Current Themes in Adult Social Care 18 October 2017 Martin Samuels Director for Adults and Wellbeing (Co-Chair, West Midlands Branch, ADASS)

Current Themes Quality of Care Funding and Scope State of the provider market Funding and Scope From austerity to scarcity Integration with the NHS Divided by a common language Philosophy From care to wellbeing

Quality of Care State of Care Report System at tipping point Number of nursing beds reducing 4000 fewer over past two years Staff shortages for nursing & registered managers 90k vacancies in total Up to 30% staff turnover Most care is good But 31% of nursing homes Requires Improvement or Inadequate Main areas of weakness are governance & leadership Hospitals struggling High demand, delayed discharges, impact on planned care

Funding and Scope Spending on adult social care falling Consequences Reduced by 2.6% in cash terms since 2010 One of lowest proportions of GDP in developed world Reduced £6bn (25%+) compared to steady spend per head NHS spending increased by total social care spend (£16bn+) Consequences Shift in balance towards Learning Disability Now 40% of spend Narrowing to eligible needs only 1.2m older people now not receiving care Ambulance at bottom of cliff Rate of life expectancy growth has reduced

Integration with the NHS - BCF Longstanding recognition of interdependence between NHS and social care Aged 65+ occupy most hospital beds Dementia main cohort of delayed hospital discharges 2/3 of social care referrals from NHS Better Care Fund designed to promote integration Financial transfers from CCGs to councils Plan at level of each HWB 2017/18 Guidance New target to reduce DToC to 3.5% (release 3000 beds) Funding transfer linked to performance in Sept 2017

Integration with the NHS - Issues Episodic Fix broken machine Professional knows best Free National Public sector provision Ongoing Living a good life Choice and control Means-tested Local Private sector provision Evidence base Structural merger absorbs energy Lack of clarity over accountability & professional cultures Limited evidence that integrated teams save cash Improved user experience

Philosophy – From Care… THE CARE BUS FACTS ABOUT ADULT SOCIAL CARE 1.5% of population c35% of council budget (net) 75% of ASC budget (net) 1/3 residential/nursing, 2/3 community services 2/3 over 65, 1/3 under 65 THE CARE BUS Dependency

Care Duration THE CARE BUS THE CARE BUS

Managing Demand Capacity Nursing beds Care Workforce 33% increase required over next 10 years (65 beds+ self funders) Care Workforce 50% extra workers required in the next 10 years Capacity THE CARE BUS Dependency By 2034 the over 65s will increase by 45%, or 31% of the total population Over 85s will increase to more than double, to 6% of the total population

The Challenge – Culture THE CARE BUS Dependency Social care teams

Reengineering the Bus Short term support and care Primary prevention Targeted prevention Short term support and care Long term support and care THE WELLBEING BUS Reengineering the Bus Independence

Concluding Thoughts Current model is broken Structural integration Funding, staffing, outcomes Reaching a tipping point Structural integration Limited evidence of impact Realities of organisational culture From care to wellbeing Prevention Empowerment Community capacity & resilience