1. Use of Resources Summit: Opportunities & Challenges to Making Changes John Jackson Director for Social & Community Services Oxfordshire County Council

2. Some key questions Why is this so important? What is the context? What do we know already? What does this document tell us? How can we help others? What uncertainties/opportunities do we face? What are the key messages?

3. Why is this so important? We have a duty to both service users and taxpayers to spend public money well We have faced significant financial pressures over the last few years. These are getting worse In Oxfordshire, we have delivered £20m over the last 3 years but.. Need to find another £50m over the next 5 years (25%) NHS needs to find £240m over 3 years (from 2011/12) – 30% Nationally NHS needs to find up to £20bn

4. What is the context? Nationally history of efficiency savings; improving financial management; mixed picture of working with the NHS; Putting People First Oxfordshire Effective medium term planning Strong financial management since problems in early 2000s Very good working relationship with NHS going back over 10 years Mixed performance in terms of value for money and service performance

5. What do we know already? Relatively low level of spend on adults with Learning Disabilities and good service outcomes Relatively high spend on Older People and middle of the range outcomes High spend not because of high use of residential care but high unit costs Performance on PD and Mental Health in the middle Assessment and care management costs may be high

6. What does this document tell us? Learn from Dudley what they have done by process mapping their assessment process Visit Croydon to find out what they are doing to avoid admissions to hospital Find out how we can reduce our level of spend on residential care for older people from over 50% to 40% (like Windsor & Maidenhead and West Berkshire) Are we developing extra care for dementia like Hertfordshire have?

7. What does this document tell us? What can we learn from what North Yorkshire are doing on telecare? What can we learn from the Just Checking system that is being used in Staffordshire, Herefordshire and Warwickshire? What do we think about Norfolks night owls service or Salfords Rapid Response Service? Look at what Thurrock are doing with their day centres for adults with learning disabilities. We are already planning to visit Devon with the PCT to see their complex care teams

8. How can we help others? Oxfordshire is doing good work on: Adults with learning disabilities Adult Placements If day services for older people have a future under self-directed support, then we have one very good model in Bicester Continence

9. How can we help others? Much good practice elsewhere in South East Examples given earlier Milton Keynes: working with the NHS Kent Card Buckinghamshire: low spend on older people but good outcomes East Sussex: prevention POPP Surrey: demonstrator site for User Led Organisation Work of the Joint Improvement Partnership (JIP) Work of Improvement and Efficiency South East

10. What uncertainties/opportunities do we face? Uncertainties: Comprehensive Spending Review 2010 Impact of self-directed support – what services will be used? Future funding arrangements: will they help or hinder the search for value for money? Uncertain public expectations and understanding Opportunities: Savings through prevention and early intervention (but need more information) Working effectively with the NHS using the fact that they are under significant financial pressures as well. Total Place? If you have to go on a diet, the best time is when youve been extremely well fed

11. Key Messages We have to embrace this if we are to survive We will let down vulnerable people if we dont take this seriously We must make sure that we have sufficient management capacity to do this well We must use the fact that the NHS is under serious financial pressures for the first time in over 10 years to improve joint working so that we get better value for money from our joint resources We have a duty to share good practice and learn from others