The Spending Review and social care - Andrew Cozens


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Andrew Cozens CBE, Strategic Adviser for Children, Adults and Health Services at the Local Government Association, gives his outlook on the Spending Review implications for social care.

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The Spending Review and social care - Andrew Cozens

  1. 1. The Spending Review and social care Andrew Cozens 4 November 2010
  2. 2. The key components <ul><li>NHS support to social care : £800m rising to £1bn over 4 years – including £300m for reablement (via NHS) </li></ul><ul><li>New social care allocation £530m rising to £1bn over 4 years (un-ringfenced in RSG) </li></ul><ul><li>Existing social care grants (£2.4 bn by 2014) wrapped up and inflation-proofed (un-ringfenced) </li></ul><ul><li>New transfer of responsibility grants (but not new money) for learning disabilities and health reform, and for public health. </li></ul>
  3. 3. Good news but… <ul><li>Good news were we in a settled state </li></ul><ul><li>Demography, pay and price inflation is fully funded (if the baseline is right) </li></ul><ul><li>Important change in mood music in relationships between NHS and social care </li></ul>
  4. 4. Known unknowns <ul><li>Distribution arrangements and formulae </li></ul><ul><li>Conditions of NHS grant and for public health </li></ul><ul><li>Who will hold it after PCTs go? </li></ul>
  5. 5. The wider context <ul><li>Local government facing reduction of 26% in grant funding over SR period </li></ul><ul><li>Distribution issues for grant create disproportionate effects </li></ul><ul><li>Central government contributes 62% of social care through grant, councils contribute 38% through council tax </li></ul><ul><li>Adult social care is 40-50% available budget for top tier council </li></ul>
  6. 6. The wider pressures <ul><li>NHS settlement is worst since 1951 (IFS) – knock-on consequences </li></ul><ul><li>Unsettled NHS </li></ul><ul><li>Impact of cuts in related council areas – housing, Supporting People, family support, leisure etc. </li></ul><ul><li>Unknown impact of benefit changes on demand </li></ul>
  7. 7. Closing the gap <ul><li>Estimated share at 25% + 4% demography (LGA submission to SR) is £6.33bn over 4 years </li></ul><ul><li>Offset by £2bn in SR by 2014 if fully passported </li></ul><ul><li>Agreed 3% efficiency savings (from telecare, reablement, different service patterns, review of business processes etc.) £1.7bn </li></ul><ul><li>Gap to close £2.63bn or £657m per year </li></ul>
  8. 8. Closing the gap <ul><li>Simplified grant funding and greater freedoms </li></ul><ul><li>Reduction in burdens of performance management </li></ul><ul><li>Community budget pilots </li></ul><ul><li>Wider local government productivity programme – shared services, outsourcing </li></ul>
  9. 9. Adult social care implications <ul><li>Recognising how much is ‘untouchable’ </li></ul><ul><li>Managing the delicate ecology of care and support </li></ul><ul><li>Progress with personalisation </li></ul><ul><li>Search for productivity and efficiency gains </li></ul><ul><li>Review of eligibility criteria </li></ul><ul><li>Increased charges </li></ul>
  10. 10. Adult social care implications <ul><li>Information and advice to support good decision making by self-funders </li></ul><ul><li>Step up efforts with NHS (PCT and consortia) to reduce emergency admissions and crisis response and reablement and better management of long-term conditions </li></ul><ul><li>Process redesign and simplification </li></ul><ul><li>Collaborative commissioning with providers to design new services (extending range and type?) that do more for less </li></ul>
  11. 11. Interdependence <ul><li>To promote the joining up of local NHS services, social care and improvement, we need: </li></ul><ul><li>The relationship between councils and the proposed NHS Commissioning Board to be clearly defined. </li></ul><ul><li>Councils are given adequate financial support to carry out their local health improvement role. </li></ul><ul><li>Outcomes frameworks for the NHS, public health and social care need to reflect linkages between and across the system – and translate into commissioning outcomes for new GP consortia. </li></ul>