Joint Working in a Cold Climate
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Transcript of Joint Working in a Cold Climate
Joint Working in a Cold Climate
NHS Confed Conference7th July 2011
Peter HayADASS President
Contents
Social Care – the long big gap
• 1999 Royal Commission
• 2006 Kings Fund Wanless Report
• 2008 HM Govt. “Why England Needs a New Care and Support System” estimates a £6bn gap over the next 20 years.
• 2011/12 ADASS finds whatever the gap, a further £1bn is the reduction from councils
• 2012/14 ADASS estimates a further £1bn
Reform isn’t just resources
• Fewer people received help whilst resources increased and eligibility stayed fixed
• People find the care system complex to understand and navigation difficult
• People do not understand who pays for what
• Changing needs and an outdated model are a bad combination
Spending review impact
Protecting health and education spending mean a significant reduction in funding for local government.
This is with £1bn transferred from NHS in the bottom line
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Core City Slide
• Append 2b council plan
ADASS Budget Survey – May ‘11
• Councils are reducing their budgets for adult social care by £991M, representing a 6.9% reduction against a 10% reduction in overall spending by councils.
• Councils are reducing by £169M their spend on Supporting People.
• 13% of councils are changing their FACS criteria. There are now 78% councils at Substantial in 11/12 compared to 70% in 10/11 and 4% at critical only.
• 79% councils have frozen or increased fees to providers.
• £425m of demographic pressures were identified with 41% of councils fully funding these pressures.
ADASS Survey – joint monies
• The full amount of the reablement resources has been identified with strong levels of agreement with the NHS on areas of spend.
• 95% of the Winter Pressure allocation was identified, with 89% of councils reporting agreement on how this allocation will be spent.
• The full year NHS Transfer (total of £650k?) is still to be determined with 57% not yet agreed
• Carer’s money – more importantly- strategies appears slow to impact
Consequences showing in Year One
• Instability to the already long unstable care system
• Blaming cuts misses the gaps!• Plenty of challenge – post Birmingham
ADASS survey shows 20 councils with JR challenges to budget (eligibility, fees and )
• Move to Clusters means that radical changes for enablement, QIPP etc are probably slow off the mark
Potential Impact of Year Two
• Update from survey
Less hindrance to integrate than 2010?
Source: NHS/Confed Where Next for Health and Social Care Integration, June 2010
Performance Regimes
Financial pressures
Organisational complexity
Changing leadership
Financial complexity
Cold Climate Consequence
• Money will get worse before it gets better
• Dilnot proposals for reform and resources
• The unintended Dilnot/Gloucester trap – eligibility frozen whilst it is the only legal tap on resource
• Local reforms slow off the ground?
• Known hindrances appear to have strengthened
How do we warm up?
• Prepare for worse to come
• Quickly make up ground for transformation of health and care
• Ensure together we get Dilnot addressed
• Recognise that great health and care are interdependent (not exclusively)
• Use the obvious wins (Kerslake/Glasby) in QIPP
Citizen purchased care – own resources
MEANS
NEEDS Enablement
Support and information offer
Citizen purchased care – state resources
Prevention
Citizen purchased care – own resources
Transformation model for reducing resources
‘A wider service offer’