West Midlands ADASS
- A Regional Summary and Perspective
Challenge Workshop – 4 April 2014
SLI is a Journey – and not
always predictable!
www.hascc.com wmadass 4 April 2014
2
The Purpose of Regional SLI
 Share Good Practice (regionally)
 Learn from Others (nationally)
 Encourage Networking
 P...
Our Regional Structure
 The Improvement and Efficiency West Midlands
Board, involving Chief Officers and Members,
oversee...
The Components of SLI
 Regional Networks: such as Performance and Improvement, which collates,
analyses, and promotes Cou...
Additional Work
 Annual Challenge Workshop – 4 April 2014: DASSs
to do a mini-challenge with each other and
common streng...
Other Perspectives on SLI/Peer
Challenge (1) – what balance?
www.hascc.com wmadass 4 April 2014
7
Other Perspectives on SLI/Peer
Challenge (2) – where are you?
www.hascc.com wmadass 4 April 2014
8
How Has it Made Any
Difference? (1)
 It’s shaped our Regional business plan which has 3 key
elements: Integration, Preven...
How Has it Made Any
Difference? (2)
 Some general learning points and improvements have
been:
 Experts by Experience bei...
How Has it Made Any
Difference? (3)
 The Challenge Team has to be both fair and robust –
two Challenges have resulted in ...
How Has it Made Any
Difference? (4)
DASS Comments:
 gave a wake up call, and major impetus to a review, on
personalisatio...
Summary and Personal
Perspective on Strengths and
Other Observations (1)
 There have been some major strengths identified...
Summary and Personal
Perspective on Strengths and
Other Observations (2)
 Observations:
o Adult safeguarding has been ass...
Summary and Personal
Perspective on Strengths and
Other Observations (3)
o Councils are moving gradually towards co-
produ...
Summary and Personal
Perspective on Strengths and
Other Observations (4)
o There is limited evidence of any links between ...
Summary and Personal
Perspective on Strengths and
Other Observations (5)
 More on the Money: To state the obvious, the Us...
Summary and Personal
Perspective on Strengths and
Other Observations (6)
 Plus:
o The IFS said the Chancellor’s extension...
Summary and Personal
Perspective on Strengths and
Other Observations (7)
 NAO - ASC in England Overview Report March 2013...
Summary and Personal
Perspective on Strengths and
Other Observations (8)
 The Health Foundation and Nuffield Trust Report...
Summary and Personal
Perspective on Strengths and
Other Observations (9)
 Barker Commission Interim Report 3 April 2014:
...
Summary and Personal
Perspective on Strengths and
Other Observations (10)
 Regional: Analysis of 3 Councils from Budget
P...
Summary and Personal
Perspective on Strengths and
Other Observations (11)
 The Commissioning Response:
o Exhaust efficien...
Summary and Personal
Perspective on Strengths and
Other Observations (12)
 Questions?:
o Does the commissioning response ...
Summary and Personal
Perspective on Strengths and
Other Observations (13)
 Summary:
o If SLI, Transformation, and Savings...
Conclusions
 There has been good progress over the last year with all the
foundations stones in place for an effective Re...
Recommendations -
Process:
 Self-assessment template - any changes?
 Submission date of the new self-assessment to be ag...
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Wmadass challenge workshop 4 April 2014

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Wmadass challenge workshop 4 April 2014

  1. 1. West Midlands ADASS - A Regional Summary and Perspective Challenge Workshop – 4 April 2014
  2. 2. SLI is a Journey – and not always predictable! www.hascc.com wmadass 4 April 2014 2
  3. 3. The Purpose of Regional SLI  Share Good Practice (regionally)  Learn from Others (nationally)  Encourage Networking  Provide Support  Celebrate Innovation  For the WM ADASS Branch to provide Leadership and Accountability on SLI www.hascc.com wmadass 4 April 2014 3
  4. 4. Our Regional Structure  The Improvement and Efficiency West Midlands Board, involving Chief Officers and Members, oversees all SLI activity  There is an Adult Social Care SLI Board chaired by a Chief Executive that is responsible for driving and monitoring progress on the SLI programme – this involves the LGA and CQC  The Performance Network, the Head of Adult Social Care/IEWM, and the Peer Challenge Programme Lead report to the WM ADASS Branch which provides the leadership on SLI www.hascc.com wmadass 4 April 2014 4
  5. 5. The Components of SLI  Regional Networks: such as Performance and Improvement, which collates, analyses, and promotes Council ASC performance ; CHC; Assistive Technology; Safeguarding; Carers and Dementia Care  Regional Improvement Projects: Winterbourne View; Smarter Commissioning; Dementia Friendly Communities; Improving Personalisation etc  Self-Assessment and Performance Data: against 6 domains related to ASCOF (S/As 12-33 pages in length), and regional performance data has been collated with comparisons for national, regional and family group averages. DASSs have the option of a 1:1 challenge on their self assessment and data  Peer Challenge Programme: 3.5 day peer challenge involving Experts by Experience and Cabinet Members  Offers of Support: Examples include a LA with a high recurring overspend and a follow-on advisory role following a peer challenge  Learning Events: Making It Real; CHC Learning Disabilities; Making It Work – health and social care integration. A dedicated website has been set up: http://hscwm.org.uk/ www.hascc.com wmadass 4 April 2014 5
  6. 6. Additional Work  Annual Challenge Workshop – 4 April 2014: DASSs to do a mini-challenge with each other and common strengths and areas for improvement to be identified  Risk Triggers: the Region to consider: looking at what other Regions have done, such as the North West, and to seek to have a small number of risk triggers to provide early warning signs for requesting/providing support www.hascc.com wmadass 4 April 2014 6
  7. 7. Other Perspectives on SLI/Peer Challenge (1) – what balance? www.hascc.com wmadass 4 April 2014 7
  8. 8. Other Perspectives on SLI/Peer Challenge (2) – where are you? www.hascc.com wmadass 4 April 2014 8
  9. 9. How Has it Made Any Difference? (1)  It’s shaped our Regional business plan which has 3 key elements: Integration, Prevention/Use of Resources, and Care Bill Implementation  The Region has focussed on some areas of low performance – DToCs and Out of Authority placements/LD, and made improvements  The Regional Peer Challenge programme has been completed in 6 Councils – nearly half of the 14 Councils in the 1st year  The scope for Peer Challenges has included: progress on personalisation; assessment of savings plans; adult safeguarding; commissioning to reduce demand and promote community self-reliance and support; and the effectiveness of prevention/reablement support www.hascc.com wmadass 4 April 2014 9
  10. 10. How Has it Made Any Difference? (2)  Some general learning points and improvements have been:  Experts by Experience being a part of the Challenge Team brings a different perspective and challenge, especially on assessing progress on areas like personalisation and co-production  We started with the duration being 2.5 days but after the first Challenge extended this to 3.5/4 days to give greater breadth and depth to the process  Each Team benefits from a 12-14 page summary of the Council's performance/self assessment with a planning meeting in advance – the summary reduces the reading and the meeting helps the team understand their roles, and also allocates tasks/parts of the scope www.hascc.com wmadass 4 April 2014 10
  11. 11. How Has it Made Any Difference? (3)  The Challenge Team has to be both fair and robust – two Challenges have resulted in “detailed dialogue” with either the Chief Executive and/or the DASS both during and after the Challenge visit. One has received on-going support from the lead DASS  Another Council, outside the peer challenge programme, has received an external appraisal of its budget position and savings plans  The host DASSs have stated that the Peer Challenge: www.hascc.com wmadass 4 April 2014 11
  12. 12. How Has it Made Any Difference? (4) DASS Comments:  gave a wake up call, and major impetus to a review, on personalisation;  had insufficient evidence for some conclusions;  “since the report (and the feedback) I have spent a lot more time with front line staff and we have developed a clearer strategy for customer engagement in some of our programmes. I have also made a greater priority to engage with wider stakeholders – especially the voluntary sector”;  gave us some new ideas and highlighted key risks for our strategic change programme; and  convinced me of the benefits of a MASH (Multi-Agency Safeguarding Hub) www.hascc.com wmadass 4 April 2014 12
  13. 13. Summary and Personal Perspective on Strengths and Other Observations (1)  There have been some major strengths identified in each Peer Challenge:  Carers services and support in Telford & Wrekin  The new operating model for reablement and early intervention in Walsall  The vision for IT enabled self assessment which includes sign posting, triage, safe guarding triggers and user feedback from providers in Worcestershire  Prevention services/support for adult safeguarding, and the Board arrangements in Dudley  The MASH for both children and adults in Stoke (and Staffs)  The POD in Coventry – a very personalised and outcome based recovery programme in mental health services www.hascc.com wmadass 4 April 2014 13
  14. 14. Summary and Personal Perspective on Strengths and Other Observations (2)  Observations: o Adult safeguarding has been assessed to be sound in the two Councils where it was the main scope o Safeguarding Adult Boards should be more rigorous in their oversight and monitoring of action plans on Winterbourne View and the Francis Report (especially the latter) o Progress on personalisation is patchy and performance is comparatively low (against the CIPFA family groupings) for a number of Councils o There is not a sense of a strong culture of personalisation being embedded in some Councils and the Making it Real priorities are not always completed www.hascc.com wmadass 4 April 2014 14
  15. 15. Summary and Personal Perspective on Strengths and Other Observations (3) o Councils are moving gradually towards co- production with people who use services, but it is not always evident o Black and Minority Ethnic Communities are rarely referred to in self-assessments and there is limited attention to, or presentation of, their needs and responses by host Councils during visits o Often, early intervention and prevention, including reablement, are put forward as the main transformation initiative, but there has been a lack of a detailed, robust business case behind some such plans – and the scale/pace is often moderate www.hascc.com wmadass 4 April 2014 15
  16. 16. Summary and Personal Perspective on Strengths and Other Observations (4) o There is limited evidence of any links between early intervention and prevention, and to Corporate leadership, as opposed to Adult Social Care, on Councils helping communities to help themselves ie. community asset building o Budget and Resource plans are extremely demanding in all Councils. Some may be unrealistic without a fundamental review, particularly by those Councils in which existing savings have not been achieved and which are over-spending o Further integration plans with the NHS are in their initial stages and no Council that has had a peer challenge has chosen to go down a route of wholesale integration – this is an observation, not a criticism www.hascc.com wmadass 4 April 2014 16
  17. 17. Summary and Personal Perspective on Strengths and Other Observations (5)  More on the Money: To state the obvious, the Use of Resources is a challenge for all Councils. Specific comments -  What we know of the national position (ADASS): o Local Government is faced with funding reductions of 33% over 4 years – approximately 8% a year. 2015-17 cuts will be at the same rate o In contrast, total public spending is being reduced by 8% over 4 years o The net spending on adult social care is £13bn o Equals: 34% of total local govt spending (£39bn) o Total annual savings from ASC are £2.68bn by March 2014 – 20% of net spending www.hascc.com wmadass 4 April 2014 17
  18. 18. Summary and Personal Perspective on Strengths and Other Observations (6)  Plus: o The IFS said the Chancellor’s extension of austerity to 2018/19 means that by the end of this financial year, 60% of planned spending cuts will be yet to come o ASC remains a large part of local government costs and will need to contribute to savings, whilst demand grows via demographic changes o Impact: 35% of Councils have reduced the number of older people using services by more than 40% between 2005/6 and 2012/13 (ageuk) o 896,000 65+ received services in 2012/13 compared to 1,231,000 in 2005/6 (ageuk) www.hascc.com wmadass 4 April 2014 18
  19. 19. Summary and Personal Perspective on Strengths and Other Observations (7)  NAO - ASC in England Overview Report March 2013: o ASC spending fell 8% (£1.4bn) in real terms between 2010/11 and 2012/13 – 75% via reduced volumes of care and 25% by reducing costs o Between 2007/8 and 2012/13, new referrals remained constant around 2m, assessments dropped from 660,050 to 603,250, and new users declined from 476,830 to 403,995 (minus 15%) o The number of adults receiving state-funded care fell from 1.8m in 2008/9 to 1.3m in 2012/13 – a drop of nearly 30% o The Audit Commission noted that ASC savings constituted 14% of LA savings in 10/11 to 11/12, but totalled 52% in 12/13 to 13/14 o It is difficult to assess the impact of preventative services www.hascc.com wmadass 4 April 2014 19
  20. 20. Summary and Personal Perspective on Strengths and Other Observations (8)  The Health Foundation and Nuffield Trust Report March 2014: o Services in the community for older adults have seen the biggest reductions, with £539 million taken out of home and day care alone – a 23 per cent reduction in expenditure (from 9/10 to 12/13) o It is highly likely that reduced spending on social care for older adults is having a negative effect on the health and wellbeing of users and carers, but poor linkage between health and social care data at a national level means that it is currently difficult to quantify the impact o “….without adequate data to assess this impact, the NHS and government are flying blind when it comes to managing demand and planning for the future” Holly Holder, joint author (Guardian 26 March 2014) www.hascc.com wmadass 4 April 2014 20
  21. 21. Summary and Personal Perspective on Strengths and Other Observations (9)  Barker Commission Interim Report 3 April 2014: o “Improved productivity, improvements in end-of-life care, better integration, ensuring NHS money is spent on what is cost-effective are explored (option 1), but considered insufficient to meet all the costs” o Proposals are considered for the ‘harder’ long-term choices, including extending NHS charges, developing a health insurance market, and introducing a hypothecated tax for health and social care. Responses to these are requested. www.hascc.com wmadass 4 April 2014 21
  22. 22. Summary and Personal Perspective on Strengths and Other Observations (10)  Regional: Analysis of 3 Councils from Budget Plans for 2014/15 and beyond – for ASC each Council plans to save around £20-25m over the next 4-5 years  Another Council is planning to save 15% of its ASC budget in one year - 2015/16  In at least 3/6 peer challenges, existing savings were behind schedule and/or demand pressures were causing an overspend www.hascc.com wmadass 4 April 2014 22
  23. 23. Summary and Personal Perspective on Strengths and Other Observations (11)  The Commissioning Response: o Exhaust efficiencies and cuts in non-essential services and “back-office” functions o Transformation, to bring about the salvation of adult social care via the holy trinity of: Personalisation Integration, with Health (via the Care Bill and the Better Care Fund) Early Intervention and Prevention support, including communities supporting themselves www.hascc.com wmadass 4 April 2014 23
  24. 24. Summary and Personal Perspective on Strengths and Other Observations (12)  Questions?: o Does the commissioning response on personalisation, integration, and reablement/prevention have sufficient scale and pace? o Is Market development sufficiently sophisticated/comprehensive? - Andrew Kerslake: “Moving from the procurement of care to market facilitation is hard for most commissioners” o Can you continue to fund and expand prevention/reablement/early intervention if the evidence base is poor, and if demand pressures/budget savings persist? o How realistic are plans for 2015/16, especially if existing savings are not being delivered? o Is the Region learning enough from each other about the response to the challenges on the use of resources? www.hascc.com wmadass 4 April 2014 24
  25. 25. Summary and Personal Perspective on Strengths and Other Observations (13)  Summary: o If SLI, Transformation, and Savings Plans are based on the Holy Trinity of personalisation, integration, and prevention – will they be able to deliver both better outcomes and the required savings? o Or is it mythology rather than evidence based change? o Together, they are meant to solve the financial challenge – what some might see as heroic actions which, according to Andrea Sutcliffe (when at SCIE) lead to a mistaken assumption, for example, “that integration is the new fresh-faced comic book hero fearlessly felling new foes” (Guardian). Are you ready to find your own, new, heroic initiatives?! www.hascc.com wmadass 4 April 2014 25
  26. 26. Conclusions  There has been good progress over the last year with all the foundations stones in place for an effective Regional approach to SLI  There are some clear signs of learning, mutual support, and constructive and robust challenge from SLI, with more work to do on “so what?” from our arrangements  There is further work to do on areas such as risk triggers and using the Challenge Workshop to inform the Region’s future Business Plan and approach to SLI, including peer challenge  There are some areas to consider for the commissioning response to the current challenges  The Financial Challenge remains significant and may benefit from a more coordinated regional, learning approach www.hascc.com wmadass 4 April 2014 26
  27. 27. Recommendations - Process:  Self-assessment template - any changes?  Submission date of the new self-assessment to be agreed – end of June 2014?  Final Letters after a Peer Challenge should be published on the WMADASS website and Council websites  The Region should develop Risk Triggers and Early Warning signs for SLI - via the Performance Network?  Plus: o Updated performance data for 13/14 to be prepared o Information Leaflet for participants to be written on the purpose/process of peer challenge (full guidance already drafted) o Evaluation/Feedback Template, post the Peer Challenge, to be developed o Anything else from the TEASC summary docs (circulated by David Anwyl- Hughes by email on 26 March) www.hascc.com wmadass 4 April 2014 27

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