1. Herefordshire Public Services Consultation on local priorities Improving the way we fund and prioritise services

2. Introduction Please tick the one answer which best represents your response to each question When completed please return it to us in the Freepost envelope provided.

3. What will happen after the events?  We will bring together the responses from all the events  We will look at the findings and use it to help us plan our priorities.  We will feedback to local people about how the feedback has influenced our decision making.  We may not be able to do everything suggested, but we will be clear if we can’t and tell you why not.

4. Overview - finance Comprehensive Spending Review 2010 – aimed at deficit reduction Cuts to councils of 27% in cash terms (front loaded) Council savings target 2012/13 estimated £8m Key Financial Risk - Adult Social Care Other pressures e.g. waste disposal, children’s safeguarding Financial position for 2013/14 uncertain -changes to local government funding

5. Finance – where the money comes from

6. Finance – where the money is spent

7. Finance question 1 1.Should the council prioritise the funding of services for vulnerable people at the expense of other services? e.g. the elderly; vulnerable young people; people with learning and physical disabilities

8. Finance question 1 answers  Strongly agree  Agree  Disagree  Strongly Disagree

9. Finance question 2 2.Would you accept the council not providing some services if it means it protects and develops other ones ?

10. Finance question 2 answers  Strongly agree  Agree  Disagree  Strongly Disagree

11. Finance question 3 3.Would you be willing to pay more council tax to help protect services?

12. Finance question 3  Strongly agree  Agree  Disagree  Strongly Disagree

13. Finance question 4 4.Where there is a sound case to do so do you think the council should get other organisations to provide more of its functions?

14. Finance question 4 answers  Strongly agree  Agree  Disagree  Strongly Disagree

15. Finance question 5 5. Should we increase the support available to help people access services on-line? E.g. Improve Broad Band coverage, increase public internet access points, etc.

16. Finance question 5 answers  Strongly agree  Agree  Disagree  Strongly Disagree

17. Finance question 6 6. Do you think you or your town or parish council could get involved in delivering some services?

18. Finance question 6 answers  Strongly agree  Agree  Disagree  Strongly Disagree

19. Finance question 7 7. Is it appropriate that the council transfers buildings and assets to local groups to deliver services of benefit to the community?

20. Finance question 7  Strongly agree  Agree  Disagree  Strongly Disagree

21. Adult Social Care Demographic changes and financial pressures are creating challenges for Adult Social Care nationally The county has a relatively older profile compared to the national average. The Government expects that all adults using social care services will have a personal budget by 2013

22. Adult Social Care The council follows Government guidance to ensure people don’t pay more than they can afford to when charging for services. The Government says that people who have savings over £23,250 are able to pay the full cost of services. We have to apply that rule as do all other councils.

23. Adult Social Care Current policy means that some people pay less than they can afford to because services for day care, meals and transport are subsidised Work is underway with care providers in the County to re-design day care and meals giving people more choice and control over the services they receive. The cost of care provided varies widely across services. If charges are based on the actual cost of care people receive, this could lead to some people paying more for services but not more than they can afford to pay

24. Adult Social Care - Question 1 information We are introducing personal budgets for all people who are assessed as needing services. We want to make sure that charges are fair no matter how people choose to arrange their support.

25. Adult Social Care - Question 1 information One option is to remove all current subsidies which would mean that those that can afford to pay the full cost of services will do so.

26. Adult Social Care – Question 1 1.We think people should pay the full cost for services such as home care, day care, transport and meals where they can afford to. Do you agree?

27. Adult Social Care – Question 2 Answers  Strongly agree  Agree  Disagree  Strongly Disagree

28. Adult Social Care - Question 2 information There are different ways for us to work out how to set charges under a new system, we could a) set an average charge, this means everyone would pay the same for the service b) charge the actual cost, this would mean if someone needed less care, they may pay less but others would need to pay more

29. Adult Social Care – Question 2 2. Which way do you think is best to charge?

30. Adult Social Care – Question 3 answers  Average  Actual Cost  Don’t Know

31. Health Care in Herefordshire People in Herefordshire enjoy a good standard of health and wellbeing. Life expectancy is higher than the England average for both men and women. Compared to the rest of England, children born in Herefordshire are less likely to die in infancy and can expect to spend a greater proportion of their lives in good health.

32. DescriptionExpenditute £% NHS Providers £ 187,341,27664.47 Non NHS Providers £ 23,735,9688.17 Prescribing £ 32,419,26911.16 Primary Care Infrastructure £ 6,303,7302.17 Primary Care Contracts £ 22,524,0037.75 Dental £ 7,098,0942.44 Misc £ 11,152,2743.84 Total £ 290,574,614 NHS ProviderExpenditure £% Wye Valley NHS Trust £ 113,400,00061% 2gether Mental Health FT £ 16,606,7979% Gloucester £ 8,309,1034% Birmingham £ 4,353,6862% Worcester £ 4,588,9232% Other £ 40,082,76721% Total £ 187,341,276 Current NHS Expenditure in Herefordshire

33. Percentage Mortality by Cause Nearly all of these causes of mortality are influenced by unhealthy lifestyle behaviours

34. A higher than average ratio of older people within the local population with a higher prevalence of long term conditions, such as dementia and diabetes. Increased public expectations of public sector services resulting in growth in demand for services Inequalities in access to services and the health and social care outcomes achieved for different social groups within Herefordshire Serving a dispersed rural community at a local level A reduction in public sector resources Smoking remains the single most important cause of premature death, ill-health, and hospital admission in Herefordshire. Rapidly rising rates of alcohol-related hospital admissions. Obesity is a major contributing factor to poor health, disability and premature death. Health related challenges in Herefordshire

35. Healthcare Question 1 1.NHS Herefordshire spends around 65% of its budget on Hospital Care. Would you like this to continue or would you like more to be spent on community services?

36. Healthcare Question 1 answers  Continue current funding  Invest more in preventing illness  Invest more in community services  Invest more in hospital care

37. Healthcare Question 2 2.Please rate the access to healthcare services in Herefordshire:

38. Healthcare Question 2 - answers  Very Good  Good  Poor  Very poor

39. Healthcare Question 3 3.If you have a bad cold that you cannot treat yourself where would you most likely go to receive treatment?

40. Healthcare Question 3 answers  GP  Pharmacist  Walk in Centre at ASDA (Hereford)  Minor Injury Unit  A&E Department at Hospital

41. Healthcare Question 4 4.If productivity improvements saved £100k would you prefer this to be reinvested in the prevention or treatment of disease?

42. Healthcare Question 4 answers  Disease prevention  Treatment of disease

43. Overview - Health and Wellbeing Vision for Health and Wellbeing: “Working with people in Herefordshire to live independently and to be safe and well”.

44. Overview - Health and Wellbeing We will do this by encouraging people, and their communities, to help themselves and, where necessary, ensure access to advice, care and support which is financially sustainable, of high quality, timely, accessible and innovative.

45. Overview - Health and Wellbeing We want to raise the profile of health and wellbeing with local people and; We’d like to talk you about the things which will improve your health and wellbeing.

46. Health & wellbeing – Question 1 information The cost of falls-related admissions for older people in Herefordshire is substantial and could be reduced through strength and balance training, assessment of hazards in the home, assessment of vision and medication review.

47. Health and wellbeing – Question 1 1.People can do things which will help them stay independent and well throughout their life.

48. Health & wellbeing – Question 1  Strongly Agree  Agree  Disagree  Strongly Disagree

49. Health & Wellbeing – Question 2 information Circulatory disease is the single largest cause of long term ill-health and disability in Herefordshire. Smoking, being obese and type 2 diabetes are all causes of circulatory disease.

50. Health & Wellbeing – Question 2 2.People need to do more to help themselves stay well.

51. Health and Wellbeing – Question 2  Strongly Agree  Agree  Disagree  Strongly Disagree

52. Health & wellbeing – Question 3 Obesity and lack of physical activity are major contributing factors to poor health, disability and deaths in Herefordshire. These are major risk factors for strokes and myocardial infarction (heart attacks). Obesity levels are rising year on year and physical activity levels are low.

53. Health & wellbeing – Question 3 3.Services should focus on helping people change unhealthy behaviours.

54. Health Priorities – Question 3  Strongly Agree  Agree  Disagree  Strongly Disagree

55. Thank you Your answers have been very useful and will be collated with feedback from other localities.