Adult Social Care

Budget Gap – 5 Year Forecast

Outturn 2014/15

Outturn Comparison 2013/14 & 2014/15

2013/14 2014/15

Budget £130.5m £132.7m

Expenditure £132.7m £133.6m

Variation £2.2m o/s £0.9m o/s

Outturn for 2014/15 is net of the following additional funding:

Section 256 £11.4m (£1.5m used against pressures)

Winter Resilience £0.8m

DTOC Grant £0.5m

* These amount to 7% of the Adult Social Care budget (excl LDPS)

Main Pressures 14/15

ASC Home Care £0.7m o/s

ASC Direct Payments £0.8m o/s

LD Residential (External) £1.3m o/s

LD Direct Payments £0.9m o/s

Care Act PressuresIn conjunction with South West ADASS colleagues we have been modelling the financial effect of the 2016 Care Act changes. These will require refining throughout the summer but the initial findings are as follows

• £4.3m total additional cost in 15/16 rising to £18.5m in 25/26• 150 new over 65 clients in 15/16 rising to 580 in 25/26. Cost

ranges from £1.7m to £8.8m• 2,700 working age adults receiving additional financial support

in 15/16 at a cost of £2.6m. This increases to 3,800 in 25/26 costing £9.7m

• Unknown number of carers assessments and support packages (census figure is 58,000 people)

More work to be done on this and considerable uncertainty regarding population not currently supported financially by Somerset County Council.

Fair Price for CareCurrent Domiciliary Care Hourly Rate Local Comparator Rates

Urban £15.84 p/h £15.51 - £17.59 p/h

Rural £16.68 p/h £17.65 p/h

Current Residential/Nursing Rates Local Comparator Rates

Residential £457.47 p/w £398 - £447 p/w

SRC £514.41 p/w £487 - £491 p/w

Nursing £584.32 p/w £570 - £595 p/w

EMI Nursing £614.12 p/w £590 - £633 p/w

For comparison the current approach to Continuing Health Care fee levels in Somerset is split across 3 levels:•Level 1 - £650 per week•Level 2 - £850 per week•Level 3 - Individual Fee Agreement

Adult Social CareADASS SOUTH WEST ADULT SOCIAL CARE IMPROVEMENT PROGRAMME

Adult Social Care

Areas of performance concern

•Personalisation (overall ASCOF 1C figure low)

•Personalisation (low number of PBs)

•Personalisation (no carers getting PBs or DPs)

•New residential and nursing placements high

•LD clients in paid employment low

•Delayed Transfers of Care high

Learning Disabilities

• LD demographic

Projected increase in the number people with a moderate to severe learning disbility in Somerset from 2012 to 2016

-2%

0%

2%

4%

6%

8%

10%

12%

14%

2012 2013 2014 2015 2016

Year

% In

cre

as

e

All age groups People aged 18-64 People aged 65+ and over

Projected increase in the number of people with a moderate to severe learning disability from 2012-2016

Learning Disabilities

Clients in receipt of long term care during the year 2014/15 (SALT definition):

Age Residential & Nursing

Community based

Total

18-64 302 1,151 1,453

65 & over 55 92 147

Spend v Other Authorities on LD

Learning DisabilitiesWhat are we doing to improve?

•Transition improved via the new strategy (SLT July 2015)

•Move to social enterprise

•Dedicated adult social care worker to review day services and move to employment where possible

•Generic teams to build on existing good practice and innovation

•Move away from risk aversion and paternalism

•Enabling people to take risks associated with lifestyle choices

•Asperger's

Assessments and ReviewsActions being taken to reduce backlogs

•Embedding new assessment and review processes to ensure optimise use of resources

•Monitored via “Performance Wednesday” reports

•QA process in place to ensure meet ASCOF criteria

•SOMs and team managers taking ownership for removing backlogs against agreed targets

•Implementation of local assessment “centres/ hubs” in SCC offices

Bridgwater local hub has been operational since 18th May in Morgan House

ASCWs spend 3 days a week in the hub and see on average 2-3 people a day

Learning to be shared with other areas

Safeguarding

Year Safeguarding Concerns received, April - May

Number accepted as safeguarding

% accepted as safeguarding of total concerns received

2014-15 535 181 34%

2015-16 774 307 39%

Safeguarding progress

•New governance arrangements for SAB

•Three year strategic plan

•SAB Board Manager

•Additional resources from CCG

•Implementation of MSP

•Audit system in place

•Dedicated safeguarding service in place

Deprivation of Liberty

• Deprivation of Liberty Safeguard (DOLS) is a legal framework within the Mental Capacity Act which authorises the deprivation of liberty of a person in a hospital or care home when the person lacks the capacity to consent to stay and to be subject to continuous supervision and control.

• When considering a DOLS it is important to remember this affects only individuals that have been formally assessed as lacking mental capacity to make an informed decision .

• The legal presumption is one of having capacity

Deprivation of Liberty

Strategic Commissioning

Reconfiguration to support the transformation, integration and policy change

•Contract management activity and staff transferred to ASC Operational Commissioning in May

Continuing to work closely with this team and procurement to ensure optimise skill sets by clearly defining roles, responsibilities and handoffs

•2 Strategic Commissioning Managers supporting the DASS to deliver strategic agenda

Internal focus to support transformation agenda and meet anticipated future demand profiles

External focus on the integration agenda

Health Integration

• Joint Commissioning posts for LD and Mental Health

• Better Care Fund and the role of Health and Wellbeing Board

• Integrated Outcome Based Commissioning Decision

“Health and social care commissioners in Somerset are seeking to move to an outcomes based commissioning (OBC) approach to contracting health and social care services, in an effort to improve outcomes for people in the county whilst promoting greater financial sustainability”

Health Integration

Advantages

•Potential to move money around the whole health and social care system (e.g. from acute hospitals to prevention/social care)

•Joined up services for people

•Less duplication of commissioned services/assessments

Disadvantages

•Less control/relinquish SCC budget

•Potential for model to be led by one LARGE provider

•Where does safeguarding and children’s services fit given that statutory responsibility remains with LA?

Our vision:

“People in Somerset will remain independent for as long as possible because we help their families and

communities give them the support they need to

reduce the risk of them losing their independence.

When people do need care or support this will be

through high quality, joined up social care, health and wellbeing

services. These should where possible enhance rather than replace their existing informal support

networks. People will be in control of the care and support services they

receive, so that these are delivered where, when, and by the people they want, and achieve the

outcomes that are important for them.”

Managing and Signposting Demand

• We need to help people to find solutions to their emerging social care needs without their having to become a ‘service user’.

• A key principle is to respond to needs in the most immediate and proportionate way.

• What can they do for themselves, with their family, in their community?

• Good information, advice and signposting is the key to this.

• Must be more ‘carer aware’, must always consider the potential use

Workforce by September

• First point of contact, assessment and support planning, safeguarding and quality and community hospital teams all in place

• By end June all key competencies and skills mapped for each role in the new OD

• JDs and evaluations for key roles completed by end July

• Staff and union consultations over July and August

• New OD in place September

• Review OD end February 2016

• Permanent workforce scoped and costed with plans in place to recruit staff

SUMMARY • Budget shortfall

Care Act Pressures Fair Price for Care

• Learning Disabilities Performance in key metrics needs to improve Actions in place, social enterprise

• Adult Social CareAssessments and reviews backlogs being addressedSafeguarding is improvingDoLs - pressureMental Health service issuesParity with Children's services and corporate risk

• Strategic Commissioning - Supporting the transformation agenda