1. The Care Sector – 2015 A personal view Ian Turner Chair Registered Nursing Home Association Implementation Advisor – DH /LGA The Partnership in Care – Responsible individual

2. Health and well-being gap  If the nation fails to get serious about prevention then recent progress in healthy life expectancies will stall, health inequalities will widen, and our ability to fund beneficial new treatments will be crowded-out by the need to spend billions of pounds on wholly avoidable illness Source: NHS Five Year Forward View

3. Care and quality gap  Unless we reshape care delivery, harness technology, and drive down variations in quality and safety of care, then patients’ changing needs will go unmet, people will be harmed who should be cured, and unacceptable variations in outcomes will persist. Source: NHS Five Year Forward View

4. Funding and efficiency gap  If we fail to match reasonable funding levels with wide-ranging and sometimes controversial system efficiencies, the result will be some combination of worse services, fewer staff, deficits, and restrictions on new treatments Source: NHS Five Year Forward View

5. Care Sector Major Issues  Comprehensive Spending Review  National Living Wage  Auto-enrolment of pensions  Duplication of inspection  Immigration  Safeguarding  Meaningful dialogue  Technology

6. Where is the sector?  Fewer people are receiving state funded care  People’s needs are more complex  The care market is fragile  Quality is compromised  Labour market is challenging  There are impacts on the NHS Source: ADAS and sector submission to DH

7. Submission to the CSR  Cross subsidisation is endemic  Increase in LA fees to implement National Living Wage of the order of 5-8% annually  Effect on National Insurance (Universal Credit)  Pension Contributions in next three years  Productivity gains are simply not possible in the provider sector

8. National Living Wage  No provider is against the policy  Business values will be reduced since EBITA reduced  Staff will expect differentials to be maintained  Labour market will not improve since all sectors must implement the NLW

9. National Living Wage  Announcement of CSR later in November  Where is the money going to come from?  How elastic is the price for self – funders?

10. Auto-enrolment of Pensions  Three issues:  When do you need to act? Your staging date  Who is to be your pension provider?  How are you going to implement, clerically or by software?  Plan for the costs, employer contributions 1% to end Sept17, 2% to end Sept18, 3% thereafter. Employees contribute 1%, 3% & 5%

11. Cutting Red Tape Review  Cabinet Office recently consulted (summer 2015) on the Care Sector for potential to cut red tape  Major issue which emerged was the duplication of inspection by different agencies, CQC, LA, and CCG in the main  Different agencies requiring different standards / actions  Common issue: Zeroise risk vs minimise risk

12. Immigration  Nursing shortage is now accepted as an issue within DH  Pressure for more integrated workforce planning numbers, but no major change in the numbers in the short term  Nursing as a shortage occupation; the key issue  Be aware that the quota for restricted certificates of sponsorship has been reached for the first time this half year

13. Safeguarding Growing acceptance that safeguarding is being overused Complaints virtually disappeared Poor practice should be recognised as such and dealt with Categorization of issues needs to be addressed

14. Meaningful dialogue Financial reforms have shown the need for a more meaningful dialogue between providers and LA’s. 2020 is only four years away Need to determine an agreed mechanism and update process to discuss price Need to consider the offer for self funders both before and after 2020 (S18(3))

15. Meaningful dialogue  Market position statements need to cover the entire market and not just commissioned services  Workforce is the most pressing problem for all of us; what more initiatives can we jointly take? Are we all using a Question of Care or Care Ambassadors?  Integrated services; exactly what are we trying to achieve that is practical to clients?  Failure regimes and risk management

16. Transparency SoS is pressing for “intelligent transparency” Honesty about failings Hence the Duty of Candour Whether it is pressure area care, medication incidents, or, in the case of the NHS, avoidable deaths, we need to prepare for greater transparency

17. Technology  Expect the need to implement information technology in the next few years: ▫NHS mail to use on admission and discharge of residents / clients, but also allows telemedicine being used in the current vanguards ▫Access to health records, which allows access to lab results, prescriptions ordered as well as full medical history

18. Future trends  Enhanced medical cover, one Care Home, one GP Practice with patient opt out of service to traditional GP cover  Telemedicine allowing more treatment wherever you live; eg Vanguards  Greater integration and transparency of services