In this slideshow, Richard Kirby, Chief Executive, Walsall Healthcare NHS Trust, explores the challenges facing providers of adult health and social care in an age of austerity. Richard spoke at the QualityWatch breakfast seminar ‘Social care for older adults: the impact of the cuts’, following the launch of our report Focus on: Social care for older people. Find out more at: www.qualitywatch.org.uk

1. Health and Adult Social Care in
Walsall
May 2014
Working Together in the
Age of Austerity

2. A bit of background
• Walsall: ranked 30 / 326 LAs on indices of
multiple deprivation.
• Issues: deprivation, educational attainment,
poor health, diversity and inequality.
• Health and social care economy:
– Walsall Healthcare NHS Trust.
– Walsall Council Social Care (80% commissioned).
– Walsall Clinical Commissioning Group.
– Dudley & Walsall Mental Health NHS Trust.

3. Our shared financial challenge
• Walsall Adult Social Care:
– £14m savings delivered over last 3 years.
– 14/15 £63m net budget after £11m reduction.
– 2015/16: tbc but further reduction necessary.
• Walsall Healthcare NHS Trust:
– £230m turnover.
– c. £40m savings delivered in last 4 years.
– c. £50m needed in next 5 years.

4. The burning platform
• Large increases in emergency admissions to
hospital (>20% in last 2 years. NB. Stafford).
• Hospital bed occupancy >95%.
• Pressure on discharge and intermediate care: +1
day av LOS in last 3-4 months.
• Rising readmissions: 14% up to 16% in last year
• Over-reliance on nursing and residential home
care for step down
• Insufficient capacity in health and social care
market for care at home (1 week in April 120
clinically stable patients)

5. Our approach
• Renewed commitment to work together.
• Investment in community
– CCG investment in community health services
– Social care investment in reablement, home care
– Review of urgent care and walk in centres
• Locality-based multi-disciplinary teams.
• Improving intermediate care.
• Reduced reliance on institutional care
through targeted and joint early intervention

6. Prognosis . . .
• Some early signs of progress:
– Impact of reablement for “simple” discharges.
– 200 high users referred to community matrons
and 60% not readmitted since.
– Rise in emergency admissions halted.
– Increased end of life care in community.
• But lots still to do:
– Hospital capacity pressures.
– Co-ordination and capacity in the community.
– Managing the most vulnerable better.

7. Issues and next steps
• Austerity – 60% public sector reductions
still to come.
• Better Care Fund – national policy vs local
implementation.
• Integration – how far do we go?
• Institutional impact – FT application.
• Non-statutory players – community groups
and voluntary sector.