Adult Transformation & Commissioning
Introduction
Background 5
National Picture5
Local Picture6
Section 2
Subsection 2.1
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Introduction
Over the years it has been recognised that there are significant pressures within the Health and Social Care system compounded by reducing budgets and increasing needs as people live longer. To ensure residents of Cornwall get the service they need the Health and Social Care system needs to think differently.
Adult Social Care saw the biggest reform in over 60 years to the system with the introduction of The Care Act 2014, The Care Act has been in force almost two years but it will take a while before the culture, practice and bureaucracy of the preceding legislation is eradicated. This is leading to inconsistency and inefficiency in many areas of the service. In comparison to the very best authorities with responsibility for social care, many people in Cornwall are not yet offered either a rapid response to their requests for help or real choice in how their needs could be met at home or as close to home as possible. Practitioners are struggling to cope with the demands placed on them, as are care businesses in Cornwall.
To transform Adult Social Care over the next three years to enable it to manage more effectively present and future demand.Notwithstanding significant budget increases in previous years the Service will need to manage within reducing resources in future years. The challenge will be managing demand for those with eligible unmet care needs or people with low levels of needs from entering the system through a range of preventative services that will avoid or delay the need for care and support. New ways of working will be in accordance with the way people wish to live their lives, maximising their independence. The programme will be underpinned by the values and principles of the Council’s Adult Social Care service, which are to provide care at home or as close to home as possible, including help into employment with appropriate support where this is needed.
It is proposed to organise the current and future strategies around three simplified themes to help reinforce the primary purpose of the service. These are;
- Shaping the road to 2020/21(Our direction)
- Care closer to home(Our operating model)
- Key to Life(Our enablers)
The drive to change is to strive for excellence bench marking against high performing councils to ensure that what is offered in Cornwall is sustainable, high quality services which are flexible to meet the grow population of Cornwall. The Adults Transformation and Commissioning service plans firmly cuts across 3 of the eight strategic aims for Cornwall Council
- Partners working together
- Healthier and Safe communities
- Being efficient, effective and innovative
Cornwall Council Strategy 2015 – 2020– to create a sustainable Cornwall
Adults Transformation and Commissioning Service is a new service currently led by an interim Service Director, interviews are underway. The service is made up of
Insert staff structure – Service director (tier 3) Head of… (tier 4) Service/Commissioning Manager (Tier 5)
Background
National Picture
Over the last five years councils nationally have removed around £5bn from their care budgets having seen a near 40% real terms reduction in funding since 2010. For authorities with social care functions (upper tier authorities) adult social care accounts for over one pound in three spent by councils. Around 28.5% of savings identified by authorities are in adult social care.[1] In one sense, the fact that social care’s contribution to total savings is less than its proportion of total budget, suggests that the service is being protected compared to other areas of local authority spend. However, the cash spent on adult social care has fallen from £14.5bn in 2010/11 to £14.1bn in 2015/16 compared to the National Health Service budget which has risen from £102bn to £116.4bn over the same period. By 2020 the Local Government Association estimates that local authorities will have a £5.8bn gap of which, £2.6bn in adult social care. Indeed recent research undertaken by the Association of Directors of Adult Social Services shows a projected overspend on adult social care in 2016/17 of £441m based on responses from 129 out of 151 authorities with social care duties[2]. This overspend is after the budgeted use of reserves, thus the underlying picture is likely to be problematic for a great many councils.
Local Picture
The controllable element of the budget is showing the combined overspend across Adult Social Care service areas will be £2.130m. This compares favourably to other large authorities in the south west and also nationally. It is acknowledged corporately that £4.5m of savings due to be made this year, is undeliverable in 2016/17 due to delays in progressing integrated commissioning, partly due to the financial and operational pressures in the local health system.
The overspend is of significant concern to both the directorate and senior leadership teams. Work is progressing well in minimising the projected outturn position. Cornwall Council overall has a strong record of delivering within budget and has one of the strongest balance sheets of any large English local authority. This is in comparison to the local National Health Service where the Clinical Commissioning Group has a reported deficit (overspend) of £53.7m for 2016/17.
The net revenue budget for Adult Social Care will increase from £126.3m to £146.2m by 2019/20 representing a £19.9m (16%) increase –over half of the earmarked growth; £13.1m is being delivered in 2017/18 alone.
Whilst the growth of c.£19.9m in the net revenue budget is a significant cash boost to the provision of Adult Social Care, the service will still need to deliver savings of £36.2m over the period to achieve financial balance. Furthermore over the past two years significant one off funding has been made available to the service outside of the net revenue budget mentioned above will not be available in future years. This totals £4.5m of funding from the Corporate Budget Equalisation Reserve and £6m of corporate contingency (£3m in each year).
Of the above cumulative savings challenge, £13.5m is currently dependent upon the integration of social care and health services (MTFP Savings reference AD8). This saving is a risk that has previously been highlighted by the Section 151 officer in the budget report to Cabinet on the 22nd November 2016. This report is focused on delivering the total quantum of savings required by Adult Social Care and as such covers the cumulative £13.5m of savings dependent on the integration of social care and health services.
There may be an impact arising from changes to legislation around the living wage which potentially adds to the cost of provision of home care during the 2017/18 financial year. In the Autumn Statement on the 23rd November 2016 the rise announced to the National Living Wage was £0.30p per hour.
Along with the National Health Service in Cornwall, the Council is committed to find new ways of working that will help the health and social care system eliminate a forecast gap based on projected future demand of c.£277m by 2020/21. Whilst joining up front line services where possible and integrating commissioning functions will undoubtedly improve efficiency and the user experience, alone they will not close the projected financial gap. Changing internal processes, procedures and culture should ensure that prevention, technological solutions and reablement are optimised to achieve improved outcomes and deliver a significant and sustainable contribution to the necessary need to manage demand very differently to today. These pressures are felt most acutely by all people who come into contact with either the National Health Service or Adult Social Care in a crisis.
The Children, Families and Adults directorate faces a number of critical challenges in the short and medium term:
It is forced into being reactive rather than proactive which results in buying too much of the things people do not want and at too high a price; e.g. where there is no capacity in care at home, a care home bed is purchased which is unlikely to deliver the best outcomes for the individual and create dependency.
Other contributing factors are:
- the rising average cost per person supported;
- waiting times for a service, including rising delays in discharge from acute hospital beds;
- the poor quality provided by some services and the number of care homes likely to be unfit for purpose in the near future;
On average Adult Social Care receives approximately 23700 requests for advice or help per year. This activity results in about 6600 statutory assessments being carried out. For older people, this means another 1990 packages of care are required with around 280 people having to be admitted to long term residential care. Spending on residential care now accounts for 58% of the annual purchasing budget for older people; 34% of spend is on buying domiciliary care.
If practice decisions matched that of the best performing councils, there would be 84 fewer people per year needing to be admitted to residential care to meet their needs. However, we will have to change how we respond to requests for help. Practitioners need to be able to signpost more people to alternative service and encourage people to take greater responsibility for their own care needs.This would reduce the number of people that have assessed unmet care needs and therefore needing access to adult social care. Once a person is assessed as being eligible it is necessary to undertake reviews; all of whichconsume vast amounts of practitioners’ and managers’ time meeting statutory procedures.
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Outcome 1: The Care Closer to Home programme
Evidence /- Where are we now? Current position and what is influencing the need for change, consider the needs of customers, residents survey feedback and staff feedback
Outcome /
- Where do we want to be and why?, consider why you are doing this and what you are trying to achieve
Aim/Objective /
- How are we going to get there
Actions
Link to Council Strategy / Business Plan / Corporate Business Plan 2016 – 2020
- Ambitious Cornwall
- Healthier and Safe Communities
- Partners working together
- Being efficient, effective and innovative
Comprehensive Impact Assessment
Performance /
- How will we know when we get there
- Consider performance and project tools
- Consider SMART performance measures and targets
- KPI and/or measures linked to outcomes and objective
Risks / What might stop us, consider potential and identified challenges risks and impacts, risks need to be identified, mitigated and managed for example via the CIA process
Outcome : The Key to Life programme
Evidence /- Where are we now? Current position and what is influencing the need for change, consider the needs of customers, residents survey feedback and staff feedback
Outcome /
- Where do we want to be and why?, consider why you are doing this and what you are trying toachieve
Aim/Objective /
- How are we going to get there
Actions
Link to Council Strategy / Business Plan / Corporate Business Plan 2016 – 2020
- Ambitious Cornwall
- Healthier and Safe Communities
- Partners working together
- Being efficient, effective and innovative
Comprehensive Impact Assessment
Performance /
- How will we know when we get there
- Consider performance and project tools
- Consider SMART performane measures and targets
- KPI and/or measures linked to outcomes and objective
Risks / What might stop us, consider potential and identified challenges risks and impacts, risks need to be identified, mitigated and managed for example via the CIA process
Outcome : Innovation sites
Evidence /- Where are we now? Current position and what is influencing the need for change, consider the needs of customers, residents survey feedback and staff feedback
Outcome /
- Where do we want to be and why?, consider why you are doing this and what you are trying to achieve
Aim/Objective /
- How are we going to get there
Actions
Link to Council Strategy / Business Plan / Corporate Business Plan 2016 – 2020
- Ambitious Cornwall
- Healthier and Safe Communities
- Partners working together
- Being efficient, effective and innovative
Comprehensive Impact Assessment
Performance /
- How will we know when we get there
- Consider performance and project tools
- Consider SMART performane measures and targets
- KPI and/or measures linked to outcomes and objective
Risks / What might stop us, consider potential and identified challenges risks and impacts, risks need to be identified, mitigated and managed for example via the CIA process
Outcome : The Transformation Programme
Evidence /- Where are we now? Current position and what is influencing the need for change, consider the needs of customers, residents survey feedback and staff feedback
Outcome /
- Where do we want to be and why?, consider why you are doing this and what you are trying to achieve
Aim/Objective /
- How are we going to get there
Actions
Link to Council Strategy / Business Plan / Corporate Business Plan 2016 – 2020
- Ambitious Cornwall
- Healthier and Safe Communities
- Partners working together
- Being efficient, effective and innovative
Comprehensive Impact Assessment
Performance /
- How will we know when we get there
- Consider performance and project tools
- Consider SMART performance measures and targets
- KPI and/or measures linked to outcomes and objective
Risks / What might stop us, consider potential and identified challenges risks and impacts, risks need to be identified, mitigated and managed for example via the CIA process
Outcome : Day Centres and respite care units
Evidence /- Where are we now? Current position and what is influencing the need for change, consider the needs of customers, residents survey feedback and staff feedback
Outcome /
- Where do we want to be and why?, consider why you are doing this and what you are trying to achieve
Community inclusion building on the Living Well, employment options for people with learning disabilities and those with mental health problems
Delivery of long term care and support.
Aim/Objective /
- How are we going to get there
Actions
Link to Council Strategy / Business Plan / Corporate Business Plan 2016 – 2020
- Ambitious Cornwall
- Healthier and Safe Communities
- Partners working together
- Being efficient, effective and innovative
Comprehensive Impact Assessment
Performance /
- How will we know when we get there
- Consider performance and project tools
- Consider SMART performance measures and targets
- KPI and/or measures linked to outcomes and objective
Risks / What might stop us, consider potential and identified challenges risks and impacts, risks need to be identified, mitigated and managed for example via the CIA process
Outcome : Quality Assurance – High Quality Commissioned Services
Evidence /- Where are we now? Current position and what is influencing the need for change, consider the needs of customers, residents survey feedback and staff feedback
Outcome /
- Where do we want to be and why?, consider why you are doing this and what you are trying to achieve
Aim/Objective /
- How are we going to get there
Robust action plans and recommendations that enables commissioning to make informed decision on continued commissioning
Strengthened relationship with the Adult Safeguarding Team that supports step up and down from organisational abuse
Sustain relationship with NHS Kernow for joint QA visits and sharing of information
Actions
Link to Council Strategy / Business Plan / Corporate Business Plan 2016 – 2020
- Ambitious Cornwall
- Healthier and Safe Communities
- Partners working together
- Being efficient, effective and innovative
Comprehensive Impact Assessment
Performance /
- How will we know when we get there
- Consider performance and project tools
- Consider SMART performance measures and targets
- KPI and/or measures linked to outcomes and objective
Risks / What might stop us, consider potential and identified challenges risks and impacts, risks need to be identified, mitigated and managed for example via the CIA process
Outcome : External Work Development and Traded Service
Evidence /- Where are we now? Current position and what is influencing the need for change, consider the needs of customers, residents survey feedback and staff feedback
Outcome /
- Where do we want to be and why?, consider why you are doing this and what you are trying to achieve
Aim/Objective /
- How are we going to get there
New elearning platform which is easier for providers to access and enables training to be offered as a traded service
Actions /
- Identify elearning platform
- Workforce needs analysis
Link to Council Strategy / Business Plan / Corporate Business Plan 2016 – 2020
- Ambitious Cornwall
- Partners working together
- Being efficient, effective and innovative
Comprehensive Impact Assessment
Performance /
- How will we know when we get there
- Consider performance and project tools
- Consider SMART performance measures and targets
- KPI and/or measures linked to outcomes and objective
Risks / What might stop us, consider potential and identified challenges risks and impacts, risks need to be identified, mitigated and managed for example via the CIA process
Outcome 10: Workforce Planning[CD1]