1. Future challenges for health and social care Spending Review – what it means for health and social care: The King’s Fund conference 1 November 2010 Richard Humphries Senior Fellow The King’s Fund

2. From this –

3. To this – (insert montage of newspaper headlines – cuts, closures etc)

4. Headline issues › Financial challenges › NHS › social care › local government › impact on third sector › Public and patient expectations › Policy shifts › NHS White Paper › new vision for adult social care › localism › personalisation › Big Society › Dilnot Commission › Demography and technology

5. Tensions › NHS and social care interface › immediate service pressures › the NHS £1b for social care › testing local relationships › NHS and local government interface › opportunities for different relationships › service configuration – scrutiny role › focus on place and outcomes › leadership and management capacity › unresolved policy conflicts › organisational shifts – asymmetrical › competition and choice v collaboration and integration › localism v the postcode lottery › personal budgets and macro commissioning › pace and scale of change

6. What can be done ? – some ideas › assess the long-term resource needs of health and social care as a single whole system, not as separate services › synchronise financial settlements for the NHS and local government to make it easier to configure joint planning of resources › adopt rules for engagement to prevent local unilateral decisions and encourage sensible joint management of service pressures › make a stronger push towards pooling of budgets for older people (where progress has been slowest) › increase NHS spend on key social care services such as reablement that impact directly on patient experiences and outcomes › understand impact of NHS services on social care costs and outcomes › develop better local metrics to measure and manage how resources are being used › dialogue and conversations between local leaders