SUPPORTING PEOPLE TO LIVE AND DIE WELL EAST MIDLANDS REGIONAL OVERVIEW 11 JANUARY 2011

1. SUPPORTING PEOPLE TO LIVE AND DIE WELL EAST MIDLANDS REGIONAL OVERVIEW 11 JANUARY 2011 MICK CONNELL DIRECTOR OF ADULTS AND COMMUNITIES

2. Key issues and concerns and end of life care • Context • Personalisation • Partnership • Efficiency • The Challenge Ahead

3. Context • Coalition Government • Massive Changes: • Localism • NHS White Paper • Big Society • Financial Climate • What does it all mean for us?

4. Personalisation in Leicestershire Putting People First (PPF) Self-Directed Support

5. New Customer Pathway Adult Social Care Service Community Customer Service Centre Re- ablement RAS  Support Plan  Personal Budget Advice & Information Prevention & Early Intervention Review Support in place. Live your life. Outcomes met

6. PPF is everyone’s business • Transport • Volunteering • Social Inclusion • Community development • Creative provider services • Information and advice access points • Regeneration and social enterprises • Transitions

7. Think Local, Act Personal • Next steps for Transforming Adult Social Care (PPF2): • A proposed sector-wide commitment to moving forward with personalisation and community based support • Building on progress, recognising the new political and financial climate • A vision for Adult Social Care: Capable communities and • active citizens • The 7 P’s – key principles for a modern system of social care

8. Encouraging continued reform • Personalised care and support (direct payments is the • preferred delivery model for most) • Preventative, community-based approaches • Integrated service delivery • Supporting the continuation of individuals, families and • communities • Reducing the need for acute health care and support • Reducing duplication and improving outcomes

9. Partnership • “shifting the power from the state to the people, where people, in their every day lives, in their homes, in their neighbourhood, in their work place ….. don’t always turn to official, local authorities or central government for answers to the problems they face”. (David Cameron July 2010) • Continuation of Putting People First - Capable communities and • active citizens • Principles extended to the NHS – “No decision about me without • me” • Collaboration and strong partnership horizontally and vertically • At the same time government wants to curb local government • spending and the expectation is for councils to comply with the • policy and the requirements to reduce overall public expenditure.

10. Key elements of the Adult Social Care Vision andNHS Equity and Excellence: Liberating the NHS • Key Principles • Adult Social Care Vision • Partnership • Prevention • Personalisation • Plurality • Protection • Productivity • People • Key Values • Principles for the NHS • Putting Patients and public first • Improving healthcare outcomes • Autonomy, accountability and democratic legitimacy • Cutting bureaucracy and improving efficiency

11. Direction of travel for Adult Social Care and the NHS • Adult Social Care Vision • Breaking down barriers • Extending roll out of personal budgets • Increasing use of direct payments • Making services more personalised • and more preventative • Focused on outcome • Devolving power to frontline workers • and carers • Stable financial base for next 4 years • Equity and excellence: Liberating the NHS • Is centred on patients and carers • Achieves quality and outcomes • Refuses to tolerate unsafe and substandard • care • Reduces inequalities in care • Puts clinicians in the driving seat and sets • hospital and providers free to innovate • and adopt best practice • Is transparent and accountable for quality • Citizens have a greater say in how the NHS • is run • Is efficient and dynamic with reduced • bureaucracy nationally, regionally and locally

12. Implications for Adult Social Care • Challenges • Continuous and rapid change for next 3 years • NHS and Adult Social Care required to achieve unprecedented efficiency gains despite increase and growth in funding • Invest in Prevention – identify models to suit all groups • Meeting needs and addressing inequalities • GPs responsible for commissioning majority of services • New governance arrangements for Health and Wellbeing Boards • Capacity building, culture shift and embedding the new structure • Opportunities • Leadership role for Adult Social Care at all levels • Ambition to increase quality through implementing best practice and increase options for prevention • Integrated re-ablement with investment for NHS long term conditions and improved responses to hospital discharge • Increase profile for public health • ASC will have major role for integration both in commissioning and service • Better intelligence on needs (JSNA/mortality profiles)

13. Efficiency • It’s grim! • Some councils are affected more than others • Maximise efficiency in any way possible • Service reductions are inevitable • A new, more sustainable model is needed: • state and individual • new funding arrangements for social care

14. Population • Still growing • Growing ever older and more diverse • 65+ Generation have £1trn of assets - in 2020 their assets will • exceed GDP and exceed national debt • Adults with complex needs are fastest growing and highest • demand client group for care and support - they have few assets • Inequality of health, wealth and opportunity widening

15. Health and Social Care • Putting People First - delivering but is it enough? • National Care Service - is there political will for a step change? • Integration - why this time? • Quality and innovation - can commissioning deliver?

16. Transformation • Putting People First • Personal budgets • Self Assessment • Independence at home • Shift from day and residential services • Prevention and re-ablement • National Care Service • Prevention and reablement • One assessment • One service • One budget • All pay/some pay? • Pay now/pay later? National / Local How far / How fast?

17. 3 stages 2009 2014 … Efficiency System Reform Manage Impact Maximise efficiency Speed up reform Squeeze costs Make case for Radical change • Deliver system • Change • Health • Local Government • Total Place • New Offer • Commercial options • Political repositioning • Either … • -Implement new • Offer and funding • Model or .. • Reduce core • Services and manage • Community impact

18. Common efficiency priorities • Review eligibility, high cost placements and Resource • Allocation System [how much does each individual get?] • Review, rationalise or reduce residential homes and day • services (including supported employment) [closing high cost, • inflexible, in-house services] • Reduce overheads through management restructures, • customer centres, higher productivity assessment and care • management [organising a lower cost system] • Stopping or reducing uplifts to providers and voluntary • organisations [passing efficiency targets on to the market and • partners]

19. The Future: Adult Social Care rising to the challenge

20. Key issues • Build a sustainable model • Empower individuals • Supporting carers and families • Cradle to grave • Getting the culture right • Reflecting diversity • Skilling up our workforce • Integrated approaches • Working together • Having confidence in ourselves

21. and don’t forget • TRUST and OPTIMISM