor – Non elective admissions for patients over the age of 75 is a reduction of 9.57%. Roll out of teams is planned as part of Better Care Funding (BCF)

13. Better Health, Better Care, Better Value CCG Financial Position 2015/16 £3m In Year Deficit TOTAL BUDGET £317m £15.5m BCF contribution (Not new money) SCC £8.4m NCC £7.1m £12.3m Savings Target

14. Better Health, Better Care, Better Value Make Up of SCC £8.4m BCF Contribution Supporting Independence by provision of community based interventions £4m Integrated Community Teams and Out of Hospital Teams £1.5m Urgent Care Programme £1.6m Support for people with dementia and mental health problems £0.7m £1m (Included in schemes above) £0.6m 4 Commissioned Schemes including Section 256 Protecting Social Care (minimum transfer) Care Act and Carers Contribute to meeting national BCF Conditions & 3.5% NEL admissions performance element

15. Better Health, Better Care, Better Value Making Savings Across the System GYW PMO TRANSACTIONAL SAVINGS GYW already an efficient system – very limited opportunities. Health and Social Care working together to produce efficiencies and improve value for money TRANSFORMATIONAL SAVINGS COMBINED BUDGETS JOINT COMMISSIONING