Important Considerations in the Coming Year

1. What is important in the coming year? David Behan Director-General, Social Care, Local Government and Care Partnerships, Department of Health ADASS Spring Conference April 2012

2. Economic Context • Budget confirms squeeze to 2016/17 • Need £10bn in more savings • Public spending – reduction of £80bn in four years • Economy will be 10-15% smaller than we thought it would be • Importance of productivity

3. OBR • 50% chance of reducing PSBR from 9.9% of GDP (10/11) to 1.5% in 2015/16 • Public spend 40% of GDP in early 2000s – return to 2002/03 level • Why an issue? GDP will be smaller than the Government assumed • 1.7% growth forecast in 2011 but revised to 0.81%. Slower growth pushes deficit higher • Longer term outlook – increase spend on long term care as % of GDP 1.2% 2015/16 to 2.0% in 2060/61 (health 7.4% to 9.8%)

5. What is important? • Quality • Dignity • Outcomes • How might this be taken forward? • Transparency and improvement • Behavioural insight / Nudge • Deregulation • PbR/SIBs etc • Community Budgets • Choice / personalisation • “Big Society”

6. Challenges • Ageing population; diversity; decline in sense of British identity • Disconnection government and the public – legitimacy and fairness

7. NHS Reform: CCG • Developing clinically-led commissioning • Empowering patients and communities • Developing the new public health system • Education and training • Health research • Informatics Source: the month, March 2012

8. Key milestones for commissioning development in 2012/13 • April-May 2012 – second checkpoint for CSSs (outline business plan) • April 2012 – final authorisation guidance issued by the Board Authority (further guidance may be issued by the Board) • May-June 2012 – development support for prospective CCG leaders; recruitment of CSS leaders and remaining NHS Commissioning Board senior leadership posts • July 2012 – first wave of authorisation applications (subsequent waves in September, October and November) • July – December 2012 – recruitment to remaining posts in CCGs, CSSs and the Board and agreement on when appointed staff will take up formal employment • August 2012 – third checkpoint for CSSs (submission of final business plan) • October 2012 – the Board becomes ENDPB; first set of authorisation decisions (subsequent decisions in November, December and January); decisions on hosting of CSSs • January 2013 – completion of authorisation decisions • April 2013 – the Board and authorised CCGs take on full statutory powers

9. Public health milestones 2012/13 • April 2012 - PCTs with local authorities to agree plans for the transfer of public health functions and teams to local authorities • Spring 2012 we will publish a consultation on a public health workforce strategy • Spring 2012 – appointment of chief executive designate and agree PHE structure • Early summer - all local areas will agree on the vision and strategy for the new public health role in local authorities • Summer 2012 – publication of full People Transition Policy (PTP) and establish the PHE staff transfer process • Autumn 2012 – publication of public health workforce strategy • April 2013 - PHE will be created • April 2013 - local authorities will take on new public health responsibilities

10. The interface between Local Government and DH • Great progress • Moving from legislation to implementation on health and care reforms • Health and wellbeing boards’ focus on building strong relationships and shared purpose - the foundation of collaborative leadership • Important to involve NHS Commissioning Board, Healthwatch, CCGs. Local Government is more advanced than partners – leading and driving implementation and creating new partnerships • Important that Local Government nurtures local Healthwatch - a genuine champion for communities and people using services • DH will continue to build a collaborative approach nationally working with the LGA, ADASS and others

11. Social Care Reform • In the current public spending environment, we need to make sure that we achieve sustainable reform. This is why we launched an engagement to discuss the key priorities for the reform of social care in September 2011. • Co-led by the Government and the care and support sector, ‘Caring for our future’ brought together the recommendations from the Law Commission and the Commission on Funding of Care and Support, alongside other key areas for change. • Over the period of the engagement exercise: - over 300 engagement events took place - more than 640 separate responses were submitted, in the form of letters, independent reports, feedback forms and website comments - over 14,400 people visited this website

12. What did we hear? (1/2) We heard that collectively we should: • Share responsibility for improving the system • Shift the emphasis to an approach which focuses on building individual and community assets • Empower people with choice and control through a universal offer for information, advice and care navigation for citizens balancing national and local information • Re-balance the social care market to encourage innovative and preventative action • Develop integrated and transformational leadership underpinned by a quality workforce

13. What did we hear? (2/2) • Strengthen the social care quality framework and build a system based on quality not cost • Develop shared outcomes measures, based on user/carer experience • Pilot direct payments in residential care • Mainstream housing and planning into care planning • Strike an appropriate regulatory environment for financial products

14. Market oversight and market shaping • Southern Cross highlighted the risks involved when a large, national provider fails - but this was within the context of a market which has been operating successfully for many years • It was successful because everyone at national and local level had a part to play • In October, we published a discussion paper on market oversight and are now considering what we have heard. We intend to outline our direction of travel in the White Paper • We are working with the sector on how to support the development of a diverse range of quality care and support services • For example - exploring how commissioning practices can focus on delivering quality and value for money, rather than on price alone • We are looking at how we can better support local authorities in understanding their local market and develop more collaborative relationships with providers

15. Think Local Act Personal • Over 30 national partners committed to real change in adult social care • Goal is to change systems and processes to help people access care and support – and ensure that people have better lives through greater personalisation • A successful first year for TLAP - mentioned as a model of good practice for sector-led improvement in Whitehall - and good budgetary control • greater involvement of users and providers than the previous arrangements - 'Making it Real' a powerful statement of user focus that has been recognised in the sector • this year's challenge is to get new organisations to sign up and commit resources, and address emerging policy issues - quality, and personalisation for older people and those with dementia. • What is the local equivalent at local level?

16. Dementia • There are 670,000 people in England with dementia, numbers are expected to double in the next 30 years. Dementia costs society an estimated £19bn a year. • The aim of the Prime Minister’s Challenge is to seek improvements in 3 overarching workstreams to take forward the National Dementia Strategy : • Raising awareness & dementia-friendly communities • Improving health and care • Research • DH will report to the Prime Minister in six months time, setting out progress on the Challenge. • Sarah co-leading with Sir Ian Carruthers

17. Mental Health • Last year we published a new mental health strategy - with a call to action agreed with ADASS and others • Now working with ADASS on an implementation framework to set out our priorities at local and at national level to implement the strategy • Local government will have leading role in promoting mental health and well being - because of the new public health responsibility role Implementation Framework will recommend – • Use community care & carers assessment to identify ways to support independence and promote recovery • Work with CCGs to remodel support for people using mental health services to focus on early intervention, personalisation & recovery and improve support for those with complex needs • Work with directors of children's services to improve transitions between children's and adult mental health services • Work with housing services to cut the use of out of area placements and high cost residential care services

18. Learning Disability • The Government is committed to improving outcomes for people with learning disabilities and to a vision of inclusion and equality • A key aim is to give people with learning disabilities, and the families who care for them greater choice and control over decisions which affect their lives • Health, housing and employment are priorities - improving access to high quality healthcare, employment and supporting people to live in their own homes. • The new Adult Social Care Outcomes Framework published on 31 March and effective from 2011/12 includes measures on employment and housing for people with learning disabilities.

19. Winterbourne View • The final report will be published once the other investigations and reports are completed - following the conclusion of the criminal proceedings and the Serious Case Review. • If this is delayed, the DH will publish an interim report in June • The main findings so far are: • All parts of the system have a role which they must play to drive up standards of care and prevent abuse - commissioners, providers, workforce, regulators and government. • Too many people with learning disabilities and behaviour described as challenging in assessment and treatment units - and staying there too long. • This model of care is outdated – we need people to be living in community settings with appropriate support • Nothing as bad as Winterbourne View has been found, but in many units there is evidence of poor quality of care, poor care planning, lack of meaningful activities and inappropriate use of restraint • There is confusion regarding roles and accountabilities in commissioning and providing care to improve individuals’ outcomes

20. Troubled families • - The Prime Minister has committed to turn around the lives of 120,000 troubled families by 2015. CLG is leading on the Troubled Families Programme, and DH is working with them on the health input. • - The programme is to be delivered by local authorities according to local need. Many local authorities have now appointed Troubled Families Co-ordinators to oversee the work. • - CLG recently published guidance for local authorities on identifying troubled families, which specifies that they consider particular priority health problems including: • emotional and mental health problems • drug and alcohol misuse • long term health conditions • health problems caused by domestic abuse • under 18 conceptions

21. Health inequalities • About addressing the unacceptable gap in health that we observe right across society. Life expectancy is at an all time high overall, but there are still areas where the poorest communities die more than a decade earlier than the richest ones. • The Act introduced statutory health inequalities duties – meaning that Secretary of State, NHS Commissioning Board, Clinical Commissioning Groups must all now demonstrate that they have regard to the need to reduce health inequalities in everything they do • No equivalent duty on LAs – but new role in public health, including ring-fenced grant for first time ever, will mean they have a massive contribution to make • SofS will have a duty to promote integration between health, health-related and social care services where this will have the effect of reducing health inequalities. • Particular acute focus on the very most vulnerable people - homeless and rough sleeps, migrants and asylum seekers, Gypsies and Travellers, and sex workers

23. Conclusion The political and economic challenge is unprecedented. Our leadership challenge is to: • Shape and take forward the reform of the care and support system • Embed the principles of quality and dignity at te heart of reform of services Leadership does make a difference – we need to support each other so we can “be the best we can be”